Ranking Questions Research Articles

Opportunities and Challenges of Disease Progression Modeling in Drug Development - An IQ Perspective.

Disease progression modeling (DPM) represents an important model-informed drug development framework. The scientific communities support the use of DPM to accelerate and increase efficiency in drug development. This article summarizes International Consortium for Innovation & Quality (IQ) in Pharmaceutical Development mediated survey conducted across multiple biopharmaceutical companies on challenges and opportunities for DPM. Additionally, this summary highlights the viewpoints of IQ from the 2021 workshop hosted by the US Food and Drug Administration (FDA). Sixteen pharmaceutical companies participated in the IQ survey with 36 main questions. The types of questions included single/multiple choice, dichotomous, rank questions, and open-ended or free text. The key results show that DPM has different representation, it encompasses natural disease history, placebo response, standard of care as background therapy, and can even be interpreted as pharmacokinetic/pharmacodynamic modeling. The most common reasons for not implementing DPM as frequently seem to be difficulties in internal cross-functional alignment, lack of knowledge of disease/data, and time constraints. If successfully implemented, DPM can have an impact on dose selection, reduction of sample size, trial read-out support, patient selection/stratification, and supportive evidence for regulatory interactions. The key success factors and key challenges of disease progression models were highlighted in the survey and about 24 case studies across different therapeutic areas were submitted from various survey sponsors. Although DPM is still evolving, its current impact is limited but promising. The success of such models in the future will depend on collaboration, advanced analytics, availability of and access to relevant and adequate-quality data, collaborative regulatory guidance, and published examples of impact.

Emergency provider preference for powered intraosseous devices and satisfaction with features improving safety, reliability, and ease-of-use

ABSTRACT Background Powered intraosseous (IO) systems are valuable devices for emergent situations, with limited data on user preferences. A simulation/survey-based study was conducted among emergency medical service (EMS) providers to evaluate attitudes toward general powered IO system features to measure preferences/satisfaction for the most-commonly used and a novel powered IO system (with a passive safety needle, battery life indicator, and snap-securement/dressing). Research Design and Methods Forty-two EMS providers completed a simulated activity using both powered IO systems and a 30-item questionnaire, including multiple choice, free-text, ranking, and Likert-like questions. Ranking scores were reported using a scale of 0 (least important/satisfactory) to 100 (most important/satisfactory). Statistical significances were evaluated via Wilcoxon signed-rank sum test. Results Providers indicated driver performance (mean score ± SD; 77.8 ± 27.5) and IO needle safety mechanism (63.1 ± 27.9) as the most important features. Participants reported significantly higher (p < 0.001) satisfaction with the novel IO system overall, and its needle safety, battery life indicator, securement/dressing, and ease-of-use. Powered driver performance satisfaction was similar and favorable for the novel (88.1 ± 18.2) and traditional (87.1 ± 15.3) systems. Conclusions These findings highlight the value of clinician/user input and demonstrate EMS providers are more satisfied with a powered IO system featuring design elements intended to enhance safety and ease-of-use.

Views on increased federal access to state and local National Syndromic Surveillance Program data: a nominal group technique study with state and local epidemiologists

BackgroundUS public health authorities use syndromic surveillance to monitor and detect public health threats, conditions, and trends in near real-time. Nearly all US jurisdictions that conduct syndromic surveillance send their data to the National Syndromic Surveillance Program (NSSP), operated by the US. Centers for Disease Control and Prevention. However, current data sharing agreements limit federal access to state and local NSSP data to only multi-state regional aggregations. This limitation was a significant challenge for the national response to COVID-19. This study seeks to understand state and local epidemiologists’ views on increased federal access to state NSSP data and identify policy opportunities for public health data modernization.MethodsIn September 2021, we used a virtual, modified nominal group technique with twenty regionally diverse epidemiologists in leadership positions and three individuals representing national public health organizations. Participants individually generated ideas on benefits, concerns, and policy opportunities relating to increased federal access to state and local NSSP data. In small groups, participants clarified and grouped the ideas into broader themes with the assistance of the research team. An web-based survey was used to evaluate and rank the themes using five-point Likert importance questions, top-3 ranking questions, and open-ended response questions.ResultsParticipants identified five benefit themes for increased federal access to jurisdictional NSSP data, with the most important being improved cross-jurisdiction collaboration (mean Likert = 4.53) and surveillance practice (4.07). Participants identified nine concern themes, with the most important concerns being federal actors using jurisdictional data without notice (4.60) and misinterpretation of data (4.53). Participants identified eleven policy opportunities, with the most important being involving state and local partners in analysis (4.93) and developing communication protocols (4.53).ConclusionThese findings identify barriers and opportunities to federal-state-local collaboration critical to current data modernization efforts. Syndromic surveillance considerations warrant data-sharing caution. However, identified policy opportunities share congruence with existing legal agreements, suggesting that syndromic partners are closer to agreement than they might realize. Moreover, several policy opportunities (i.e., including state and local partners in data analysis and developing communication protocols) received consensus support and provide a promising path forward.

