Displaying publications 1 - 20 of 312 in total

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  1. Ratnasingam J, Niyaz M, Mariyappan S, Ong T, Chan SP, Hew FL, et al.
    Arch Osteoporos, 2024 Mar 20;19(1):18.
    PMID: 38503995 DOI: 10.1007/s11657-024-01371-w
    Fracture risk stratification is crucial in countries with limited access to bone density measurement. 24.8% women were in the high-risk category while 30.4% were in the low-risk category. In the intermediate risk group, after recalculation of fracture risk with bone density, 38.3% required treatment. In more than half, treatment decisions can be made without bone density.

    PURPOSE: We aimed to examine the role of age-dependent intervention thresholds (ITs) applied to the Fracture Risk Assessment (FRAX) tool in therapeutic decision making for osteoporosis in the Malaysian population.

    METHODS: Data were collated from 1380 treatment-naïve postmenopausal women aged 40-85 years who underwent bone mineral density (BMD) measurements for clinical reasons. Age-dependent ITs, for both major osteoporotic fracture (MOF) and hip fracture (HF), were calculated considering a woman with a BMI of 25 kg/m2, aged between 40 and 85years, with a prior fragility fracture, sans other clinical risk factors. Those with fracture probabilities equal to or above upper assessment thresholds (UATs) were considered to have high fracture risk. Those below the lower assessment thresholds (LATs) were considered to have low fracture risk.

    RESULTS: The ITs of MOF and HF ranged from 0.7 to 18% and 0.2 to 8%, between 40 and 85years. The LATs of MOF ranged from 0.3 to 11%, while those of HF ranged from 0.1 to 5.2%. The UATs of MOF and HF were 0.8 to 21.6% and 0.2 to 9.6%, respectively. In this study, 24.8% women were in the high-risk category while 30.4% were in the low-risk category. Of the 44.8% (n=618) in the intermediate risk group, after recalculation of fracture risk with BMD input, 38.3% (237/618) were above the ITs while the rest (n=381, 61.7%) were below the ITs. Judged by the Youden Index, 11.5% MOF probability which was associated with a sensitivity of 0.62 and specificity of 0.83 and 4.0% HF probability associated with a sensitivity of 0.63 and a specificity 0.82 were found to be the most appropriate fixed ITs in this analysis.

    CONCLUSION: Less than half of the study population (44.8%) required BMD for osteoporosis management when age-specific assessment thresholds were applied. Therefore, in more than half, therapeutic decisions can be made without BMD based on these assessment thresholds.

