Primary Decision Research Articles

Development and expert inspections of the user interface for a primary care decision support system

BackgroundGeneral practitioners play a unique key role in diagnosing patients with unclear diseases. Decision support systems in primary care can assist with diagnosis provided that they are efficient and user-friendly. ObjectivesThe objective of this study is to develop a high-fidelity prototype of the user interface of a clinical decision support system for primary care, particularly for diagnosis support in unclear diseases, using expert inspections at an early stage of development to ensure a high level of usability. MethodsThe user interface prototype was iteratively developed based on previous research, design principles, and usability guidelines. During the development phase, three usability inspections were carried out by all experts at four-week intervals as heuristic walkthrough. Each inspection consisted of two parts: 1) Task-based inspection 2) Free exploration and evaluation based on usability heuristics. Five domain experts assessed the current status of development.The tasks in the inspections were based on the task model derived in the requirements analysis: perform data entry, review and discuss results, schedule further diagnostics, refer to specialists and close case. ResultsAs a result of this iterative development, a high-fidelity, clickable user interface prototype was created that is able to fulfil all six tasks of our task model. The usability inspections identified a total of 196 usability issues (for all 3 inspections; Part 1: 90 issues, Part 2: 106 issues), ranging in severity from minor to severe. These served the continuous adjustment and improvement of the prototype. All main tasks were completed successfully despite these problems. ConclusionUsability inspections through heuristic walkthroughs can support and optimise the development of a user-centred decision support system in order to ensure its suitability for performing relevant tasks.

Real-World Evidence of Clinical Outcomes of the Use of the Adalimumab Biosimilar SB5 in Rheumatic and Gastrointestinal Immune-Mediated Inflammatory Diseases: 12-Month Data from the PERFUSE Study.

There is a need for published data on real-world use of SB5, an adalimumab (ADL) biosimilar approved in Europe in 2017, on the basis of evidence from pre-clinical and analytic data as well as phase I and III clinical studies demonstrating equivalent efficacy and comparable pharmacokinetics, safety and immunogenicity profiles as the reference ADL. The purpose of this study was to estimate patient persistence on SB5 at 12 months post-initiation using clinical and healthcare claims data from the French Système National des Données de Santé (national healthcare claims database, SNDS) in addressing data gaps. PERFUSE is a 12-month, observational, multi-centre cohort study of patients with rheumatic or gastrointestinal immune-mediated inflammatory diseases (IMIDs) who initiated routine SB5 treatment between October 2018 and October 2020, either as their first ADL (naïve) or transitioning from another ADL (switched). Clinical data, including disease activity scores, C-reactive protein levels, and dosing information, were collected as available from patient records captured during routine visits to specialist physicians. Persistence data were supplemented with data from the French national healthcare claims database (SNDS). Analyses of clinical data were descriptive, while persistence was assessed using a Kaplan-Meier survival analysis. Overall, 911 patients were included: 507 from rheumatology centres [116 with rheumatoid arthritis (RA), 78 psoriatic arthritis (PsA), and 313 ankylosing spondylitis (AS)] and 404 from gastroenterology centres [316 with Crohn's disease (CD) and 88 ulcerative colitis (UC)]. Among naïve patients, 12-month remission/low activity rates were 58% for RA, 66% for PsA, 59% for AS, 94% for CD, and 85% for UC, increasing significantly from baseline for all indications (p < 0.05). Switched patients' remission rates remained stable between baseline and month 12 (M12) for all indications (p > 0.05). Persistence (95% CI) at M12 among naïve patients was 59% (46.5, 68.8) for RA, 65% (49.7, 77.1) for PsA, 56% (48.3, 62.6) for AS, 70% (63.0, 75.7) for CD, and 42% (30.7, 53.1) for UC, compared to 60% (42.7, 73.7) for RA, 57% (37.3, 72.1) for PsA, 55% (45.8, 64.0) for AS, 63% (53.4, 71.7) for CD, and 56% (27.2, 77.6) for UC among switched patients. No significant differences were observed between naïve and switched patients (p > 0.05). SNDS pairing provided information on 68 of the 132 patients (52%) who were lost to follow-up in the clinical database, of whom 57 (84%) were confirmed persistent at M12 and 11 (16%) non-persistent. Primary treatment failure (naïve patients) and patient decision (switched patients) were the most common reasons stated for treatment discontinuation. SB5 provides clinically effective treatment of both gastrointestinal and rheumatic IMIDs for naïve and switched patients, with no loss of control observed when switching. Persistence was comparable between naïve and switched populations, though the reasons for non-persistence differed. Trial registration number: Clinical Trials identifier NCT03662919. Trial registration date: 10 September 2018.

