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At the onset of the COVID-19 pandemic, many public libraries offered virtual storytimes (VSTs). Who proposed, authorized, and developed these programs? What impact did they have in the short term and long term? To find out, we created a survey on the decision and evaluation processes behind VST. We received 415 responses from children's librarians throughout the United States. Our findings indicate that children's librarians exercised keen administrative and management skills in launching VSTs and the programs prioritized children's socioemotional development and learning. However, assessment of the programs is somewhat lacking as libraries tended to focus on outputs like the number of views rather than more meaningful indicators of program value for the community. [ABSTRACT FROM AUTHOR]

Objective: Medication management in home hospice is challenging for family caregivers (FCGs). We tested a patient-centered medication review and FCG support program delivered by hospice staff called "Shared Medication PLanning In (SiMPLIfy) Home Hospice." Methods: A pilot cluster-randomized trial at two U.S. home hospice agencies measured the primary outcome of reduction in Medication Regimen Complexity Index (MRCI) (range 0 [no medications]–no upper limit) and secondary outcome of Family Caregiver Medication Administration Hassle Scale (FCMAHS) (range 0 [no hassle−120 [greatest hassle]). Results: Twenty-two patient-FCG dyads enrolled. Mean baseline MRCI in the intervention group = 39 (95% CI: 30.9, 47.1) and control group = 25.5 (95% CI: 21.0–30.1). Half of intervention patients (3 of 6) had reduced MRCI compared with 26.7% (4 of 15) control patients (p = 0.07). MRCI was not significantly associated with caregiver burden. FCMAHS differed between spousal and nonspousal FCGs (p = 0.12). Conclusion: A clinician-FCG-patient communication program in home hospice is feasible and may reduce medication complexity. SiMPLIfy has the potential to reduce polypharmacy. [ABSTRACT FROM AUTHOR]

Purpose: To identify clinician-perceived barriers and facilitators to the delivery of outcome measurement and evidence-based treatment practices and integration of these practices in aphasia rehabilitation. Materials and methods: Using a convergent mixed methods design, aphasia clinicians (n = 87) across care settings in the United States completed an online survey designed within the Theoretical Domains Framework (TDF). Participants responded to open-ended questions and rated Likert scale statements. Qualitative data were analyzed using content analysis and quantitative data were summarized using descriptive statistics. Results: Factors related to the TDF domain of "environmental context and resources" (priority and productivity demands; characteristics of resources) were cited as primary barriers in 70% of qualitative responses for both outcome and treatment practices and were consistent with Likert rating statements. Facilitators were associated with TDF domains of "memory, attention, decision-making" (decision-making processes), "knowledge" (awareness of evidence) and "social influences" (client and caregiver preferences). Conclusions: Organizational-level factors and the misalignment of the research evidence with clinical needs are barriers to delivering evidence-based care in aphasia rehabilitation. Theoretically informed strategies such as establishing organizational infrastructure for practice change, developing clinically relevant evidence through research-practice partnerships, and implementing algorithms to support clinical decision-making can address barriers and leverage facilitators. IMPLICATIONS FOR REHABILITATION: Rehabilitation research needs to engage clinical partners and consider the healthcare context to provide the field with evidence-based outcome measures and treatment recommendations that meet the needs of the clinical environment. Clinical decision-making tools and algorithms have potential to support systematic, evidence informed care. Future implementation efforts need to test strategies that go beyond knowledge and skills training. Clinicians are optimistic for change in clinical practice within themselves and the profession. [ABSTRACT FROM AUTHOR]

Introduction: Although current recommendations support vaginal breech birth as a reasonable option, access to breech birth in US hospitals is limited. This study explored the experiences of decision‐making and perceptions of access to care in people who transferred out of the hospital system to pursue home breech birth. Methods: We conducted a mixed methods study of people with a singleton, term breech fetus who transferred out of the US hospital system to pursue home breech birth. Twenty‐five people completed an online demographic and psychosocial survey, and 23 (92%) participated in semi‐structured interviews. We used an interpretive description approach informed by situational analysis to analyze qualitative data about participants' experiences and perceived access to care. Results: Of 25 individuals who left the hospital system to pursue a home breech birth, most felt denied informed choice (64%) and threatened or coerced into cesarean (68%). The majority reported low or very low autonomy in decision‐making (n = 20, 80%) and high decisional satisfaction using validated measures. Many participants felt safer in a hospital setting but were not able to access care for planned vaginal breech hospital birth, despite extensive efforts. Participants felt "backed into a corner" and "forced into homebirth," perceiving a lack of access to safe and respectful care in the hospital system. Conclusion: Some service users believe that home birth is their only option when they cannot access hospital‐based care for vaginal breech birth. Current barriers to care for breech birth limit birthing people's autonomy and may be placing them and their infants at increased risk. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale) is the first three-phase risk instrument designed specifically for perioperative patients. The purpose of this study was to establish validity and reliability evidence for the Munro Scale. This study also had a goal to reduce the data into more manageable constructs with fewer items. Methods: Exploratory and confirmatory factor analyses were used to test the hypothesized model for risk assessment using the Munro Scale to identify latent variables. A retrospective review of charts from 630 risk assessments was analyzed from two community acute care hospital settings. Results: The model explained 95% of the variance in the cumulative final risk level, R2 =.95, F (20, 588) = 501.88, p <.001. Six latent variables emerged in the model with a cumulative contribution rate of 56% of the variance. Similar results were obtained in studies with Chinese and Turkish translations of the Munro Scale. Conclusions: The validity and reliability evidence obtained in this study supports the implementation of the Munro Scale for clinical practice in the perioperative setting. [ABSTRACT FROM AUTHOR]

