Deciding analytically or trusting your intuition? The advantadges and disadvantadges of analytic and intuitive thought

Recent research has highlighted the notion that people can make judgmentsand choices by means of two systems that are labeled here tacit(or intuitive) and deliberate (or analytic). Whereas most decisionstypically involve both systems, this chapter examines the conditions underwhich each system is liable to be more effective. This aims to illuminatethe age-old issue of whether and when people should trust intuition or analysis. To do this, a framework is presented to understand how thetacit and deliberate systems work in tandem. Distinctions are also madebetween the types of information typically used by both systems as wellas the characteristics of environments that facilitate or hinder accuratelearning by the tacit system. Next, several experiments that havecontrasted intuitive and analytic modes on the same tasks are reviewed.Together, the theoretical framework and experimental evidence leads tospecifying the trade-off that characterizes their relative effectiveness.Tacit system responses can be subject to biases. In making deliberate systemresponses, however, people might not be aware of the correct rule to dealwith the task they are facing and/or make errors in executing it. Whethertacit or deliberate responses are more valid in particular circumstancesrequires assessing this trade-off. In this, the probability of making errorsin deliberate thought is postulated to be a function of the analytical complexityof the task as perceived by the person. Thus the trade-off is one of bias (inimplicit responses) versus analytical complexity (when tasks are handled indeliberate mode). Finally, it is noted that whereas much attention has beenpaid in the past to helping people make decisions in deliberate mode, effortsshould also be directed toward improving ability to make decisions intacit mode since the effectiveness of decisions clearly depends on both. Thistherefore represents an important frontier for research.

Experimental support for the make-up hypothesis in nestling tawny owls (Strix aluco)

Body condition can affect coloration of traits used in sexual selection and parent-offspring communication by inducing rapid internal changes in pigment concentration or aggregation, thickness of collagen arrays, or blood flux. The recent "makeup hypothesis" proposes an alternative honesty-reinforcing mechanism, with behaviorally mediated deposition of substances on body surfaces ("cosmetics") generating covariation between body condition and coloration. In birds, the uropygial gland wax is actively spread on feathers using the bill and changes in its deposition rate may cause rapid changes in bill and plumage coloration. Using tawny owl nestlings, we tested 3 predictions of the makeup hypothesis, namely that 1) quantity of preen wax deposited accounts for variation in bill coloration, 2) an immune stimulation (induced by injection of a lipopolysaccharide [LPS]) impairs uropygial gland wax production, and 3) different intensities of immune stimulations (strong vs. weak stimulations induced by injections of either LPS or phytohemagglutinin [PHA], respectively) and high versus low food availabilities result in different bill colorations. We found that 1) preen wax reduced bill brightness, 2) a challenge with LPS impaired uropygial gland development, and 3) nestlings challenged with LPS had a brighter bill than PHA-injected nestlings, whereas diet manipulation had no significant effect. Altogether, these results suggest that a strong immune challenge may decrease preen wax deposition rate on the bill of nestling birds, at least by impairing gland wax production, which causes a change in bill coloration. Our study therefore highlights that cosmetic colors might signal short-term variation in immunological status.

For public service or money: Understanding geographical imbalances in the health workforce in Ethiopia

Geographical imbalances in the health workforce have been a consistent feature of nearly all health systems, and especially in developing countries. In this paper we investigate the willingness to work in a rural area among final year nursing and medical students in Ethiopia. Analyzing data obtained from contingent valuation questions, we find that household consumption and the student s motivation to help the poor, which is our proxy for intrinsic motivation, are the main determinants of willingness to work in a rural area. We investigate whoe is willing to help the poor and find that women are significantly more likely than men. Other variables, including a rich set of psychosocial characteristics, are not significant. Finally, we carry out some simulation on how much it would cost to make the entire cohort of starting nurses and doctors chooseto take up a rural post.