Understanding Solid Oxide Fuel Cell Hybridization: A Critical Review

A holistic literature review of 399 articles is presented on hybrid solid oxide fuel cell (SOFC) systems and taxonomized through a unique classification methodology that considers primary energy sources, component configurations, system outputs and relevant analysis. In the reviewed research articles, primarily four different types of technologies are used to complement the energy production of the fuel cell stack. As a result, four respective categories were established in terms of the coupling components, inclusive of (1) wind turbines (WTs), (2) solar systems (SS), (3) thermal power plant turbines (TPPTs) and (4) piston engines (PEs). Additional classification was needed to further subdivide the evaluated system configurations, due to the wide spectrum of system outputs encountered in the reviewed literature. That involved (a) electrical power generation (PG), (b) four types of cogeneration (CG), (c) four types of trigeneration (TG) and (d) two types of multigeneration (MG). Depending on the type of assessment in respective research, literature was further categorized as computational, experimental, or both computational and experimental. The most prevalent hybrid system amongst the 102 designs, as adapted from the reviewed literature, is the SOFC/gas turbine (GT) application, with the overwhelming majority producing exclusively electrical power output. The particular system is physically demonstrated in an existing 220-kW experimental facility established by the National Fuel Cell Research Center (NFCRC). The identified systems were predominantly computationally examined and research focused on operating conditions around specific design load ratings. Energy, exergy, economic, and environmental assessments were typically followed by sensitivity studies in the reviewed literature. The primary decision variables in most cases revolved around SOFC operating conditions, such as temperatures over 1000 °C as well as elevated pressures. Those resulted in the deterioration of the electrochemical cell and failed to be addressed by the majority of encountered studies. Improvements in the conversion efficiency of PG applications were enabled by natural gas (NG)-fed pressurized SOFCs, directly coupled to GTs. The most efficient power configuration in terms of thermodynamic performance was achieved by coupling PEs to SOFCs and a metal hydride reactor (MHR) to unlock a maximum net system efficiency of 79.54%. CG systems integrating solar cells (SCs) and photovoltaic panels (PVs) to SOFC subsystems can result in a combined efficiency of approximately 90% and sustain this over a broad energy demand range. TG systems incorporating gasifiers to SOFC/GT subsystems achieved a combined efficiency of 93%, whereas the optimal combined efficiency in MG configurations was identified at 79.5% by coupling SCs to the SOFC/GT/organic Rankine cycle turbine (ORCT) subsystems. In terms of cost-effectiveness, configurations that relied on increasing levels of renewable energy (RE) technologies resulted in high overall levelized cost of electricity (LCOE). This cost was increased further when power storage units were deployed to address wind and solar intermittency challenges. Configurations classified under TPPTs operating on low carbon-content fuels were preferred in terms of providing lower LCOE, while applications operating on gasified biomass and coal blends should deploy additional CO2 capture and storage units to mitigate respective emissions.

Gender differentials in primary processing and market participation by mopane worm harvesters in Zimbabwe: insights from the COVID-19 pandemic phase

