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.
The world currently faces several severe social and environmental crises, including economic under-development, widespread poverty and hunger, lack of safe drinking water for one-sixth of the world's ...population, deforestation, rapidly increasing levels of pollution and waste, dramatic declines in soil fertility and biodiversity, and global warming.Inequality, Democracy, and the Environmentsheds light on the structural causes of these and other social and environmental crises, highlighting in particular the key role that elite-controlled organizations, institutions, and networks play in creating these crises.
Liam Downey focuses on four topics-globalization, agriculture, mining, and U.S. energy and military policy-to show how organizational and institutional inequality and elite-controlled organizational networks produce environmental degradation and social harm. He focuses on key institutions like the World Bank, the International Monetary Fund, the U.S. Military and the World Trade Organization to show how specific policies are conceived and enacted in order to further elite goals. Ultimately, Downey lays out a path for environmental social scientists and environmentalists to better understand and help solve the world's myriad social and environmental crises.Inequality, Democracy and the Environmentpresents a passionate exposé of the true role inequality, undemocratic institutions and organizational power play in harming people and the environment.
This paper develops a parsimonious process-level theory that connects organizational structure to exploration and exploitation. Toward this end, it develops a mathematical model of organizational ...decision making that combines an information processing approach in the spirit of Sah and Stiglitz Sah RK, Stiglitz JE (1986) The architecture of economic systems: Hierarchies and polyarchies.
Amer. Econom. Rev.
76(4):716–727 with elements from signal detection theory. The model is first used to explore a “design space” of organizations and identify trade-offs and dominance relationships among alternative organization designs. The paper then studies open questions in the organization design literature, such as the extent to which exploration and exploitation can be produced by one organization and what is the effect of organization size on exploration. More broadly, this research speaks to calls for the introduction of more process-level explanations in the organizations literature. The paper concludes with testable hypotheses and managerially relevant insights.
Preterm birth is a global health priority. Using a progestogen during high-risk pregnancy could reduce preterm birth and adverse neonatal outcomes.
We did a systematic review of randomised trials ...comparing vaginal progesterone, intramuscular 17-hydroxyprogesterone caproate (17-OHPC), or oral progesterone with control, or with each other, in asymptomatic women at risk of preterm birth. We identified published and unpublished trials that completed primary data collection before July 30, 2016, (12 months before data collection began), by searching MEDLINE, Embase, CINAHL, the Maternity and Infant Care Database, and relevant trial registers between inception and July 30, 2019. Trials of progestogen to prevent early miscarriage or immediately-threatened preterm birth were excluded. Individual participant data were requested from investigators of eligible trials. Outcomes included preterm birth, early preterm birth, and mid-trimester birth. Adverse neonatal sequelae associated with early births were assessed using a composite of serious neonatal complications, and individually. Adverse maternal outcomes were investigated as a composite and individually. Individual participant data were checked and risk of bias assessed independently by two researchers. Primary meta-analyses used one-stage generalised linear mixed models that incorporated random effects to allow for heterogeneity across trials. This meta-analysis is registered with PROSPERO, CRD42017068299.
Initial searches identified 47 eligible trials. Individual participant data were available for 30 of these trials. An additional trial was later included in a targeted update. Data were therefore available from a total of 31 trials (11 644 women and 16185 offspring). Trials in singleton pregnancies included mostly women with previous spontaneous preterm birth or short cervix. Preterm birth before 34 weeks was reduced in such women who received vaginal progesterone (nine trials, 3769 women; relative risk RR 0·78, 95% CI 0·68–0·90), 17-OHPC (five trials, 3053 women; 0·83, 0·68–1·01), and oral progesterone (two trials, 183 women; 0·60, 0·41–0·90). Results for other birth and neonatal outcomes were consistently favourable, but less certain. A possible increase in maternal complications was suggested, but this was uncertain. We identified no consistent evidence of treatment interaction with any participant characteristics examined, although analyses within subpopulations questioned efficacy in women who did not have a short cervix. Trials in multifetal pregnancies mostly included women without additional risk factors. For twins, vaginal progesterone did not reduce preterm birth before 34 weeks (eight trials, 2046 women: RR 1·01, 95% CI 0·84–1·20) nor did 17-OHPC for twins or triplets (eight trials, 2253 women: 1·04, 0·92–1·18). Preterm premature rupture of membranes was increased with 17-OHPC exposure in multifetal gestations (rupture <34 weeks RR 1·59, 95% CI 1·15–2·22), but we found no consistent evidence of benefit or harm for other outcomes with either vaginal progesterone or 17-OHPC.