Greece and Platonic Love in E. M. Forster's Maurice, or the greatness and limits of Antiquity as a source of inspiration.

The aim of this article is to show how, although the evident idealization of Greece and Platonic love throughout the Victorian-Edwardian England, both also show their limits. In order to make it clear the author refers constantly to the implicit Greek texts such as Plato's Symposium and Phaedrus and perhaps even to Plutarch¿s Eroticus in search of a Classical Tradition which is highly significant in order to understand that England at the beginning of the twentieth century.

Prevalence of Acute Coronary Syndrome in Patients Suspected for Pulmonary Embolism or Acute Aortic Syndromes: Rational for "Double" and "Triple" Rule-Out Concepts

PURPOSE To evaluate the prevalence of acute coronary syndrome (ACS) in patients presenting initially with atypical chest pain and suspected to have pulmonary embolism (PE) or acute aortic syndromes (AAS). To evaluate the overlap between ACS, PE and AAS in routine practice and determine how many patients could have benefit from a single CT protocol to rule out ACS at the same time as PE and AAS. METHOD AND MATERIALS Our electronic hospital database revealed 1122 consecutive patients who underwent a thoracic CT angiography for PE or AAS from 2004 to 2006 (mean age, 63±13 years). Patients without chest pain were excluded from this study. Thus, 447 patients presented with isolated atypical chest were included in the analysis. All patients who underwent a thoracic CT scan previously received standard clinical care and were initially considered as non ACS. The final diagnosis was obtained by the hospital stay report. RESULTS Among the 447 patients with atypical chest pain, 25 (5.5%) were finally found to have ACS: 19 patients (4.2%) were suspected for PE and 6 (1. 3%) were suspected for AAS. There were 90 patients diagnosed to have PE, 89 (98.8%) of them were suspected for PE while only 1 (1%) was suspected for AAS. Eleven patients diagnosed to have AAS, 9 (82%) of them were suspected for AAS while 2 (18%) were suspected for PE. CONCLUSION In clinical practice, the overlap between PE, AAS and ACS is limited which make the triple rule-out studies less recommended to be done at the time being because of the high dose radiation. A double rule-out investigation is suggested to be done for patients being evaluated for atypical chest pain and suspected of having AAS or PE because of a significant overlap between the two entities as well it doesn't implicate any increment in radiation dose. CLINICAL RELEVANCE/APPLICATION With 64-slice CT, coronary circulation and total chest can be evaluated at the same time offering new opportunitie for the evaluation of three major life-threatening conditions :ACS,PE and AAS.

Alcohol may not cause partner violence but it seems to make it worse: a cross national comparison of the relationship between alcohol and severity of partner violence.

This study assesses whether severity of physical partner aggression is associated with alcohol consumption at the time of the incident, and whether the relationship between drinking and aggression severity is the same for men and women and across different countries. National or large regional general population surveys were conducted in 13 countries as part of the GENACIS collaboration. Respondents described the most physically aggressive act done to them by a partner in the past 2 years, rated the severity of aggression on a scale of 1 to 10, and reported whether either partner had been drinking when the incident occurred. Severity ratings were significantly higher for incidents in which one or both partners had been drinking compared to incidents in which neither partner had been drinking. The relationship did not differ significantly for men and women or by country. We conclude that alcohol consumption may serve to potentiate violence when it occurs, and this pattern holds across a diverse set of cultures. Further research is needed that focuses explicitly on the nature of alcohol's contribution to intimate partner aggression. Prevention needs to address the possibility of enhanced dangers of intimate partner violence when the partners have been drinking and eliminate any systemic factors that permit alcohol to be used as an excuse. Clinical services for perpetrators and victims of partner violence need to address the role of drinking practices, including the dynamics and process of aggressive incidents that occur when one or both partners have been drinking.