    Matched MeSH terms: Decision Making
  2. Shafei H, Rahman RA, Lee YS
    Environ Sci Pollut Res Int, 2024 Feb;31(10):14858-14893.
    PMID: 38285259 DOI: 10.1007/s11356-024-31862-9
    This study aims to compare the impact of Construction 4.0 technologies on different organizational core values, focusing on sustainability and resiliency, well-being, productivity, safety, and integrity. To achieve that aim, the study objectives are the following: (i) identify the critical Construction 4.0 technologies between core values; (ii) appraise overlapping critical Construction 4.0 technologies between core values; (iii) examine the ranking performance of Construction 4.0 technologies between core values; and (iv) analyze the interrelationships between Construction 4.0 technologies and core values. First, twelve Construction 4.0 technologies were identified from a national strategic plan. Then, the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) that incorporates subjective and objective weights was used to evaluate the impact of the Construction 4.0 technologies on the five core values. Finally, the collected data was analyzed using the following techniques: fuzzy TOPSIS, normalization, overlap analysis, agreement analysis, sensitivity analysis, ranking comparison, and Spearman correlation. The study findings reveal four critical Construction 4.0 technologies that enhance all five core values: building information modeling (BIM), Internet of Things (IoT), big data and predictive analytics, and autonomous construction. Also, there is a high agreement on the Construction 4.0 technologies that enhance well-being and productivity. Lastly, artificial intelligence (AI) has the highest number of very strong relationships among the core values. The originality of this paper lies in its comprehensive comparison of the impact of Construction 4.0 technologies on multiple organizational core values. The study findings provide valuable insights in making strategic decisions in adopting Construction 4.0 technologies.
    Matched MeSH terms: Decision Making
  3. Tanimu B, Hamed MM, Bello AD, Abdullahi SA, Ajibike MA, Shahid S
    Environ Sci Pollut Res Int, 2024 Feb;31(10):15986-16010.
    PMID: 38308777 DOI: 10.1007/s11356-024-32128-0
    Choosing a suitable gridded climate dataset is a significant challenge in hydro-climatic research, particularly in areas lacking long-term, reliable, and dense records. This study used the most common method (Perkins skill score (PSS)) with two advanced time series similarity algorithms, short time series distance (STS), and cross-correlation distance (CCD), for the first time to evaluate, compare, and rank five gridded climate datasets, namely, Climate Research Unit (CRU), TERRA Climate (TERRA), Climate Prediction Center (CPC), European Reanalysis V.5 (ERA5), and Climatologies at high resolution for Earth's land surface areas (CHELSA), according to their ability to replicate the in situ rainfall and temperature data in Nigeria. The performance of the methods was evaluated by comparing the ranking obtained using compromise programming (CP) based on four statistical criteria in replicating in situ rainfall, maximum temperature, and minimum temperature at 26 locations distributed over Nigeria. Both methods identified CRU as Nigeria's best-gridded climate dataset, followed by CHELSA, TERRA, ERA5, and CPC. The integrated STS values using the group decision-making method for CRU rainfall, maximum and minimum temperatures were 17, 10.1, and 20.8, respectively, while CDD values for those variables were 17.7, 11, and 12.2, respectively. The CP based on conventional statistical metrics supported the results obtained using STS and CCD. CRU's Pbias was between 0.5 and 1; KGE ranged from 0.5 to 0.9; NSE ranged from 0.3 to 0.8; and NRMSE between - 30 and 68.2, which were much better than the other products. The findings establish STS and CCD's ability to evaluate the performance of climate data by avoiding the complex and time-consuming multi-criteria decision algorithms based on multiple statistical metrics.
    Matched MeSH terms: Decision Making
  4. Idris IB, Hamis AA, Bukhori ABM, Hoong DCC, Yusop H, Shaharuddin MA, et al.
    BMC Womens Health, 2023 Dec 02;23(1):643.
    PMID: 38042837 DOI: 10.1186/s12905-023-02792-4
    OBJECTIVES: Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making. The autonomy of women is believed to be crucial in improving their health-related outcomes. This review discusses factors that influence autonomy among women in healthcare decision making.

    DESIGN: Systematic review.

    DATA SOURCES: PubMed, Web of Science and Scopus were searched from 2017-2022.

    ELIGIBILITY CRITERIA: The inclusion criteria include original articles, case studies and reports that has been written in the English Language, while manuscripts with no full article, reviews, newspaper reports, grey literatures, and articles that did not answer the review objectives were excluded.

    DATA EXTRACTION AND SYNTHESIS: We carried out data extraction using a standardized data extraction form, that has been organized using Microsoft Excel. A narrative synthesis was carried out to combine the findings of all included articles.

    RESULTS: A total of 70 records were identified and 18 were reviewed, yielding eight articles to be included in the accepted list of studies. All studies were conducted in developing countries and most of the studies were cross sectional. Factors that were associated with women's autonomy in healthcare decision making were age, women's education and occupation, husbands'/partners' education and occupation, residential location or region of residence, household wealth index as well as culture and religion.

    CONCLUSIONS: Identification of these factors may help stakeholders in improving women's autonomy in healthcare decision making. Policymakers play a crucial role in healthcare decision making by enacting laws and policies that protect women's rights, promoting gender-sensitive healthcare services, ensuring access to comprehensive information, promoting health education, and supporting vulnerable populations. These efforts ensure women's autonomy including able to access to unbiased and effective healthcare services.

