Subjective Value Research Articles

Satisfactory Clinical Outcomes After Latissimus Dorsi Tendon Transfer for Irreparable Posterosuperior Massive Rotator Cuff Tears: A 10- to 20-Year Follow-up.

Latissimus dorsi tendon transfer (LDTT) leads to good clinical outcomes and recovery of function. A previous study have evaluated the outcomes of LDTT at a minimum 10-year follow-up and found durable improvements in shoulder function and pain relief but observed that shoulders with fatty infiltration of the teres minor muscle and insufficiency of the subscapularis muscle tended to have inferior results. To evaluate the outcomes of LDTT with a minimum follow-up of 10 years in a sizeable cohort for the treatment of irreparable posterosuperior massive rotator cuff tears (mRCTs). Case series; Level of evidence, 4. Patients who underwent LDTT for irreparable mRCTs between 2004 and 2013, performed by the same senior surgeon, were included in this study. All intraoperative and postoperative complications, as well as whether patients required conversion to reverse shoulder arthroplasty (RSA), were noted. At a minimum follow-up of 10 years, an independent observer collected range of motion measurements and clinical scores, including those for the Constant score, the Subjective Shoulder Value, and a visual analog scale for pain; the subacromial space was also assessed. A total of 143 patients (147 shoulders) that underwent LDTT, with a minimum follow-up of 10 years, were included; of these, 24 patients (24 shoulders, 16%) were lost to follow-up, 1 patient (1 shoulder, 0.7%) died 9 years after the index procedure for reasons unrelated to shoulder surgery, and 18 patients (18 shoulders, 12%) required conversion to RSA, of which 6 underwent conversion at ≥6 years after LDTT. The remaining 101 patients (104 shoulders), including 3 patients who were scheduled to undergo RSA, were assessed at a mean time of 12.3 ± 2.2 years (range, 10-20 years) after index LDTT, comprised 52 men (53 shoulders) and 49 women (51 women) and had a mean age of 61.6 ± 8.0 years (range, 39-81 years) at the time of index surgery. Complications were noted in 14 shoulders, of which 4 required a reoperation. The Constant score improved by 34.2 ± 11.7 points, the adjusted Constant score by 43.5 ± 15.3 points, and the Subjective Shoulder Value score by 50.4 ± 16.4 points. The subacromial space decreased by 0.3 ± 2.0 mm. At a minimum follow-up of 10 years, LDTT for the treatment of irreparable posterosuperior mRCTs led to satisfactory clinical scores. Of the 147 shoulders that underwent LDTT, 18 (12%) required conversion to RSA.

Uncemented reverse total shoulder arthroplasty: is it a safe option for elderly patients with proximal humerus fractures?

Reverse shoulder arthroplasty (RSA) is a common surgical procedure for elderly patients with proximal humerus fractures. Cement fixation of the humeral stem is considered the gold standard for this procedure. Due to the high prevalence of osteoporosis in this patient population, the risk of intraoperative fractures is increased when uncemented stems are used. Stem loosening is another concern of uncemented stems. However, the use of cement is associated with the risk of cement embolisation, impairment of tuberosity healing, and technical difficulties for later revisions. This study aimed (i) to evaluate the clinical and radiological outcomes of patients treated with uncemented RSA for proximal humerus fractures at two years postoperatively, and (ii) to compare these outcomes between patients with and without decreased low bone quality as measured by the deltoid tuberosity index. The single-centre prospective study included 54 shoulders (52 patients) with a proximal humerus fracture between 2019 and 2022. Enrolled were patients aged 65 and older with acute or secondary displaced three- or four-part fractures or head-split fractures treated with RSA using the same uncemented system and tubercula refixation. At 24 months post-surgery, clinical evaluations included range of motion (ROM), Constant-Murley Score (CS), Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) Score. Radiological assessments evaluated scapular notching, radiolucent lines, and greater tuberosity healing. The mean age was 79 years (± 8), 87% were female, and 69% had osteoporotic fractures. At the two-year follow-up, the median SSV was 90% (IQR 80-95), the median CS Score was 76.5 (IQR 72-81), and the median ASES Score was 89.9 (IQR 82-93). The ROM measurements were: median active forward flexion 140° (IQR 120-160), median external rotation 30° (IQR 20-40), and median active internal rotation 6 (IQR 4-8). The greater tuberosity healing rate was 94.5%. Although osteoporotic fractures occurred more often in older patients (mean 81 vs. 72 years, respectively), no other significant differences were detected between the groups. One case of aseptic stem loosening occurred in the non-osteoporotic group. Even in osteoporotic proximal humerus fractures, cementless stems combined with tubercula refixation resulted in favourable outcomes and were not associated with increased complications.