BackgroundGender disparities in access to inputs, markets, financial inclusion, and participation in strategic value chains are major developmental challenges in emerging economies. Participation in the edible insect value chain has become an essential source of income, food, and nutrition in some African countries. This paper uses a bivariate probit model to examine the gender differentials for primary mopane worm harvesters’ participation in primary processing and market participation during COVID-19 in Southeastern Zimbabwe. Using a structured questionnaire, the data were gathered from 393 primary harvesters in five purposively selected wards in the Gwanda District of Zimbabwe. This study examines the gender differentials for primary mopane worm harvesters’ participation in primary processing and market participation during COVID-19 in Southeastern Zimbabwe.ResultsResults show that women are likelier to participate in primary value addition to preparing for the lean season opportunities. There are gender differentials in the participation in markets during COVID-19. Results show a significant negative relationship between participants' ages and female engagement in mopane processing and a positive correlation with female involvement in lean COVID-19 season marketing. Male harvesters’ participation in the lean market during the COVID-19 pandemic was significantly correlated positively with age and education level, while the choice to participate in the lean market was negatively correlated with the dependency ratio.ConclusionsCollaborative, community-centric, and gender-accommodative development of the mopane worm value chain is important. Focal issues are on supporting primary value addition for lean season market participation and during market shocks such as COVID-19. This can be a leap towards gender equality and improving livelihoods of women and men in mopane harvesting areas. The study recommends marketing and district-specific policies explicitly addressing mopane worm harvesting and marketing affects market participation and primary value-addition decisions.

Financial Literacy of the Undergraduate Students at the College of Hilly Region in Nepal: A Case of Okhaldunga Campus

This study aims to evaluate the status of financial literacy of the undergraduate students of the campus situated in a hilly region of Nepal taking into consideration of 108 students as the convenient sample respondents among from the 459 students studying at the Okaldhunga Campus, Okaldhunga. The data collected through face-to-face manner and structured Google form of questionnaire and analyzed with the help of descriptive statistics indicates that the undergraduate students did not differ by gender in respect to their level of financial knowledge. However, younger, higher-income earners, and management students demonstrated comparatively higher level of financial knowledge than their counterparts. In terms of financial behavior, respondents predominantly adopt moderate spending habits and prioritize saving for future security, commonly depositing savings into bank accounts and using additional income for fixed deposits. Most respondents track their expenses at least occasionally, with the primary motivation for saving being to create a safety net for emergencies. Regarding financial influence, many students rely on family and social media for guidance on managing their money, and parents are often the primary decision[1]makers for finances in many households.

Development of the BOLT-2 Roughness Experiment for Flight

A sounding rocket research flight called BOLT-2, which stands for Boundary Layer Turbulence 2, was initiated with the goal of studying hypersonic boundary-layer transition and turbulence. The BOLT-2 research vehicle is based on a three-dimensional geometry with concave surfaces and swept leading edges that provides two separate and distinct, also redundant, flowpaths for conducting measurements. One side of BOLT-2 is dedicated to smooth surface transition and turbulence, to better study the natural instability processes, whereas the other has been assigned to study forced transition and turbulence using discrete roughness trips. The present paper is intended to document the primary drivers and decisions made that lead up to finalizing the roughness-side experiment for the BOLT-2 flight.

The role of sexual partner in women's seeking for labiaplasty: a systematic review and meta-analysis.

The primary reasons for labiaplasty usually revolve around aesthetic, sexual, and functional concerns. Upon delving deeper into these issues, it becomes apparent that sexual partners play a controversial role in influencing women's decisions to undergo surgery. This study aimed to investigate the impact of sexual partners on women's choices to pursue labiaplasty. A comprehensive search was conducted across electronic databases covering the period from January 2000 to February 2024. After removing duplicates, a total of 931 articles were retrieved by searching keywords in titles and abstracts. The meta-analysis revealed that 36.7% of women who sought labiaplasty cited their partners' negative comments as a factor influencing their decision. After applying the eligibility criteria and excluding irrelevant articles, a total of 12 articles involving 962 participants were included in the analysis. With the exception of 2 articles, the majority of the studies suggested a discernible influence of male partners on women's decisions to seek labiaplasty. Frequently, sexual partners are not the primary decision makers, nor do they exert significant pressure when it comes to seeking labiaplasty. In certain instances, women seeking labiaplasty acknowledged that their sexual partners did influence their decisions, either by making disparaging comments about their genitalia or by directly pressuring or requesting them to undergo labiaplasty. Additionally, women might opt for labiaplasty out of fear of their partner's negative remarks or to enhance sexual pleasure for their partners. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. The findings of this study can be applied in prelabiaplasty counseling sessions to acknowledge and explore the role of the sexual partner in women's decision making. This study stands as the inaugural systematic review examining the impact of sexual partners on women seeking labiaplasty, encompassing all original studies exploring the role of the sexual partner. However, a notable limitation lies in the varied interpretations of the sexual partner's role, that the heterogeneous nature of these interpretations poses a challenge to providing a more precise answer through meta-analysis. Based on the findings of this systematic review, it is evident that sexual partners exert multifaceted influences on women's decisions to seek labiaplasty. While not serving as the primary decision makers, women opt for labiaplasty with the aim of enhancing attractiveness in sexual relationships and mitigating potential negative comments from their partners.