Alcohol may not "cause" partner violence but it seems to make it worse : a cross-national comparison of partner aggression involving alcohol with aggression not involving alcohol

This study assesses whether severity of physical partner aggression is associated with alcohol consumption at the time of the incident, and whether the relationship between drinking and aggression severity is the same for men and women and across different countries. National or large regional general population surveys were conducted in 13 countries as part of the GENACIS collaboration. Respondents described the most physically aggressive act done to them by a partner in the past 2 years, rated the severity of aggression on a scale of 1 to 10, and reported whether either partner had been drinking when the incident occurred. Severity ratings were significantly higher for incidents in which one or both partners had been drinking compared to incidents in which neither partner had been drinking. The relationship did not differ significantly for men and women or by country. We conclude that alcohol consumption may serve to potentiate violence when it occurs, and this pattern holds across a diverse set of cultures. Further research is needed that focuses explicitly on the nature of alcohol's contribution to intimate partner aggression. Prevention needs to address the possibility of enhanced dangers of intimate partner violence when the partners have been drinking and eliminate any systemic factors that permit alcohol to be used as an excuse. Clinical services for perpetrators and victims of partner violence need to address the role of drinking practices, including the dynamics and process of aggressive incidents that occur when one or both partners have been drinking.

Effect of religion on suicide attempts in outpatients with schizophrenia or schizo-affective disorders compared with inpatients with non-psychotic disorders

Little is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.

No interactions between previously associated 2-hour glucose gene variants and physical activity or BMI on 2-hour glucose levels.

Gene-lifestyle interactions have been suggested to contribute to the development of type 2 diabetes. Glucose levels 2 h after a standard 75-g glucose challenge are used to diagnose diabetes and are associated with both genetic and lifestyle factors. However, whether these factors interact to determine 2-h glucose levels is unknown. We meta-analyzed single nucleotide polymorphism (SNP) × BMI and SNP × physical activity (PA) interaction regression models for five SNPs previously associated with 2-h glucose levels from up to 22 studies comprising 54,884 individuals without diabetes. PA levels were dichotomized, with individuals below the first quintile classified as inactive (20%) and the remainder as active (80%). BMI was considered a continuous trait. Inactive individuals had higher 2-h glucose levels than active individuals (β = 0.22 mmol/L [95% CI 0.13-0.31], P = 1.63 × 10(-6)). All SNPs were associated with 2-h glucose (β = 0.06-0.12 mmol/allele, P ≤ 1.53 × 10(-7)), but no significant interactions were found with PA (P > 0.18) or BMI (P ≥ 0.04). In this large study of gene-lifestyle interaction, we observed no interactions between genetic and lifestyle factors, both of which were associated with 2-h glucose. It is perhaps unlikely that top loci from genome-wide association studies will exhibit strong subgroup-specific effects, and may not, therefore, make the best candidates for the study of interactions.

How do we make the (right) diagnosis of acute appendicitis?

Objectives: To evaluate the correct diagnosis in unselected patients presenting withsuspected acute appendicitis in the Emergency Department in Hospital Trueta. To evaluate the different scenarios to achieve the correct diagnosis in patients with suspected acute appendicitis estimated by clinical evaluation without imaging, US only, CT only or US in all patients followed by CT after a non-diagnostic US.Design: Cross-sectional study conducted between April 2014 and March 2015.Settings: Medium-sized teaching hospital in Girona.Participants: Consecutive adult patients, 14 years old or older, with clinically suspectedacute appendicitis evaluated at the emergency department.Main outcome: Correct diagnosis of acute appendicitis

Do Objective Measures of Blood Alcohol Concentrations Make More Sense than Self-reports in Emergency Department Studies?

