967 resultados para choice making


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RESUMO Os atributos do solo estão relacionados com o desenvolvimento e a produção das culturas, tanto anuais como perenes. O presente trabalho teve como objetivo determinar os atributos químicos e físicos do solo três anos após a aplicação de sistemas de manejo para implantação de porta-enxertos de videira, em um Nitossolo Vermelho com textura muito argilosa. Os sistemas de manejo consistiram na confecção ou não de camalhões e/ou de drenos antes da implantação das mudas de porta-enxertos Dog Ridge. Os atributos químicos (pH em água e teores de matéria orgânica e de macronutrientes) foram determinados em amostras coletadas na linha da cultura, nas camadas de 0-0,1; 0,1-0,2; 0,2-0,3 e 0,3-0,4 m de profundidade. Os atributos físicos do solo (teor de argila, densidade, porosidade, resistência à penetração e estabilidade dos agregados) foram determinados em amostras coletadas com estrutura preservada nas camadas de 0,025-0,075; 0,125-0,175; 0,225-0,275 e 0,325-0,375 m de profundidade. Também foram determinadas a massa seca de raízes do portaenxerto nas camadas de 0-0,2 e 0,2-0,4 m de profundidade e suas correlações com os atributos do solo. A confecção de camalhões alterou significativamente a maioria dos atributos químicos do solo e proporcionou maior uniformidade nos valores em profundidade, criando condições mais favoráveis ao crescimento radicular nas camadas mais profundas. Os atributos físicos foram menos afetados do que os químicos pela confecção de camalhões ou drenos, e não foram observados valores restritivos ao crescimento radicular nas camadas amostradas após quatro anos da aplicação dos sistemas de manejo do solo. A confecção de drenos alterou menos os atributos químicos e físicos do solo do que a confecção de camalhões.

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Previous research has shown that different foods are stereotypically associated with gender and that eating in a role-congruent way fulfills an impression management function. On the other hand, other studies revealed that adapting one's food consumption to that of the co-eaters is a means to gain social approval as well. In the present study, we bridge these two distinct lines of research by studying what happens when the two norms (conforming to the gender-based stereotype and imitating the co-eater) conflict, that is with opposite-sex co-eaters. Results indicated that the tendency to match the co-eaters' supposed consumption generally appeared over and above one's gender-congruent choice. In addition, as expected, gender differences also emerged: while men were always willing to adapt to the co-eaters, women's intention to eat the feminine food was independent from the co-eaters' gender.

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Information processing in groups has long been seen as a cooperative process. In contrast with this assumption, group members were rarely found to behave cooperatively: They withhold unshared information and stick to initial incorrect decisions. In the present article, we examined how group members' cooperative and competitivemotives impact on group information processing and propose that information sharing and use in groups could be seen as strategic behavior. We reviewed the latest developments in the literature investigating different forms of strategic information processing and their underlying mechanisms. This review suggests that explicit cooperative goals are needed for effective group decision-making.

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The present study evaluates the performance of four methods for estimating regression coefficients used to make statistical decisions regarding intervention effectiveness in single-case designs. Ordinary least squares estimation is compared to two correction techniques dealing with general trend and one eliminating autocorrelation whenever it is present. Type I error rates and statistical power are studied for experimental conditions defined by the presence or absence of treatment effect (change in level or in slope), general trend, and serial dependence. The results show that empirical Type I error rates do not approximate the nominal ones in presence of autocorrelation or general trend when ordinary and generalized least squares are applied. The techniques controlling trend show lower false alarm rates, but prove to be insufficiently sensitive to existing treatment effects. Consequently, the use of the statistical significance of the regression coefficients for detecting treatment effects is not recommended for short data series.

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OBJECTIVE: We examined the influence of clinical, radiologic, and echocardiographic characteristics on antithrombotic choice in patients with cryptogenic stroke (CS) and patent foramen ovale (PFO), hypothesizing that features suggestive of paradoxical embolism might lead to greater use of anticoagulation. METHODS: The Risk of Paradoxical Embolism Study combined 12 databases to create the largest dataset of patients with CS and known PFO status. We used generalized linear mixed models with a random effect of component study to explore whether anticoagulation was preferentially selected based on the following: (1) younger age and absence of vascular risk factors, (2) "high-risk" echocardiographic features, and (3) neuroradiologic findings. RESULTS: A total of 1,132 patients with CS and PFO treated with anticoagulation or antiplatelets were included. Overall, 438 participants (39%) were treated with anticoagulation with a range (by database) of 22% to 54%. Treatment choice was not influenced by age or vascular risk factors. However, neuroradiologic findings (superficial or multiple infarcts) and high-risk echocardiographic features (large shunts, shunt at rest, and septal hypermobility) were predictors of anticoagulation use. CONCLUSION: Both antithrombotic regimens are widely used for secondary stroke prevention in patients with CS and PFO. Radiologic and echocardiographic features were strongly associated with treatment choice, whereas conventional vascular risk factors were not. Prior observational studies are likely to be biased by confounding by indication.