Influence of packaging, husbandry, feeding practices, and price transparency on consumer segments preferences for milk in Germany: A conjoint and latent class analysis

Despite a slight decline in average consumption in recent years, milk remains a significant component of diets in Western countries, including Germany. Concurrently, there has been growing awareness of the impact of food choices on climate, environment, and animal welfare. This study examines how various attributes of milk—such as packaging, husbandry practices, feeding methods, price, and price transparency—affect consumer decisions, using fresh milk as a case study.We conducted a choice experiment with 250 participants, who selected from product alternatives varying in price, milk features, cow husbandry and feeding practices, packaging types, and labels. Contrary to previous studies, which identified price as a primary decision criterion, our findings indicate that price was secondary for most participants, except for a specific segment.Label influence was minimal, while packaging had a significant impact on consumer choices. Interestingly, most respondents preferred glass packaging, despite its potential environmental drawbacks, suggesting a need to explore whether this preference is based on misconceptions about its environmental benefits.The type of husbandry emerged as the most influential factor in consumer decisions. In terms of animal welfare, there was a strong preference for pasture milk, particularly for "Year-round grazing with mother-bonded calf rearing." This preference not only explains the marketing trend towards pasture milk but also presents an opportunity for sustainable farms to differentiate themselves and attract customers amidst a decline in pasture-based milk production.

Sex differences in change-of-mind neuroeconomic decision-making is modulated by LINC00473 in medial prefrontal cortex.

Changing one's mind is a complex cognitive phenomenon involving a continuous re-appraisal of the trade-off between past costs and future value. Recent work modeling this behavior across species has established associations between aspects of this choice process and their contributions to altered decision-making in psychopathology. Here, we investigated the actions in medial prefrontal cortex (mPFC) neurons of long intergenic non-coding RNA, LINC00473, known to induce stress resilience in a striking sex-dependent manner, but whose role in cognitive function is unknown. We characterized complex decision-making behavior in male and female mice longitudinally in our neuroeconomic foraging paradigm, Restaurant Row, following virus-mediated LINC00473 expression in mPFC neurons. On this task, mice foraged for their primary source of food among varying costs (delays) and subjective value (flavors) while on a limited time-budget during which decisions to accept and wait for rewards were separated into discrete stages of primary commitments and secondary re-evaluations. We discovered important differences in decision-making behavior between female and male mice. LINC00473 expression selectively influenced multiple features of re-evaluative choices, without affecting primary decisions, in female mice only. These behavioral effects included changing how mice (i) cached the value of the passage of time and (ii) weighed their history of economically disadvantageous choices. Both processes were uniquely linked to change-of-mind decisions and underlie the computational bases of distinct aspects of counterfactual thinking. These findings reveal a key bridge between a molecular driver of stress resilience and psychological mechanisms underlying sex-specific decision-making proclivities.

Confidence judgments interfere with perceptual decision making

Determining one’s confidence in a decision is a vital part of decision-making. Traditionally, psychological experiments have assessed a person’s confidence by eliciting confidence judgments. The notion that such judgments can be elicited without impacting the accuracy of the decision has recently been challenged by several studies which have shown reactivity effects—either an increase or decrease in decision accuracy when confidence judgments are elicited. Evidence for the direction of reactivity effects has, however, been decidedly mixed. Here, we report three studies designed to specifically make reactivity effects more prominent by eliciting confidence judgment contemporaneously with perceptual decisions. We show that confidence judgments elicited contemporaneously produce an impairment in decision accuracy, this suggests that confidence judgments may rely on a partially distinct set of cues/evidence than the primary perceptual decision and, additionally, challenges the continued use of confidence ratings as an unobtrusive measure of metacognition.