    Matched MeSH terms: Decision Making
  5. Umair S, Ho JA, Ng SSI, Basha NK
    Omega (Westport), 2023 Nov;88(1):216-244.
    PMID: 34505539 DOI: 10.1177/00302228211045170
    Organ transplantation is considered an alternative treatment to save lives or to improve the quality of life and is a successful method for the treatment of patients with end-stage organ diseases. The main objective of the current study was to explore the determinants of the attitudes and willingness to communicate the posthumous organ donation decisions to the families. Questionnaires were used to test the hypothesized relationships. The results confirmed altruism, knowledge, empathy, and self-identity as the antecedents to attitude. We also found perceived behavioral control, moral norms, and attitude as significant antecedents to the willingness to donate organs after death. The results of the study also indicated that those who were willing to sign the donor card were also willing to communicate their decision to their families. Religiosity moderated the relationship between willingness to donate and signing the donor card, and it strengthened the relationship. The findings of this study would provide insight into the factors which can influence posthumous organ donation among university students in Pakistan.
    Matched MeSH terms: Decision Making
  6. Dejun Z, Remi RA, Mouchun Y, Romanus O, Mihajlo J
    Afr J Reprod Health, 2023 Oct 31;27(10):65-80.
    PMID: 37915165 DOI: 10.29063/ajrh2023/v27i10.6
    This study examined the effect of various dimensions of women's empowerment on childcare use in Nigeria, utilizing information from five rounds of the National Demographic and Health Surveys. The analysis made use of both binary and multinomial logistic regression. The findings show that women who share household choices with their spouses were more likely to undertake postnatal care for their babies in either private or public hospitals compared to self-medication/others/traditional. Also, women who owned houses and those who participate in economic activities are significantly more inclined to use postnatal services for babies in health facilities. By implication, women empowerment is a significant factor to consider in improving childcare services in Nigeria. This suggests that in order to improve the health of children, women's inputs in household decision-making should be accommodated, while efforts should be made to enhance household socioeconomic position, and support mothers to have formal education. The findings also suggest that promoting women's empowerment can play a crucial role in increasing the demand for formal childcare services.
    Matched MeSH terms: Decision Making
  7. Sheeran N, Jones L, Pines R, Jin B, Pamoso A, Eigeland J, et al.
    J Commun Healthc, 2023 Jul;16(2):186-196.
    PMID: 37401877 DOI: 10.1080/17538068.2022.2095098
    BACKGROUND: Patient-centered care (PCC) is the prevailing model of care globally. However, most research on PCC has been conducted in Westernized countries or has focused on only two facets of PCC: decision-making and information exchange. Our study examined how culture influences patients' preferences for five facets of PCC, including communication, decision-making, empathy, individualized focus, and relationship.

    METHODS: Participants (N = 2071) from Hong Kong, the Philippines, Australia, and the U.S.A. completed an online survey assessing their preferences for exchange of information, autonomy in decision-making, expression and validation of their emotions, focus on them as an individual, and the doctor-patient relationship.

    RESULTS: Participants from all four countries had similar preferences for empathy and shared decision-making. For other facets of PCC, participants in the Philippines and Australia expressed somewhat similar preferences, as did those in the U.S.A. and Hong Kong, challenging East-West stereotypes. Participants in the Philippines placed greater value on relationships, whereas Australians valued more autonomy. Participants in Hong Kong more commonly preferred doctor-directed care, with less importance placed on the relationship. Responses from U.S.A. participants were surprising, as they ranked the need for individualized care and two-way flow of information as least important.

    CONCLUSIONS: Empathy, information exchange, and shared decision-making are values shared across countries, while preferences for how the information is shared, and the importance of the doctor-patient relationship differ.

    Matched MeSH terms: Decision Making
  8. Pines R, Sheeran N, Jones L, Pearson A, Pamoso AH, Jin YB, et al.
    Med Care Res Rev, 2023 Apr;80(2):205-215.
    PMID: 35815591 DOI: 10.1177/10775587221108749
    Inadequate consideration has been given to patient preferences for patient-centered care (PCC) across countries or cultures in our increasingly global society. We examined what 1,698 participants from the United States, Hong Kong, Philippines, and Australia described as important when making health care decisions. Analysis of frequencies following directed content coding of open-ended questions revealed differences in patients' preferences for doctor behaviors and decision-making considerations across countries. Being well informed by their doctor emerged as most important in decision-making, especially in Hong Kong. Participants in Australia and the United States wanted their doctor to meet their emotional needs. The safety and efficacy of treatments were the most common consideration, especially for Hong Kong. Findings suggest that doctors should focus on information exchange and identifying patient concerns about efficacy, lifestyle impact, cost, and recovery speed. Rather than assuming patients prefer shared decision-making, doctors must assess patient's decision control preferences.
    Matched MeSH terms: Decision Making
  9. Lee PY, Cheong AT, Ghazali SS, Rashid AA, Ong SC, Ong SY, et al.
    Health Expect, 2022 Dec;25(6):2837-2850.
    PMID: 36098241 DOI: 10.1111/hex.13590
    BACKGROUND: Shared decision-making has been shown to improve the quality of life in metastatic breast cancer patients in high-literacy and high-resource settings. However, limited studies have examined the cultural preferences of metastatic breast cancer patients with shared decision-making implementation and the barriers encountered in an Asian setting where societal norms predominate and physician decision-making is at the forefront. This paper aims to identify (1) barriers to practising shared decision-making faced by healthcare professionals and patients and (2) strategies for implementing shared decision-making in the context of metastatic breast cancer management in Malaysia.

