Professional decision-making in medicine: Development of a new measure and preliminary evidence of validity

INTRODUCTION: This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment. METHODS: Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs. RESULTS: Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions. CONCLUSIONS: These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies

Enabling hotspot detection and public health response to the COVID-19 pandemic

INTRODUCTION: Public-facing maps of COVID-19 cases, hospital admissions, and deaths are commonly displayed at the state, county, and zip code levels, and low case counts are suppressed to protect confidentiality. Public health authorities are tasked with case identification, contact tracing, and canvasing for educational purposes during a pandemic. Given limited resources, authorities would benefit from the ability to tailor their efforts to a particular neighborhood or congregate living facility. METHODS: We describe the methods of building a real-time visualization of patients with COVID-19-positive tests, which facilitates timely public health response to the pandemic. We developed an interactive street-level visualization that shows new cases developing over time and resolving after 14 days of infection. Our source data included patient demographics (ie, age, race and ethnicity, and sex), street address of residence, respiratory test results, and date of test. RESULTS: We used colored dots to represent infections. The resulting animation shows where new cases developed in the region and how patterns changed over the course of the pandemic. Users can enlarge specific areas of the map and see street-level detail on residential location of each case and can select from demographic overlays and contour mapping options to see high-level patterns and associations with demographics and chronic disease prevalence as they emerge. CONCLUSIONS: Before the development of this tool, local public health departments in our region did not have a means to map cases of disease to the street level and gain real-time insights into the underlying population where hotspots had developed. For privacy reasons, this tool is password-protected and not available to the public. We expect this tool to prove useful to public health departments as they navigate not only COVID-19 pandemic outcomes but also other public health threats, including chronic diseases and communicable disease outbreaks

Criticism and outstanding leadership : an evaluation of leader reactions and critical outcomes

Outstanding political leaders are frequently called upon to make high-stakes decisions. Because of the controversial and highly visible nature of these issues, they often face intense criticism. Leaders' responses to criticisms not only affect follower reactions, but also the successful resolution of the contested issue. The present study examines leader and follower reactions to different types of criticisms. A historiometric approach was used to examine biographies containing criticisms of 120 world leaders and to explore leader behaviors in response to criticisms. Specifically, leader response strategies and their success in terms of follower reactions and resolution of the criticism were examined. The results indicated that collaborative or confrontational leader response strategies proved most effective in terms of the leader's ability to continue forward with a particular agenda item and to gather support of those around him or her. Conversely, avoidant, diverting attention, and persuasive response strategies proved less effective

Exploring perceptions of healthcare technologies enabled by artificial intelligence: An online, scenario-based survey

BACKGROUND: Healthcare is expected to increasingly integrate technologies enabled by artificial intelligence (AI) into patient care. Understanding perceptions of these tools is essential to successful development and adoption. This exploratory study gauged participants\u27 level of openness, concern, and perceived benefit associated with AI-driven healthcare technologies. We also explored socio-demographic, health-related, and psychosocial correlates of these perceptions. METHODS: We developed a measure depicting six AI-driven technologies that either diagnose, predict, or suggest treatment. We administered the measure via an online survey to adults (N = 936) in the United States using MTurk, a crowdsourcing platform. Participants indicated their level of openness to using the AI technology in the healthcare scenario. Items reflecting potential concerns and benefits associated with each technology accompanied the scenarios. Participants rated the extent that the statements of concerns and benefits influenced their perception of favorability toward the technology. Participants completed measures of socio-demographics, health variables, and psychosocial variables such as trust in the healthcare system and trust in technology. Exploratory and confirmatory factor analyses of the concern and benefit items identified two factors representing overall level of concern and perceived benefit. Descriptive analyses examined levels of openness, concern, and perceived benefit. Correlational analyses explored associations of socio-demographic, health, and psychosocial variables with openness, concern, and benefit scores while multivariable regression models examined these relationships concurrently. RESULTS: Participants were moderately open to AI-driven healthcare technologies (M = 3.1/5.0 ± 0.9), but there was variation depending on the type of application, and the statements of concerns and benefits swayed views. Trust in the healthcare system and trust in technology were the strongest, most consistent correlates of openness, concern, and perceived benefit. Most other socio-demographic, health-related, and psychosocial variables were less strongly, or not, associated, but multivariable models indicated some personality characteristics (e.g., conscientiousness and agreeableness) and socio-demographics (e.g., full-time employment, age, sex, and race) were modestly related to perceptions. CONCLUSIONS: Participants\u27 openness appears tenuous, suggesting early promotion strategies and experiences with novel AI technologies may strongly influence views, especially if implementation of AI technologies increases or undermines trust. The exploratory nature of these findings warrants additional research