Coping among South Asian individuals living with chronic illnesses: A latent profile analysis.

Individuals' coping differs based on sociocultural determinants and the nature of illness. This study developed a coping typology for South Asians with chronic illnesses and differentiated the coping profiles based on sociocultural determinants. Individuals (n = 384) with chronic illness were recruited. The Brief COPE scale was used for data collection and latent profile analysis for typology development. The class differences were examined in terms of age, gender, socioeconomic status, education, type of family, smoking, primary decision maker in the family, type of community, number of years living with chronic illness and type of health care services used. Latent profile analysis supported four class model: Avoider-Emotion (n = 34, 9%), Problem-Emotion (n = 128, 33.9%), Problem-Avoider (n = 55, 14.6%) and Emotion-Avoider (n = 161, 42.6%) copers. Comparison of classes across chronic illness showed that individuals with chronic respiratory disorders were Emotion-Avoider and Avoider-Emotion copers, those with cardiac problems were Problem-Emotional and Problem-Avoiders copers, those with renal problems were Emotional-Avoiders and Problem-Emotions copers, and individuals with mental health issues were mainly Problem-Emotional and Emotion-Avoider copers. These class differences were statistically different (χ2 = 134, df = 18, p < .001). The findings can be useful for developing coping programmes for South Asian populations in low- and middle-income countries and South Asian immigrants.

Human papillomavirus vaccine beliefs and intentions Post-COVID-19 vaccine release among mothers in Alabama

PurposeThe current study sought to determine if the release of COVID-19 vaccines influenced Alabama mothers’ attitudes and behaviors regarding HPV vaccination of their adolescent children. MethodsA social media survey was conducted August − September 2022 among mothers of adolescents ages 9–18, who self-identified as Alabama residents and their child(ren)’s primary medical decision maker. The survey assessed demographics, vaccine knowledge and opinions, vaccination history, influences on vaccination decisions, and how COVID-19 vaccine release affected vaccine opinions. Univariable and multivariable analyses were conducted. ResultsOf 241 responses, most participants were white (82.0 %, n = 196), non-Hispanic (96.6 %, n = 230), and privately insured (64.5 %, n = 151), with annual household incomes ≥$61,000 (45.4 %, n = 103). The majority (60.8 %) reported that their child either had or planned to receive the HPV vaccine. The release of COVID-19 vaccines did not change the majority of parental opinions towards HPV, with 78.5 % (n = 161) reporting no change. Among those who experienced a change, 25 % (n = 5) reported an increased likelihood of having their child vaccinated for HPV and 75 % (n = 15) reported a decrease in likelihood. Moderate and high HPV knowledge scores were associated in multivariable analysis with increased likelihood of having their child vaccinated for HPV (“moderate” knowledge AOR: 12.4, 95 % CI: 1.98–78.1; “high” knowledge AOR: 12.8, 95 % CI: 2.00–82.1). Positive HPV opinion scores in the univariable analysis similarly showed increased odds (AOR = 1.5). ConclusionsThese findings indicate that, in this population, COVID-19 vaccine release did not significantly impact subsequent HPV vaccination decision making. Parental perceptions regarding vaccination are critical to informing future interventions.