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BACKGROUND: Shared Decision Making (SDM) is increasingly advocated as a model for medical decision making. However, there is still low use of SDM in clinical practice. High impact factor journals might represent an efficient way for its dissemination. We aimed to identify and characterize publication trends of SDM in 15 high impact medical journals. METHODS: We selected the 15 general and internal medicine journals with the highest impact factor publishing original articles, letters and editorials. We retrieved publications from 1996 to 2011 through the full-text search function on each journal website and abstracted bibliometric data. We included publications of any type containing the phrase "shared decision making" or five other variants in their abstract or full text. These were referred to as SDM publications. A polynomial Poisson regression model with logarithmic link function was used to assess the evolution across the period of the number of SDM publications according to publication characteristics. RESULTS: We identified 1285 SDM publications out of 229,179 publications in 15 journals from 1996 to 2011. The absolute number of SDM publications by journal ranged from 2 to 273 over 16 years. SDM publications increased both in absolute and relative numbers per year, from 46 (0.32% relative to all publications from the 15 journals) in 1996 to 165 (1.17%) in 2011. This growth was exponential (P < 0.01). We found fewer research publications (465, 36.2% of all SDM publications) than non-research publications, which included non-systematic reviews, letters, and editorials. The increase of research publications across time was linear. Full-text search retrieved ten times more SDM publications than a similar PubMed search (1285 vs. 119 respectively). CONCLUSION: This review in full-text showed that SDM publications increased exponentially in major medical journals from 1996 to 2011. This growth might reflect an increased dissemination of the SDM concept to the medical community.

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Background. Le considérable déclin de la malaria au niveau mondial remet en question la stratégie de chimioprophylaxie pour les voyageurs à destination de pays à risque modéré à faible de malaria. Un consensus international de la meilleure stratégie de prévention reste à trouver. Suivant le mouvement actuel de partage décisionnel, cette étude invite le voyageur au sein du débat comme acteur du processus de décision. Objectifs. Investiguer les préférences des voyageurs à destination de pays à risque modéré à faible de malaria en matière de prévention contre la malaria, en mettant en perspective leur perception du risque et les raisons de leur choix. Méthodologie. Dans la salle d'attente du Centre de Vaccination et Médecine de Voyage, les voyageurs à destination de risque modéré à faible de malaria remplissent un questionnaire et choisissent la méthode de prévention qu'ils préfèrent aidés d'un tableau leur proposant 4 choix possible ; mesure de prévention des piqûres de moustique uniquement, chimioprophylaxie, traitement de réserve seul et traitement de réserve avec test diagnostic rapide. Ils reçoivent aussi une échelle de risque illustrant les risques de malaria et d'effets indésirables des anti-malariques comparés à différents autres risques liés au voyage, inspirée par les palettes de Paling de la Communication Risk Institut. Résultats. De décembre 2012 à décembre 2013, 391 voyageurs on été inclus. 59 (15%) ont choisi la chimioprophylaxie, 116 (30%) un traitement de réserve, 112 (29%) un traitement de réserve avec test rapide diagnostic, 100 (26%) une prévention des piqûre de moustiques uniquement, and 4 (1%) plusieurs alternatives. Les raisons de choisir une chimioprophylaxie étaient la sécurité (42%), l'action préventive (29%), l'efficacité (15%) et la facilité d'utilisation (15%). Les raisons de choisir un traitement de réserve étaient moins de prise de médicament (29%), moins d'effets secondaires de ceux-ci (23%) et le prix (9%). Les voyageurs choisissant la chimioprohylaxie l'avaient plus souvent déjà utilisée par le passé [OR=3.0 (CI 1.7-5.44)], sans différence en terme de profil démographique, caractéristique du voyage ou comportement à risque. Conclusions. Quand interrogés, 85% des voyageurs à destination de pays à risque modéré à faible de malaria préfèrent ne pas prendre la chimioprophylaxie, bien que la plupart des pays la recommande encore. Les raisons avancées sont cohérentes avec leur choix. Les nouvelles recommandations devraient prendre en compte la préférence des voyageurs et inclure un processus de décision partagé.

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Laboratory and field experiments have demonstrated in many cases that malaria vectors do not feed randomly, but show important preferences either for infected or non-infected hosts. These preferences are likely in part shaped by the costs imposed by the parasites on both their vertebrate and dipteran hosts. However, the effect of changes in vector behaviour on actual parasite transmission remains a debated issue. We used the natural associations between a malaria-like parasite Polychromophilus murinus, the bat fly Nycteribia kolenatii and a vertebrate host the Daubenton's bat Myotis daubentonii to test the vector's feeding preference based on the host's infection status using two different approaches: 1) controlled behavioural assays in the laboratory where bat flies could choose between a pair of hosts; 2) natural bat fly abundance data from wild-caught bats, serving as an approximation of realised feeding preference of the bat flies. Hosts with the fewest infectious stages of the parasite were most attractive to the bat flies that did switch in the behavioural assay. In line with the hypothesis of costs imposed by parasites on their vectors, bat flies carrying parasites had higher mortality. However, in wild populations, bat flies were found feeding more based on the bat's body condition, rather than its infection level. Though the absolute frequency of host switches performed by the bat flies during the assays was low, in the context of potential parasite transmission they were extremely high. The decreased survival of infected bat flies suggests that the preference for less infected hosts is an adaptive trait. Nonetheless, other ecological processes ultimately determine the vector's biting rate and thus transmission. Inherent vector preferences therefore play only a marginal role in parasite transmission in the field. The ecological processes rather than preferences per se need to be identified for successful epidemiological predictions.