Professional Decision-Making in Research (PDR): The validity of a new measure

In this paper, we report on the development and validity of the Professional Decision-Making in Research (PDR) measure, a vignette-based test that examines decision-making strategies used by investigators when confronted with challenging situations in the context of empirical research. The PDR was administered online with a battery of validity measures to a group of NIH-funded researchers and research trainees who were diverse in terms of age, years of experience, types of research, and race. The PDR demonstrated adequate reliability (alpha = .84) and parallel form correlation (r = .70). As hypothesized, the PDR was significantly negatively correlated with narcissism, cynicism, moral disengagement, and compliance disengagement; it was not correlated with socially desirable responding. In regression analysis, the strongest predictors of higher PDR scores were low compliance disengagement, speaking English as a native language, conducting clinical research with human subjects, and low levels of narcissism. Given that the PDR was written at an eighth grade reading level to be suitable for use with English as a second language participants and that only one-fourth of items focused on clinical research, further research into the possible roles of culture and research ethics training across specialties is warranted. This initial validity study demonstrates the potential usefulness of the PDR as an educational outcome assessment measure and a research instrument for studies on professionalism and integrity in research

Consequences identification in forecasting and ethical decision-making

Forecasting involves predicting outcomes based on observations of the situation at hand. We examined the impact of the number and types of consequences considered on the quality of ethical decision-making. Undergraduates role played several ethical problems in which they forecast potential outcomes and made decisions. Performance pressure (difficult demands placed on the situation) and interpersonal conflict (clashes among people in the problem situation) were manipulated within each problem scenario. The results indicated that the identification of potential consequences was positively associated with both higher quality forecasts and more ethical decisions. Neither performance pressure nor interpersonal conflict affected the quality of forecasts or decisions. Theoretical and practical implications of these findings and the use of this research approach are discussed

Social presence and dishonesty in retail

Self-service checkouts (SCOs) in retail can benefit consumers and retailers, providing control and autonomy to shoppers independent from staff, together with reduced queuing times. Recent research indicates that the absence of staff may provide the opportunity for consumers to behave dishonestly, consistent with a perceived lack of social presence. This study examined whether a social presence in the form of various instantiations of embodied, visual, humanlike SCO interface agents had an effect on opportunistic behaviour. Using a simulated SCO scenario, participants experienced various dilemmas in which they could financially benefit themselves undeservedly. We hypothesised that a humanlike social presence integrated within the checkout screen would receive more attention and result in fewer instances of dishonesty compared to a less humanlike agent. This was partially supported by the results. The findings contribute to the theoretical framework in social presence research. We concluded that companies adopting self-service technology may consider the implementation of social presence in technology applications to support ethical consumer behaviour, but that more research is required to explore the mixed findings in the current study.<br/

Parallel computation of 3-D soil-structure interaction in time domain with a coupled FEM/SBFEM approach