Purpose: Concerns about self-reports have led to calls for objective measures of blood alcohol concentration (BAC). The present study compared objective measures with self-reports. Methods: BAC from breath or blood samples were obtained from 272 randomly sampled injured patients who were admitted to a Swiss emergency department (ED). Self-reports were compared a) between those providing and refusing a BAC test, and b) to estimated peak BAC (EPBAC) values based on BACs using the Widmark formula. Results: Those providing BACs were significantly (P < 0.05) younger, more often male, and less often reported alcohol consumption before injury, but consumed higher quantities when drinking. Eighty-eight percent of those with BAC measures gave consistent reports (positive or negative). Significantly more patients reported consumption with negative BAC measures (N = 29) than vice versa (N = 3). Duration of consumption and times between injury and BAC measurement predicted EPBAC better than did the objective BAC measure. Conclusions: There is little evidence that patients who provide objective BAC measures deliberately conceal consumption. ED studies must rely on self-reports, eg, take the time period between injury and ED admission into account. Clearly, objective measures are of clinical relevance, eg, to provide optimal treatment in the ED. However, they may be less relevant to establishing effects in an epidemiologic sense, such as estimating risk relationships. In this respect, efforts to increase the validity and reliability of self-reports should be preferred over the collection of additional objective measures.

A systematic review of existing data on long-term lithium therapy: neuroprotective or neurotoxic?

Lithium is an efficacious agent for the treatment of bipolar disorder, but it is unclear to what extent its long-term use may result in neuroprotective or toxic consequences. Medline was searched with the combination of the word 'Lithium' plus key words that referred to every possible effect on the central nervous system. The papers were further classified into those supporting a neuroprotective effect, those in favour of a neurotoxic effect and those that were neutral. The papers were classified into research in humans, animal and in-vitro research, case reports, and review/opinion articles. Finally, the Natural Standard evidence-based validated grading rationale was used to validate the data. The Medline search returned 970 papers up to February 2006. Inspection of the abstracts supplied 214 papers for further reviewing. Eighty-nine papers supported the neuroprotective effect (6 human research, 58 animal/in vitro, 0 case reports, 25 review/opinion articles). A total of 116 papers supported the neurotoxic effect (17 human research, 23 animal/in vitro, 60 case reports, 16 review/opinion articles). Nine papers supported no hypothesis (5 human research, 3 animal/in vitro, 0 case reports, 1 review/opinion articles). Overall, the grading suggests that the data concerning the effect of lithium therapy is that of level C, that is 'unclear or conflicting scientific evidence' since there is conflicting evidence from uncontrolled non-randomized studies accompanied by conflicting evidence from animal and basic science studies. Although more papers are in favour of the toxic effect, the great difference in the type of papers that support either hypothesis, along with publication bias and methodological issues make conclusions difficult. Lithium remains the 'gold standard' for the prophylaxis of bipolar illness, however, our review suggests that there is a rare possibility of a neurotoxic effect in real-life clinical practice even in closely monitored patients with 'therapeutic' lithium plasma levels. It is desirable to keep lithium blood levels as low as feasible with prophylaxis.

