785 resultados para end of life decision-making


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We examined the maturation of decision-making from early adolescence to mid-adulthood using fMRI of a variant of the Iowa gambling task. We have previously shown that performance in this task relies on sensitivity to accumulating negative outcomes in ventromedial PFC and dorsolateral PFC. Here, we further formalize outcome evaluation (as driven by prediction errors [PE], using a reinforcement learning model) and examine its development. Task performance improved significantly during adolescence, stabilizing in adulthood. Performance relied on greater impact of negative compared with positive PEs, the relative impact of which matured from adolescence into adulthood. Adolescents also showed increased exploratory behavior, expressed as a propensity to shift responding between options independently of outcome quality, whereas adults showed no systematic shifting patterns. The correlation between PE representation and improved performance strengthened with age for activation in ventral and dorsal PFC, ventral striatum, and temporal and parietal cortices. There was a medial-lateral distinction in the prefrontal substrates of effective PE utilization between adults and adolescents: Increased utilization of negative PEs, a hallmark of successful performance in the task, was associated with increased activation in ventromedial PFC in adults, but decreased activation in ventrolateral PFC and striatum in adolescents. These results suggest that adults and adolescents engage qualitatively distinct neural and psychological processes during decision-making, the development of which is not exclusively dependent on reward-processing maturation.

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BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

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Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

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The rapid growth of urban areas has a significant impact on traffic and transportation systems. New management policies and planning strategies are clearly necessary to cope with the more than ever limited capacity of existing road networks. The concept of Intelligent Transportation System (ITS) arises in this scenario; rather than attempting to increase road capacity by means of physical modifications to the infrastructure, the premise of ITS relies on the use of advanced communication and computer technologies to handle today’s traffic and transportation facilities. Influencing users’ behaviour patterns is a challenge that has stimulated much research in the ITS field, where human factors start gaining great importance to modelling, simulating, and assessing such an innovative approach. This work is aimed at using Multi-agent Systems (MAS) to represent the traffic and transportation systems in the light of the new performance measures brought about by ITS technologies. Agent features have good potentialities to represent those components of a system that are geographically and functionally distributed, such as most components in traffic and transportation. A BDI (beliefs, desires, and intentions) architecture is presented as an alternative to traditional models used to represent the driver behaviour within microscopic simulation allowing for an explicit representation of users’ mental states. Basic concepts of ITS and MAS are presented, as well as some application examples related to the subject. This has motivated the extension of an existing microscopic simulation framework to incorporate MAS features to enhance the representation of drivers. This way demand is generated from a population of agents as the result of their decisions on route and departure time, on a daily basis. The extended simulation model that now supports the interaction of BDI driver agents was effectively implemented, and different experiments were performed to test this approach in commuter scenarios. MAS provides a process-driven approach that fosters the easy construction of modular, robust, and scalable models, characteristics that lack in former result-driven approaches. Its abstraction premises allow for a closer association between the model and its practical implementation. Uncertainty and variability are addressed in a straightforward manner, as an easier representation of humanlike behaviours within the driver structure is provided by cognitive architectures, such as the BDI approach used in this work. This way MAS extends microscopic simulation of traffic to better address the complexity inherent in ITS technologies.

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Vague words and expressions are present throughout the standards that comprise the accounting and auditing professions. Vagueness is considered to be a significant source of inexactness in many accounting decision problems and many authors have argued that the neglect of this issue may cause accounting information to be less useful. On the other hand, we can assume that the use of vague terms in accounting standards is inherent to principle based standards (different from rule based standards) and that to avoid vague terms, standard setters would have to incur excessive transaction costs. Auditors are required to exercise their own professional judgment throughout the audit process and it has been argued that the inherent vagueness in accounting standards may influence their decision making processes. The main objective of this paper is to analyze the decision making process of auditors and to investigate whether vague accounting standards create a problem for the decision making process of auditors, or lead to a better outcome. This paper makes the argument that vague standards prompt the use of System 2 type processing by auditors, allowing more comprehensive analytical thinking; therefore, reducing the biases associated with System 1 heuristic processing. If our argument is valid, the repercussions of vague accounting standards are not as negative as presented in previous literature, instead they are positive.

