Silicone breast implants and magnetic resonance imaging screening for rupture: do U.S. Food and Drug Administration recommendations reflect an evidence-based practice approach to patient care?

Regular magnetic resonance imaging has been recommended for the purpose of screening for silicone implant rupture. However, when its use as a screening test is critically examined, it appears that evidence to support its use is lacking. For example, there is no conclusive evidence at this time to show that using magnetic resonance imaging screening of asymptomatic women leads to a reduction in patient morbidity. Furthermore, based on existing data, it is unclear whether the potential benefits of screening magnetic resonance imaging tests outweigh the risks and potential costs for the patient. In the face of this uncertainty, shared medical decision making can be recommended. For different women, underlying beliefs and values will sway decision making in different directions. By engaging a woman in the process of shared medical decision making, however, the plastic surgeon and her or his patients can make a mutually agreeable choice that reflects the patient's individual values and health preferences.     

Can women in labor give informed consent to epidural analgesia?

There are reasons to believe that decision‐making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women’s decisional capacity. Decision‐making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to ‘understanding’ alone. A systematic literature search identified a total of 20 empirical studies focused on women’s decision‐making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women’s autonomy. To fill in the significant gap in clinical knowledge about laboring women’s decision‐making capacity, well‐designed prospective and retrospective studies may be required.     

Opportunistic versus life-cycle-oriented decision making in multi-loop recovery: an eco-eco study on disposed vehicles

Purpose  

Multinational companies have recently been encouraged by government policies to implement Extended Producer Responsibility. One objective is to stimulate high-level recovery, and the other is to introduce life cycle thinking. This paper studies decision making in recovery, comparing opportunistic decision making with short-term profit maximization (usually leading to one loop) versus a life-cycle perspective (leading to multiple loops). The question is (1) which business benefits this brings as well as reduction of environmental impact and (2) whether companies should be inclined to think multi-loop and if so how governments could stimulate this.     

Genetic testing for late-onset diseases: effect of disease controllability, test predictivity, and gender on the decision to take the test

This study was designed to investigate the influence of the predictive power of the genetic test, the disease's controllability, and gender on the intention to take a predictive genetic test. Another aim was to examine the certainty of the intention to take the test. Nine scenarios were presented to a convenience sample of 121 men and women. Each scenario described a hypothetical and devastating late-onset disease and manipulated the level of disease controllability and test predictive value. The more predictivity the test offered and the more controllable the disease, the more the subjects were interested in being tested and the more certain their decision to take the test. Men's decisions were more positive than women's. There were also interactions between disease controllability and gender and between disease controllability and test predictivity. It seems that the factor that most influences the decision not to take the test is low disease controllability. This effect is more pronounced in women. Gender differences in decision making and information processing may be pertinent. The data show a marked gap between the decision itself and the certainty of that decision. The strength of the decision may be a better predictor of actual test uptake than the direction of the decision.     

Livestock production,age, and gender among the Keiyo of Kenya

This article is based on a study of time allocation and decision making patterns among the Keiyo in three ecological zones of Elgeyo-Marakvet District, Kenya. It finds that age and gender are important factors to consider when examining livestock production among African smallholder farmers. This is especially true where males are absent from home for wage labor. In these situations women, young males between the ages of 6–15, and persons of both sexes aged 65 and over spend considerable amounts of time engaged in livestock-related activities. These women are also more actively involved in decision making concerning the marketing of milk. The results indicate that there is a definite need to consider the contributions of these other persons when efforts are being made to improve elements of the livestock sector.     

The decision to terminate childbearing: Differences in preoperative ambivalence between tubal ligation women and vasectomy wives

Abstract

This paper examines the degree of preoperative ambivalence expressed by 255 currently married tubal ligation patients compared to 167 wives of vasectomy patients regarding the decision to terminate childbearing and aspects of the decision‐making process which account for differences between groups. Data indicate that tubal ligation women are significantly more certain and comfortable with their decision than are vasectomy wives. In order to explain this finding, analysis focused on sociodemographic factors; time factors related to the decision; variables related to communication with spouse and others; factors internal to the individual, including interest in another child and motivation for the decision; external constraints on the decision; and couple dynamics in the decision‐making process. Results indicate that group differences in ambivalence are primarily due to the effects of strong male control over the termination decision, as perceived by the wife, and a disproportionate prevalence of this pattern among vasectomy couples. An interaction effect between male dominance and group membership was also found. Implications of study results for preoperative counseling, including likely sources of future regret, are considered.     

