The Soviet experience in Afghanistan provides a compelling perspective on the far-reaching hazards of military intervention. In 1985, Mikhail Gorbachev decided that a withdrawal from Afghanistan ...should occur as soon as possible. The Soviet Union's senior leadership had become aware that their strategy was unraveling, their operational and tactical methods were not working, and the sacrifices they were demanding from the Soviet people and military were unlikely to produce the forecasted results. Despite this state of affairs, operations in Afghanistan persisted and four more years passed before the Soviets finally withdrew their military forces.
In No Miracles, Michael Fenzel explains why and how that happened, as viewed from the center of the Soviet state. From that perspective, three sources of failure stand out: poor civil-military relations, repeated and rapid turnover of Soviet leadership, and the perception that Soviet global prestige and influence were inexorably tied to the success of the Afghan mission. Fenzel enumerates the series of misperceptions and misjudgments that led to the Soviet invasion of Afghanistan, tracing the hazards of their military intervention and occupation. Ultimately, he offers a cautionary tale to nation states and policymakers considering military intervention and the use of force.
The posterior parietal cortex (PPC) has an important role in many cognitive behaviours; however, the neural circuit dynamics underlying PPC function are not well understood. Here we optically imaged ...the spatial and temporal activity patterns of neuronal populations in mice performing a PPC-dependent task that combined a perceptual decision and memory-guided navigation in a virtual environment. Individual neurons had transient activation staggered relative to one another in time, forming a sequence of neuronal activation spanning the entire length of a task trial. Distinct sequences of neurons were triggered on trials with opposite behavioural choices and defined divergent, choice-specific trajectories through a state space of neuronal population activity. Cells participating in the different sequences and at distinct time points in the task were anatomically intermixed over microcircuit length scales (<100 micrometres). During working memory decision tasks, the PPC may therefore perform computations through sequence-based circuit dynamics, rather than long-lived stable states, implemented using anatomically intermingled microcircuits.
Experimental games model situations in which the future outcomes of individuals and groups depend on their own choices and on those of other (groups of) individuals. Games are a powerful tool to ...identify the neural and psychological mechanisms underlying interpersonal and group cooperation and coordination. Here we discuss recent developments in how experimental games are used and adapted, with an increased focus on repeated interactions, partner control through sanctioning, and partner (de)selection for future interactions. Important advances have been made in uncovering the neurobiological underpinnings of key factors involved in cooperation and coordination, including social preferences, cooperative beliefs, (emotion) signaling, and, in particular, reputations and (in)direct reciprocity. Emerging trends at the cross-sections of psychology, economics, and the neurosciences include an increased focus on group heterogeneities, intergroup polarization and conflict, cross-cultural differences in cooperation and norm enforcement, and neurocomputational modeling of the formation and updating of social preferences and beliefs.
The application of genomic profiling assays using plasma circulating tumor DNA (ctDNA) is rapidly evolving in the management of patients with advanced solid tumors. Diverse plasma ctDNA technologies ...in both commercial and academic laboratories are in routine or emerging use. The increasing integration of such testing to inform treatment decision making by oncology clinicians has complexities and challenges but holds significant potential to substantially improve patient outcomes. In this review, the authors discuss the current role of plasma ctDNA assays in oncology care and provide an overview of ongoing research that may inform real‐world clinical applications in the near future.
Objective. The IPDAS Collaboration has developed a checklist and an instrument (IPDASi v3.0) to assess the quality of patient decision aids (PDAs) in terms of their development process and shared ...decision-making design components. Certification of PDAs is of growing interest in the US and elsewhere. We report a modified Delphi consensus process to agree on IPDASi (v3.0) items that should be considered as minimum standards for PDA certification, for inclusion in the refined IPDASi (v4.0). Methods. A 2-stage Delphi voting process considered the inclusion of IPDASi (v3.0) items as minimum standards. Item scores and qualitative comments were analyzed, followed by expert group discussion. Results. One hundred and one people voted in round 1; 87 in round 2. Forty-seven items were reduced to 44 items across 3 new categories: 1) qualifying criteria, which are required in order for an intervention to be considered a decision aid (6 items); 2) certification criteria, without which a decision aid is judged to have a high risk of harmful bias (10 items); and 3) quality criteria, believed to strengthen a decision aid but whose omission does not present a high risk of harmful bias (28 items). Conclusions. This study provides preliminary certification criteria for PDAs. Scoring and rating processes need to be tested and finalized. However, the process of appraising the quality of the clinical evidence reported by the PDA should be used to complement these criteria; the proposed standards are designed to rate the quality of the development process and shared decision-making design elements, not the quality of the PDA’s clinical content.