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Promover a atividade empreendedora é hoje mais do que nunca uma prioridade para as economias em desenvolvimento. Em diferentes partes do mundo, empreendedores têm sido reconhecidos como verdadeiros agentes de transformação, e as novas empresas que eles criam tornam-se condutoras de inovação, que ao final pode ser difundida ao resto da economia. Teorias de economia urbana, que analisam a dinâmica da relação entre aglomeração urbana e atividade econômica, enfatizam a importância da concentração espacial das indústrias num mesmo setor industrial. Entender os incentivos que dão início à atividade empreendedora é algo novo e o foco desses estudos tem sido principalmente em alguns poucos casos de economias industrializadas. Não obstante, o sucesso de um punhado de clusters de alta tecnologia, como o Vale do Silício, por exemplo, na Califórnia, Estados Unidos, não pode ser replicado, e as condições locais devem ser consideradas a fim de entender a surgimento desses ecossistemas. Este estudo pretende investigar os critérios em que os empreendedores fundamentam suas decisões quando selecionam as localizações do seu negócio. Especificamente, a pesquisa explora o recente movimento dos ecossistemas de empreendedores na Cidade do México e em São Paulo, as duas maiores áreas metropolitanas da América Latina, à luz das teorias de economia urbana. A fim de chegar aos resultados, a pesquisa segue o método baseado sobre uma análise comparativa de estudo de casos em dois bairros: Vila Leopoldina em São Paulo e a Colônia Roma Norte na Cidade do México. Os resultados consolidados baseados em entrevistas qualitativas realizadas nos dois bairros revelam que o lugar/sitio urbano, definido em termos de laços locais assim como da atmosfera geral do ambiente, continua sendo importante para os atores apesar das comunicações de alta velocidade que produzem mais interações entre as regiões do mundo. Além disso, a relação entre o empreendedor e o seu entorno é altamente dependente do estágio de desenvolvimento e da natureza da atividade da empresa; redes informais revelam-se essenciais para identificar as oportunidades de negócio antes de serem progressivamente substituídas por relações instituídas com fundos de capital de risco ou incubadoras. Estes dois ecossistemas nascentes geram suas próprias características, o que já pode sugerir suas futuras evoluções.

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The influence of the national culture on consumer decision-making styles is investigated using a sample of Americans, Brazilians, Chinese, and Japanese consumers who have purchased a cell phone in the past three years. To make the research possible, a survey was used as a method of data collection. It relates Hofstede’s cultural classification typology with Sproles and Kendall’s consumer style inventory (CSI). The multivariate analysis of variance (MANOVA) results indicate six decision-making styles together with other consumer behavioral characteristics that can be used to distinguish and profile consumers who purchase cell phones. Empirical findings reveal that among Americans, Brazilians, and Japanese; Americans are the most quality conscious, brand conscious, innovative, and hedonistic shoppers; Brazilians are the most loyal, and Japanese, the most confused by overchoice consumers. Conceptual contributions and managerial implications are discussed.

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Investigações anteriores relacionadas ao schadenfreude concentraram-se nos fatores que provocam o prazer no infortúnio do outro. A presente pesquisa tem como objetivo investigar o impacto do schadenfreude na tomada de decisão. Dois estudos (um em laboratório e uma em campo) abordam o impacto do schadenfreude em decisões realizadas no passado e no futuro em eventos desportivos. O primeiro estudo confronta sentimentos de orgulho em uma vitória do time favorito contra os sentimentos de perda schadenfreude de uma equipe rival. Os resultados mostraram que as pessoas preferiam enviar notícias sobre a vitória da equipe favorita (orgulho) ao invés da perda do time rival (schadenfreude) quando as diferenças de pontuação no jogo eram pequenas (por exemplo: time favorito 1 x 0 outro, contra, o time rival 0 x 1 favorito). No entanto, as pessoas eram mais propensas a fazer a escolha schadenfreude (por exemplo, escolher o envio de uma notícia sobre a derrota de um time rival) quando o resultado era alto (por exemplo, time favorito 5 x 0 rival, contra, time rival 0 x 5 favorito). O segundo estudo no campo examina como schadenfreude influencia a vontade de apostar contra um time rival. Para responder a esse problema, a preferência da equipe do participante é avaliada (Participantes que apoiam time alvo contra os que apoiam o rival). Uma manipulação de louvor é adicionada, tal que os consumidores vejam ou não um elogio à equipe alvo enquanto eles estão fazendo uma aposta sobre o resultado da partida. Os resultados mostram que os torcedores do time alvo não foram influenciados pela manipulação de louvor. No entanto, torcedores do time rival aumentaram sua probabilidade de aposta contra o time alvo (ou seja, mostraram um comportamento que envolve o schadenfreude) quando esta foi elogiada antes do jogo.