A multicriteria decision making approach for estimating the number of clusters in a data set

Determining the number of clusters in a data set is an essential yet difficult step in cluster analysis. Since this task involves more than one criterion, it can be modeled as a multiple criteria decision making (MCDM) problem. This paper proposes a multiple criteria decision making (MCDM)-based approach to estimate the number of clusters for a given data set. In this approach, MCDM methods consider different numbers of clusters as alternatives and the outputs of any clustering algorithm on validity measures as criteria. The proposed method is examined by an experimental study using three MCDM methods, the well-known clustering algorithm-k-means, ten relative measures, and fifteen public-domain UCI machine learning data sets. The results show that MCDM methods work fairly well in estimating the number of clusters in the data and outperform the ten relative measures considered in the study.     

Intimate Partner Violence,Relationship Power Inequity and the Role of Sexual and Social Risk Factors in the Production of Violence among Young Women Who Have Multiple Sexual Partners in a Peri-Urban Setting in South Africa

Introduction

This paper aims to assess the extent and correlates of intimate partner violence (IPV), explore relationship power inequity and the role of sexual and social risk factors in the production of violence among young women aged 16–24 reporting more than one partner in the past three months in a peri-urban setting in the Western Cape, South Africa. Recent estimates suggest that every six hours a woman is killed by an intimate partner in South Africa, making IPV a leading public health problem in the country. While there is mounting evidence that levels of IPV are high in peri-urban settings in South Africa, not much is known about how it manifests among women who engage in concomitantly high HIV risk behaviours such as multiple sexual partnering, transactional sex and age mixing. We know even less about how such women negotiate power and control if exposed to violence in such sexual networks.

Methods

Two hundred and fifty nine women with multiple sexual partners, residing in a predominantly Black peri-urban community in the Western Cape, South Africa, were recruited into a bio-behavioural survey using Respondent Driven Sampling (RDS). After the survey, focus group discussions and individual interviews were conducted among young women and men to understand the underlying factors informing their risk behaviours and experiences of violence.

Findings

86% of the young women experienced IPV in the past 12 months. Sexual IPV was significantly correlated with sex with a man who was 5 years or older than the index female partner (OR 1.7, 95% CI 1.0–3.2) and transactional sex with most recent casual partner (OR 2.1, 95% CI 1.1–3.8). Predictably, women experienced high levels of relationship power inequity. However, they also identified areas in their controlling relationships where they shared decision making power.

Discussion

Levels of IPV among young women with multiple sexual partners were much higher than what is reported among women in the general population and shown to be associated with sexual risk taking. Interventions targeting IPV need to address sexual risk taking as it heightens vulnerability to violence.     

Effects of the status of women on the first-birth interval in Indian urban society

The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women--education, employment, role in family decision making, and age at marriage--along with three socioeconomic variables--per capita income of the family, social position of the household, and the caste system--on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.     

Types of Integration in Risk Assessment and Management,And Why They Are Needed

Risk-based decision making requires that the decision makers and stakeholders are informed of all risks that are potentially significant and relevant to the decision. The International Programme on Chemical Safety of the World Health Organization has developed a framework for integrating the assessment of human health and ecological risks. However, other types of integration are needed to support particular environmental decisions. They are integration of exposure and effects, of multiple chemicals and other hazardous agents, of multiple routes of exposure, of multiple endpoints, multiple receptors, multiple spatial and temporal scales, a product's life cycle, management alternatives, and socioeconomics with risk assessment. Inclusion of all these factors in an integrated assessment could lead to paralysis by analysis. Therefore, it is important that assessors be cognizant of the decision process and that decision makers and those who will influence the decision (stakeholders) be involved in planning the assessment to ensure that the degree of integration is necessary and sufficient.     