Abstract PO1-08-04: Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making

Abstract Background: Prior work from our group has shown a high rate of familial breast cancer (BC) among rural BC patients (pts), with 33% reporting &amp;gt; 1 first-degree family members with BC and 55% meeting NCCN germline genetic testing (GGT) criteria (Shelton CH et al. NC Med. J; 2022). In 2018, we increased GGT to include all BC pts and observed: 1) many pts were out-of-criteria per NCCN guidelines but had actionable pathogenic germline variants (PGVs) and 2) knowledge of GGT factored significantly into shared decision making by providers and patients, including for positive and negative results. Beginning in 2019, concurrent with the recommendation from the American Society of Breast Surgeons, we expanded this model of universal GGT to an IRB-approved study to measure the impact of prospective testing on shared decision-making. Herein we report the real-world implementation of universal GGT for patients with BC and genetics-informed treatment decision-making in a rural community practice. Methods: From 2019-2022 all BC pts at a small, rural community hospital were offered GGT. Demographics, clinical features, and GGT results were collected along with clinician-reported clinical recommendations for treatment based on GGT results. Descriptive statistics and two-tailed Fisher’s exact test were employed and significance was set at p&amp;lt; 0.05. Results: 210 BC pts were offered GGT and 192 (91%) underwent testing [97% female, 95% non-Hispanic White, mean age at diagnosis of 62, 75% Stage I], with all but 7 pts completing GGT before primary treatment decisions. 104 (54%) of patients were in-criteria (IC) and 88 (46%) out-of-criteria (OOC) with NCCN GGT guidelines. PGVs were identified in 25 pts (13%) and 15 genes, most commonly BRCA1/2 (5 pts), PALB2 (3), monoallelic MUTYH (3) and ATM, BARD1, CHEK2 (2 pts each). PGV frequencies were 15% in IC and 11% in OOC patients (p=0.495). 46 (24%) pts had only a variant of uncertain significance (VUS) results. 70% of patients had &amp;gt; 1 clinical management change based on their GGT results. Changes in breast surgery, uptake of risk-reducing bilateral salpingo-oophorectomy, surveillance and clinical follow-up were significantly higher in patients with PGV compared to those with VUS/negative results (p &amp;lt; 0.0001). Compared to those with negative results, patients with PGVs in BRCA1 and BRCA2 were significantly more likely to undergo bilateral mastectomy (BLM) while those with PGVs in other genes or with VUS were not significantly more likely to elect for BLM than those with negative results. Clinicians reported that return of GGT reinforced their recommendation for 73/138 (53%) of patients who underwent breast-conserving therapy. GGT results aided in radiation therapy strategy for 54% of pts, most often resulting in dose de-escalation (accelerated fractionation) for negative/VUS pts (Table). Conclusions: Universal GGT for patients with BC was successfully implemented in a rural community practice with &amp;gt;90% uptake. Treatment was enhanced in those with clinically actionable PGVs and de-escalated in those without PGVs. Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making Changes in Radiation Therapy Strategy based on GGT Citation Format: Charles Shelton, Sarah Nielsen, Antonio Ruiz, Lauren Shelton, Karen Freas, Sarah Poll, Brandie Heald, Daniel Pineda-Alvarez, Edward Esplin, Rachel Ellsworth, Hannah Montgomery. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-04.

Trends in decision-making by primary care physicians regarding common infectious complaints

Background Primary care physicians played an important role in the global response during the COVID-19 pandemic, but with the absence of laboratory and diagnostics services, the move to telehealth and the focus on respiratory assessment, they faced increased uncertainty when making clinical decisions. Objectives This paper aims to examine the impact of the pandemic on decisions made by primary care physicians, as measured by referrals to chest X-ray and laboratory tests and by prescriptions of antibiotics. Methods We conducted a retrospective study of all visits recorded with fever or cough, presenting to 209 community clinics in Southern Israel during the years 2018–2022. We describe changes in outcome rates across time and use multivariate generalised linear mixed effects model to compare the odds of referrals and prescriptions between periods, while accounting for gender, age, clinic sector, visit type, diagnosis, and season. Results In total, 609,823 visits to primary care physicians complied with the cohort definitions. Social restrictions were associated with a decline in all measured outcomes for primary care physician decisions, most prominently among ages 20-59, for throat culture referral during the first lockdown (OR = 0.46) and for cephalosporine prescription during the second lockdown (OR = 0.55). This trend persisted following the cancellation of the restrictions. Conclusions Despite higher uncertainty during the COVID-19 social restrictions, the overall course of clinical decision-making processes was maintained, and was associated with a reduction in the use of auxiliary resources, which can improve the quality of patient care by lowering costs and supporting prevention of future antibiotics resistance.

Addition of Contrast-enhanced Mammography to Tomosynthesis for Breast Cancer Detection in Women with a Personal History of Breast Cancer: Prospective TOCEM Trial Interim Analysis.