Neural reward system reflects individual value comparison strategy in cost-benefit decisions.

A core assumption in decision neuroscience is that individuals decide between options by comparing option-specific subjective reward values. Psychological accounts challenge this view and suggest that decisions are better explained by comparisons between choice attributes than by comparisons between option-specific values, casting doubts on the interpretation of activation in the neural reward system as subjective value signals. Here, we provide neuroimaging and pharmacological evidence that value-related neural activity follows the value comparison strategy employed by an individual on the psychological level. Neural model comparisons reveal that activation in the striatum, rather than generally reflecting attribute-wise or option-wise value comparisons, reflects the value comparison strategy that provides the best explanation for an individual's choice behavior. Strikingly, manipulating activation in the dopaminergic reward system reveals that dopamine antagonism counteracts the engagement in an individual's dominant value comparison strategy. Together, our findings provide evidence for the biological plausibility of psychological accounts of decision making and emphasize the importance of neural model comparisons to prevent misinterpretations of brain activation.

Do I want to study psychology and why? Can I succeed in blended learning? The perseverance and changes in success expectancies and the subjective task value of non-traditional Swiss students

Do I want to study psychology and why? Can I succeed in blended learning? The perseverance and changes in success expectancies and the subjective task value of non-traditional Swiss students

Understanding the Multifactorial Influences on Postsurgical Pain After Rotator Cuff Repair: A Retrospective Cohort Study.

The experience of chronic postsurgical pain (CPSP) can vary widely among patients after rotator cuff repair (RCR). To determine the prevalence and predictive factors of CPSP at 6 months after RCR. Cohort study; Level of evidence, 3. The following assessments were conducted preoperatively and 6 months postoperatively in adult patients with RCR who had undergone primary arthroscopic RCR (N = 1987): Constant score, pain assessed on the numeric rating scale (0-10), the Subjective Shoulder Value, the Oxford Shoulder Score, and quality of life as measured by the EuroQol-5 Dimensions-5 Level (EQ-5D-5L). Patient characteristics-including age, sex, body mass index, and smoking status-and surgical factors-including the duration of surgery and the American Society of Anesthesiologists (ASA) classification-were also reported. Multivariate logistic regression analysis was performed to determine which variables were predictors for CPSP. The prevalence of moderate to severe preoperative pain in the patients was 30.4% for CPSP. After adjusting for age, surgery duration, ASA classification, sex, and body mass index, results revealed that unique predictors for CPSP were as follows: (1) the presence of preoperative negative affect-assessed using the anxiety/depression dimension of the EQ-5D-5L (odds ratio [OR], 1.46 (P < .001); (2) preoperative pain (OR, 1.17; P < .001); and (3) shoulder function (OR, 0.96; P < .001). None of the surgical factors appeared to predict CPSP. Patients predisposed to CPSP can be identified during the preoperative phase. Collectively, there is a call for a more in-depth assessment of biopsychosocial risk factors that could substantially influence the postoperative pain experience.