The final publication is available at Springer via http://dx.doi.org/10.1007/s10915-011-9551-xThis paper introduces a parallel algorithm for the scaled boundary finite element method (SBFEM). The application code is designed to run on clusters of computers, and it enables the analysis of large-scale soil-structure-interaction problems, where an unbounded domain has to fulfill the radiation condition for wave propagation to infinity. The main focus of the paper is on the mathematical description and numerical implementation of the SBFEM. In particular, we describe in detail the algorithm to compute the acceleration unit impulse response matrices used in the SBFEM as well as the solvers for the Riccati and Lyapunov equations. Finally, two test cases validate the new code, illustrating the numerical accuracy of the results and the parallel performances. © Springer Science+Business Media, LLC 2011.Jose E. Roman and Enrique S. Quintana-Orti were partially supported by the Spanish Ministerio de Ciencia e Innovacion under grants TIN2009-07519, and TIN2008-06570-C04-01, respectively.Schauer, M.; Román Moltó, JE.; Quintana Orti, ES.; Langer, S. (2012). Parallel computation of 3-D soil-structure interaction in time domain with a coupled FEM/SBFEM approach. Journal of Scientific Computing. 52(2):446-467. doi:10.1007/s10915-011-9551-xS446467522Anderson, E., Bai, Z., Bischof, C., Demmel, J., Dongarra, J., Croz, J.D., Greenbaum, A., Hammarling, S., McKenney, A., Sorensen, D.: LAPACK User’s Guide. Society for Industrial and Applied Mathematics, Philadelphia (1992)Antes, H., Spyrakos, C.: Soil-structure interaction. In: Beskos, D., Anagnotopoulos, S. (eds.) Computer Analysis and Design of Earthquake Resistant Structures, p. 271. Computational Mechanics Publications, Southampton (1997)Appelö, D., Colonius, T.: A high-order super-grid-scale absorbing layer and its application to linear hyperbolic systems. J. Comput. Phys. 228(11), 4200–4217 (2009)Astley, R.J.: Infinite elements for wave problems: a review of current formulations and a assessment of accuracy. Int. J. Numer. Methods Eng. 49(7), 951–976 (2000)Balay, S., Buschelman, K., Eijkhout, V., Gropp, W.D., Kaushik, D., Knepley, M., McInnes, L.C., Smith, B.F., Zhang, H.: PETSc users manual. Tech. Rep. ANL-95/11 - Revision 3.1, Argonne National Laboratory (2010)Benner, P.: Contributions to the numerical solution of algebraic Riccati equations and related eigenvalue problems. Dissertation, Fak. f. Mathematik, TU Chemnitz–Zwickau, Chemnitz, FRG (1997)Benner, P.: Numerical solution of special algebraic Riccati equations via an exact line search method. In: Proc. European Control Conf. ECC 97, Paper 786, BELWARE Information Technology, Waterloo (B) (1997)Benner, P., Quintana-Ortí, E.: Solving stable generalized Lyapunov equations with the matrix sign function. Numer. Algorithms 20(1), 75–100 (1999)Benner, P., Byers, R., Quintana-Ortí, E., Quintana-Ortí, G.: Solving algebraic Riccati equations on parallel computers using Newton’s method with exact line search. Parallel Comput. 26(10), 1345–1368 (2000)Benner, P., Quintana-Ortí, E.S., Quintana-Ortí, G.: Solving linear-quadratic optimal control problems on parallel computers. Optim. Methods Softw. 23(6), 879–909 (2008)Bettess, P.: Infinite Elements. Penshaw Press, Sunderland (1992)Blackford, L.S., Choi, J., Cleary, A., D’Azevedo, E., Demmel, J., Dhillon, I., Dongarra, J., Hammarling, S., Henry, G., Petitet, A., Stanley, K., Walker, D., Whaley, R.C.: ScaLAPACK Users’ Guide. Society for Industrial and Applied Mathematics, Philadelphia (1997)Borsutzky, R.: Braunschweiger Schriften zur Mechanik - Seismic Risk Analysis of Buried Lifelines, vol. 63. Mechanik-Zentrum Technische Universität. Braunschweig (2008)Dongarra, J.J., Whaley, R.C.: LAPACK working note 94: A user’s guide to the BLACS v1.1. Tech. Rep. UT-CS-95-281, Department of Computer Science, University of Tennessee (1995)Engquist, B., Majda, A.: Absorbing boundary conditions for the numerical simulation of waves. Math. Comput. 31(139), 629–651 (1977)Granat, R., Kågström, B.: Algorithm 904: The SCASY library – parallel solvers for Sylvester-type matrix equations with applications in condition estimation, part II. ACM Trans. Math. Softw. 37(3), 33:1–33:4 (2010)Guerrero, D., Hernández, V., Román, J.E.: Parallel SLICOT model reduction routines: The Cholesky factor of Grammians. In: Proceedings of the 15th Triennal IFAC World Congress, Barcelona, Spain (2002)Harr, M.E.: Foundations of Theoretical Soil Mechanics. McGraw-Hill, New York (1966)Hilbert, H., Hughes, T., Taylor, R.: Improved numerical dissipation for time integration algorithms in structural dynamics. Earthquake Eng. Struct. Dyn. 5, 283 (1977)Kleinman, D.: On an iterative technique for Riccati equation computations. IEEE Trans. Autom. Control AC-13, 114–115 (1968)Lehmann, L.: Wave Propagation in Infinite Domains. Springer, Berlin (2006)Lehmann, L., Langer, S., Clasen, D.: Scaled boundary finite element method for acoustics. J. Comput. Acoust. 14(4), 489–506 (2006)Liao, Z.P., Wong, H.L.: A transmitting boundary for the numerical simulation of elastic wave propagation. Soil Dyn. Earthq. Eng. 3(4), 174–183 (1984)Lysmer, J., Kuhlmeyer, R.L.: Finite dynamic model for infinite media. J. Eng. Mech. 95, 859–875 (1969)Meskouris, K., Hinzen, K.G., Butenweg, C., Mistler, M.: Bauwerke und Erdbeben - Grundlagen - Anwendung - Beispiele. Vieweg Teubner, Wiesbaden (2007)MPI Forum: The message passing interface (MPI) standard (1994). http://www.mcs.anl.gov/mpiNewmark, N.: A method of computation for structural dynamics. J. Eng. Mech. Div. 85, 67 (1959)Petersen, C.: Dynamik der Baukonstruktionen. Vieweg/Sohn Verlagsgesellschaft, Braunschweig (2000)Roberts, J.: Linear model reduction and solution of the algebraic Riccati equation by use of the sign function. Int. J. Control 32, 677–687 (1980)Schauer, M., Lehmann, L.: Large scale simulation with scaled boundary finite element method. Proc. Appl. Math. Mech. 9, 103–106 (2009)Wolf, J.: The Scaled Boundary Finite Element Method. Wiley, Chichester (2003)Wolf, J., Song, C.: Finite-Element Modelling of Unbounded Media. Wiley, Chichester (1996

Estudo interlaboratorial em digestão anaeróbia Relato de atividades e desempenho dos laboratórios em 2016-2017.

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