End-user acceptability of personal protective equipment disinfection for potential reuse: a survey of health-care workers in Aotearoa New Zealand

The COVID-19 pandemic has highlighted personal protective equipment (PPE) supply, distribution, and disposal issues worldwide. Calls to conserve PPE stocks and increase supply resulted in the rapid development of potential disinfection methods, with the possibility of improvements in medical waste reduction. However, how receptive health-care workers are to PPE reuse remains unknown. We aimed to examine the views of health-care workers who used PPE during the first COVID-19 wave in Aotearoa New Zealand, in relation to acceptability of PPE disinfection and reuse. In this multi-methods survey, health-care workers in New Zealand, were invited via a multimodal recruitment strategy to complete a survey regarding use of PPE during the first COVID-19 wave. Gender question options were male, female, gender diverse, or prefer not to say. Demographic differences in self-reported PPE reuse and acceptability were examined. The survey included closed (single-response, multi-response, ranking, and Likert-scale questions) and open-text questions. Any open-text comments were analysed with thematic analysis. The survey was built and deployed using Qualtrics software. 1411 health-care workers completed the survey between Oct 7 and Nov 30, 2020. 1397 participants had gender data available (1140 [82%] female and 257 [18%] male) and 995 (74%) of 1347 were of New Zealand European ethnicity. PPE reuse was common and reported by 628 (45%) of the 1411 participants, with 396 (63%) of the 628 reporting reusing PPE multiple times in 1 day. Acceptability of the concept of PPE disinfection for potential reuse was high overall (1196 [85%] of 1411) but varied depending on the type of PPE. Thematic analysis confirmed that PPE reuse was already occurring and respondents recognised the potential benefits of reduced medical wastage and increased PPE supply. Important caveats for consideration included the availability of scientific evidence, level of negotiated risk, and trust in the organisation undertaking PPE disinfection, with clear communication about decontamination processes being crucial to acceptability. PPE reuse occurred frequently during the first wave of COVID-19 in New Zealand. Although support for the disinfection of PPE for reuse was high, the success of any future programmes to reuse PPE will require meaningful engagement and clear communication with health-care workers. Further research into PPE disinfection safety and logistics is warranted, alongside the development of standard operating procedures and clearly communicated policies for the end user, should this more sustainable health-care practice be planned for adoption in certain settings. New Zealand Ministry of Business, Innovation and Employment (COVID-19 Innovation Acceleration Fund) and the Medical Assurance Society Foundation.

Clinical Experts' Opinion Improves the Attitude of Medical Students Toward ‌Basic Sciences' Courses.

The medical curriculum consists of basic pre-clinical and clinical parts. Basic sciences are required for diagnostic and clinical reasoning but students do not have a positive attitude toward basic sciences, mostly because of the lack of clinical relevancy. Basic sciences have many applications in the prevention, diagnosis, and treatment of a broad range of diseases but do not attract the attention of medical students. The aim of this study was to investigate the influence of clinical experts' opinions on the attitude of medical students toward basic sciences, particularly immunology. The opinion of six clinical specialists in different fields was recorded in a video clip, presenting the application of basic sciences and immunology in their routine practice. The attitude of second-year medical students toward the basic science courses was evaluated by a questionnaire containing four ranking questions and one short answer. The video clip was streamed and after that, students were answering the same questions. In total, 188 students including 129s-year students (M/F ratio: 0.92) and 59 third-year students M/F ratio: 0.90) participated in the study. For all ranking questions, the mean score was significantly increased after watching the interviews' film streaming. Before watching the video clip, only 14.9% of students considered immunology as an important course but after that, the percentage significantly increased to 58.5% (P < 0.001). The results of this study showed that knowing clinical specialists' opinions about basic sciences significantly improved the attitude of students toward basic science courses, in particular immunology.

