Ethics Consultation in Pediatrics: Long-Term Experience From a Pediatric Oncology Center

There is little information about the content of ethics consultations (EC) in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records (2000–2011) at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is needed on the role of ethics consultation in pediatrics.     

The psychological construal of health behaviors

IntroductionIn order to optimize the effectiveness of behavior change interventions, we need to understand how the construal level – how we mentally represent or construe events or behaviors – influences health-related choices.ObjectiveTo examine the impact of mental construal on health decisions. Based on the Construal Level Theory, we predicted that people would give more weight to “cognitive considerations” when making a choice after being primed with the high-level perspective, whereas they would give higher weights to “sensory considerations” after being primed with the low-level perspective.MethodIn the first experiment, ninety-nine participants were primed with either high-level or low-level perspective across decision scenarios about vaccination and physical safety. The second experiment investigated nutrition decisions, which asked seventy participants to taste food that either had no label or was labelled “organic”. Organic label should prime high-level construal as it implies outcomes (e.g., product quality and healthiness) that are more distant in time and uncertain, in contrast with sensory dimensions (e.g. taste and appearance), which are immediately present. Participants rated cognitive and sensory considerations as well as action intentions.ResultsThe first study revealed that after the priming with the high-level construal, cognitive considerations became more important than sensory considerations in predicting protective action intentions, whereas after priming with the low-level construal, sensory considerations became more important. The second study revealed that only sensory considerations predicted decisions to consume the non-labelled product and only the cognitive score predicted decisions to consume the organic-labelled product.ConclusionWe demonstrated a moderating effect of construal-level mindset in health-protective decisions. We also discuss the implications for health promotion and policy, such as optimizing the effectiveness of behavior change interventions.     

时间压力对品牌决策中图形框架效应的影响

本研究以大学生为被试,以孙彦等人（2012）所研究的”MP3购买问题”为实验材料,采用2（时间压力：有时间压力/无时间压力）×2（图形版本：图形版本1/图形版本2）×2（品牌类型：品牌A/品牌B）三因素混合设计探讨了时间压力对品牌决策中图形框架效应的影响。结果表明：（1）在无时间压力条件下被试的品牌决策偏好受到了图形版本的影响,即出现了图形框架效应;（2）在有时间压力条件下图形框架效应对品牌决策偏好的影响被弱化了,说明图形框架效应是一个精细加工的过程。     

Assessing preference for reinforcers using demand curves, work-rate functions, and expansion paths

Much research has focused on the effects of environmental variability on foraging decisions. However, the general pattern of preference for variability in delay to reward and aversion to variability in amount of reward remains unexplained a either a mechanistic or a functional level. Starlings' preferences between a fixed and a variable option were studied in two treatments, A and D. The fixed option was the same in both treatments (20-s fixed-interval delay, five units food). In Treatment A the variable option gave two equiprobable amounts of food (20-s delay, three or seven units) and in D it gave two equiprobable delays to food (2.5-s or 60.5-s delays, five units). In both treatments the programmed ratio [amount/(intertrial interval+latency+delay)] in the fixed option equaled the arithmetic mean of the two possible ratios in the variable option (ITI = 40 s, latency = 1 s). The variable option was strongly preferred in Treatment D and was weakly avoided in Treatment A. These results are discussed in the light of two theoretical models, a form of constrained rate maximization and a version of scalar expectancy theory. The latter accommodates more of the data and is based on independently verifiable assumptions, including Weber's law.     

心理距离与决策者角色对风险决策的影响

采用改编的I0S量表测量自我与他人的心理距离,在收益和损失情境下,综合探讨了为他人和预测他人决策时心理距离对个体风险偏好的影响.结果发现:(1)与他人心理距离越远,个体决策时越偏好风险,且反应时越短;(2)个体预测他人决策时比为他人决策时更偏好风险,但两者反应时没有显著差异;(3)心理距离与决策者角色存在交互作用,即预测时个体认为远心理距离他人比近心理距离他人更冒险,而为他人决策时两者差异消失;(4)决策角色与决策框架、心理距离与决策框架存在交互作用:在收益框架下,自我他人心理距离较远时个体更偏好风险,且个体预测比为他人决策时更冒险,损失条件下无差异.依据相关理论对这些结果进行了分析讨论.     

