28584929	Drug addiction can be described as aberrant allocation of effort toward acquiring drug, despite associated costs. It is unclear if this behavioral pattern results from an overvaluation of reward or to an altered sensitivity to costs.Present experiments assessed reward sensitivity and effortful choice in rats following 1 week of withdrawal from methamphetamine (mAMPH).	Rats were treated with either saline or an escalating dose mAMPH regimen, then tested after a week without the drug. In experiment 1, rats were given a free choice between water and various concentrations of sucrose solution to assess general reward sensitivity. In experiment 2, rats were presented with a choice between lever-pressing for sucrose pellets on a progressive ratio schedule or consuming freely-available chow.	In experiment 1, we found no differences in sucrose preference between mAMPH- and saline-pretreated rats. In experiment 2, when selecting between two options, mAMPH-pretreated rats engaged in less lever-pressing for sucrose pellets (p < 0.01) and switched from this preferred reward to the chow sooner than saline-pretreated rats (p < 0.05). This effect was not consistent with general reward devaluation or loss of motivation.	These findings demonstrate that mAMPH exposure and withdrawal lead to steeper discounting of reward value by effort, an effect that is consistent with the effect of mAMPH on discounting by delay, and which may reflect an underlying shared mechanism.	
28543944	The anterior cingulate cortex (ACC) is known to be involved in effortful choice, yet its role in cost-benefit evaluation of qualitatively different rewards (more/less preferred), beyond magnitude differences (larger/smaller), is poorly understood. Selecting between qualitatively different options is a decision type commonly faced by humans. Here, we assessed the role of ACC on a task that has primarily been used to probe striatal function in motivation. Rats were trained to stable performance on a progressive ratio schedule for sucrose pellets and were then given sham surgeries (control) or excitotoxic NMDA lesions of ACC. Subsequently, a choice was introduced: chow was concurrently available while animals could work for the preferred sucrose pellets. ACC lesions produced a significant decrease in lever presses for sucrose pellets compared to control, whereas chow consumption was unaffected. Lesions had no effect on sucrose pellet preference when both options were freely available. When laboratory chow was not concurrently available, ACC-lesioned rats exhibited similar lever pressing as controls. During a test under specific satiety for sucrose pellets, ACC-lesioned rats also showed intact devaluation effects. The effects of ACC lesions in our task are not mediated by decreased appetite, a change in food preference, a failure to update value or a learning deficit. Taken together, we found that ACC lesions decreased effort for a qualitatively preferred option. These results are discussed with reference to effects of striatal manipulations and our recent report of a role for basolateral amygdala in effortful choice.
28529018	Previous research has implicated the positive modulation of anandamide, an endocannabinoid neurotransmitter, on feeding behavior. Anandamide is particularly noteworthy as it acts as an endogenous ligand of the CB1 receptor, the same receptor that is activated by tetrahydrocannabinol, the primary psychoactive component in Cannabis sativa. Cannabis legalization in North America has presented with a need to study endocannabinoid agonists and their effects on behavior. Much has yet to be determined in terms of the role of the endocannabinoid system in decision-making scenarios. The research presented here tested the hypothesis that anandamide would augment motivation and reward processing via appetitive and consummatory measures during an operant, foraging task. A three-box design was used in order to provide the animals with a free choice, exploratory foraging environment. Discrimination, preference, and incentive contrast were analyzed as discrete measures of decision-making in the three-box paradigm. Anandamide administration (1mg/kg) was found to significantly increase motivation for the optimal foraging outcome and alter basic processing of reward information involved in discrimination and relative valuation. The positive effects of anandamide on eating behavior and motivation have implications toward possible treatment modalities for patient populations presenting with disorders of motivation. These findings suggest the need for continued investigation of the endocannabinoid system as a central component of motivated behavior.
28478374	promoting vaginal births after caesarean section (VBAC) for eligible women and increasing rates of successful VBACs are the best strategies to reduce the number of repeat caesarean sections (CS). Knowledge of factors that are associated with women's decision-making around mode of birth after CS is important when developing strategies to promote VBAC. This study assessed which factors are associated with women's preferences for VBAC versus elective repeat caesarean section (ERCS) in a new pregnancy after one previous caesarean in Switzerland.cross-sectional web-survey.	Western Switzerland.	French-speaking women living in Western Switzerland, with one previous CS who gave birth subsequently to a child after a complication-free pregnancy were eligible to participate in the survey. Of 393 women who started the survey in November/December 2014, 349 were included: 227 who planned a VBAC and 122 who planned an ERCS at term.	univariable and multivariable analyses were conducted to describe and compare women who had planned a VBAC with women who had planned an ERCS in a pregnancy following a CS. Logistic regression modelling was used to investigate predictors that were associated with a preference for a VBAC at term. Analyses were performed with SPSS 22 and Stata 13.	of the women planning a VBAC, 62.6% VBAC gave birth vaginally. Predictors which were significantly associated with increased odds of women choosing a VBAC: duration since previous birth in years (OR=1.11 95% CI [1.03-1.20], p=0.010), having had midwifery care during pregnancy (OR=2.09, 95% CI [1.08-4.05], p=0.029), being advised by their healthcare provider to attempt a VBAC (OR=4.20, 95% CI [1.75-10.09], p=0.001), preference for VBAC during the third trimester of their pregnancy (OR=3.98, 95% CI [1.77-8.93], p=0.001), and wishing to let the child choose the moment of birth (OR=1.46, 95% CI[1.22-1.74], p<0.001). The importance of safety for the mother decreased the odds of women preferring a VBAC (OR=0.74, 95% CI [0.60-0.90], p=0.003) while a motivation for more immediate bonding with the baby after birth increased the odds of preferring a VBAC at term (OR=1.25, 95% CI [1.06-1.46], p=0.007).	caregivers' recommendations about mode of birth after CS, women's preferences during the third trimester and midwifery care during pregnancy were found to be the most important predictors for preferring a VBAC at term. These results indicate that midwifery antenatal care might be a key factor for fostering women's preference for a VBAC.	women with a history of CS who feel ambivalent about the mode of birth are likely to benefit from access to midwifery support.	
28466068	Animal models of decision-making rely on an animal's motivation to decide and its ability to detect differences among various alternatives. Food reinforcement, although commonly used, is associated with problematic confounds, especially satiety. Here, we examined the use of brain stimulation reward (BSR) as an alternative reinforcer in rodent models of decision-making and compared it with the effectiveness of sugar pellets. The discriminability of various BSR frequencies was compared to differing numbers of sugar pellets in separate free-choice tasks. We found that BSR was more discriminable and motivated greater task engagement and more consistent preference for the larger reward. We then investigated whether rats prefer BSR of varying frequencies over sugar pellets. We found that animals showed either a clear preference for sugar reward or no preference between reward modalities, depending on the frequency of the BSR alternative and the size of the sugar reward. Overall, these results suggest that BSR is an effective reinforcer in rodent decision-making tasks, removing food-related confounds and resulting in more accurate, consistent, and reliable metrics of choice.
28294136	Modifying behavior to maximize reward is integral to adaptive decision-making. In rodents, the μ-opioid receptor (MOR) system encodes motivation and preference for high-value rewards. Yet it remains unclear whether and how human MORs contribute to value-based decision-making. We reasoned that if the human MOR system modulates value-based choice, this would be reflected by opposite effects of agonist and antagonist drugs. In a double-blind pharmacological cross-over study, 30 healthy men received morphine (10 mg), placebo, and the opioid antagonist naltrexone (50 mg). They completed a two-alternative decision-making task known to induce a considerable bias towards the most frequently rewarded response option. To quantify MOR involvement in this bias, we fitted accuracy and reaction time data with the drift-diffusion model (DDM) of decision-making. The DDM analysis revealed the expected bidirectional drug effects for two decision subprocesses. MOR stimulation with morphine increased the preference for the stimulus with high-reward probability (shift in starting point). Compared to placebo, morphine also increased, and naltrexone reduced, the efficiency of evidence accumulation. Since neither drug affected motor-coordination, speed-accuracy trade-off, or subjective state (indeed participants were still blinded after the third session), we interpret the MOR effects on evidence accumulation efficiency as a consequence of changes in effort exerted in the task. Together, these findings support a role for the human MOR system in value-based choice by tuning decision-making towards high-value rewards across stimulus domains.
28274654	R**esults from animal gambling models have highlighted the importance of dopaminergic neurotransmission in modulating decision making when large sucrose rewards are combined with uncertainty. The majority of these models use food restriction as a tool to motivate animals to accomplish operant behavioral tasks, in which sucrose is used as a reward. As enhanced motivation to obtain sucrose due to hunger may impact its reward-seeking effect, we wanted to examine the decision-making behavior of rats in a situation where rats were fed ad libitum. For this purpose, we chose alcohol-preferring AA (alko alcohol) rats, as these rats have been shown to have high preference for sweet agents. In the present study, AA rats were trained to self-administer sucrose pellet rewards in a two-lever choice task (one pellet vs. three pellets). Once rational choice behavior had been established, the probability of gaining three pellets was decreased over time (50%, 33%, 25% then 20%). The effect of d-amphetamine on decision making was studied at every probability level, as well as the effect of the dopamine D1 receptor agonist SKF-81297 and D2 agonist quinpirole at probability levels of 100% and 25%. d-Amphetamine increased unprofitable choices in a dose-dependent manner at the two lowest probability levels. Quinpirole increased the frequency of unprofitable decisions at the 25% probability level, and SKF-82197 did not affect choice behavior. These results mirror the findings of probabilistic discounting studies using food-restricted rats. Based on this, the use of AA rats provides a new approach for studies on reward-guided decision making.
28209705	To explore patients' perspectives on care received from diabetes education teams (a registered nurse and a registered dietitian) integrated into primary care.Qualitative study using semistructured, one-on-one interviews.	Three diabetes education programs operating in 11 primary care sites in one region of Ontario.	Twenty-three patients with diabetes.	Purposeful sampling was used to recruit participants from each site for interviews. Educator teams invited patients with whom they had met at least once to participate in semistructured interviews. Data were analyzed using thematic analysis with NVivo 11 software.	The diabetes education teams integrated into primary care exhibited many of the principles of person-centred care, as evidenced by the 2 overarching themes. The first is personalized care, with the subthemes care environment, shared decision making, and patient preference for one-on-one care. Participants described feeling included in partnerships with their health care providers, as they collaborated with physicians and diabetes educators to develop knowledge and set goals in the convenience and comfort of their usual primary care settings. Many participants also expressed a preference for one-on-one sessions. The second theme is patient-provider relationship, with the subthemes respect, supportive interaction, and facilitating patient engagement. Supportive environments created by the educators built trusting relationships, where patients expressed enhanced motivation to improve their self-care.	Diabetes educators integrated into primary care can serve to enrich the experience of patients, provide key education to improve patient understanding, and support primary care physicians in providing timely and comprehensive clinical care. Diabetes patients appear to benefit from convenient access to interprofessional teams of educators in primary care to support diabetes self-management.	
28098523	Based on theoretical and empirical similarities between Construal level theory of psychological distance and the Need for cognitive closure (NFC) theory, it could be hypothesized that psychological distance and NFC represent constructs that overlap to some degree. Since both theories describe judgmental behavior in terms of schematic processing, we hypothesized that primacy effect, a schema-driven phenomenon, is strengthened under the heightened NFC and psychological distance. We tested this hypothesis in an impression formation experiment while manipulating psychological distance and measuring NFC. Low NFC and psychological closeness reflect preference for situationally specific, contextually rich information, and therefore their joint effect resulted in reliance on all available information regardless of their position in a sequence. High NFC and psychological distance produced a preference for clear, schematic, stable knowledge, and therefore weighed first information more, which resulted in the primacy effect.
28083675	Motivated behavior can be characterized by a substantial exertion of effort, and organisms often make effort-related decisions based upon analyses of work-related response costs and reinforcement preference. Moreover, alterations in effort-based choice can be seen in people with major depression and schizophrenia. Effort-related decision making is studied using tasks offering choices between high effort options leading to highly valued reinforces vs low effort/low reward options. Interference with dopamine (DA) transmission by administration of the DA D2 family antagonist haloperidol biases behavior towards the lower effort option that can be obtained with minimal work, and previous research has shown that DA interacts with other transmitters, including adenosine and GABA, to regulate effort-based choice.The present studies focused upon the ability of the glycine transport inhibitor bitopertin to attenuate haloperidol-induced shifts in effort-related choice behavior.	Effort-based choice in rats was assessed using the concurrent fixed ratio (FR) 5/chow feeding choice task and the T-maze barrier choice procedure.	Haloperidol shifted effort-based choice, biasing animals towards the low effort option in each task. Co-administration of bitopertin (1.0-10.0 mg/kg) significantly attenuated haloperidol-induced shifts in choice behavior, but the same doses of bitopertin had no effect when administered alone.	These results indicated that elevation of extracellular glycine via inhibition of glycine uptake was able to reverse the effects of D2 antagonism. Increases in extracellular glycine, possibly through actions on the glycine allosteric site on the NMDA receptor, may be a useful strategy for treating motivational dysfunctions in humans.	
27984049	Dopamine is known to influence motivational processes, however the precise role of this neurotransmitter remains a contentious issue. In the current study we sought to further characterize dopamine signaling in reward-based decision-making and consummatory behavior in mice, via lateral ventricle infusion of the dopamine D2 receptor antagonist eticlopride. In Experiment 1, we examined effort-based decision-making, in which mice had a choice between one lever, where a single response led to the delivery of a low value reward (2% sucrose); and a second lever, which led to a higher value reward (20% sucrose) that gradually required more effort to obtain. As the response schedule for the high value reward became more strict, low dose (4μg in 0.5μl) central infusions of eticlopride biased preference away from the high value reward, and toward the lever that led to the low value reward. Similarly, a higher dose of eticlopride (8μg in 0.5μl) also disrupted choice responding for the high value reward, however it did so by increasing omissions. In Experiment 2, we assessed the effects of eticlopride on consumption of 20% sucrose. The antagonist led to a dose-dependent reduction in intake, and through an analysis of licking microstructure, it was revealed that this in part reflected a reduction in the motivation to engage in consummatory behavior, rather than alterations in the evaluation of the reward. These results suggest that disruptions in D2 receptor signaling reduce the willingness to engage in effortful operant responding and consumption of a desirable outcome.
27969575	Contralateral prophylactic mastectomy (CPM) reduces the risk of contralateral breast cancer (BC) following unilateral BC, but may not increase survival in BRCA1/2 mutation negative women. Despite this, and the risk for adverse physical and psychological impact, uptake is increasing in BRCA1/2 mutation negative women. We aimed to quantify the degree of reduction in lifetime contralateral BC risk women required to justify CPM, and to explore demographic, disease and psychosocial predictors of preferences using Protection Motivation Theory (PMT) as a theoretical framework. Reasoning behind preferences was also examined.388 women previously diagnosed with unilateral BC, of negative or unknown BRCA1/2 status, were recruited from an advocacy group research database. Two hypothetical risk trade-off scenarios were used to quantify the reduction in lifetime contralateral BC risk that women judged necessary to justify CPM, using a 5% and 20% baseline. Demographic, disease and PMT measures were assessed using a questionnaire.	Most women required their risk to be more than halved from a 5% or 20% baseline to justify CPM. Polarised preferences were also common, with some women consistently accepting or refusing CPM independent of risk/benefit trade-offs. Preferences were associated with coping self-efficacy and having a prior CPM. Explanations for judging CPM worthwhile included reducing or eliminating contralateral BC risk, attaining breast symmetry and reducing worry.	Risk-reduction preferences were highly variable. Decisive factors in women's preferences for CPM related to clinical, psychological and cosmetic outcomes, but not to demographic or disease characteristics.	
27943064	Attention-deficit/hyperactivity disorder (ADHD) is characterized by deficits in impulse control across a range of behaviors, from simple actions to those involving complex decision-making (e.g., preference for smaller-sooner versus larger later rewards). This study investigated whether changes in motor response control with increased cognitive load and motivational contingencies are associated with decision-making in the form of delay discounting among 8-12 year old children with and without ADHD. Children with ADHD (n = 26; 8 girls) and typically developing controls (n = 40; 11 girls) completed a standard go/no-go (GNG) task, a GNG task with motivational contingencies, a GNG task with increased cognitive load, and two measures of delay discounting: a real-time task in which the delays and immediately consumable rewards are experienced in real-time, and a classic task involving choices about money at longer delays. Children with ADHD, particularly girls, exhibited greater delay discounting than controls during the real-time discounting task, whereas diagnostic groups did not significantly differ on the classic discounting task. The effect of cognitive load on response control was uniquely associated with greater discounting on the real-time task for children with ADHD, but not for control children. The effect of motivational contingencies on response control was not significantly associated with delay discounting for either diagnostic group. The findings from this study help to inform our understanding of the factors that influence deficient self-control in ADHD, suggesting that impairments in cognitive control may contribute to greater delay discounting in ADHD.
27935269	To analyze motivation, food self-administration and decision-making were evaluated in adolescent, adult, and aged rats. Subjects were trained to press a lever (fixed ratio, FR1 and FR5) in an operant chamber, to obtain chocolate flavor pellets. They assessed the progressive ratio (PR), extinction, and reinstatement of the behavior. To estimate decision-making for food, rats were trained in the conditioned place preference (CPP) paradigm: (a) associating one compartment with lab chow (LCh) one day and the other compartment with rice krisspies (RK), the next day. (b) Training similar to (a) but on the day RK was the reinforcer, it was delivered with a progressive delay. In addition, CB1 and CB2 receptor expression in the nucleus accumbens (NAcc) and prefrontal cortex (PFC) was estimated by means of Western blot. Adolescent rats consumed higher amounts of RK/body weight than adult and aged rats during FR1, FR5, and PR. Extinction was more prolonged for adolescent rats than for adult and aged rats. First CPP condition, all three groups of rats preferred the RK-associated compartment. Second CPP condition, adolescent rats developed equal preference to both compartments, while adult and aged rats preferred the RK-associated compartment. Rats per group ate a similar amount of either reinforcer. Adolescent rats exhibited low expression of CB1R in the NAcc and low expression of both CB1R and CB2R in the PFC compared with adult and aged rats. Adolescent rats display higher motivation for palatable food and an indiscriminate seeking behavior suggesting involvement of both homeostatic and hedonic systems in their decision-making processes. © 2016 Wiley Periodicals, Inc. Develop Neurobiol 77: 917-927, 2017.
27926450	In the past, medicine was dominated by acute diseases. Since treatments were unknown to patients they followed their medical doctors´ directives-at least for the duration of the disease. Behavior was thus largely motivated by avoiding expected costs associated with alternative behaviors (I-must). The health challenges prevailing today are chronic conditions resulting from the way we chose to live. Traditional directive communication has not been successful in eliciting and maintaining appropriate lifestyle changes. An approach successful in other fields is to motivate behavior by increasing expected rewards (I-want). Drawing on neuroeconomic and marketing research, we outline strategies including simplification, repeated exposure, default framing, social comparisons, and consumer friendliness to foster sustained changes in preference. We further show how these measures could be integrated into the health care system.
27926437	Motivation is a complex neurobiological process that initiates, directs, and maintains goal-oriented behavior. Although distinct components of motivated behavior are difficult to investigate, appetitive and consummatory phases of motivation are experimentally separable. Different neurotransmitter systems, particularly the mesolimbic dopaminergic system, have been associated with food motivation. Over the last two decades, however, research focusing on the role of opioid signaling has been particularly growing in this area. Opioid receptors seem to be involved, via neuroanatomically distinct mechanisms, in both appetitive and consummatory aspects of food reward. In the present chapter, we review the pharmacology and functional neuroanatomy of opioid receptors and their endogenous ligands, in the context of food reinforcement. We examine literature aimed at the development of laboratory animal techniques to better understand different components of motivated behavior. We present recent data investigating the effect of opioid receptor antagonists on food preference and effort-related decision making in rats, which indicate that opioid signaling blockade selectively affects intake of relatively preferred foods, resulting in reduced willingness to exert effort to obtain them. Finally, we elaborate on the potential role of opioid system manipulations in disorders associated with excessive eating and obesity.
27676193	Correct inhaler technique can increase medication efficacy, reducing both dose and side effects. Patient preference for inhaler device has not been fully explored, and we hypothesized that if patients have a preference and can choose their inhaler, they might be more likely to use it correctly. Our aim was to determine the preferences, attitudes, and perceptions of patients with asthma toward their inhalers, and to evaluate whether any of these factors were related to inhalation technique.Twenty-five patients with asthma (mean age 43.1 years) participated. Qualitative semi-structured interviews and quantitative patient satisfaction and preference questionnaires (PASAPQ) were used to explore patients' preferences, attitudes, and perceptions about their inhalers. Objective inhalation technique assessment was performed. Data were triangulated to identify characteristics that could indicate a relationship between inhaler technique, satisfaction, preference, and decision making.	Themes from qualitative interviews were as follows: asthma inhalers and expectations; inhaler preference; characteristics of an ideal inhaler; perceived effectiveness of inhalers; and inhalers and patient decision making. PASAPQ scores indicated that all patients were at least "somewhat satisfied" with their inhalers, regardless of technique. Only 12% of inhalers were used correctly, despite pilot PASAPQ data suggesting that most patients were confident with their technique. The inhaler technique was unlikely to be related to satisfaction, perception of inhaler devices, or choice in device selection. Patients with correct inhaler technique were more aware of their asthma and expressed motivation to achieve optimal asthma control.	The majority of the asthmatic patients did not use their inhaler(s) correctly, despite most having confidence in their technique. Patients attributed confidence in their inhaler technique to their belief that their inhaler was effective. Most patients had not been involved in decision making about which inhalation device to use. These findings highlight the lack of understanding of the important role of correct inhaler technique in asthma management.	
27630611	People's preferences for risks have been a subject of interest to researchers in both the economy and psychology fields over the last few years. This has given rise to many important findings about the role of psychological factors that influence people's choices. The presented studies focused on the role of motivational systems (described by Higgins in the Regulatory Focus Theory) in explaining people's financial choices. The main goal was to examine the relationship between people's chronic promotion and prevention motivational system and their propensity to (1) invest, (2) undertake investment risks, and (3) assume financial risks in gambling tasks in both the gain and loss decision-making frame. Moreover, we aimed to investigate how chronic motivational systems confronted with situationally induced promotion and prevention motivation would affect people's propensity to invest and embrace financial risks. Two CAWI studies on a Polish national representative sample (N 1 = 1093; N 2 = 1096) were conducted. The second study consisted of two waves with a 2-week break. The studies provided evidence of higher chronic promotion motivation as well as higher prevention motivation associated with the propensity to invest; however, induced promotion motivation results in a lower propensity to invest compared to induced prevention motivation. Participants with an activated promotion system built more risky portfolios than individuals with an induced prevention system. Moreover, participants with a low chronic promotion system built more risky portfolios than individuals with a high promotion motivation system as long as their prevention system was also low. In terms of gambling decisions in both the gain and loss frame, a higher level of chronic promotion motivation and situationally induced promotion motivation were related to the preference for the non-sure option over the sure one. 
27593494	To develop a list of non-emergent, potentially harmful interventions commonly performed in ICUs that require a clear understanding of patients' treatment goals.A 2016 policy statement from the American Thoracic Society and American College of Critical Care Medicine calls on intensivists to engage in shared decision-making when "making major treatment decisions that may be affected by personal values, goals, and preferences."	A three-round modified Delphi consensus process was conducted via a panel of 6 critical care physicians, 6 ICU nurses, 6 former ICU patients, and 6 family members from 6 academic and community-based medical institutions in the U.S. mid-Atlantic region.	Recommendations about 8 interventions achieved consensus among respondents.	Clinical and patient/family participants in a modified Delphi consensus process were able to identify preference-sensitive decisions that should trigger clinicians to clarify patient goals and consider initiating shared decision-making.	
27590594	Randomised controlled trials (RCTs) often fail to recruit sufficient participants, despite altruism being cited as their motivation. Previous investigations of factors influencing participation decisions have been methodologically limited. This study evaluated how women weigh up different motivations after initially expressing altruism, and explored their understanding of a trial and its alternatives. The trial was the 'Quality of Life after Mastectomy and Breast Reconstruction' (QUEST) trial.Thirty-nine women participated in qualitative interviews 1 month post-surgery. Twenty-seven women (10 trial decliners and 17 acceptors) who spontaneously mentioned 'altruism' were selected for thematic analysis. Verbatim transcripts were coded independently by two researchers. Participants' motivations to accept or decline randomisation were cross-referenced with their understanding of the QUEST trials and the process of randomisation.	The seven emerging themes were: (1) altruism expressed by acceptors and decliners; (2) overriding personal needs in decliners; (3) pure altruism in acceptors; (4) 'hypothetical altruism' amongst acceptors; (5) weak altruism amongst acceptors; (6) conditional altruism amongst acceptors; and (7) sense of duty to participate. Poor understanding of the trial rationale and its implications was also evident.	Altruism was a motivating factor for participation in the QUEST randomised controlled trials where the main outcomes comprised quality of life and allocated treatments comprised established surgical procedures. Women's decisions were influenced by their understanding of the trial. Both acceptors and decliners of the trial expressed 'altruism', but most acceptors lacked an obvious treatment preference, hoped for personal benefits regarding a treatment allocation, or did not articulate complete understanding of the trial.	QUEST A, ISRCTN38846532 ; Date assigned 6 January 2010. QUEST B, ISRCTN92581226 ; Date assigned 6 January 2010.	
27555829	Recent work has found that personality factors that confer vulnerability to addiction can also affect learning and economic decision making. One personality trait which has been implicated in vulnerability to addiction is intolerance to uncertainty (IU), i.e., a preference for familiar over unknown (possibly better) options. In animals, the motivation to obtain drugs is often assessed through conditioned place preference (CPP), which compares preference for contexts where drug reward was previously received. It is an open question whether participants with high IU also show heightened preference for previously rewarded contexts. To address this question, we developed a novel computer-based CPP task for humans in which participants guide an avatar through a paradigm in which one room contains frequent reward (i.e., rich) and one contains less frequent reward (i.e., poor). Following exposure to both contexts, subjects are assessed for preference to enter the previously rich and previously poor room. Individuals with low IU showed little bias to enter the previously rich room first, and instead entered both rooms at about the same rate which may indicate a foraging behavior. By contrast, those with high IU showed a strong bias to enter the previously rich room first. This suggests an increased tendency to chase reward in the intolerant group, consistent with previously observed behavior in opioid-addicted individuals. Thus, the personality factor of high IU may produce a pre-existing cognitive bias that provides a mechanism to promote decision-making processes that increase vulnerability to addiction. 
27529090	Most women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women's intentions to undergo CPM.Three hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group's research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario.	PMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM's advantages) and response costs (CPM's disadvantages) were unique individual predictors of intentions.	Decision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors.	Patients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.	
27497935	Motivational dysfunctions such as anergia, fatigue, and reduced effort expenditure are common in patients with depression and other disorders. Pro-inflammatory cytokines are implicated in depression, and cytokine administration induces motivational deficits in humans.These studies focused on the effects of the cytokine interleukin-6 (IL-6) on effort-related decision-making.	Rats were assessed using the concurrent fixed ratio 5-lever pressing/chow feeding choice procedure, which measures the tendency of rats to work for a preferred food (high carbohydrate pellets) in the presence of a concurrently available but less preferred substitute (lab chow).	IL-6 (2.0-8.0 μg/kg IP) shifted choice behavior, significantly decreasing lever pressing and increasing chow intake. Further experiments showed that the adenosine A2A antagonist MSX-3 and the stimulant methylphenidate attenuated the effort-related impairments produced by IL-6, increasing lever pressing and decreasing chow intake in IL-6 treated rats. The same doses of IL-6 did not alter food intake or preference in parallel free-feeding choice studies, demonstrating that these low doses were not altering preference for the high carbohydrate pellets or generally suppressing appetite. Also, IL-6 did not affect body temperature. Microdialysis studies showed that 8.0 μg/kg IL-6 significantly decreased extracellular dopamine in nucleus accumbens core.	In summary, IL-6 reduces the tendency to work for food, even at low doses that do not produce fever or loss of appetite. Dopaminergic mechanisms may be involved in these effort-related effects. This research has implications for the involvement of cytokines in motivational dysfunctions such as anergia and fatigue.	
27418069	Gambling is a harmless, recreational pastime that is ubiquitous across cultures. However, for some, gambling becomes a maladaptive and compulsive, and this syndrome is conceptualized as a behavioural addiction. Laboratory models that capture the key cognitive processes involved in gambling behaviour, and that can be translated across species, have the potential to make an important contribution to both decision neuroscience and the study of addictive disorders. The Iowa gambling task has been widely used to assess human decision-making under uncertainty, and this paradigm can be successfully modelled in rodents. Similar neurobiological processes underpin choice behaviour in humans and rats, and thus, a preference for the disadvantageous "high-risk, high-reward" options may reflect meaningful vulnerability for mental health problems. However, the choice behaviour operationalized by these tasks does not necessarily approximate the vulnerability to gambling disorder (GD) per se. We consider a number of psychological challenges that apply to modelling gambling in a translational way, and evaluate the success of the existing models. Heterogeneity in the structure of gambling games, as well as in the motivations of individuals with GD, is highlighted. The potential issues with extrapolating too directly from established animal models of drug dependency are discussed, as are the inherent difficulties in validating animal models of GD in the absence of any approved treatments for GD. Further advances in modelling the cognitive biases endemic in human decision-making, which appear to be exacerbated in GD, may be a promising line of research. 
26927320	Feeding experiences with low-quality foods can be improved when these foods are ingested in close temporal association with foods of higher nutritional quality. However, preference for low-quality foods in nature seems to be rather insensitive to past positive experiences and more related to their intrinsic nutritional value. An explanation for this observation is still lacking, mainly because little is known about how herbivores use information about low-quality foods during foraging. Our objective was to provide original information about this issue using a small ruminant (sheep; Ovis aries) as animal model. We manipulated the sheep's experience with a low-quality food (wheat straw) using a conditioning procedure ("oral-delay conditioning procedure"), and then we evaluated the use of this information in a simulated foraging scenario provided with wheat straw and a variable amount of a high-quality food in spatially separated feeding stations. Inclusion of wheat straw into the diet was strongly dependent on the availability of the high-quality food. We observed a threshold level in the availability of the high-quality food, which defined a zone of drastic change in the likelihood of inclusion of the wheat straw into the diet (i.e., acceptance or rejection of wheat straw). This threshold level did not change for sheep with (CS+) or without (CS-) a previous positive experience with wheat straw. However, once foraging conditions stimulated all sheep to start including the wheat straw into the diet (i.e., below the threshold level), the intake of this food was greater by CS+ sheep. This increased intake was not explained by a higher motivation to eat the wheat straw but to a greater amount of time spent foraging this food and less time spent searching for the preferred higher-quality alternative. We discuss these results based on optimal foraging models and learning models of diet selection. 
26840853	The study objective was to examine factors that influence African American (AA) family members' end-of-life care decision outcomes for a relative who recently died from serious illness.A cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales.	Family members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict.	This research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs' preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.	
26752394	When patients are not able to speak for themselves, surrogate decision makers are asked to guide treatment decisions and formulate a plan of care in accordance with what the patients would have wanted. This necessitates an exploration into the patients' views about life and how it should be lived, how the patients constructed their identity or life story, and their attitudes towards sickness and suffering. When an individual appoints a surrogate, such as a healthcare power of attorney, a common presumption is that this designation evinces merit. This obscures the possibility of multiple other considerations that influence individual choice. This article presents a clinical case in which the claim to know someone best created a controversy that brought treatment decisions to a standstill. Further, it illuminates how the question, "Given the current medical condition, what would this person want?" risks presuming that a singular, unambiguous preference exists and that one person can provide the answer. Clinical ethicists can play a vital role in situations when there is a dispute among a designated surrogate and family members over a patient's preference. By embracing the complexity of the desire to synthesize seemingly irreconcilable perspectives about identity, uncovering the reasons that underlie disagreement, and guiding inquiry in such a way that allows stakeholders to move beyond the conflict, clinical ethicists can facilitate decision making that honors the patient and may mitigate moral distress. 
26716987	The aim of this study was to assess the extent to which Need for Cognitive Closure (NCC), an individual-level epistemic motivation, can explain inter-individual variability in the cognitive effort invested on a perceptual decision making task (the random motion task). High levels of NCC are manifested in a preference for clarity, order and structure and a desire for firm and stable knowledge. The study evaluated how NCC moderates the impact of two variables known to increase the amount of cognitive effort invested on a task, namely task ambiguity (i.e., the difficulty of the perceptual discrimination) and outcome relevance (i.e., the monetary gain associated with a correct discrimination). Based on previous work and current design, we assumed that reaction times (RTs) on our motion discrimination task represent a valid index of effort investment. Task ambiguity was associated with increased cognitive effort in participants with low or medium NCC but, interestingly, it did not affect the RTs of participants with high NCC. A different pattern of association was observed for outcome relevance; high outcome relevance increased cognitive effort in participants with moderate or high NCC, but did not affect the performance of low NCC participants. In summary, the performance of individuals with low NCC was affected by task difficulty but not by outcome relevance, whereas individuals with high NCC were influenced by outcome relevance but not by task difficulty; only participants with medium NCC were affected by both task difficulty and outcome relevance. These results suggest that perceptual decision making is influenced by the interaction between context and NCC. 
26703458	The Analytic Hierarchy Process (AHP), developed by Saaty in the late 1970s, is one of the methods for multi-criteria decision making. The AHP disaggregates a complex decision problem into different hierarchical levels. The weight for each criterion and alternative are judged in pairwise comparisons and priorities are calculated by the Eigenvector method. The slowly increasing application of the AHP was the motivation for this study to explore the current state of its methodology in the healthcare context.A systematic literature review was conducted by searching the Pubmed and Web of Science databases for articles with the following keywords in their titles or abstracts: "Analytic Hierarchy Process," "Analytical Hierarchy Process," "multi-criteria decision analysis," "multiple criteria decision," "stated preference," and "pairwise comparison." In addition, we developed reporting criteria to indicate whether the authors reported important aspects and evaluated the resulting studies' reporting.	The systematic review resulted in 121 articles. The number of studies applying AHP has increased since 2005. Most studies were from Asia (almost 30%), followed by the US (25.6%). On average, the studies used 19.64 criteria throughout their hierarchical levels. Furthermore, we restricted a detailed analysis to those articles published within the last 5 years (n = 69). The mean of participants in these studies were 109, whereas we identified major differences in how the surveys were conducted. The evaluation of reporting showed that the mean of reported elements was about 6.75 out of 10. Thus, 12 out of 69 studies reported less than half of the criteria.	The AHP has been applied inconsistently in healthcare research. A minority of studies described all the relevant aspects. Thus, the statements in this review may be biased, as they are restricted to the information available in the papers. Hence, further research is required to discover who should be interviewed and how, how inconsistent answers should be dealt with, and how the outcome and stability of the results should be presented. In addition, we need new insights to determine which target group can best handle the challenges of the AHP.	
26655156	Leadership is widespread across the animal kingdom. In self-organizing groups, such as fish schools, theoretical models predict that effective leaders need to balance goal-oriented motion, such as toward a known resource, with their tendency to be social. Increasing goal orientation is predicted to increase decision speed and accuracy, but it is also predicted to increase the risk of the group splitting. To test these key predictions, we trained fish (golden shiners, Notemigonus crysoleucas) to associate a spatial target with a food reward ("informed" individuals) before testing each singly with a group of eight untrained fish who were uninformed ("naive") about the target. Informed fish that exhibited faster and straighter paths (indicative of greater goal orientation) were more likely to reach their preferred target and did so more quickly. However, such behavior was associated with a tendency to leave untrained fish behind and, therefore, with failure to transmit their preference to others. Either all or none of the untrained fish stayed with the trained fish in the majority of trials. Using a simple model of self-organized coordination and leadership in groups, we recreate these features of leadership observed experimentally, including the apparent consensus behavior among naive individuals. Effective leadership thus requires informed individuals to appropriately balance goal-oriented and socially oriented behavior. 
26640444	In social interactions, individuals may sometimes pursue their own interests at the expense of their interaction partner. Such self-interested behaviors impose a threat to the interaction partner's freedom to act. The current article investigates this threat in the context of interdependence and reactance theory. We explore how vested interests influence reactance process stages of an advisor-client interaction. We aim to explore the interactional process that evolves. In two studies, participants took the perspective of a doctor (advisor) or a patient (client). In both studies we incorporated a vested interest. In Study 1 (N = 82) we found that in response to a vested interest of their interaction partner, patients indicated a stronger experience of reactance, more aggressive behavioral intentions, and more biased cognitions than doctors. A serial multiple mediation revealed that a vested interest engendered mistrust toward the interaction partner and this mistrust led to an emerging reactance process. Study 2 (N = 207) further demonstrated that doctors expressed their reactance in a subtle way: they revealed a classic confirmation bias when searching for additional information on their preliminary decision preference, indicating stronger defense motivation. We discuss how these findings can help us to understand how social interactions develop dynamically. 