Decisions to seek cognitive performance feedback: Potential determinants of feedback value and consequences for learning

Performance feedback is essential for effective learning. Feedback contains both informational and affective properties. Following negative feedback (indicating an incorrect response), the unpleasant experience of being wrong can diminish the value of constructive information that feedback also provides. This can hinder motivation to seek feedback, which can impede learning. Therefore, research into factors that directly shape the subjective value of feedback is critical. The current study investigated potential behavioral and physiological contributors to feedback valuation and to subsequent feedback-seeking behavior. Fifty-nine participants completed a willingness-to-pay associative memory task that measured feedback valuation via trial-wise decisions to either purchase or forgo feedback during a learning phase in service of maximizing a performance-contingent monetary reward during a future test phase. Skin conductance response (SCR) was also measured during feedback decisions. Lower confidence in response accuracy significantly predicted higher likelihood of purchasing feedback during learning. Neither self-reported emotional responses to feedback nor SCR during feedback decisions predicted feedback purchases. Purchase decisions yielding negative feedback significantly predicted better performance during test. These results suggest that confidence during learning significantly impacts performance feedback valuation and should be considered when devising methods to motivate feedback-seeking in settings where learning is critical to success.

Profiles of John Henryism and subjective task value in higher education: the motivations and attributions of nontraditional students

AbstractSchool psychology scholars argue that diversifying the profession will advance equity and social justice. Yet, nontraditional and racially and ethnically minoritized students are underrepresented in school psychology programs. These diverse college students bring complex identities that may complicate as well as enrich their paths to achievement. This is a challenge as higher education environments often do not optimize support for these students. To address this challenge, we investigated the influence of a school‐based task on cognitive engagement, subjective task value, positive and negative emotions, identities, and context‐sensitive high‐effort coping called John Henryism in 294 U.S. college students. Correlation and regression analysis demonstrated a strong relationship between John Henryism and subjective task value. Latent profile analysis and follow‐up logistic regression demonstrated that older and Latinx students predicted membership in the group that was high in John Henryism and subjective task value. We discuss theoretical and practical implications of this work in better understanding the mixed consequences of achievement motivation, contextualizing subjective task value using John Henryism, and recommendations for higher education institutions.

Cost-benefit analysis: just a step in the HIA process

Abstract The economic analysis within Health Impact Assessments (HIA) is a critical component in informing public policy decisions by assessing the financial implications of health outcomes associated with the different intervention options. Health metrics play a role defining the cost-effectiveness and societal value associated with the interventions. These metrics, quantifying the health impacts, include quality-adjusted life years (QALYs), years of life lost (YLLs) or disability-adjusted life years (DALYs). On another level, such metrics need to be translated into cost-effectiveness and societal value in which other methods play a role, such as the value of statistical life (VSL) or the value of a life year (VOLY). While VSL quantifies the value individuals place on reducing mortality risk, VOLY evaluates the value attributed to extending life expectancy. On another hand, uncertainties related to economic valuation pose challenges to the accuracy and reliability of cost estimates within HIA. These come from several factors, including data quality, methodological differences across studies, and subjective judgments involved in valuing health states. In fact, estimating the economic value of a prevented death involves multifaceted considerations and important assumptions. Additionally, assigning monetary values to non-fatal health outcomes, such as disability or reduced quality of life, involves subjective assessments and value judgments. By selecting appropriate metrics, considering diverse data sources, and addressing methodological steps and uncertainties, HIA practitioners can improve the utility of economic assessments, facilitating evidence-based decision-making in public health policy and resource allocation. This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&amp;D Unit (reference UIDP/4255/2020).