自我—他人危机决策信息加工过程的差异:来自眼动的证据

本研究采用iView X-RED眼动仪,分两个实验来考察自我-他人危机决策的信息加工过程的差异。实验一采用单因素实验设计探讨自我-他人危机决策的信息加工过程,结果表明：为自我决策组的平均阅读时间、平均注视时间、平均注视次数、平均凝视时间、平均回视次数都显著高于为他人决策组。实验二采用2（任务框架：积极,消极）x2（决策者角色：为自我、为他人）混合实验设计,结果表明：在积极框架下,为自我决策组平均阅读时间、平均注视时间、平均注视次数、平均凝视时间、平均回视次数显著高于为他人决策组;在消极框架下,两个组没有显著差异。总体表现为,自我-他人危机决策的信息加工过程存在差异,且受任务框架的影响。     

Working hard for money decreases risk tolerance

This research examines how the effort that consumers exert to earn money affects their risk tolerance. We theorize and find that working harder—that is, more effortful earning—increases perceived ownership and valuation of earnings, and thus aversion to losing them, resulting in lower risk tolerance, even when risk is associated with better expected outcomes. Documenting this causal negative effort–risk relationship is important because it (1) runs contrary to consumers' lay beliefs and population-level analysis which conversely suggest a positive effort–risk correlation (i.e., a Simpson's paradox, Experiment 2), (2) expands understanding of how the way in which people acquire money affects risk tolerance beyond classic research on windfall gains (i.e., unanticipated rewards) and house money (i.e., unrealized gains), and hence (3) reveals a unique mechanism of perceived ownership that drives this negative causal relationship. Leveraging this unique mechanism, we further show that this negative effort–risk relationship can be attenuated by changing the currency of the money that consumers earn to be one that consumers have low ownership over (e.g., Bitcoin for non-crypto users).     

医疗人工智能研究的风险评估及应对

医疗人工智能研发机构在开展疾病辅助诊断、治疗、预测、管理等研发活动时,需结合不同的技术特点及研究规律进行充分的风险评估并有效应对风险,包括：健康数据驱动研究应该特别关注算法技术可靠性、高质量数据以及信息保护等方面的风险;评价医学人工智能干预措施的临床试验应该关注治疗安全性以及责任归属等方面的风险;评价医学人工智能效果与对社会影响的研究应该关注评价指标、方法与结果的可靠性等。只有研发各方在早期识别出可能会对个体、机构、社会等产生的风险,并做好相应的风险防控,才能促进人工智能技术在医学领域的健康发展。

     

医患关系中个人自主的局限与突围——关怀伦理对医疗决策的启示

知情同意和医疗家长主义的改良方式都将自主性理解为一种个人自主,通过对知情同意和改良后的医疗家长主义中个人自主因素的批判性反思,可以发现它们在个人自主的影响下仍然难以解决医疗程序的形式化、医患关系的沉默问题。借助关怀伦理的视角和对关怀关系的分析,表明自主性可以在人与人之间的关怀和支持中实现,并鼓励医生、患者家属对医疗决策的积极参与,促进医患关系的良好发展。因此,关怀伦理对关系的强调将有助于打破个人自主的局限性,并为医疗决策方式带来一种关系转向,也为其提供了一个新的理论基础。

     

情景预见对跨期决策的影响机制

为了探究情景预见对跨期决策的影响机制,研究采用延迟折扣任务范式,检验了在情景预见对跨期决策的影响中延迟时间知觉起到的中介作用。两个实验分别操纵了情景预见中未来事件与自我有关的信息和未来事件的情绪特征,结果均发现情景预见通过改变个体对延迟等待时间的时距知觉影响了跨期决策。想象与自己、与母亲有关的未来事件,想象积极、中性情绪效价的未来事件都使得被试将延迟等待时间知觉为较短的时间段,更倾向于选择延迟奖励。想象消极情绪效价的未来事件使得被试将延迟等待时间知觉为较长的时间段,更加偏好即时奖励。本研究有助于增进人们对情景预见影响跨期决策现象的理解。