    METHODS: We conducted a qualitative study involving 12 patients diagnosed with metastatic breast cancer, 16 healthcare professionals and 5 policymakers from surgical and oncology departments at public healthcare centres in Malaysia. Semi-structured in-depth interviews and focus group discussions were conducted. The interviews were recorded, transcribed verbatim and analysed using the thematic approach. Nvivo software was used to manage and analyse the data.

    RESULTS: Five main themes emerged from the study: healthcare provider-patient communication, workforce availability, cultural and belief systems, goals of care and paternalism versus autonomy. Other strategies proposed to overcome barriers to implementing shared decision-making were training of healthcare professionals and empowering nurses to manage patients' psychosocial issues.

    CONCLUSION: This study found that practising shared decision-making in the public health sector remains challenging when managing patients with metastatic breast cancer. The utilization of decision-making tools, patient empowerment and healthcare provider training may help address the system and healthcare provider-patient barriers identified in this study.

    PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the study design, recruitment and analysis.

    Matched MeSH terms: Decision Making
  10. Marzuki AA, Vaghi MM, Conway-Morris A, Kaser M, Sule A, Apergis-Schoute A, et al.
    J Child Psychol Psychiatry, 2022 Dec;63(12):1591-1601.
    PMID: 35537441 DOI: 10.1111/jcpp.13628
    BACKGROUND: Computational research had determined that adults with obsessive-compulsive disorder (OCD) display heightened action updating in response to noise in the environment and neglect metacognitive information (such as confidence) when making decisions. These features are proposed to underlie patients' compulsions despite the knowledge they are irrational. Nonetheless, it is unclear whether this extends to adolescents with OCD as research in this population is lacking. Thus, this study aimed to investigate the interplay between action and confidence in adolescents with OCD.

    METHODS: Twenty-seven adolescents with OCD and 46 controls completed a predictive-inference task, designed to probe how subjects' actions and confidence ratings fluctuate in response to unexpected outcomes. We investigated how subjects update actions in response to prediction errors (indexing mismatches between expectations and outcomes) and used parameters from a Bayesian model to predict how confidence and action evolve over time. Confidence-action association strength was assessed using a regression model. We also investigated the effects of serotonergic medication.

    RESULTS: Adolescents with OCD showed significantly increased learning rates, particularly following small prediction errors. Results were driven primarily by unmedicated patients. Confidence ratings appeared equivalent between groups, although model-based analysis revealed that patients' confidence was less affected by prediction errors compared to controls. Patients and controls did not differ in the extent to which they updated actions and confidence in tandem.

    CONCLUSIONS: Adolescents with OCD showed enhanced action adjustments, especially in the face of small prediction errors, consistent with previous research establishing 'just-right' compulsions, enhanced error-related negativity, and greater decision uncertainty in paediatric-OCD. These tendencies were ameliorated in patients receiving serotonergic medication, emphasising the importance of early intervention in preventing disorder-related cognitive deficits. Confidence ratings were equivalent between young patients and controls, mirroring findings in adult OCD research.

    Matched MeSH terms: Decision Making/physiology
  11. Abousheishaa AA, Lazim NHM, Tang SL, Sulaiman AH, Huri HZ, Guan NC
    Patient Educ Couns, 2022 Jul;105(7):2466-2474.
    PMID: 34844812 DOI: 10.1016/j.pec.2021.11.007
    OBJECTIVES: This study aimed to develop and assess the effectiveness of an encounter decision aid for Malaysian patients with MDD to support treatment decision-making during the consultation.