26571285	The aim of this systematic review is to establish the best available evidence of the effectiveness of health literacy interventions on the informed consent process for health care users. The specific review question is:What is the effectiveness of health literacy interventions on health care users' informed consent to health procedures processes?Informed consent is a fundamental principal in the health care context which nowadays includes the patient's capacity to judge and to be involved in the decision making concerning their care that ensures that the care received reflects their goals, preferences and values. The importance of obtaining a valid consent before any medical procedure is well-established. In a US court case in 1914, it was stated that it is the right of any adult with the capability of making decisions concerning his own body, and that any surgical operation without the patient's consent could be considered as an assault. In another US court case, the court stated that it is a doctor's duty to make a reasonable disclosure to his patient of the nature, probable consequences and dangers of the proposed treatment to the patient. The application of the doctrine of informed consent as a legal procedure may slightly differ from country to country or from state to state, and may have different forms even within the same country. For example in the UK, consent can be written, verbal or non-verbal/implied, and a written consent form is not the actual consent itself but merely serves as evidence that consent has been given. If the elements of voluntariness, appropriate information and capacity have not been satisfied, a signed informed consent form will not make the consent valid. Nowadays it is widely accepted that prior to the application of any medical procedure, its benefits, risks and alternatives must have been explained to the patient, and the competent patient should have voluntarily and understandingly consented. Hence, the informed consent refers both to the health professional's obligation of information disclosure to the patient and to the quality of the patient's understanding and decision making. In other words, it does not refer to the single moment of the agreement, but to the whole complex process of gaining information, deciding and consenting. Several factors may restrict informed consent, including the patient's competence, provision of limited information, ineffective communication between patients and professionals, the hospital environment itself and privacy problems.According to the World Health Organization (WHO), people are increasingly urged to make choices for themselves or for their family members in regards to health care use. However, at the same time, inadequate or problematic health literacy skills have been reported in approximately half of the adult population in eight European countries. "Health literacy is linked to literacy and entails people's knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgments and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course". There are many instruments measuring either health literacy in general or some dimensions of health literacy (e.g. numeracy), health literacy related to specific issues (e.g. nutrition, diabetes) or health literacy of specific populations (e.g. adolescents). The diversity of existing instruments, which includes diversity in terms of scoring and ranges, makes the comparison of the results of different studies difficult. Index thresholds and ranges for different levels of health literacy for most tools were set based either on that of other well established health literacy instruments used in the same study, or on experts' assessments of the required health literacy scores. Adequate health literacy could be considered as the capacity of successfully completing most tasks required to function in the health care setting.Low or inadequate health literacy has been found to have several adverse effects on health and health care use: reduced ability to take medications properly and to interpret labels and health messages, poorer overall health status and higher risk of mortality in seniors, increased emergency department and hospital use, and decreased use of preventive interventions.Most studies examining the relationship between health literacy and informed consent conclude that patients with low health literacy are less likely to participate in decision making concerning their health care. According to a recent literature review, health care users' literacy, together with other factors, were found to be important determinants of a patient's capacity to provide fully informed consent. According to this review, 21 to 86% of the patients were able to recall the potential risks and complications of their medical procedure. This percentage may be even lower because most of the included studies referred to self-reported recall, which may be a flawed measure. According to the literature, much of the written material related to the informed consent is too difficult for health care users to understand. In addition, in their study, McCarthy et al. observed that during consultations, physicians spoke and used significantly more complex language than their patients, which may result in inappropriate communication for the patients, mainly for those with limited literacy. The situations described above may raise a number of critical legal and ethical problems. Health professionals, who shape the conditions of interactions with the patient, are responsible for adapting appropriate interventions, such as communication approaches that take into account patients' health literacy. These interventions could have a major contribution to the improvement of the informed consent process.Sheridan et al. conducted a systematic review on interventions designed to reduce the effects of limited health literacy in general. Some of the outcomes of the included studies were comprehension and behavioral intent, outcomes which could be strongly related to the informed consent process. Without making any distinction of the studies referring to the informed consent process, they conclude that several health literacy interventions, for example, adding video to narrative, could improve an individual's comprehension. Schenker et al. conducted a systematic review on the interventions to improve patient comprehension of medical and surgical procedures, including articles published until 2008. One of their conclusions was that, in most studies, while particular attention is needed for interventions provided to patients with limited literacy, the literacy of the patients was not addressed or assessed.Since then, many articles on health literacy and informed consent have been published. According to a recent review on best practices and new models of health literacy for informed consent, which includes papers published from 2004 to 2014, over half of the collected articles were published since 2010. This review, which is limited to literature within the US and its territories, and does not focus on the evaluation of the recommended practices in the literature, concludes that different tactics for simplifying written documents and clarifying verbal exchanges, and the use of multimedia formats and computerized exchanges might ameliorate constraints to health literate communications required for informed consent.Studies have evaluated the effectiveness of health literacy interventions which aim to improve the informed consent process. Improvement of the informed consent process may refer not only to the patients' comprehension but also, for example, to the recall of the information provided, to their intention to ask for clarifications, or to their satisfaction with the procedure. Interventions described and tested in the literature focus on the improvement of the print material, the process (e.g. the communication of the appropriate information) or both. Davis et al. conducted a randomized controlled trial to compare two polio vaccine pamphlets written at a sixth grade level - an international standardized pamphlet and an easy-to-read pamphlet - for the comprehension and preference among parents. Although the parents in the intervention group (N=304) achieved significantly higher comprehension than the control group (N=306) (65% vs 60%, p<0.005), the authors concluded that simplifying written material increases appeal but not the comprehension to an adequate level without use of instructional graphics. Similarly, Lorenzen et al. found that a reader friendly informed consent document to surgical procedures was more commonly read by the health care users as compared to the original consent document; however, no difference was found in terms of the participants' capacity to describe the procedure in their own words. Kang et al. evaluated recall and comprehension of orthodontic informed consent among pairs of children and their parents (N=90) applying three different informed consent procedures. According to this study, a combination of improving the readability of consent materials and the informed consent process (audio and visual cues) led to better recall for the patients and better recall and comprehension for their parents compared to an improved readability form or the usual informed consent form. Smith et al. used a randomized controlled trial to compare a decision aid (booklet and DVD) specifically designed for adults with low literacy skills (N=357) with a standard information booklet (N=173) on screening for bowel cancer. They found that the proportion of participants making an informed choice was 22% higher in the intervention group than in the control group (34% vs 12%, P<0.001). Matsuyama et al. (ABSTRACT TRUNCATED)	
26554387	Mesolimbic dopamine (DA) regulates behavioral activation and effort-related decision-making in motivated behaviors. Mesolimbic DA D2 receptors are co-localized with adenosine A2A receptors, and they interact in an antagonistic manner.A T-maze task was developed to assess dopaminergic involvement in preference between a reinforcer that involves vigorous voluntary activity (running wheel) and a reinforcer that requires minimal behavioral activation (sucrose pellets). Haloperidol (D2 antagonist) was administered to adenosine A2A receptor knockout (A2AKO) and wild-type (WT) littermate controls to assess the involvement of these two receptors in the selection of running wheel activity versus sucrose consumption.	Under control conditions, mice spent more time running and less time eating. In WT mice, haloperidol reduced time running but actually increased time-consuming sucrose. However, A2AKO mice did not show the haloperidol-induced shift from running wheel activity to sucrose intake. Prefeeding reduced sucrose consumption in the T-maze in both strains, indicating that this paradigm is sensitive to motivational devaluation. Haloperidol increased c-Fos immunoreactivity in anterior cingulate cortex (ACg) and nucleus accumbens (Acb) core of WT but not KO mice.	These results indicate that after DA antagonism, the preference for vigorous physical activity is reduced, while palatable food selection increases. Adenosine A2A receptor deletion provides resistance to these effects of D2 receptor antagonism. These two receptors in Acb core and ACg seem to be involved in the regulation of the intrinsic reinforcing characteristics of voluntary exercise but not in the regulation of the primary reinforcing characteristics of palatable sedentary reinforcers.	
26493973	The resolution of an approach-avoidance conflict induced by ambivalent information involves the appraisal of the incentive value of the outcomes and associated stimuli to orchestrate an appropriate behavioral response. Much research has been directed at delineating the neural circuitry underlying approach motivation and avoidance motivation separately. Very little research, however, has examined the neural substrates engaged at the point of decision making when opposing incentive motivations are experienced simultaneously. We hereby examine the role of the dorsal and ventral hippocampus (HPC) in a novel approach-avoidance decision making paradigm, revisiting a once popular theory of HPC function, which posited the HPC to be the driving force of a behavioral inhibition system that is activated in situations of imminent threat. Rats received pre-training excitotoxic lesions of the dorsal or ventral HPC, and were trained to associate different non-spatial cues with appetitive, aversive and neutral outcomes in three separate arms of the radial maze. On the final day of testing, a state of approach-avoidance conflict was induced by simultaneously presenting two cues of opposite valences, and comparing the time the rats spent interacting with the superimposed 'conflict' cue, and the neutral cue. The ventral HPC-lesioned group showed significant preference for the conflict cue over the neutral cue, compared to the dorsal HPC-lesioned, and control groups. Thus, we provide evidence that the ventral, but not dorsal HPC, is a crucial component of the neural circuitry concerned with exerting inhibitory control over approach tendencies under circumstances in which motivational conflict is experienced.
26481449	A preference for "naturals" over "strivers" in performance judgments was investigated to test whether the effect is generalizable across domains, as well as to ascertain any costs imposed on decision quality by favoring naturals. Despite being presented with entrepreneurs equal in achievement, participants judged the natural and his business proposal to be superior to the striver and his proposal on multiple dimensions of performance and success (Study 1a and Study 1b). These findings were extended in Study 2, which quantified the costs of the naturalness bias using conjoint analysis to measure specific decision tradeoffs. Together, these three studies show that people tend to pass over better-qualified individuals in favor of apparent naturals. 
26463543	We use an application-files experimental design to investigate a new topic in the assessment of candidates for junior-engineering jobs. Our focus is on two semi-finalists, a man and a woman, who show clearly different but still good levels of academic record. We keep the gap between those levels constant, but vary the sex category of the better performer. We also include control conditions in which the two have similar records. Each assessor's task was to choose either one applicant or neither, and to rate both in competence and suitability. The control-group competence ratings indicate no gender bias by either men or women; the experimental-conditions competence data are consistent with the candidates' records as predicted, but also show women minimizing the record of the better-performing male candidate. Choice and suitability, on the other hand, reveal a preference for the female applicant across respondents and conditions, as anticipated given the more open nature of those two questions, while still reflecting the academic records. Findings and their interpretation are presented in detail. 
26456353	The prefrontal cortex (PFC) is critical for higher-order cognitive functions, including decision-making. In psychiatric conditions such as schizophrenia, prefrontal dysfunction co-occurs with pronounced alterations in decision-making ability. These alterations include a diminished ability to utilize probabilistic reinforcement in guiding future choice, and a reduced willingness to expend effort to receive reward. Among the neurochemical abnormalities observed in the PFC of individuals with schizophrenia are alterations in the production and function of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). To probe how PFC GABA hypofunction may contribute to alterations in cost/benefit decision-making, we assessed the effects GABAA-receptor antagonist bicuculline (BIC; 50 ng in 0.5 μl saline/hemisphere) infusion in the medial PFC of rats during performance on a series of well-validated cost/benefit decision-making tasks. Intra-PFC BIC reduced risky choice and reward sensitivity during probabilistic discounting and decreased the preference for larger rewards associated with a greater effort cost, similar to the behavioral sequelae observed in schizophrenia. Additional experiments revealed that these treatments did not alter instrumental responding on a progressive ratio schedule, nor did they impair the ability to discriminate between reward and no reward. However, BIC induced a subtle but consistent impairment in preference for larger vs. smaller rewards of equal cost. BIC infusion also increased decision latencies and impaired the ability to "stay on task" as indexed by reduced rates of instrumental responding. Collectively, these results implicate prefrontal GABAergic dysfunction as a key contributing factor to abnormal decision-making observed in schizophrenia and other neuropsychiatric conditions with similar neurobiological and behavioral alterations.
26301954	Men, like the male of many animal species, use gifts to build satisfactory relationships with a desired woman. From the woman's perspective, all gifts are not always equally rewarding; the reward value of a gift depends on two factors: (1) the giver and (2) the type of the gift (the gift's social meaning). In this study, we investigated how these two factors interactively determine the reward value of a gift. Specifically, we examined how the neural processing for understanding a gift's social meaning is modulated by preferences for the giver. We performed a functional magnetic resonance imaging (fMRI) study in which a female participant was asked to judge a gift from a male she was acquainted with in real life. We examined the interactive effects between (1) the female participant's attitude toward the male acquaintance (liked vs. uninteresting) and (2) the type of the gift (romantic [e.g., bouquet, earrings, and perfumes] vs. non-romantic [e.g., pencils, memo pad, and moneybox]). We found that preference for an acquaintance selectively modulated activity in the anterior cingulate cortex (ACC) in response to romantic gifts, compared to non-romantic gifts. In contrast, if the woman was indifferent toward an acquaintance, no activity modulation was observed in this area for the same gifts. In addition, the ACC showed functional connectivity with the supplementary motor area/dorsal ACC (SMA/dACC), an area within the dorsal mediofrontal cortex, suggesting that it integrates action monitoring and emotional and cognitive processing in decision-making. These results suggest that attitude toward an opposite sex member has a modulatory role in recognizing the social meaning of material goods--preference for the member is a powerful modulator of social reward processing.
26254238	To evaluate the effectiveness of patient decision aids (PtDA) compared to usual education on appropriate and timely access to total joint arthroplasty in patients with osteoarthritis.A randomized controlled trial (RCT) with patients undergoing orthopedic screening. Control and intervention arms received usual education; intervention arm also received a PtDA and a surgeon preference report. Wait times (primary outcome) were described using stratified Kaplan-Meier survival curves with patients censored at the time of death or loss to follow-up, and multivariable Cox proportional hazards regression. Secondary outcomes were compared using stratified Cochran-Mantel-Haenszel chi-squared tests.	343 patients were randomized to intervention (n = 174) or control (n = 169). The typical patient was 66 years old, retired, living with someone, and 51% had high school education or less. The intervention was associated with a trend towards reduction in wait time (hazard ratio (HR) 1.25, 95% confidence interval (CI) 0.99-1.60, P = 0.0653). Median wait times were 3 weeks shorter in intervention than in control at the community site with no difference at the academic site. Good decision quality was reached by 56.1% intervention and 44.5% control (Relative risk (RR) 1.25; 95% CI 1.00-1.56, P = 0.050). Surgery rates were 73.2% intervention and 80.5% controls (RR 0.91: 95% CI 0.81-1.03) with 12 intervention (7.3%) and eight control participants (4.9%) returning to have surgery within 2 years (P = 0.791).	Compared to controls, decision aid recipients had shorter wait times at one site, fewer surgeries, and were more likely to reach good decision quality, but overall effect was not statistically significant.	
26230746	Drivers' risk-taking is a key issue of road safety. This study explored individual differences in drivers' decision-making, linking external behaviours to internal neural activity, to reveal the cognitive mechanisms of risky driving. Twenty-four male drivers were split into two groups (risky vs. safe drivers) via the Drivier Behaviour Questionnaire-violation. The risky drivers demonstrated higher preference for the risky choices in the paradigms of Iowa Gambling Task and Balloon Analogue Risk Task. More importantly, the risky drivers showed lower amplitudes of feedback-related negativity (FRN) and loss-minus-gain FRN in both paradigms, which indicated their neural processing of error-detection. A significant difference of P300 amplitudes was also reported between groups, which indicated their neural processing of reward-evaluation and were modified by specific paradigm and feedback. These results suggested that the neural basis of risky driving was the decision patterns less revised by losses and more motivated by rewards.Risk-taking on the road is largely determined by inherent cognitive mechanisms, which can be indicated by the behavioural and neural patterns of decision-making. In this regard, it is feasible to quantize drivers’ riskiness in the cognitive stage before actual risky driving or accidents, and intervene accordingly.	
26219396	The self-positivity bias, which is inherent to healthy people, is known to be blunted in depression. The lack of positive or excessive negative self-reference is considered to be a potential mechanism underlying depressive rumination. However, the motivational factors that drive people to approach and avoid emotional self-related materials are still unclear. Therefore, we measured intrinsic motivation that is associated with emotional self-references by using a reward-based decision-making task (pay-per-view paradigm). Forty-nine undergraduates completed two tasks in which they were asked to choose between negative vs. positive references (Task 1) and self vs. other references (Task 2) for variable monetary rewards. Participants with lower levels of depressive symptoms showed a self-positivity bias, sacrificing rewards for the opportunity to engage in positive self-reference, whereas those with higher levels of depressive symptoms had no specific preference for either negative or positive self-reference (Task 1). However, all participants sacrificed monetary rewards for the opportunity for self-reference versus other reference, regardless of the symptom level or the primed valence (Task 2). Together, these findings suggest that depressive cognition could be characterised by the lack of intrinsic motivation for positive self-reference, which is attributable to the biased valence selection, but not to self-other preferences.
26156636	Touchscreens are widely used to examine rodent cognition. Current paradigms require animals to view stimuli and nose poke at an appropriate touchscreen location. After responding, there is little screen interaction and, as infra-red touchscreens eliminate the need for physical contact, minimal somatosensory feedback. It is therefore unclear if touchscreens can support the vigorous, repetitive responding required in paradigms like progressive ratio (PR) for assessing motivation and effort-related choice (ERC) for assessing decision-making.This study aims to adapt and validate PR and ERC for the rodent touchscreen.	Male C57Bl/6 mice were trained until responding on PR stabilised. Amphetamine, sulpiride and raclopride were administered via the intraperitoneal route to modify performance. Mice were transferred to ERC and paradigm parameters adjusted to demonstrate behavioural modification. ERC reward preference was assessed by home cage choice analysis.	PR performance stabilised within seven sessions. Amphetamine (1 mg/kg) increased and raclopride (0.3 mg/kg) decreased performance by 63 and 28 %, respectively, with a 20-min injection-test interval. Sulpiride (50 mg/kg) decreased performance by 19 % following a 40-min injection-test interval. Increasing ERC operant requirements shifted responding from the operant response-dependent preferred reward towards the freely available alternative.	Vigorous, repetitive responding is sustainable in touchscreen PR and ERC and task validation mirrors non-touchscreen versions. Thus, motivation and reward-related decision-making can be measured directly with touchscreens and can be evaluated prior to cognitive testing in the same apparatus to avoid confounding by motivational factors.	
26156579	Researchers using an achievement goal theory and caring climate framework have highlighted the connection between fitness center members' climate perceptions and their exercise motivation. However, much of what is known comes from current members, with little known about former and non-members' perceptions. The purpose of this study was to compare current, former, and non-members' perceptions of the motivational climate of a university campus fitness facility. Faculty and staff ( N = 657) at a large American university completed a one-time mixed-methods survey about their perceptions of the motivational climate (i.e. caring climate; preference for caring, task-, ego-involving climate), staff behaviors (i.e. caring, task involving), and usage of their campus fitness facility. Despite usage, quantitative analyses indicated that all participants reported valuing a caring, task-involving climate over a non-caring, ego-involving climate when choosing a fitness center. When asked about the particular fitness center for this study, current members were more likely than former and never users to perceive a caring climate where staff engaged in task-involving behaviors. Content analysis of the qualitative comments revealed that three main themes emerged with regard to perceptions and fell into positive, negative, and neutral categories. Overall, current users were more likely to perceive caring behaviors among the staff such as taking measures to welcome members and supporting their individualized goals. Former and never users were more likely to perceive staff as unhelpful, unwelcoming, and unfriendly. In an effort to remove barriers to physical activity, fitness professionals should consider how their behaviors, interactions, and promotional materials impact individuals' decision of whether to exercise at their fitness facility. The findings include a discussion for fitness staff to consider when creating advertisement and outreach efforts as well as how to foster the most effective climate to attract and retain exercisers.
26140930	This pilot study explored the feasibility and acceptability of a stage-tailored motivational interviewing intervention with education that focuses on changes in end-of-life (EOL) communication, completion of advance directives (ADs), and readiness for advance care planning (ACP).One group pretest-posttest design was implemented with 30 low-income older adults.	This pilot study showed its feasibility in enhancing ACP. Action for ACP-that is, identifying a proxy for decision making and documenting EOL treatment preference in an AD-increased significantly by 23.3% (n = 7). The participants' readiness for ACP, knowledge, self-efficacy, positive attitudes, and perceived importance of ACP increased significantly after the intervention.	Health care professionals and service providers who interact with older adults should tailor ACP dialogues in accordance with individuals' motivation.	
26122606	The uneven distribution of allied health professionals (AHPs) in rural and remote Australia and other countries is well documented. In Australia, like elsewhere, service delivery to rural and remote communities is complicated because relatively small numbers of clients are dispersed over large geographic areas. This uneven distribution of AHPs impacts significantly on the provision of services particularly in areas of special need such as mental health, aged care and disability services.This study aimed to determine the relative importance that AHPs (physiotherapists, occupational therapists, speech pathologists and psychologists - "therapists") living in a rural area of Australia and working with people with disability, place on different job characteristics and how these may affect their retention.	A cross-sectional survey was conducted using an online questionnaire distributed to AHPs working with people with disability in a rural area of Australia over a 3-month period. Information was sought about various aspects of the AHPs' current job, and their workforce preferences were explored using a best-worst scaling discrete choice experiment (BWSDCE). Conditional logistic and latent class regression models were used to determine AHPs' relative preferences for six different job attributes.	One hundred ninety-nine AHPs completed the survey; response rate was 51 %. Of those, 165 completed the BWSDCE task. For this group of AHPs, "high autonomy of practice" is the most valued attribute level, followed by "travel BWSDCE arrangements: one or less nights away per month", "travel arrangements: two or three nights away per month" and "adequate access to professional development". On the other hand, the least valued attribute levels were "travel arrangements: four or more nights per month", "limited autonomy of practice" and "minimal access to professional development". Except for "some job flexibility", all other attributes had a statistical influence on AHPs' job preference. Preferences differed according to age, marital status and having dependent children.	This study allowed the identification of factors that contribute to AHPs' employment decisions about staying and working in a rural area. This information can improve job designs in rural areas to increase retention.	
26065910	Novelty seeking (NS) is a personality trait reflecting excitement in response to novel stimuli. High NS is usually a predictor of risky behaviour such as drug abuse. However, the relationships between NS and risk-related cognitive processes, including individual risk preference and the brain activation associated with risk prediction, remain elusive. In this fMRI study, participants completed the Tridimensional Personality Questionnaire to measure NS and performed a probabilistic decision making task. Using a mathematical model, we estimated individual risk preference. Brain regions associated with risk prediction were determined via fMRI. The NS score showed a positive correlation with risk preference and a negative correlation with the activation elicited by risk prediction in the right posterior insula (r-PI), left anterior insula (l-AI), right striatum (r-striatum) and supplementary motor area (SMA). Within these brain regions, only the activation associated with risk prediction in the r-PI showed a correlation with NS after controlling for the effect of risk preference. Resting-state functional connectivity between the r-PI and r-striatum/l-AI was negatively correlated with NS. Our results suggest that high NS may be associated with less aversion to risk and that the r-PI plays an important role in relating risk prediction to NS. 
25957322	Intravaginal practices (IVPs) are associated with an increased risk of bacterial vaginosis and may play a role in HIV transmission. The objective of this study was to identify the importance of factors underlying the decision to engage in IVP using conjoint analysis; a novel statistical technique used to quantify health-related decisions. This study was a cross-sectional study. HIV-infected women in Zambia completed audio computer-administered self-interview questionnaires assessing demographic, risk factors and IVPs. Reasons for engaging in IVPs were explored using conjoint questionnaires. Conjoint analysis was used to identify the relative importance of factors for engaging in IVPs. Results of the conjoint analysis demonstrated that hygiene was the most important reason for engaging in IVPs (mean importance score = 61, SD = 24.3) followed by partner's preference (mean importance score = 20, SD = 14.4) and health (mean importance score = 17, SD = 13.5). When making the decision to engage in IVPs, women rank the importance of hygiene, partner preference and health differently, according to their personal characteristics. The use of conjoint analysis to define the characteristics of women more likely to engage in specific practices should be used to develop tailored rather than standardised IVP interventions, and such interventions should be incorporated into clinical practice and women's health programmes. 
25943702	The subthalamic nucleus (STN) has been argued to be an important component of reward-sensitive basal ganglia circuitry. This view is especially supported by the behavioral changes observed after STN inactivation, which could reflect impairments in the motivational control of action. However, it is still unclear how the STN integrates reward information and to what extent such integration correlates with behavior. In this study, the response properties of STN neurons in monkeys performing reaching movements with a cue predicting the identity of an upcoming liquid reward (juice or water) were investigated. Although the timing of movements reliably indicated that monkeys had greater motivation for juice than water, rarely did task-related changes in neuronal activity depend on the nature of the expected reward. Conversely, when presented with a choice of selecting a response that leads to juice or water delivery, animals showed a clear preference for juice and more than half of the neurons were differentially modulated dependent on the reward obtained, mostly after the monkeys's overt choice of action. Under such circumstances, an increase in activity specifically followed the action outcomes across the population of neurons when monkeys failed to choose the juice reward. These results indicate that STN neurons encode whether or not a preferred reward had been received when a choice between response alternatives is required. This differential neuronal activity might reflect the participation of the STN in evaluating the reward value of chosen actions, thus highlighting its contribution to decision-making processes. 
25943578	Efficacy of patient decision aids (PtDAs) may be influenced by trial participants' identity either as patients seeking to benefit personally from involvement or as volunteers supporting the research effort.To determine if study characteristics indicative of participants' trial identity might influence PtDA efficacy.	We undertook exploratory subgroup meta-analysis of the 2011 Cochrane review of PtDAs, including trials that compared PtDA with usual care for treatment decisions. We extracted data on whether participants initiated the care pathway, setting, practitioner interactions, and 6 outcome variables (knowledge, risk perception, decisional conflict, feeling informed, feeling clear about values, and participation). The main subgroup analysis categorized trials as "volunteerism" or "patienthood" on the basis of whether participants initiated the care pathway. A supplementary subgroup analysis categorized trials on the basis of whether any volunteerism factors were present (participants had not initiated the care pathway, had attended a research setting, or had a face-to-face interaction with a researcher).	Twenty-nine trials were included. Compared with volunteerism trials, pooled effect sizes were higher in patienthood trials (where participants initiated the care pathway) for knowledge, decisional conflict, feeling informed, feeling clear, and participation. The subgroup difference was statistically significant for knowledge only (P = 0.03). When trials were compared on the basis of whether volunteerism factors were present, knowledge was significantly greater in patienthood trials (P < 0.001), but there was otherwise no consistent pattern of differences in effects across outcomes.	There is a tendency toward greater PtDA efficacy in trials in which participants initiate the pathway of care. Knowledge acquisition appears to be greater in trials where participants are predominantly patients rather than volunteers.	
25917242	advance care planning (ACP) is a process to establish an individual's preference for care in the future; few UK studies have been conducted to ascertain public attitudes towards ACP.the aim of this study was to assess the attitudes of older people in East Midlands through the development and administration of a survey.	the survey questionnaire was developed on the basis of a literature review, exploratory focus groups with older adults and expert advisor input. The final questions were then re-tested with lay volunteers.	thirteen general practices were enrolled to send out surveys to potential participants aged 65 or older. There were no additional inclusion or exclusion criteria for participants.	simple descriptive statistics were used to describe the responses and regression analyses were used to evaluate which items predicted responses to key outcomes.	of the 5,375 (34%) community-dwelling older peoples, 1,823 returned questionnaires. Seventeen per cent of respondents had prepared an ACP document; of whom, 4% had completed an Advance Decision to Refuse Treatment (ADRT). Five per cent of respondents stated that they had been offered an opportunity to talk about ACP. Predictors of completing an ACP document included: being offered the opportunity to discuss ACP, older age, better physical function and male gender. Levels of trust were higher for families than for professionals. One-third of the respondents would be interested in talking about ACP if sessions were available.	although a third of the respondents were in favour of discussing ACP if the opportunity was available with their GP, only a relative minority (17%) had actively engaged. Preferences were for informal discussions with family rather than professionals.	
25894484	Research and theory suggest that emotional goals are increasingly prioritized with age. Related empirical work has shown that, compared with younger adults, older adults attend to and remember positive information more than negative information. This age-related positivity effect has been eliminated in experiments that have explicitly demanded processing of both positive and negative information. In the present study, we explored whether a reduction of the preference for positive information over negative information appears when the material being reviewed holds personal relevance for the individual. Older participants whose health varied from poor to very good reviewed written material prior to making decisions about health related and non-health-related issues. As predicted, older adults in relatively poor health (compared with those in relatively good health) showed less positivity in review of information while making health-related decisions. In contrast, positivity emerged regardless of health status for decisions that were unrelated to health. Across decision contexts, those individuals who focused more on positive information than negative information reported better postdecisional mood and greater decision satisfaction. Results are consistent with the theoretical argument that the age-related positivity effect reflects goal-directed cognitive processing and, furthermore, suggests that personal relevance and contextual factors determine whether positivity emerges.

25864420	The technologies currently available to detect the presence of foetal genetic abnormalities are complex, and undergoing prenatal diagnostic testing can have wide-ranging repercussions. Before individuals can decide with certainty whether or not to take these tests, they first need to grasp the many psychosocial and clinical dimensions of prenatal genetic testing.To test a model integrating key psychosocial and clinical factors as predictors of decisional conflict in decisions about whether or not to undergo prenatal genetic testing.	Adults (n = 457) read one of four hypothetical scenarios asking them to imagine expecting a child and considering the option of a prenatal test able to detect a genetic condition; age of condition onset (birth vs. adulthood) and its curability (no cure vs. curable) were manipulated. Participants completed measures of decisional conflict, perceived benefits from normal results, test response efficacy, condition coherence, child-related worry, perceived disagreement with the other parent's preference, motivation to comply with doctors' perceived preferences, and parity.	Prenatal testing decisional conflict was positively predicted by perceiving normal results as beneficial, doubting the test's reliability, lacking understanding of the genetic condition, worrying about the health of the foetus, perceiving differences of opinion from partner/spouse, wanting to follow doctors' preferences, and being childless.	These results, of growing relevance given the increasing availability of new technologies in pregnancy care, can inform communication strategies that facilitate couples' decision making.	This study provides insights into factors that might complicate prenatal testing decision making.	
25850959	The use of the conjugacy property for members of the exponential family of distributions is commonplace within Bayesian statistical analysis, allowing for tractable and simple solutions to problems of inference. However, despite a shared motivation, there has been little previous development of a similar property for using utility functions within a Bayesian decision analysis. As such, this article explores a class of utility functions that appear to be reasonable for modeling the preferences of a decisionmaker in many real-life situations, but that also permit a tractable and simple analysis within sequential decision problems. 
25813727	This article explores how structural factors associated with the profession and organization of medicine can constrain internal medicine residents, leading them to sometimes limit or terminate treatment in end-of-life care in ways that do not always embrace patient autonomy. Specifically, it examines the opportunities and motivations that explain why residents sometimes arrogate decision-making for themselves about life-sustaining treatment. Using ethnographic data drawn from over two years at an American community hospital, I contend that unlike previous studies which aggregate junior and senior physicians' perspectives, medical trainees face unique constraints that can lead them to intentionally or unintentionally overlook patient preferences. This is especially salient in cases where they misunderstand their patients' wishes, disagree about what is in their best interest, and/or lack the standing to pursue alternative ethical approaches to resolving these tensions. The study concludes with recommendations that take into account the structural underpinnings of arrogance in decision-making about life-sustaining treatment. 
25799355	Empirical findings on public goods dilemmas indicate an unresolved dilemma: that increasing size-the number of people in the dilemma-sometimes increases, decreases, or does not influence cooperation. We clarify this dilemma by first classifying public goods dilemma properties that specify individual outcomes as individual properties (e.g., Marginal Per Capita Return) and group outcomes as group properties (e.g., public good multiplier), mathematically showing how only one set of properties can remain constant as the dilemma size increases. Underpinning decision-making regarding individual and group properties, we propose that individuals are motivated by both individual and group preferences based on a theory of collective rationality. We use Van Lange's integrated model of social value orientations to operationalize these preferences as an amalgamation of outcomes for self, outcomes for others, and equality of outcomes. Based on this model, we then predict how the public good's benefit and size, combined with controlling individual versus group properties, produce different levels of cooperation in public goods dilemmas. A two (low vs. high benefit) by three (2-person baseline vs. 5-person holding constant individual properties vs. 5-person holding constant group properties) factorial experiment (group n = 99; participant n = 390) confirms our hypotheses. The results indicate that when holding constant group properties, size decreases cooperation. Yet when holding constant individual properties, size increases cooperation when benefit is low and does not affect cooperation when benefit is high. Using agent-based simulations of individual and group preferences vis-à-vis the integrative model, we fit a weighted simulation model to the empirical data. This fitted model is sufficient to reproduce the empirical results, but only when both individual (self-interest) and group (other-interest and equality) preference are included. Our research contributes to understanding how people's motivations and behaviors within public goods dilemmas interact with the properties of the dilemma to lead to collective outcomes. 
25766451	Individuals with a higher subjective discount rate concentrate more on the present and delay is more significant for them. However, when a risky asset is delayed, not only is the outcome delayed but also the risk. In this paper, we suggest a new, two-stage experimental method with real monetary incentives that allows us to distinguish between the effect of the risk and the effect of the time when pricing a risky asset. We show that when individuals have greater preference for the present, their risk aversion for a risky asset realized in the future decreases. We argue that the effect of the risk for future asset is lower for individuals with higher time preference because they discount not only the outcome but also the risks. 
25713474	Contrasting with separate-sexed animals, simultaneous hermaphrodites display unique reproductive strategies as they are male and female at the same time. Simultaneous hermaphrodites that copulate unilaterally, for instance, make a decision to mate as a male or female. Previous studies have demonstrated that sex role preference in hermaphrodites is flexible and is controlled by several, often confounding, factors. We examined the relationship between sex role decisions and 3 life-history traits (age, size, and mating history) in the great pond snail, Lymnaea stagnalis. Based on our field observations, which indicate that adult individuals show overlapping generations and large variation in body size during the breeding season, we performed a sex role choice experiment in the laboratory. We found that young and small snails mate as males first. Both age and size significantly affected sex role decision, with age having a stronger effect. Furthermore, we tested whether L. stagnalis becomes reluctant to inseminate a mate after being inseminated because it is known that after insemination, male investment substantially reduces. Contrary to expectations, our results indicate that the receipt of seminal fluid does not seem to reduce male motivation. In sum, sex role decisions in L. stagnalis are largely determined by age and size but not by having received seminal fluid. This mating pattern, however, does not fully support the size-advantage model because large or old individuals did not perform better as females in our experiment. These results imply a conflicting mating interest, rather than harmonious agreement, between age- and size-different hermaphrodites.

25647696	Low doses of dopamine (DA) antagonists and accumbens DA depletions reduce food-reinforced instrumental behavior but do not impair primary food motivation, causing animals to reallocate behavior away from food-reinforced tasks with high response requirements and select less effortful alternatives. However, it is uncertain if this same pattern of effects would occur if sucrose was used as the reinforcer.These experiments studied the impact of DA depletion and antagonism on performance of an effort-related choice task using sucrose as the reinforcer, as well as sucrose consumption, preference, and taste reactivity tests.	The effects of DA manipulations were assessed using a task in which rats chose between lever pressing on a fixed ratio 7 schedule for 5.0 % sucrose versus freely consuming a less concentrated solution (0.3 %).	The DA depleting agent tetrabenazine shifted effort-related choice, decreasing lever pressing for 5.0 % sucrose but increasing intake of the concurrently available 0.3 % sucrose. Tetrabenazine did not affect sucrose appetitive taste reactivity, or sucrose consumption or preference, in free consumption tests. The D1 antagonist ecopipam and the D2 antagonist haloperidol also shifted choice behavior at doses that did not alter sucrose consumption or preference. In contrast, sucrose pre-exposure reduced consumption across all conditions. D3 antagonism had no effects.	D1 and D2 receptor blockade and DA depletion reduce the tendency to work for sucrose under conditions that leave fundamental aspects of sucrose motivation (intake, preference, hedonic reactivity) intact. These findings have implications for studies employing sucrose intake or preference in animal models of depression.	
25632118	Drosophila melanogaster egg-laying site selection offers a genetic model to study a simple form of value-based decision. We have previously shown that Drosophila females consistently reject a sucrose-containing substrate and choose a plain (sucrose-free) substrate for egg laying in our sucrose versus plain decision assay. However, either substrate is accepted when it is the sole option. Here we describe the neural mechanism that underlies females' sucrose rejection in our sucrose versus plain assay. First, we demonstrate that females explored the sucrose substrate frequently before most egg-laying events, suggesting that they actively suppress laying eggs on the sucrose substrate as opposed to avoiding visits to it. Second, we show that activating a specific subset of DA neurons triggered a preference for laying eggs on the sucrose substrate over the plain one, suggesting that activating these DA neurons can increase the value of the sucrose substrate for egg laying. Third, we demonstrate that neither ablating nor inhibiting the mushroom body (MB), a known Drosophila learning and decision center, affected females' egg-laying preferences in our sucrose versus plain assay, suggesting that MB does not mediate this specific decision-making task. We propose that the value of a sucrose substrate- as an egg-laying option-can be adjusted by the activities of a specific DA circuit. Once the sucrose substrate is determined to be the lesser valued option, females execute their decision to reject this inferior substrate not by stopping their visits to it, but by actively suppressing their egg-laying motor program during their visits. 
25625894	Research on the neural efficiency hypothesis of intelligence (NEH) has revealed that the brains of more intelligent individuals consume less energy when performing easy cognitive tasks but more energy when engaged in difficult mental operations. However, previous studies testing the NEH have relied on cognitive tasks that closely resemble psychometric tests of intelligence, potentially confounding efficiency during intelligence-test performance with neural efficiency per se. The present study sought to provide a novel test of the NEH by examining patterns of prefrontal activity while participants completed an experimental paradigm that is qualitatively distinct from the contents of psychometric tests of intelligence. Specifically, participants completed a personal decision-making task (e.g., which occupation would you prefer, dancer or chemist?) in which they made a series of forced choices according to their subjective preferences. The degree of decisional conflict (i.e., choice difficulty) between the available response options was manipulated on the basis of participants' unique preference ratings for the target stimuli, which were obtained prior to scanning. Evoked oxygenation of the prefrontal cortex was measured using 16-channel continuous-wave functional near-infrared spectroscopy. Consistent with the NEH, intelligence predicted decreased activation of the right inferior frontal gyrus (IFG) during low-conflict situations and increased activation of the right-IFG during high-conflict situations. This pattern of right-IFG activity among more intelligent individuals was complemented by faster reaction times in high-conflict situations. These results provide new support for the NEH and suggest that the neural efficiency of more intelligent individuals generalizes to the performance of cognitive tasks that are distinct from intelligence tests. 
25575871	Based on social projection research, four studies investigated whether people rely on their own regulatory focus when making predictions about others. Chronic (Study 1) and induced (Study 2) regulatory focus shaped estimations of others' strategic promotion or prevention inclinations and choices between enriched (fitting promotion) and impoverished options (fitting prevention). Providing indirect process evidence via boundary conditions, participants only relied on their induced regulatory focus in predictions of others' inclinations to seek romantic alternatives to the extent that this did not run counter to stereotypic gender beliefs (Study 3). In addition, participants only relied on their induced regulatory focus in preference predictions concerning promotion and prevention products when they lacked idiosyncratic target knowledge (Study 4). These effects were not mediated by mood, judgment-certainty, perceived task-enjoyment, or task-difficulty. Implications of these findings for social projection research as well as possible interpersonal consequences are delineated. 
25454867	Health Authorities recommend annual vaccination of healthcare personnel (HCP) against influenza to protect vulnerable patients. Nevertheless, vaccination rates have been low among European HCP. Here we report on a longitudinal survey study to identify social cognitive predictors of the motivation to obtain influenza vaccination, and to test whether intention is a good predictor of actual vaccination behaviour. Dutch HCP (N=1370) were invited to participate in a survey (baseline). To link intention to behaviour, participants who completed the first survey (N=556) were sent a second survey after vaccinations were offered (follow-up). Multinominal regression analysis showed that HCP with a positive attitude and a higher frequency of past vaccinations were more likely to have a high intention to get vaccinated. A negative attitude, high feelings of autonomy in the decision whether to get vaccinated, a preference of inaction over vaccination, a lesser sense of personal responsibility, and high self-protection motives increased the probability of no intention to get vaccinated. Social cognitive predictors were identified that explain the intention to get vaccinated against influenza of HCP, which in turn proved to be a good predictor of behaviour. Future interventions should focus on these variables to increase vaccination coverage rates. 
25392118	The aim of this study is to gain insight into arthritis patients' motives for (not) wanting to be involved in medical decision-making (MDM) and the factors that hinder or promote patient involvement. In-depth semi-structured interviews were conducted with 29 patients suffering from Rheumatoid Arthritis (RA). Many patients perceived the questions about involvement in MDM as difficult, mostly because they were unaware of having a choice. Shared decision-making (SDM) was generally preferred, but the preferred level of involvement varied between and within individuals. Preference regarding involvement may vary according to the type of treatment and the severity of the complaints. A considerable group of respondents would have liked more participation than they had experienced in the past. Perceived barriers could be divided into doctor-related (e.g. a paternalistic attitude), patient-related (e.g. lack of knowledge) and context-related (e.g. too little time to decide) factors. This study demonstrates the complexity of predicting patients' preferences regarding involvement in MDM: most RA patients prefer SDM, but their preference may vary according to the situation they are in and the extent to which they experience barriers in getting more involved. Unawareness of having a choice is still a major barrier for patient participation. The attending physician seems to have an important role as facilitator in enhancing patient participation by raising awareness and offering options, but implementing SDM is a shared responsibility; all parties need to be involved and educated. 
25348470	Cooperation in one-shot anonymous interactions is a widely documented aspect of human behaviour. Here we shed light on the motivations behind this behaviour by experimentally exploring cooperation in a one-shot continuous-strategy Prisoner's Dilemma (i.e. one-shot two-player Public Goods Game). We examine the distribution of cooperation amounts, and how that distribution varies based on the benefit-to-cost ratio of cooperation (b/c). Interestingly, we find a trimodal distribution at all b/c values investigated. Increasing b/c decreases the fraction of participants engaging in zero cooperation and increases the fraction engaging in maximal cooperation, suggesting a role for efficiency concerns. However, a substantial fraction of participants consistently engage in 50% cooperation regardless of b/c. The presence of these persistent 50% cooperators is surprising, and not easily explained by standard models of social preferences. We present evidence that this behaviour is a result of social preferences guided by simple decision heuristics, rather than the rational examination of payoffs assumed by most social preference models. We also find a strong correlation between play in the Prisoner's Dilemma and in a subsequent Dictator Game, confirming previous findings suggesting a common prosocial motivation underlying altruism and cooperation. 
25344101	Evaluate baseline factors that may explain the influence of study site on decisional conflict (DC) in men from the Personal Patient Profile: Prostate (P3P) randomized trial.476 cases from 5 P3P sites were included. Participants completed baseline demographic assessments, 4 subscales of the DC scale at baseline (uncertainty, informed, values clarity, and support), the Expanded Prostate Cancer Index Composite (short form) and the State-Trait Anxiety Inventory. Site data regarding typical practices were collected. Linear regressions were used to model the relation between baseline DC scores and study site adjusting for the list of variables.	Baseline decisional uncertainly (p = 0.001) and informed (p = 0.03) subscales were significantly different across sites. Participant demographic and baseline measures were significantly different (p < 0.05) between sites except for trait anxiety. We identified participant level factors that explained study site differences at baseline for the decisional uncertainty and values clarity subscales: a preferred treatment choice at study entry, whether the study program was accessed at home vs. in clinic, number of doctors consulted pre-study, working status, state anxiety, information from the media or a health care provider, and perceived knowledge level. State anxiety was associated with higher DC across all subscales.	Individual characteristics of men seeking consultation for LPC were associated with DC at baseline, not the site alone; anxiety contributed to higher conflict. These findings will inform future development and implementation of the P3P and other decision support interventions.	