Background: International retirement migration, which is the seasonal or permanent relocation of older people to another country, has grown in popularity in recent years. These retirees are motivated by the promise of warmer winter climates that are conducive to participating in health-promoting recreational and social activities. Ease of cross-border travel facilitates this transnational practice when undertaken seasonally. However, border closures and other travel-related measures put in place to manage the spread of COVID-19, disrupted travel, including for older Canadians who typically winter in the United States (US). During the 2020-21 winter season, for example, Canadians were advised not to engage in non-essential international travel and the land border between Canada and the US was closed to all but essential travellers. Nonetheless, retirement migration remained a significant draw for many Canadian retirees. Here, we qualitatively explore the factors that Canadian international retirement migrants considered when deciding whether or not to travel to the US for the 2020-21 winter during the COVID-19 pandemic. Methods: Guided by case study methodology, semi-structured interviews were conducted with 31 Canadian international retirement migrants who had wintered in the US prior to the COVID-19 pandemic and were in the US at the outset of the pandemic in late winter 2020. Interviews were transcribed verbatim and thematically analyzed to decipher what factors were most important to their travel-related decision-making during the pandemic. We structure the thematic results around four factors previously identified to motivate older people to become international retirement migrants and thus inform decision-making: the destination, the people, the cost, and the movement. Results: The previously identified factors that motivate older people to participate in international retirement migration include: the destination (e.g., climate and amenities), the people (e.g., social networks), the cost (e.g., health insurance and living costs), and the movement (e.g., ease of travel). These factors informed how international retirement migrants made decisions to travel abroad or not in the 2020-21 winter season. For example, destination-based factors included a lack of public health measures and high case counts, people-based factors comprised of less opportunities to engage in social activities, cost-based factors involved maintaining property investments and the lack of COVID-19 treatment coverage in available travel health insurance plans, and movement-based factors included challenges in ease of access when travel was viewed as essential or non-essential. These factors disincentivized or motivated international retirement migrants to travel abroad in the 2020-21 winter season during the COVID-19 pandemic. Conclusions: The results of this study support the need to create tailored decision-support tools for international retirement migrants to make informed travel-related decisions during crisis events so as to protect their health and wellbeing. More research is needed to explore perceptions of risk, especially health risks, among international retirement migrants and how they differently affect their travel-related decisions. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to better understand how neonatology (Neo) and maternal–fetal medicine (MFM) physicians approach the process of shared decision-making (SDM) with parents facing extremely premature (<25 weeks estimated gestational age) delivery during antenatal counseling. Study Design Attending physicians at U.S. centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. Preferences for conveying information are reported elsewhere. Here, we report clinicians' self-assessments of their ability to engage in deliberations and decision-making and perceptions of what is important to parents in the SDM process. Multivariable logistic regression analyzed respondents' views with respect to individual characteristics, such as specialty, gender, and years of clinical experience. Results In total, 74 MFMs and 167 Neos representing 94% of the 81 centers surveyed responded. Neos versus MFMs reported repeat visits with parents less often (<0.001) and agreed that parents were more likely to have made delivery room decisions before they counseled them less often (p < 0.001). Respondents reported regularly achieving most goals of SDM, with the exception of providing spiritual support. Most respondents reported that spiritual and religious views, risk to an infant's survival, and the infant's quality of life were important to parental decision-making, while a physician's own personal choice and family political views were reported as less important. While many barriers to SDM exist, respondents rated language barriers and family views that differ from those of a provider as the most difficult barriers to overcome. Conclusion This study provides insights into how consultants from different specialties and demographic groups facilitate SDM, thereby informing future efforts for improving counseling and engaging in SDM with parents facing extremely early deliveries and supporting evidence-based training for these complex communication skills. Key Points Perceptions differed by specialty and demographics. Parents' spiritual needs were infrequently met. Barriers to shared decision-making exist. [ABSTRACT FROM AUTHOR]

Parent-led, home-based education, or homeschooling, has grown rapidly over recent decades with participation rates increasing more than 100-fold to now nearly one in 25 students nationwide in the United States. However, the research base has not grown correspondingly, and homeschoolers remain understudied. We systematically surveyed a population of homeschooling families (N = 881 responses) who had reported homeschooling a high-ability student to learn more about their characteristics and perceptions. Specifically, we report a mixed-methods analysis of the survey responses addressing whether and why these parents would or would not consider returning their child to a traditional school setting. Respondents were predominantly mothers who reported a high level of formal education and who were primarily responsible for implementing homeschooling with their child. Qualitative thematic analysis of open-ended responses yielded five main themes: preference, academics, concerns about future educational opportunities, satisfaction, and well-being. Findings both support and extend prior research with this population. [ABSTRACT FROM AUTHOR]

Intimate Partner Violence (IPV) is a pervasive public health crisis that impacts individuals across the gender spectrum. Traditionally, IPV is conceptualized through a gendered lens, with men as the perpetrators and women as the victims. The current study explored the association between perpetrator/victim sex, prosecutor gender role attitudes, and prosecutorial decision-making in a case of alleged IPV. We hypothesized that prosecutors with more traditional gender role attitudes would be more lenient, and this effect to be exacerbated in cases involving a female perpetrator. Criminal prosecutors across the United States (N = 94) completed the Male Role Norms Inventory—Revised and read case materials describing the alleged IPV between a heterosexual couple (e.g., arrest report, medical records). The victim/perpetrator sex was manipulated to involve either a female- (male victim) or male- (female victim) perpetrated IPV case. Results indicate that gender role attitudes were not associated with prosecutorial decision-making. However, prosecutors perceived the violence as more serious and the perpetrator as more likely to reoffend when the perpetrator was male; further, they attributed more blame to the female victim. An interaction between perpetrator sex and prosecutor gender role attitudes indicates those with more traditional beliefs were more likely to blame the female (rather than male) victim. These data suggest extralegal factors related to the perpetrator (i.e., perpetrator sex), rather than prosecutor individual differences (i.e., gender role attitudes), are associated with prosecutor discretionary decision-making. In tandem with real-world disparities in the prosecution of IPV based on perpetrator sex, the current research stresses the importance of exploring a diversity of factors that account for these observed differences. [ABSTRACT FROM AUTHOR]