Can a single question replace patient-reported outcomes in the follow-up of elbow arthroplasty? A validation study

BackgroundTo assess the results after elbow arthroplasty it is essential to gather patient-reported outcome measures (PROMs). However, the acquisition of PROMs poses a challenge because of potential low literacy, lengthiness and diversity of questionnaires, and questionnaire fatigue. Instead of a questionnaire, patient-reported outcomes can be collected using a single assessment numeric evaluation (SANE), the subjective elbow value (SEV). The aim of this pilot study is to assess the correlation between the SEV and conventionally used patient reported outcome measures (PROMs) after elbow arthroplasty.Materials and methodsThe SEV was added to our follow-up system in 2021, consisting of a scale from 0 to 10 in which the patients are asked to rate the overall functionality of their elbow, 0 corresponds to very poor functionality and 10 to a perfectly functional or healthy elbow. All patients who underwent elbow arthroplasty (total or radial head) and responded to the SEV question were retrospectively identified and included. The correlation between the SEV at the final follow-up and the Oxford Elbow Score (OES), and between the SEV and the Quick Disbailities of the Arm, Shoulder, and Hand (quickDASH) score was assessed using Pearson’s r.ResultsIn total, 82 patients responded to the SEV question and were included in the study, with a median follow-up of 5 years [interquartile range (IQR) 3–7]. Of these patients, 17 (21%) underwent radial head arthroplasty and 65 (79%) total elbow arthroplasty. The Pearson’s r for the correlation between SEV and OES was 0.502 (p < 0.001) and between the SEV and the QuickDASH −0.537 (p < 0.001), which correspond to a moderate correlation.ConclusionsThe SEV shows a moderate correlation with conventional PROMs, demonstrating its potential in simplifying the follow-up of elbow arthroplasty, possibly decreasing time, costs, and patients’ questionnaire fatigue compared with conventional PROM questionnaires.Evidence level: III.

Representation of Anticipated Rewards and Punishments in the Human Brain.

Subjective value is a core concept in neuroeconomics, serving as the basis for decision making. Despite the extensive literature on the neural encoding of subjective reward value in humans, the neural representation of punishment value remains relatively understudied. This review synthesizes current knowledge on the neural representation of reward value, including methodologies, involved brain regions, and the concept of common currency representation of diverse reward types in decision-making and learning processes. We then critically examine existing research on the neural representation of punishment value, highlighting conceptual and methodological challenges in human studies and insights gained from animal research. Finally, we explore how individual differences in reward and punishment processing may be linked to various mental illnesses, with a focus on stress-related psychopathologies. This review advocates for the integration of both rewards and punishments within value-based decision-making and learning frameworks, leveraging insights from cross-species studies and utilizing ecological gamified paradigms to reflect real-life scenarios.

Objective Visual Acuity Estimation via the Optokinetic Response to High-pass Filtered Stimuli: An Exploratory Study

Aims: Optokinetic-based paradigms used to derive objective visual acuity suffer so far from low predictive power. Arguably, the contribution of the peripheral stimulation and the discrepancy between detection and discrimination threshold can bias the outcomes. In this respect, high-pass filtered stimuli (HPSs) have the advantage of activating only the foveal region and their detection and discrimination thresholds converge. In this exploratory study a novel optokinetic-based induction method (named “ghost oktotype”) that uses HPSs is probed. The aim was to establish whether this type of procedure is worth being extensively investigated. Study Design: Analytical transversal study. Place and Duration of Study: Department of Ophthalmology, University of Turin, Italy, between June 2023 and June 2024. Methodology: After testing for their subjective acuity (expressed as logMAR) at ten different defocusing conditions, four normal and cooperative subjects were repeatedly administered sequences of HPS-Landolt rings arranged on a serial pattern that drifted horizontally. Their angular size was logarithmically reduced and objective acuity was computed for each defocusing condition as a function of the smallest size of the rings that evoked the optokinetic reflex (logMAER). The estimate was compared to the subjective values obtained both at the conventional Landolt-C ETDRS charts and with modified ETDRS charts made up of high-pass filtered Landolt Cs. Results: The repeatability of the HPS-based optokinetic paradigm was good in the three subjects (ICC=0.77; 0.86; 0.89) and the outcomes were significantly correlated with the conventional ETDRS values (R2=0.96, R2=0.88, R2=0.81: P&lt;0.001). Nevertheless, objective visual acuity was lower (higher logMAER) compared to the subjective, conventional assessment with the ETDRS chart, especially at the highest acuities. This difference decreased when logMAER was compared to the subjective discrimination acuity (logMAR) measured with the HPS-ETDRS charts, and, supposedly, to detection acuity. Conclusion: According to these preliminary results, high-pass filtered stimuli reduce the mismatch between subjective and objective acuity. Within this frame, the “ghost” oktotype could be a promising tool to assess visual acuity in non-collaborative patients and is worth being extensively investigated. Forthcoming studies could support our impression i.e., that detection and not resolution is the main requisite for the optokinetic response. This peculiarity must be considered when investigating the potential of the optokinetic-based paradigms to derive resolution acuity.