The spatial and temporal variations in the atmospheric COsub.2 concentrations evidently respond to anthropogenic COsub.2 emission activities. NOsub.2, a pollutant gas emitted from fossil fuel ...combustion, comes from the same emission sources as COsub.2. Exploiting the simultaneous emissions characteristics of NOsub.2 and COsub.2, we proposed an XCOsub.2 prediction approach to reconstruct XCOsub.2 data based on the data-driven machine learning algorithm using multiple predictors, including satellite observation of atmospheric NOsub.2, to resolve the issue of data gaps in satellite observation of XCOsub.2. The prediction model showed good predictive performance in revealing COsub.2 concentrations in space and time, with a total deviation of 0.17 ± 1.17 ppm in the cross-validation and 1.03 ± 1.15 ppm compared to ground-based XCOsub.2 measurements. As a result, the introduction of NOsub.2 obtained better improvements in the COsub.2 concentration responding to the anthropogenic emissions in space. The reconstructed XCOsub.2 data not only filled the gaps but also enhanced the signals of anthropogenic COsub.2 emissions by using NOsub.2 data, as NOsub.2 strongly responds to anthropogenic COsub.2 emissions (Rsup.2 = 0.92). Moreover, the predicted XCOsub.2 data preferred to correct the abnormally low XCOsub.2 retrievals at satellite observing footprints, where the XCOsub.2_uncertainity field in the OCO-2 and OCO-3 products indicated a larger uncertainty in the inversion algorithm.
Objective
To identify determinants of shared decision making in patients with multiple myeloma (MM) to facilitate the design of a program to maximize the effects of shared decision making.
Methods
...This prospective longitudinal study recruited 276 adult patients (52% male, mean age 62.86 y, SD 15.45). Each patient completed the eHealth Literacy Scale (eHEALS), Multidimensional Trust in Health Care Systems Scale (MTHCSS), Patient Communication Pattern Scale (PCPS), and 9‐Item Shared Decision‐Making Questionnaire (SDM‐Q‐9) at baseline and the SDM‐Q‐9 again 6 months later. One family member of the patient completed the Family Decision‐Making Self‐Efficacy (FDMSE) at baseline. Structural equation modeling (SEM) was used to investigate the associations between eHealth literacy (eHEALS), trust in the health care system (MTHCSS), self‐efficacy in family decision making (FDMSE), patient communication pattern (PCPS), and shared decision making (SDM‐Q‐9).
Results
SEM showed satisfactory fit (comparative fit index = 0.988) and significant correlations between the following: eHealth literacy and trust in the health care system (β = 0.723, P < 0.001); eHealth literacy and patient communication pattern (β = 0.242, P < 0.001); trust in the health care system and patient communication pattern (β = 0.397, P < 0.001); self‐efficacy in family decision making and patient communication pattern (β = 0.264, P < 0.001); eHealth literacy and shared decision making (β = 0.267, P < 0.001); and patient communication pattern and shared decision making (β = 0.349, P < 0.001).
Conclusions
Patient communication and eHealth literacy were found to be important determinants of shared decision making. These factors should be taken into consideration when developing strategies to enhance the level of shared decision making.
Many contemporary accounts of human reasoning assume that the mind is equipped with multiple heuristics that could be deployed to perform a given task. This raises the question of how the mind ...determines when to use which heuristic. To answer this question, we developed a rational model of strategy selection, based on the theory of rational metareasoning developed in the artificial intelligence literature. According to our model people learn to efficiently choose the strategy with the best cost-benefit tradeoff by learning a predictive model of each strategy's performance. We found that our model can provide a unifying explanation for classic findings from domains ranging from decision-making to arithmetic by capturing the variability of people's strategy choices, their dependence on task and context, and their development over time. Systematic model comparisons supported our theory, and 4 new experiments confirmed its distinctive predictions. Our findings suggest that people gradually learn to make increasingly more rational use of fallible heuristics. This perspective reconciles the 2 poles of the debate about human rationality by integrating heuristics and biases with learning and rationality.
•Shared decision making increases influenza vaccination rates in adult patients.•Interventions focused only on patient activation, might not be sufficient.•A multidisciplinary approach of health care ...providers showed effectiveness.
Shared decision making (SDM) is a promising approach, to bridge major barriers concerning vaccination by patient education and personal interaction of health care provider (HCP) and patient. SDM affects patient adherence, enhances patient knowledge, decreases decisional conflict and improves trust in the physician in most areas of health care. The shared decision making process (SDM process) is characterised by three key components: patient activation, bi-directional exchange of information and bi-directional deliberation of options.
To assess the impact of SDM processes on influenza vaccination rates in outpatient care patients.
A systematic literature search in MEDLINE, CENTRAL, EMBASE, PsycINFO and ERIC was conducted (2020–02-05). Randomized controlled trials (RCTs) and cluster RCTs, that aimed to improve influenza vaccination rates in adult patients in outpatient care were included. We examined effects of SDM processes on influenza vaccination rates by meta-analysis, and considered the extent of SDM processes in the analysed interventions and possible effect modifiers in subgroup analyses.
We included 21 studies, with interventions including face-to-face sessions, telephone outreach, home visits, Health Care Practitioner (HCP) trainings and supporting educational material. In 12 studies, interventions included all elements of a SDM process. A meta-analysis of 15 studies showed a positive effect on vaccination rates (OR of 1.96 (95% CI: 1.31 to 2.95)). Findings further suggest that interventions are effective across different patients groups and could increase effectiveness when the interaction is facilitated by multidisciplinary teams of HCP in comparison to interventions delivered by individual HCP.
This systematic review and meta-analysis provide evidence that SDM processes can be an effective strategy to increase influenza vaccination rates. Further research with more detailed descriptions of SDM implementation modalities is necessary to better understand which components of SDM are most effective.
Trial Registration: PROSPERO: CRD42020175555
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