Background The treatment landscape for locally advanced/metastatic urothelial carcinoma (la/mUC) has evolved. This study examined US prescribing patterns and clinical decision-making for first-line (1L) and first-line maintenance (1LM) treatment. Materials and Methods US-based oncologists (N  = 150) completed an online survey on patient demographics, practice patterns, and important factors considered in 1L/1LM selection. Multivariable logistic regression was used to assess factors associated with more vs less frequent 1L/1LM prescribing. Results Physician reports estimated that 23% of patients with la/mUC had not received any systemic therapy in the previous 6 months; however, 46% received 1L, 32% received second-line, and 22% received subsequent-line systemic treatments. Of patients who were receiving 1L treatment, 72% were estimated to be receiving 1L platinum-based chemotherapy. Around 69% of patients eligible for 1LM received the treatment. Physicians categorized as frequent prescribers reported overall survival (OS), disease control rate (DCR), and rate of grade 3/4 adverse events (AEs) as factors associated with 1L treatment selection (all P  < .05). OS, rate of grade 3/4 immune-mediated AEs, and inclusion in institutional guidelines were reported as attributes used in 1LM treatment selection (all P  < .05). Multivariable analysis revealed OS, DCR, and rate of grade 3/4 AEs as important factors in oncologists' 1L treatment selection; academic practice setting and use of Response Evaluation Criteria in Solid Tumors version 1.1 were associated with 1LM use (all P  < .05). Conclusion OS and AEs were found to be relevant factors associated with offering 1L and 1LM treatment. Variability exists in physicians' decision-making in the real-world setting for la/mUC. [ABSTRACT FROM AUTHOR]

Introduction: Current implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. Methods: Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents' PrEP status. Results: The median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1). Conclusions: Participants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients. [ABSTRACT FROM AUTHOR]

Introduction: Multiple sclerosis (MS) is a neurodegenerative disease characterized by progressive deterioration of cognitive and physical functioning, reducing activities of daily living and quality of life (QoL). Several treatments are available that modify the course of the disease and reduce the frequency of relapses. Although effective, all treatment options are accompanied by adverse events, and this study aimed to assess the extent to which patients were involved in the choice of treatment.Methods: Data were drawn from the Adelphi Multiple Sclerosis Disease Specific Program (DSP)™, a cross-sectional survey of healthcare practitioners (HCP) and their patients with MS in real-world clinical settings in Europe and the United States (US) between December 2020 and July 2021. HCPs reported patient demographics, clinical characteristics, current and previous treatment, and treatment outcomes. Patients voluntarily completed questionnaires reporting the physical and psychological impact of their MS and its treatment. Regression analysis with inverse probability of treatment weighting was used to compare treatment outcomes in patients actively involved in their current treatment choice with those who were not.Results: Of a total of 692 patients, median age 40 years and 64% female, mostly diagnosed with relapsing-remitting MS, those who were involved in shared decision-making tended to choose oral therapies such as dimethyl fumarate more often than HCPs. MS had greater impact on physical and psychological functioning in patients whose HCP made treatment decisions solely. Patients involved in decision-making reported greater satisfaction with their treatment and a better QoL.Discussion: Because no single optimal therapy exists for patients with MS, treatments should be individualized with consideration of patients' preferences. Our study shows that shared decision-making is under-utilized in the management of MS and supports the benefits of patient involvement.Conclusion: Patients who have an active role in treatment decision-making show improved wellbeing and QoL, and overall treatment satisfaction.Plain Language Summary: Multiple sclerosis (MS) is a disease that affects the brain, causing symptoms such as blurred vision and problems with movements, thoughts, and feelings. MS is a lifelong condition that becomes worse over time and limits the activities that people can do. There are many treatments that can help to reduce relapses (when symptoms become worse), but all have their benefits and drawbacks. It is often the physician who decides which treatment to use, but we wanted to know if patients would feel better if they were involved in the decision.Using our standardized and validated questionnaires, we surveyed physicians and nurses who treat patients with MS in Europe and the United States of America between December 2020 and July 2021, to assess how they felt about the treatment they chose and its effect on the patient. We also asked the patients themselves how they felt about their illness and treatment, whether they were given the chance to choose which treatment to take, and how their treatment affected their symptoms and overall quality of life.The information provided by both the physicians and their patients was used to compare how patients responded when they were involved in the treatment decisions. We found that patients who were involved in choosing their treatment were more satisfied with their treatment and responded better than those whose physicians decided alone. Therefore, it is important for physicians treating patients with MS to consider their patients' preferences when deciding which treatment is best for them. [ABSTRACT FROM AUTHOR]

Background: Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate. Objectives: To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic. Design: A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States. Methods: This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status. Results: Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky. Conclusion: Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group. [ABSTRACT FROM AUTHOR]

The 'health paradox' is a phenomenon in which immigrants report better health than their native-born counterparts despite experiencing numerous adversities. This study examines the 'health paradox' among adolescent girls in the U.S. and evaluates the understudied pathways and conditions in the immigration status-health link, including the role of emotional (i.e. depressive symptoms) and cognitive (i.e. decision-making) domains. Drawing on Wave I (1994–1995) and Wave II (1996) of a nationally representative longitudinal study of adolescents (Add Health), a series of regression models was conducted to explore the relationship between girls' immigration status and health (N = 6,543). Further, mean centered multiplicative terms and the KHB decomposition procedure were used to assess the moderating and mediating effects of depressive symptoms and decision-making. Results reveal that, in general, foreign-born girls enjoy better health as compared to their native-born counterparts, which is partially explained by their fewer depressive symptoms. Importantly, however, the experience of higher levels of depressive symptoms appears to decrease immigrant girls' resilience. The ability to be thoughtful and reflective when making choices serves as a health protective factor among girls overall, suggesting the need to foster adolescent girls' decision-making skills to improve their health. Policy recommendation based on our findings are discussed. [ABSTRACT FROM AUTHOR]

Maternal morbidity and mortality disproportionately affect Black birthing people. Multiple factors contribute to these disparities, including variations in quality health care, structural racism, and implicit bias. Interactions between Black patients and perinatal clinicians could further affect perinatal care use and subsequent perinatal outcomes. This integrative review aims to synthesize quantitative and qualitative literature published in peer-reviewed journals in English within the past 10 years that address patient-clinician interactions during the perinatal period for Black birthing people in the United States. A systematic search of CINAHL, PubMed, PsycINFO, MEDLINE, and Embase recovered 24 articles that met the eligibility criteria for inclusion in this review. The following themes emerged from synthesizing Black patients' interactions with perinatal clinicians: Care Quality, Communication, Power Dynamic, and Established Relationships. Mutual respect, effective communication, and shared decision-making may be key modifiable factors to address through clinician education to improve perinatal care for many Black persons. [ABSTRACT FROM AUTHOR]