Analysis Neutrophil-to-Lymphocyte and Monocyte-to- Lymphocyte Ratios in Pediatric Respiratory Infections

Indonesia ranks third among countries with the highest tuberculosis (TB) cases worldwide. Pneumonia also stands as a leading cause of death among infants in developing nations. The delay in diagnosing and the challenges in distinguishing TB and pneumonia have significant impacts on elevated morbidity and mortality rates. Both Neutrophil-to-Lymphocyte Ratio (NLR) and Monocyte-to-Lymphocyte Ratio (MLR) serve as inflammatory biomarkers utilized for rapid and straightforward bacteremia evaluation. This study aimed to analyze the difference between NLR and MLR in diagnosing of TB and pneumonia in children. This study was retrospective cross-sectional research utilizing secondary data at the time of initial diagnosis by a clinician as TB or pneumonia. Subjects with TB and/or pneumonia were treated at Dr. Wahidin Sudirohusodo Hospital, Makassar from January 2017 to December 2021. The research sample consisted of 150 patients with pediatric patients with pneumonia. Statistical analyses involved the Kolmogorov-Smirnov test, Mann-Whitney U test, and Receiver Operating Characteristic (ROC). This study examined NLR and MLR as supportive biomarkers for diagnosing TB and pneumonia. The NLR (AUC 0.674) and MLR (AUC 0.63) values in TB subjects were reasonably good in distinguishing between TB diagnosis and healthy subjects. The NLR (AUC 0.77) and MLR (AUC 0.787) values were effective in distinguishing pneumonia diagnosis from healthy control with better sensitivity and specificity compared to TB subjects. However, NLR (AUC 0.401) and MLR (AUC 0.384) values were not recommended to distinguish pneumonia from tuberculosis due to low AUC and extremely low sensitivity and specificity. The NLR and MLR values cannot be used to differentiate TB and pneumonia in children due to their low sensitivity and specificity.

Value construction through sequential sampling explains serial dependencies in decision making.

Many decisions are expressed as a preference for one item over another. When these items are familiar, it is often assumed that the decision maker assigns a value to each of the items and chooses the item with the highest value. These values may be imperfectly recalled, but are assumed to be stable over the course of an interview or psychological experiment. Choices that are inconsistent with a stated valuation are thought to occur because of unspecified noise that corrupts the neural representation of value. Assuming that the noise is uncorrelated over time, the pattern of choices and response times in value-based decisions are modeled within the framework of Bounded Evidence Accumulation (BEA), similar to that used in perceptual decision-making. In BEA, noisy evidence samples accumulate over time until the accumulated evidence for one of the options reaches a threshold. Here, we argue that the assumption of temporally uncorrelated noise, while reasonable for perceptual decisions, is not reasonable for value-based decisions. Subjective values depend on the internal state of the decision maker, including their desires, needs, priorities, attentional state, and goals. These internal states may change over time, or undergo revaluation, as will the subjective values. We reasoned that these hypothetical value changes should be detectable in the pattern of choices made over a sequence of decisions. We reanalyzed data from a well-studied task in which participants were presented with pairs of snacks and asked to choose the one they preferred. Using a novel algorithm ( Reval ), we show that the subjective value of the items changes significantly during a short experimental session (about 1 hour). Values derived with Reval explain choice and response time better than explicitly stated values. They also better explain the BOLD signal in the ventromedial prefrontal cortex, known to represent the value of decision alternatives. Revaluation is also observed in a BEA model in which successive evidence samples are not assumed to be independent. We argue that revaluation is a consequence of the process by which values are constructed during deliberation to resolve preference choices.