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Background. Molecular tests for breast cancer (BC) risk assessment are reimbursed by health insurances in Switzerland since the beginning of year 2015. The main current role of these tests is to help oncologists to decide about the usefulness of adjuvant chemotherapy in patients with early stage endocrine-sensitive and human epidermal growth factor receptor 2 (HER2)-negative BC. These gene expression signatures aim at predicting the risk of recurrence in this subgroup. One of them (OncotypeDx/OT) also predicts distant metastases rate with or without the addition of cytotoxic chemotherapy to endocrine therapy. The clinical utility of these tests -in addition to existing so-called "clinico-pathological" prognostic and predictive criteria (e.g. stage, grade, biomarkers status)-is still debated. We report a single center one year experience of the use of one molecular test (OT) in clinical decision making. Methods. We extracted from the CHUV Breast Cancer Center data base the total number of BC cases with estrogen-receptor positive (ER+), HER2-negative early breast cancer (node negative (pN0) disease or micrometastases in up to 3 lymph nodes) operated between September 2014 and August 2015. For the cases from this group in which a molecular test had been decided by the tumor board, we collected the clinicopathologic parameters, the initial tumor board decision, and the final adjuvant systemic therapy decision. Results. A molecular test (OT) was done in 12.2% of patients with ER + HER2 negative early BC. The median age was 57.4 years and the median invasive tumor size was 1.7 cm. These patients were classified by ODX testing (Recurrence Score) into low-, intermediate-, and high risk groups, respectively in 27.2%, 63.6% and 9% of cases. Treatment recommendations changed in 18.2%, predominantly from chemotherapyendocrine therapy to endocrine treatment alone. Of 8 patients originally recommended chemotherapy, 25% were recommended endocrine treatment alone after receiving the Recurrence Score result. Conclusions. Though reimbursed by health insurances since January 2015, molecular tests are used moderately in our institution as per the decision of the multidisciplinary tumor board. It's mainly used to obtain a complementary confirmation supporting the decision of no chemotherapy. The OncotypeDx Recurrence Score results were in the intermediate group in 66% of the 9 tested cases but contributed to avoid chemotherapy in 2 patients during the last 12 months.

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This article assesses whether changes in government choice for policy concertation with trade unions and employers are better explained by international or domestic factors. We compare patterns of corporatist governance in a strongly Europeanized policy domain (labor migration policy) and in a weakly Europeanized policy domain (welfare state reforms) over the last 20 years in Austria and Switzerland. We show that there is no systematic difference in patterns of concertation between the two policy sectors and that factors linked to party politics play a bigger role in the choice of governments for concertation. If the base of party support for policies is divided, governments are more prone to resort to corporatist concertation as a way to build compromises for potentially controversial or unpopular policies. By contrast, ideologically cohesive majority coalitions are less prone to resort to concertation because they do not need to build compromises outside their base of party support.

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BACKGROUND: Evidence regarding the different treatment options of status epilepticus (SE) in adults is scarce. Large randomized trials cover only one treatment at early stage and suggest the superiority of benzodiazepines over placebo, of intravenous lorazepam over intravenous diazepam or over intravenous phenytoin alone, and of intramuscular midazolam over intravenous lorazepam. However, many patients will not be treated successfully with the first treatment step. A large randomized trial covering the treatment of established status (ESETT) has just been funded recently by the NIH and will not start before 2015, with expected results in 2018; a trial on the treatment of refractory status with general anesthetics was terminated early due to insufficient recruitment. Therefore, a prospective multicenter observational registry was set up; this may help in clinical decision-making until results from randomized trials are available. METHODS/DESIGN: SENSE is a prospective, multicenter registry for patients treated for SE. The primary objective is to document patient characteristics, treatment modalities and in-house outcome of consecutive adults admitted for SE treatment in each of the participating centres and to identify predictors of outcome. Pre-treatment, treatment-related and outcome variables are documented systematically. To allow for meaningful multivariate analysis in the patient subgroups with refractory SE, a cohort size of 1000 patients is targeted. DISCUSSION: The results of the study will provide information about risks and benefits of specific treatment steps in different patient groups with SE at different points of time. Thus, it will support clinical decision-making and, furthermore, it will be helpful in the planning of treatment trials. TRIAL REGISTRATION: DRKS00000725.