    METHODS: The decision aid prototype was developed following a literature review and six focus groups. Alpha testing assessed its comprehensibility, acceptability, usability and desirability through user-centered cognitive interviews. Beta-testing evaluated preliminary evidence on its efficacy using the SDM Scale and PDMS. Feasibility was assessed by timing the consultation.

    RESULTS: The alpha testing demonstrated that the decision aid was patient-oriented, comprehensible, comprehensive, concise and objective with an appealing design. Beta-testing indicated that PtDA significantly increased patients satisfaction with SDM from patients' [83.32 (13.92) vs 85.76 (13.80); p 

    Matched MeSH terms: Decision Making
  12. Lee YK, Ng CJ, Lee PY, Tong WT, Sa'at H
    Z Evid Fortbild Qual Gesundhwes, 2022 Jun;171:89-92.
    PMID: 35610129 DOI: 10.1016/j.zefq.2022.04.020
    Shared decision making (SDM) activities in Malaysia began around 2010. The rise in the numbers of patients with chronic disease in Malaysia underscores a growing need for doctors to practice patient-centred care and SDM as more Malaysians come into regular contact with health decision-making scenarios. Recent guidelines for medical professionalism have emphasized that options and risks be discussed in consultations, especially for procedures with risk of adverse outcomes. Although SDM is not legally required, principles of SDM are applied in legal judgements on informed consent. Research on SDM has grown to include the adoption of patient and public involvement in research, an increased emphasis on incorporating local cultural values in SDM, and implementation of SDM in Malaysia's health system and organizational culture. While COVID-19 hindered the progress of SDM research, one positive development was that vaccination choices heightened public consciousness about personal decisional autonomy and the need to discuss pros and cons with doctors before making a medical decision.
    Matched MeSH terms: Decision Making
  13. Albahri OS, Zaidan AA, Albahri AS, Alsattar HA, Mohammed R, Aickelin U, et al.
    J Adv Res, 2022 Mar;37:147-168.
    PMID: 35475277 DOI: 10.1016/j.jare.2021.08.009
    INTRODUCTION: The vaccine distribution for the COVID-19 is a multicriteria decision-making (MCDM) problem based on three issues, namely, identification of different distribution criteria, importance criteria and data variation. Thus, the Pythagorean fuzzy decision by opinion score method (PFDOSM) for prioritising vaccine recipients is the correct approach because it utilises the most powerful MCDM ranking method. However, PFDOSM weighs the criteria values of each alternative implicitly, which is limited to explicitly weighting each criterion. In view of solving this theoretical issue, the fuzzy-weighted zero-inconsistency (FWZIC) can be used as a powerful weighting MCDM method to provide explicit weights for a criteria set with zero inconstancy. However, FWZIC is based on the triangular fuzzy number that is limited in solving the vagueness related to the aforementioned theoretical issues.

    OBJECTIVES: This research presents a novel homogeneous Pythagorean fuzzy framework for distributing the COVID-19 vaccine dose by integrating a new formulation of the PFWZIC and PFDOSM methods.

    METHODS: The methodology is divided into two phases. Firstly, an augmented dataset was generated that included 300 recipients based on five COVID-19 vaccine distribution criteria (i.e., vaccine recipient memberships, chronic disease conditions, age, geographic location severity and disabilities). Then, a decision matrix was constructed on the basis of an intersection of the 'recipients list' and 'COVID-19 distribution criteria'. Then, the MCDM methods were integrated. An extended PFWZIC was developed, followed by the development of PFDOSM.

    RESULTS: (1) PFWZIC effectively weighted the vaccine distribution criteria. (2) The PFDOSM-based group prioritisation was considered in the final distribution result. (3) The prioritisation ranks of the vaccine recipients were subject to a systematic ranking that is supported by high correlation results over nine scenarios of the changing criteria weights values.

    CONCLUSION: The findings of this study are expected to ensuring equitable protection against COVID-19 and thus help accelerate vaccine progress worldwide.

