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Correctly estimating the hormone receptor status for estrogen (ER) and progesterone (PGR) is crucial for precision therapy of breast cancer. It is known that conventional diagnostics (immunohistochemistry, IHC) yields a significant rate of wrongly diagnosed receptor status. Here we demonstrate how Dempster Shafer decision Theory (DST) enhances diagnostic precision by adding information from gene expression. We downloaded data of 3753 breast cancer patients from Gene Expression Omnibus. Information from IHC and gene expression was fused according to DST, and the clinical criterion for receptor positivity was re-modelled along DST. Receptor status predicted according to DST was compared with conventional assessment via IHC and gene-expression, and deviations were flagged as questionable. The survival of questionable cases turned out significantly worse (Kaplan Meier p < 1%) than for patients with receptor status confirmed by DST, indicating a substantial enhancement of diagnostic precision via DST. This study is not only relevant for precision medicine but also paves the way for introducing decision theory into OMICS data science.
Shared Decision-making (SDM), a medical decision-making model, was popularized in the late 1980s in reaction to then predominate paternalistic decision-making, aiming to better meet the needs of patients. Extensive research has been conducted internationally examining the benefits of SDM implementation; however, existing theory on how SDM works, for whom, in which circumstances, and why is limited. While literature has shown positive patient, health care provider, and system benefits (SDM outputs), further research is required to understand the nuances of this type of decision-making. As such, we set out to address: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved engagement in the Shared Decision-making process?"
The mitochondrial gene cytochrome c oxidase I (COI) is commonly used for DNA barcoding in animals. However, most of the COI barcode nucleotides are conserved and sequences longer than about 650 base pairs increase the computational burden for species identification. To solve this problem, we propose a decision theory-based COI SNP tagging (DCST) approach that focuses on the discrimination of species using single nucleotide polymorphisms (SNPs) as the variable nucleotides of the sequences of a group of species. Using the example of 126 teleost mackerel fish species (order: Scombriformes), we identified 281 SNPs by alignment and trimming of their COI sequences. After decision rule making, 49 SNPs in 126 fish species were determined using the scoring system of the DCST approach. These COI-SNP barcodes were finally transformed into one-dimensional barcode images. Our proposed DCST approach simplifies the computational complexity and identifies the most effective and fewest SNPs to resolve or discriminate species for species tagging.
In humans, risk attitude is highly context-dependent, varying with wealth levels or for different potential outcomes, such as gains or losses. These behavioral effects have been modelled using prospect theory, with the key assumption that humans represent the value of each available option asymmetrically as a gain or loss relative to a reference point. It remains unknown how these computations are implemented at the neuronal level. Here we show that macaques, like humans, change their risk attitude across wealth levels and gain/loss contexts using a token gambling task. Neurons in the anterior insular cortex (AIC) encode the 'reference point' (i.e., the current wealth level of the monkey) and reflect 'loss aversion' (i.e., option value signals are more sensitive to change in the loss than in the gain context) as postulated by prospect theory. In addition, changes in the activity of a subgroup of AIC neurons correlate with the inter-trial fluctuations in choice and risk attitude. Taken together, we show that the primate AIC in risky decision-making may be involved in monitoring contextual information used to guide the animal's willingness to accept risk.
The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions. In this protocol, we outline a study that will explore: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved decision making?"
In bioinformatics, we pre-process raw data into a format ready for answering medical and biological questions. A key step in processing is labeling the measured features with the identities of the molecules purportedly assayed: "molecular identification" (MI). Biological meaning comes from identifying these molecular measurements correctly with actual molecular species. But MI can be incorrect. Identifier filtering (IDF) selects features with more trusted MI, leaving a smaller, but more correct dataset. Identifier mapping (IDM) is needed when an analyst is combining two high-throughput (HT) measurement platforms on the same samples. IDM produces ID pairs, one ID from each platform, where the mapping declares that the two analytes are associated through a causal path, direct or indirect (example: pairing an ID for an mRNA species with an ID for a protein species that is its putative translation). Many competing solutions for IDF and IDM exist. Analysts need a rigorous method for evaluating and comparing all these choices.
Decision making can be regarded as the outcome of cognitive processes leading to the selection of a course of action among several alternatives. Borrowing a central measurement from information theory, Shannon entropy, we quantified the uncertainties produced by decisions of participants within an economic decision task under different configurations of reward probability and time. These descriptors were used to obtain blood oxygen level-dependent (BOLD) signal correlates of uncertainty and two clusters codifying the Shannon entropy of task configurations were identified: a large cluster including parts of the right middle cingulate cortex (MCC) and left and right pre-supplementary motor areas (pre-SMA) and a small cluster at the left anterior thalamus. Subsequent functional connectivity analyses using the psycho-physiological interactions model identified areas involved in the functional integration of uncertainty. Results indicate that clusters mostly located at frontal and temporal cortices experienced an increased connectivity with the right MCC and left and right pre-SMA as the uncertainty was higher. Furthermore, pre-SMA was also functionally connected to a rich set of areas, most of them associative areas located at occipital and parietal lobes. This study provides a map of the human brain segregation and integration (i.e., neural substrate and functional connectivity respectively) of the uncertainty associated to an economic decision making paradigm.
Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others' experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions.
Clinical trial recruitment is a continuing challenge for medical researchers. Previous efforts to improve study recruitment have rarely been informed by theories of human decision making and behavior change. We investigate the trial recruitment strategies reported by study recruiters, guided by two influential theoretical frameworks: shared decision-making (SDM) and the Theoretical Domains Framework (TDF) in order to explore the utility of these frameworks in trial recruitment.
Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts.
This research was motivated by the nurses' decision-making process in the current emergency department (ED) triage process in the United States. It explores how continuous vital signs monitoring can be integrated into the ED. The article presents four shortcomings on current ED triage systems and proposes a new conceptual clinical decision support model that exploits the benefits of combining wireless wearable devices with Multi-Attribute Utility Theory to address those shortcomings. A literature review was conducted using various engineering and medical research databases, analyzing current practices and identifying potential improvement opportunities. The results from the literature review show that advancements in wireless wearable devices provide opportunities to enhance current ED processes by monitoring patients while they wait after triage and, therefore, reduce the risk of an adverse event. A dynamic mathematical decision support model to prioritize patients is presented, creating a feedback loop in the ED. The coupling of wearable devices (to collect data) with decision theory (to synthesize and organize the information) can assist in reducing sources of uncertainty inherent to ED systems. The authors also address the feasibility of the proposed conceptual model.
This study aimed to determine whether risk awareness of coronavirus disease (COVID-19) affects visits to national parks. We analyzed the tourist decision-making process during the current pandemic using the theory of planned behavior as a framework, adding variables relevant to the pandemic, such as risk perception and risk reduction behavior, to the model. Based on a literature review, we developed a research model describing the impact relationship between risk perception, the theory of planned behavior, and risk reduction behavior and tested nine hypotheses. Results of a survey of 555 visitors to two national parks supported eight of the nine hypotheses. Although the results are limited, they reaffirm the usefulness of the theory of planned behavior in explaining tourism behavior. This work is significant in that we would be able to extend the scope of subsequent research beyond a discussion of the direct effects on optimistic perceptions (bias) and risk reduction behavior as well as visit intention, by explaining the probability even in unprecedented crises such as COVID-19. Humans may be negotiating the constraints (COVID-19) or embodied tourism need through the personal bias. Furthermore, we discuss the theoretical implications of the results for tourism behavior research.
We know little about the best approaches to design training for healthcare professionals. We thus studied how user-centered and theory-based design contribute to the development of a distance learning program for professionals, to increase their shared decision-making (SDM) with older adults living with neurocognitive disorders and their caregivers.
Computerised clinical decision support (CCDS) has been shown to improve processes of care in some healthcare settings, but there is little evidence related to its use or effects in pre-hospital emergency care. CCDS in this setting aligns with policies to increase IT use in ambulance care, enhance paramedic decision-making skills, reduce avoidable emergency department attendances and improve quality of care and patient experience. This qualitative study was conducted alongside a cluster randomised trial in two ambulance services of the costs and effects of web-based CCDS system designed to support paramedic decision-making in the care of older people following a fall. Paramedics were trained to enter observations and history for relevant patients on a tablet, and the CCDS then generated a recommended course of action which could be logged. Our aim was to describe paramedics' experience of the CCDS intervention and to identify factors affecting its implementation and use.
The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outlines the theory-based development of a website for GP guidelines, and piloting of a new risk calculator/decision aid.
Human success and even survival depends on our ability to predict what others will do by guessing what they are thinking. If I accelerate, will he yield? If I propose, will she accept? If I confess, will they forgive? Psychologists call this capacity "theory of mind." According to current theories, we solve this problem by assuming that others are rational actors. That is, we assume that others design and execute efficient plans to achieve their goals, given their knowledge. But if this view is correct, then our theory of mind is startlingly incomplete. Human action is not always a product of rational planning, and we would be mistaken to always interpret others' behaviors as such. A wealth of evidence indicates that we often act habitually-a form of behavioral control that depends not on rational planning, but rather on a history of reinforcement. We aim to test whether the human theory of mind includes a theory of habitual action and to assess when and how it is deployed. In a series of studies, we show that human theory of mind is sensitive to factors influencing the balance between habitual and planned behavior.
In the Ultimatum Game, participants typically reject monetary offers they consider unfair even if the alternative is to gain no money at all. In the present study, ERPs were recorded while subjects processed different offers of a proposer. In addition to clearly fair and unfair offers, mid-value offers which cannot be easily classified as fair or unfair and therefore involve more elaborate decision making were analyzed. A fast initial distinction between fair and other kinds of offers was reflected by amplitude of the feedback related negativity (FRN). Mid-value offers were associated with longer RTs, and a larger N350 amplitude. In addition, source analyses revealed a specific involvement of the superior temporal gyrus and the inferior parietal lobule during processing of mid-value offers compared to offers categorized clearly as fair or unfair, suggesting a contribution of mentalizing about the intention of the proposer to the decision making process. Taken together, the present findings support the idea that economic decisions are significantly affected by non-rational factors, trying to narrow the gap between formal theory and the real decisional behaviour.
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