早熟桃最佳采收期的多目标决策模型研究

本文在拟合出早熟桃品种早花露品质诸项指标变化曲线的基础上，结合市场价格变化，以经济效益作为目标函数，建立了适时采收的多目标决策模型，并由此求出该品种在合肥地区最佳采收期是5月24日，为早熟桃生产取得最佳经济效益提供理论指导.     

The ecology of information: an overview on the ecological significance of making informed decisions

Information is characterized as the reduction of uncertainty and by a change in the state of a receiving organism. Thus, organisms can acquire information about their environment that reduces uncertainty and increases their likelihood of choosing a best‐matching strategy. We define the ecology of information as the study of how organisms acquire and use information in decision‐making and its significance for populations, communities, landscapes and ecosystems. As a whole, it encompasses the reception and processing of information, decision‐making, and the ecological consequences of making informed decisions. The first two stages constitute the domains of, e.g. sensory ecology and behavioral ecology. The exploration of the consequences of information use at larger spatial and temporal scales in ecology has lagged behind these other disciplines. In our overview we characterize information, discuss statistical decision theory as a quantitative framework to analyze information and decision‐making, and discuss potential ecological ramifications. Rather than attempt a cursory review of the enormity of the scope of information we highlight information use in development, breeding habitat selection, and interceptive eavesdropping on alarm calls. Through these topics we discuss specific examples of ecological information use and the emerging ecological consequences. We emphasize recurring themes: information is collected from multiple sources, over varying temporal and spatial scales, and in many cases links heterospecifics to one another. We conclude by breaking from specific ecological contexts to explore implications of information as a central organizing principle, including: information webs, information as a component of the niche concept, and information as an ecosystem process. With information having such an enormous reach in ecology we further cast a spotlight on the potential harmful effects of anthropogenic noise and info‐disruption.     

Rationality Wars and the War on Terror: Explaining Terrorism and Social Unrest

Terrorism is problematic at multiple levels. Social scientists debate its cause; policymakers debate what to do about it; many debate the meaning and political use of the term; and many live in fear of it. Current explanations of terrorism hinge on competing models of decision making. Anthropologists are increasingly influential in decision theory as issues of rationality, culture, and evolutionary psychology are invoked to explain patterns in human decision making. In this article, I review and critique current explanations of terrorism, I relate these explanations to larger debates in decision theory and anthropology, and I present an example of how current schisms may be transcended.     

The value of being a resource specialist: behavioral support for a neural hypothesis

The neural hypothesis of diet breadth proposes that selecting an appropriate behavior is more efficient if simple or exaggerated cues can be used as a basis of decision making rather than making a choice among many complex sensory inputs. I propose that simple signals overcome the problem of multiple sensory inputs and the consequent need for the brain to decide among inputs from these multiple channels. Experiments on grasshoppers show that there is a significant time cost in having to make a choice, relative to situations in which individuals have grown accustomed to having no choice. Those with a choice were shown to be less decisive by two different measures than those without a choice. It is argued that the data, showing lengthy decision times as a result of having a choice, would involve a significant ecological risk. It is further argued that the reduced risk of quick decisions would favor specialization of resource use. The evolution of resource-specific cues that have often been called sign stimuli are considered critical elements of restricted resource use.     

Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes

ObjectiveTo determine patients'' preferences for a shared or directed style of consultation in the decision making part of the general practice consultation.DesignStructured interview, with video vignettes of acted consultations.Setting5 practices in Lothian, Scotland.Participants410 patients (adults and adults accompanying children) attending surgery appointments.ResultsPatients varied in their preference for involvement in decision making in the consultation. Under multiple regression analysis, patients'' preference was found to be independently predicted by the problem viewed (patients presented with physical problems preferred a directed approach), patients'' age (patients aged 61 or older were more likely to prefer the directed approach), social class (social classes I and II were more likely to prefer the shared approach), and smoking status (smokers more likely to prefer the shared approach). Those patients who were able to answer (or who thought their doctor''s style similar to those in the vignettes) were more likely to describe their own doctor''s style as similar to their preferred style. No major association in preference was found with sex, frequency of attendance, or perceived chronic ill health.ConclusionPatients may vary in their desire for involvement in decision making in consultations. Although this variation seems to depend on the presenting problem, age, social class, and smoking status, these associations are not absolute, with large minorities in each group. Doctors need the skills, knowledge of their patients, and the time to determine on which occasions, with which illnesses, and at which level their patients wish to be involved in decision making.     