Assessing the Influence of Long-Term Gender-Affirming Hormone Therapy on Cardiovascular Risk in Transgender Men through Carotid Intima-Media Thickness.

Background: Transgender men use exogenous androgen for male pattern virilization. Hysterectomy and bilateral salpingo-oophorectomy (HBSO) is performed to stop the endogenous estrogen secretion. Cardiovascular disease (CVD) risk has been shown to increase with long-term use of androgens and the removal of estrogen. We aimed to investigate the CVD risk in these individuals by measuring internal and common carotid artery intima-media thicknesses (CIMT). Methods: In this cohort study, data were collected from transgender men who had undergone HBSO and used androgens for at least two years (median treatment duration was 5 years in our research). Cisgender women in the same age range were selected as the control group. Demographics, vital signs, and hematological values of transgender patients and cisgender women subjects in the control group were noted. CVD markers were compared with sonographically measured CIMT values. Results: The mean age and body mass index (BMI) of the study group were 32.6 and 25.3, respectively. Weight, systolic-diastolic blood pressure, hemoglobin, hematocrit, low-density lipoprotein (LDL), serum triglyceride (TG), HbA1c levels, internal CIMT, and common CIMT values of the study group were higher, while the high-density lipoprotein (HDL) level was significantly lower compared the control group (p1 = 0.025, p2 = 0.010, p3 = 0.002, p4 = 0.001, p5 = 0.001, p6 = 0.012, p7 = 0.008, p8 = 0.007, p9 = 0.013, and p10 = 0.001). There was also an increase in the body weight, BMI, LDL, and TG levels of the study group after the testosterone treatment (p1 = 0.025, p2 = 0.019, p3 = 0.001, p4 = 0.001, and p5 = 0.001). Conclusions: We demonstrated that the use of testosterone therapy in transgender men is associated with higher CIMT values. While further investigation is needed to assess morbidity and mortality rates, we recommend that regular clinical and radiological examinations be performed in these individuals to accurately evaluate the risk of CVD.

Varieties of Consequentialism and Deontology in Theories of Tort Law

AbstractAn important contribution of Gregory Keating’s Reasonableness and Risk is to mount objections to law and economics whilst articulating an alternative deontological vision of tort law to that offered by corrective justice theorists. In this paper I offer two reservations about Keating’s account. One is that some forms of consequentialism can accommodate at least some aspects of his deontological theory, so we must be careful to distinguish between claims that strike at the heart of consequentialism and those that are only a problem for wealth maximisation. The second is that there are yet other varieties of deontology besides Kantianism and Keating’s alternative to it, and while I accept some of Keating’s claims, I think we should reject others. I will make the case for each of these reservations via discussion of three core features of Keating’s account: the harm/benefit asymmetry, the commitment to objective rather than subjective valuation, and his justification of strict liability.

Convertible glenoid replacement in the anatomical total shoulder arthroplasty: medium-term results.