    Matched MeSH terms: Decision Making
  14. Nadeem MA, Surienty L, Haque MM
    Front Public Health, 2022;10:1004767.
    PMID: 36452948 DOI: 10.3389/fpubh.2022.1004767
    The agriculture sector is a traditional economic pillar of many emerging economies. However, it is facing greater occupational health and safety (OHS) challenges in Pakistan, and its performance is continuously decreasing. An effective OHS implementation provides better control over OHS challenges and may help to restore its former glory. Therefore, this study aims to explore different organizational decision-making styles and safety accountability to put OHS into practice in this sector. Based on institutional theory, a theoretical framework was developed. Two hundred and eighty-seven agriculture farms in Punjab, Pakistan were surveyed and analyzed using SmartPLS 3.3.7. The findings revealed that implementation styles (rational and incremental) and safety accountability positively impact OHS implementation. Similarly, the moderating role of mimetic motives was found positively significant in the relationship between rational style and OHS implementation, and negatively significant in the relationship between incremental style and OHS implementation. While no moderating effect of mimetic motive was found between safety accountability and OHS implementation. This study suggested that OHS implementation should not be viewed as a social or technical issue alone. Strategic arrangements should be made at the organizational level to gain better control over OHS challenges by considering the institutional environment in which the organization operates.
    Matched MeSH terms: Decision Making
  15. Shunnmugam B, Ng CJ, Aishah Mohd Taib N, Chinna K
    Asia Pac J Public Health, 2021 11;33(8):914-922.
    PMID: 34467767 DOI: 10.1177/10105395211036625
    This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts' opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.
    Matched MeSH terms: Decision Making
  16. Marzuki AA, Tomic I, Ip SHY, Gottwald J, Kanen JW, Kaser M, et al.
    JAMA Netw Open, 2021 Nov 01;4(11):e2136195.
    PMID: 34842925 DOI: 10.1001/jamanetworkopen.2021.36195
    IMPORTANCE: Adults with obsessive-compulsive disorder (OCD) display perseverative behavior in stable environments but exhibit vacillating choice when payoffs are uncertain. These findings may be associated with intolerance of uncertainty and compulsive behaviors; however, little is known about the mechanisms underlying learning and decision-making in youths with OCD because research into this population has been limited.

    OBJECTIVE: To investigate cognitive mechanisms associated with decision-making in youths with OCD by using executive functioning tasks and computational modeling.

    DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, 50 youths with OCD (patients) and 53 healthy participants (controls) completed a probabilistic reversal learning (PRL) task between January 2014 and March 2020. A separate sample of 27 patients and 46 controls completed the Wisconsin Card Sorting Task (WCST) between January 2018 and November 2020. The study took place at the University of Cambridge in the UK.

    MAIN OUTCOMES AND MEASURES: Decision-making mechanisms were studied by fitting hierarchical bayesian reinforcement learning models to the 2 data sets and comparing model parameters between participant groups. Model parameters included reward and punishment learning rates (feedback sensitivity), reinforcement sensitivity and decision consistency (exploitation), and stickiness (perseveration). Associations of receipt of serotonergic medication with performance were assessed.

    RESULTS: In total, 50 patients (29 female patients [58%]; median age, 16.6 years [IQR, 15.3-18.0 years]) and 53 controls (30 female participants [57%]; median age, 16.4 years [IQR, 14.8-18.0 years]) completed the PRL task. A total of 27 patients (18 female patients [67%]; median age, 16.1 years [IQR, 15.2-17.2 years]) and 46 controls (28 female participants [61%]; median age, 17.2 [IQR, 16.3-17.6 years]) completed the WCST. During the reversal phase of the PRL task, patients made fewer correct responses (mean [SD] proportion: 0.83 [0.16] for controls and 0.61 [0.31] for patients; 95% CI, -1.31 to -0.64) and switched choices more often following false-negative feedback (mean [SD] proportion: 0.09 [0.16] for controls vs 0.27 [0.34] for patients; 95% CI, 0.60-1.26) and true-positive feedback (mean [SD] proportion: 0.93 [0.17] for controls vs 0.73 [0.34] for patients; 95% CI, -2.17 to -1.31). Computational modeling revealed that patients displayed enhanced reward learning rates (mean difference [MD], 0.21; 95% highest density interval [HDI], 0.04-0.38) but decreased punishment learning rates (MD, -0.29; 95% HDI, -0.39 to -0.18), reinforcement sensitivity (MD, -4.91; 95% HDI, -9.38 to -1.12), and stickiness (MD, -0.35; 95% HDI, -0.57 to -0.11) compared with controls. There were no group differences on standard WCST measures and computational model parameters. However, patients who received serotonergic medication showed slower response times (mean [SD], 1420.49 [279.71] milliseconds for controls, 1471.42 [212.81] milliseconds for patients who were unmedicated, and 1738.25 [349.23] milliseconds for patients who were medicated) (control vs medicated MD, -320.26 [95% CI, -547.00 to -88.68]) and increased unique errors (mean [SD] proportion: 0.001 [0.004] for controls, 0.002 [0.004] for patients who were unmedicated, and 0.008 [0.01] for patients who were medicated) (control vs medicated MD, -0.007 [95% CI, -3.14 to -0.36]) on the WCST.