Integrating biodiversity into decision making

The prominent theme in the debates concerning biodiversity has been the integration of biodiversity into social and economical processes. Integration has meant two different but related things: on one hand, biological phenomena have been contextualized in social and economical processes; on the other hand, biological issues have been incorporated into decision making. These two aspects of integration are related: knowing the context of biodiversity helps in assessing its worth for decision making. In what follows we will first look at the ramifications of decision making, on how to proceed when dealing with apparently incommensurable dimensions. Secondly, we will highlight some key issues in both biological and social impact assessment. Finally, we will propose a process model which takes into account the multiple aspects of biodiversity.     

Neural basis of quasi-rational decision making

Standard economic theories conceive homo economicus as a rational decision maker capable of maximizing utility. In reality, however, people tend to approximate optimal decision-making strategies through a collection of heuristic routines. Some of these routines are driven by emotional processes, and others are adjusted iteratively through experience. In addition, routines specialized for social decision making, such as inference about the mental states of other decision makers, might share their origins and neural mechanisms with the ability to simulate or imagine outcomes expected from alternative actions that an individual can take. A recent surge of collaborations across economics, psychology and neuroscience has provided new insights into how such multiple elements of decision making interact in the brain.     

The number needed to treat: a clinically useful measure of treatment effect.

The relative benefit of an active treatment over a control is usually expressed as the relative risk, the relative risk reduction, or the odds ratio. These measures are used extensively in both clinical and epidemiological investigations. For clinical decision making, however, it is more meaningful to use the measure "number needed to treat." This measure is calculated on the inverse of the absolute risk reduction. It has the advantage that it conveys both statistical and clinical significance to the doctor. Furthermore, it can be used to extrapolate published findings to a patient at an arbitrary specified baseline risk when the relative risk reduction associated with treatment is constant for all levels of risk.     

Exploring foraging decisions in a social primate using discrete-choice models

Abstract There is a growing appreciation of the multiple social and nonsocial factors influencing the foraging behavior of social animals but little understanding of how these factors depend on habitat characteristics or individual traits. This partly reflects the difficulties inherent in using conventional statistical techniques to analyze multifactor, multicontext foraging decisions. Discrete-choice models provide a way to do so, and we demonstrate this by using them to investigate patch preference in a wild population of social foragers (chacma baboons Papio ursinus). Data were collected from 29 adults across two social groups, encompassing 683 foraging decisions over a 6-month period and the results interpreted using an information-theoretic approach. Baboon foraging decisions were influenced by multiple nonsocial and social factors and were often contingent on the characteristics of the habitat or individual. Differences in decision making between habitats were consistent with changes in interference-competition costs but not with changes in social-foraging benefits. Individual differences in decision making were suggestive of a trade-off between dominance rank and social capital. Our findings emphasize that taking a multifactor, multicontext approach is important to fully understand animal decision making. We also demonstrate how discrete-choice models can be used to achieve this.     

Contraceptive use dynamics of Asian women in Britain

In-depth interviews were conducted with married Asian women from Indian, Pakistani and Bangladeshi backgrounds, to investigate patterns of contraceptive use and influences on contraceptive decision making. The results show two distinctively different contraceptive 'lifecycles'. Non-professional women typically have little knowledge about contraception until after their marriage or first birth. Their patterns of contraceptive behaviour show low levels of contraceptive use until after their first birth, when condom use is most prevalent. Non-professional women are influenced by their extended family, religion and cultural expectations on their fertility and family planning decisions. Professional women show an entirely different pattern of contraceptive behaviour. They are more likely to have knowledge about contraception before marriage, use some method of contraception throughout their childbearing years (typically the pill) and cite personal, practical or economic considerations in their fertility decisions rather than religious, cultural or extended family influences.