Predicting dentists decisions: a choice-based conjoint analysis of Medicaid participation

Objectives: Private practice dentists are the major source of care for the dental safety net; however, the proportion of dentists who participate in state Medicaid programs is low, often due to poor perceptions of the program’s administration and patient population. Using a discrete choice experiment and a series of hypothetical scenarios, this study evaluated trade-offs dentists make when deciding to accept Medicaid patients. Methods: An online choice-based conjoint survey was sent to 272 general dentists in Iowa. Hypothetical scenarios presented factors at systematically varied levels. The primary determination was whether dentists would accept a new Medicaid patient in each scenario. Using an ecological model of behavior, determining factors were selected from the categories of policy, administration, community, and patient population to estimate dentists’ relative preferences. Results: 62 percent of general dentists responded to the survey. The probability of accepting a new Medicaid patient was highest (81 percent) when reimbursement rates were 85 percent of the dentist’s fees, patients never missed appointments, claims were approved on first submission, and no other practices in the area accepted Medicaid. Although dentists preferred higher reimbursement rates, 56 percent would still accept a new Medicaid patient when reimbursement decreased to 55 percent if they were told that the patient would never miss appointments and claims would be approved on initial submission. Conclusions: This study revealed trade-offs that dentists make when deciding to participate in Medicaid. Findings indicate that states can potentially improve Medicaid participation without changing reimbursement rates by making improvements in claims processing and care coordination to reduce missed appointments.Funding for this project came from an Innovation Fund for Oral Health award from the DentaQuest Foundation (Boston, MA)

The willingness of US pediatric dentists to use Atraumatic restorative treatment (ART) with their patients: a conjoint analysis

Objectives: The atraumatic restorative treatment (ART) was developed as an affordable, patient-friendly dental caries management procedure that does not need extensive operator training or special skills. The aim of this study was to determine factors that influence the decision to use ART using an innovative marketing research technique known as conjoint analysis. Methods: A conjoint survey was completed by 723 members of the American Academy of PediatricDentistry.Three factors (age of the child, level of cooperation, type of insurance) were varied across three levels to create nine patient scenarios. The weights that practitioners placed on these factors in decisions to use ART in treating carious lesions were determined by conjoint analysis. Factors such as lesion location, depth, and extension were fixed in the nine clinical scenarios. Results: Seven-hundred twenty-three pediatric dentists completed the survey (32 percent). Age of the child was the most important factor in pediatric dentists’ decisions to use ART (46 percent) compared with level of cooperation (41 percent) and type of insurance coverage (11 percent). For the age factor, the age of 2 years had the greatest utility (0.55) compared with age 4 (−0.09) and age 6 (−0.46). For types of insurance coverage, having no insurance (0.124) had the greatest utility compared with having public insurance (−0.119). Conclusions: Although insurance coverage was the least important among the factors, being without insurance, being very young, and being uncooperative was the scenario where pediatric dentists most favored ART when making trade offs between different factors using the conjoint design.This project was funded by NIH/NIDC R T32 grant DEO 14678-06

The combined role of task, child’s age and individual differences in understanding decision processes

It is important to understand the impact of individual differences in decision making from childhood to adulthood. This cohort-based study extends our knowledge by comparing decision making of children across the age range of 8 to 17 years and their parents. Based on prior research and theory focusing on different types of framing effects, we uncover several key differences across ages, including levels of risk taking and sensitivity to expected value differences between risky and riskless choices. Furthermore, we find that measures such as Numeracy and Surgency help explain both age-related and individual differences on our tasks, especially for decisions involving risk. We discuss the role of diverse task measures in understanding how individual difference factors affect different aspects of decision making, including the ability and effort to process numerical information and the ability to suppress affective reactions to stimulus labels