Factors Influencing Continued Wearable Device Use in Older Adult Populations: Quantitative Study

The increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. This study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. Older adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants' intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. The study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants' age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. This study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies.

Australian and New Zealand Nurses: Social and Emotional Attributes and Work Engagement

The COVID-19 pandemic presented significant job engagement challenges for the nursing workforce with increased pressures and workplace changes. Nursing staff shortages have increased nurse anxiety, burnout, fear, low morale and intentions to leave the profession. Nursing care is inherently stressful and at times complex, with stress often due to work inconsistencies, a lack of role clarity, workloads and time pressures. This study explores nurses job engagement, by looking specifically at nurses social-emotional attributes – Occupational Commitment, Self-efficacy Beliefs, Collective Efficacy Beliefs, Resilience, Adaptability and Emotional Labour. This protocol describes a mixed methods convergent parallel study, incorporating a survey questionnaire. The survey comprised of quantitative and qualitative questions, with data collected simultaneously, analysed separately, and integrated in the final analysis step. The survey design used validated social-emotional items, sorting and ranking questions and short answer responses. Analysis will involve individual and comparative analysis of the two participants groups, they are: Australian nurses ( n = 86) and New Zealand Nurses ( n = 275). Data collection was conducted during two different time periods – Australian pilot (2020-21) and in New Zealand (2022–2023). Recruitment involved the use of professional and personal nursing networks, newsletters and social media communications. Ethics approval was obtained through participating universities in both countries. Results will be disseminated through peer-reviewed publications, conferences, blogs, newsletters and reports to nursing networks. The study will provide valuable insights into nurses’ social-emotional attributes and the role they play in job engagement.

Students' Perceptions of Global Jinzai: A Comparative Study of University Students in Malaysia, Japan and Vietnam

In recent years in Japan, the term Global Jinzai has frequently appeared for the human skills development through soft skills programs in higher learning institutions which bridges the competency and human capital necessary for the economic development. This study aims to explore the Global Jinzai skills set practiced by the Japanese companies by exploring the perception of Japanese, Malaysian and Vietnamese students who will be the future employees in companies. This study utilized a quantitative approach where participants’ views of Global Jinzai have been obtained via Google Form surveys delivered to 216 university students from Malaysia, Japan and Vietnam. The surveys include 13 demographic questions, 79 likert scale questions ranging from 1-strongly disagree to 5-strongly agree, 5 likert scale questions ranging from 1-not at all important to 5-very important and lastly is 5 ranking questions with 1-having highest priority to 5-having lowest priority. This paper provides the students perceptions on Global Jinzai and suggests recommendations to improve students’ perceptions towards Global Jinzai.

Perceptions of the Emergency Medicine Resident Selection Process by Program Directors Following the Transition to a Pass/Fail USMLE Step 1.

Beginning January 26th, 2022, the National Board of Medical Examiners transitioned scoring of the United States Medical Licensing Examination (USMLE) Step 1 from a 3-digit score to pass/fail. In the past, the Step 1 score has been weighted heavily by program directors (PDs) as one of the most important metrics when assessing medical student's competitiveness. The objective of this study was to evaluate the perceptions of emergency medicine (EM) PDs on the transition to a pass/fail USMLE Step 1 exam, and to elicit the opinions of EM PDs on the USMLE examinations' ability to predict resident performance. A survey consisting of ranking and multiple-choice questions was sent to EM PDs. The multiple-choice questions were asked to determine EM PDs level of confidence in the ability of Step 1 and Step 2 Clinical Knowledge (CK) to predict a student's ability to succeed in residency. The ranking questions focused on assessing each program's current resident selection practices in comparison to expected selection criteria changes following a transition to pass/fail Step 1. R studio and MATLAB were used for statistical analysis, and a P value <0.05 was considered significant. The survey was completed by 57 (20.21%) EM PDs. When asked if Step 1 and Step 2 CK are accurate predictors of a resident's ability to perform clinically within EM, only 10.5% of PDs answered 'yes' to Step 1 being predictive, compared to 31.6% for Step 2 CK. Regarding selection criteria, the top quartile of attributes (standardized letters of evaluation [1st], away rotations [2nd], clerkship grades [3rd] and Step 2 CK score [4th]) remained the same following the transition. Our results indicate that the top quartile of attributes might remain the same, despite most PDs agreeing that Step 2 CK is a better predictor of a resident's performance.