Background Digital breast tomosynthesis (DBT) is often inadequate for screening women with a personal history of breast cancer (PHBC). The ongoing prospective Tomosynthesis or Contrast-Enhanced Mammography, or TOCEM, trial includes three annual screenings with both DBT and contrast-enhanced mammography (CEM). Purpose To perform interim assessment of cancer yield, stage, and recall rate when CEM is added to DBT in women with PHBC. Materials and Methods From October 2019 to December 2022, two radiologists interpreted both examinations: Observer 1 reviewed DBT first and then CEM, and observer 2 reviewed CEM first and then DBT. Effects of adding CEM to DBT on incremental cancer detection rate (ICDR), cancer type and node status, recall rate, and other performance characteristics of the primary radiologist decisions were assessed. Results Among the participants (mean age at entry, 63.6 years ± 9.6 [SD]), 1273, 819, and 227 women with PHBC completed year 1, 2, and 3 screening, respectively. For observer 1, year 1 cancer yield was 20 of 1273 (15.7 per 1000 screenings) for DBT and 29 of 1273 (22.8 per 1000 screenings; ICDR, 7.1 per 1000 screenings [95% CI: 3.2, 13.4]) for DBT plus CEM (P < .001). Year 2 plus 3 cancer yield was four of 1046 (3.8 per 1000 screenings) for DBT and eight of 1046 (7.6 per 1000 screenings; ICDR, 3.8 per 1000 screenings [95% CI: 1.0, 7.6]) for DBT plus CEM (P = .001). Year 1 recall rate for observer 1 was 103 of 1273 (8.1%) for (incidence) DBT alone and 187 of 1273 (14.7%) for DBT plus CEM (difference = 84 of 1273, 6.6% [95% CI: 5.3, 8.1]; P < .001). Year 2 plus 3 recall rate was 40 of 1046 (3.8%) for DBT and 92 of 1046 (8.8%) for DBT plus CEM (difference = 52 of 1046, 5.0% [95% CI: 3.7, 6.3]; P < .001). In 18 breasts with cancer detected only at CEM after integration of both observers, 13 (72%) cancers were invasive (median tumor size, 0.6 cm) and eight of nine (88%) with staging were N0. Among 1883 screenings with adequate reference standard, there were three interval cancers (one at the scar, two in axillae). Conclusion CEM added to DBT increased early breast cancer detection each year in women with PHBC, with an accompanying approximately 5.0%-6.6% recall rate increase. Clinical trial registration no. NCT04085510 © RSNA, 2024 Supplemental material is available for this article.

WaveTel – Introduction of AutoRecharge

The WaveTel case concerns distribution channel management, technology adoption and NPD issues in the Indian telecom industry. WaveTel, part of the JBL group, is the largest telecom operator in India. It entered a competitive market in 2016 and quickly rose to the top spot on the back of cheap data and call rates and a strong 4G network. The case is set in 2021 when the company has introduced AutoRecharge – a technology solution that automates the selling of prepaid recharge balance from distributors to retailers. The primary decision point that the case protagonist, Diwakar Kumar, CEO of StratG – the consulting firm that helped conceptualize and develop AutoRecharge for WaveTel – faces is how to salvage a launch gone awry. Should he recommend that WaveTel proceed with the rollout? If yes, then how does he overcome channel resistance and conflict? Or should he recommend killing the solution and going back to the drawing board?

Power transformer fault diagnosis using dynamic multiscale graph modeling and M2SGCN network based on statistical fusion

Power equipment fault diagnostics hold significant importance for the stability of power grid systems. In pursuit of this objective, this paper proposes a fault diagnosis method that utilizes dynamic multiscale graph (DMG) modeling and the multiscale multi-stream GCN(M2SGCN) network, incorporating statistical fusion. Specifically, a novel DMG modeling method is proposed to derive visibility graph data and horizontal visibility graph data from vibration signals across multiple scales. Next, a comprehensive neural network architecture named M2SGCN is established to learn global and local features simultaneously, providing a more precise representation. Subsequently, a Dempster Shafer evidence theory statistical fusion technique combined with an adaptive threshold model (DSTFusion) is utilized to integrate primary decision results for enhanced fault diagnosis accuracy. In addition, two datasets obtained from single-phase and three-phase power transformers are analyzed to demonstrate the evolution process. When compared to state-of-the-art indicators such as accuracy, precision, recall, and F1 scores, the method proposed excels in multiple aspects, successfully detecting fault states before their occurrence and achieving outstanding performance.