Involvement of the V2 Vasopressin Receptor in Adaptation to Limited Water Supply

Mammals adapted to a great variety of habitats with different accessibility to water. In addition to changes in kidney morphology, e.g. the length of the loops of Henle, several hormone systems are involved in adaptation to limited water supply, among them the renal-neurohypophysial vasopressin/vasopressin receptor system. Comparison of over 80 mammalian V2 vasopressin receptor (V2R) orthologs revealed high structural and functional conservation of this key component involved in renal water reabsorption. Although many mammalian species have unlimited access to water there is no evidence for complete loss of V2R function indicating an essential role of V2R activity for survival even of those species. In contrast, several marsupial V2R orthologs show a significant increase in basal receptor activity. An increased vasopressin-independent V2R activity can be interpreted as a shift in the set point of the renal-neurohypophysial hormone circuit to realize sufficient water reabsorption already at low hormone levels. As found in other desert mammals arid-adapted marsupials show high urine osmolalities. The gain of basal V2R function in several marsupials may contribute to the increased urine concentration abilities and, therefore, provide an advantage to maintain water and electrolyte homeostasis under limited water supply conditions

Standards and Practices for Forecasting

One hundred and thirty-nine principles are used to summarize knowledge about forecasting. They cover formulating a problem, obtaining information about it, selecting and applying methods, evaluating methods, and using forecasts. Each principle is described along with its purpose, the conditions under which it is relevant, and the strength and sources of evidence. A checklist of principles is provided to assist in auditing the forecasting process. An audit can help one to find ways to improve the forecasting process and to avoid legal liability for poor forecasting

Lifestyle impact and the biology of the human scrotum

The possession of a scrotum to contain the male gonads is a characteristic feature of almost all mammals, and appears to have evolved to allow the testes and epididymis to be exposed to a temperature a few degrees below that of core body temperature. Analysis of cryptorchid patients, and those with varicocele suggest that mild scrotal warming can be detrimental to sperm production, partly by effects on the stem cell population, and partly by effects on later stages of spermatogenesis and sperm maturation. Recent studies on the effects of clothing and lifestyle emphasize that these can also lead to chronically elevated scrotal temperatures. In particular, the wearing of nappies by infants is a cause for concern in this regard. Together all of the evidence indirectly supports the view that lifestyle factors in addition to other genetic and environmental influences could be contributing to the secular trend in declining male reproductive parameters. The challenge will be to provide relevant and targeted experimental results to support or refute the currently circumstantial evidence.Richard Ivel

A comparison of lecture and interactive training designed to reduce the influence of interfering materials : an application to soil science

Digitized by Kansas Correctional Industrie

All Frames Are Not Created Equal: A Typology of Framing Effects

Accentuate the positive or accentuate the negative? The literature has been mixed as to how the alternative framing of information in positive or negative terms affects judgments and decisions. We argue that this is because different studies have employed different operational definitions of framing and thus have tapped different underlying processes. We develop a typology to distinguish between three different kinds of valence framing effects. First we discuss the standard risky choice framing effect introduced by Tversky and Kahneman (1981) to illustrate how valence affects willingness to take a risk. Then we discuss attribute framing, which affects the evaluation of object or event characteristics, and goal framing, which affects the persuasiveness of a communication. We describe the distinctions, provide a number of examples of each type, and discuss likely theoretical mechanisms underlying each type of framing effect. Our typology helps explain and resolve apparent confusions in the literature, ties together studies with common underlying mechanisms, and serves as a guide to future research and theory development. We conclude that a broader perspective, focused on the cognitive and motivational consequences of valence-based encoding, opens the door to a deeper understanding of the causes and consequences of framing effects

A tale of two pizzas: Building up from a basic product versus scaling down from a fully-loaded product

Consumers in the U. S. and Italy were asked to either build up from a consumable base product (pizza) by adding components or scale down from a fully-loaded product by subtracting components. In each country consumers ended up with significantly more ingredients, and a pizza for a higher cost, in the Scale Down Condition than in the Build Up Condition. Results are discussed in terms of the principle of "loss aversion" underlying phenomena such as "the endowment effect," marketing implications of this effect, and future research needs