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We sought to confirm, refute, or modify a 4-step process for implementing shared decision-making (SDM) in pediatrics that involves determining 1) if the decision includes >1 medically reasonable option; 2) if one option has a favorable medical benefit-burden ratio compared to other options; and 3) parents' preferences regarding the options; then 4) calibrating the SDM approach based on other relevant decision characteristics. METHODS: We videotaped a purposive sample of pediatric inpatient and outpatient encounters at a single US children's hospital. Clinicians from 7 clinical services (craniofacial, neonatology, oncology, pulmonary, pediatric intensive care, hospital medicine, and sports medicine) were eligible. English-speaking parents of children who participated in inpatient family care conferences or outpatient problem-oriented encounters with participating clinicians were eligible. We conducted individual postencounter interviews with clinician and parent participants utilizing video-stimulated recall to facilitate reflection of decision- making that occurred during the encounter. We utilized direct content analysis with open coding of interview transcripts to determine the salience of the 4-step SDM process and identify themes that confirmed, refuted, or modified this process. RESULTS: We videotaped 30 encounters and conducted 53 interviews. We found that clinicians' and parents' experiences of decision-making confirmed each SDM step. However, there was variation in the interpretation of each step and a need for flexibility in implementing the process depending on specific decisional contexts. CONCLUSIONS: The 4-step SDM process for pediatrics appears to be salient and may benefit from further guidance about the interpretation of each step and contextual factors that support a modified approach. [ABSTRACT FROM AUTHOR]

Research suggests that simulation in nursing education is a learning strategy that promotes critical thinking and utilization of clinical judgment in a safe environment without fear of retribution if errors are made. Senior nursing students in a small liberal arts university participated in a complex simulation that involved a pregnant patient with preeclampsia. The students were charged with doing a complete assessment of the patient and unborn baby. Upon completion of the assessment, the students utilized their critical thinking skills to determine the best treatment for the patient and baby that rendered the best outcomes. The goal of the exercise was to provide the students with a realistic scenario that advanced quickly into an emergent situation. The majority of students will not work in labor and delivery, but they will experience situations in their respective units that require quick thinking and critical decision-making. This simulation was a strategy to help facilitate these students into their transition to practice. [ABSTRACT FROM AUTHOR]

Precipitation has increased across most of the United States over the last century. The Northeast region has seen the largest increase of ∼15 percent, predominantly from an increase in the frequency of extreme events, and these trends will continue. Commercial diversified fruit and vegetable (F&V) growers in the Northeast are among the most vulnerable to the flooding that can result from this trend. These growers, as part of broader social networks, can also be part of the process of adaptation and transformation of the regional landscape. Here, I review literature on expected precipitation changes, farmer experimentation and decision-making, the effects of flooding on agriculture and F&V systems, and the adaptation options available to and in use by growers. I draw on two case studies and highlight how these growers' experiences complement the literature, and add context on advising needs, the challenge of prioritization, and the emotions that accompany changing rainfall patterns. [ABSTRACT FROM AUTHOR]

Errors in clinical decision-making are disturbingly common. Recent studies have found that 10 to 15% of all clinical decisions regarding diagnoses and treatment are inaccurate. Here, we experimentally study the ability of structured information-sharing networks among clinicians to improve clinicians' diagnostic accuracy and treatment decisions. We use a pool of 2,941 practicing clinicians recruited from around the United States to conduct 84 independent group-level trials, ranging across seven different clinical vignettes for topics known to exhibit high rates of diagnostic or treatment error (e.g., acute cardiac events, geriatric care, low back pain, and diabetes-related cardiovascular illness prevention). We compare collective performance in structured information-sharing networks to collective performance in independent control groups, and find that networks significantly reduce clinical errors, and improve treatment recommendations, as compared to control groups of independent clinicians engaged in isolated reflection. Our results show that these improvements are not a result of simple regression to the group mean. Instead, we find that within structured information-sharing networks, the worst clinicians improved significantly while the best clinicians did not decrease in quality. These findings offer implications for the use of social network technologies to reduce errors among clinicians. [ABSTRACT FROM AUTHOR]

Policymakers, practitioners, and governing bodies increasingly recognize the critical role stakeholder engagement plays in successful environmental planning and decision-making. Although stakeholder engagement can improve project outcomes, identifying best practices for stakeholder engagement that apply to diverse topics and settings can be a challenge. Informed by our experience using Q methodology (QM) in five stakeholder meetings in agricultural watershed across the United States, this paper highlights our use of QM as an engagement tool and provides insights for future use. It demonstrates how QM addresses fundamental stakeholder engagement principles and provides guidance on using QM in stakeholder meetings. While we acknowledge inherent QM limitations regarding stakeholder participation and competent facilitators, we used QM to provide a flexible meeting structure that allowed participants to develop opinions and safely engage with peers and decision makers on complex and, at times, controversial topics. Insights on the use of Q methodology as a meeting facilitation tool Overview of how to use Q methodology for in stakeholder meetings Details how Q methodology can fulfill stakeholder engagement best practices [ABSTRACT FROM AUTHOR]