Identifying the important social outcomes for childhood cancer survivors: an e-Delphi study protocol

IntroductionOptimising the health of childhood cancer survivors is important given the high long-term survival rate coupled with a significant late effects burden. Included within the WHO’s definition of ‘Health’ are...

Allergen management under a voluntary PAL regulatory framework – A survey of Canadian food processors

Canadian regulations require food business operators (FBOs) to implement preventive controls to manage allergens and ensure their accurate declaration. However, the use of precautionary allergen labelling (PAL) is voluntary and competent authorities provide limited guidance on its use. The objective of this study was to present an overview of Canadian FBOs' current allergen management practices, including the mechanisms used to evaluate the need for PAL in finished products, and to investigate potential areas for improvement. Canadian FBOs were invited to answer an online survey of 48 questions covering allergen management practices and perceptions. Eighty-four full survey responses (margin of error of 9% at a 90% confidence level) were obtained. Differences in responses to multiple choice questions per company size were determined using chi-square and Fisher's exact tests. Kruskal-Wallis tests were used to analyse responses to rating or forced ranking questions. Survey respondents' allergen management practices were based on a combination of recognized best practices, third-party quality systems' standards, and regulatory requirements. Concerning practices related to the criteria used to reach PAL decisions were noted, which could be addressed with increased awareness and use of risk-based approaches and a clearer regulatory policy. Analytical testing applicability and interpretation, access to information on unintentional allergen presence in raw materials, and clarity on the expectations related to the current regulatory framework on food allergens and its enforcement, were identified as challenges faced by Canadian FBOs. The results of this survey and its analysis could be used by regulators – to inform potential policy changes, by FBOs – to map industry practices, and by allergic consumers – to better understand how manufacturers manage allergens in their operations.

Radiation adverse outcome pathways (AOPs) are on the horizon: advancing radiation protection through an international Horizon-Style exercise

Purpose The Adverse Outcome Pathway (AOP) framework, a systematic tool that can link available mechanistic data with phenotypic outcomes of relevance to regulatory decision-making, is being explored in areas related to radiation risk assessment. To examine the challenges including the use of AOPs to support the radiation protection community, an international horizon-style exercise was initiated through the Organisation for Economic Co-operation and Development Nuclear Energy Agency High-Level Group on Low Dose Research Radiation/Chemical AOP Joint Topical Group. The objective of the HSE was to facilitate the collection of ideas from a range of experts, to short-list a set of priority research questions that could, if answered, improve the description of the radiation dose-response relationship for low dose/dose-rate exposures, as well as reduce uncertainties in estimating the risk of developing adverse health outcomes following such exposures. Materials and methods The HSE was guided by an international steering committee of radiation risk experts. In the first phase, research questions were solicited on areas that can be supported by the AOP framework, or challenges on the use of AOPs in radiation risk assessment. In the second phase, questions received were refined and sorted by the SC using a best-worst scaling method. During a virtual 3-day workshop, the list of questions was further narrowed. In the third phase, an international survey of the broader radiation protection community led to an orderly ranking of the top questions. Results Of the 271 questions solicited, 254 were accepted and categorized into 9 themes. These were further refined to the top 25 prioritized questions. Among these, the higher ranked questions will be considered as ‘important’ to drive future initiatives in the low dose radiation protection community. These included questions on the ability of AOPs to delineate responses across different levels of biological organization, and how AOPs could be applied to address research questions on radiation quality, doses or dose-rates, exposure time patterns and deliveries, and uncertainties in low dose/dose-rate effects. A better understanding of these concepts is required to support the use of the AOP framework in radiation risk assessment. Conclusion Through dissemination of these results and considerations on next steps, the JTG will address select priority questions to advance the development and use of AOPs in the radiation protection community. The major themes observed will be discussed in the context of their relevance to areas of research that support the system of radiation protection.