Oppimistehtaan toimintamallin kehittäminen

Educaworks Oy on toiminut viisi vuotta oppimistehtaana, jonka omistajia ovat olleet yritykset ja oppilaitokset. Yrityksen pääasiallisia työntekijöitä ovat tähän mennessä olleet ammattiopiston työssäoppijat ja parina viimeisenä vuotena on yrityksellä ollut palkkalistoillaan omia työntekijöitä. Tässä työssä luotiin vaihtoehtoja Educaworks Oy:n tulevalle toiminnalle lähtien siitä, että tämä nykyinen toimintamalli on tullut tiensä päähän ja tarvitaan uusi malli toiminnan jatkamiselle.Työssä haettiin hyviä käytäntöjä Suomesta benchmarkingin avulla. Näiden mallienvahvuuksia hyödyntämällä pystyttiin kehittämään vaihtoehto Educaworks Oy:n tulevalle toiminnalle. Tämä malli, oppimistehdas osana osaamiskeskittymää, valittiin toteutettavaksi kolmesta eri vaihtoehdosta, joista kaksi muuta olivat oppimistehdas yrityksenä ja oppimistehdas osana koulutusorganisaatiota. Valitussa vaihtoehdossa hyödynnetään Savonia-ammattikorkeakoulun suunnitteilla olevaa EducaTech Center-hanketta, jossa on tarkoitus luoda Iisalmeen teknologiateollisuuden osaamiskeskittymä seuraavan EU-kauden 2007-2013 aikana. Valitussa mallissa Educaworks Oy hyödyntää tulevassa toiminnassaan tämän osaamiskeskittymän uutta kone- ja laitekantaa sekä tekee yhteistyötä keskittymän tutkimus- ja tuotekehityshenkilökunnan kanssa. Yritykset pääsevät parhaiten osallisiksi Educa Tech Center osaamiskeskittymän tuottamista palveluista hankkimalla Educaworks Oy:n osakkeita ja pääsemällä täten keskittymän ytimeen sen tuotannollisen toimijan, Educaworks Oy:n, avulla. Educaworks Oy toimii tässä keskittymässä komponenttitoimittajan roolissa ollen malli komponenttitoimittajasta muillealueella oleville vastaaville verkostoissa toimiville yrityksille. Educaworks Oy:n toiminnan toisena periaatteena tulee olemaan työssäoppiminen. Työssäoppiminen on tänä päivänä osa ammatillista koulutusta ja sen merkityskorostuu yhä enemmän, koska oppilaat tulevat opiskelemaan tänä päivänä monesti lähtökohdista, joissa heillä ei ole ollut mahdollisuutta harjoittaa käytännön taitojaan ennen ammatillisten opiskelujen aloittamista. Työpaikoilla ei ole vielä kovin hyvää valmiutta toteuttaa sitä opetushallituksen tavoitetta, että oppilaatoppisivat työssäoppimisjaksoilla uusia asioita ohjatusti. Työpaikoilta puuttuu työssäoppimisen ohjaajat ja oppilaiden tekemät harjoitteet ovat liian monta kertaa ammatillisesti kovin vaatimattomia jäysteenpoisto- tai kappaleenvaihtotöitä koneistuksesta puhuttaessa. Tässä työssä luodaan mallia oppilaiden ohjatulle työssäoppimiselle tehtyjen tieteellisten tutkimusten pohjalta. Tavoitteena on, että Educaworks Oy:ssä pystyttäisiin jatkossa kouluttamaan myös muiden alueen teknologiateollisuuden yritysten työntekijöitä toimimaan työssäoppimisen ohjaajina.

Toimintolaskennan hyödyntäminen Kelan johtamisessa ja toiminnan ohjauksessa

Pro gradu-tutkielman päätavoite on mallintaa toimintolaskennan ja sen tulosten hyödyntämisen mahdollisuuksia Kelan johtamisessa. Tutkielma on empiirinen työ ja sen tutkimusmenetelmänä on case-tutkimus. Tutkielman doktriini koostui eritoten julkishallinnon toimintolaskentaa jatoimintojohtamista koskevasta kirjallisuudesta. Tutkielman empiirinen aineisto kerättiin haastatteluin, dokumentteja tutkimalla sekä havainnoimalla työskentelyä Kelan päätoimitalossa Helsingissä. Tutkielman perusteella Kelalla on laajat mahdollisuudet hyödyntää toimintolaskentaa johtamisessa. Hyödyntämisen mahdollisuudet voidaan ryhmitellä sisäisen laskennan tehtävien mukaisesti. Tehtävät ovat raportointi ulkoisille sidosryhmille ja tiedon tuottaminen strategiseen ja operatiiviseen johtamiseen. Ulkoisiin sidosryhmiin liittyviä mahdollisuuksia ovat tulosten raportointi, rahoituksen uudistaminen, lainmuutoskustannusten arviointi sekä muilta organisaatioilta ja asiakkailta veloitettavien palveluiden hinnoittelu ja hintojen perusteleminen. Strategiseen ohjaukseen liittyviä mahdollisuuksia ovat tulosohjauksen kehittäminen, investointilaskelmat sekä ulkoistamispäätökset. Operatiiviseen ohjaukseen liittyviä mahdollisuuksia ovat puolestaan prosessien analysointi ja kehittäminen, benchmarking, sisäinen hinnoittelu ja tulosten viestiminen henkilöstölle. Sekä strategiseen että operatiiviseen ohjaukseen liittyviä hyödyntämisen mahdollisuuksia ovat resurssien käytönseuranta ja tehostaminen, työn tasauksen kehittäminen sekä suorituksen mittaaminen.