Reflections of Women Standard Setters in the United States

SYNOPSIS Motivated by trends toward gender equality on standard-setting boards in the United States, this study interviews women members of the FASB, GASB, and EITF to understand the factors critical to their successful nomination and appointment. Semistructured interviews were conducted with women standard setters to root our understanding in their own experiences and perceptions. Value emerged as a generalizing theme. Participants perceived value to the board in nomination as associated with professional expertise and ties with professional societies. Most participants perceived value in giving back to the profession by serving as a voice for an important stakeholder group as a critical factor for acceptance. Women standard setters consistently downplay the idea that diversity, equity, and inclusion represent primary decision criteria for board membership. Instead, their reflections imply that it is up to the profession to implement practices that promote the advancement of the most competent professionals from all backgrounds. Data Availability: Anonymized interview data are available upon request to the authors and are subject to prior consent by participants to share. JEL Classifications: M41; M48.

Is the Electroconvulsive Therapy Video on YouTube Supportive Information for Patients and Their Primary Caregivers?

Electroconvulsive therapy (ECT) is a significant contemporary medical treatment modality for various mental disorders that have not responded to other treatments. YouTube is a valuable place to get health-related educational content that can have a big impact on patients' and their primary caregivers' behaviors and decisions. The aim of the study is to analyze the content of YouTube videos related to ECT to investigate the quality and reliability of videos as supportive information for patients and their primary caregivers. A total of 250 videos related to ECT that are available on YouTube were analyzed. The Global Quality Scale and the modified DISCERN tool were used to assess the quality and reliability of the videos. Details of the content of the video, caregiver appearance, methods of information presentation, source of the video, and video parameters were analyzed as well. The analysis revealed that the median total score of Global Quality Scale was 3 (interquartile range, 2; min-max, 1-5), which means the video quality was medium. The median total score of the modified DISCERN tool was 3 (interquartile range, 1; min-max, 0-5), which means the videos were highly reliable. Most of the video sources in the included videos were educational (41.2%, n = 103) from formal caregivers, and there was no significant difference between Global Quality Scale scores, video parameters, and modified DISCERN scores. YouTube is considered a supportive source of information related to ECT but needs more encouragement from formal caregivers to disseminate high-quality and reliable healthcare content on YouTube platforms to ensure access to accurate information.

A National Survey of Perceptions Around Conditions Associated With Pharmacy Faculty Workload Equity

ObjectiveTo assess pharmacy faculty members’ perceptions of conditions associated with workload equity and factors that can improve workload equity. MethodsA 26-item survey instrument was developed and distributed via email to members of the American Association of Colleges of Pharmacy Council of Faculties. Questions pertained to the workload distribution, fairness in assignment, and perception of the conditions associated with workload equity (transparency, context, credit, clarity, norms, and accountability) as well as institutional and individual demographics. ResultsA total of 662 responses were obtained (response rate 15.9%). Respondents’ demographics were comparable to available national data. Approximately 41% of respondents reported their institutions did not have a written faculty workload policy. Most respondents reported their workload assignment was fair (highest with research/scholarship) but reported only moderate alignment between assigned and actual workloads. The rating level for what domains the primary decision maker uses to assign workload was highest for context, followed by credit, clarity, and transparency. Transparency was reported as the most needed condition to improve faculty perception of workload equity. Respondents also rated increasing trust between leadership and faculty and increasing productivity and accountability as the most important reasons to minimize workload inequities. ConclusionThis was the first national survey of pharmacy faculty perceptions around the conditions associated with workload equity. Though additional research is needed in this area, programs can work to implement strategies associated with all of the conditions, particularly transparency, to improve faculty perceptions of equity.