The older generation of high thickness metal-backed glenoid prostheses had a high failure rate. The goal of our study was to analyze the medium-term clinical and radiological results of a technically modified generation of metal backed glenoids with 35% decrease in thickness. Thirty-nine patients (43 shoulders) with a mean age of 66.5 years at surgery were examined from two to ten years (mean 71.2 months) using the Constant-Score, Subjective Shoulder Value and X-ray in a.p. and axial view. Indication for surgery included patients with glenoid types B1, B2, or B3 and/or posterior subluxation but intact rotator cuff, or patients who did not want a reverse prosthesis and had high functional demands. Inclusion criteria comprised participation in a clinical and radiological follow-up examination, along with a minimum follow-up duration of 24 months. Additionally, in all cases, the Constant Score and the Subjective Shoulder Value (PROM) had to be determined. Exclusion criteria were an incomplete dataset, implantation of a different prosthesis type, and failure to meet the minimum follow-up time. The absolute Constant Score (CS) improved significantly (p < 0.0001) from 43 ± 13 (range: 20-69) points before to 80 ± 13 (range: 46-98) points after surgery. The only preoperative negative influencing factor on the result was the glenoid protrusion according to Lévigne (p = 0.0150). No significant differences in functional outcomes were found between glenoid types A2,B1,B2 and B3. Radiolucent lines at the interface were observed in a total of four patients (13%). Radiological signs of glenoid osteolysis were seen in six patients (20%).Humeral upward migration was observed in four patients (13%) and posterior shoulder joint decentering occurred in one patient (3%). Implant-specific complications occurred in three cases (7%). Due to a massive rotator cuff tear, two cases (4.7%) had to be converted to a reversed implant, with the primary metal component remaining in place. If the implant-specific and rotator cuff-associated complications are summarized, the rate is 11.7%. All components that required conversion to an reverse implant have so far remained free of complications. Favorable clinical results can be achieved, especially in patients with an eccentric glenoid type. Severe preoperative glenoid erosion (Walch A2, B2, B3) does not appear to have any influence on postoperative functional results. The complication and revision rates are significantly better than in previous studies with conventional metal-backed glenoid components. Conversion of the anatomical glenoid component to a reverse system was always possible and good clinical results were achieved.

Decision-making process for risk-reducing salpingo-oophorectomy among Korean women with hereditary breast cancer: A grounded theory study

PurposeTo explore the decision-making process regarding Risk-Reducing Salpingo-Oophorectomy (RRSO) among women with hereditary breast cancer in Korea, with a focus on complex interpersonal interactions and sociocultural influences. MethodThis qualitative, grounded theory study conducted semi-structured and in-depth interviews with 17 women with hereditary breast cancer between March and December 2021. Theoretical sampling and constant comparison were utilized for data analysis. ResultsThe core concept identified was ‘Navigating optimal trajectories for preserving myself,’ encompassing four stages: (1) conflicting between cancer-free health and maintaining integrated self; (2) recognizing the decision-maker: myself vs. physician; (3) seeking meaningful information; and (4) evaluating decision results and prioritizing values. Women’s conflict was influenced by the time given to decide, the timing of BRCA results, complexity of surgical choices, diverse perspectives, and the quality of information. This process often reiterated until RRSO was undertaken. ConclusionWomen with hereditary breast cancer grapple with conflicting decisions to preserve their integrated selves. The decision-making process is complex and subjective, influenced by physician-dominated decision-making culture, subjective meaningful information, individual values, and decisional circumstances. Supporting women in prioritizing their values and providing comprehensive information on the physical, emotional, relational, and social impacts of each option are crucial. Oncology nurses can play a vital role in bridging the gap between physician-dominated decision-making and patient autonomy by facilitating communication and supporting patient-centered care.

Assessment of Haematological Parameters and Body Mass Index Among Geriatric Out- Patients in Ekpoma, Edo State