Vaginal progesterone and 17-OHPC both reduced birth before 34 weeks' gestation in high-risk singleton pregnancies. Given increased underlying risk, absolute risk reduction is greater for women with a short cervix, hence treatment might be most useful for these women. Evidence for oral progesterone is insufficient to support its use. Shared decision making with woman with high-risk singleton pregnancies should discuss an individual's risk, potential benefits, harms and practicalities of intervention. Treatment of unselected multifetal pregnancies with a progestogen is not supported by the evidence.
Patient-Centered Outcomes Research Institute.
Shared decision making (SDM)-when clinicians and patients make medical decisions together-is moving swiftly from an ethical ideal toward widespread clinical implementation affecting millions of ...patients through recent policy initiatives. We argue that policy initiatives to promote SDM implementation in clinical practice carry the risk of several unintended negative consequences if limitations in defining and measuring SDM are not addressed. We urge policy makers to include prespecified definitions of desired outcomes, offer guidance on the tools used to measure SDM in the multitude of contexts in which it occurs, evaluate the impact of SDM policy initiatives over time, review that impact at regular intervals, and revise SDM measurement tools as needed.
All adaptive organisms face the fundamental tradeoff between pursuing a known reward (exploitation) and sampling lesser-known options in search of something better (exploration). Theory suggests at ...least two strategies for solving this dilemma: a directed strategy in which choices are explicitly biased toward information seeking, and a random strategy in which decision noise leads to exploration by chance. In this work we investigated the extent to which humans use these two strategies. In our "Horizon task," participants made explore-exploit decisions in two contexts that differed in the number of choices that they would make in the future (the time horizon). Participants were allowed to make either a single choice in each game (horizon 1), or 6 sequential choices (horizon 6), giving them more opportunity to explore. By modeling the behavior in these two conditions, we were able to measure exploration-related changes in decision making and quantify the contributions of the two strategies to behavior. We found that participants were more information seeking and had higher decision noise with the longer horizon, suggesting that humans use both strategies to solve the exploration-exploitation dilemma. We thus conclude that both information seeking and choice variability can be controlled and put to use in the service of exploration.
Making sense of recommendations Yeomans, Michael; Shah, Anuj; Mullainathan, Sendhil ...
Journal of behavioral decision making,
October 2019, Letnik:
32, Številka:
4
Journal Article
Recenzirano
Computer algorithms are increasingly being used to predict people's preferences and make recommendations. Although people frequently encounter these algorithms because they are cheap to scale, we do ...not know how they compare to human judgment. Here, we compare computer recommender systems to human recommenders in a domain that affords humans many advantages: predicting which jokes people will find funny. We find that recommender systems outperform humans, whether strangers, friends, or family. Yet people are averse to relying on these recommender systems. This aversion partly stems from the fact that people believe the human recommendation process is easier to understand. It is not enough for recommender systems to be accurate, they must also be understood.
In contrast to two-way decisions (2WD), three-way decisions (3WD) can effectively reduce decision risks by utilizing a new delayed decision option. This article incorporates 3WD into multiattribute ...decision-making (MADM) based on an outranking relation. We construct the outranked set for each alternative and introduce a hybrid information table that combines an MADM matrix with a loss function table. We propose three strategies to design a new 3WD model for MADM. The rationality and effectiveness of the proposed 3WD method are demonstrated by solving a problem of enterprise project investment target selections. Finally, we provide the comparative analysis and two experimental evaluations. The results show that the proposed 3WD method is effective and practically useful.
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.
PDF