    CONCLUSIONS AND RELEVANCE: The results of this cross-sectional study indicated that youths with OCD showed atypical probabilistic reversal learning but were generally unimpaired on the deterministic WCST, although unexpected results were observed for patients receiving serotonergic medication. These findings have implications for reframing the understanding of early-onset OCD as a disorder in which decision-making is associated with uncertainty in the environment, a potential target for therapeutic treatment. These results provide continuity with findings in adults with OCD.

    Matched MeSH terms: Decision Making/physiology*
  17. Mustapa MAC, Batcha MFN, Amin L, Arham AF, Mahadi Z, Yusoff NAM, et al.
    J Sci Food Agric, 2021 Oct;101(13):5457-5468.
    PMID: 33709409 DOI: 10.1002/jsfa.11194
    BACKGROUND: Genetically modified (GM) crops have become a controversial global issue since their commercialization in 1996. However, despite technological advancements, only a few studies have investigated farmers' attitudes towards GM crops in Malaysia. Therefore, this study aims to analyse such attitudes and their determining factors. A validated questionnaire was distributed to farmers in the Cameron Highlands, Pahang (n = 176). SPSS software was used to analyse the descriptive statistics of the farmers' attitudes to GM crops, while SmartPLS software was used to determine the predictors.

    RESULTS: Descriptive analysis shows that the farmers claimed to have a high level of self-efficacy, and perceived GM crops as possessing high benefits which translate into a highly positive attitude towards GM crops. However, at the same time, they rated GM crops as involving moderate risks and would incur moderate costs to farm, as well as acknowledging a low level of support from the government. The structural equation model (SEM) analysis demonstrates that five factors have been identified as direct predictors of attitude to GM crops: government support (ß = 0.364, P 

    Matched MeSH terms: Decision Making
  18. Alsalem MA, Alsattar HA, Albahri AS, Mohammed RT, Albahri OS, Zaidan AA, et al.
    J Infect Public Health, 2021 Oct;14(10):1513-1559.
    PMID: 34538731 DOI: 10.1016/j.jiph.2021.08.026
    The problem complexity of multi-criteria decision-making (MCDM) has been raised in the distribution of coronavirus disease 2019 (COVID-19) vaccines, which required solid and robust MCDM methods. Compared with other MCDM methods, the fuzzy-weighted zero-inconsistency (FWZIC) method and fuzzy decision by opinion score method (FDOSM) have demonstrated their solidity in solving different MCDM challenges. However, the fuzzy sets used in these methods have neglected the refusal concept and limited the restrictions on their constants. To end this, considering the advantage of the T-spherical fuzzy sets (T-SFSs) in handling the uncertainty in the data and obtaining information with more degree of freedom, this study has extended FWZIC and FDOSM methods into the T-SFSs environment (called T-SFWZIC and T-SFDOSM) to be used in the distribution of COVID-19 vaccines. The methodology was formulated on the basis of decision matrix adoption and development phases. The first phase described the adopted decision matrix used in the COVID-19 vaccine distribution. The second phase presented the sequential formulation steps of T-SFWZIC used for weighting the distribution criteria followed by T-SFDOSM utilised for prioritising the vaccine recipients. Results revealed the following: (1) T-SFWZIC effectively weighted the vaccine distribution criteria based on several parameters including T = 2, T = 4, T = 6, T = 8, and T = 10. Amongst all parameters, the age criterion received the highest weight, whereas the geographic locations severity criterion has the lowest weight. (2) According to the T parameters, a considerable variance has occurred on the vaccine recipient orders, indicating that the existence of T values affected the vaccine distribution. (3) In the individual context of T-SFDOSM, no unique prioritisation was observed based on the obtained opinions of each expert. (4) The group context of T-SFDOSM used in the prioritisation of vaccine recipients was considered the final distribution result as it unified the differences found in an individual context. The evaluation was performed based on systematic ranking assessment and sensitivity analysis. This evaluation showed that the prioritisation results based on each T parameter were subject to a systematic ranking that is supported by high correlation results over all discussed scenarios of changing criteria weights values.
    Matched MeSH terms: Decision Making
  19. Ho CH, Ismail AK, Liu SH, Tzeng YS, Li LY, Pai FC, et al.
    Clin Toxicol (Phila), 2021 Sep;59(9):794-800.
    PMID: 33605805 DOI: 10.1080/15563650.2021.1881535
    BACKGROUND: The incidence of acute compartment syndrome (ACS) following snakebite envenomation may be seriously overestimated in Taiwan. Snakebite-induced ACS is difficult to determine solely by clinical examination. Snakebite patients previously underwent surgical intervention based on speculation and general clinical examinations suggesting ACS presentations instead of direct intracompartmental pressure (IP) measurement prior to fasciotomy. Point-of-care ultrasound (POCUS) is a relatively widely available noninvasive tool. This study aimed to evaluate snakebite-envenomated patients for the presence of subcutaneous edema and diastolic retrograde arterial flow (DRAF).