25331913	. Extensive use of unnecessary antibiotics has driven the emergence of resistant bacterial strains, posing a threat to public health. Physicians are more likely to prescribe antibiotics when they believe that patients expect them. Current attempts to change these expectations highlight the distinction between viruses and bacteria ("germs are germs"). Fuzzy-trace theory further predicts that patients expect antibiotics because they make decisions based on categorical gist, producing strategies that encourage risk taking when the status quo is bad (i.e., "why not take a risk?"). We investigate both hypotheses.. We surveyed patients visiting the emergency department of a large urban hospital (72 [64%] were African American) using 17 Likert scale questions and 2 free-response questions regarding patient expectations for antibiotics.	. After the clinical encounter, 113 patients completed the survey. Fifty-four (48%) patients agreed with items that assess the "germs are germs" hypothesis, whereas 86 (76%) agreed with items that assess the "why not take a risk?" hypothesis. "Why not take a risk?" captures significant unique variance in a factor analysis and is neither explained by "germs are germs" nor by patients' lack of knowledge regarding side effects. Of the 81 patients who rejected the "germs are germs" hypothesis, 61 (75%) still indicated agreement with the "why not take a risk?" hypothesis. Several other misconceptions were also investigated.	. Our findings suggest that recent public health campaigns that have focused on educating patients about the differences between viruses and bacteria omit a key motivation for why patients expect antibiotics, supporting fuzzy-trace theory's predictions about categorical gist. The implications for public health and emergency medicine are discussed.	
25328051	Successful decision making often requires weighing a given option's costs against its associated benefits, an ability that appears perturbed in virtually every severe mental illness. Animal models of such cost/benefit decision making overwhelmingly implicate mesolimbic dopamine in our willingness to exert effort for a larger reward. Until recently, however, animal models have invariably manipulated the degree of physical effort, whereas human studies of effort have primarily relied on cognitive costs. Dopamine's relationship to cognitive effort has not been directly examined, nor has the relationship between individuals' willingness to expend mental versus physical effort. It is therefore unclear whether willingness to work hard in one domain corresponds to willingness in the other. Here we utilize a rat cognitive effort task (rCET), wherein animals can choose to allocate greater visuospatial attention for a greater reward, and a previously established physical effort-discounting task (EDT) to examine dopaminergic and noradrenergic contributions to effort. The dopamine antagonists eticlopride and SCH23390 each decreased willingness to exert physical effort on the EDT; these drugs had no effect on willingness to exert mental effort for the rCET. Preference for the high effort option correlated across the two tasks, although this effect was transient. These results suggest that dopamine is only minimally involved in cost/benefit decision making with cognitive effort costs. The constructs of mental and physical effort may therefore comprise overlapping, but distinct, circuitry, and therapeutic interventions that prove efficacious in one effort domain may not be beneficial in another. 
25299258	Topic review.Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement.	Spinal disorders are common and are an important cause of pain and disability. Numerous complementary and competing treatment strategies are used to treat spinal disorders, and the costs of these treatments is substantial and continue to rise despite clear evidence of improved health status as a result of these expenditures.	The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgments and caveats to their use are presented.	Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested, and the role of prospective registries in measuring value is discussed.	Value can be measured in spine care through the use of appropriate economic measures and patient-reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives.	
25074724	The theory of motivated information management (TMIM) provides one framework to examine information-seeking behaviors, especially in conversations involving sensitive or difficult information such as preferences for end-of-life (EOL) care. The spouse plays a significant role in decision making surrounding EOL care. Consequently, individuals need information about spouses' EOL preferences in order to ensure carrying out those desires. Our findings support the value of TMIM as a framework to understand factors that influence couples' EOL care information-seeking behaviors. In support of the theory, we provide factors that influence the initiation or avoidance of EOL conversations between spouses. 
25030206	Decision-makers present a systematic tendency to avoid ambiguous options for which the level of risk is unknown. This ambiguity aversion is one of the most striking decision-making biases. Given that human choices strongly depend on the options' presentation, the purpose of the present study was to examine whether ambiguity aversion influences the framing effect during decision making. We designed a new financial decision-making task involving the manipulation of both frame and uncertainty levels. Thirty-seven participants had to choose between a sure option and a gamble depicting either clear or ambiguous probabilities. The results revealed a clear preference for the sure option in the ambiguity condition regardless of frame. However, participants presented a framing effect in both the risk and ambiguity conditions. Indeed, the framing effect was bidirectional in the risk condition and unidirectional in the ambiguity condition given that it did not involve preference reversal but only a more extreme choice tendency.
25006693	Low-income women have the lowest rates of breastfeeding in the United States. Greater understanding of factors that predict intention to feed artificial breastmilk substitute is needed to inform the design and timing of interventions to promote breastfeeding among vulnerable women. This study aimed to identify demographic and reproductive characteristics and other factors associated with intent to feed artificial breastmilk substitute among low-income women.Data from 520 low-income women interviewed at 24-41 weeks of gestation during enrollment in a prenatal breastfeeding education intervention study were analyzed. Participant characteristics, reasons for feeding decision, and sources and types of information received were compared among women intending to feed only artificial breastmilk substitute and other women.	Most participants (95%) had already chosen an infant feeding method at the time of interview. There were no differences in plans to return to work by feeding plan. Women reporting intention to feed only artificial breastmilk substitute were less likely to report receiving information about the benefits of breastfeeding, how to breastfeed, and pumps and were more likely to cite personal preference and convenience as reasons for their decision. Women were more likely to intend to feed artificial breastmilk substitute if they had a previous live birth or had not breastfed a child, including the most recent.	These findings suggest breastfeeding promotion should target women early and include sensitive, effective ways to promote breastfeeding among women who have not previously successfully breastfed. Breastfeeding history should be elicited, and plans to pump should be supported prenatally.	
25001954	Research in rodents and humans has shown divergent effects of the glucocorticoids corticosterone and cortisol (CRT) on reward processing. In rodents, administration of CRT increases reward drive by facilitating dopamine release in the ventral striatum. In humans, correspondingly, risky decision-making increases when CRT levels are elevated. Human stress studies contrariwise show that elevated CRT is accompanied by a decrease in reward-related brain activity. There are however no direct insights into how CRT acts on the reward system in the human brain. Accordingly, we used pharmacological functional magnetic resonance imaging (pharmaco-fMRI) to investigate the effects of CRT on the brain's reward system. In a randomized within-subject design we administered a high dose of CRT (40 mg) and placebo to twenty healthy male volunteers on separate days, and used a monetary incentive delay task to assess the effects of the hormone on the striatum and the amygdala in anticipation of potential reward. In contrast to animal studies, we show that this high dose of CRT strongly decreases activity of the striatum in both reward and non-reward conditions. Furthermore, we observed reductions in activity in the basolateral amygdala, a key regulator of the brain's reward system. Crucially, the overall down-regulation of the brain's reward circuit was verified on the subjective level as subjects reported significantly reduced reward preference after CRT. In sum, we provide here direct evidence in humans that CRT acts on brain regions involved in reward-related behavior, that is, the basolateral amygdala and the striatum. Our findings suggest that CRT in the quantity and time course presently used globally down-regulates the reward system, and thereby decreases motivational processing in general.
24989055	Students' motives for studying Dentistry have been a subject of interest for years because of the potential for understanding the psychological makeup and subsequent job satisfaction for the dentist. It is also useful in identifying expectations of the profession. This study therefore tried to identify study motives and career preferences of dental students especially with respect to the practice of paediatric dentistry.This was a cross-sectional study using a self-administered questionnaire. The final year students in six dental schools in Nigeria were required to fill the questionnaire. Students were asked to rank their motives and career preferences on a Likert like scale with points ranging from 0-5 where 0 represented a factor that had no influence on their decision and 5 represented a very influential factor. The underlying dimensions for study motives, career preference, impression about and motive for interest in the practice of paediatric dentistry were identified using factor analysis.	One hundred and seventy nine of 223 students (80.3%) participated in this study. Motives for the practice of dentistry included characteristics of the profession, altruism and intellectual challenges, existence of artistic theme in dentistry and parent's recommendation. Overall, 67.1% of respondents indicated interest in postgraduate studies and 50.8% were interested in paediatric dentistry practice. The main motives for showing interest in the practice of paediatric dentistry were 'personal interest, professional interest and interest of significant others in children', and 'family influence'. Significantly more males than females were interested in the practice of paediatric dentistry though the motives for interest in the practice of paediatric dentistry did not differ significantly by sex or age.	The non-significant sex difference in the motives for interest in the practice of paediatric dentistry is a possible reflection of changes in strong cultural themes in the motives for career choices in Nigeria.	
24964036	Patients are often encouraged to participate in treatment decision-making. Most studies on this subject focus on choosing between different curative treatment types. In the last phase of life treatment decisions differ as they often put more emphasis on weighing quantity against quality of life, such as whether or not to start treatment aimed at life prolongation but with the possibility of side effects. This study aimed to obtain insight into cancer patients' preferences and the reasons for patients' preferred role in treatment decision-making at the end of life.28 advanced cancer patients were included at the start of their first line treatment. In-depth interviews were held prior to upcoming treatment decisions whether or not to start a life prolonging treatment. The Control Preference Scale was used to start discussing the extent and type of influence patients wanted to have concerning upcoming treatment decision-making. Interviews were audio taped and transcribed.	All patients wanted their physician to participate in the treatment decision-making process. The extent to which patients themselves preferred to participate seemed to depend on how patients saw their own role or assessed their own capabilities for participating in treatment decision-making. Patients foresaw a shift in the preferred level of participation to a more active role depending in the later phase of illness when life prolongation would become more limited and quality of life would become more important.	Patients vary in how much involvement they would like to have in upcoming treatment decision-making. Individual patients' preferences may change in the course of the illness, with a shift to more active participation in the later phases. Communication about patients' expectations, wishes and preferences for participation in upcoming treatment decisions is of great importance. An approach in which these topics are openly discussed would be beneficial.	
24933694	People's expectations about the future are guided not just by the contingencies of situations but also by what they hope or wish will happen next. These preferences can inform predictions that run counter to what should or must occur based on the logic of unfolding events. Effects of this type have been regularly identified in studies of judgment and decision making, with individuals' choices often reflecting emotional rather than rational influences. Encouraging individuals to rely less on their emotional considerations has proven a challenge as affective responses are generated quickly and are seemingly informative for decisions. In 6 experiments we examined whether individuals could be encouraged to rely less on their affective preferences when making judgments about future events. Participants read stories in which contexts informed the likelihood of events in ways that might run counter to their preferential investments in particular outcomes. While being less than relevant given the logic of events, participants' affective considerations remained influential despite time allotted for predictive reflection. In contrast, instructional warnings helped attenuate the influence of affective considerations, even under conditions previously shown to encourage preferential biases. The findings are discussed with respect to factors that mediate preference effects, and highlight challenges for overcoming people's reliance on affective contributors to everyday judgments and comprehension.
24927494	A growing body of evidence indicates that integrating family planning (FP) services into HIV care is effective at improving contraceptive uptake among HIV-positive women in resource-poor settings, yet little research has examined HIV-positive men's experiences with such integration. We conducted in-depth interviews with 21 HIV-positive men seeking care at HIV clinics in Nyanza, Kenya. All clinics were intervention sites for a FP/HIV service integration cluster-randomized trial. Grounded theory was used to code and analyze the data. Our findings highlight men's motivations for FP, reasons why men prefer obtaining their FP services, which include education, counseling, and commodities, at HIV care clinics, and specific ways in which integrated FP/HIV services fostered male inclusion in FP decision-making. In conclusion, men appear invested in FP and their inclusion in FP decision-making may bolster both female and male agency. Men's positive attitudes towards FP being provided at HIV care clinics supports the programmatic push towards integrated delivery models for FP and HIV services.
24911320	Novelty seeking refers to the tendency of humans and animals to explore novel and unfamiliar stimuli and environments. The idea that dopamine modulates novelty seeking is supported by evidence that novel stimuli excite dopamine neurons and activate brain regions receiving dopaminergic input. In addition, dopamine is shown to drive exploratory behavior in novel environments. It is not clear whether dopamine promotes novelty seeking when it is framed as the decision to explore novel options versus the exploitation of familiar options. To test this hypothesis, we administered systemic injections of saline or GBR-12909, a selective dopamine transporter (DAT) inhibitor, to monkeys and assessed their novelty seeking behavior during a probabilistic decision making task. The task involved pseudorandom introductions of novel choice options. This allowed monkeys the opportunity to explore novel options or to exploit familiar options that they had already sampled. We found that DAT blockade increased the monkeys' preference for novel options. A reinforcement learning (RL) model fit to the monkeys' choice data showed that increased novelty seeking after DAT blockade was driven by an increase in the initial value the monkeys assigned to novel options. However, blocking DAT did not modulate the rate at which the monkeys learned which cues were most predictive of reward or their tendency to exploit that knowledge. These data demonstrate that dopamine enhances novelty-driven value and imply that excessive novelty seeking-characteristic of impulsivity and behavioral addictions-might be caused by increases in dopamine, stemming from less reuptake.
24865576	Gender bias continues to be a concern in many work settings, leading researchers to identify factors that influence workplace decisions. In this study we examine several of these factors, using an organizing framework of sex distribution within jobs (including male- and female-dominated jobs as well as sex-balanced, or integrated, jobs). We conducted random effects meta-analyses including 136 independent effect sizes from experimental studies (N = 22,348) and examined the effects of decision-maker gender, amount and content of information available to the decision maker, type of evaluation, and motivation to make careful decisions on gender bias in organizational decisions. We also examined study characteristics such as type of participant, publication year, and study design. Our findings revealed that men were preferred for male-dominated jobs (i.e., gender-role congruity bias), whereas no strong preference for either gender was found for female-dominated or integrated jobs. Second, male raters exhibited greater gender-role congruity bias than did female raters for male-dominated jobs. Third, gender-role congruity bias did not consistently decrease when decision makers were provided with additional information about those they were rating, but gender-role congruity bias was reduced when information clearly indicated high competence of those being evaluated. Fourth, gender-role congruity bias did not differ between decisions that required comparisons among ratees and decisions made about individual ratees. Fifth, decision makers who were motivated to make careful decisions tended to exhibit less gender-role congruity bias for male-dominated jobs. Finally, for male-dominated jobs, experienced professionals showed smaller gender-role congruity bias than did undergraduates or working adults.
24856850	Selective estrogen receptor modulators (SERMs) reduce breast cancer risk by 38%. However, uptake is low and the reasons are not well understood. This study applied protection motivation theory (PMT) to determine factors associated with intention to take SERMs.Women at increased risk of breast cancer (N=107), recruited from two familial cancer clinics in Australia, completed a questionnaire containing measures of PMT constructs. Hierarchical multiple linear regression analysis was used to analyze the data.	Forty-five percent of women said they would be likely or very likely to take SERMs in the future. PMT components accounted for 40% of variance in intention to take SERMs. Perceived vulnerability, severity and response efficacy appeared the most influential in women's decisions to take or not take SERMs.	Many women are interested in SERMs as a risk management option. Accurate risk estimation and an understanding of the benefits of SERMs are critical to women's decision making.	Health professionals need to explore women's perceptions of their risk and its consequences, as well as providing clear evidence-based information about the efficacy of SERMs. Exploring the source and strength of beliefs about SERMs may allow more effective, tailored counseling.	
24845527	Recent decision-making work has focused on a distinction between a habitual, model-free neural system that is motivated toward actions that lead directly to reward and a more computationally demanding goal-directed, model-based system that is motivated toward actions that improve one's future state. In this article, we examine how aging affects motivation toward reward-based versus state-based decision making. Participants performed tasks in which one type of option provided larger immediate rewards but the alternative type of option led to larger rewards on future trials, or improvements in state. We predicted that older adults would show a reduced preference for choices that led to improvements in state and a greater preference for choices that maximized immediate reward. We also predicted that fits from a hybrid reinforcement-learning model would indicate greater model-based strategy use in younger than in older adults. In line with these predictions, older adults selected the options that maximized reward more often than did younger adults in three of the four tasks, and modeling results suggested reduced model-based strategy use. In the task where older adults showed similar behavior to younger adults, our model-fitting results suggested that this was due to the utilization of a win-stay-lose-shift heuristic rather than a more complex model-based strategy. Additionally, within older adults, we found that model-based strategy use was positively correlated with memory measures from our neuropsychological test battery. We suggest that this shift from state-based to reward-based motivation may be due to age related declines in the neural structures needed for more computationally demanding model-based decision making. 
24776488	Some personality traits and comorbid psychiatric diseases are linked to a propensity for excessive alcohol drinking. The objective of this study was to investigate the association between individual differences in risk-related behaviors, voluntary alcohol intake and preference. Outbred male Wistar rats were tested in a novel open field, followed by assessment of behavioral profiles using the multivariate concentric square field (MCSF) test. Animals were classified into high risk taking and low risk taking on the basis of open-field behavior and into high risk-assessing (HRA) and low risk-assessing (LRA) on the basis of the MCSF profile. Finally, voluntary alcohol intake was investigated using intermittent access to 20% ethanol and water for 5 weeks. Only minor differences in voluntary alcohol intake were found between high risk taking and low risk taking. Differences between HRA and LRA rats were more evident, with higher intake and increased intake over time in HRA relative to LRA rats. Thus, individual differences in risk-assessment behavior showed greater differences in voluntary alcohol intake than risk taking. The findings may relate to human constructs of decision-making and risk taking associated with a predisposition to rewarding and addictive behaviors. Further studies are needed to clarify the relationship between risk-related behaviors, including risk-assessment behavior, and liability for excessive alcohol intake. 
24699673	Olfaction based behavioral experiments are important for the investigation of sensory coding, perception, decision making and memory formation. The predominant experimental paradigms employ forced choice operant assays, which require associative learning and reinforced training. Animal performance in these assays not only reflects odor perception but also the confidence in decision making and memory. In this study, we describe a versatile and automated setup, "Poking-Registered Olfactory Behavior Evaluation System" (PROBES), which can be adapted to perform multiple olfactory assays. In addition to forced choice assays, we employ this system to examine animal's innate ability for odor detection, discrimination and preference without elaborate training procedures. These assays provide quantitative measurements of odor discrimination and robust readouts of odor preference. Using PROBES, we find odor detection thresholds are at lower concentrations in naïve animals than those determined by forced choice assays. PROBES-based automated assays provide an efficient way of analyzing innate odor-triggered behaviors. 
24668615	Individuals switch from risk seeking to risk aversion when mathematically identical options are described in terms of loss versus gains, as exemplified in the reflection and framing effects. Determining the neurobiology underlying such cognitive biases could inform our understanding of decision making in health and disease. Although reports vary, data using human subjects have implicated the amygdala in such biases. Animal models enable more detailed investigation of neurobiological mechanisms. We therefore tested whether basolateral amygdala (BLA) lesions would affect risk preference for gains or losses in rats. Choices in both paradigms were always between options of equal expected value-a guaranteed outcome, or the 50:50 chance of double or nothing. In the loss-chasing task, most rats exhibited strong risk seeking preferences, gambling at the risk of incurring double the penalty, regardless of the size of the guaranteed loss. In the betting task, the majority of animals were equivocal in their choice, irrespective of bet size; however, a wager-sensitive subgroup progressively shifted away from the uncertain option as the bet size increased, which is reminiscent of risk aversion. BLA lesions increased preference for the smaller guaranteed loss in the loss-chasing task, without affecting choice on the betting task, which is indicative of reduced risk seeking for losses, but intact risk aversion for gains. These data support the hypothesis that the amygdala plays a more prominent role in choice biases related to losses. Given the importance of the amygdala in representing negative affect, the aversive emotional reaction to loss, rather than aberrant estimations of probability or loss magnitude, may underlie risk seeking for losses. 
24467419	This article examines the role of promotion motivation in decision making in the domain of gains. Using a stock investment paradigm in which individuals believed that they were making decisions that were real and consequential, we found that promotion motivation, and not prevention motivation, predicted the likelihood of switching between risky and conservative choices in the domain of gains. Promotion-focused participants chose a relatively risky option when their stock portfolio remained unchanged (stuck at 0, the status quo) but switched to a relatively conservative option when they had just experienced a large gain (Studies 1-4), both when regulatory focus was measured (Study 1) and manipulated (Studies 2-4). Studies in which progress was manipulated (Study 3) and measured (Study 4) provided evidence that it is perceptions of progress that underlie this tactical switch in risk preferences within the promotion system. We discuss the implications of these findings for decision making and the role of progress in self-regulation.
24440196	Delayed reward discounting (DRD) is a behavioral economic index of time preference, referring to how much an individual devalues a reward based on its delay in time, and has been linked to a wide array of health behaviors. It is commonly assessed using a task that asks participants to make dichotomous choices between two monetary rewards, one available immediately and the other after a delay. This study sought to shorten an extended iterative DRD assessment to increase its versatility and efficiency. Data were drawn from two young adult samples, an exploratory sample (N=130) and a confirmatory sample (N=247). In the exploratory sample, eight items were identified as predicting the majority of the variance in the full task area under the curve (AUC) (R(2)=.821; p<.001). In the confirmatory sample, the same eight items similarly predicted the majority of variance in the full task AUC (R(2)=.844, p<.001). These results provide initial support for the validity of a brief 8-item assessment of DRD. Priorities for further validation and potential applications are discussed. 
24384400	This study investigated whether participants prefer contexts with relatively little cognitive conflict and whether this preference is related to context-specific control. A conflict selection task was administered in which participants had to choose between two categories that contained different levels of conflict. One category was associated with 80% congruent Stroop trials and 20% incongruent Stroop trials, while the other category was associated with only 20% congruent Stroop trials and 80% incongruent Stroop trials. As predicted, participants selected the low-conflict category more frequently, indicating that participants avoid contexts with high-conflict likelihood. Furthermore, we predicted a correlation between this preference for the low-conflict category and the control implementation associated with the categories (i.e., context-specific proportion congruency effect, CSPC effect). Results however did not show such a correlation, thereby failing to support a relationship between context control and context selection. 
24381567	The Iowa Gambling Task (IGT) is based on the assumption that a decision maker is equally motivated to seek reward and avoid punishment, and that decision making is governed solely by the intertemporal attribute (i.e., preference for an option that produces an immediate outcome instead of one that yields a delayed outcome is believed to reflect risky decision making and is considered a deficit). It was assumed in the present study that the emotion- and cognition-based processing dichotomy manifests in the IGT as reward and punishment frequency and the intertemporal attribute. It was further proposed that the delineation of emotion- and cognition-based processing is contingent upon reward and punishment as manifested in the frame of the task (variant type) and task motivation (instruction type). The effects of IGT variant type (reward vs. punishment) and instruction type (task motivation induced by instruction types: reward, punishment, reward and punishment, or no hint) on the intertemporal and frequency attributes of IGT decision-making were analyzed. Decision making in the reward variant was equally governed by both attributes, and significantly affected by instruction type, while decision making in the punishment variant was differentially affected by the two attributes and not significantly impacted by instruction type. These results suggest that reward and punishment manifested via task frame as well as the task motivation may facilitate the differentiation of emotion- and cognition-based processing in the IGT. 
24381153	Direct oral anticoagulants (DOACs) were developed for the treatment of thromboembolic diseases to overcome limitations of vitamin K antagonists (VKA). International guidelines on atrial fibrillation acknowledge patients' for antiembolic therapy with VKA or DOAC as relevant decision criteria. The objective assessment of patients' preference social interactions and psychological factors are hard to measure albeit representing important contributors. After a series of structured interviews and pilot studies assessing the preparedness to use DOAC as an anticoagulant and the motivation of patients to participate in clinical studies with DOAC, seven items were identified from several questionnaires by regression analysis. Those items were seen the best to describe the willingness to change anticoagulation from VKA to DOAC. By their use, we aim to develop a tool for the objective identification of the patients' preferences for VKA or for DOAC to increase adherence to therapy and to reduce anticoagulant undertreatment. German-speaking patients were asked to fill out a questionnaire consisting of biographic data and the seven selected items, and 180 patients completed the questionnaire so far. Of these, 90 patients were on treatment with VKA (group 1), 57 patients changed anticoagulation from VKA to DOAC (group 2), 29 patients were DOAC naive patients (group 3), and 4 patients changed from DOAC to VKA (group 4). Overall, 94 patients received VKA, 29 patients received dabigatran, 50 patients received rivaroxaban, and 7 patients received apixaban as an anticoagulant. Eight patients were younger than 40 years, 35 patients were aged between 40 and 59 years, 53 patients were aged between 60 and 70 years, and 84 patients were aged older than 70 years. Indication for anticoagulation were atrial fibrillation (n = 106), pulmonary embolism (n = 24), deep vein thrombosis (n = 40), artificial heart valve replacement (n = 8), or other diseases (n = 2). Based on the results of the analysis, a score will be suggested to identify the preference of patients for anticoagulation with VKA or DOAC. This tool may be useful for practitioners and health-care professionals to support patient adherence to therapy, and thereby increase treatment effectiveness.
24355000	To identify the changes and associated factors in decisional conflict and regret in patients with localised prostate cancer up to six months postprimary treatment.Various treatments of differing qualities can be used for patients with localised prostate cancer; these treatments may cause conflicts in treatment decision-making and post-treatment regret.	A quantitative longitudinal study.	A total of 48 patients were recruited from a 3700-bed medical centre in northern Taiwan and assessed at pretreatment and one and six months post-treatment. Demographic characteristics, clinical information and results from the psychosocial adjustment to illness scale, decisional conflict scale and decision regret scale were collected. Data were analysed based on the generalised estimating equations models.	The overall decisional conflict substantially improved over time. However, the feeling of being less informed was high and did not improve considerably during the study period. Education level, decision preferences and psychosocial adjustment were associated with decisional conflict and influenced decision-making. The feeling of ineffective decision-making and decisional regret was low, post-treatment. Psychosocial adjustment was associated with effective decision-making and decisional regret.	In patients with localised prostate cancer, decisional conflict reduced considerably up to six months post-treatment. Moreover, the patients were satisfied with their treatment decision-making and believed that they had made the correct choice up to six months post-treatment. However, patients may have experienced feelings of being less informed pre- and post-treatment, particularly those with lower education levels, a preference for passive roles, or inferior psychosocial adjustment. Consequently, health professionals must provide adequate medical information and psychosocial intervention to help patients in the decision-making process.	Nurses and healthcare providers must provide localised prostate cancer patients with adequate information and psychosocial intervention to reduce decisional conflict.	
24345424	Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study.Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer.	Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants' eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content.	We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a significant condition by format interaction on fixation duration, P<.001. When comparing the two video decision aids, participants viewing the narrative version spent more time searching for information than participants viewing the control version of the decision aid. In contrast, participants viewing the narrative version of the text decision aid spent less time searching for information than participants viewing the control version of the text decision aid. Further, narratives appear to have a global effect on information search; these effects were not limited to specific sections of the decision aid that contained topics discussed in the patient stories.	The observed increase in fixation duration with video patient testimonials is consistent with the idea that the vividness of the video content could cause greater elaboration of the message, thereby encouraging greater information search. Conversely, because reading requires more effortful processing than watching, reading patient narratives may have decreased participant motivation to engage in more reading in the remaining sections of the Web decision aid. These findings suggest that the format of patient stories may be equally as important as their content in determining their effect on decision making. More research is needed to understand why differences in format result in fundamental differences in information search.	
24305809	Motivated behaviors are often characterized by a high degree of behavioral activation, and work output and organisms frequently make effort-related decisions based upon cost/benefit analyses. Moreover, people with major depression and other disorders often show effort-related motivational symptoms such as anergia, psychomotor retardation, and fatigue. It has been suggested that tasks measuring effort-related choice behavior could be used as animal models of the motivational symptoms of depression, and the present studies characterized the effort-related effects of the vesicular monoamine transport (VMAT) inhibitor tetrabenazine. Tetrabenazine produces depressive symptoms in humans and, because of its selective inhibition of VMAT-2, it preferentially depletes dopamine (DA). Rats were assessed using a concurrent fixed-ratio 5/chow feeding choice task that is known to be sensitive to dopaminergic manipulations. Tetrabenazine shifted response choice in rats, producing a dose-related decrease in lever pressing and a concomitant increase in chow intake. However, it did not alter food intake or preference in parallel free-feeding choice studies. The effects of tetrabenazine on effort-related choice were reversed by the adenosine A2A antagonist MSX-3 and the antidepressant bupropion. A behaviorally active dose of tetrabenazine decreased extracellular DA in nucleus accumbens and increased expression of DARPP-32 in accumbens medium spiny neurons in a pattern indicative of reduced transmission at both D1 and D2 DA receptors. These experiments demonstrate that tetrabenazine, which is used in animal models to produce depression-like effects, can alter effort-related choice behavior. These studies have implications for the development of animal models of the motivational symptoms of depression and related disorders. 
24277774	Prevention-focused individuals are motivated to maintain the status quo. Given this, we predicted that individuals with a strong prevention focus, either as a chronic predisposition or situationally induced, would treat their initial decision on how to behave on a first task as the status quo and would thus be motivated to repeat that decision on a subsequent task-even for decisions that were ethically questionable. Results from five studies supported this prediction in multiple ethical domains: whether or not to overstate performance (Studies 1, 2a, and 2b), whether or not to disclose disadvantageous facts (Study 3), and whether or not to pledge a donation (Study 4). The prevention-repetition effect was observed both when the initial and subsequent decisions were in the same domain (Studies 1-3) and when they were in different domains (Study 4). Alternative accounts for this effect, such as justification for the initial decision and preference for consistency, were ruled out (Study 2b). 
24173172	To determine the women's perception and factors influencing willingness to have cesarean section on maternal request (CSMR) in the absence of medical or obstetric indication.A cross-sectional questionnaire-based survey of 752 antenatal clinic attendees at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti. Pre-tested questionnaires were used to elicit information on socio-demographic and obstetric variables, awareness and perspective of CSMR and the willingness to request CS without physician's recommendation. Frequency tables were generated and univariate and multivariate logistic regression were used to determine factors that influenced CSMR using SPSS software version 16.0.	Forty-eight (6.4 %) of the respondents reported willingness to request CS. The most common motivations for the request were fear of losing the baby during labor, delay in conception and fear of labor pains. Analysis by simple logistic regression and multiple regression showed age, parity and educational status were not significantly related to the decision for CSMR.	CSMR is an evolving entity in obstetrics practice in the developing countries. Delay in conception, fear of labor pain and loss of baby during labor appear to be strong motivations.	

23999959	To describe the association between parents' attention-deficit/hyperactivity disorder (ADHD) treatment preferences and goals and treatment initiation.Parents/guardians of children aged 6 to 12 years diagnosed with ADHD in the past 18 months and not currently receiving combined treatment (both medication and behavior therapy [BT]) were recruited from 8 primary care sites and an ADHD treatment center. Parents completed the ADHD Preference and Goal Instrument, a validated measure, and reported treatment receipt at 6 months. Logistic regression was used to analyze the association of baseline preferences and goals with treatment initiation. Using linear regression, we compared the change in preferences and goals over 6 months for children who initiated treatment versus others.	The study included 148 parents/guardians. Baseline medication and BT preference were associated with treatment initiation (odds ratio [OR]: 2.6 [95% confidence interval (CI):1.2-5.5] and 2.2 [95% CI: 1.0-5.1], respectively). The goal of academic achievement was associated with medication initiation (OR: 2.1 [95% CI: 1.3-3.4]) and the goal of behavioral compliance with initiation of BT (OR: 1.6 [95% CI: 1.1-2.4]). At 6 months, parents whose children initiated medication or BT compared with others had decreased academic and behavioral goals, suggesting their goals were attained. However, only those initiating BT had diminished interpersonal relationship goals.	Parental treatment preferences were associated with treatment initiation, and those with distinct goals selected different treatments. Results support the formal measurement of preferences and goals in practice as prioritized in recent national guidelines for ADHD management.	
23999536	the rise in life expectancy, together with age-related increase in the incidence of most cancers, has led to mounting interest in cancer screening in older people. In England, routine invitations stop and an 'opt-in' (individual request) process is available from ages 71 to 76 years for breast and colorectal screening respectively. Little is known about public attitudes towards age-stoppage policy.this study examined public attitudes to current stoppage policy, information preferences and intentions to request screening beyond the age of routine invitations.	participants (n = 927; age 60-74 years) were recruited as part of a TNS Research International survey and took part in home-based, computer-assisted interviews.	measures included: (i) attitudes towards current stoppage policy, (ii) preference for communications about screening after the end of the routine invitation period and (iii) intention to opt-in.	the majority of respondents (78%) did not agree with age-based stoppage policies. Most (83%) wanted a strong recommendation to opt-in after this age, although the number who thought they would follow such a recommendation was much lower (27%). A majority of participants (54%) thought information on screening at older ages should come from their general practitioner (GP).	this survey indicates that older people in England wish to continue to be actively invited for cancer screening, although only a minority think that they would ultimately take up the offer. Primary care may play a role in negotiating a shared decision that is based on individual circumstances.	
23979875	Despite the expected health benefits of colorectal cancer screening programs, participation rates remain low in countries that have implemented such a screening program. The perceived benefits and risks of the colorectal cancer screening technique are likely to influence the decision to attend the screening program. Besides the diagnostic accuracy and the risks of the screening technique, which can affect the health of the participants, additional factors, such as the burden of the test, may impact the individuals' decisions to participate. To maximise the participation rate of a screening program for a new colorectal cancer program in the Netherlands, it is important to know the preferences of the screening population for alternative screening techniques.The aim of this study was to explore the impact of preferences for particular attributes of the screening tests on the intention to attend a colorectal cancer screening program.	We used a web-based questionnaire to elicit the preferences of the target population for a selection of colon-screening techniques. The target population consisted of Dutch men and women aged 55-75 years. The analytic hierarchy process (AHP), a technique for multi-criteria analysis, was used to estimate the colorectal cancer screening preferences. Respondents weighted the relevance of five criteria, i.e. the attributes of the screening techniques: sensitivity, specificity, safety, inconvenience, and frequency of the test. With regard to these criteria, preferences were estimated between four alternative screening techniques, namely, immunochemical fecal occult blood test (iFOBT), colonoscopy, sigmoidoscopy, and computerized tomographic (CT) colonography. A five-point ordinal scale was used to estimate the respondents' intention to attend the screening. We conducted a correlation analysis on the preferences for the screening techniques and the intention to attend.	We included 167 respondents who were consistent in their judgments of the relevance of the criteria and their preferences for the screening techniques. The most preferred screening method for the national screening program was CT colonography. Sensitivity (weight = 0.26) and safety (weight = 0.26) were the strongest determinants of the overall preferences for the screening techniques. However, the screening test with the highest intention to attend was iFOBT. Inconvenience (correlation [r] = 0.69), safety (r = 0.58), and the frequency of the test (r = 0.58) were most strongly related to intention to attend.	The multi-criteria decision analysis revealed the attributes of the screening techniques that are most important so as to increase intention to participate in a screening program. Even though the respondents may recognize the high importance of diagnostic effectiveness in the long term, their short-term decision to attend the screening tests may be less driven by this consideration. Our analysis suggests that inconvenience, safety, and frequency of the test are the strongest technique-related determinants of the respondents' intention to participate in colorectal screening programs.	
23962230	Women diagnosed with early breast cancer (stage I or II) can be offered the choice between mastectomy or breast conservation surgery with radiotherapy due to equivalence in survival rates. A wide variation in the surgical management of breast cancer and a lack of theoretically guided research on this issue highlight the need for further research into the factors influencing women's choices. An extended Theory of Planned Behaviour (TPB) could provide a basis to understand and predict women's surgery choices. The aims of this study were to understand and predict the surgery intentions and choices of women newly diagnosed with early breast cancer, examining the predictive utility of an extended TPB.Sixty-two women recruited from three UK breast clinics participated in the study; 48 women, newly diagnosed with early breast cancer, completed online questionnaires both before their surgery and after accessing an online decision support intervention (BresDex). Questionnaires assessed views about breast cancer and the available treatment options using items designed to measure constructs of an extended TPB (i.e., attitudes, subjective norms, perceived behavioural control, and anticipated regret), and women's intentions to choose mastectomy or BCS. Objective data were collected on women's choice of surgery via the clinical breast teams. Multiple and logistic regression analyses examined predictors of surgery intentions and subsequent choice of surgery.	The extended TPB accounted for 69.9% of the variance in intentions (p <.001); attitudes and subjective norms were significant predictors. Including additional variables revealed anticipated regret to be a more important predictor than subjective norms. Surgery intentions significantly predicted surgery choices (p <.01).	These findings demonstrate the utility of an extended TPB in predicting and understanding women's surgery intentions and choices for early breast cancer. Understanding these factors should help to identify key components of interventions to support women while considering their surgery options.	
23917499	Risk taking can lead to ruin, but sometimes, it can also provide great success. How does our brain make a decision on whether to take a risk or to play it safe? Recent studies have revealed the neural basis of risky decision making. In this review, we focus on the role of the anterior insular cortex (AIC) in risky decision making. Although human imaging studies have shown activations of the AIC in various gambling tasks, the causal involvement of the AIC in risky decision making was still unclear. Recently, we demonstrated a causality of the AIC in risky decision making by using a pharmacological approach in behaving rats-temporary inactivation of the AIC decreased the risk preference in gambling tasks, whereas temporary inactivation of the adjacent orbitofrontal cortex (OFC) increased the risk preference. The latter finding is consistent with a previous finding that patients with damage to the OFC take abnormally risky decisions in the Iowa gambling task. On the basis of these observations, we hypothesize that the intact AIC promotes risk-seeking behavior, and that the AIC and OFC are crucial for balancing the opposing motives of whether to take a risk or avoid it. However, the functional relationship between the AIC and OFC remains unclear. Future combinations of inactivation and electrophysiological studies may promote further understanding of risky decision making.
23906508	Low trait self-control constitutes a core criterion in various psychiatric disorders. Personality traits such as low self-control are mostly indexed by self-report measures. However, several theorists emphasized the importance of differentiating between explicit and implicit indices of personality traits, Therefore, the present study examined the unique predictive validity of an implicit measure of trait self-control for spontaneous dysfunctional behavior.As a measure of implicit trait self-control, we used an irrelevant feature task: a speeded reaction time task comprising a task-relevant stimulus feature (i.e., capital vs. lower case letter type) and a task-irrelevant feature (high vs. low self-control word type). The irrelevant feature had to be ignored, while participants (n = 34) responded to the relevant stimulus feature. However, their response was either congruent or incongruent with the irrelevant stimulus feature, resulting in facilitated or deteriorated task performance. As indicators of trait-related spontaneous dysfunctional behavior, we included indices of frustration tolerance and the preference for short-term reward over meeting long-term goals. We also included two explicit measures of trait self-control: a self-report questionnaire and an explicit self-relevance rating of the implicit task stimuli.	Specifically the implicit measure of trait self-control showed predictive validity for the target self-control behaviors.	The predictive validity of implicit measures of personality traits requires further study in larger, non-student samples.	As predicted, the implicit measure of trait self-control showed superior predictive power for spontaneous trait-related behavior. This finding points to the relevance of complementing the routinely used self-report measures with implicit measures of trait self-control.	
23894295	It has long been assumed that people treat cognitive effort as costly, but also that such effort costs may vary greatly across individuals. Individual differences in subjective effort could present a major and pervasive confound in behavioral and neuroscience assessments, by conflating cognitive ability with cognitive motivation. Self-report cognitive effort scales have been developed, but objective measures are lacking. In this study, we use the behavioral economic approach of revealed preferences to quantify subjective effort. Specifically, we adapted a well-established discounting paradigm to measure the extent to which cognitive effort causes participants to discount monetary rewards. The resulting metrics are sensitive to both within-individual factors, including objective load and reward amount, and between-individual factors, including age and trait cognitive engagement. We further validate cognitive effort discounting by benchmarking it against well-established measures of delay discounting. The results highlight the promise and utility of behavioral economic tools for assessing trait and state influences on cognitive motivation. 
23828394	This study investigated satisfaction with treatment decision (SWTD), decision-making preferences (DMP), and main treatment goals, as well as evaluated factors that predict SWTD, in patients receiving palliative cancer treatment at a Swiss oncology network.Patients receiving a new line of palliative treatment completed a questionnaire 4-6 weeks after the treatment decision. Patient questionnaires were used to collect data on sociodemographics, SWTD (primary outcome measure), main treatment goal, DMP, health locus of control (HLoC), and several quality of life (QoL) domains. Predictors of SWTD (6 = worst; 30 = best) were evaluated by uni- and multivariate regression models.	Of 480 participating patients in eight hospitals and two private practices, 445 completed all questions regarding the primary outcome measure. Forty-five percent of patients preferred shared, while 44 % preferred doctor-directed, decision-making. Median duration of consultation was 30 (range: 10-200) minutes. Overall, 73 % of patients reported high SWTD (≥24 points). In the univariate analyses, global and physical QoL, performance status, treatment goal, HLoC, prognosis, and duration of consultation were significant predictors of SWTD. In the multivariate analysis, the only significant predictor of SWTD was duration of consultation (p = 0.01). Most patients indicated hope for improvement (46 %), followed by hope for longer life (26 %) and better quality of life (23 %), as their main treatment goal.	Our results indicate that high SWTD can be achieved in most patients with a 30-min consultation. Determining the patient's main treatment goal and DMP adds important information that should be considered before discussing a new line of palliative treatment.	