Aging is associated with physiological changes that affect various bodily systems, including the hematological system. This study aimed to evaluate hematological parameters and Body Mass Index (BMI) in geriatric subjects (≥60 years) and compare them with apparently healthy young adults (20-33 years). A total of 100 subjects (50 geriatrics and 50 controls) were recruited for this study. Hematological parameters, including white blood cell count, lymphocyte count, granulocyte count, red blood cell count, hemoglobin concentration, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and platelet count, were assessed. BMI was calculated, and comparisons were made between geriatric and control groups. The results showed higher BMI values in geriatric subjects, although not statistically significant. White blood cell count was lower in geriatric subjects, while lymphocyte count, granulocyte count, and platelet count showed no significant differences. Hemoglobin concentration and packed cell volume were significantly higher in geriatric subjects. The findings suggest that ageing is associated with changes in hematological parameters and BMI, which may not necessarily indicate disease. The study's results are consistent with World Health Organization (WHO) criteria for hematological values among blacks and highlight the importance of considering age-related changes in hematological parameters when assessing the health status of geriatric subjects.

Adaptation and validation of an inventory for assessing subjective task value beliefs regarding the decision to pursue postgraduate studies

The desire to pursue postgraduate studies is motivated by several interrelated and multifaceted factors ranging from intrinsic to extrinsic. However, little consensus exists in the literature regarding an instrument that assesses an individual’s motivation for pursuing postgraduate education. In this study, we adapted and validated a pre-existing inventory that evaluates the individuals’ motives for pursuing postgraduate studies using the subjective task value beliefs framework. The study, in particular, focused on assessing the factor structure, construct validity, and reliability of the adapted scale. Study participation invitations were sent to a pool of postgraduate students in two higher education institutions, of which 501 students finally responded to the online questionnaire. The exploratory and confirmatory factor analyses were used to analyse the data to address the research objectives. The results revealed a five-factor structure for the adapted scale with excellent construct validity and reliability indicators. The findings of the research add value to the psychometric literature and also provide a useful instrument for use among instructors, researchers, and university administrators in their line of duty.

Non-Invasive Bracing of Acromioclavicular Joint Dislocations is not Superior to Early Functional Rehabilitation and not Inferior to Surgical Stabilization in Rockwood type III and V Injuries

BackgroundTreatment of acromioclavicular joint (ACJ) separations remains controversial. Yet, conservative treatment has become more common even for high-grade injuries. Available conservative treatment does to date however not address the loss of anatomical joint integrity in Rockwood (RW) III and V injuries. In a recent case report, we outlined the concept of restoring ACJ integrity by non-invasively bracing a RW V injury. AimThe purpose of this study was to prospectively evaluate the clinical and radiological efficacy of a modern Kenny-Howard splint like brace and compare it to early functional rehabilitation or surgery for RW III and V injuries after a minimum of 12 months. MethodsPatients with acute RW III injuries (n=18) and patients with RW V injuries who refused surgery (n=7) were prospectively enrolled and treated with an ACJ brace and followed up clinically and radiologically for 12 months. Endpoint results were compared to injury grade-, sex-, age-, and follow-up-period-matched patients treated with early functional rehabilitation (n=23) and surgical TightRope stabilization (n=23). Clinical outcomes included Constant Score (CS), Subjective Shoulder Value (SSV), Taft Score (TS), and modified Acromioclavicular Joint Instability Score (mAJIS) and radiological outcome included coracoclavicular (CC) index. ResultsCS, SSV, TS, and mAJIS improved in RW III and CS and SSV in RW V patients treated with the ACJ brace. Significance was only reached in RW III patients (p < 0.001). Radiological indices did not improve over time in RW III and V patients. No differences were found when comparing functional and cosmetic outcomes (CS, SSV, TS, mAJIS) after a minimum of 12 months between bracing, surgery, and early functional rehabilitation in RW III and V patients. The CC index was most improved in patients treated by surgery compared to bracing after a minimum of 12 months (p=0.0011 for RW III). ConclusionBrace treatment led to comparable clinical and cosmetic outcomes as early functional rehabilitation or surgery in patients with high grade ACJ injuries after a minimum of 12 months. However, no sustainably improved reduction of the ACJ resulted from bracing, when compared to early functional rehabilitation, thus questioning its utility. While surgery ensured radiological improvement compared to bracing, no benefit was seen over early functional rehabilitation.