Despite a significant reduction of human papillomavirus (HPV) infection in the United States in the past decade, Korean American (KA) women experience a disproportionately high cervical cancer burden due to low HPV vaccination rates. Given associations between parental decision-making and adolescent vaccination, it is crucial to identify and address factors influencing parental HPV vaccination decision-making for their children. The purpose of this study was to examine the sociodemographic characteristics and health literacy factors in relation to KA women's willingness to allow their daughters to receive HPV vaccination. We used baseline data collected from 560 KA women who participated in a cluster-randomized trial designed to promote mammography and Pap test screening. Participants answered study questionnaires measuring individual characteristics, cancer literacy, HPV knowledge, and HPV vaccination decision-making for their daughters. Multivariate logistic regression analysis was conducted to identify the correlates of HPV vaccination decision-making among participants. Over half of the participants (54%) endorsed HPV vaccination for their daughters. Low knowledge, compared to high and medium HPV knowledge (aOR 3.48, CI 2.01–6.04 and aOR 2.14, CI 1.46–3.12, respectively), were significantly associated with higher odds of participants' intention to vaccinate their daughters. Additionally, in comparison to low cancer literacy, middle-range cancer literacy (aOR 1.70, CI 1.08–2.68) was significantly associated with higher odds of participants' intention to vaccinate their daughters. Misperceptions about cancer and low HPV knowledge among KA women should be considered when providing vaccine counseling and developing interventions to promote cervical health in this population. [ABSTRACT FROM AUTHOR]

In the United States, it is estimated that fewer than 30% of sexual assaults are reported to law enforcement, less than 5% will result in an arrest, and approximately 3% will result in a felony conviction. The present study examines a census of sexual assault reports from 2012 to 2020 in a large police department in the Midwest region of the United States, considering only those cases presented to the district attorney's office for consideration (n = 700). Victim characteristics, suspect characteristics, and incident characteristics were examined as relating to a prosecutor accepting a case for charges. Further, a series of "ideal victim" characteristics were identified and used to create an additive scale based on prior research. The most significant predictors of prosecutor acceptance in the full sample were a lack of "date rape" drugs, continued cooperation from the victim, the suspect having a prior arrest for sexual assault, and the assault being reported within 24 h of occurring. A separate model was conducted for only those cases with continued cooperation from the victim. The researchers discuss the implications of these significant factors and suggest training to change false perceptions of victims among criminal justice officials and to increase victim reporting/cooperation in cases of sexual assault. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to examine how female sex worker's motivations, desires, intentions and behaviours towards childbearing and childbearing avoidance inform their contraceptive decision‐making. We explored the influence of social determinants of health in the domains of social context (sexual partners and experiences of violence), healthcare access, economic instability on the contraceptive decision‐making process. Design: We conducted a qualitative descriptive study informed by Miller's Theory of Childbearing Motivations, Desires and Intentions through the lens of social determinants of health. Methods: Participants were recruited from a parent study, EMERALD, in July–September, 2020. Data were collected from 22 female sex workers ages 18–49 using semi‐structured 45 to 60‐min audio‐recorded interviews and transcribed verbatim. Theory guided the development of the study's interview guide and thematic analytic strategy. Results: Five themes emerged related to contraceptive decision‐making: Motivations (value of fatherhood), Desires (relationships with love), Intentions and Behaviours (drugs overpower everything, contraceptive strategies and having children means being a protector). Women's contraceptive decision‐making often included intentions to use contraception. However, social determinants such relationships with clients and intimate partners, interpersonal violence and challenges accessing traditional health care offering contraceptive services often interfered with these intentions and influenced contraceptive behaviours. Conclusion: Women's contraceptive decision‐making process included well‐informed desires related to childbearing and contraceptive use. However, social determinants across domains of health interfered with autonomous contraceptive decision‐making. More effort is needed to examine the influence of social determinants on the reproductive health of this population. Impact: Findings from this study build on existing research that examines social determinants impacting reproductive health among female sex workers. Existing theoretical frameworks may not fully capture the influence constrained reproductive autonomy has on contraceptive decision‐making. Future studies examining interpersonal and structural barriers to contraception are warranted. Patient or Public Contribution: The parent study, EMERALD, collaborated with community service providers in the study intervention. [ABSTRACT FROM AUTHOR]

The current study aimed to explore the factors that influence how social workers make decisions and develop their decision‐making skills in care proceedings, and to identify effective support and intervention to develop social worker decision‐making skills. The study employed a mixed thematic approach across two phases of study: an initial inductive thematic analysis of responses to an online qualitative questionnaire and then a mixed thematic analysis of follow‐up focus groups and interviews with social workers working in various social work roles within England and Northern Ireland. The findings identified a number of themes that help to understand the decision‐making skills of social workers; thorough assessment skills, relationship‐based anti‐oppressive practice, being mindful of the lived experience of the child and using critical reflection to make complex decisions. Wider structural factors that support or hinder decision‐making, particularly in respect of organizational support and management supervision were also identified. Social workers can be supported to develop decision‐making skills through additional training, reflective learning and management support to develop their practice wisdom within this field. [ABSTRACT FROM AUTHOR]