23815456	The present research examined how decision reversibility can affect motivation. On the basis of extant findings, it was suggested that 1 way it could affect motivation would be to strengthen different regulatory foci, with reversible decision making, compared to irreversible decision making, strengthening prevention-related motivation relatively more than promotion-related motivation. If so, then decision reversibility should have effects associated with the relative differences between prevention and promotion motivation. In 5 studies, we manipulated the reversibility of a decision and used different indicators of regulatory focus motivation to test these predictions. Specifically, Study 1 tested for differences in participants' preference for approach versus avoidance strategies toward a desired end state. In Study 2, we used speed and accuracy performance as indicators of participants' regulatory motivation, and in Study 3, we measured global versus local reaction time performance. In Study 4, we approached the research question in a different way, making use of the value-from-fit hypothesis (Higgins, 2000, 2002). We tested whether a fit between chronic regulatory focus and focus induced by the reversibility of the decision increased participants' subjective positive feelings about the decision outcome. Finally, in Study 5, we tested whether regulatory motivation, induced by decision reversibility, also influenced participants' preference in specific product features. The results generally support our hypothesis showing that, compared to irreversible decisions, reversible decisions strengthen a prevention focus more than a promotion focus. Implications for research on decision making are discussed.
23800366	A comprehensive model of the relationships among different shared decision-making related constructs and their effects on patient-relevant outcomes is largely missing. Objective of our study was the development of a model linking decision-making in medical encounters to an intermediate and a long-term endpoint. The following hypotheses were tested: physicians are more likely to involve patients who have a preference for participation and are willing to take responsibility in the medical decision-making process, increased patient involvement decreases decisional conflict, and lower decisional conflict favourably influences patient satisfaction with the physician.This model was tested in a German primary care sample (N = 1,913). Psychometrically tested instruments were administered to assess the following: patients' preference for being involved in medical decision-making, patients' experienced involvement in medical decision-making, decisional conflict, and satisfaction with the primary care provider. Structural equation modelling was used to explore multiple associations. The model was tested and adjusted in a development sub-sample and cross-validated in a confirmatory sample. Demographic and clinical characteristics were accounted for as possible confounders.	Local and global indexes suggested an acceptable fit between the theoretical model and the data. Increased patient involvement was strongly associated with decreased decisional conflict (standardised regression coefficient Β = -.73). Both high experienced involvement (Β = .34) and low decisional conflict (B = -.28) predicted higher satisfaction with the physician. Patients' preference for involvement was negatively associated with the experienced involvement (B = -.24).	Altogether, our model could be largely corroborated by the collected empirical data except the unexpected negative association between preference for involvement and experienced involvement. Future research on the associations among different SDM-related constructs should incorporate longitudinal studies in order to strengthen the hypothesis of causal associations.	
23741364	Social animals can use both social and private information to guide decision making. While social information can be relatively economical to acquire, it can lead to maladaptive information cascades if attention to environmental cues is supplanted by unconditional copying. Ants frequently employ pheromone trails, a form of social information, to guide collective processes, and this can include consensus decisions made when choosing a place to live. In this study, I examine how house-hunting ants balance social and private information when these information sources conflict to different degrees. Social information, in the form of pre-established pheromone trails, strongly influenced the decision process in choices between equivalent nests, and lead to a reduced relocation time. When trails lead to non-preferred types of nest, however, social information had less influence when this preference was weak and no influence when the preference was strong. These results suggest that social information is vetted against private information during the house-hunting process in this species. Private information is favoured in cases of conflict and this may help insure colonies against costly wrong decisions.
23740918	There has been a marked increase of women in dentistry in Brazil and in many countries around the world. The behavioral mechanisms behind the choice of career differ between men and women, and the inclination to care for others is thought by some to be more present in women than it is in men. This article discusses the reasons that lead women to choose dentistry as a profession in Brazil and the impact of feminization on the current and future profile of the profession, based on the ethics of care. The authors' review of the relevant literature published between 2000 and 2011, primarily in Brazil, suggests that whereas men have tended to choose dentistry as a good business opportunity, women have tended to base their decision on relations with other people and the flexibility of practicing the profession. Many women dentists have been found to decide to work fewer hours, report more interruptions in their activities, and have less preference to work in private practice than men dentists. In the view of service users and dental auxiliaries in Brazil, women dentists invest more time in their patients and communicate in a more pleasant, sensitive, and friendly manner. The conclusion suggests that characteristics often associated with women can affect the dental profession in Brazil by introducing greater concern with the promotion of health and other people's well-being in contrast to traditional dentistry based on curative procedures.
23731223	In an ongoing longitudinal qualitative cohort study of cancer patients' needs and preferences across the cancer journey, we harvested a subset of accounts pertaining to conversations between patients and their clinicians around clinical trials. Recognising these conversations as a departure from the more routine discourses of clinical care, in that they enter into new dimensions of investment and motivation on the part of clinicians, we engaged in both secondary analysis of banked data and focussed interviewing of cancer patients to better understand how cancer patients describe communications in relation to decisions pertaining to clinical trials participation. Using constant comparative techniques informed by the interpretive description approach to applied qualitative methodology to guide a systematic analysis of this set of data, we documented patterns and themes across patient accounts. The resulting thematic depiction of clinical trials discourses from a patient perspective contrasts with assumptions apparent in the professional literature relating to the clinical advantage of trials participation, and illuminates aspects of patient-clinician interaction that are particularly amenable to disruption within this delicate and nuanced discourse. Findings from this study have implications for our understanding of the complexities of cancer communication at the delicate intersection of patient care and knowledge generation. 
23700484	While shared decision making (SDM) promotes health-related decisions that are informed, value-based and adhered to, few studies report on theory-based approaches to SDM adoption by healthcare professionals. We aimed to identify the factors influencing dietitians' intentions to adopt two SDM behaviours: 1) present dietary treatment options to patients and 2) help patients clarify their values and preferences.We conducted a cross-sectional postal survey based on the Theory of Planned Behaviour among 428 randomly selected dietitians working in clinical practice across the Province of Quebec, Canada. We performed descriptive analyses and multiple regression analyses to determine the variables that explained the variance in intention to perform the behaviours.	A total of 203 dietitians completed the questionnaire. Their ages were from 23 to 66 and they had been practising dietetics for 15.4±11.1 years (mean ± SD). On a scale from 1 to 7 (from strongly disagree to strongly agree), dietitians' intentions to present dietary treatment options and to clarify their patients' values and preferences were 5.00±1.14 and 5.68±0.74, respectively. Perceived behavioural control (β = 0.56, ρ<0.0001), subjective norm (β = 0.16, ρ<0.05), and moral norm (β = 0.22, ρ<0.0001), were the factors significantly predicting the intention to present dietary treatment options, while perceived behavioural control (β = 0.60, ρ<0.0001), attitude (β = 0.20, ρ<0.05), and professional norm (β = 0.22, ρ<0.001), significantly predicted the intention to help patients' clarify their values and preferences.	Our results showed that dietitians intend to adopt the two SDM behaviours studied. Factors influencing intention were different for each behaviour, except for perceived behavioural control which was common to both behaviours. Thus, perceived behavioural control could be a key factor in interventions aiming to encourage implementation of SDM by dietitians.	
23637842	Despite explicitly wanting to quit, long-term addicts find themselves powerless to resist drugs, despite knowing that drug-taking may be a harmful course of action. Such inconsistency between the explicit knowledge of negative consequences and the compulsive behavioral patterns represents a cognitive/behavioral conflict that is a central characteristic of addiction. Neurobiologically, differential cue-induced activity in distinct striatal subregions, as well as the dopamine connectivity spiraling from ventral striatal regions to the dorsal regions, play critical roles in compulsive drug seeking. However, the functional mechanism that integrates these neuropharmacological observations with the above-mentioned cognitive/behavioral conflict is unknown. Here we provide a formal computational explanation for the drug-induced cognitive inconsistency that is apparent in the addicts' "self-described mistake". We show that addictive drugs gradually produce a motivational bias toward drug-seeking at low-level habitual decision processes, despite the low abstract cognitive valuation of this behavior. This pathology emerges within the hierarchical reinforcement learning framework when chronic exposure to the drug pharmacologically produces pathologicaly persistent phasic dopamine signals. Thereby the drug hijacks the dopaminergic spirals that cascade the reinforcement signals down the ventro-dorsal cortico-striatal hierarchy. Neurobiologically, our theory accounts for rapid development of drug cue-elicited dopamine efflux in the ventral striatum and a delayed response in the dorsal striatum. Our theory also shows how this response pattern depends critically on the dopamine spiraling circuitry. Behaviorally, our framework explains gradual insensitivity of drug-seeking to drug-associated punishments, the blocking phenomenon for drug outcomes, and the persistent preference for drugs over natural rewards by addicts. The model suggests testable predictions and beyond that, sets the stage for a view of addiction as a pathology of hierarchical decision-making processes. This view is complementary to the traditional interpretation of addiction as interaction between habitual and goal-directed decision systems.
23602071	This paper is a qualitative study of women's well-being and reproductive health status among married women in mining communities in India. An exploratory qualitative research design was conducted using purposive sampling among 40 selected married women in a rural Indian mining community. Ethical permission was obtained from Goa University. A semi-structured indepth interview guide was used to gather women's experiences and perceptions regarding well-being and reproductive health in 2010. These interviews were audiotaped, transcribed, verified, coded and then analyzed using qualitative content analysis. Early marriage, increased fertility, less birth intervals, son preference and lack of decision-making regarding reproductive health choices were found to affect women's reproductive health. Domestic violence, gender preference, husbands drinking behaviors, and low spousal communication were common experiences considered by women as factors leading to poor quality of marital relationship. Four main themes in confronting women's well-being are poor literacy and mobility, low employment and income generating opportunities, poor reproductive health choices and preferences and poor quality of martial relationships and communication. These determinants of physical, psychological and cultural well-being should be an essential part of nursing assessment in the primary care settings for informed actions. Nursing interventions should be directed towards participatory approach, informed decision making and empowering women towards better health and well-being in the mining community.
23581893	It is important to understand the factors that influence the undergraduate medical students' specialties choice for the post-graduation.To identify the number of undergraduate medical students who decided their post-graduate specialty career, factors that may influence their decision to select a particular specialty, and their career specialties preference.	A self-administered questionnaire was used to achieve the objectives.	Less than half of the students (40.2%) showed a future specialty preference. Senior students and having background about specialties were the significant factors for career choices. General Surgery (27.4%), ENT-Ophthalmology (24.6%) and Internal Medicine (22%) were preferred specialties. Male students preferred General Surgery (15.7%), Internal Medicine (15%), ENT-Ophthalmology (12%) and Orthopedics (9.1%). Female students showed interest in ENT-Ophthalmology (12.1%), Surgery (11.7%), Pediatrics (10.8%) and Dermatology (8.2%). The least popular specialties were Community Medicine, (6.6%), Anesthesia, (6%) and Forensic Medicine (4.6%). Obstetrics and Gynecology (Ob/Gyne) was a less popular branch even in female students.	General Surgery, ENT-Ophthalmology and Internal Medicine were the most preferred specialties, while Community Medicine, Forensic and Ob/Gyne, even for female students were least selected specialties. Proper information and counseling should be offered to students about the challenges and opportunities to select their future careers.	
23575841	An inability to adjust choice preferences in response to changes in reward value may underlie key symptoms of many psychiatric disorders, including chemical and behavioral addictions. We developed the rat gambling task (rGT) to investigate the neurobiology underlying complex decision-making processes. As in the Iowa Gambling task, the optimal strategy is to avoid choosing larger, riskier rewards and to instead favor options associated with smaller rewards but less loss and, ultimately, greater long-term gain. Given the demonstrated importance of the orbitofrontal cortex (OFC) and basolateral amygdala (BLA) in acquisition of the rGT and Iowa Gambling task, we used a contralateral disconnection lesion procedure to assess whether functional connectivity between these regions is necessary for optimal decision-making. Disrupting the OFC-BLA pathway retarded acquisition of the rGT. Devaluing the reinforcer by inducing sensory-specific satiety altered decision-making in control groups. In contrast, disconnected rats did not update their choice preference following reward devaluation, either when the devalued reward was still delivered or when animals needed to rely on stored representations of reward value (i.e., during extinction). However, all rats exhibited decreased premature responding and slower response latencies after satiety manipulations. Hence, disconnecting the OFC and BLA did not affect general behavioral changes caused by reduced motivation, but instead prevented alterations in the value of a specific reward from contributing appropriately to cost-benefit decision-making. These results highlight the role of the OFC-BLA pathway in the decision-making process and suggest that communication between these areas is vital for the appropriate assessment of reward value to influence choice.
23570480	Increases in regional emergency department (ED) efficiencies might be obtained by shifting patients to less crowded EDs. The authors sought to determine factors associated with a patient's decision to choose a specific regional ED. Based on prior focus group discussions with volunteers, the hypothesis was that distance to a specific ED and perceived ED wait times would be important.A cross-sectional survey was developed using qualitative focus group methodology. The resulting survey was composed of 17 questions relating to patient decisions in choosing a specific ED and was administered in each of six EDs in a single urban Canadian health region at all hours of the day. Ambulatory patients with a Canadian Triage and Acuity Scale (CTAS) level 3 to 5 and aged ≥19 years were surveyed. The primary outcome was the proportion of patients whose main motivation for attending a specific ED was either distance traveled to reach the ED or perceived ED waiting time. Multivariable logistic regression was performed to assess factors influencing both of these reasons.	A total of 757 patients were approached and 634 surveys (83.8%) were completed. Distance from the ED (named by 44.0% of respondents as their primary reason) and perceived ED wait times (9.3%) were the main motivations for patients to attend a specific ED. Multivariable analysis of factors associated with choosing distance revealed that ED distance < 10 km (adjusted odds ratio [OR] = 2.20, 95% confidence interval [CI] = 1.45 to 3.33; p = 0.001) and age ≥ 60 years (adjusted OR = 1.58, 95% CI = 1.12 to 2.26; p = 0.04) were significant in choosing a particular ED. Multivariable analysis of factors influencing wait times demonstrated that having a painful complaint (adjusted OR = 1.42, 95% CI = 1.05 to 1.98; p = 0.047) and age < 60 years (OR = 1.47, 95% CI = 1.02 to 2.14; p = 0.049) were significant in choosing a particular ED.	In a multicenter survey of patients from an urban health region, distance to a specific ED and perceived ED wait times were the most important reasons for choosing that ED. Younger patients and those with painful conditions appear to place greater priority on wait times.	
23551395	Despite the effectiveness of highly active antiretroviral therapy (HAART), HIV remains a major cause of mortality in the USA, largely as a result of poor HIV treatment adherence. In this study we assessed the association between five patient-centred factors and adherence to HIV treatment.We surveyed 244 adults at two HIV clinics in Houston, Texas between October 2009 and April 2010. Participants were given a questionnaire and their charts were reviewed for clinical data. Survey items assessed the following factors: self-assessed HIV knowledge, awareness of disease biomarkers, intention to adhere to HIV treatment, health literacy and decision-making style. The primary outcome measure was HAART adherence during the previous month. Logistic regressions were performed to calculate the effect of each factor on adherence.	All participants had HIV/AIDS and were on HAART at enrolment. Eight per cent of participants were female, 57% were African-American and 16% were Hispanic. Mean age was 58.1 years. Sixty-eight per cent were adherent to HAART during the last month. On univariate analysis, a preference for wanting choices, correct knowledge of recent HIV viral load level, and intention to adhere to HIV treatment were significantly associated with adherence. On multivariate analysis, only intention to adhere to HIV treatment remained statistically significant after adjusting for other factors (odds ratio 2.2; 95% confidence interval 1.1 to 4.3).	Intention to adhere to HIV treatment was significantly associated with self-reported adherence to HAART. Interventions that bolster patients' intentions to adhere to HIV treatment during clinical encounters may improve adherence to HAART and HIV control.	
23479062	Advance care planning (ACP) prepares patients and their families for future health care decisions; however, the needs of adolescent oncology patients for participation in ACP have not been well studied.To examine the efficacy of family-centered ACP.	Two-group randomized controlled trial in a pediatric oncology program.	Sixty adolescents aged 14 to 21 years with cancer and their surrogates or families were enrolled in the study between January 17, 2011, and March 29, 2012.	Thirty dyads received 3- to 60-minute sessions 1 week apart. Intervention dyads completed (1) the Lyon Family-Centered ACP Survey, (2) the Respecting Choices interview, and (3) Five Wishes. Control subjects received standard care plus information.	Statement of treatment preferences and Decisional Conflict Scale score.	The mean age of the adolescents was 16 years; 36 (60%) were male, 30 (50%) white, 26 (43%) black, and 4 (7%) Asian. Diagnoses were as follows: leukemia (14 patients [47%]), brain tumor (8 [27%]), solid tumor (6 [20%]), and lymphoma (2 [7%]). Significantly increased congruence was observed for intervention dyads compared with controls for 4 of the 6 disease-specific scenarios; for example, for situation 2 ("treatment would extend my life by not more than 2 to 3 months"), intervention dyads demonstrated higher congruence (κ = 0.660; P < .001) vs control dyads (κ = -0.0636; P = .70). Intervention adolescents (100%) wanted their families to do what is best at the time, whereas fewer control adolescents (62%) gave families this leeway. Intervention adolescents were significantly better informed about end-of-life decisions (t = 2.93; effect size, 0.961; 95% CI, 0.742-1.180; P = .007). Intervention families were more likely to concur on limiting treatments than controls. An ethnic difference was found in only one situation.	Advance care planning enabled families to understand and honor their adolescents' wishes. Intervention dyads were more likely than controls to limit treatments. Underserved African American families were willing to participate.	
23355894	Navigation and environmental perception precede most actions in mobile organisms. Navigation is based upon the fundamental assumption of a ubiquitous Preference for the Nearest of otherwise equivalent navigational goals (PfN). However, the magnitude and triggers for PfN are unknown and there is no clear evidence that PfN exists. I tested for PfN in human participants on a retrieval task. Results of these experiments provide the first evidence for PfN. Further, these data quantify the three primary PfN triggers and provide an experimental structure for using PfN as a behavioral metric across domains. Surprisingly, PfN exists at a high, but not universal, magnitude. Further, PfN derives most from the absolute distance to the farthest of multiple goals (d(f)), with little influence of the distance to the nearest goal (d(n)). These data provide previously unavailable quantification of behavioral motivation across species and may provide a measurable index of selection. These methods hold particular import for behavioral modification because proximity is a powerful determinant of decision outcomes across most behaviors.
23349127	In this article, I examine how race motivates women's decisions to undergo aesthetic rhinoplasty in Caracas, Venezuela. Through a combination of cultural domain analysis and thematic analysis of qualitative interviews, I explore how the preference for whiteness and associated facial features dovetail with the aesthetic ideals promoted by cosmetic surgeons. Rhinoplasty is offered by physicians and interpreted by patients as a resolution to body dissatisfaction and low self-esteem. The clinical ethos of objectivity established by cosmetic surgeons fails to acknowledge how perceptions of the self and body are strongly tied to racial marginalization: patients' efforts to alter the nose reveal attempts to change not only how the body looks, but how it is lived. As a result, cosmetic surgery only acts as a stop-gap measure to heighten one's self-esteem and body image.
23280632	Recent trends suggest that bilateral mastectomy (BM) is on the rise among women diagnosed with unilateral breast cancer. Few studies have investigated the factors associated with the decision to have more aggressive surgery among young, high risk patients.As part of a larger study, 284 women aged 50 and under completed an initial survey within 6 weeks of a breast cancer diagnosis. We assessed sociodemographics, medical and family history variables, treatment recommendations, preferences and concerns, distress, perceived risk, knowledge, and neuroticism. We used multiple regression with backward entry to assess the relationship between these variables and our outcomes of decisional conflict and intentions for BM.	Higher decisional conflict was associated with being less educated, unmarried, more anxious and less likely to have received a surgical recommendation. Preference for BM was associated with higher neuroticism, perceived risk for contralateral breast cancer, pre-testing risk of carrying a BRCA1/2 mutation, having received either a surgical recommendation (vs. no recommendation), and lower preference for lumpectomy.	For younger women, a surgical recommendation is associated with lower decisional conflict and stronger intention for BM. Results highlight the importance of effective risk communication and decision support between a woman and her surgeon.	
23228820	To determine the motivations and preferences of women participating in visual inspection with acetic acid (VIA) mass cervical cancer screening programs in southeastern Nigeria.By means of interviewer-based questionnaires, data were collected from women participating in mass cervical cancer screenings with VIA in 3 randomly selected communities in each of 2 southeastern Nigerian states between March 1, 2011, and March 31, 2012.	A total of 2312 women were interviewed. Support from husband and community opinion leaders were the most frequently reported factors that motivated the women to participate in the screening. Most participants expected an immediate result for the screening test and immediate treatment for any abnormalities detected.	Community-based advocacy for cervical cancer screening is a very effective method of creating awareness for cervical cancer screening. Support from spouses and community leaders are important factors in a woman's decision to utilize cervical cancer screening services in southeastern Nigeria. Immediate results and treatments would make the most impact. Family and community participation should be integrated into cervical cancer prevention programs. This, together with a "see and treat" approach, may be central to overcoming the poor utilization of cervical cancer screening services in Nigeria and similar rural settings.	
23219137	Intensity modulated radiotherapy (IMRT) allows a better coverage of the target volume and a better saving of organs at risk with a decrease of toxicity in head and neck cancers. It requires more human labor and materials compared to conformational radiotherapy. If they are insufficient, a selection of the patients receiving IMRT may be necessary, raising an ethical problem.We collected the motives guiding the choice of the technique of radiotherapy for head and neck cancers during a month of physicists' shortage.	Nineteen patients received IMRT and eight conformational radiotherapy. Conformational irradiation was chosen in palliative and postsurgery treatments, to reduce delay, in laryngeal tumors and re-irradiation. IMRT was preferred for complex target volumes and the localizations at risk of important xerostomia following conformational radiotherapy. These choices were confronted with the bioethics criteria of Beauchamp and Childress. The beneficence justified the use of IMRT or conformational radiotherapy depending on the circumstances. The non-maleficence attempted to decrease the toxicity with IMRT. Justice was questioned by the selection. The autonomy of patients was not totally respected in the choice.	To help in the choice of the patients receiving an IMRT in a crisis situation, we proposed a hierarchical organization of selection criteria: complex volumes close to critical organs at risk, localization with high risk of xerostomia, long life expectancy and postoperative delay constraints.	
23187060	A priority system is one in which previously registered donors receive a preference in the allocation of organs for transplant ahead of those who have not registered. Supporters justify these systems on the basis that they are fair and will encourage donor registration. This article reviews existing studies of public reactions to priority systems, as well as studies of the extent to which the moral principle of reciprocity affects decision making in organ donation. The role of reciprocity in the public discourse surrounding the enactment of priority systems in Singapore and Israel is described. One factor that seems to have been relevant in these countries is the existence of a religious minority that is perceived as willing to take an organ but not to donate one. Although this perception may have fueled a resentment of perceived "free-riders," concerns were raised about the social divisiveness of priority systems. In sum, people appear to be sensitive to the principle of reciprocity in the context of organ donation, but this sensitivity does not always translate into support for priority systems. Further research into whether public messaging about organ donation could be modified to encourage registration by appeal to the golden rule would be worthwhile.
23173834	Posthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries.We surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive.	Mean(SD) age was 32(9) year, 27% were males, 50% were patients' companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p < 0.001), donor-only informed consent (5[3,7], p < 0.001), and presumed consent (7[3,10], p < 0.001). The addition of a financial or medical incentive, respectively, reduced ranking of mandated choice to 7[4,9], p < 0.001, and 5[3,8], p < 0.001; for donor-or-surrogate informed consent to 7[5,9], p < 0.001, and 5[3,7], p = 0.004; and for donor-only informed consent to 8[6,10], p < 0.001, and 5[3,7], p = 0.56. Distribution of ranking score of perception of norm and preference were similar except for no-organ donation (11[7,11] vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p < 0.001), more preferred mandated choice with financial incentive option (6[3,8] vs. 8[4,9], p < 0.001), and less preferred mandated choice with medical incentive option (7[4,9] vs. 5[2,7], p < 0.001). There was no association between consenting options ranking scores and age, health status, education level, or knowing an organ donor or recipient.	We conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference.	
23136439	We often have to make risky decisions between alternatives with outcomes that can be better or worse than the outcomes of safer alternatives. Although previous studies have implicated various brain regions in risky decision making, it remains unknown which regions are crucial for balancing whether to take a risk or play it safe. Here, we focused on the anterior insular cortex (AIC), the causal involvement of which in risky decision making is still unclear, although human imaging studies have reported AIC activation in various gambling tasks. We investigated the effects of temporarily inactivating the AIC on rats' risk preference in two types of gambling tasks, one in which risk arose in reward amount and one in which it arose in reward delay. As a control within the same subjects, we inactivated the adjacent orbitofrontal cortex (OFC), which is well known to affect risk preference. In both gambling tasks, AIC inactivation decreased risk preference whereas OFC inactivation increased it. In risk-free control situations, AIC and OFC inactivations did not affect decision making. These results suggest that the AIC is causally involved in risky decision making and promotes risk taking. The AIC and OFC may be crucial for the opposing motives of whether to take a risk or avoid it.
23083131	Prior research has demonstrated the valence-framing effect, in which leading people to frame a preference negatively (e.g., 'I oppose Romney') yields stronger attitudes than does leading people to frame that same preference positively (e.g., 'I support Obama'). Three studies tested whether or not depth of processing (as operationalized by manipulations of motivation and ability to cognitively process) moderate the effect. The valence-framing effect was replicated, such that opposers manifested stronger attitudes than did supporters, but only when attitudes were relevant to the participants (Experiments 1 and 3), and when participants were not under cognitive load (Experiment 2). Our results thus identify depth of processing as an important moderator of the valence-framing effect and provide potential insight into the effect's mechanism.
23073366	Recent studies have shown that in situations where resources have been acquired collaboratively, children at around 3 years of age share mostly equally. We investigated 3-year-olds' sharing behavior with a collaborating partner and a free-riding partner who explicitly expressed her preference not to collaborate. Children shared more equally with the collaborating partner than with the free rider. These results suggest that young children are sensitive to the contributions made by others to a collaborative effort (and possibly their reasons for not collaborating) and distribute resources accordingly.
23067061	Research has shown that people's abilities to develop and act from a coherent sense of self are facilitated by satisfaction of the basic psychological needs for competence, relatedness, and autonomy. The present study utilized functional near infrared spectroscopy (fNIRS) to examine the effect of need satisfaction on activity in the medial prefrontal cortex (MPFC), a key region in processing information about the self. Participants completed a decision-making task (e.g., Which occupation would you prefer, dancer or chemist?) in which they made a series of forced choices according to their personal preferences. The degree of decisional conflict (i.e., choice difficulty) between the available response options was manipulated on the basis of participants' unique preference ratings for the target stimuli, which were obtained prior to scanning. Need satisfaction predicted elevated MPFC activity during high-conflict relative to low-conflict situations, suggesting that one way need satisfaction may promote self-coherence is by enhancing the utilization of self-knowledge in the resolution of decisional conflicts.
23057535	People's decision to join an organ donor registry and have a discussion with family about their organ donation preference increases the likelihood that their family will consent to donation of their organs. This study explores the effectiveness of three interventions compared to a control condition to increase individual consent (registering and discussing donation wishes) for organ donation. Australian residents who had not previously communicated their consent (N = 177) were randomly allocated to complete an online survey representing either an extended theory of planned behaviour motivational intervention (strengthening intention via attitudes, subjective norms, control, moral norms and identity), a volitional intervention using constructs from the health action process approach (strengthening the translation of intentions into action using action plans and coping plans), a combined motivational and volitional intervention, or a control condition. Registering, but not discussing, intentions increased in the motivational compared to non-motivational conditions. For joining the organ donor registry, the combination of strengthening intentions (motivational) as well as forming specific action (when, where, how, and with whom for discussing) and coping (listing potential obstacles and how these may be overcome) plans (volitional) resulted in significantly higher rates of self-reported behaviour. There was no evidence for this effect on discussion.
22930369	In two experiments, we provide evidence for a fundamental discussion asymmetry, namely, preference-consistent information sharing. Despite being in a dyadic situation requiring open information exchange and being given no incentive to do so, participants communicated more information that supported their individually preferred decision alternative than information that contradicted it. Preference-consistent information sharing was not caused by biased recall and occurred in written as well as in face-to-face communication. Moreover, we tested whether preference-consistent information sharing was influenced by statements by bogus discussion partners indicating that they held a congruent versus incongruent preference to the participants' preference and that they understood versus did not understand the participants' preference. We found that when partners stated that they understood the participants' preference, subsequent preference-consistent information sharing was considerably reduced. This indicates that a motivation to be understood by others might be an important driving force underlying preference-consistent information sharing.
22921348	The aim of this exhaustive descriptive epidemiological study was to determine the clinical approach to be adopted by practitioners specializing exclusively in pediatric odontology and by orthodontists when confronted with decayed molars in children and adolescents.A questionnaire was sent out to all corresponding practitioners (n=2076). Six questions related to treatment decisions taken when faced with decayed permanent first molars (unfavorable short or middle-term prognosis) in patients needing, or not, orthodontic care. The Chi(2) test was used to compare responses.	Thirty-eight per cent of pedodontists (n=38) and 12.5% (n=246) of orthodontists answered the questionnaire. Faced with a permanent first molar with an unfavorable middle-term prognosis, 75.7% needed criteria to help them reach their treatment decision. In decreasing order of importance, these criteria were: presence of the third molar, patient motivation, inter-arch relationship, patient's oral hygiene, facial type, anterior jaw-teeth discrepancy and the number of molars to be extracted. Faced with a permanent first molar requiring extraction and when orthodontic treatment was not required, 31.7% of practitioners decided to close the maxillary space immediately as opposed to 13.4% who closed the space at the mandible. In the presence of a single decayed first molar, 68.7% of practitioners did not extract the antagonist or contralateral first molars.	These treatment decisions were not always unanimous and call for a combined approach between dental surgeon and orthodontist.	
22901601	international estimates suggest that caesarean section on maternal request range from 4% to 18% of all caesarean section. An increasing number of surveys have investigated women's reasons for a caesarean section in the absence of a medical indication but few studies have solely studied first-time mothers motivation for this request.to describe the underlying reasons for the desire for a caesarean section in the absence of medical indication in pregnant first-time mothers.	a qualitative descriptive study, with content analysis of interviews with 12 first-time mothers.	the overarching theme formulated to illustrate the central interpreted meaning of the underlying desire for a planned caesarean section was based on deeply rooted emotions'. Four categories were identified as related to the request for a caesarean section on maternal request. The categories was identified as 'always knowing that there are no other options than a caesarean section', 'caesarean section as a more controlled and safe way of having a baby', own negative experiences of health care and having problems dealing with other people's reaction about their mode of delivery.	the results show that for these first-time mothers deeply rooted emotions described as stronger than fear of birth were behind their wish for a planned caesarean section.	
22901496	breast-feeding initiation rates have improved in Scotland, but exclusive and partial breast-feeding rates fall rapidly for several reasons. We aimed to examine whether antenatal feeding intention was associated with satisfaction with infant feeding method; and to explore the similarities and differences in infant feeding experience of women with different antenatal feeding intention scores.antenatal questionnaire assessment of infant feeding intentions, based on the theory of planned behaviour; two-weekly postnatal follow-up of infant feeding practice by text messaging; final telephone interview to determine reasons for and satisfaction with infant feeding practice.	355 women in eastern Scotland were recruited antenatally; 292 completed postnatal follow up. Antenatal feeding intentions broadly predicted postnatal practice. The highest satisfaction scores were seen in mothers with no breast-feeding intention who formula fed from birth, and those with high breast-feeding intention who breastfed for more than 8 weeks. The lowest satisfaction scores were seen in those with high intention scores who only managed to breast feed for less than 3 weeks. This suggests that satisfaction with infant feeding is associated with achieving feeding goals, whether artificial milk or breast feeding. Reasons for stopping breast feeding were broadly similar over time (too demanding, pain, latching, perception of amount of milk, lack of professional support, sibling jealousy). Perseverance appeared to mark out those women who managed to breast feed for longer; this was seen across the socio-economic spectrum. Societal and professional pressure to breast feed was commonly experienced.	satisfaction with actual infant feeding practice is associated with antenatal intention; levels are higher for those meeting their goals, whether formula feeding from birth or breast feeding for longer periods. Perceived pressure to breast feed raises questions about informed decision making. Identifying those who will benefit most from targeted infant feeding support is crucial.	

22749075	Shared decision making is based on the idea of cooperation and partnership between patients and doctors. In this concept both parties may initiate and perform specific decision-making steps. However, the common observation-based instruments focus solely on doctors' behaviour. Content and quality of information provided to involve patients in medical decisions are hardly considered in evaluation of SDM. This study investigates the advantages of a revised observer inventory taking into account these aspects.Based on the OPTION scale, a more comprehensive observation-based inventory was developed, additionally considering both the patient-sided indicators for patient involvement and the criteria of evidence-based patient information. The inventory comprises three scales (doctor, patient, doctor-patient dyad) and 15 indicators each. Rater training and re-analyses of 76 consultations previously analysed using the OPTION scale were conducted. Convergent validities were calculated between the observer-based scales and the patients' ratings on the Shared Decision Making Questionnaire, the Decisional Conflict Scale and the Control Preference Scale.	Interrater reliabilities of the revised scales were high (r=.87 to .74) and even higher when only the dyadic perspective was coded (.86). The revised inventory provided additional information on the involvement taking place. No substantive correlations were found between observation-based and patients' subjective judgments.	The observers' perspective on patient involvement needs to consider patient activities. Inconsistencies of patients' and observers' judgements concerning patient participation need further investigation.	
22704113	Although obtaining informed consent for distal hypospadias repair is common practice, little is known about the uncertainty or conflict between consenting parents faced with this decision. We systematically evaluated decisional conflict between parents who elected to have their child undergo hypospadias surgery.A total of 100 couples who were counseled about treatment options agreed to participate. Using a validated questionnaire, the Decisional Conflict Scale, we prospectively collected data on decisional conflict demographics, preference for circumcision, education level and prior knowledge about hypospadias.	All parents elected surgical repair. Evidence of decisional conflict was encountered in 28% of participants (score less than 25 in 72%, 25 to 37.5 in 23.5%, greater than 37.5 in 4.5%). No statistically significant differences among parents were noted for total score (mean ± SD 16.1 ± 12 in mothers and 18.3 ± 12.6 in fathers) or subscales, except the informed subscale (mean ± SD 16.7 ± 14.3 in mothers and 21.1 ± 16.6 in fathers). Parental self-report of prior knowledge about hypospadias and preference for neonatal circumcision correlated with lower Decisional Conflict Scale scores (p = 0.02 and p <0.01, respectively). No statistical association was found between score and parental education level (p = 0.7) or expertise of the counselor (staff vs pediatric urology fellow, p = 0.4).	These data describe the level of decisional conflict in couples agreeing to proceed with hypospadias repair, with no evidence of significant discrepancy between them. The novel description of factors related to decreased decisional conflict might help focus efforts aimed at minimizing difficulties encountered during the decision making process.	
22696526	It is well known that subjects tend to misattribute task-irrelevant signals, incorporating them into the information on which a decision is made. Such misattribution has been reported to originate only from a social or a cognitive stage of information processing. However, we provide the initial evidence that misattribution also originates at a lower, visuomotor stage. This type of misattribution occurs only when subjects do not notice a visuomotor conflict. Misattribution at a social or a cognitive stage facilitates decision-making if the misattributed information is consistent with the decision and impedes decision-making if the information is in conflict with the decision. However, misattribution originating at a visuomotor stage only impedes decision-making, suggesting a fundamental difference between the mechanisms for the two types of misattribution. Furthermore, misattribution effects that originate in a visuomotor interaction stage also affect subjective preference ratings, suggesting that the misattribution exerts an influence on global brain processing.
22683801	We have developed a novel laboratory rodent model to detect competitive, non-competitive and no-hurdle foraging behaviors as seen in natural environment. However, it is not clear which brain region is important for the food foraging activity. In the present study, we evaluated the effect of lesions in the bilateral anterior cingulate cortex (ACC) on the rat food foraging behavior with the established model. In contrast to the sham lesion group (saline microinjection into the ACC), bilateral complete ACC chemical lesions (kainic acid microinjection into the ACC) significantly decreased the amount of foraged food in the competitive food foraging tests, non-competitive or no-hurdle foraging test. Moreover, the deficit of the food foraging activity was more prominent in the competitive food foraging test than in the non-competitive food and no-hurdle foraging test after ACC lesions. No alterations after ACC lesions were found in other behaviors including elevated plus-maze test (EPM), forced swimming test (FST), open field test (OFT), sucrose preference test and exploratory behavior. These findings suggest that the ACC mediate the food foraging-related behaviors.
22677349	We undertook the current investigation to explore how the pressures of serving as a surrogate decision-maker (SDM) for an acutely ill family member influence attitudes regarding clinical investigation.We conducted a prospective study involving SDMs for critically ill patients cared for in the ICUs of two urban hospitals. Measurements included participation in focus groups designed to explore perceptions of ICU care and clinical research. Audiotapes were transcribed and analyzed to identify common patterns and themes using grounded theory. Demographic and clinical data were summarized using standard statistical methods.	Seventy-four SDMs (corresponding to 24% of eligible patients) participated. Most SDMs were women and described long-term relationships with the patients represented. SDMs described their role as "overwhelming," their emotions were accentuated by the fatigue of the ICU experience, and they relied on family members, social contacts, and religion as sources of support. Altruism was reported as a common motivation for potential study participation, a sentiment often strengthened by the critical illness episode. Although research was viewed as optional, some SDMs perceived invitation for research participation as tacit acknowledgment of therapeutic failure. SDMs expressed a preference for observational studies (perceived as low risk) over interventional designs (perceived as higher risk). Trust in the ICU team and the research enterprise seemed tightly linked.	Despite significant emotional duress, SDMs expressed interest in investigation and described multiple factors motivating participation. Consent processes that minimize the effects of anxiety may be one strategy to enhance recruitment.	
22663343	This paper provides a developmental overview of relevant theory and research on delay discounting and neuroeconomics, and their implications for contingency management (CM) approaches to treatment. Recent advances in the neuroscience of decision making have the potential to inform treatment development for adolescent substance use in general, and CM treatments in particular. CM interventions may be informed by research on delay discounting, a type of decision making that reflects how individuals value immediate versus delayed rewards. Delay discounting reliably distinguishes substance abusers from nonabusers and is a significant predictor of individual differences in response to substance use treatments. Discounting may also be important in predicting response to CM, as CM attempts to directly influence this decision-making process, shifting the preference from the immediate rewards of use to delayed rewards for choosing not to use. Multiple neural processes underlie decision making, and those processes have implications for adolescent substance abuse. There are significant neurodevelopmental processes that differentiate adolescents from adults. These processes are implicated in delay discounting, suggesting that adolescence may reflect a period of plasticity in temporal decision making. Understanding the neural mechanisms of delay discounting has led to promising working memory interventions directly targeting the executive functions that underlie individual choices. These interventions may be particularly helpful in combination with CM interventions that offer immediate rewards for brief periods of abstinence, and may show particular benefit in adolescence due to the heightened neural plasticity of systems that underlie temporal discounting in adolescence.
22658413	Two experiments examined biases in children's (5/6- and 7/8-year-olds) and adults' moral judgments. Participants at all ages judged that it was worse to produce harm when harm occurred (a) through action rather than inaction (omission bias), (b) when physical contact with the victim was involved (physical contact principle), and (c) when the harm was produced as a direct means to an end rather than as an unintended but foreseeable side effect of the action (intention principle). The youngest participants, however, did not incorporate benefit when making judgments about situations in which harm to one individual resulted in benefit to five individuals. Older participants showed some preference for benefit resulting from action (commission) as opposed to inaction (omission). The findings are discussed in the context of the theory that moral judgments result, in part, from the operation of an inherent, intuitive moral faculty compared with the theory that moral judgments require development of necessary cognitive abilities.