Est-ce qu'en discuter fait la différence ? Opinions de jeunes adultes atteints de maladies chroniques après avoir été transférés vers des soins pour adultes [Does talking about it make a difference? Opinions of chronically ill young adults after being transferred to adult care].

1) Introduction: pour les jeunes souffrant de maladie chronique, l'objectif de la transition vers les soins pour adultes est d'optimiser leur fonctionnement et leur potentiel. Le but de cette étude pilote était d'évaluer si les jeunes adultes souffrant de maladie chronique jugeaient que le passage vers les soins adultes était plus facile lorsque la question de la transition avait été discutée au préalable avec leur pédiatre. 2) Matériel et méthodes: deux groupes de jeunes adultes atteints de maladie chronique ont été identifiés selon l'existence (n = 70) ou non (n = 22) d'une discussion préalable avec leur pédiatre à propos de la transition vers une prise en charge pour adultes. Ces deux groupes ont été comparés pour des variables démographiques et de santé. Les variables significatives en analyse bivariée ont été incluses dans une régression logistique descendante pas à pas. 3) Résultats: les jeunes adultes qui avaient discuté de la transition étaient significativement plus nombreux à se sentir prêts (72,9 % vs 45,5 %) et accompagnés (58,6 % vs 27,3 %) pour le transfert, à avoir consulté leur spécialiste pour adultes (60 % vs 31,8 %) et à voir leur médecin sans la présence de leurs parents (70 % vs 40,9 %). En analyse multivariée, seuls, le fait de se sentir accompagné (odds ratio ajustée [ORa] : 3,56) et celui d'avoir consulté leur spécialiste pour adultes (ORa : 4,14) étaient significatifs. 4) Conclusions: la préparation des jeunes souffrant de maladie chronique au transfert vers les soins pour adultes semble bénéfique. Cependant, le transfert lui-même n'est qu'une petite partie du concept beaucoup plus large de la transition vers la vie adulte. Une transition bien planifiée doit permettre à ces jeunes adultes d'atteindre tout leur potentiel. INTRODUCTION: The goal of transition in healthcare for young people with chronic illnesses is to maximize their functioning and potential. The purpose of this pilot study was to assess whether young adults with chronic illnesses found that the transition to adult care was easier when the transition was discussed in advance with their pediatric specialist. METHODS: Two groups were created according to whether patients had discussed (n=70) or not (n=22) the transition with their pediatric specialist and compared regarding demographic and health-related variables. All the significant variables at the bivariate level were included in a backward stepwise logistic regression. RESULTS: Youth who had discussed the transition were significantly more likely to feel ready for the transfer (72.9% vs 45.5%) and accompanied (58.6% vs 27. %) during transfer, to have consulted their specialist for adults (60.0% vs 31.8%), and seen their doctor without the presence of their parents (70.0% vs 40.9%). At the multivariate level, only feeling accompanied during transfer (adjusted odds ratio (aOR): 3.56) and having consulted their specialist for adults (aOR: 4.14) remained significant. CONCLUSIONS: Preparing chronically ill youths for transfer to adult care appears to be beneficial for them. However, transfer is only a small part of the much broader transition that is preparation for adult life. A well-planned transition should allow these young people to reach their full potential.