Perception and reaction of Nanyang Technological University (NTU) researchers to different forms of research integrity education modality

BackgroundResearch and academic institutions use various delivery channels to deliver Research Integrity (RI) education in their communities. Yet there is no consensus on the best delivery method and the effectiveness of these channels in inculcating a positive RI culture varies across institutions. Hence, this study aimed to understand the preferences of the research community in Nanyang Technological University (NTU), Singapore.MethodsAn online survey was conducted on NTU research community to understand their experience with, and preference for each RI education mode offered in NTU. The RI education modes surveyed in the general ranking question are Data Management Plan (DMP) workshops, Epigeum e-Learning, Compass e-newsletter (email), and NTU policy on Research Integrity and Responsible Conduct of Research. There were 242 responses, comprising 50% research students, 32.2% research staff and 17.8% faculty members. Non-parametric statistical techniques were used to analyse preferences across different RI education modes and within sub-groups (i.e., fields, age, native language, roles in research community).ResultsMore than 92% of respondents subscribed to the importance of RI education, but with different preferences for education modes. With respect to RI education in NTU, Compass e-newsletters were ranked the lowest (p < 0.05). Most felt that they were too wordy and unengaging, making it difficult to absorb information. Similarly, Epigeum e-Learning (p < 0.05) and ‘policy’ (p < 0.05) were found to be too lengthy in presentation. The compulsory NTU RI education modes (Epigeum e-learning and ‘policy’) enjoyed higher participation rates of 70–80% compared with 32–37% for the self-regulated modes (DMP workshop and e-newsletter). This suggests that regulatory mechanisms are still necessary to promote participation in RI education, and thus, core RI education content should be made compulsory in research/academic institutions. Although Epigeum is a compulsory course, some may not have participated in the programme due to technical issues or they might have forgotten to participate in the programme within the permissible timeframe. For all four RI education modes in NTU, the lack of awareness was among the top cited reasons for not participating.ConclusionsMost NTU researchers perceived RI education positively although they may have reservations for some approaches. Conversely, e-Learning is favored over all the other modes except for the mode of Policy. Findings from this study are useful for improving the design of RI education strategies to be more appealing to the research community by enhancing user experience in terms of user-friendliness, relevance to specialisation, providing concise information and better presentation of materials For institutions with similar modes of RI education as NTU, these results may be relevant in improving participation rates and presentation of RI education modes, such as the use of infographics and more concise information.

Assessing the Impact of Changes to USMLE Step 1 Grading on Evaluation of Neurosurgery Residency Applicants in the United States: A Program Director Survey

Neurosurgery (NS) is among the most selective specialties in the United States. As the United States Medical Licensing Examination (USMLE) Step 1 transitions to a binary pass/fail score, residency programs face unclear challenges in screening and evaluating applicants. The aim of this study is to provide insights into the perceived impact of changes to the USMLE Step 1 grading in the applicant selection process. We created a survey using questions regarding NS program demographics, the perceived predictive abilities of Step 1 and Step 2 clinical knowledge (CK), and several factors that programs consider when assessing applicants. We queried program directors (PDs), program coordinators (PCs), and assistant PDs at 117 NS residency programs. Respondents were asked to rank these factors in order of importance for selection at their respective training program. We used descriptive statistics and a Wilcoxon matched-pairs signed-rank test to evaluate the effects of these changes using STATA17. A total of 35 (30%) residency programs responded with 26 (74%) completing the factor ranking questions. 86% (95% confidence interval, 71.5%-94.3%) disagreed that the changes will better prepare students clinically. USMLE Step 2 CK scores, class rank, and away rotations saw significant increases in priority in the absence of a graded Step 1, whereas letters of recommendation and surrogates for research productivity saw notable, but not significant, changes after adjusting for multiple testing. Reporting binary Step 1 grades marks a significant shift in assessing applicants for NS residency by emphasizing Step 2 CK, class rank, and research productivity.