22647303	Neurobiological mechanisms that normally control food intake and energy expenditure can be overcome by environmental cues and by stress. Of particular importance is the influence of the mesolimbic reward pathway. In genetically susceptible individuals, problematic over-eating likely reflects a changing balance in the control exerted by homeostatic versus reward circuits that are strongly influenced by environmental factors such as stress. Both stress and activation of the reward pathway have been shown to increase food intake and promote a preference for palatable, high-energy foods. Recent research has focused on the important role of circulating and central neuropeptides that powerfully regulate the brain response to food cues. For example, ghrelin has a potent positive effect on the motivational aspects of food intake, and central oxytocin may be involved in satiety. Thus, the decision to eat, or indeed to over-eat, involves a complex integrated neurobiology that includes brain centres involved in energy balance, reward and stress and their regulation by metabolic and endocrine factors.
22606995	The four principles of Beauchamp and Childress--autonomy, non-maleficence, beneficence and justice--have been extremely influential in the field of medical ethics, and are fundamental for understanding the current approach to ethical assessment in health care. This study tests whether these principles can be quantitatively measured on an individual level, and then subsequently if they are used in the decision making process when individuals are faced with ethical dilemmas.The Analytic Hierarchy Process was used as a tool for the measurement of the principles. Four scenarios, which involved conflicts between the medical ethical principles, were presented to participants who then made judgments about the ethicality of the action in the scenario, and their intentions to act in the same manner if they were in the situation.	Individual preferences for these medical ethical principles can be measured using the Analytic Hierarchy Process. This technique provides a useful tool in which to highlight individual medical ethical values. On average, individuals have a significant preference for non-maleficence over the other principles, however, and perhaps counter-intuitively, this preference does not seem to relate to applied ethical judgements in specific ethical dilemmas.	People state they value these medical ethical principles but they do not actually seem to use them directly in the decision making process. The reasons for this are explained through the lack of a behavioural model to account for the relevant situational factors not captured by the principles. The limitations of the principles in predicting ethical decision making are discussed.	
22569506	Acute stress can exert beneficial or detrimental effects on different forms of cognition. In the present study, we assessed the effects of acute restraint stress on different forms of cost/benefit decision-making, and some of the hormonal and neurochemical mechanisms that may underlie these effects. Effort-based decision-making was assessed where rats chose between a low effort/reward (1 press=2 pellets) or high effort/reward option (4 pellets), with the effort requirement increasing over 4 blocks of trials (2, 5, 10, and 20 lever presses). Restraint stress for 1 h decreased preference for the more costly reward and induced longer choice latencies. Control experiments revealed that the effects on decision-making were not mediated by general reductions in motivation or preference for larger rewards. In contrast, acute stress did not affect delay-discounting, when rats chose between a small/immediate vs larger/delayed reward. The effects of stress on decision-making were not mimicked by treatment with physiological doses of corticosterone (1-3 mg/kg). Blockade of dopamine receptors with flupenthixol (0.25 mg/kg) before restraint did not attenuate stress-induced effects on effort-related choice, but abolished effects on choice latencies. These data suggest that acute stress interferes somewhat selectively with cost/benefit evaluations concerning effort costs. These effects do not appear to be mediated solely by enhanced glucocorticoid activity, whereas dopaminergic activation may contribute to increased deliberation times induced by stress. These findings may provide insight into impairments in decision-making and anergia associated with stress-related disorders, such as depression.
22548807	Everything else being the same, an equal outcome is generally preferred; however, an equitable allocation sometimes is possible only by sacrificing the total amount of resources available to society. Moreover, direct interests may interact with the perception of equality. Here, we have investigated individual preferences, and their neural basis, by employing a task in which an allocation of a fixed amount between the subject and another person (MS condition) or two third parties (TP condition) is randomly determined. The subject can accept or reject the outcome, in the same fashion as the Ultimatum Game: thus an unequal offer may be rejected at the cost of a loss in total amount. Behavioral results show preference for equal outcomes in TP and for equal and advantageous outcomes in MS. An activation of medial prefrontal cortex (mPFC), extending to the anterior middle cingulate cortex (aMCC), was found in MS unequal outcomes, particularly for disadvantageous outcomes and consequent rejections. The anterior insula (AI) was active for unequal outcomes, in both MS and TP. We propose that the equal treatment is a default social norm, and its violation is signaled by the AI, whereas aMCC/mPFC activation, negatively correlated to rejections, reflects the effort to overcome the default rule of equal treatment in favor of a self-advantageous efficiency.
22508582	The altruistic act of body donation provides a precious resource for both teaching and researching human anatomy. However, relatively little is known about individuals who donate their bodies to science (donors), and in particular whether donors in different geographical locations share similar characteristics. A multicenter prospective survey of donors registering during 2010 in three different geographical locations, New Zealand, Ireland, and the Republic of South Africa, was conducted to identify donor characteristics. The 28-question survey included sections on body donation program awareness, reasons for donating, giving tendency, education, ethnicity, relationship status, occupation, religion, and political preference. Two hundred surveys (81%) were returned [New Zealand 123 (85% response rate), Republic of South Africa 41 (67%), and Ireland 36 (92%)]. Results indicate that donors share certain characteristics including reason for donating (80% cited a desire to aid medical science as the main reason for wishing to donate their body); family structure (most donors are or have been in long-term partnerships and ≥ 85% have siblings); and a higher proportion with no religious affiliation compared to their reference population. Some variations between locations were noted including donor age, the mode of program awareness, occupation, relationship status, political preference, organ donor status and with whom donors had discussed their decision to donate. This information could be important for assisting the identification of potential body donors in new and established bequest programs.
22496116	Cardiac stress testing in patients at low risk for acute coronary syndrome is associated with increased false-positive test results, unnecessary downstream procedures, and increased cost. We judged it unlikely that patient preferences were driving the decision to obtain stress testing.The Chest Pain Choice trial was a prospective randomized evaluation involving 204 patients who were randomized to a decision aid or usual care and were followed for 30 days. The decision aid included a 100-person pictograph depicting the pretest probability of acute coronary syndrome and available management options (observation unit admission and stress testing or 24-72 hours outpatient follow-up). The primary outcome was patient knowledge measured by an immediate postvisit survey. Additional outcomes included patient engagement in decision making and the proportion of patients who decided to undergo observation unit admission and cardiac stress testing. Compared with usual care patients (n=103), decision aid patients (n=101) had significantly greater knowledge (3.6 versus 3.0 questions correct; mean difference, 0.67; 95% CI, 0.34-1.0), were more engaged in decision making as indicated by higher OPTION (observing patient involvement) scores (26.6 versus 7.0; mean difference, 19.6; 95% CI, 1.6-21.6), and decided less frequently to be admitted to the observation unit for stress testing (58% versus 77%; absolute difference, 19%; 95% CI, 6%-31%). There were no major adverse cardiac events after discharge in either group.	Use of a decision aid in patients with chest pain increased knowledge and engagement in decision making and decreased the rate of observation unit admission for stress testing.	
22496115	Vascular access options in coronary angiography can be considered a preference-sensitive decision, where the benefits/risks have different levels of significance, depending on the individual patient. For preference-sensitive healthcare options, patient decision aids (PtDA) significantly improve the process of decision-making. The purpose of this trial was to evaluate the effectiveness of an evidence-based PtDA compared with usual care in patients eligible for radial and femoral artery access.We conducted a single-center, nonblinded, randomized controlled trial with patients eligible for both femoral and radial access as per their treating physician. The PtDA was designed to guide patients to make an informed choice, consistent with their preferences and values. The primary outcome, decisional conflict, was assessed using the validated decisional conflict scale. One hundred fifty patients were randomized (vascular access PtDA=76 versus usual care=74). The intervention group had a significantly reduced decisional conflict scale compared with control (unadjusted 14.8 versus 19.5, P=0.04) and were significantly more knowledgeable regarding risks/benefits associated with each vascular access (mean knowledge score 3/5 (95% confidence interval, 2.6 to 3.3) versus 2/5 (95% confidence interval, 1.7 to 2.3, P<0.01). PtDA patients had better informed value congruence with their vascular access received (47.3% versus 25.7%, P<0.01). There were no significant differences in procedural success or safety between the 2 groups.	A vascular access PtDA for eligible patients undergoing coronary angiogram procedures reduces decisional conflict and improves value congruence and the patients' knowledge of their healthcare options; however, a multicenter study, powered to confirm these benefits and evaluate differences in procedural success or complications, is required.	
22481147	Although studies have demonstrated change in fertility preferences over time, there is a lack of definitive knowledge about the level and direction of change among individuals, especially young and unmarried women. Furthermore, little is known about the factors associated with changes in fertility preferences over time.The analysis uses the first five waves of data from a longitudinal study of a random sample of women aged 15-25 in southern Malawi. The data were collected four months apart over an 18-month period, between June 2009 and December 2010. Multinomial logit regression models were used to calculate relative risk ratios and identify associations between four categories of life events-reproductive, relationship, health and economic-and shifts in fertility timing preferences.	In each four-month period, more than half of the women reported changes in the desired timing of their next birth, and delays and accelerations in timing desires were common. Several life events, including having a child, entering a serious relationship and changes in household finances were associated with changes in the level and direction of fertility preference.	Shifts in fertility timing preferences often occur in response to changes in life circumstances. Understanding the reasons for these shifts may aid family planning providers in meeting women's contraceptive needs.	
22419009	When urinary diversion is indicated, patient information concerning the advantages and disadvantages of different types of urinary diversion and their choices is of utmost importance for the functional outcome and patient satisfaction. There is a variety of choices for incontinent urinary diversion (ureterocutaneostomy, ileal conduit, colonic conduit) and continent urinary diversion (continent anal urinary diversion, continent cutaneous urinary diversion and urethral bladder substitution). In the individual case, the choices may be limited by patient criteria and/or medical criteria. Important patient criteria are preference, age and comorbidity, BMI, motivation, underlying disease and indication for cystectomy. Medical criteria which possibly limit choices of type of urinary diversion are kidney function/upper urinary tract status and limitations concerning the gastrointestinal tract, concerning urethra/sphincter as well as the ability and motivation to perform intermittent self-catheterization. Preoperative information may use simulation of certain postoperative scenarios (urethral self-catheterization, fixation of water-filled conduit bags, holding test for anal liquids) to allow the individual patient to choose the optimal type of urinary diversion for his/her given situation from the mosaic of choices and possible individual limitations.
22415282	At the individual level, practicing high-quality medical care means doing the right thing for a patient as safely as possible. Some medical decisions have one optimal course of action, but most have multiple reasonable options with outcomes that will be valued differently by different people. For these preference-sensitive decisions, involving patients in a shared decision-making process is critical. Patient decision aids are tools that help make shared decision making practical. Policy changes at the federal and state level can help make shared decision making with the active participation of informed patients the rule rather than the exception.
22409114	This pilot study measured participants' comfort with their decision making to have a lumpectomy and radiation or total mastectomy to treat their breast cancer. Findings showed 87% of the patients believed they had made an informed choice and were satisfied with their decision making regarding their surgical procedure selection.
22343029	The human tendency to acquire and keep large quantities of goods has become a serious concern, but has yet to be examined from a neuroscientific perspective. The mesolimbocortical system, particularly the orbitofrontal cortex (OFC) and nucleus accumbens (NAcc), is implicated when humans and animals acquire rewards. However, this may not extend to acquisitiveness per se, which involves fairly mundane items and is interconnected with a failure to discard. Moreover, the NAcc has not been implicated in neuroimaging studies of the extreme acquisitiveness of compulsive hoarders. In a study of the neural bases of normal acquisitiveness, subjects made decisions during functional neuroimaging to acquire or remove everyday items from a hypothetical collection, while maximizing personal preference or monetary profit. All decisions engaged the OFC, but the OFC and all regions of interest shifted in their relative involvement across the four decision contexts. The NAcc was only engaged during personal acquisition to the extent of problematic hoarding, suggesting that even common items can acquire an incentive salience that makes them hard to resist for acquisitive individuals. The types of items preferred also shifted with condition, with subjects only being biased toward expensive items when instructed to maximize profit. Item preferences even differed depending on whether participants were acquiring versus removing items, even though the task only differed superficially in the two conditions. Acquisitiveness reflects a complex mix of affective, cognitive, and personality factors that extend well beyond the drive to acquire valuable resources, with important implications for basic decision science, sustainability, and pathologies associated with compulsive acquisition.
22333900	Genetic tests have traditionally been offered by health professionals. However, genomic tests have been available direct to the consumer for the last decade, increasingly via the Internet. The aim of this systematic review was to ascertain the evidence concerning use of direct-to-consumer genomic testing from the consumer perspective. Primary research was identified using the search terms 'direct-to-consumer' and 'genomic or genetic' in six bibliographic databases and citation searching of findings. In all, 17 papers were reviewed: 3 qualitative and 14 quantitative. Findings indicate a low level of awareness of direct-to-consumer genomic testing and, because of the hypothetical nature of many studies, little evidence from users of such tests. Although potential users appear to be interested in information about their risks of developing common diseases, concerns were expressed about privacy of genetic risk information and the reliability of genomic tests. Consumers were anxious about the nature of the results. There appeared to be a preference to access genomic tests via a health professional, or to discuss the results and obtain advice from a health professional. Authors of only two papers recruited participants who had used direct-to-consumer tests and samples from the large quantitative studies were not representative of the population. These factors limit the value of the available evidence. However, we conclude that there is public interest in direct-to-consumer genomic tests, and that this is likely to result in an increased workload for a range of health professionals. We also consider that there are educational implications for both consumers and health professionals.
22321338	The benevolence hypothesis (both donor and recipient gain) suggests that blood donors, compared to non-blood donors have a general altruistic motivational preference based on warm glow (i.e., "I donate because it makes me feel good"). With objective behavioral economics tests of altruism and warm-glow giving, this paper offers the first direct experimental test of this hypothesis. The prediction that blood donors will be motivated in general by warm glow was compared to predictions from other theoretical models: strong reciprocity and empathy.Four experiments and one prospective study examined blood donors' and nondonors' motivations for general charitable giving and blood donation. Variants of the dictator game (DG; a charity DG [CDG] and a warm-glow version of a CDG) were used to provide objective measures of altruism.	Blood donors gave less than nondonors on the CDG, but gave more on the warm-glow version. Blood donors' actual donations (in the CDGs and blood donation) were associated with feelings of warm glow. There was no evidence that blood donors were motivated by strong reciprocity or empathic concerns.	This paper offers objective behavioral evidence that blood donors' charitable giving and blood donation, compared to non-blood donors, is more strongly motivated by warm glow. This provides additional support for the benevolence hypothesis of blood donation.	
22288820	Zebrafish (Danio rerio) have an innate tendency to join shoals. Based on this, we refined visual choice tests to focus on social interaction and novelty preference. Our design follows mouse three-chamber sociability protocols, except testing is conducted under 940 Lux fluorescent lighting. Initially, we compared performance among zebrafish strains: inbred (AB) or wild-crossbred (WIK) from Zebrafish International Resource Center, to golden and short-fin from Petco stores. AB fish exhibited a preference for shoaling; they dwelled longest near transparent boxes containing zebrafish, while short fin favored blue boxes without fish. AB and golden exhibited a strong preference for social novelty, not evident in short-fin or WIK fish. Serotonin and cannabinoids shape mammalian social behavior, and equivalents of both receptor types are expressed in the zebrafish brain. We examined the effects of the cannabinoid receptor agonist WIN 55,212-2 (1 mg/l), or serotonin 5-HT(1A)  receptor agonist buspirone (10 mg/l) on Petco short-fin social choice. Fish were bath exposed to test compounds for 10 min, under these conditions [(3) H]CP55,940 (4 nm) bound to brain with a concentration of 1.9-6.4 fmol/mg 5-30 min afterward. Social approach was measured 20 min after acclimation to the test arena. WIN 55,212-2 and buspirone increased dwelling near boxed zebrafish. In zebrafish whole-brain homogenates, buspirone displaced [(3) H] 8-hydroxy-N,N-dipropylaminotetralin (dissociation constant, K(D)  = 16 ± 1.2 nm) with an inhibition constant (K(i) ) of 1.8 ± 1.0 nm lower than that of WAY 100,635 (K(i) ∼1000 nm). These fish social choice tests may enhance social behavior research, and are useful for studying the effects of genetic manipulations, pharmaceuticals or environmental toxins.
22258736	This study was to evaluate the participation role and conflict of patients during the decision-making process for endoscopic or surgical treatment for early gastric cancer (EGC).In this prospective observational study, the sequential survey for patients under consideration for treatment of differentiated EGC was performed at the tertiary referral center.	Among the 82 responders, 63.4% preferred endoscopic resection. The total decisional conflict scores were high and significantly different between groups that preferred endoscopic resection or surgical treatment (44.8 vs. 51.6, P = 0.016). Values assigned to the two treatment attributes "preservation of stomach (OR = 0.51)" and "bother in case of incomplete resection (OR = 2.13)" clearly discriminated between patients reaching a final decision of surgical gastrectomy or endoscopic resection. Regarding the participation role, a shared role was more frequent in the group with preference for endoscopic treatment before consultation (42.3% vs. 24.0%, P = 0.045). However, at the time of therapeutic decision, the passive role was most remarkable, both for the endoscopic (53.2%) and surgical (71.4%) groups.	Despite the high overall decisional conflict, patients with preference for endoscopic treatment tended to be more autonomous. After consultation, all patients exhibited a passive participation role in the decision-making process.	
22235982	Risk-taking, measured with laboratory tasks such as the Balloon Analog Risk Task (BART), is associated with real-life manifestations of risky behaviors, which may be an important component of inherited liability to alcohol use disorders. To identify genomic factors that influence these traits, the current study (i) characterized performance of a rodent version of the BART in multiple inbred rat strains, (ii) tested the degree to which performance was under genetic control, (iii) explored sex differences in performance, and (iv) evaluated the risk-taking behavior of F1 progeny of high-risk- and low-risk-taking strains to examine modes of inheritance.Male and female rats (N = 100) from 5 inbred strains (Wistar-Furth, Fischer-344, Lewis, Spontaneously Hypertensive, Brown Norway) and Wistar-Furth × Fischer-344 hybrids were tested in the rat-BART, as well as in tests of locomotor activity, sucrose preference, and general motivation.	About 55% of the variance in risk-taking behavior was attributable to heritable factors. The Fischer-344 strain was the most risk-taking and the most variable in responding. The mating of low-risk-taking Wistar-Furth and Fischer-344 rats produced progeny that behaved most like the Fischer-344 strain. Consistent with prior research in this laboratory (Jentsch et al., 2010), all rats were sensitive to changes in both risk and reinforcement parameters in the rat-BART; rats decreased voluntary risk-taking in the face of increasing risk and increased lever pressing when reinforcement probabilities were reduced.	Our results endorse a moderately heritable pattern of risk-taking behavior in rats. The behavior of the hybrid progeny suggests a polygenic model with most gene effects transmitted by mode of dominant inheritance. The identification of high-risk and low-risk strains allows for isolation of quantitative trait loci associated with task performance and for probing the relationships between risk-taking and dimensions of alcohol use disorders.	
22221928	This paper compares the introduction of policies to promote or strengthen patient choice in four Northern European countries - Denmark, England, the Netherlands and Sweden. The paper examines whether there has been convergence in choice policies across Northern Europe. Following Christopher Pollitt's suggestion, the paper distinguishes between rhetorical (discursive) convergence, decision (design) convergence and implementation (operational) convergence (Pollitt, 2002). This leads to the following research question for the article: Is the introduction of policies to strengthen choice in the four countries characterised by discursive, decision and operational convergence? The paper concludes that there seems to be convergence among these four countries in the overall policy rhetoric about the objectives associated with patient choice, embracing both concepts of empowerment (the intrinsic value) and market competition (the instrumental value). It appears that the institutional context and policy concerns such as waiting times have been important in affecting the timing of the introduction of choice policies and implementation, but less so in the design of choice policies. An analysis of the impact of choice policies is beyond the scope of this paper, but it is concluded that further research should investigate how the institutional context and timing of implementation affect differences in how the choice policy works out in practice.
22212839	Abnormalities involving the prefrontal cortex (PFC) have long been postulated to underpin the pathophysiology of schizophrenia. Investigations of PFC integrity have focused mainly on the dorsolateral PFC (DLPFC) and abnormalities in this region have been extensively documented. However, defects in schizophrenia may extend to other prefrontal regions, including the ventromedial PFC (VMPFC), and evidence of VMPFC abnormalities comes from neuropathological, structural and functional studies. Patients with acquired brain injury to the VMPFC display profound disruption of social behaviour and poor judgment in their personal lives. The Iowa Gambling Task (IGT) was developed to assess decision-making in these neurological cases : it presents a series of 100 choices from four card decks that differ in the distribution of rewarding and punishing outcomes. Whilst healthy volunteers gradually develop a preference for the two "safe" decks over the course of the task, patients with VMPFC lesions maintain a preference for the two "risky" decks which are associated with high reinforcement in the short term, but significant long-term debt. Interestingly, damage to VMPFC may cause both poor performance on the IGT and lack of insight concerning the acquired personality modification. Recently, our group reported a trait-related decisionmaking impairment in the three phases of bipolar disorder. In a PET study, VMPFC dysfunction was shown in bipolar manic patients impaired on a decision-making task and an association between decision-making cognition and lack of insight was described in mania. A quantitative association between grey matter volume of VMPFC and memory impairment was previously reported in schizophrenia. Research suggests that lack of insight is a prevalent feature in schizophrenia patients, like auditory hallucinations, paranoid or bizarre delusions, and disorganized speech and thinking. Because schizophrenia is associated with significant social or occupational dysfunction, previous research assessed decision-making function but indicates conflicting results. Thirteen studies have reported impaired IGT performance in patients with schizophrenia and, in seven reports, no significant differences in IGT performance between patient and healthy control groups were found. Those discrepancies may relate to multiple factors. First, most of the studies included small sample size and negative findings may be due to the large variance of net scores. Second, as suggested by Rodríguez-Sánchez et al., there is a wide disparity in performance by control subjects across studies. Third, intelligence quotient (IQ) score and level of education may be correlated with IGT performance, which may explain IGT performance differences in studies that did not control for educational or IQ score. Fourth, only two studies have systematically controlled for substance use disorder, a potential confounder. Fifth, only two studies assessed the impact of antipsychotic (AP) class on performance. Sixth, to our knowledge, no study assessed the impact of AP dosage on decision-making ability, while AP dose-reduction and dopamine increase, might lead to improvements, in cognitive functions in schizophrenia and in IGT performance in bipolar disorder, respectively. Finally, discrepancies between studies may be related to the heterogeneity of diagnostic groups. Two of the negative studies included schizophrenia and schizoaffective disorder while positive studies have generally included only patients with schizophrenia. Nevertheless, some studies that included only patients with schizophrenia failed to find differences between groups. Thus, further research should assess decision-making in schizophrenia by testing a large group of patients with homogeneity of diagnostic, in comparison with a large group of control subjects. Authors should control for IQ or level of education, substance use disorder and smoking status. While it is now accepted that DLPFC defects in schizophrenia may extend to VMPFC, future investigations should test for an association between memory, insight ability and IGT performance and assess the impact of antipsychotic dosage upon performance.
22154867	To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.Patient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized controlled trial (RCT). The primary outcome was decisional conflict; secondary outcomes included knowledge, preparation for decision-making, preference for participation, involvement in decision-making, decision regret, and adherence.	Out of 2480 randomized participants, 657 (26.5%) provided analyzable data immediately after using the system. Three months later, data from 131 (5.3%) participants could be included in the analysis. The PD group reported a significantly lower overall decisional conflict than the SPI group (38.7 vs. 45.1; p=0.028 via multiple imputation estimator). The largest standardized effect (Cohen's d 0.56) resulted from the preparation for decision-making (PD 59.4 vs. SPI 46.8; p<0.001).	PD may be an effective tool to reduce decisional conflict and prepare participants for treatment decision-making. However, the large dropout rate needs to be taken into account.	This study shows how a health insurance fund can support shared decision-making and how a decision aid can be evaluated in a RCT under routine care conditions.	
22145881	In this article, it will be argued that one of the key contributions of the ventromedial prefrontal cortex (vmPFC) to goal-directed action selection lies both in retrieving the value of goals that are the putative outcomes of the decision process and in establishing a relative preference ranking for these goals by taking into account the value of each of the different goals under consideration in a given decision-making scenario. These goal-value signals are then suggested to be used as an input into the on-line computation of action values mediated by brain regions outside of the vmPFC, such as parts of the parietal cortex, supplementary motor cortex, and dorsal striatum. Collectively, these areas can be considered to be constituent elements of a multistage decision process whereby the values of different goals must first be represented and ranked before the value of different courses of action available for the pursuit of those goals can be computed.
22131407	Many psychiatric disorders are characterized by abnormal risky decision-making and dysregulated dopamine receptor expression. The current study was designed to determine how different dopamine receptor subtypes modulate risk-taking in young adult rats, using a "Risky Decision-making Task" that involves choices between small "safe" rewards and large "risky" rewards accompanied by adverse consequences. Rats showed considerable, stable individual differences in risk preference in the task, which were not related to multiple measures of reward motivation, anxiety, or pain sensitivity. Systemic activation of D2-like receptors robustly attenuated risk-taking, whereas drugs acting on D1-like receptors had no effect. Systemic amphetamine also reduced risk-taking, an effect which was attenuated by D2-like (but not D1-like) receptor blockade. Dopamine receptor mRNA expression was evaluated in a separate cohort of drug-naive rats characterized in the task. D1 mRNA expression in both nucleus accumbens shell and insular cortex was positively associated with risk-taking, while D2 mRNA expression in orbitofrontal and medial prefrontal cortex predicted risk preference in opposing nonlinear patterns. Additionally, lower levels of D2 mRNA in dorsal striatum were associated with greater risk-taking. These data strongly implicate dopamine signaling in prefrontal cortical-striatal circuitry in modulating decision-making processes involving integration of reward information with risks of adverse consequences.
22081115	Patient participation in goal setting and decision making is a core component of the rehabilitation process, but there is little information on what patients want to achieve after allogeneic stem cell transplantation (allo-SCT). The aim of this study was to describe adult patients' perceptions of goals related to health and function, as well as self-perceived limitations and facilitating strategies in the first 13 months after allo-SCT.Fifteen patients with a median age of 44 years (range, 22-65 years) were interviewed on one occasion during the first year after allo-SCT. Data were analysed using qualitative content analysis.	Results showed that patients felt that time after allo-SCT largely concerned: "to be healthy" and "to participate in a normal life". Some patients felt it was easy to set goals while others found it difficult. Most described goals had a long-term character. Patients were faced with a wide variety of limitations of which a few did not link to a described goal. Several facilitating strategies were described that either had or could help patients to reach their goals.	Our results indicate that assistance with setting achievable goals, including individualised strategies and support from health care professionals to realise the goals, may assist in the rehabilitation to restore health and function after allo-SCT.	
22022832	Laboratory studies on a range of animals have identified a bias that seems to violate basic principles of rational behavior: a preference is shown for feeding options that previously provided food when reserves were low, even though another option had been found to give the same reward with less delay. The bias presents a challenge to normative models of decision making (which only take account of expected rewards and the state of the animal at the decision time). To understand the behavior, we take a broad ecological perspective and consider how valuation mechanisms evolve when the best action depends upon the environment being faced. We show that in a changing and uncertain environment, state-dependent valuation can be favored by natural selection: Individuals should allow their hunger to affect learning for future decisions. The valuation mechanism that typically evolves produces the kind of behavior seen in standard laboratory tests. By providing an insight into why learning should be affected by the state of an individual, we provide a basis for understanding psychological principles in terms of an animal's ecology.
22012275	Decision-making policies are subject to modulation by changing motivational states. However, so far, little is known about the neurochemical mechanisms that bridge motivational states with decision making. Here we examined whether dopamine (DA) in the nucleus accumbens core (AcbC) modulates the effects of motivational states on effort-based decision making. Using a cost-benefit T-maze task in rats, we examined the effects of AcbC DA depletions on effort-based decision making, in particular on the sensitivity of effort-based decision making to a shift from a hungry to a sated state. The results demonstrated that, relative to sham controls, rats with AcbC DA depletion in a hungry as well as in a sated state had a reduced preference for effortful but large-reward action. This finding provides further support for the notion that AcbC DA regulates how much effort to invest for rewards. Importantly, our results further revealed that effort-based decision making in lesioned rats, as in sham controls, was still sensitive to a shift from a hungry to a sated state; that is, their preferences for effortful large-reward actions became lower after a shift from a restricted to a free-feeding regimen. These finding indicate that AcbC DA is not necessarily involved in mediating the effects of a shift in motivational state on decision-making policies.
21999460	This paper is a report of a study conducted to explore how the family members of older people who will undergo haemodialysis treatment for the rest of their lives perceive participation.The rights of families to participate in treatment and health care are supported by international law, and by national law in Norway since 1999.	This study, which employed an explorative qualitative approach, was carried out in Norway in 2008. Data were derived from transcribed interviews with seven family members underwent critical discourse analysis.	Three discourse practices about the next of kin perception of participation were found: (1) to care and take control, (2) to struggle for involvement, and (3) to be forgotten and powerless. The next of kin said that they had no dialogue with the healthcare team, and some fought to be included in the decision-making process.	The dominant part of the discourse as expressed by the next of kin seems to be a paternalistic ideology. Thus, finding ways to enable the next of kin to participate in the decision-making process seems to be a major challenge for the healthcare team in the dialysis units.	
21976032	To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD.Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c) treatment goals and preferences.	The majority of families preferred to be primary or shared decision makers regarding treatment decisions. Families' perspectives on the cause of the child's symptoms varied and often were not consistent with a biomedical framework. Families described multiple areas of impairment on child, family relationships, and family functioning. Perspectives toward evidence-based treatments were mixed, with families also expressing interest in and pursuing interventions not delineated in current treatment guidelines.	These findings reinforce the importance of eliciting families' perspectives and involving these important stakeholders in shared decision making as critical components of family-centered care for children with ADHD.	
21924593	Progress notes are narrative summaries about the status of patients during the course of treatment or care. Time and efficiency pressures have ensured clinicians' continued preference for unstructured text over entering data in forms when composing progress notes. The ability to extract meaningful data from the unstructured text contained within the notes is invaluable for retrospective analysis and decision support. The automatic extraction of data from unstructured notes, however, has been largely prevented due to the complexity of handling abbreviations, misspelling, punctuation errors and other types of noise.We present a robust system for cleaning noisy progress notes in real-time, with a focus on abbreviations and misspellings.	The system uses statistical semantic analysis based on Web data and the occasional participation of clinicians to automatically replace abbreviations with the actual senses and misspellings with the correct words.	An accuracy of as high as 88.73% was achieved based only on statistical semantic analysis using Web data. The response time of the system with the caching mechanism enabled is 1.5-2s per word which is about the same as the average typing speed of clinicians.	The overall accuracy and the response time of the system will improve with time, especially when the confidence mechanism is activated through clinicians' interactions with the system. This system will be implemented in a clinical information system to drive interactive decision support and analysis functions leading to improved patient care and outcomes.	
21813369	To evaluate the acceptance and tolerability of the nH1N1 2009 vaccine in HIV-positive individuals.758 patients were included in this prospective study. Different study populations were formed: The Tolerability Study Group consists of HIV-infected patients who visited three outpatient clinics (Cologne, Bonn, Freiburg) during a predefined time period. Patients were offered nH1N1 vaccination. Those accepting were administered a standard dose AS03 adjuvant nH1N1 vaccine. Questionnaires to report side effects occurring within 7 days after immunization were handed out. In a substudy conducted during the same time period, acceptance towards immunization was recorded. This Acceptance Study Group consists of all HIV-infected patients visiting the Cologne clinic. They were offered vaccination. In case of refusal, motivation was recorded.	In the Tolerability Study Group, a total of 475 patient diaries returned in the three study centres could be evaluated, 119 of those (25%) reported no side effects. Distribution of symptoms was as follows: Pain 285/475 patients (60%), swelling 96 (20%), redness 54 (11%), fever 48/475 (10%), muscle/joint ache 173 (36%), headache 127 (27%), and fatigue 210 (44%). Association of side effects with clinical data was calculated for patients in Cologne and Bonn. Incidence of side effects was significantly associated with CDC stages A, B compared to C, and with a detectable viral load (>50 copies/mL). No correlation was noted for CD4 cell count, age, gender or ethnicity. - In the Acceptance Study Group, 538 HIV-infected patients were offered vaccination, 402 (75%) accepted, while 136 (25%) rejected. Main reasons for rejection were: Negative media coverage (35%), indecisiveness with preference to wait until a later date (23%), influenza not seen as personal threat (19%) and scepticism towards immunization in general (10%).	A total of 622 HIV-infected patients were vaccinated against nH1N1-influenza in the three study centres. No severe adverse events were reported. The tolerability was in most parts comparable to general population. Acceptance rate towards influenza vaccination was high (75%). Those refusing the immunization mentioned negative media coverage as the major influence on their decision.	
21775875	The past two decades have yielded profound advances in the fields of prenatal diagnosis and fetal intervention. Although fetal interventions are driven by a beneficence-based motivation to improve fetal and neonatal outcomes, advancement in fetal therapies raises ethical issues surrounding maternal autonomy and decision making, concepts of innovation versus research, and organizational aspects within institutions in the development of fetal care centers. To safeguard the interests of both the pregnant woman and the fetus, the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics make recommendations regarding informed consent, the role of research subject advocates and other independent advocates, the availability of support services, the multidisciplinary nature of fetal intervention teams, the oversight of centers, and the need to accumulate maternal and fetal outcome data.
21767033	The term social preference refers to decision makers' satisfaction with their own outcomes and those attained by comparable others. The present research was inspired by what appears to be a discrepancy in the literature on social preferences--specifically, between a class of studies demonstrating people's concern with inequality and others documenting their motivation to increase social welfare. The authors propose a theoretical framework to account for this puzzling difference. In particular, they argue that a characteristic of the decision setting--an individual's role in creating the outcomes, referred to as agency--critically affects decision makers' weighting of opposing social motives. Namely, in settings in which people can merely judge the outcomes, but cannot affect them ("low agency"), their concern with inequality figures prominently. In contrast, in settings in which people determine the outcomes for themselves and others ("high agency"), their concern with the welfare of others is prominent. Three studies using a new salary-allocation paradigm document a robust effect of agency. In the high-agency condition, participants had to assign salaries, whereas in the low-agency condition, they indicated their satisfaction with equivalent predetermined salaries. It was found that, compared with low-agency participants, high-agency participants were less concerned with disadvantageous salary allocations and were even willing to sacrifice a portion of their pay to better others' outcomes. The effects of agency are discussed in connection to inequality aversion, social comparison, prosocial behavior, and preference construction.
21734862	Motivational theories of choice focus on the influence of goal values and strength of reinforcement to explain behavior. By contrast relatively little is known concerning how the cost of an action, such as effort expended, contributes to a decision to act. Effort-based decision making addresses how we make an action choice based on an integration of action and goal values. Here we review behavioral and neurobiological data regarding the representation of effort as action cost, and how this impacts on decision making. Although organisms expend effort to obtain a desired reward there is a striking sensitivity to the amount of effort required, such that the net preference for an action decreases as effort cost increases. We discuss the contribution of the neurotransmitter dopamine (DA) toward overcoming response costs and in enhancing an animal's motivation toward effortful actions. We also consider the contribution of brain structures, including the basal ganglia and anterior cingulate cortex, in the internal generation of action involving a translation of reward expectation into effortful action.
21732213	The current paper presents a novel approach to understanding and treating addiction. Drawing from work in behavioral economics and developments in the new field of neuroeconomics, we describe addiction as pathological patterns of responding resulting from the persistently high valuation of a reinforcer and/or an excessive preference for the immediate consumption of that reinforcer. We further suggest that, as indicated by the competing neurobehavioral decision systems theory, these patterns of pathological choice and consumption result from an imbalance between two distinct neurobehavioral systems. Specifically, pathological patterns of responding result from hyperactivity in the evolutionarily older impulsive system (which values immediate and low-cost reinforcers) and/or hypoactivity in the more recently evolved executive system (which is involved in the valuation of delayed reinforcers). This approach is then used to explain five phenomena that we believe any adequate theory of addiction must address.
21719189	An empirical model of landowners' conservation incentive program choice is developed in which information about landowners' socio-economic and property characteristics and their attitudes, is combined with incentive program attributes. In a Choice survey landowners were presented with the choice of two incentive programs modelled as 'bundles of attributes' mimicking a voluntary choice scenario. Landowner behaviour and decision and the type of conditions and regulations they preferred were analyzed. Based on choice survey data, landowner heterogeneity was accounted for using a latent class approach to estimate the preference parameters. Three latent classes of landowners with different attitudes to the role and outcome of establishing conservation reserves on private land were identified: multi-objective owners; environment owners; and production owners. Only a small proportion of landowners, mostly environment owners, would voluntarily join a program. Although compensation funding contributed to voluntary program choice for multi-objective owners and environment owners, welfare losses were around 4000 AUD per hectare, which is less than the average agricultural land value in Tasmania. Landowners for whom compensation funding contributed to voluntary program choice were also most likely to set aside land for conservation without payment. This raises the possibility that the government's compensation expenditure could potentially be either reduced or re-allocated to landowners who will not voluntarily take conservation action. Increasing participation in conservation incentive programs and minimizing the welfare losses associated with meeting conservation targets may be best achieved by offering programs that allow flexibility in terms of legal arrangements and other program attributes.

21541125	The effects of a history of differential reinforcement for selecting a free-choice versus a restricted-choice stimulus arrangement on the subsequent responding of 7 undergraduates in a computer-based game of chance were examined using a concurrent-chains arrangement and a multiple-baseline-across-participants design. In the free-choice arrangement, participants selected three numbers, in any order, from an array of eight numbers presented on the computer screen. In the restricted-choice arrangement, participants selected the order of three numbers preselected from the array of eight by a computer program. In initial sessions, all participants demonstrated no consistent preference or preference for restricted choice. Differential reinforcement of free-choice selections resulted in increased preference for free choice immediately and in subsequent sessions in the absence of programmed differential outcomes. For 5 participants, changes in preference for choice were both robust and lasting, suggesting that a history of differential reinforcement for choice may affect preference for choice.
21506025	Previous studies have shown important effects of stress on decision making (DM). In addition, individuals differ in their relative activation of the left and right hemispheres (hemispheric preference; HP), with possible implications for DM. This study tested the relationship between stress, HP and their interaction, with DM in managers. We included a sample of 114 managers from Israel, Italy and France. Stress was inversely and significantly related to DM thoroughness (r=-.333), left-HP (r=-.24) and was positively correlated with instinctiveness DM (r=.25; all p<.05). Importantly, a stress×HP interaction accounted for an additional and significant 9% of the variance in thoroughness, beyond their main effects, nationality and gender. In this interaction, only in right HP managers, but not in left HP managers, stress was inversely correlated with thoroughness. A stress×HP interaction was not found for instinctiveness. Theoretically, our results advise investigating both situational (stress) and personal or biological (HP) factors in the job stress field. Practically, it can guide stress specialists to whom to provide scarce counseling resources of stress management, to improve workers' DM and well-being.
21495529	Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.
21475138	The decision to have bariatric surgery should be based on accurate information on possible risks and benefits of all treatment options. The goal of this study was to determine whether a video-based bariatric decision aid intervention results in superior decision quality compared to an educational booklet. We conducted a prospective, randomized controlled trial among adult patients in a single health plan who met standard criteria for bariatric surgery. Patients were randomly assigned to review either a video-based decision aid (intervention) or an educational booklet on bariatric surgery (control). Changes in patient decision quality were assessed using bariatric-specific measures of knowledge, values, and treatment preference after 3 months. Of 152 eligible participants, 75 were randomly assigned to the intervention and 77 to the control. The 3-month follow-up rate was 95%. Among all participants, significant improvements were observed in knowledge (P < 0.001), values concordance (P = 0.009), decisional conflict (P < 0.001), decisional self-efficacy (P < 0.001), and in the proportion who were "unsure" of their treatment choice (P < 0.001). The intervention group had larger improvements in knowledge (P = 0.03), decisional conflict (P = 0.03), and outcome expectancies (P = 0.001). The proportion of participants choosing bariatric surgery did not differ significantly between groups, although there was a trend toward decreased surgical choice in the intervention group (59% booklet vs. 42% video at 3 months; P = 0.16). The use of bariatric surgery decision aids was followed by improved decision quality and reduced uncertainty about treatment at 3 months. The video-based decision aid appeared to have a greater impact than the educational booklet on patient knowledge, decisional conflict, and outcome expectancies.