Objective The study aimed to better understand how neonatology and maternal fetal medicine (MFM) physicians convey information during antenatal counseling that requires facilitating shared decision-making with parents facing options of resuscitation versus comfort care after extremely early delivery Study Design Attending physicians at US centers with both Neo and MFM fellowships were invited to answer an original online survey about antenatal counseling for extremely early newborns. The survey assessed information conveyed, processes for facilitating shared decision-making (reported separately), and clinical experiences. Neonatology and MFM responses were compared. Multivariable logistic regression analyzed topics often and seldom discussed by specialty groups with respect to respondents' clinical experience and resuscitation option preferences at different gestational weeks. Results In total, 74 MFM and 167 neonatologists representing 94% of the 81 centers surveyed responded. Grouped by specialty, respondents were similar in counseling experience and distribution of allowing choices between resuscitation and no resuscitation for delivery at specific weeks of gestational ages. MFM versus neonatology reported similar rates of discussing long-term health and developmental concerns and differed in all other categories of topics. Neonatologists were less likely than MFM to discuss caregiver impacts (odds ratio [OR]: 0.14, 95% confidence interval [CI]: 0.11–0.18, p < 0.001) and comfort care details (OR: 0.19, 95% CI: 0.15–0.25, p < 0.001). Conversely, neonatology versus MFM respondents more frequently reported "usually" discussing topics pertaining to parenting in the NICU (OR: 1.5, 95% CI: 1.2–1.8, p < 0.001) and those regarding stabilizing interventions in the delivery room (OR: 1.8, 95% CI: 1.4–2.2, p < 0.001). Compared with less-experienced respondents, those with 17 years' or more of clinical experience had greater likelihood in both specialties to say they "usually" discussed otherwise infrequently reported topics pertaining to caregiver impacts. Conclusion Parents require information to make difficult decisions for their extremely early newborns. Our findings endorse the value of co-consultation by MFM and neonatology clinicians and of trainee education on antenatal consultation education to support these families. Key Points Neonatology versus MFM counselors provide complementary information. More experience was linked to discussing some topics. Co-consultation and trainee education is supported. What information parents value requires study. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to understand the experiences of youth who had been prescribed antipsychotics but did not have psychosis, mania, autism spectrum disorder, or developmental disability. Methods: Twenty-three qualitative telephone interviews were conducted with youth aged 11–18 who had been prescribed an antipsychotic medication but did not have a diagnosis of psychotic disorder, bipolar disorder, autism spectrum disorder, or developmental disability. Participants were recruited from four U.S. healthcare systems participating in the pragmatic trial Safer Use of Antipsychotics in Youth (SUAY). Interviews were recorded, transcribed and analyzed using template analysis techniques. Results: Prior to initiating an antipsychotic medication, most participants experienced behavioral health crises; many felt that they had no options other than to start the medication. Other core themes included: (1) antipsychotics had both positive psychosocial outcomes, such as improvement of family life, and adverse effects, such as drowsiness or weight gain, (2) antipsychotics were only one part of a broader treatment plan, (3) efforts were made to maximize benefits and minimize side effects through careful titration, (4) feedback from friends and family was important in the decision to continue. Conclusions: The findings provide valuable insights into how to engage youth in conversations around the use of antipsychotics. [ABSTRACT FROM AUTHOR]

How police officers exercise their unique power to use deadly force continues to be a topic of interest among academics and has recently become arguably the most visible public policy issue related to the criminal justice system in the United States. Academic interest in officers' use of deadly force includes attention to how officers make the decision to discharge their firearms during encounters with citizens. Binder and Scharf posited that actions and decisions made by officers early in a high-risk police-citizen encounter can impact their decision to use deadly force at the conclusion of the encounter. This decision-making model, however, has been subject to very little empirical scrutiny in the decades since it was proposed (see Fridell & Binder; Scharf & Binder for notable exceptions). To bring their comprehensive framework back to the forefront and provide additional empirical assessment, the authors used the Binder and Scharf model as a framework to examine 82 officers' decisions to shoot or hold fire in incidents that involved multiple officers who ultimately made different decisions regarding lethal force. Results from the qualitative analysis suggest that the presence and actions of other officers on scene can have a notable impact on officers' decision-making during a high-risk police-citizen encounter. Furthermore, findings from this study extend the Binder-Scharf model by highlighting the role of conscious and unconscious decision-making and the impact of social roles on officers' choices during an officer-involved shooting. [ABSTRACT FROM AUTHOR]

Clinical practice guidelines for paediatric neuromuscular disorders (NMDs) recommend timely provision of wheelchair equipment. The aim of this qualitative study was to understand healthcare professionals' clinical perspectives and practices when recommending wheelchair equipment for the first time, as well as perceived barriers and enablers to timely wheelchair provision. Twenty-one healthcare professionals (HCPs) from Australia and the United States participated in an interview (response rate: 88%, 16/21 women). Participants were from diverse disciplines, based in hospital or community health settings, and had at least one year of experience working in paediatric neuromuscular care. Child fatigue, falls and engagement in age-appropriate activity were common reasons for HCP's wheelchair recommendation. HCPs were acutely aware of parents' experiences of grief and loss throughout the wheelchair prescription process, and over half acknowledged the lack of psychological care available to families affected by NMDs. Multi-disciplinary collaboration, psychologically-informed care, and shared decision-making with stakeholders were perceived enablers of wheelchair transition. Barriers included limited access to equipment, lengthy funding processes and lack of funding for home and vehicle modifications. Integrated psychosocial care is needed to support families throughout their child's disease progression, including wheelchair transition. Implementation of readiness for change tools, and development of tailored informational resources is recommended. Improved access to equipment options and trials, and more efficient funding processes are highly likely to improve parental engagement throughout the wheelchair prescription process. Healthcare professionals express a strong demand for integrated psychosocial care within paediatric neuromuscular clinics to support families throughout transitions, including wheelchair introduction. Identifying parents' readiness for change can inform their information and support needs, strengthen their decision-making capacity and facilitate timely wheelchair introduction. Stronger collaboration between hospital- and community-based health professionals working in paediatric neuromuscular care is recommended to facilitate knowledge exchange and support families' transition to wheelchair use. Access to equipment options for extended loan or trial in the community can support timely wheelchair introduction. [ABSTRACT FROM AUTHOR]

Aims: To explore the research hot topics and main contents in the field of the influence of mental fatigue on athletic performance, and to provide new ideas and directions for future research in this field. Methods: Using CiteSpace and VOSviewer visualization tool software core collection of Web of Science database to TS = (“mental fatigue” OR “mental exertion” OR “cognitive fatigue” OR “Cognitive exertion” OR “mental exhaustion” OR “mental tiredness”) AND (“athletic performance” OR “technical skill*” OR “Skill*” OR “technique” OR “decision making” OR “performance”) AND (“Humans”) searched for the influence of mental fatigue on athletic performance from 2001 to 2021 to conduct visual analysis. Research hot topics were analyzed from the aspects of high-impact countries/regions, institutions, authors, high-frequency keywords, and mutation terms. Results: A total of 658 publications were identified finally, and there has been an increasing trend in the annual number of publications, with the United States ranking first in the number of publications and influence. Future research will focus on promoting the application of EEG technology as an objective indicator for assessing mental fatigue, exploring effective methods and measures for pharmacological or non-pharmacological interventions against fatigue, and focusing on the effects of mental fatigue on endurance performance, technical skills, and sports-related decision-making. Conclusion: The results of the present study help us understand the status of the mental fatigue and athletic performance field and its recent developments. [ABSTRACT FROM AUTHOR]

Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients' decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists' decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists' decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings. [ABSTRACT FROM AUTHOR]

Introduction: Treatment decisions in older adults with acute myeloid leukemia (AML) are challenging, particularly for those who are not candidates for intensive chemotherapy (IC), and the trade-offs patients, their families and physicians consider when choosing a treatment option are not well understood. This qualitative research explored the value of extending survival and the treatment decision-making process from a multi-stakeholder perspective. Methods: Overall, 28 patients with AML (≥ 65 years old, unsuitable for IC), 25 of their relatives and 10 independent physicians from the US, UK and Canada took part in one-on-one, 60-minute qualitative interviews. Results: Across all stakeholders, improved health-related quality of life (HRQoL), extended survival and relief of AML symptoms were recognized as most important in AML treatment decision-making. However, extending survival in 'good health' was more important than extending survival alone, particularly because of the extra time it gives patients and their relatives together, and allows patients to achieve important goals. Patients' limited understanding of available treatment options, paired with incorrect perceptions of treatment side effects, impacted their involvement in the treatment decision-making process. Patients and physicians perceived physicians to have the most influence in the decision-making process despite their priorities not always aligning. Conclusion: These findings illustrate the importance of having structured discussions which explicitly assess patients' goals and their understanding and expectations of treatments and also the need for patient friendly resources about the lived experience of AML and available treatment options. These measures will help to ensure that patients are fully involved in the shared decision-making process. [ABSTRACT FROM AUTHOR]

The increasingly urgent need to develop knowledge and practices to manage flood risks drives innovative information design. However, experts often disagree about design practices. As a result, flood‐risk estimates can diverge, leading to different conclusions for decision‐making. Using examples of household‐scale fluvial (riverine) flood‐risk information in the United States, we assess design features and risk communication approaches that may lead to more actionable information for decision‐making. We argue that increased attention to uncertainty characterization and model diagnostics is a critical intermediate step for developing simpler approaches for designing flood‐risk information. Simpler frameworks are desirable because flood risks change over time, and simpler frameworks are less costly to update. Developing frameworks for large spatial domains require collaboration grounded in principles of open science. Finally, systematically evaluating how decision‐makers access and use information can provide new insights to guide risk communication and information design. Plain Language Summary: Climate change can cause temperatures to rise and precipitation to become more extreme. The impacts of these changes on flooding vary in space and time and are uncertain. For example, changes in future flooding differ between urban and rural areas. We discuss the diversity of available approaches for creating flood‐risk information. We suggest avenues for improvement, including (a) refining model diagnostics and uncertainty characterization to identify simpler model frameworks; (b) increasing information transparency and accessibility; and (c) improving understanding of links between decision‐making and risk communication. Key Points: Designing flood‐risk information for decisions about property‐scale flood adaptation poses nontrivial conceptual and operational challengesMany national‐scale flood‐risk estimates fail to account for regional flood‐risk dynamics, especially information that integrates projected future changesPromising avenues toward more actionable flood‐risk information include improving uncertainty characterization, design transparency, and risk communication [ABSTRACT FROM AUTHOR]

Prosecutors exercise substantial discretion within the criminal justice process, potentially allowing for discrepant treatment of criminal cases. The purpose of this research was to examine the association between prosecutorial implicit biases and victim gender and sexual orientation in an intimate partner violence (IPV) case. Participants, 201 prosecutors from across the United States, completed two Implicit Association Tests to measure implicit gender attitudes and implicit attitudes regarding lesbian, gay, bisexual, and queer individuals. Participants were randomly assigned to one of four conditions (opposite-sex couple/female victim, opposite-sex couple/male victim, same-sex couple/female victim, same-sex couple/male victim) and read a case file of an alleged IPV arrest. Consistent with our hypotheses, prosecutors were 65% more likely to prosecute under the severest criminal penalty when the victim was female or included an opposite-sex couple. However, we found no evidence that implicit biases related to prosecutorial decisions. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the perspectives of international experts and Danish citizens on relevant knowledge about population-based breast, colorectal and cervical cancer screening., Methods: This was a qualitative interview study with focus group interviews with experts and Danish citizens eligible for breast, colorectal and/or cervical cancer screening. Data were collected using semi-structured interview guides, audio-recorded and transcribed verbatim. A thematic analysis was conducted., Results: Participants were nine international experts from Germany, Canada, the USA, Sweden, the Netherlands and Australia, and 54 citizens from Denmark. Most citizens had 'adequate' or 'problematic' levels of health literacy. Themes that experts and citizens agreed on were: knowledge about the disease and symptoms, practical information about screening, benefits of screening, the option of non-participation and the importance of having numeric information of possible screening outcomes. Experts agreed on the importance of knowledge about the harms of screening, but only a minority of citizens considered this important., Conclusions: The experts and citizens disagreed on the relevance of knowledge about harms of screening and agreed on other relevant knowledge., Practice Implications: What experts and citizens find important may not align when making informed decisions. Therefore, experts and citizens needs to be involved when developing questionnaires., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Take-up gaps in safety net programs, long documented in the US, are an important policy problem as non-take up compromises the equity objectives and efficacy of programs. The Social Security Disability program is an example of this: more than 20 million adults report a work disability, but only around 11 million currently receive disability benefits through the Social Security Disability Insurance or Supplemental Security Income programs., Objectives: We examine decision-making around benefits application among adults with self-reported work disability who have never applied for disability benefits., Methods: We conducted 39 interviews with work-disabled adults who have never applied for disability benefits. Thematic analysis identified key barriers and inhibitors to disability application., Results: High transaction costs involved in disability applications coupled with the widespread perception of low approval rates was mentioned as a critical deterrent. Uncertain and lengthy medical processes after disability onset were also frequently reported as a key deterrent. Stigma about receiving disability benefits did not emerge as a factor in application behavior, although a change in self-concept involving an adjustment to benefit-receiving, work-disabled status was cited as a barrier to claiming., Conclusion: Our results broadly align with those of other research that examined the information, transaction, and social costs of applying for benefits. Nevertheless, the qualitative data afford a more in-depth, grounded understanding of the primary factors affecting application decisions, and how those interact. These insights are important to inform targets for interventions to reduce barriers to take-up of benefits among potentially eligible adults with disabilities., Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level., Methods: The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation., Discussion: The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts., Trial Registration: ClinicalTrials.gov NCT06171737. Registered on December 15, 2023., Competing Interests: Declarations. Ethics approval and consent to participate {24}: Ethical approval for the study will be provided by each site individually. The majority of sites approved waiver of written consent to participate in this minimal risk trial, and consent is implied by completion of the survey. Consent for publication {32}: At 6 sites, participants will receive an information sheet reviewing options, benefits, and risks of the trial and consent will be implied by return of the pre-visit survey. At one site, research staff will obtain written consent and at one site research staff will obtain and document verbal consent. Competing interests {28}: NL reports being a consultant for Edwards Lifesciences. CK reports a K23 from NHLBI (K23HL153892). CD reports paid consulting fees from Medtronic and Record Medical. EK reports receiving honoraria from Abbott, Boston Scientific, Edwards, and Medtronic. ND receives research support from the American Heart Association, NIH, AHRQ, and Merck and research funding and consulting for Abiomed. KS reports receiving funding for shared decision-making research from PCORI, AHRQ, and NIH, outside submitted work. KS developed the Shared Decision-Making Process scale (copyright Massachusetts General Hospital) that is being used as an outcome measure in the study. KV reports receiving support for shared decision-making research from PCORI and AHRQ outside submitted work and receiving research funding from Google LLC outside the submitted work. SE reports receiving research funding and consulting fees from Edwards Lifesciences and Medtronic. VT reports advising and research with Artivion, AtriCure, Boston Scientific, Abbott Vascular, CroiValve, Edwards Lifesciences, Medtronic, JenaValve, HighLife, Innovalve, and DASI Simulations. JM reports institutional grant support from the University of Colorado School of Medicine: Philips Medical Systems, Medtronic Corporation. SS reports travel sponsored by the ACC, Global Heart Hub, TCT, and Heart Valve Collaboratory and significant financial interests in Heart Valve Voice US. AN has received institutional research funding and speaker fees from Edwards Lifesciences, which is involved in products for the treatment of aortic stenosis. AB reports receiving honoraria for teaching a course at Edwards Lifesciences. DM, MC, YC, KG, NQ, and DK report no conflicts of interest., (© 2024. The Author(s).)