Identification of research priorities for suicide prevention in Nepal: a Delphi study

BackgroundSuicide is a significant public health concern in Nepal and there is a need for an evidence-based suicide prevention programme to facilitate stakeholders working towards suicide prevention in Nepal. Collaborative research between stakeholders focussing on shared priorities can help to prevent and control suicide. Hence, we aimed to develop a consensus list of research priorities for suicide prevention in Nepal.MethodsThe Delphi expert consensus method was used to elicit the prioritized research questions for suicide prevention in Nepal. Participants comprised suicide prevention experts (psychologists, psychiatrists, psychiatric nurses, researchers and advocates) and people with lived experience. Three rounds of Delphi were conducted; round 1: one to one interviews involving open ended questions used to generate research questions; round 2: ranking of the research questions using a 5-point Likert scale, and round 3: re-ranking of research questions in light of individual and group responses.ResultsForty-two participants participated in round 1 followed by 38 in round 2 and 39 in round 3 . 522 research questions were generated through round 1 which were grouped together and reduced to 33 research questions sent for ranking in round 2. Using a cut off of at least 70% of the panel ranking questions as ‘very important’ or ‘important’, 22 questions were retained. These research questions were sent for re-rating in round 3 resulting in a final list of prioritized questions.ConclusionsThis is the first expert consensus study to identify the top research priorities for suicide prevention in Nepal, and used experts in suicide prevention and those with lived experience. A consensus was reached regarding the studies needed to improve suicide data quality, assess the burden and identify factors associated with suicide. A priority driven approach to suicide prevention research may ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.

Why hunt? Why gather? Why share? Hadza assessments of foraging and food-sharing motive

Over the last half century, anthropologists have vigorously debated the adaptive motivations underlying food acquisition choices and food-sharing among hunter-gatherer groups. Numerous explanations have been proposed to account for high-levels of generosity in food-sharing, including self- and family-provisioning, reciprocity, tolerated theft and pro-social- or skill-signaling. However, few studies have asked foragers directly and systematically about the motivations underlying their foraging and sharing decisions. We recruited 110 Hadza participants and employed a combination of free-response, yes/no, ranking and forced-choice questions to do just this. In free-response answers, respondents typically gave outcome-oriented accounts of foraging motive (e.g., to get food) and moralistic accounts of sharing motive (e.g., I have a good heart). In ranking tasks, participants gave precedence to reciprocity as a motive for sharing food beyond the household. We found small but clear gender differences in foraging motive, in line with previous predictions: women were more likely than men to rank family-provisioning highly whereas men were more likely than women to rank skill-signaling highly. However, despite these gender differences, the relative importance of different motivations was similar across genders and skill-signaling, sharing and family-provisioning were the most important motivators of foraging activity for both men and women. Contrary to the expectations of tolerated theft, peer complaints and requests for food ranked very low. There are several compelling reasons that evolutionary thinkers, typically interested in ultimate-level adaptive processes, have traditionally eschewed direct and explicit investigations of motive. However, these data may yet provide important insights.

Why soil testing is not enough: A mixed methods study of farmer nutrient management decision-making among U.S. producers

Understanding farmers’ nutrient management decision-making is critical to minimizing nutrient loss to water resources. This research examines farmer decision-making in the United States surrounding nutrients (primarily nitrogen and phosphorus) and water quality among 105 farmers in Missouri, North Carolina, and Ohio. Data were collected between 2015 and 2016 using a mixed-methods approach of in-person farmer interviews and accompanying quantitative surveys with demographic and Likert ranking questions. This work presents findings regarding 1) how farmers made decisions, 2) who and what they consult with when making decisions, and 3) how their views on local water quality and regional pollution impact their choices. Farmers reported many resources for information when making nutrient management decisions including yield data, market prices, weather, product availability, prior experience, risk management/avoidance, university research reports, soil and tissue sampling, and social networks. Location also shaped how farmers made nutrient management decisions both because of differences in the structure and types of professional and informal support available to farmers as well as how individuals perceived the severity of local water problems. Younger farmers saw more room for improvement in their nutrient management practices while older farmers were more likely to be satisfied with current practices and decisions. Ultimately, our findings suggest we need to tailor programs and education to regional economic, social norm, and environmental contexts with recognition that past experiences and long-term knowledge shape how farmers receive new interventions. Constructing multifaceted approaches to address these diverse conditions is a critical step in improving water quality when it comes to nutrient management choices.