21326029	Clinical trials provide information for developing new treatment strategies, enhancing cancer knowledge, and improving trial effectiveness. However, factors related to patients' participation in clinical trials have not been explored in Taiwan.This study explored cancer patients' willingness to participate in clinical trials and motivational factors, barriers, needs, expectations, and other factors influencing their decision making.	In this cross-sectional study, information was collected using structured questionnaires with cancer patients from an academic medical center.	Among 184 cancer patients sampled, most (87.5%) were willing to participate in a clinical trial. Their attitude toward participating in clinical trials was positive (average motivational score = 59.09; highest scoring item was "chance of cure"). Participants had a slight barrier level for participating in clinical trials (average barrier score = 21.51; highest scoring item was "concern over adverse effects of drugs used in clinical trials"). They had strong needs for clinical trial participation (average need factors score = 59.24; highest scoring need item was "supply of clinical trial-related information by medical personnel, including study purpose, adverse effects, effectiveness, and notices"). Participants had expectations of clinical trial participation (average expectations score = 66.58; highest scoring item was "nonrecurrence of tumor"). Factors predicting participation in clinical trials included medical issues and subjective viewpoint.	These study results can help clinical researchers understand cancer patients' willingness to participate in clinical trials and other influencing factors.	Clinical research nurses can use this information in discussions with cancer patients and important stakeholders to help eligible patients better understand clinical trials to make informed decisions about participation.	
21299312	Why do some people take risks and live for the present, whereas others avoid risks and save for the future? The evolutionary framework of life history theory predicts that preferences for risk and delay in gratification should be influenced by mortality and resource scarcity. A series of experiments examined how mortality cues influenced decisions involving risk preference (e.g., $10 for sure vs. 50% chance of $20) and temporal discounting (e.g., $5 now vs. $10 later). The effect of mortality depended critically on whether people grew up in a relatively resource-scarce or resource-plentiful environment. For individuals who grew up relatively poor, mortality cues led them to value the present and gamble for big immediate rewards. Conversely, for individuals who grew up relatively wealthy, mortality cues led them to value the future and avoid risky gambles. Overall, mortality cues appear to propel individuals toward diverging life history strategies as a function of childhood socioeconomic status, suggesting important implications for how environmental factors influence economic decisions and risky behaviors.
21114056	Virtually all Western countries are seeking to bring retirement ages more in line with increases in longevity. The central question in this paper is whether individuals choose a retirement age that fits their life expectancy. This would be ideal from a public policy perspective. The present study aims to test empirically whether retirement planning varies with expectations of survival among a sample of older employees in the Netherlands. Two questions are addressed: (1) What are older employees' expectations of their remaining lifetime, and what factors influence this subjective life expectancy? (2) Are individuals who perceive longer life horizons (high subjective life expectancy) more inclined to retire later than people who expect to live shorter? Using data from a panel study on retirement behaviour in the Netherlands (N=1621 older employees aged 50-60), regression and survival models are estimated to examine the effect of subjective life expectancy on retirement planning and behaviour. The results indicate that subjective life expectancy is a factor that is taken into account in retirement decision making, at least as far as retirement intentions are concerned. Older employees with longer time horizons have a preference for later retirement. When it comes to actual behaviour, however, time horizon does not appear to play a role. The results suggest that particularly employees with a high perceived life expectancy and an intention to work longer do not succeed in carrying their intentions into effect.
21112174	Cancer patients increasingly expect to be involved in treatment decision-making. We investigated factors that motivate cancer doctors to involve their patients in treatment decisions.We conducted 22 telephone interviews with doctors treating breast, colorectal, gynaecological, haematological or prostate/urological cancer. Interviews probed doctors for attitudes to shared decision-making (SDM), views of when patient involvement is appropriate and what motivated them to encourage involvement. Interviews were audio-recorded. Themes were identified using framework analysis.	Cancer doctors described disease, patient, doctor and societal influences on their support for patient involvement in treatment decisions. Treatment recommendations were described as 'clear-cut' or 'grey'. When treatment options were clear-cut, the impact of treatment on patients' quality of life and self-image and the influence of consumer groups motivated doctors' support of patient involvement.	Australian cancer doctors express differing support of patient involvement in decision-making dependent on context, impact and effect that involvement may have. Doctors described meeting patient involvement preferences as a challenge, and needing to identify different characteristics, anxiety levels and levels of understanding to guide them to involve patients in decisions.	Models of shared decision-making may warrant refinement to better guide doctors to elicit and discuss information and involvement preferences.	
21047860	Actions can create preferences, increasing the value ascribed to commodities acquired at greater cost. This behavioural finding has been observed in a variety of species; however, the causal factors underlying the phenomenon are relatively unknown. We sought to develop a behavioural platform to examine the relationship between effort and reinforcer value in mice trained under demanding or lenient schedules of reinforcement to obtain food. In the initial experiment, expenditure of effort enhanced the value of the associated food via relatively lasting changes in its hedonic attributes, promoting an acquired preference for these reinforcers when tested outside of the training environment. Moreover, otherwise neutral cues associated with those reinforcers during training similarly acquired greater reinforcing value, as assessed under conditioned reinforcement. In a separate experiment, expenditure of effort was also capable of enhancing the value of less-preferred low-caloric reinforcers. Analysis of licking microstructure revealed the basis for this increased valuation was, in part, due to increased palatability of the associated reinforcer. This change in the hedonic taste properties of the food can not only serve as a basis for preference, but also guide decision-making and foraging behaviour by coordinating a potentially adaptive repertoire of incentive motivation, goal-directed action and consumption.
20713793	The traditional objective of advance care planning has been to have patients make treatment decisions in advance so that clinicians can attempt to provide care consistent with their goals. The authors contend that the objective for advance care planning ought to be the preparation of patients and surrogates to participate with clinicians in making the best possible in-the-moment medical decisions. They provide practical steps for clinicians to help patients and surrogate decision makers achieve this objective in the outpatient setting. Preparation for in-the-moment decision making shifts the focus from having patients make premature decisions based on incomplete information to preparing them and their surrogates for the types of decisions and conflicts they may encounter when they do have to make in-the-moment decisions. Advance directives, although important, are just one piece of information to be used at the time of decision making.
20649686	To determine whether a disease-specific planning process can improve surrogate understanding of goals of patients with life-limiting illnesses for future medical treatments.A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007.	Six outpatient clinics of large community or university health systems in three Wisconsin cities.	Competent, English-speaking adults aged 18 and older with chronic congestive heart failure or chronic renal disease and their surrogate decision-makers.	Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision-making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and the degree of decision-making latitude granted to the surrogate.	Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision-making.	Three hundred thirteen patient-surrogate pairs completed the study. As measured according to kappa scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group kappa scores ranged from 0.61 to 0.78, whereas control group kappa scores ranged from 0.07 to 0.28.	Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step toward ensuring that patient goals for care are known and honored.	
20615843	This article discusses the development of Web-based online decision support tools intended for researchers examining the issue of shared decision making for the population of individuals with serious mental illnesses.The authors describe the background and use of decision support tools to facilitate shared decision-making between individuals diagnosed with a psychiatric condition and clinicians and describes a novel software platform that allows researchers and other system designers to build decision support systems.	In supporting ongoing research efforts, an online decision support tool appears to be useful for individuals facing preference-sensitive decisions and an online designer tool allows for rapid deployment of these research sites to support ongoing research efforts in shared decision making.	
20604652	Establishing pregnancy location is key to minimising the risks of abortion, and establishing gestational age optimises women's choice of procedure and timing. There is limited information in UK practice about the views of women having an ultrasound before an abortion with regards to whether they would wish to see the scan image of their fetus. We therefore surveyed the views of women having pre-abortion ultrasound scans and the views of ultrasonographers, using self-completed anonymous questionnaires. Responses were available for analysis from 191 women aged 16 to over 45. A total of 25 (13%) women had seen their scan. Of those who did not see their scan, 40 (24%) said they would have liked to see it, to aid their decision-making, as a right, or out of curiosity. Nine out of 17 ultrasonographers completed their questionnaires. Four ultrasonographers thought that women having scans before an abortion should see their scan images if they wished and another four thought they should not because of possible psychological effects. Their response also highlighted possible effects of such scans on those performing them. Given the choice, a larger number of women would like to see their scan images than actually ask. Women request to see their pre-abortion ultrasound images for their own individual reasons, which should be respected. Ultrasonographers may have conflict or ethical dilemmas when performing pre-abortion scans and they should be supported in identifying women for whom looking at their scan images would be of benefit.
20441134	Risk preference during decision making depends not only on the potential risk and profits but also on the roles taken in the current task. Those who perform tasks are more risk-seeking than those who only watch. Given the prominent effect of experiencing the task, the player-spectator discrepancies are supposed to arise in the experiencing phase instead of the choosing phase. In the present study, the authors separated the experiencing role and the choosing role through a stylus maze task in which participants first performed in pairs-one as the player and the other as the spectator-and then chose from two rewarding options for themselves or their partners. The findings show that the experience as players induced a risk-seeking tendency in decision making, which suggests that it was the experiencing role, rather than the choosing role, that caused the difference of risk preference, at least for financially motivated groups and under similar task conditions.
20377844	Most women use some method of pain relief during labour. There is extensive research evidence available of pharmacological pain relief during labour; however this evidence is not readily available to pregnant women. Decision aids are tools that present evidence based information and allow preference elicitation.We developed a labour analgesia decision aid. Using a RCT design women either received a decision aid or a pamphlet. Eligible women were primiparous, > or = 37 weeks, planning a vaginal birth of a single infant and had sufficient English to complete the trial materials. We used a combination of affective (anxiety, satisfaction and participation in decision-making) and behavioural outcomes (intention and analgesia use) to assess the impact of the decision aid, which were assessed before labour.	596 women were randomised (395 decision aid group, 201 pamphlet group). There were significant differences in knowledge scores between the decision aid group and the pamphlet group (mean difference 8.6, 95% CI 3.70, 13.40). There were no differences between decisional conflict scores (mean difference -0.99 (95% CI -3.07, 1.07), or anxiety (mean difference 0.3, 95% CI -2.15, 1.50). The decision aid group were significantly more likely to consider their care providers opinion (RR 1.28 95%CI 0.64, 0.95). There were no differences in analgesia use and poor follow through between antenatal analgesia intentions and use.	This decision aid improves women's labour analgesia knowledge without increasing anxiety. Significantly, the decision aid group were more informed of labour analgesia options, and considered the opinion of their care providers more often when making their analgesia decisions, thus improving informed decision making.	Trial registration no: ISRCTN52287533.	
20191497	Physician preference has previously been shown to be an important determinant of prescription patterns, independent of patient-specific factors. We evaluated whether physician preference was important in the decision to select anti-tumor necrosis factor (anti-TNF) therapy rather than nonbiologic disease-modifying antirheumatic drugs (DMARDs) among rheumatoid arthritis (RA) patients initiating a new RA medication.Using data from the Consortium of Rheumatology Researchers of North America, we identified RA patients who had never taken biologics initiating either anti-TNF therapy or a DMARD in 2001-2008. Physician preference for the use of anti-TNF agents was calculated using data from the preceding calendar year for each physician's other RA patients. Multivariable logistic regression with generalized estimating equations accounted for clustering of patients within the physician practice and evaluated the relationship between physician preference and receipt of anti-TNF therapy, controlling for patient-related factors and disease activity using the Clinical Disease Activity Index.	We identified 1,532 RA patients initiating anti-TNF therapy or a DMARD. In models adjusting for tender and swollen joint counts and global disease activity, physician preference for the use of anti-TNF therapy was an independent predictor of receipt of these agents. Patients of physicians in the highest and middle tertiles of physician preference had a 2.50 (95% confidence interval [95% CI] 1.76-3.56) and 1.70 (95% CI 1.22-2.39) greater likelihood of receiving anti-TNF medications, respectively.	Physician preference is an important determinant of patients' receipt of anti-TNF therapy and may be useful to examine in future studies of RA treatment patterns, costs, and medication safety.	
20093836	Shared decision-making is gaining favor in clinical practice, although the extent to which patients want to be involved in choosing their treatment varies substantially. Because data are lacking on the preferences of patients with chronic diseases such as inflammatory bowel disease (IBD), we wanted to assess IBD patients' preferences about being involved in such decisions.Adult IBD patients were asked to anonymously complete an online survey on their preferences. Non-parametric tests (chi(2)) were used to determine the relationship between responses and respondents.	The questionnaire was completed by 1,067 patients, 617 with Crohn's disease and 450 with ulcerative colitis. Patients' mean age was 43 (SD 13.7) years; the majority were female (66%). In total, 866 patients (81%) reported it as 'very important' to be actively involved in the decision-making process, and another 177 (17%) rated it as 'quite important'. When asked how their treatment could be improved, 537 patients (50%) wanted close, equitable collaboration with their physician. This preference was significantly associated with a disease duration of <or=8 years (p = 0.03). Gender and type of IBD were not significantly associated with patients' preferences.	This study demonstrates IBD patients' desire to be actively involved in the decision-making process. Further research is needed on physicians' perspectives on shared decision-making, and on finding predictive factors for developing a model for shared decision-making in IBD.	
19949492	Students chose between two allocation options, one that gave the allocator more and another participant still more (the "optimal" choice) and one which gave the allocator less and the other participant still less (the "competitive" choice). In a within-subjects design, students' behavior patterns were significantly correlated across the two rounds of decision-making; however, students allocated more optimally when the allocation involved real rather than hypothetical money, suggesting that both motivational context and individuals' personality and/or experience influence preference patterns. The nature of the putative other participant did not affect the allocation: students allocated in a comparable fashion whether the other participant was said to be male, female, or a computer.
19940177	Several theories of self-control [including intertemporal bargaining (Ainslie, 1992) and self-signaling (Bodner and Prelec, 2001)] imply that intertemporal decisions can be more farsighted than would be predicted by the incentive associated with rewards outside a decision context. We examined this hypothesis using behavior and functional neuroimaging. First, subjects expressed preferences between amounts of money delayed by 4 months and smaller amounts available that day. This allowed us to establish "indifference pairs" individualized to each participant: immediate and delayed amounts that were equally preferred. Participants subsequently performed a reaction time functional magnetic resonance imaging task (Knutson et al., 2001a) that provided them with distinct opportunities to win each of the rewards that comprised the indifference pairs. Anatomical region of interest analysis as well as whole-brain analysis indicated greater response recruited by the immediate rewards (relative to the preference-matched delayed rewards) in regions previously implicated as sensitive to incentive value using the same task (including bilateral putamen, bilateral anterior insula, and midbrain). Reaction time to the target was also faster during the immediate relative to delayed reward trials (p < 0.01), and individual differences in reaction time between immediate versus delayed reward trials correlated with variance in magnetic resonance signal in those clusters that responded preferentially to immediate rewards (r = 0.33, p < 0.05). These findings indicate a discrepancy in incentive associated with the immediate versus the preference-matched delayed rewards. This discrepancy may mark the contribution of self-control processes that are recruited during decision-making but that are absent when rewards are individually anticipated.
19933891	Despite the acknowledged importance of ethics education in medical school, little empirical work has been done to assess the needs and preferences of medical students regarding ethics curricula.Eighty-three medical students at the University of New Mexico participated in a self-administered written survey including 41 scaled questions regarding attitudes, needs, and preferences toward medical ethics and ethics education.	Students reported strong personal interest in learning more about ethics in clinical medicine and research. They most strongly endorsed as valid objectives of ethics education the goals of helping professionals "better recognize ethical issues and clarify values-laden choices," "improve patient care and clinical decision-making," and "improve ethical practices in clinical research." Participants strongly agreed that "professional attitudes and values are an appropriate focus for medical education" and also expressed strong interest in learning more about specific ethical topics and learning methods. Women more strongly endorsed interest in additional ethics education and a preference for increased ethics education than men. Preclinical participants expressed a greater desire for additional training on all ethics topics than clinical students.	The medical students surveyed strongly affirmed ethics education in medical school and expressed clear preferences for curricular topics and teaching methods.	
19837855	To clarify the role and function of the will in psychoanalytic theory and praxis, the use and meaning of the concept of will are traced in the philosophical tradition influencing Freud, in Freud's own view of will, and in the subsequent history of psychoanalysis. Functions of the will relevant to psychoanalysis are described in terms of intellective preference and executive functioning. Operations of will as an executive function of the ego-self are analyzed, emphasizing will as efficient cause of motivated actions. The will functions to decide, choose, and initiate action directed to motivationally determined goals. The conclusion is drawn that will action is determined and directed by motivational influences, and that will decision and choice, while predominantly secondary process in organization, can operate consciously or unconsciously. Expressions of will action in psychopathology and in the analytic process are briefly discussed.
19792056	Directors of residential agencies for persons with intellectual disability in one U.S. state completed a self-administered, mailed survey to assess relative importance of information sources and decision factors in proxy healthcare decision-making. The most important sources were physician recommendations and input from the person; family input, care staff recommendations, and medical records were less valued. The person's wishes and best interests and recommendations of medical experts were the most important decision factors. Less important were benefits and risks of the intervention, family wishes, and health status; little emphasis was accorded to religious affiliation and extra cost to agency. More research is needed on how best to elicit the wishes and determine what constitutes the "best interests" of these vulnerable individuals.
19780851	The study aimed to quantify the preferences of young physicians for different attributes relevant to practice establishment in Germany.Qualitative in-depth interviews of 22 physicians were conducted to identify relevant practice attributes. Based on this information, a questionnaire was developed containing a discrete choice experiment comprised of a "best-worst scaling" (BWS) task. It was mailed to a representative sample of 14,939 young physicians who were close to making a decision regarding practice establishment. Regression analysis was used to estimate utility weights quantifying physicians' preferences for practice attributes.	Qualitative interviews identified six attributes: "professional cooperation,""income,""career opportunities of the partner,""availability of child care,""leisure activities," and "on-call duties." For the BWS task, 5,026 returned questionnaires were analyzed. Results indicated that a change in income led to the largest utility change compared with changes in other attributes. Additional net income to compensate the disutility of a rural practice as compared with an urban practice was 9,044euro/months (U.S.$ 11,938). Yet, nonmonetary attributes such as on-site availability of childcare and fewer on-call duties would decrease the additional income required to compensate the disutility of a rural practice.	The results offer quantifiable information about young physicians' preferences in establishing a practice. It can assist health policy makers in developing tailored incentive-based interventions addressing urban-rural inequalities in physician coverage.	
19764268	In-depth interviews of students with qualitative analysis of the responses were used to explore perceptions of the non-academic advantages and disadvantages of Advanced Placement (AP) and International Baccalaureate (IB) program participation, and differences between the AP and IB programs in those perceptions. Results revealed that benefits of participation, including pride in completing more challenging work, similarity and special bonds among participants, better treatment (more respect and responsibility) from teachers, better overall class atmosphere, and preference for AP and IB courses were consistent across schools and between programs. Also consistent were the disadvantages students reported, with marked differences in the intensity of disadvantages between the AP and IB programs. Specifically, as the amount of time students spent in homogeneously grouped settings increased, so did the workload, the intensity of the perceived social/emotional disadvantages of the workload, the perceived range of negative feelings between participants and non-participants, and the perceived negativity of participant strereotypes.
19744938	Many everyday tasks involve repeated choices in which past outcomes are used to estimate payoffs but in which present payoffs may differ from past ones. Two experiments with 10 decision problems employing the decisions-from-feedback paradigm examined the choice between two risky options, wherein the payoff probabilities for one option could change over a sequence of trials. Participants either saw the outcomes associated with each option, or additionally were given a "history" summarizing the outcomes of previous trials. Participants adapted quickly to new problems, but adapted slowly to payoff changes. Providing a history improved initial choices, but had a null or negative impact on later ones-although, appropriately, the summary received less weight in later trials. An associative choice model captured changes in preference, but not initial patterns of choice. The findings emphasize the adaptive value of forgetting in unstable decision environments, but illustrate how providing additional relevant information may hinder this.
19477336	This chapter presents a cognitive computational view of decision making as the search for, and accumulation of, evidence for options under consideration. It is based on existing models that have been successful in traditional decision tasks involving preferential choice. The model assumes shifting attention over time that determines momentary inputs to an evolving preference state. In this chapter, the cognitive model is extended to illustrate how links from the motor system may be incorporated. These links can basically be categorized into one of three influences: modifying the subjective evaluation of choice options, restricting attention, and altering the options that are to be found in the choice set. The implications for the formal model are introduced and preliminary evidence is drawn from the extant literature.
19416743	Motivation, depending on the relative preference and magnitudes of rewards, can influence our goal-directed action. Reward preferences can modulate neurons in the striatum (ventral and dorsal portions), lateral prefrontal and orbitofrontal cortex, but it remains unclear where in the brain and how any motivational change affects subsequent rewarding action. The present study sought to test whether the lateral prefrontal and other regions in monkeys during a visuo-motor task may change the activities in response to the reward preferences. After defining the rating of reward preference in a choice test, we measured regional cerebral blood flow of two Japanese monkeys during the task where the cognitive requirement was always the same, but the motivational significance varied by different rewards (raisin, banana flavored pellet, plain pellet, and banana), using positron emission tomography with H2(15)O. We showed that lateral prefrontal, orbitofrontal, parietal, striatal (ventral and dorsal), and cerebellar activities may be modulated depending on the reward preferences. The present results may include the brain regions subserving motivational changes by subjective reward significances.
19404228	To determine which rehydration method, oral or intravenous, parents would choose for their child when given the opportunity to make an informed decision and to determine factors influencing preference.Parents of children, aged 6 months to 5 years, who presented to a pediatric emergency department with a chief complaint of vomiting and/or diarrhea were eligible. After triage evaluation and before physician assessment, research assistants presented educational materials regarding the method, risks, and benefits of both oral and intravenous rehydration. Parents were then asked to complete a survey asking them their preference, reasons for their preference, questions about their child's current illness, and demographic information.	Two hundred sixty parents completed the study. Ninety eight (38%) preferred oral rehydration, and 162 (62%) preferred intravenous rehydration. Time of day, presence of siblings in the ED requiring parental attention, presence of another adult to provide support, parental age, educational attainment, and employment status were not statistically associated with the stated preference. Of those parents who selected intravenous rehydration, 53% stated that they would choose oral rehydration if there was an oral medication available that would significantly decrease vomiting. Of those parents who selected oral rehydration, 32% stated that they would choose intravenous rehydration if there was a topical medication available that would significantly decrease the pain of intravenous catheter placement.	When given the opportunity to make an informed decision, more parents chose intravenous rehydration. However, the prospect of an effective oral antiemetic medication might lead more parents to choose oral rehydration.	
19388013	Brain derived neurotrophic factor (BDNF) regulates neural development and synaptic transmission. We have tested the hypothesis that functional variation in the BDNF gene (Val66Met polymorphism, rs6265) affects brain reward circuitry encoding human judgment and decision-making regarding relative preference. We quantified relative preference among faces with emotional expressions (angry, fearful, sad, neutral, and happy) by a keypress procedure performed offline to measure effort traded for viewing time. Keypress-based relative preferences across the ensemble of faces were mirrored significantly by fMRI signal in the orbitofrontal cortex, amygdala, and hippocampus when passively viewing these faces. For these three brain regions, there was also a statistically significant group difference by BDNF genotype in the fMRI responses to the emotional expressions. In comparison with Val/Met heterozygotes, Val/Val individuals preferentially sought exposure to positive emotions (e.g., happy faces) and had stronger regional fMRI activation to aversive stimuli (e.g., angry, fearful, and sad faces). BDNF genotype accounted for approximately 30% of the variance in fMRI signal that mirrors keypress responses to these stimuli. This study demonstrates that functional allelic variation in BDNF modulates human brain circuits processing reward/aversion information and relative preference transactions.
19364749	In 1950, Tinbergen described the elicitation of offspring begging by the red spot on the bill of parent gulls, and this became a model system for behavioural studies. Current knowledge on colour traits suggests they can act as sexual signals revealing individual quality. However, sexual signals have never been studied simultaneously in relationship to parent-offspring and sexual conflicts. We manipulated the red-spot size in one member of yellow-legged gull pairs and observed their partners' feeding efforts in relationship to offspring begging. In the enlarged-spot group, partners doubled their effort compared with the other groups. Furthermore, in the reduced-spot group, partners provided food in relationship to offspring begging, contrasting with the fixed effort of the partners of enlarged-spot gulls. Manipulated gulls, independently of treatment, provided food in relationship to chicks begging only when the partner's investment was low, and performed a fixed effort when the partner's contribution was high. Results demonstrate that the red spot in yellow-legged gulls functions as a sexual signal and indicate that parental rules are plastic, depending on the information on offer. Previous evidence and this study indicate that this signal is used by all family members to adjust decision rules. The incorporation of sexual signals in parent-offspring interactions can be crucial in understanding intra-familial conflicts.
22029452	One hundred and ninety participants (95 undergraduates and 95 employees) responded to a factorial survey in which a number of case-based organizational allocation tasks were described. Participants were asked to imagine themselves as employees in fictitious organizations and chose among three allocations of employee-development schemes invested by the manager in different work groups. The allocations regarded how such investments should be allocated between two parties. Participants chose twice, once picking the fairest and once the best allocation. One between-subjects factor varied whether the parties represented social (i.e., choosing among allocations between two different work groups) or temporal comparisons (i.e., choosing among allocations between the present and the following year). Another between-subjects factor varied whether participants' in-group was represented by the parties or not. One allocation maximized the outcome to one party, another maximized the joint outcome received by both parties, and a third provided both parties with equal but lower outcomes. It was predicted that equality, although always deficient to both parties, would be the preferred allocation when parties represented social comparisons and when choices were based on fairness. When parties represented temporal comparisons, and when choices were based on preference, maximizing the joint outcome was hypothesized to be the preferred allocation. Results supported these hypotheses. Against what was predicted, whether the in-group was represented by the parties or not did not moderate the results, indicating that participants' allocation preferences were not affected by self-interest. The main message is that people make sensible distinctions between what they prefer and what they regard as fair. The results were the same for participating students who imagined themselves as being employees and participants who were true employees, suggesting that no serious threats to external validity are committed when university students are used as participants.
19291229	Environmental stimuli constantly compete for human attention and in many cases decisions are made based on the affective meaning they convey. Although the network of structures involved in processing affective value has been well described, the specific contribution of these structures to the process by which affective value guides decision making is less well understood and is the focus of the present study. Thus, subjects read descriptions of individually tailored holidays, varying in incentive value and then made preference judgements, cognitive judgements or no decision. Choices made from an affective perspective, compared with those made from a cognitive perspective, activated a region of the anterior insula/operculum and also the anterior cingulate cortex. Furthermore, activity in perigenual, anterior cingulate cortex was correlated with subjective ratings of incentive value. In contrast, medial orbitofrontal cortex (OFC) and a region of posterior ventrolateral prefrontal cortex (PFC), bordering on the insula, were found to be more active when affective stimuli guided response selection than when no selection was made. However, only the activity in the ventrolateral PFC was specific to response selection based on affective compared with cognitive judgements. It is proposed that the necessary introspection required to make subjective preference judgements is provided by the insula and cingulate cortices, while the medial OFC and posterior ventrolateral PFC/insula cortices contribute to stimulus evaluation and motivational aspects of response selection, respectively.
19271852	A skew in the base rate of upcoming events can often provide a better cue for accurate predictions than a contingency between signals and events. The authors study prediction behavior and test people's sensitivity to both base rate and contingency; they also examine people's ability to compare the benefits of both for prediction. They formalize these notions and propose a new measure of the regularity in the environment (ExpPA). In two experiments they test whether the notions underlying this measure capture prediction behavior. In the first experiment, they compare participants' prediction behavior, preference, and assessment of contingencies in two data sets that differ only in their base rate. In the second, in which the contribution of contingency over base rate is manipulated, they study participants' willingness to forgo a costly predictor. Results indicate a close correspondence between ExpPA and behavior.
18940597	The structural effects of cocaine on neural systems mediating cognition and motivation are not well known. By comparing the thickness of neocortical and paralimbic brain regions between cocaine-dependent and matched control subjects, we found that four of 18 a priori regions involved with executive regulation of reward and attention were significantly thinner in addicts. Correlations were significant between thinner prefrontal cortex and reduced keypresses during judgment and decision making of relative preference in addicts, suggesting one basis for restricted behavioral repertoires in drug dependence. Reduced effortful attention performance in addicts also correlated with thinner paralimbic cortices. Some thickness differences in addicts were correlated with cocaine use independent of nicotine and alcohol, but addicts also showed diminished thickness heterogeneity and altered hemispheric thickness asymmetry. These observations suggest that brain structure abnormalities in addicts are related in part to drug use and in part to predisposition toward addiction.
18834933	Humans and some birds and insects sometimes prefer alternatives associated with greater past cost or need, sometimes affording losses. It has been proposed that this is widespread because learning may include knowledge about both the physical properties of alternatives and state-dependent fitness gains. We examine the phenomenon for the first time in a fish, the banded tetra (Astyanax fasciatus). During training we paired two different color cues to identical food rewards, one under greater deprivation than the other. We then tested preference between these cues under both deprivation states. Consistent with previous results in other taxa, the fish preferred the cue associated with previous greater deprivation regardless of the condition under which they were tested. These results provide further support to the view that organisms assign value using state-dependent increments in fitness during learning. Although generally adaptive, under experimental conditions state-dependent valuation learning can lead to paradoxical choices.
18764765	As technology has simplified meeting basic needs, humans have cultivated increasingly psychological avenues for occupying their consumption energies, moving from consuming food to consuming concepts; we propose that consideration of such "conceptual consumption" is essential for understanding human consumption. We first review how four classes of conceptual consumption-consuming expectancies, goals, fluency, and regulatory fit-impact physical consumption. Next, we benchmark the power of conceptual consumption against physical consumption, reviewing research in which people forgo positive physical consumption-and even choose negative physical consumption-in order to engage in conceptual consumption. Finally, we outline how conceptual consumption informs research examining both preference formation and virtual consumption, and how it may be used to augment efforts to enhance consumer welfare.
18756249	Human social interaction is strongly shaped by other-regarding preferences, that is, a concern for the welfare of others. These preferences are important for a unique aspect of human sociality-large scale cooperation with genetic strangers-but little is known about their developmental roots. Here we show that young children's other-regarding preferences assume a particular form, inequality aversion that develops strongly between the ages of 3 and 8. At age 3-4, the overwhelming majority of children behave selfishly, whereas most children at age 7-8 prefer resource allocations that remove advantageous or disadvantageous inequality. Moreover, inequality aversion is strongly shaped by parochialism, a preference for favouring the members of one's own social group. These results indicate that human egalitarianism and parochialism have deep developmental roots, and the simultaneous emergence of altruistic sharing and parochialism during childhood is intriguing in view of recent evolutionary theories which predict that the same evolutionary process jointly drives both human altruism and parochialism.
18701235	To appraise instruments used as primary outcome measures in trials measuring the effectiveness of patient decision support interventions.Primary outcome measures were identified in trials of patient decision aids included in the 2003 Cochrane Review. Instruments were appraised for: use in calculating sample size, appropriateness, reliability, validity, responsiveness, precision, interpretability, acceptability, and feasibility.	Of the 35 trials, there were 35 unique primary outcome measures and 8 instruments were appraised. Actual or preferred choice was the primary outcome measure in 18 trials. Two instruments met at least 6 of 8 appraisal criteria: Control Preference Scale (n=2 trials) and Decisional Conflict Scale (n=5 trials). The Decision Conflict Scale was used to calculate sample size in 4 trials.	Decision was the most consistent outcome measure. Most publications provided inadequate detail for appraising the instruments. Four instruments (Decisional Conflict, Control Preferences, Genetic Testing Knowledge Questionnaire, and McBride's Satisfaction with Decision) measured one or more International Patient Decision Aid Standards criteria for evaluating effectiveness.	Selecting relevant and high quality outcome measures remains challenging and is an important area for further research in the field of shared decision making.	
18605485	People who prefer larger, later gains over smaller, sooner gains when considering outcomes far in the future often reverse their preference as the alternatives become closer in time. This finding, which is contrary to a normative economic account of intertemporal choice, has been interpreted as support for hyperboloid discounting, but the results can also be explained by steeper discounting of smaller amounts. The present study is the first to demonstrate that analogous preference reversals occur with losses: People who preferred a smaller, sooner loss over a larger, later loss when the outcomes were far in the future reversed their preference when these alternatives were closer in time. Because there was no magnitude effect (i.e., smaller losses were not discounted more steeply than larger losses), the present findings strongly support the proposition that reversals in preference between delayed outcomes occur because of the hyperboloid shape of the discounting function.
18595569	To adapt ethnically appropriate radio and newspaper messages in order to increase information-seeking and recruitment to the high-risk Prostate Cancer Risk Assessment Program (PRAP) using input from focus groups.We conducted four gender- and ethnic specific-focus groups composed of up to eight participants each. Group participants ranged in age from 35-69 and were either at risk for prostate cancer or were married to someone at risk. Participants evaluated both print and radio advertisements for a PRAP media recruitment campaign, and their recommendations were used to adapt the advertisements.	Trigger words, e.g,, "research program," were found to be a particular issue for African-American men who cited concerns about "experimentation," while the other groups cited concerns about time commitments and cost. In the print messages, familial themes garnered an overall favorable response, but Caucasian-American participants responded negatively to the use of photos of age-appropriate models.	Focus groups are useful in checking health professional assumptions about health messages prior to developing awareness or recruitment advertisements or materials. There was an implied preference for "younger" models among Caucasian Americans. Radio and print messages were adapted using the focus group recommendations, i.e., focusing on familial themes, adding race-specific risk estimates and using younger-than-target group models.	
18595283	We evaluated behavior exhibited by individuals with developmental disabilities using progressive-ratio (PR) schedules. High- and low-preference stimuli were determined based on the results of a paired-stimulus preference assessment and were evaluated in subsequent reinforcer and PR assessments using concurrent and single schedules of presentation. In Experiment 1, results showed that for 2 of 3 participants, stimuli determined to be low-preference functioned as reinforcers when evaluated independent of high-preference stimuli. Further, the results from Experiment 2 showed that low-preference stimuli also functioned as reinforcers under gradually increasing PR requirements. Results suggest that for cases in which a high-preference stimulus is unavailable or impractical, the contingent delivery of relatively less preferred stimuli may maintain appropriate behavior, even as schedule requirements increase.
18578848	In this article, we present a new framework for interpreting cultural differences in behavior -- what we call the institutional approach. In this framework, individuals' behaviors are conceptualized as strategies adapted to various incentive structures. Cultural differences in behavior are thus viewed as differences in the default adaptive strategies that individuals come to rely on in unclear situations. Through two studies, we demonstrate that the East Asian "preference" for conformity is actually a default strategy to avoid accrual of negative reputation. When the possibility for negative evaluations in a given situation was clearly defined, cultural differences in the tendency for uniqueness disappeared. This approach carries important implications to psychologists who interpret cultural differences in behavior in terms of preferences, and can serve as a common framework branching out toward other disciplines in the social sciences.
18512422	Undergraduate students in Singapore (N = 80) learned about the competence (low vs. high) and likability (low vs. high) of a future interaction partner and indicated their attraction toward that stranger. The effect of likability was two times as large as that of competence. Because of the additive effects of the two manipulated factors on attraction, the authors interpreted the preference for lovable fools over competent jerks as an outcome of a generalized supremacy of likability over competence.
18444743	It has often been argued and found that preference diversity is beneficial for the quality of group decisions. However, this literature has neglected the fact that in many situations, it is also possible not to choose. Further, preference diversity can be based on attractions, aversions, or both. The authors argue that some types of preference diversity can lead to biased discussions and choice refusal (i.e., the group refuses to choose any of the available options). In a laboratory experiment, three different patterns were observed. When group members held different aversions before discussion, discussions were aversion driven and group members quickly agreed to refuse all alternatives. When each alternative had both a proponent and an adversary, discussions were longer and unbiased but still often led to refusal, which was accompanied by relatively low levels of outcome satisfaction. Only when preference diversity was based only on attractions did it lead to unbiased discussion, low prevalence of refusal, and high outcome satisfaction. Implications for group decision making are discussed.
18422549	Decision-making and reinforcement sensitivity were investigated in 23 children with ADHD and 20 healthy controls using a gambling paradigm.Children were required to choose between three alternatives that carried (A) small rewards and small penalties (advantageous), (B) large rewards and increasing penalties and (C) small rewards and increasing penalties (both disadvantageous). Penalties increased either in frequency or magnitude in two independent conditions. Heart rate (HR) and skin conductance (SC) were measured to examine whether impaired decision-making was accompanied by autonomic abnormalities.	Children with ADHD showed a maladaptive response style compared to controls by demonstrating a smaller preference for the advantageous alternative, when penalties increased in magnitude. When penalties increased in frequency, children with ADHD performed like controls. Group differences in decision-making attenuated after the task was administered twice. Compared to controls, performance of children with ADHD in the magnitude condition was accompanied by increased HR acceleration following reward. In this condition, the post-selection SC of children with ADHD was larger for advantageous than for disadvantageous alternatives, in contrast to controls who showed an opposite SC pattern.	The current findings suggest that during decision-making, children with ADHD may be sensitive to the frequency but blind to the magnitude of penalty.	
18361671	This research examined how the presentation of items related to goals and temptations influences the dynamic of self-regulation, as reflected in evaluation and choice. The authors found that when items, such as healthy and unhealthy foods or academic and leisure activities, are presented together in a unified choice set (e.g., in 1 image) and seem to complement each other, people express a positive evaluation of and a preference for tempting items. Conversely, when the items are presented apart from each other in 2 choice sets (e.g., 2 images) and seem to compete with each other, people express a positive evaluation of and preference for goal items.
18354119	While the question of whether our actions are determined or are the result of free will is a deep one in philosophy, it does not need to be answered for forensic psychiatrists to give evidence in court. As Stephen Morse has pointed out, the absence of free will is not named as an excusing condition. The insanity defense, for instance, requires proof of functional impairment, to which psychiatrists can usefully testify. Of the approaches available to determinism, my own preference is that of Herbert Hart: until we know that determinism is true, we will continue to prefer a system that requires persons to have made proper choices to act as they did before we hold them responsible. This seems to resemble Dr. Felthous' preferred option, that mentally responsible choices are choices made in the presence of a relatively natural ability to have decided otherwise.
18349431	People who exhibit value-induced bias- distorting relevant probabilities to justify medical decisions- may make suboptimal decisions.The authors examined whether and in what conditions people exhibit value-induced bias.	Volunteers on the Web imagined having a serious illness with 2 possible diagnoses and a treatment with the same "small probability'' of success for each diagnosis. The more serious diagnosis was designed as a clear-cut decision to motivate most subjects to choose treatment; the less serious diagnosis was designed to make the treatment a close-call choice. Subjects were randomized to estimate the probability of treatment success before or after learning their diagnosis. The "after group'' had the motivation and ability to distort the probability of treatment success to justify their treatment preference. In study 1, subjects learned they had the more serious disease. Consistent with value-induced bias, the after group was expected to give higher probability judgments than the ;;before group.'' In study 2, subjects learned they had the less serious disease, and the after group was expected to inflate the probability if they desired treatment and to reduce it if they did not, relative to the before group.	In study 1, there was no difference in the mean probability judgment between groups, suggesting no distortion of probability. In study 2, the slope of probability judgment regressed on desire for treatment was steeper for the after group, indicating that distortion of probability did occur.	In close-call but not clear-cut medical decisions, people may distort relevant probabilities to justify their preferred choices.	
18042310	In two studies, we examined the role of social comparisons in regret management. In the first study, participants received a (relatively) negative outcome after which they were presented with base-rate information about the performance of other participants in the experiment. Results showed that experienced regret decreased as a result of base-rate information showing that most others made even worse decisions than oneself. In the second study, we investigated whether people actively seek this kind of consensual information to validate their decision. After inducing regret by means of a manipulated outcome in a trivia quiz, participants could obtain information about the outcomes of previous participants or about the type of items used in the quiz. Participants' preference was determined by whether or not they believed that they would be given a second chance. In case of a negative and final outcome, participants preferred information about the prevalence of others who had an even worse outcome. When the outcome was non-final, participants preferred information about the type of items used in the test. Both strategies were accompanied with a decrease in regret. Implications for research on regret and decision making are discussed.
17693034	Studying the neural mechanisms underlying complex goal-directed behaviors, such as social behavior, reward seeking or punishment avoidance, has become increasingly tractable in humans, nonhuman primates and rodents. In most experiments, however, goal-directed behaviors are measured in a laboratory setting, which is vastly different from the context in which these behaviors naturally occur. This study adapted a reward assessment paradigm, previously conducted with rhesus monkeys (Macaca mulatta) in the controlled environment of a Wisconsin General Testing Apparatus (WGTA) [Machado CJ, Bachevalier J (2007) The effects of selective amygdala, orbital frontal cortex or hippocampal formation lesions on reward assessment in nonhuman primates. Eur J Neurosci 25:2885-2904], to a more naturalistic context. We used this new paradigm to examine the effects of bilateral amygdaloid, hippocampal or orbital frontal cortex lesions on established food and nonfood preferences. Behavioral modification following reinforcer devaluation was also measured. Consistent with our previous study, none of the lesions produced changes in preference for palatable foods relative to pre-surgery, but animals with amygdala lesions displayed heightened preference for unpalatable foods that control or other operated animals typically avoided. In contrast to several previous WGTA-based experiments, nonfood preference was not affected by any of the lesions. Finally, animals with orbital frontal cortex lesions continued to select preferred foods after satiation, but those with amygdala, hippocampal or sham lesions altered their foraging behavior appropriately and selected less of the sated food. These findings parallel food devaluation results obtained with these same animals when tested in the WGTA. Overall, this study stresses the importance of testing context when measuring decision-making abilities in nonhuman primates with selective brain lesions.