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Corporate governance has been in the spotlight for the past two decades, being subject of numerous researches all over the world. Governance is pictured as a broad and diverse theme, evolving through different routes to form distinct systems. This scenario together with 2 types of agency problems (investor vs. management and minorities vs. controlling shareholders) produce different definitions for governance. Usually, studies investigate whether corporate governance structures influence firm performance, and company valuation. This approach implies investors can identify those impacts and later take them into consideration when making investment decisions. However, behavioral finance theory shows that not always investors take rational decisions, and therefore the modus operandi of those professionals needs to be understood. So, this research aimed to investigate to what extent Brazilian corporate governance standards and practices influence the investment decision-making process of equity markets' professionals from the sell-side and buy-side. This exploratory study was carried out through qualitative and quantitative approaches. In the qualitative phase, 8 practitioners were interviewed and 3 dimensions emerged: understanding, pertinence and practice. Based on the interviews’ findings, a questionnaire was formulated and distributed to buy-siders and sell-siders that cover Brazilian stocks. 117 respondents from all over the world contributed to the study. The data obtained were analyzed through structural equation modeling and descriptive statistics. The 3 dimensions became 5 constructs: definition (institutionalized governance, informal governance), pertinence (relevance), practice (valuation process, structured governance assessment) The results of this thesis suggest there is no definitive answer, as the extent to which governance will influence an investment decision process will depend on a number of circumstances which compose the context. The only certainty is the need to present a “corporate governance behavior”, rather than simply establishing rules and regulations at firm and country level.

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The master thesis for the achievement of the academic status master of science in international management (MPGI) will aim to solve the research question of how institutional voids affect the entry decision-making process of foreign venture capital firms coming to Brazil. This is a timely matter since in the past years there has been a sudden eruption of foreign VC involvement in Brazil. Based on the actionable framework by Khanna and Palpeu (2010) we conducted quantitative as well as qualitative research with two sets of interview partners in a two-phase analysis. We interviewed experts from VC firms, foreign VC firms based in Brazil and perspective VC firms that are looking to come to Brazil. We started with the former, derived lessons learned and analyzed how they affect the latter in reaching a decision. As we expected we found that depending on the industry that ventures are in, institutional voids can either pose an opportunity or a threat and hence attract or push away potential VC firms entering Brazil. Opportunities exist especially when exploiting institutional voids, for example through ventures in the marketplace efficiency. Threats are posed by investments in for instance hard infrastructure, where the economic, political and judicial systems as well as corruption and bureaucracy play demanding roles.

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We examined how the information communicated by a scout worker influences the plant species transported by recruited workers in Acromymex balzani, Acromyrmex rugosus, and Acromyrmex crassispinus, three species of leaf-cutting ant that have different substrate and habitat preferences. We verified that certain plant species were more likely to be transported than others and that recruitment occurs. We found that recruited workers were more likely to transport non-preferred plant species when they were recruited to these by scout workers. The results suggest that the scout worker can communicate information about plant identity to recruited workers, but that recruited workers integrate the information communicated with their own experience during the decision-making process. (C) 2004 Published by Elsevier B.V.

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Digital data sets constitute rich sources of information, which can be extracted and evaluated applying computational tools, for example, those ones for Information Visualization. Web-based applications, such as social network environments, forums and virtual environments for Distance Learning, are good examples for such sources. The great amount of data has direct impact on processing and analysis tasks. This paper presents the computational tool Mapper, defined and implemented to use visual representations - maps, graphics and diagrams - for supporting the decision making process by analyzing data stored in Virtual Learning Environment TelEduc-Unesp. © 2012 IEEE.