    MATERIALS AND METHODS: Snakebite patients were prospectively recruited between 2017 and 2019. All patients were examined with POCUS to locate edema and directly visualize and measure the arterial flow in the compressed artery. The presence of DRAF in the compressed artery is suggestive of ACS development because when compartment space restriction occurs, increased retrograde arterial flow is observed in the artery.

    RESULTS: Twenty-seven snakebite patients were analyzed. Seventeen patients (63%) were bitten by Crotalinae snakes, seven (26%) by Colubridae, one (4%) by Elapidae, and two (7%) had unidentified snakebites. All Crotalinae bit patients received antivenom, had subcutaneous edema and lacked DRAF in a POCUS examination series.

    DISCUSSION: POCUS facilitates clinical decisions for snakebite envenomation. We also highlighted that the anatomic site of the snakebite is an important factor affecting the prognosis of the wounds. There were limitations of this study, including a small number of patients and no comparison with the generally accepted invasive evaluation for ACS.

    CONCLUSIONS: We are unable to state that POCUS is a valid surrogate measurement of ACS from this study but see this as a starting point to develop further research in this area. Further study will be needed to better define the utility of POCUS in patients envenomated by snakes throughout the world.

    Matched MeSH terms: Clinical Decision-Making
  20. Vepa A, Saleem A, Rakhshan K, Daneshkhah A, Sedighi T, Shohaimi S, et al.
    PMID: 34207560 DOI: 10.3390/ijerph18126228
    BACKGROUND: Within the UK, COVID-19 has contributed towards over 103,000 deaths. Although multiple risk factors for COVID-19 have been identified, using this data to improve clinical care has proven challenging. The main aim of this study is to develop a reliable, multivariable predictive model for COVID-19 in-patient outcomes, thus enabling risk-stratification and earlier clinical decision-making.

    METHODS: Anonymised data consisting of 44 independent predictor variables from 355 adults diagnosed with COVID-19, at a UK hospital, was manually extracted from electronic patient records for retrospective, case-control analysis. Primary outcomes included inpatient mortality, required ventilatory support, and duration of inpatient treatment. Pulmonary embolism sequala was the only secondary outcome. After balancing data, key variables were feature selected for each outcome using random forests. Predictive models were then learned and constructed using Bayesian networks.

    RESULTS: The proposed probabilistic models were able to predict, using feature selected risk factors, the probability of the mentioned outcomes. Overall, our findings demonstrate reliable, multivariable, quantitative predictive models for four outcomes, which utilise readily available clinical information for COVID-19 adult inpatients. Further research is required to externally validate our models and demonstrate their utility as risk stratification and clinical decision-making tools.

    Matched MeSH terms: Clinical Decision-Making
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