17683224	In this study, the authors examined (a) the effect of changes in the need to eat on expressed preferences for foods that are appropriate for different times of day and (b) whether that need is directed toward food in general or foods contextually appropriate to the time of day. Previous findings suggest that, when the goal is active relative to when it is inactive, items relevant to satisfying a goal increase in value but items unrelated to that goal decrease in value. The authors observed that, when people needed to eat, they sought foods that are contextually appropriate to the time of day of the study. Hence, the goal they sought to fulfill was narrower than seeking foods in general.
17581245	In an earlier article, it was found that the terms of preference utilitarianism are insufficiently sound for guiding nursing activity in general, including in relation to nursing involvement in euthanasia. In this article, I shall examine the terms of a more traditional philosophical approach in order to determine the moral legitimacy, or otherwise, of nursing engagement in measures intended to end the lives of patients. In attempting this task, nursing practice is considered in light of what I shall call a 'nursing-as-healing-praxis' approach which includes an account of the moral purpose of nursing and the virtues necessary for realizing that purpose. Ultimately, it is concluded that the terms of this approach rule out the involvement of nurses in euthanasia such that if euthanasia can be justified at all, those outside the nursing profession must provide for its administration.
17545350	To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy.Two-armed open exploratory randomised controlled trial.	Two research clinics deriving participants from general practices in Northeast England.	109 patients with atrial fibrillation aged over 60.	Computerised decision aid applied in shared decision-making clinic compared to evidence-based paper guidelines applied as direct advice.	Primary outcome measure was the decision conflict scale. Secondary outcome measures included anxiety, knowledge, decision-making preference, treatment decision, use of primary and secondary care services and health outcomes.	Decision conflict was lower in the computerised decision aid group immediately after the clinic; mean difference -0.18 (95% CI -0.34 to -0.01). Participants in this group not already on warfarin were much less likely to start warfarin than those in the guidelines arm (4/16, 25% compared to the guidelines group 15/16, 93.8%, RR 0.27, 95% CI 0.11 to 0.63).	Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision-making consultation than immediately following direct doctor-led advice based on paper guidelines. Furthermore, participants in the computerised decision aid group were significantly much less likely to start warfarin than those in the guidelines arm. The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids, but also reduces the uptake of a clinically effective treatment that may have important implications for health outcomes.	
17362373	Is morally motivated decision making different from other kinds of decision making? There is evidence that when people have sacred or protected values (PVs), they reject trade-offs for secular values (e.g., "You can't put a price on a human life") and tend to employ deontological rather than consequentialist decision principles. People motivated by PVs appear to show quantity insensitivity. That is, in trade-off situations, they are less sensitive to the consequences of their choices than are people without PVs. The current study examined the relation between PVs and quantity insensitivity using two methods of preference assessment: In one design, previous results were replicated; in a second, PVs were related to increased quantity sensitivity. These and other findings call into question important presumed properties of PVs, suggesting that how PVs affect willingness to make trade-offs depends on where attention is focused, a factor that varies substantially across contexts.
17336956	A fundamental question in psycholinguistic research concerns the universality of comprehension strategies. We investigated this issue by examining the so-called "subject preference" in Turkish, a language which allows for a natural (unmarked) object reading of an initial ambiguous argument. Using event-related brain potentials (ERPs), we observed increased processing difficulty in the form of a broadly distributed positivity when an initial ambiguous argument was disambiguated towards an object reading. This effect was independent of the animacy (i.e. semantic subject prototypicality) of the ambiguous argument. Our results therefore speak in favour of a universal tendency to interpret the first argument encountered as the "subject" of the clause, even in languages providing no obvious structural motivation for such a strategy. However, we argue that the underlying explanation for this preference must be modified in accordance with cross-linguistic considerations.
17335536	This study was undertaken to explore health beliefs and expectations implicit in decision-making preferences of Chinese patients admitted for a surgical procedure in a regional hospital in Hong Kong.Patient participation in decision-making about healthcare options is presently being advocated; however, its nature is complex and inadequately explored and understood.	Twenty surgical patients, 10 who desired active participation and 10 who desired passive participation, were interviewed about their reasons for their decision-making preference.	From thematic analysis of the interviews, 'trust' and 'certainty' emerged as important concepts. Of particular interest is how 'certainty' was construed differently by participants: participants who desired to be passive and have minimal participation in decision-making did not focus on 'certainty' as meaning the predictability of the treatment outcome, but rather 'certainty' related to trust and belief in the ability of the doctor to choose the best option for them. Alternatively, participants who desired greater participation in decision-making spoke much more about the 'certainty' of the treatment outcome.	These findings suggest that patients' desire for participation in decision-making about surgery may be related to beliefs, expectations and understanding about certainty.	It could potentially benefit patients if this concept was explored further prior to patients undertaking decisions about undergoing surgery.	
17154773	When market changes alter what product attributes are deemed important, consumers may intentionally try to forget old product information in an attempt to remember new product information. In Experiment 1, the authors demonstrated that intentional forgetting of this nature temporarily inhibits retrieval of old product information and leads to a benefit to memory for new product information. The results show that, after a short delay, benefits continue in the absence of costs, which is supportive of a multiple-process account of intentional forgetting. Experiment 2 extends these effects using an advertising message to stimulate forgetting. Across both experiments, results also show that brand preference is based on learning of new attribute information.
17076547	Variant Creutzfeldt-Jakob disease (vCJD) is a human prion disease caused by infection with the agent of bovine spongiform encephalopathy. After the recognition of vCJD in the UK in 1996, many nations implemented policies intended to reduce the hypothetical risk of transfusion transmission of vCJD. This was despite the fact that no cases of transfusion transmission had yet been identified. In December 2003, however, the first case of vCJD in a recipient of blood from a vCJD-infected donor was announced. The aim of this study is to ascertain and compare the factors that influenced the motivation for and the design of regulations to prevent transfusion transmission of vCJD in the UK and US prior to the recognition of this case.A document search was conducted to identify US and UK governmental policy statements and guidance, transcripts (or minutes when transcripts were not available) of scientific advisory committee meetings, research articles, and editorials published in medical and scientific journals on the topic of vCJD and blood transfusion transmission between March 1996 and December 2003. In addition, 40 interviews were conducted with individuals familiar with the decision-making process and/or the science involved. All documents and transcripts were coded and analyzed according to the methods and principles of grounded theory. Data showed that while resulting policies were based on the available science, social and historical factors played a major role in the motivation for and the design of regulations to protect against transfusion transmission of vCJD. First, recent experience with and collective guilt resulting from the transfusion-transmitted epidemics of HIV/AIDS in both countries served as a major, historically specific impetus for such policies. This history was brought to bear both by hemophilia activists and those charged with regulating blood products in the US and UK. Second, local specificities, such as the recall of blood products for possible vCJD contamination in the UK, contributed to a greater sense of urgency and a speedier implementation of regulations in that country. Third, while the results of scientific studies played a prominent role in the construction of regulations in both nations, this role was shaped by existing social and professional networks. In the UK, early focus on a European study implicating B-lymphocytes as the carrier of prion infectivity in blood led to the introduction of a policy that requires universal leukoreduction of blood components. In the US, early focus on an American study highlighting the ability of plasma to serve as a reservoir of prion infectivity led the FDA and its advisory panel to eschew similar measures.	The results of this study yield three important theoretical insights that pertain to the global management of emerging infectious diseases. First, because the perception and management of disease may be shaped by previous experience with disease, especially catastrophic experience, there is always the possibility for over-management of some possible routes of transmission and relative neglect of others. Second, local specificities within a given nation may influence the temporality of decision making, which in turn may influence the choice of disease management policies. Third, a preference for science-based risk management among nations will not necessarily lead to homogeneous policies. This is because the exposure to and interpretation of scientific results depends on the existing social and professional networks within a given nation. Together, these theoretical insights provide a framework for analyzing and anticipating potential conflicts in the international management of emerging infectious diseases. In addition, this study illustrates the utility of qualitative methods in investigating research questions that are difficult to assess through quantitative means.	
17023138	To explore an approach to measuring the quality of decisions made in the treatment of early stage breast cancer, focusing on patients' decision-specific knowledge and the concordance between patients' stated preferences for treatment outcomes and treatment received.Candidate knowledge and value items were identified after an extensive review of the published literature as well as reports on 27 focus groups and 46 individual interviews with breast cancer survivors. Items were subjected to cognitive interviews with six additional patients. A preliminary decision quality measure consisting of five knowledge items and four value items was pilot tested with 35 breast cancer survivors who also completed the control preferences scale and the decisional conflict scale (DCS).	Preference for control and knowledge did not vary by treatment. The mean of the participants' knowledge scores was 54%. There was no correlation between the knowledge scores and the informed subscale of the DCS (Pearson r = .152, n = 32, p = 0.408). Patients who preferred to keep their breast were over five times as likely to have breast-conserving surgery than those who did not (OR 5.33, 95% CI (1.2, 24.5), p = 0.06). Patients who wanted to avoid radiation were six times as likely to choose mastectomy than those who did not (OR 6.4, 95% CI (1.34, 30.61), p = 0.04).	Measuring decision quality by assessing patients' decision-specific knowledge and concordance between their values and treatment received, is feasible and important. Further work is necessary to overcome the methodological challenges identified in this pilot work.	Guidelines for early stage breast cancer emphasize the importance of including patients' preferences in decisions about treatment. The ability of doctors and patients to make decisions that reflect the considered preferences of well-informed patients can and should be measured.	
17014295	Across 3 experiments, the authors examined the effects of temporal distance on negotiation behavior. They found that greater temporal distance from negotiation decreased preference for piecemeal, single-issue consideration over integrative, multi-issue consideration (Experiment 1). They also found that greater temporal distance from an event being negotiated increased interest in conceding on the lowest priority issue and decreased interest in conceding on the highest priority issue (Experiment 2). Lastly, they found increased temporal distance from an event being negotiated produced a greater proportion of multi-issue offers, a greater likelihood of conceding on the lowest priority issue in exchange for a concession on the highest priority issue, and greater individual and joint outcomes (Experiment 3). Implications for conflict resolution and construal level theory are discussed.
16988812	Driving an automobile is an example of a goal-directed activity with high complexity in which different behavioral elements have to be integrated and brought into a sequential order. On the basis of the reafference principle and experimental results on temporal perception and cognitive control, we propose a hierarchical model of driving behavior, which can also be adapted to other goal-directed activities. Driving is conceived of as being controlled by anticipatory neuronal programs; if these programs are disrupted by unpredictable stimuli, which require an instantaneous reaction, behavioral control returns after completion of the reactive mode to the anticipatory mode of driving. In the model different levels of anticipation windows are distinguished which, however, are interconnected, in a bi-directional way: (a) Strategic level with a representation of the driving activity from the beginning to reaching the final goal; (b) Segmented tactical level with the sequence of necessary milestones to reach the goal; (c) Maneuver level where actions like passing another car or keeping a lane are controlled; (d) Short-term integration level of a few seconds which allows immediate anticipations; and (e) Synchronization level for sensorimotor control and complexity reduction within neuronal assemblies. A flow diagram schematically describes different driving situations stressing the anticipatory mode of control. In a pilot experiment with 20 subjects using a virtual driving situation in a car simulator predictions of the model could be verified, i.e., subjects showed a significant preference for the anticipatory mode of driving.
16860524	This study investigated appraisals, including motivation, and coping preferences for undergoing Apolipoprotein E (APOE) susceptibility testing for Alzheimer disease (AD).Participants were 60 adult children of individuals affected with AD enrolled in a trial investigating use and impact of APOE susceptibility testing. An exploratory qualitative study was undertaken in which participants were interviewed about their testing experience.	Most participants viewed genetic testing as providing valuable information that could help direct future health care decisions and meet their emotional concerns about living at increased risk. Participants related their motivation for genetic testing to their worries about developing AD, preference to seek information about health threats, and need to feel in control of their health.	Even without prevention or treatment options, genetic testing may be a useful coping strategy for some at-risk individuals.	Once testing becomes clinically available, practitioners need to address the value and limitations of testing as well as appraisals and efforts to cope.	
16627056	The low recruitment rates into surgical randomized controlled trials (RCTs) threaten the validity of their findings. We reviewed the reasons for nonentry of eligible patients into surgical RCTs that would form the basis for future prospective research.A systematic review of the English language literature for studies reporting reasons for nonentry of eligible patients into surgical RCTs and of recommendations made to improve the low recruitment rates.	We reviewed 401 articles, including 94 articles presenting the results of 62 studies: 23 reports of recruitment into real surgical RCTs, 11 surveys of patients regarding hypothetical surgical RCTs, 10 surveys of clinicians and 18 literature reviews. The most frequently reported patient-related reasons for nonentry into surgical RCTs were preference for one form of treatment, dislike of the idea of randomization, and the potential for increased demands. Distrust of clinicians caused by a struggle to understand, explicit refusal of a no-treatment (placebo) arm, and the mere inability to make a decision were frequently reported in studies of real RCTs and patient surveys, but were not emphasized in surveys of clinicians and review articles. Difficulties with informed consent, the complexity of study protocols, and the clinicians' loss of motivation attributable to lack of recognition were the most commonly reported clinician-related reasons.	There seems to be a discrepancy between real reasons for nonentry of eligible patients into surgical RCTS and those perceived by the clinicians, which require further prospective research. A summary and discussion of main recommendations sighted in the literature is presented.	
16621330	In two experiments, human subjects were asked to estimate their present values of single delayed rewards and their present values of temporal sequences of three rewards. Present values were solicited by asking subjects to indicate an amount of money v for which they would be indifferent between receiving v at the end of the session and receiving the delayed reward(s). A procedure was used for which responding the true value of v was the optimal strategy, and the actual payoff that each subject received was determined by one randomly selected trial. In Experiment 1 (n=29) each delayed reward was 9.90 dollars in cash. In Experiment 2 (n=19) the delayed rewards were dated 15 dollars gift certificates to a local restaurant. In both experiments, the present values of the sequences were approximately equal to the sums of the present values of their component rewards. The presence of outliers suggests that a few subjects may have valued sequences less than the sums of their single rewards. Effects of a preference for uniform sequences, if any, were too small to be detected. Discounting of sequences was well fit by a parallel hyperbolic discounting equation, consistent with Mazur's [Mazur, J.E., 1986. Choice between single and multiple delayed reinforcers. J. Exp. Anal. Behav. 46 (1), 67-77] results using multiple reinforcers.
16376146	As part of a multi-centred UK study evaluating multidisciplinary team communication, the information needs, decision making preferences and information experiences of 394 cancer patients were audited. A majority of patients (342/394, 87%) wanted all possible information, both good and bad news. Assuming that all clinicians had equal skill, the majority of patients (350/394, 89%) expressed no preference for the sex of their doctor. The largest proportion of patients (153/394, 39%) wanted to share responsibility for decision making, preference was significantly influenced by age (chi2=17.42, df=4 P=0.002) with older patients more likely to prefer the doctor to make the decisions. A majority of patients reported receiving information regarding their initial tests (313/314, 100%), diagnosis (382/382, 100%), surgery (374/375, 100%) and prognosis (308/355, 87%), fewer recalled discussions concerning clinical trials (119/280, 43%), family history (90/320, 28%) or psychosocial issues, notably sexual well-being (116/314, 37%). Cancer patients want to be fully informed and share decision making responsibility, but do not report receiving sufficient information in all areas. Multidisciplinary cancer teams need to ensure that where appropriate, someone provides patients with information about clinical trials, familial risk and psychosocial issues. Regular audits highlight gaps and omissions in the information given to patients.
16336366	Decision-making about mode of birth after a cesarean delivery presents challenges to women and their caregivers and requires a balance of risks and benefits according to individual circumstances. The study objective was to determine whether a decision-aid for women who have experienced previous cesarean birth facilitates informed decision-making about birth options during a subsequent pregnancy.A prospective multicenter randomized controlled trial of 227 pregnant women was conducted within 3 prenatal clinics and 3 private obstetric practices in New South Wales, Australia. Women with 1 previous cesarean section and medically eligible for trial of vaginal birth were recruited at 12 to 18 weeks' gestation; 115 were randomized to the intervention group and 112 to the control group. A decision-aid booklet describing risks and benefits of elective repeat cesarean section and trial of labor was given to intervention group women at 28 weeks' gestation. Main outcome measures included level of knowledge, decisional conflict score, women's preference for mode of birth, and recorded mode of birth.	Women who received the decision-aid demonstrated a significantly greater increase in mean knowledge scores than the control group (increasing by 2.17 vs 0.42 points on a 15-point scale) (p < 0.001, 95% CI for difference = 1.15-2.35). The intervention group demonstrated a reduction in decisional conflict score (p < 0.05). The decision-aid did not significantly affect the rate of uptake of trial of labor or elective repeat cesarean section. Preferences expressed at 36 weeks were not consistent with actual birth outcomes for many women.	A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evidence suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship.	
16317184	Focusing on similarities between the mood regulation approach and dissonance theory, this article addresses the interplay between dissonance and mood by examining how individuals search for information after making a decision while under the influence of positive versus negative mood. Study 1 suggested that negative mood increased the preference for consonant over dissonant information after decisions, whereas positive mood led to a more balanced information search. In Study 2, participants in negative mood rated consonant information as more pleasant and dissonant information as more annoying than participants in positive mood. In addition, the results suggested that mood regulation processes took place. In Study 3, the findings from Study 1 were replicated with a paradigm in which higher stakes were involved.
16216685	Functional magnetic resonance imaging (fMRI) has proven a useful tool for observing neural BOLD signal changes during complex cognitive and emotional tasks. Yet the meaning and applicability of the fMRI data being gathered is still largely unknown. The brain's reward system underlies the fundamental neural processes of goal evaluation, preference formation, positive motivation, and choice behavior. fMRI technology allows researchers to dynamically visualize reward system processes. Experimenters can then correlate reward system BOLD activations with experimental behavior from carefully controlled experiments. In the SPAN lab at Stanford University, directed by Brian Knutson Ph.D., researchers have been using financial tasks during fMRI scanning to correlate emotion, behavior, and cognition with the reward system's fundamental neural activations. One goal of the SPAN lab is the development of predictive models of behavior. In this paper we extrapolate our fMRI results toward understanding and predicting individual behavior in the uncertain and high-risk environment of the financial markets. The financial market price anomalies of "value versus glamour" and "momentum" may be real-world examples of reward system activation biasing collective behavior. On the individual level, the investor's bias of overconfidence may similarly be related to reward system activation. We attempt to understand selected "irrational" investor behaviors and anomalous financial market price patterns through correlations with findings from fMRI research of the reward system.
15951368	When making decisions, people have been found predominantly to seek information supporting their preferred choice and to neglect conflicting information. In this article, the authors investigate to what extent different types of advisors, who recommend a choice to someone or make a decision on behalf of someone, show the same confirmatory information search. In Experiment 1, the authors presented participants, in the role of advisors, with a client's decision problem and found that when making a recommendation, advisors conducted a more balanced information search than participants who were making a decision for themselves. However, advisors who had to make a decision on behalf of their clients revealed an increased preference for information supporting their position. Experiment 2 suggested that this confirmatory information search was caused by impression motivation: The advisors bolstered their decision to justify it to the client. The results are discussed within the multiple motive framework of the heuristic systematic model.
15923281	To examine the reasons and search strategies related to physicians' search for evidence and to compare clinician and physician manager approaches.Qualitative analysis of verbatim transcripts of four focus groups in 2002. Study setting. Clinicians and managers in community practices in Southern California.	Pediatricians, family practitioners, and general internists (i.e. child and adult primary care providers) in non-academic practice and physician managers whose primary responsibility involved making management decisions within a moderate to large sized health care delivery system (e.g. health plan, community hospital, large group practice).	Themes related to clinician and manager reasons for using evidence and approach to selecting among evidence sources.	Clinicians and managers differed substantially in their reasons for using evidence. Whereas clinicians consistently invoked clinical intuition as a guide to most routine clinical decisions, managers articulated both motivation and interest in using medical research to guide decision-making, most commonly prompted by cost. Both clinicians and managers rated trustworthiness as a paramount consideration in arbitrating between evidence sources, because neither group evinced comfort with the complexity of primary literature. Both groups expressed a preference for tested, convenient, and respected evidence sources such as expert colleagues and professional societies.	Because clinicians invoke intuition in confronting the challenges of daily practice, evidence-based medicine interventions that target managers are likely to have larger effects on health outcomes than those that target primary care providers and individual patient treatment. Ensuring trustworthiness of evidence is of the utmost importance. Because both groups express discomfort with the format of primary evidence sources, strategies should probably not rely on individual appraisal.	
15901395	When people are asked to choose between gift items, givers and receivers sometimes show different patterns of preferences. The article reports four experimental studies exploring these giver-receiver asymmetries. Whereas givers tend to prefer exclusive, but smaller gift items, receivers appear to prefer less luxurious, and more useful gifts (Experiment 1). Givers prefer gift vouchers to cash, and are concerned about timing, whereas more receivers accept cash gifts, and claim that it does not matter if the gift arrives late (Experiment 2). One interpretation of the results could be that givers conform more strongly to gift conventions (cultural norms for gift exchange). It is further argued that these differences are not due to a perceived difference between self and others (Experiment 3), but rather because of situational differences. When receivers perform separate evaluations of gifts rather than joint evaluations (pairwise comparisons), they tend to change their preference pattern towards a higher rating of exclusive gift items (Experiment 4).
15834818	Many predicted that in the latter part of the twentieth century modern technology would revolutionize higher education and "create a second Renaissance" (Sculley J. The relationship between business and higher education: A perspective on the 21st century. Commun ACM32:1056-1061, 1989 p1061). However, as the reality of the twenty-first century has set in, it is apparent that these revolutionary prophecies have fallen short. Using the lens of Douglas's Typology of Grid and Group, this case study examines (1) the organizational context of a veterinary medical college at a large Midwestern university; (2) individual faculty members' preferences toward instructional technology use; and (3) the interrelationship of culture and the decision process to implement instructional technology use in curricula. The study has several implications for instructional technology use in veterinary medical educational settings that help explain how cultural context can guide leadership decisions as well as influence faculty motivation and preference. The findings suggest that a key mitigating factor to instructional technology implementation is conflict or concord between the cultural biases of faculty members and actual cultural identity of the college (Stansberry S, Harris EL. Understanding why faculty use (or don't use) IT: Implementation of instructional technology from an organizational culture perspective. In Simonson M, Crawford M, eds. 25th Annual Proceedings: Selected Research and Development Papers Presented at the 2002 National Convention of the Association for Educational Communications and Technology, vol. 1. North Miami Beach, FL: Nova Southeastern University:viii, 507).
15819799	We studied the willingness and motives for accepting a living kidney donation in 61 kidney patients on the waiting list by a semistructured interview and a questionnaire on two occasions. Between both moments of measurement patients received general information on transplantation options. We tested whether demographic data, medical status data or quality of life correlated with treatment choice. Our results showed that 61% of the patients preferred living kidney donation to postmortal donation. Their main motivation for this choice was the better quality of the living kidney. The most often named reasons to choose postmortal donation were unwillingness to burden a loved one and fear of psychological problems in relation to the donor after transplantation. There was no statistical significant change of preference between both moments of measurement; however there seemed to be a tendency in favor of living kidney donation. Fewer years spent on renal replacement therapy correlated statistically significant with the choice for living kidney donation. These findings encourage the development of new strategies to facilitate the living kidney donation program, and confirm the need for the standard option of psychosocial support for patients.
15720481	The research aimed to identify what involvement patients want in clinical decision-making and explore the underlying factors influencing that choice, thus identifying aids and barriers to increasing patients' involvement in decision-making. The study design was inspired by interpretative phenomenology, thus the framework for analysis is intended to aid interpretation and comprehension of the patients' experiences and understanding through identifying similarities and differences in their stories. Data were collected through semi-structured interviews of twenty people who were patients in a secondary care milieu at the time of interview. Results showed that, 20% of patients chose an active role in decision-making and 80% chose a collaborative or a passive role. However what people selected on the autonomy preference index was not always reflected in the interview. Additionally, the findings suggest that the NHS maintains a paternalistic approach. Lack of staff, lack of information and poor continuity of care with nursing staff made patients feel disempowered.
15663709	The aim of this paper is to identify the factors that determine the prevalence of private medical insurance (PMI) in England.Secondary data sources are the British Household Panel Survey (BHPS) 1997-2000, Laing's Healthcare Market Review 1999-2000, the United Kingdom (U.K.) Department of Health's National Health Service Waiting Times Team, and the Work Force Statistics Branch of the Department of Health.	Logistic regression models for panel data were used to compare non-PMI subscribers with individual subscribers and those with employer-provided PMI.	The BHPS data are collected by the Institute for Social and Economic Research at the University of Essex. Other data used were collected by Laing and Buisson and the U.K. Department of Health.	Individual PMI is more prevalent among the well-educated and healthy. Income, age, sex, and political preference are key determinants of PMI prevalence for both individual and employer paid PMI. Individuals are also likely to reflect on information with regard to waiting times in deciding whether or not to purchase PMI cover. The withdrawal of the tax subsidy in 1997 to PMI subscribers over 60 years of age did not impact on their rate of withdrawal from PMI coverage relative to the rate among all PMI subscribers, but may have discouraged potential new subscribers.	Current trends in the PMI market suggest that, over time, individually purchased PMI is likely to be partially displaced by PMI purchased as part of a company-based plan. However, having PMI is linked to economic factors in both groups, suggesting a similar segment of the population valuing the responsiveness that PMI provides. Geographic factors relating to waiting times and supply-side factors are associated with both individual and company-based PMI. The withdrawal of the tax subsidy to individual subscribers older than age of 60 resulted in a significant decline in the demand for PMI. In particular, the number of new subscribers in this group declined substantially.	
15660852	The malleability of stereotyping matters in social psychology and in society. Previous work indicates rapid amygdala and cognitive responses to racial out-groups, leading some researchers to view these responses as inevitable. In this study, the methods of social-cognitive neuroscience were used to investigate how social goals control prejudiced responses. Participants viewed photographs of unfamiliar Black and White faces, under each of three social goals: social categorization (by age), social individuation (vegetable preference), and simple visual inspection (detecting a dot). One study recorded brain activity in the amygdala using functional magnetic resonance imaging, and another measured cognitive activation of stereotypes by lexical priming. Neither response to photos of the racial out-group was inevitable; instead, both responses depended on perceivers' current social-cognitive goal.
15652681	In 1998, a new organ donor registration system was implemented in the Netherlands to increase the number of potential donors. A high school education program was developed to prepare adolescents to make an informed decision about organ donation. A post-test only randomised controlled trial was conducted in 39 high schools including 2868 students. Students within schools were randomly allocated to either attend the organ donation education program or not. The impact of the program on students' intention to register their organ donation preference (and determinants thereof) were analysed using multivariate multileveling modelling (MlwiN). The results show that students who were exposed to the education program had more favourable registration intentions (B = .40), were more often willing to be donors (OR = 1.45), and had greater knowledge about (B = 3.84) and more positive social outcome expectations (B = .09) and self-efficacy regarding organ donation registration (B=.22). Lastly, they experienced significantly less negative outcome expectations related to organ donation registration (B = -.15). Students' evaluation of the school-based education program was favourable. The present organ donation registration program proved to be effective in changing determinants of organ donation registration, and a large-scale implementation in the Dutch high school curriculum is planned.
15530760	Previous studies reported inconsistent relationship between the preference for information and that for decisional autonomy in medical encounters. We hypothesized that the relationship may be dependent on people's attribution beliefs on health. To test the hypothesis, demographically representative sample of Japanese population over the age of 18 (N = 3395) were invited into self-administered questionnaire survey. Preferences for information and decisional autonomy were measured by a translated version of autonomy preference index. Health attribution was measured by a scale modified from multi-dimensional health locus of control scales. After adjusting for socio-economic status, multivariable linear regression analysis revealed that information preference was positively associated with decisional preference among individuals who believed their health is less dependent on influential others. However, the reversed relationship was observed in case of individuals with attribution to others. The results suggested that individuals may use medical information for different purposes according to the types of health-related attribution beliefs.
15528290	This paper explores South Asian patients' views and experiences of clinical trial participation, as part of a larger study which sought to assess British South Asian under-representation in clinical trials.The study was based on semi-structured interviews with South Asian trial participants in primary care and specialist treatment centres in the north of England. Fifteen South Asian patients who had participated in one of six different clinical trials to test pharmaceutical products comprised the study cohort.	South Asian motivations to participate in clinical trials are similar to those of the majority 'White' population. Clear and concise trial information (provided by caring and understanding trial staff) was considered an important aspect of the respondents' experiences. Appealing to South Asian peoples' altruistic nature by making them aware of South Asian under-representation (especially in clinical trials that investigate illnesses prevalent in their community) was also identified as a strong motivational factor. Potential barriers to their participation included: trial burden (which bears heavily on the poor), language, and discriminatory practices in the NHS, which can lead to mistrust of health professionals. In addition, female modesty and preference for female trial staff was recognized as a 'cultural' barrier to participation.	There are more similarities than differences between the experiences of British South Asians and 'White' trial participants. Present findings suggest that ethnicity operates at different levels. In addition to South Asian trial participants' culture, social class and gender are also as likely to affect their participation in clinical trials. To improve South Asian accrual rates, strategies should be designed to take into consideration linguistic differences and improving overall trust in the clinical trial team.	
15486498	This study was conducted to examine the relationship between cortisol levels and preference to a small immediate over a larger delayed monetary reward. The degree of preference to a small immediate reward (a time-discounting rate) was investigated with an economic decision-making task in which each subject made an inter-temporal choice between (a) 10,000 yen available immediately and (b) an equal or larger amount of money after a delay of one year. The time-discounting rate was defined as [the required minimal amount of the delayed monetary gain for (b) to be preferred]-10,000/10, 000. Low cortisol levels were shown to associate with a large time-discounting rate, indicating that subjects with low cortisol levels may be impulsive in inter-temporal choice.
14756595	Prospect theory assumes nonadditive decision weights for preferences over risky gambles. Such decision weights generalize additive probabilities. This article proposes a decomposition of decision weights into a component reflecting risk attitude and a new component depending on belief. The decomposition is based on an observable preference condition and does not use other empirical primitives such as statements of judged probabilities. The preference condition is confirmed by most of the experimental findings in the literature. The implied properties of the belief component suggest that, besides the often-studied ambiguity aversion (a motivational factor reflecting a general aversion to unknown probabilities), perceptual and cognitive limitations play a role: It is harder to distinguish among various levels of likelihood, and to process them differently, when probabilities are unknown than when they are known.
14744229	Theory and research on small group performance and decision making is reviewed. Recent trends in group performance research have found that process gains as well as losses are possible, and both are frequently explained by situational and procedural contexts that differentially affect motivation and resource coordination. Research has continued on classic topics (e.g., brainstorming, group goal setting, stress, and group performance) and relatively new areas (e.g., collective induction). Group decision making research has focused on preference combination for continuous response distributions and group information processing. New approaches (e.g., group-level signal detection) and traditional topics (e.g., groupthink) are discussed. New directions, such as nonlinear dynamic systems, evolutionary adaptation, and technological advances, should keep small group research vigorous well into the future.
14741877	The University of Transkei (UNITRA) medical programme follows a problem-based learning and community-based education curriculum.To gauge the views of UNITRA medical students about their future, and their career intentions.	A semi-structured questionnaire on intentions to specialize or not, preferred place of work, overall view of the future, and careers guidance.	The questionnaire was completed by 364 students (87.7% response rate). The sector preferences are 82.3% public, 6.8% university and 10.9% private. Place of work preferences are urban (37%), rural (27%), city (12%) and abroad (8%), while 16% have no preference. Rural preference varies from 48.5% among 1st year students to 5.9% among 6th year students, while urban preference are 26.2% for Year I and 64.7% for Year VI students. 89.8% of respondents intended to specialize, mainly in clinical fields, with the most influential factors in the choice of specialty being interest and challenge. Most students (78%) view the future positively, 13% say it is uncertain, 8% have no idea about the future; and 1% think the future is negative. Frequent reasons cited for a bright future are job-related, personal attitude, sense of achievement, and the type of training. Most students have received little or no career guidance and would like such topics in the curriculum.	UNITRA medical students are optimistic about the future. The majority intend to stay in South Africa and work in the public sector, and most of them wish to pursue clinical specialties.	
14531089	Food labeling was originally developed to help consumers make the right decision in choosing at food products. It (food labeling) is also helpful in consumer's education. The aim of this study was to analyze the consumers' preferences concerning foods' labeling products. The type and the form of the information and of course the information itself were analyzed. The study was carried out in the form of a questionnaire among 295 people who were the consumers of supermarkets. The only criteria for the chosen subjects were that they agree to take part in the study and that they are the heads of their families. It came out that 54% of the subjects accepted the current information about food products. More than 23% said that they didn't understand the information provided by the food labels. 66% said that food labels should have educational information concerning the role of an ingredient in health and nutrition. Everyone wanted "negative" information, for example: "this product is not recommended for..."). More than 87% stated that they want information like "this product is recommended for...". (That kind of preference doesn't go along with the current law concerning food products). The best motivation for using food labels is sickness or illness. 89% of the subjects said that the information about the food products and the nutritional value are more important than the information about the producer. Informations concerning the nutritional values in 100 g and in 1 portion of a product were easiest to understand for 71% of the subjects. The results of this study show that food labeling is very important form of consumers education.
12873274	Little is known about physician attitudes, goals, or satisfaction regarding acute postoperative and cancer pain management.To provide quantitative data regarding the status of acute postoperative and cancer pain management by Michigan physicians. To measure physician confidence, preference, and satisfaction as well as identify their pain care goals for acute postoperative and cancer pain management. To evaluate variability in acute postoperative and cancer pain decision making based upon physician demographic characteristics, knowledge, and attitudes.	A cross-sectional survey, which included two cancer and three acute postoperative pain vignettes.	A randomly-selected sample of three hundred sixty-eight licensed Michigan physicians who provide clinical care for acute postoperative and cancer pain patients.	The majority of respondents (>50%) reported providing acute postoperative pain care frequently, while a minority (<20%) reported doing so for cancer pain. The majority of the physicians (>75%) reported goals of at least adequate pain relief without distress for both acute postoperative and cancer pain. Physicians more frequently chose the optimal pain management response for men following prostatectomy (56.2%) than for women following myomectomy (42%). They also chose the optimal response for metastatic prostate cancer more frequently (16.3%) than for metastatic breast cancer pain management (10.7%).	These data highlight physician variability in acute postoperative and cancer pain management decision making. Further study of the physician variable is necessary to improve the management of acute postoperative and cancer pain.	
12747503	In this paper, decision making under time pressure for multiattribute choice alternatives in a risky environment is investigated. A model, multiattribute decision field theory (MDFT), is introduced that describes both the dynamic and the stochastic nature of decision making and accounts for the observed changes in choice probabilities, including preference reversals as a function of time limit. An experiment in which five different time limits were imposed on the decision maker is presented to test the predictions of the model. It is shown that MDFT is able to account for the complex decision behavior observed in the data. Furthermore, MDFT is compared with the predictions of decision field theory (Busemeyer & Townsend, 1993; Roe, Busemeyer, & Townsend, 2001).
12697872	To explore the sociodemographic and clinical characteristics of cancer patients seeking a second-opinion consultation and to analyze their second opinion-related motives, needs, and expectations.In 212 consecutive patients seeking a second opinion at the Surgical Oncology Outpatient Clinic, satisfaction with the first specialist, motivation for the second opinion, need for information, preference for decision participation, and hope for and expectation of a different second opinion were assessed with a questionnaire.	The mean age was 53 years. Most patients were women (82%), of whom 76% were diagnosed with breast cancer. Half of the patients (51%) had a low educational level. The majority of patients (62%) only had internal motives for second-opinion seeking associated with the need for reassurance and more certainty, whereas a substantial minority of patients (38%) also had external motives related to negative experiences or unfulfilled needs. The externally motivated patients had a higher anxiety disposition, were less satisfied with their first specialist, preferred a more active role in medical decision making, and more often hoped for and expected a different second opinion.	Motives for second-opinion consultations differ greatly. Understanding the difference between internal and external motivation is necessary to develop strategies to prevent unnecessary second-opinion seeking. Additional studies are warranted to evaluate the objective and subjective outcomes of second-opinion consultations.	
12166367	Changes to the chemical senses of taste and smell that accompany ageing are widely believed to influence food preferences and consumption in the elderly. The possibility that interactions between the residual senses of texture and trigeminal perception can compensate for specific losses was explored using a complex liquid food system, soup. A consumer panel of twenty-four young people (20-35, mean age 27.7 +/- 3.95 years) and twenty-four elderly people (>65 years, mean age 73.6 +/- 5.78 years) were used for preference tests. Eight soups were prepared using a standardised recipe, with four variations in texture and two levels of trigeminal stimulus. The consumer panel preferences were measured using a nine point hedonic scale. The hedonic data was corrected for a scaling effect, and principle components analysis was completed on the normalised data of the two age cohorts. The preference decision of both age groups was in the direction of the lower level of trigeminal stimulation. Overall the older panel was less discriminating than the younger panel. However the older panel made an attempt to grade the different textures while the younger panel seemed to ignore the textural attribute in their preference decision. The older panel's preference decreased as the thickness of the soups increased across trigeminal levels. These results suggest that perhaps a judicious selection of a certain texture or mouthfeel combined with a preferred level of trigeminal irritation could boost elderly food enjoyment. Finally, a postal questionnaire was circulated to gain an insight in to the consumer's background and thus partially explain the motivation for their preferences.
12152366	In three experiments, anticipated affective reactions to risky and certain decision outcomes were investigated. It was shown that the two affect dimensions, valence and activation, describe anticipated affective reactions. When combined in a nonlinear dimension ranging from elation to disappointment, the results were found to replicate previous research showing that anticipated affective reactions are influenced by both sign (loss or gain), magnitude, and probability of outcomes. Preference for the anticipated affective reactions was furthermore related to both affect dimensions.
12035913	Randomized clinical trial (RCT) designs, in which participants are randomly assigned to treatment and control groups, are considered the gold standard of experimental design. However, if potential participants have a strong preference for a particular study group and/or when participatory effort must be sustained over a lengthy study time frame, they may deem randomization unacceptable, refuse to be in the study, and hence prevent the purpose of randomization from being realized. This article describes several alternative designs and the decision-making process prior to selecting a partially randomized preference trial (PRPT) design to accommodate preferences of women with breast cancer for participation in a support group intervention pilot study. Recruiting women into the two randomized arms of the PRPT was problematic because most potential participants expressed a preference for a particular study group. Possible reasons for failure to randomize more of the potential participants are discussed and suggestions for future research proposed.
11865858	The emergence of new health care needs related to changing demographics, financial restraints on health care, and increased rates of chronic illness has contributed to the need for nurses with a range of highly specialized skills. Yet traditional education programs for nurses have focused on diploma level preparation for bedside staff positions. This study explores the assessments of 714 clinical nurses with diploma level preparation and 56 nurse managers about the need for postdiploma nursing education. The results reveal a preference for clinically focused university education over noncredit coursework or a generic degree program. Nurses and their managers agree on the necessity for opportunities for more preparation in gerontology and palliative care, as well as the need for all practicing nurses to learn many skills cutting across clinical areas including clinical decision-making, communication, and leadership. Strategies for assisting nurses to access university education including innovative distance education methods are discussed.

11424240	High unmet need for limiting contraception persists in most states of India despite wide access to sterilisation. Qualitative evidence from a rural community in which child mortality is high and women's autonomy is low suggests that women may seek reversibility in a contraceptive even if they have finished childbearing. This paper describes the introduction of the Copper-T 380A--a contraceptive with an effective life span of ten years--as an alternative to female sterilisation in a rural area of the state of Rajasthan, in a clinic linked to an outreach programme. The intervention addressed women's apprehensions, ensured service standards and guaranteed women's right to have the Copper-T removed at will. Data on 216 insertions over 34 months revealed a preference for the Copper-T 380A among older women and women who had achieved desired family size, especially among tribal women. More than a quarter of the 30 removals in that period were for non-medical reasons, such as family opposition, child death or remarriage. As a long-term but reversible option, the Copper-T 380A allows women room to change their minds in relation to future childbearing until they have reached menopause. Including this option in family planning services can help to meet a portion of the unmet need for contraception among women not willing to choose sterilisation, while reducing dependence on doctors and expensive equipment.