The Aortic Dissection Collaborative: Methods for building capacity for patient-centered outcomes research in the aortic dissection community

Understanding what matters most to patients can help guide research in a direction that is best situated to provide evidence that is responsive to their core concerns. This can better inform the treatment decision-making process for patients and their physicians. The Aortic Dissection (AD) Collaborative built a collaborative AD research infrastructure involving patients and other stakeholders to facilitate patient-centered outcomes research training, support, and networking among those affected by AD. Two surveys and semi-structured interviews were conducted between January and October 2020 to gather information from people with and at risk for AD and their family members to better understand their experiences and needs. Discussion of survey and interview results were then articulated as seven key topics for future research to meet the needs of the AD community. Working groups were assembled to address each of the key topics. The groups conducted landscape reviews that were focused on providing guidance for future research that directly addresses the needs identified by the AD community. Recommendations for future research generated by the working groups were compiled by the Aortic Dissection Collaborative. From these recommendations, the Aortic Dissection Collaborative advisors and stakeholders identified high-priority research questions. The research questions form the basis for a third survey, disseminated to the Virtual Research Network between November 2021 and February 2022. Final analysis of the survey will identify top ranked research questions and assess willingness to participate. These results will inform the development of future patient-centered outcomes research and comparative effectiveness research proposals.

Information efficient learning of complexly structured preferences: Elicitation procedures and their application to decision making under uncertainty

In this paper we propose efficient methods for elicitation of complexly structured preferences and utilize these in problems of decision making under (severe) uncertainty. Based on the general framework introduced in Jansen et al. (2018) [37], we now design elicitation procedures and algorithms that enable decision makers to reveal their underlying preference system (i.e. two relations, one encoding the ordinal, the other the cardinal part of the preferences) while having to answer as few as possible simple ranking questions. Here, two different approaches are followed. The first approach directly utilizes the collected ranking data for obtaining the ordinal part of the preferences, while their cardinal part is constructed implicitly by measuring the decision maker's consideration times. In contrast, the second approach explicitly elicits also the cardinal part of the decision maker's preference system, however, only an approximate version of it. This approximation is obtained by additionally collecting labels of preference strength during the elicitation procedure. For both approaches, we give conditions under which they produce the decision maker's true preference system and investigate how their efficiency can be improved. For the latter purpose, besides data-free approaches, we also discuss ways for statistically guiding the elicitation procedure if data from elicitations of previous decision makers is available. Finally, we demonstrate how the proposed elicitation methods can be utilized in problems of decision under (severe) uncertainty. Precisely, we show that under certain conditions optimal decisions can be found without fully specifying the preference system.

Occupational Engagement and Quality of Life in Occupational Therapy Students and Professionals during Coronavirus Pandemic

This nationwide study addressed how occupational engagement and quality of life (QoL) were affected in occupational therapy (OT) students and professionals during the 2019 Novel Coronavirus (COVID-19) pandemic. Research questions addressed: 1) if daily occupations changed; 2) how QoL was affected; 3) in what manner OT background influenced coping; 4) recommendations to OT students, practitioners, and the profession. Although 198 students and 249 professionals responded initially to the survey, an average of 161 professionals and 95 students completed the critical questions described herein. Six students and eight professionals participated in interviews. Separate online surveys via SurveyMonkey gathered quantitative and qualitative data from the students and professionals, and interview guides facilitated qualitative data collection from both groups. The anonymous surveys included rating scales, multiple-choice, ranking, and open-ended questions. The interviews, using open-ended questions, occurred via telephone or Skype audio calls in the summer and early fall of 2020. Both professionals and students reported their occupational engagement drastically changed due to the Pandemic. Similarly, they indicated a decrease in their own QoL compared to before the Pandemic. Grounded Theory of Pandemic Occupational Adaptation and Engagement in OT Professionals and Students emanated from the findings. The COVID-19 Pandemic affected millions in various ways. OT professionals and students reported telehealth as beneficial for treating clients and providing education to OT students. Mental health should be a priority for everyone to maintain good QoL and cope with pandemic-related and future life challenges. Participant commitment to the occupational therapy profession continues to be strong.