11357249	To identify socio-demographic, economic, medical and attitudinal factors that explain subjects' choice of test for screening for colorectal cancer (biennial faecal occult blood test versus once-only flexible sigmoidoscopy).Data obtained from a questionnaire, administered by general practitioners and returned by approximately 2700 asymptomatic subjects. Thereafter, logistic regression modelling to explain willingness to participate in screening, whether or not a test preference is expressed, and the nature of the preference.	An interest in undertaking screening is more probable if the subject is white, older, married and possesses a high health motivation. An intention to participate is more probable if the subjects are particularly worried about the disease, feel themselves to be particularly susceptible to it, and have already had experience of screening for colorectal and (if female) other cancers. Persons in receipt of a household income below 10,000 Pounds are less likely to express an interest in screening. Women are more likely to express a test preference and this preference is more likely to be for the faecal occult blood test. Subjects' worries and perception of risk are associated with reported experiences of cancer, stomach problems and depression. A positive attitude towards screening is positively associated with frequency of dental visits.	Socio-demographic, economic and other factors evidently influence subjects' preferences for particular screening tests and, by implication, the likelihood of compliance with any future screening offer. The models support the view that participation in colorectal cancer screening has as much to do with a positive attitude towards health and health promotion generally as with any specific concern about the disease.	
11138758	Five studies tested the predictions of temporal construal theory and time-discounting theories regarding evaluation of near future and distant future options (outcomes, activities, products). The options had abstract or goal-relevant features (called high-level construal features) as well as more concrete or goal-irrelevant features (called low-level construal features). The studies varied the valence (positive vs. negative) and the type of valence (affective vs. cognitive) of the low-level and high-level construal features. The results show that the weight of high-level construal features, compared with the weight of low-level construal features, is greater in determining distant future preferences than near future preferences. The implications of the results for extant theories of time-dependent changes in preference are discussed.
10946760	This cross-cultural study investigated adult dental fear patients in three countries. A joint intake interview questionnaire and a dental anxiety scale explored the level, background and concomitant factors of dental anxiety among patients at the Universities of Tel Aviv (Israel), Goteborg (Sweden), and Pittsburgh (USA). It was shown that patients at all three sites were quite similar with regard to age, sex, level of dental anxiety (DAS) and avoidance time. Negative emotions were common, with more negative everyday life effects among Swedish patients. Regardless of country, most patients stated that they had always been fearful, but environmental etiologic factors were frequently reported. Swedish patients more often reported both direct and indirect learning patterns than Israeli patients. Patients' motivation for treatment was high, while the belief in getting fear reduction was clearly lower. The most common reason for Israeli patients to seek treatment was a personal decision to try to cope with the situation, while for Swedish patients it was pain. Israeli and US patients preferred more 'active' modes of treatment such as behavioral management therapies, while Swedish patients equally preferred active and more 'passive' treatment approaches such as general anesthesia. Preference for dentist attributes were similar among groups and underlined the strong emphasis that fearful individuals place upon dentists' behaviors and their performance of dentistry.
10870433	In two experiments Differentiation and Consolidation Theory (Diff Con) (Svenson, 1992) was used to investigate individual postdecision making processes in three-member groups. It was predicted that in groups in which the subjects preferred different alternatives (conflict groups), subjects would consolidate their own preferred alternative, and not the group's final decision. A second hypothesis was that no consolidation would be indicated in groups in which all members preferred the same alternative (non-conflict groups). The results showed that in conflict groups, the members who gave up their preferred alternative (minority members) consolidated their own preference, thereby significantly regretting the group decision. In contrast, members who got their own will through in the majority decision (majority members) showed no consolidation of the group decision. The corresponding pattern of results was replicated in a second experiment, using a different decision situation. The results indicated that perceptions of social support, agreement in a group and decreasing responsibility for a group's decision, could all partly substitute consolidation by attractiveness restructuring.
10434408	The authors examined the hypothesis that the interaction between the need for cognitive structure (NCS) and the ability to achieve cognitive structure (AACS) moderates the effect of stress on information processing. NCS is the preference for using cognitive structuring, as opposed to piecemeal processes, as a means to achieve certainty. AACS is the extent to which individuals are able to apply information processes that are consistent with their levels of NCS. The hypothesis was validated in 4 studies, which showed that stress increased high-AACS participants' use of cognitive structuring if they had high NCS and reduced it if they had low NCS. An opposite effect was found for low-AACS participants. The implications of these results for the understanding of the mechanisms responsible for the effect of stress on information processing are discussed.
10424839	To explore framing or editing effects and a method to debias framing in a clinical context.Clinical scenarios using multioutcome life-expectancy lotteries of equal value required choices between two supplementary drugs that either prolonged or shortened life from the 20-year beneficial effect of a baseline drug. The effects of these supplementary drugs were presented in two conditions, using a between-subjects design. In segregated editing (n = 116) the effects were presented separately from the effects of the baseline drug. In integrated editing (n = 100), effects of supplementary and baseline drugs were combined in the lottery presentation. Each subject responded to 30 problems. To explore one method of debiasing, another 100 subjects made choices after viewing both segregated and integrated editings of 20 problems (dual framing).	Statistically significant preference reversals between segregated and integrated editing of pure lotteries occurred only when one framing placed outcomes in the gain domain, and the other framing placed them in the loss domain. When both editings resulted in gain-domain outcomes only, there was no framing effect. There was a related relationship of framing-effect shifts from losses to gains in mixed-lottery-choice problems. Responses to the dual framing condition did not consistently coincide with responses to either single framing. In some situations, dual framing eliminated or lessened framing effects.	The results support two components of prospect theory, coding outcomes as gains or losses from a reference point, and an s-shaped utility function (concave in gain, convex in loss domains). Presenting both alternative editings of a complex situation prior to choice more fully informs the decision maker and may help to reduce framing effects. Given the extent to which preferences shift in response to alternative presentations, it is unclear which choice represents the subject's "true preferences."	
10424837	Many preventive health behaviors involve immediate costs and delayed benefits. Time preference is the extent to which decision makers value future outcomes relative to immediate ones. Consequently, people with future-oriented time preferences should be more likely to adopt preventive measures. The relationship between time preferences and acceptance of a free influenza vaccination was examined.The participants were 412 corporate employees who were offered free influenza vaccinations at their workplace.	Participants' time preferences were measured in each of two domains: money and health. They also reported on whether they had accepted the influenza vaccination and their beliefs and attitudes about the vaccine.	There was a small (OR = 2.38) relationship of vaccination acceptance to monetary time preferences but not to the health time-preference measures. Other variables, such as perceived effectiveness of the vaccine, were more predictive.	This study provides some evidence of a small relationship between time preferences and preventive health behavior.	
10189978	Differences in smoke constituent exposure by ethnicity and menthol preference and differences in decisional balance and habit strength by stage of change, ethnicity, and menthol preference were examined in this 2-factor study design. Ninety-five women, half of whom were Black and half of who smoked menthol cigarettes, participated in a cigarette smoking bout in the Clinical Research Center. Measures of smoking topography, plasma cotinine and nicotine, and expired carbon monoxide were obtained in addition to self-report of the pros and cons of smoking, time to first cigarette, and smoking history. Black women smoked significantly fewer cigarettes per day, but had higher cotinine levels compared to White women. Menthol smokers (n = 49) had significantly larger puff volumes, higher cotinine levels, and shorter time to first cigarette compared to nonmenthol smokers (n = 46). Precontemplators (n = 44) were significantly lower on beliefs about the negative aspects of smoking compared to contemplators and those in preparation stage. Black women, all stages combined, had higher negative beliefs about smoking than did White women. Implications for assessment of smoking patterns and intervention are discussed.
9378681	Tustin (1994) recently observed that an individual's preference for one of two concurrently available reinforcers under low schedule requirements (concurrent fixed-ratio [FR] 1) switched to the other reinforcer when the schedule requirements were high (concurrent FR 10). We extended this line of research by examining preference for similar and dissimilar reinforcers (i.e., those affecting the same sensory modality and those affecting different sensory modalities). Two individuals with developmental disabilities were exposed to an arrangement in which pressing two different panels produced two different reinforcers according to progressively increasing, concurrent-ratio schedules. When two dissimilar stimuli were concurrently available (food and a leisure item), no clear preference for one item over the other was observed, regardless of the FR schedules in effect (FR 1, 2, 5, 10, and 20). By contrast, when two similar stimuli were concurrently available (two food items), a clear preference for one item emerged as the schedule requirements were increased from FR 1 to FR 5 or FR 10. These results are discussed in terms of implications for conducting preference assessments and for selecting reinforcers to be used under training conditions in which response requirements are relatively high or effortful.
9394635	It is well documented that the way a static choice task is "framed" can dramatically alter choice behavior, often leading to observable preference reversals. This framing effect appears to result from perceived changes in the nature or location of a person's initial reference point, but it is not clear how framing effects might generalize to performance on dynamic decision making tasks that are characterized by high workload, time constraints, risk, or stress. A study was conducted to examine the hypothesis that framing can introduce affective components to the decision making process and can influence, either favorably (positive frame) or adversely (negative frame), the implementation and use of decision making strategies in dynamic high-workload environments. Results indicated that negative frame participants were significantly impaired in developing and employing a simple optimal decision strategy relative to a positive frame group. Discussion focuses on implications of these results for models of dynamic decision making.
9316260	Identification of reinforcers for individuals with developmental disabilities is often based on the outcome of preference assessments in which participants make selections from among a variety of items. We determined the extent to which individuals might show a general preference for food items over leisure items during such assessments and whether leisure items that are "displaced" by food items might nevertheless function as reinforcers. Arrays consisting of food items only and then nonfood items only were presented separately to 14 participants and then were ranked to determined preference. The top selections from these initial assessments were subsequently combined in a third assessment, and preferences were again established. All but 2 participants showed a general preference for food items, such that selection of nonfood items in the combined arrays was displaced downward relative to selection of nonfood in the nonfood-only arrays. Two of the participants were exposed to a condition in which a nonfood item was delivered contingent on the occurrence of an adaptive response, and increased rates of responding by both individuals were observed. Results are discussed in terms of limitations posed by using only food items as reinforcers and the resulting need to take precautionary measures when attempting to identify nonfood reinforcers.
9316258	One method that has been demonstrated to improve the effectiveness of reinforcement is stimulus (reinforcer) variation (Egel, 1980). Egel found that bar pressing increased and responding occurred more rapidly during varied reinforcement than during constant reinforcement when identical stimuli were used across phases for 10 individuals with autism. The purpose of the current investigation was to assess the preferences of 7 individuals for varied presentation of slightly lower quality stimuli relative to constant access to the highest quality stimulus. Varied presentation was preferred over constant reinforcer presentation with 4 participants, and the opposite was true for 2 participants. One participant did not demonstrate a preference. These results suggest that stimulus variation may allow less preferred reinforcers to compete effectively with a more highly preferred reinforcer for some individuals.
12292118	Reproductive health is one of the major issues of current feminist debates.  The issue was brought to light because of population control policies which are being enforced through women's bodies and the spread of HIV/AIDS.  In this context, women's organizations and activists are trying to focus upon the issue of reproductive health as part of the larger issue of the position of women in families, societies, and states.  Policy makers and donor agencies are trying to address the problem as lack of awareness and knowledge of how to use contraceptives.  The authors argue in this situation that it is important to study reproductive health relative to the status of women in society.  This paper looks at the existing social construct of patriarchy and population control policies in relation to reproductive health.  Women and self, the reproductive role of women, preference for male children, family planning decision making, family planning programs and reproductive health, and the Vikalp program in two districts of Rajasthan are discussed.
8822154	People prefer a sure gain to a probable larger gain when the two choices are presented from a gain perspective, but a probable larger loss to a sure loss when the objectively identical choices are presented from a loss perspective. Such reversals of preference due to the context of the problem are known as framing effects. In the present study, schema activation and subjects' interpretations of the problems were examined as sources of the framing effects. Results showed that such effects could be eliminated by introducing into a problem a causal schema that provided a rationale for the reciprocal relationship between the gains and the losses. Moreover, when subjects were freed from framing they were consistently risk seeking in decisions about human life, but risk averse in decisions about property. Irrationality in choice behaviors and the ecological implication of framing effects are discussed.
8717589	Expected utility theory is felt by its proponents to be a normative theory of decision making under uncertainty. The theory starts with some simple axioms that are held to be rules that any rational person would follow. It can be shown that if one adheres to these axioms, a numerical quantity, generally referred to as utility, can be assigned to each possible outcome, with the preferred course of action being that which has the highest expected utility. One of these axioms, the independence principle, is controversial, and is frequently violated in experimental situations. Proponents of the theory hold that these violations are irrational. The independence principle is simply an axiom dictating consistency among preferences, in that it dictates that a rational agent should hold a specified preference given another stated preference. When applied to preferences between lotteries, the independence principle can be demonstrated to be a rule that is followed only when preferences are formed in a particular way. The logic of expected utility theory is that this demonstration proves that preferences should be formed in this way. An alternative interpretation is that this demonstrates that the independence principle is not a valid general rule of consistency, but in particular, is a rule that must be followed if one is to consistently apply the decision rule "choose the lottery that has the highest expected utility." This decision rule must be justified on its own terms as a valid rule of rationality by demonstration that violation would lead to decisions that conflict with the decision maker's goals. This rule does not appear to be suitable for medical decisions because often these are one-time decisions in which expectation, a long-run property of a random variable, would not seem to be applicable. This is particularly true for those decisions involving a non-trivial risk of death.
12320569	"Two opposing retirement options--early retirement or prolonged working life--are being presented in the burgeoning literature related to the ineluctable ageing of the work force. Both are allegedly proposed for economic reasons and claim to meet the expectations and needs of ageing workers. But what in reality are the retirement goals of older workers and which factors, individual and organizational, affect the decision to retire? In tackling this question, the article draws on a survey conducted among workers from 15 unions, mostly affiliated with the Quebec Council of Managers and Professionals. Based on data from 1,319 respondents, the findings indicate that the majority of professionals would prefer to retire earlier, that 60 is much more considered a normal retirement age than 65, and that only 8% of the respondents wish to continue working after 65--and this mostly out of economic necessity, not choice. The factors that underlie this preference for early retirement are then identified and discussed." (SUMMARY IN ENG AND SPA)
7676113	This is an empirical study of the criteria which indicate inpatient or outpatient treatment. The two essential elements to the process of indication are, firstly, the recommendation of the outpatient clinic conference and, secondly, the preference of the patient. A specially developed test inventory was used for the statistical evaluation of one hundred case decisions of our outpatient clinic conference. As expected, the indication is not reduced to a one-dimensional schema but is the result of a complex process. Nonetheless, several characteristics can be identified, such as the length of the illness, any psychosomatic pretreatment, the recommendations of the first diagnostician and the patient's own wish for a particular type of treatment. In sum, this study is an example of a descriptive analytical approach for the differential research on indication. Such an approach could be of importance when discussing how to control quality of psychosomatic and psychotherapeutic treatments.
7507389	This Quick Reference Guide for Clinicians contains highlights from the Clinical Practice Guideline of Benign Prostatic Hyperplasia: Diagnosis and Treatment. The Benign Prostatic Hyperplasia Guideline Panel, a private-sector panel of health care providers, developed the guideline after comprehensively analyzing the research literature. As a result, this guideline comprises the most current scientific knowledge of the development, diagnosis, and treatment of benign prostatic hyperplasia (BPH). The guideline makes specific recommendations to identify both the most effective methods for diagnosing BPH and the most appropriate treatments for BPH based on patient preference and clinical need. BPH affects quality of life and is very rarely a life-threatening disease. Motivation to seek active treatment will, for most patients, depend on how much their symptoms bother them. Many patients choose a regimen of "watchful waiting." The guideline details the relative benefits and harms associated with all diagnostic and treatment approaches. Treatment options discussed include watchful waiting, alpha blocker and finasteride medications, balloon dilation, and the surgical options of transurethral incision, transurethral resection, and open prostatectomy.
12295267	Data from the 1988 Ghana Demographic and Health Survey were used to analyze the relationship between relative power of spouses and agreement or disagreement on future fertility desires.  The data do not allow a comprehensive assessment of actual sources of power.  Three types of status differentials that might influence fertility decisions were studied: age, occupation, and education.  864 husband-wife pairs, in which both stated their preference to have or not have another child, were studied.  Most men were considerably older and better educated than their wives, and 8% of men vs. 2% of women had jobs in the highest status category.  69.2% of couples agreed they wanted another child and 13.5% agreed they did not.  In 5.8% of couples disagreeing, the wife, but not the husband, wanted another child; in 11.5%, the husband, but not the wife, wanted another.  The relative status variables were incorporated as regressors in a multinomial logistic regression to test the influence of status differences on agreement or disagreement.  Limited evidence was found to back any hypothesis of a relationship between relative status of spouses and agreement or disagreement.  Evidence was found, however, to support the claim that women having a higher occupational status than their husbands inclines couples toward agreeing not to have more children and away from agreement to have more.  Further research is needed to clarify the meaning of disagreement and the dynamics of resolution of differences.
12158969	In this study, cross classifications by labor force, (LF) activity and fertility status and a simple log linear model were used to model the value given to activity and fertility differentials in France alone and according to the educational level of both parents.  The variability of activity and fertility was viewed as strongly determined by the motivation for work and the preference for large or small families.  The interactions were also examined for 12 other European countries with comparable data from the European Labor Force Survey of 1990.  This analysis resulted in startling findings that variations of activity and fertility between European countries did not result from simple differences in the value women attach to work.  Geographic or national differences were found to be important in explanatory models and quite separate from changes over time or across social groups within countries.  The 2 x 2 cross classifications used in the 4 cells for analysis were women with a complete professional career (high LFP) with large and small families and women with little involvement in the labor force (low LFP) with large and small families.  Values are attached to the 4 cells.  The percentage given any one cell of the contingency table was equal to the probability that the value associated with this cell was greater than that for the 3 other ones.  The logarithms of the set of frequencies of cells a, b, c, d were rearranged to yield values for alpha, beta, and omega terms, which had behavioral meanings and were not constrained.  The scenarios were 3=fold.  The trends in France since the 1960s have been a large increase in total activity rates for women and an increase even when controlling for family size, a decline in the proportion of large families, and fertility rates without a significant trend after controlling for activity status.  Data from the 1968 and 1982 censuses for France showed that activity increased at any family size, fertility changed much less.  The average value for women's employment changes from negative to positive; it appears that there is a decreasing value given to a large family.  When educational levels are considered in 1982, again the increased value given to work was more salient for explaining the changes, where causality was based on the interdependence of fertility and activity conditioned by the incompatibility factor omega and influenced by alphas affecting activity and betas affecting fertility.
1308074	This is a cross-sectional study of first and final year clinical students of the University of Ibadan, aimed at highlighting the students' preference for specialties, its evolution in the course of training and its correlation with demographic variables. One hundred and twenty-one first year clinical and 150 final year students participated, representing 81% and 89% response rates, respectively. Whereas at the time of study 92.9% of the students intended to specialise, over 81% of this group opted for surgery, internal medicine, paediatrics, obstetrics and gynaecology and general practice. Only 5.5% of the cohort chose radiology, psychiatry, community medicine, anaesthesia and pathology. Surgery was the most popular specialty. No socio-demographic factors seemed associated with specialty choice. Specialty choice, evident before entry into the University in 42.9% of the cohort, evolved during the course of training, being affected mainly by interest aroused during the postings and the need for self-fulfilment. Specialty choice tended to fluctuate over the years. Innovativeness and dedication on the part of teachers can arouse the interest of students during posting, so that specialty choice can be more evenly spread to meet national health manpower needs.
1885624	Using data from the 1984 Canadian Fertility Survey, proportional hazards modelling was employed to determine factors associated with the likelihood of voluntary sterilisation among 5315 women of childbearing age, and the trends in timing and differences in the likelihood associated with different age cohorts. Multivariate analysis suggests that educational attainment, parity and duration since last birth at the time of sterilisation, religious commitment, province of residence and marital status at the time of sterilisation, are all important predictors. Education and parity attainment emerged as the best predictors of the timing of voluntary sterilisation in all age cohorts, but the contribution of other covariates varies between cohorts.After a brief discussion of prior analyses of the 1984 Canadian Fertility Survey (CFS) which identify some factors relating to female sterilization, the same data set is examined using Cox's proportional hazard modeling to determine the timing of sterilization and the relative likelihood of women of varying socioeconomic background to use sterilization.  The baseline hazard is set at the age of fertility (15 years) to sterilization.  The sample of 5315 was stratified in 5-year age cohorts from 25 to 39 years, plus 40-49 years.  The dependent variable was the survival time in the nonsterilized state; covariates were all converted into dummies, except duration since last birth which is a continuous variable.  The variables considered were residence in Quebec or outside the province, 3 educational groups, religious commitment by frequency of church attendance, marital status, and parity by sex of the child.  The caveat is that motivation is not considered and some variables were fixed at the time of survey.  The results of the proportional distribution of sterilization by age show a range of 9.9 in the youngest age group to 56.4 in the oldest, a distribution pattern comparable to that found in the US.  Only in the over 35 years age group does Quebec have higher percentages of sterilization.  Less educated women have higher percentages regardless of age.  A parity of 3 is the saturation point regardless of age, and there appears to be child sex considerations at a parity of 2 or 3.  The likelihood of sterilization is significantly related to education and parity at the time of sterilization; the strongest relationship is among the youngest women and education, but consistent for all age groups.  Parity is the strongest predictor.  Zero parity has a lower chance, and women 25-29 with a male child are more likely than those with a female child (14% vs. 9%).  2 births raise the chances to 43%, which supports a parity rather than a sex interpretation.  For women 30-34, a parity of 1 shows a 19% likelihood for a male child and 34% for a female child.  For younger women, the decision seems more parity related, and for older women it occurs after termination of reproduction.  Religious commitment is significant primarily in the older age groups.  It is unclear whether residence is a factor, but those aged 30-34 in Quebec have a lower chance.  Lower likelihood is also evidenced in the duration since last birth.  There were marginal effects of marital status.	
2022536	Taiwan has an active family-planning program. Yet the preference for sons is deeply ingrained in the Chinese culture and may discourage women from limiting their family size if they feel they have too few sons. In this study, research problems concerned the relationships between women's stated preferences for the sex of their children, their perceptions of their in-laws' preferences for the number and sex of their children, and their use of birth control and choice of birth control methods. It was found that few women verbalized a preference for the sex of children, but the number of boys already in the family was related to the reliability of contraceptive method used later and to the willingness to consider abortion if pregnancy occurred. The desired number and occurrence of additional children related to women's perceptions of their in-laws' preferences for boys. The perception of in-laws' preferences for girls either related negatively or was not significant.Taiwan has an active family planning program.  Yet, son preference is deeply ingrained in the Chinese culture and may discourage women from limiting their family size if they feel they have too few sons.  In this study, research problems concerned the relationships between women's stated preferences for the sex of their children, their perceptions of their in-laws' preferences for the number and sex of their children, and their use of birth control and choice of birth control methods.  It was found that few women verbalized a sex preference for their children, but the number of boys already in the family was related to the reliability of contraceptive method later used and to the willingness to consider abortion if pregnancy occurred.  The desired number and occurrence of additional children related to women's perceptions of their in-laws' preferences for boys.  The perception of their preferences for girls either related negatively or was not significant.	
12284781	This pilot study examines a population attending health centers, Etimesgut (366) and Yapracik (358), in Turkey.  The objective was to explore the relationship between age, education, work status, marriage duration, total number of living sons and daughters, ideal number of children, head of the household, and family type, and other variables such as opinions about marriage and having children.  The context was rural versus semiurban.  Another objective was to investigate the decision making process by specific topics and by what % the woman, husband, both, in-laws, and others contribute.  The sample was selected on the basis of a probability proportional size method for rate of use of various contraceptive methods, and the proportion of women aged 15-49 in each health center area.  Authority, power, and social status tend to dominate in male heads of households.  A statistically significant difference was found for the following variables between semiurban and rural households.  Rural women were less educated and had more children and longer marriage durations than semiurban women.  It is suggested that marriage age is lower for rural women.  Rural women desire more children, which is interpreted as a high fertility preference.  Semiurban spouses want more children, which may be due to the low actual childbearing.  The father in law as household head is more common in rural areas, as well as the extended family as the type of family structure.  Approaching marriage in terms of love is more common in semiurban areas.  In rural areas, children are viewed in terms of economic rewards, and as a source of security during illness and old age.  Rural women thus reflect more traditional patterns within a large kinship/community system.  Decision making findings show that conjugal interaction is comparatively weak for the study population.  Women in either areas have little power in decision making, but particularly so in rural areas.  In rural areas, in laws contribute substantial power in areas such as visiting friends (33%), communication at home (31.5%), and purchases of clothing (22.5%), daily routine (20.3%) or big items (22.8%) compared to wives 12.7%, 13.2%, 11%, 2.2%, respectively.  The author concludes that the results may help determine policies related to women, and suggests further detailed analyses of women's situation and fertility determinants.
2367000	This study examined women's attitudes and motivations towards cervical screening. The sample consisted of 680 women attending three general practices in two New Zealand towns. Subjects completed a questionnaire relating to their knowledge of the cervical smear test and their current cervical smear status. The questionnaire also assessed what influenced their decision to have an up to date smear test or what reasons subjects gave for not having a current test. Women's preference for the smear taker was also investigated. Most women in the sample (92%) indicated they knew what a cervical screening test was. Current smears were proportionately less common in the at risk groups. The most frequently reported motivation for women to have a current smear was that their doctor had recommended it (30.6%), followed by the response that it was an established part of their personal health routine (20.2%). Most women who didn't have current smear tests gave the reason that they had not got around to having a test (39.4%), with the next reported reason being that the test was embarrassing (17.8%) and their doctor didn't suggest it (14.7%). The majority of women in the sample (59.7%) preferred their own doctor to do the test. The findings of this study highlight the importance of the women's general practitioner in influencing women in high risk groups to have smear tests. They also suggest significant improvements in increasing the number of women screened could be made using existing services.
10293879	The dramatically changing environment of the health care executive prompted the current survey of graduate students in health administration. The survey examined the types of attitudes and values that may influence students' future leadership style and ethical decision making. A self-administered questionnaire was designed to provide descriptive information as well as to allow comparisons with recent surveys of practitioners and peers and with other research. Respondents to the survey, conducted in the fall of 1986, included nearly half of the full-time students in 56 participating AUPHA graduate programs and one-quarter of the part-time students (N = 1,764). Students' characteristics such as age, sex, religious preference, work experience, and career aspirations were assessed in relation to their social philosophy on health issues, instrumental and terminal values, attitudes toward achievement, and degree of idealism versus relativism in moral reasoning. The typical student was a twenty-seven-year-old white female with a stated religious preference who expected in ten years to be associated with a multi-institutional system or consulting firm. Her social philosophy showed concern for the rising cost of health care on the consumer and an emphasis on self-help. Self-respect and honesty are her highest values; her ethical ideology had components of high idealism and relativism, which is indicative of a situational decision-making style. Work orientation and mastery were both above average sources of achievement motivation for her, whereas competitiveness was about average. When group differences in attitudes and values were evaluated, however, sex was the highest predictor, followed by age, expectation of becoming a CEO, and self-assessed potential for success. Although there was substantial agreement between students' and practitioners' attitudes and values, some differences were found. Implications for future research are discussed, as well as issues relating to education for health administrators.
3730318	This paper presents findings concerning variables expected to influence the motivation of persons caring for a dementing relative in the community to continue giving care and support. The variables examined in relation to 'preference for institutional care' were those previously examined in relation to supporters' psychological well-being (Gilhooly, 1984). The results indicate that factors within the relationship between supporter and the dependent dementing relative are important determinants of motivation to continue giving support. Other variables significantly associated with advocacy of institutional care included the age of the supporter, supporter's contacts with friends, satisfaction with help from relatives, another dependent relative, and whether or not the supporter was employed. Help from the services and supporters' well-being were not significantly correlated with ratings of preference for institutional care.
4034445	The primary care physician is in an excellent position to counsel adolescents about contraception. However, an adequate understanding of the biologic and psychosocial development of this particular age-group is imperative. In addition, communication skills are necessary to advise adolescents on use of contraceptives. The goal in counseling the adolescent about sexuality is to instill a sense of sexual responsibility and to provide individualized instruction in selecting the appropriate birth control method. General factors to remember in selecting the proper method include motivation, moral-ethical responsibility, frequency of intercourse, side effects of the various contraceptive methods, and patient's preference.This article provides guidelines for counseling adolescents about sexuality and contraception.  The primary care physician who plays this role should have a basic understanding of the biologic and psychosocial development of this particular age group and develop the communication skills required to discuss sexuality with teenagers and their parents.  Young adults respond best to health care professionals who show interest, understand their behavior, and make an effort to communicate.  Contraception counseling involves discussion of 4 areas:  the patient's sexual knowledge and activity, motives for and possible complications of sexual activity, the patient's concept of sexual responsibility, and physician-patient confidentiality.  Oral contraception is the method most often requested by adolescents.  While this method may be appropriate for highly motivated adolescents who engage in frequent sexual intercourse, patients with sporadic sexual activity may be better advised to use a barrier method or condoms and spermicidal agents.  An IUD is often an appropriate choice for a sexually active immature adolescent of low intellignece with a history of repeated pregnancies and/or abortion who has demonstrated poor compliance with other contraceptive methods.  The diaphragm is best used by older, stable adolescents.  Coitus interruptus, injectable contraceptives, and douching should not be recommended to adolescents.  In many cases, the adolescent is under pressure to participate in sexual activity and needs support from the physician for her decision to abstain from intercourse.  Overall, selection of the proper method of contraception for a given adolescent involves consideration of motivation, moral-ethical responsibility, frequency of intercourse, side effects of the various methods, and the patient's preference.	
3156956	Decision time results were used to assess the strategies that 90 college undergraduates used in a complex decision-making task. Trend analyses revealed that the functions relating choice time to the number of choice alternatives in a set and the number of attributes comprising those alternatives contained linear (increasing) components. In addition, for a portion of the subjects, there was a quadratic effect of the number of attributes available to the decision maker on choice time, suggesting that these subjects adopted simplification strategies at high levels of task complexity. Reliable individual differences in these trend components were observed, consistent with individual differences in motivation and/or processing capacities. These individual differences were included in an information-processing model of decision behavior that captured the choice time data observed in this study. Subjects' ratings of apartments were used as a basis to assess the extent to which the use of simplification strategies resulted in preference reversals. Contrary to expectation, subjects whose choice times contained quadratic components demonstrated fewer preference reversals at high levels of information load.
12339804	The efficacy, the ability of Indian women to use the Billings' Ovulation Method, and its effectiveness in helping them to control their fertility was studied in a sample of urban poor living in the Delhi slums.  No attempt was made to develop a design which would rigorously test the acceptability of the method because the study was concerned with: the question of the ability of poor women to define fertility and to avoid an unwanted pregnancy by avoiding sexual relations during the fertility period; and the efficacy and use-effectiveness of the modified method which had not been tested.  The study, which extended over 36 months, recruited a sample of 5752 eligible acceptors of fertility living in the urban slums.  Natural family planning (NFP) use requires recurrent decision making at 2 stages: in the beginning of the menstrual cycle to check for signs of fertility; and to abstain from sexual relations in the fertility period.  Age was an important variable in the use of sexual abstinence oriented methods and fertility determining methods.  192 of the acceptors were below 19 years, 1545 between 20-24 years, 2089 between 25-29 years, 1236 between 30-34 years, 520 between 35-39 years, and 170 between 40-44 years.  Of 4380 of the 5302 acceptors in Treatment 1 who began to use the method after menstruation, 7 (0.16%) had a profuse discharge and could not distinguish the change in mucus because of cervicitis which was treated in cycle 2.  663 (5.4%) acceptors did not see or feel fertile mucus but noticed patches of infertile mucus throughout the cycle.  419 (69.19%) of them had a family income of less than Rs300 and 25 (3.77%) were open cases of pulmonary tuberculosis.  16 acceptors (0.37%) noticed wetness and lubrication characteristic of fertile type mucus for about 2 hours, 145 (3.31%) for 3-4 hours, and 218 (4.98%) for nearly half a day.  867 (19.79%) had 1 day, 406 (9.27%) 1-1/2 days, 939 (21.44%) for 2 days, 291 (6.64%) 2-1/2 days, 636 (14.52%) for 3 days and 187 (4.27%) 3-1/2 to 4 days of fertile mucus.  1 acceptor had 5 days of fertile mucus.  4 acceptors failed to check regularly and therefore may have missed the fertile period.  In Treatment 2 the initial decision to accept the use of the method was made by the 450 husbands before instructing their wives.  The continuation rate of 91.86% for 12 months with a standard error of 0.67% was surprisingly high for a sample with low literacy and occupational status, low female work participation rates, small family size and a preference for sons with low motivation to use other methods.  There were 9 unplanned pregnancies classified as method failures--pregnancies which occurred in acceptors who followed the method accoring to the instruction but got pregnant.  The 1 year efficacy rate (life table analysis) was 99.86%.  The 1-year use-effectiveness rate was 97.43% for the 5752 cohort.  The high efficacy rate of the method can be due to 2 factors: the correct identification of the fertile mucus; and the ability to clearly distinguish between infertile and fertile mucus.
6486121	The debate concerning the legal and ethical bases of guardian refusal of medical treatment on behalf of incompetent patients often ignores critical distinctions among types of patients and guardians. For example, patients who have expressed preferences regarding treatment while competent are distinguishable from patients who have always lacked the competency requisite to expressing a treatment preference. "Bonded guardians," whose relationship with the patient preexisted guardianship, should have a different role in the decision-making process than "non-bonded guardians," who were strangers to the patient prior to the guardian-ward relationship. This Article proposes criteria for guardian treatment refusal on behalf of incompetent patients. Under the model for guardian decision making presented here, bonded guardians should be preferred over non-bonded guardians, and bonded guardians should be allowed discretion to make treatment choices, limited only by a standard of reasonableness policed by the courts. The Author presents legal and ethical justifications for the bonded guardian's heightened role. Finally, he considers the proper roles of health professionals, hospital ethics committees, and judges in the decision-making process.
6561950	An exploratory survey was undertaken at the Medical City Hospital in Mandaluyong, Metro Manila over a 6-week period in February/March 1980 to identify and evaluate the underlying factors behind mothers' decision as to whether or not to breastfeed.  The 82 respondents wre 20-36 years old married Filipino women.  60 (73%) indicated their decision to breastfeed upon discharge from the hospital--(the breastfeeding group); 22 mothers (27%) reported that they would not breastfeed. There were nonsignificant differences between 1) the age range of the highest percentage of breastfeeding mothers (26-30) and nonbreastfeeding mothers (20-25); 2) the mean number of children (for all respondents, 2.26) with a higher mean for the nonbreastfeeding group; 3) educational level of breastfeeding group (6% more as educational level increased); and 4) A socioeconomic status and choice of infant feeding method--of the 65% of the total respondents who were employed, 70% will breastfeed and 30% will not and the majority of nonemployed women will breastfeed; 75% of the urban and 67% of the rural repsondents will breastfeed; 88% of all respondents were breastfed as babies.  56% did not believe that breastfeeding can cause breast disfigurement.  60% of the husbands did not have a preference regarding infant feeding method.  80% of the respondents claimed to have received professional advice on breastfeeding.  70% of those who received advice on breastfeeding and 60% of those who received no advice decided to breastfeed.  83% of the respondents claimed to have been exposed to mass media regarding breastfeeding and almost 30% of these decided against breastfeeding.  60 mothers asked about their personal reasons for deciding to breastfeed cited the following:  to produce a healthy baby; mother's milk is nutritious and the best; to foster a closer relationship between mother and baby; economy; and convenience in preparation.  The 22 mothers who decided to bottle feed cited the following personal reasons in order of frequency:  they were working; insufficient milk; weak body; and sore breast and cracked nipple.  Of all factors considered, past experience, e.g., breastfeeding a previous baby, and advice of close friends and relatives, were found to affect mothers' decision positively.  Employment was seen as the number 1 reason for deciding against breastfeeding.
160924	We demonstrated a general strategy for detecting motives that people wish to conceal. The strategy consists of having people choose between two alternatives, one of which happens to satisfy the motive. By counterbalancing which one does so, it is possible to distill the motive by examining the pattern of choices that people make. The motive used in the demonstration is the desire we believe most people have to avoid the physically handicapped. Because they do not wish to reveal this desire, we predicted that they would be more likely to act on it if they could appear to choose on some other basis. In two studies we found that people avoided the handicapped more often if the decision to do so was also a decision between two movies and avoidance of the handicapped could masquerade as a movie preference.
28135549	Psychological variables that differentiate fast and slow progressing farmers are studied with particular emphasis on the work of McClelland. Sixteen different sociopsychological variables were reliably measured on 51 pairs of fast and slow progressing brothers. Three analyses were done: (a) comparison of fast and slow progressing groups, (b) comparison of extreme fast and slow progressing groups, (c) correlation of the measured variables with growth in agricultural productivity. Results showed that high scores on attitude toward earning, preference for activity, pride in work, upward striving, cautious decision making, and lack of interest in maintaining personal relations were associated with progressive farm behavior; low scores on these variables were associated with static or declining farm success. However, the results failed to support McClelland's hypothesis that achievement motivation is in part responsible for economic growth.
650387	In two closely related experiments, college student subjects were instructed to choose between a drug that allegedly interfered with performance and a drug that allegedly enhanced performance. This choice was the main dependent measure of the experiment. The drug choice intervened between work on soluble or insoluble problems and a promised retest on similar problems. In Experiment 1, all subjects received success feedback after their initial problem-solving attempts, thus creating one condition in which the success appeared to be accidental (noncontingent on performance) and one in which the success appeared to be contingent on appropriate knowledge. Males in the noncontingent-success condition were alone in preferring the performance-inhibiting drug, presumably because they wished to externalize probable failure on the retest. The predicted effect, however, did not hold for female subjects. Experiment 2 replicated the unique preference shown by males after noncontingent success and showed the critical importance of success feedback.
926053	One hundred seventy-eight male and female undergraduates completed the Eysenck Personality Inventory and indicated their risk preference assessed under the assumptions of Coombs' portfolio theory. Extraverts preferred higher risk significantly more than did introverts, and also showed significantly greater risk preference change as expected value increased. It was suggested that a theoretically defensible selection of both personality variables and a risk assessment model may lead to greater personality-risk predictability.
880826	The retrospective examination of records in the San Francisco General Hospital Family Planning Clinic during the period from 1970 to 1976 showed a sharp drop in oral contraceptive usage in the last year and a corresponding increase in  diaphragm use.  The extent of this change in preference by initial users of different contraceptive methods was studied on a monthly basis from March 1975 through March 1976.  Diaphragm usage increased significantly by 1% per month, while pill usage showed a significant decline in usage by 1% per month.  The trend appears to be due to a desire on the part of the clients to use a noninvasive and nonpharmacologic method of contraception.
12263428	Natural family planning methods include the temperature method and the ovualtion method; sometimes the 2 methods are used together.  The fundamental feature of natural family planning is sexual abstinence a few days before and after ovulation.  Such methods are the only ones approved by the Catholic Church, and are the methods of choice for only a minority of catholics.  The author conducted a survey among 80 couples practicing the rhythm method; 62 couples answered questions as to reasons for choosing natural methods, religiosity, and sharing decision making, home work, and child care.  40% of couples were under 30; 45% had been married less than 5 years, and 32% had no children; average length of time using the method was 27 months.  58% of respondents had chosen the method because of a preference for natural methods, and only 31% because of a sense of duty toward the church; 40% of those who accepted it out of preference and not out of obedience found sexual abstinence acceptable.  79% of couples indicated to arrive at decisions by talking things over, and 65% claimed to share household responsibilities, and 73% childcare responsibilities.  37% rated themselves as deeply religious; 13% were using the method in combination with use of condom during fertile days because they did not wish to abstain from coitus.
1187295	Ss rated on a 1 to 13 Likert scale their preference for four environmental scenes which differed in complexity. Ss were then given 30 sec. to solve each of 10 3-, 5-, or 7-letter single-solution anagrams. Finally the Ss rated four new slides which were of the same complexity level as the slides seen during the first session. Change scores were calculated by subtracting the preference ratings at each complexity level during the first session from the rating at the corresponding complexity level during the second session. The Anagram Complexity X Slide Complexity interaction was significant: the complexity of the slides showing the most positive change scores was inversely related to the complexity of the anagrams attempted. The results were discussed in terms of optimal level of stimulation theories.