Problem: The high-value, midwifery-led birth centre (BC) model of care is underutilized in the United States, a country with high rates of obstetric intervention and maternal morbidity and mortality., Background: Birth setting decision-making is a complex, preference-sensitive, and resource-dependent process. Understanding how people choose BCs for care may help increase the utilization of BCs and generate positive perinatal outcomes., Aim: This study explores the decision-making experiences of people with Medicaid insurance who chose to give birth in a BC in Massachusetts by gathering interview data to interpret and provide meaning about their selection of birth setting., Methods: We employed a hermeneutic phenomenology study to interview people about their decision to give birth in a BC. Interview data were coded using a hybrid deductive-inductive approach and analyzed using reflexive thematic analysis to interpret and provide meaning., Findings: Twelve women participated in the study. Five themes emerged that described participants' decision-making processes: 1) Stepping Away from "the System," 2) Decision-Making with External Influences, 3) Accessing BC Care, 4) Finding a Home at the BC, and 5) Decision-Making as a Temporal Process., Discussion: The decision to choose a BC was a dynamic process that occurred over time and was influenced by factors such as the quality of care, accessibility, external influences, and the physical environment., Conclusion: Prioritizing an individual's capacity to choose their birth setting and fostering awareness about options in the context of informed decision-making are pivotal steps toward attaining equity in perinatal health. Securing public insurance coverage and equitable reimbursement for BCs represent essential policies aimed at facilitating universal access to the BC model for all people., Competing Interests: Declaration of competing interest We have no conflicts of interest to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control., (© 2024 Michigan Association for Infant Mental Health.)

While an increasing body of literature has assessed police response to intimate partner violence (IPV), a dearth of this research has examined police decision-making with formal reports of IPV among Latina immigrants. Using a LatCrit theoretical framework, the current study addressed this substantive gap through the systematic methods of the grounded theory approach to assess a sample of 36 police case files drawn from an agency located in one of the fifth most populous and diverse US cities. Results from the current study identified five themes related to shortcomings in police response to Latina immigrant IPV victims. The themes included cultural coercive control, language barriers, victim participation, case clearance efforts, and service provision. Policy implications and avenues for future research are discussed. [ABSTRACT FROM AUTHOR]

Solar power is now economically competitive with fossil fuels in many countries, yet relatively few homeowners have elected to install solar panels. A principal reason for this behavior stems from cognitive biases—such as myopia, inertia, and herding—that cause consumers to avoid investing in long-term measures, even those that are financially attractive to them and produce social benefits, such as reducing the long-term consequences of climate change. A behavioral risk audit can demonstrate ways to address these cognitive biases, in concert with short-term economic incentives, social influences and regulation to spark climate action now. We focus on the installation of solar panels and the additional use of solar energy, an issue that has global relevance. The behavioral risk audit offers a way to guide decisions on how to incentivize and accelerate diffusion of solar in the United States and offers lessons for other countries. Key policy insights Solar power is now economically competitive with fossil fuels in many countries, yet relatively few homeowners have installed solar panels on their property. Cognitive biases such as myopia, inertia, and herding cause consumers to avoid investing in long-term measures, such as solar panels, even if they are financially attractive. A behavioral risk audit that addresses biases in concert with short-term economic incentives, social influences and regulation encourages the adoption of solar panels. [ABSTRACT FROM AUTHOR]

Scholars of foreign policy decision-making have argued that international interactions ultimately are grounded in people acting singly or in groups. Unfortunately, data limitations prevent many of these crucial foreign policy decision-making theories from being rigorously tested and systematically compared with theories from alternative perspectives. A promising approach to remedying this deficiency is the addition of decision-making variables to existing, large- N data sets. In this study, we coded a series of foreign policy decision-making variables for all U.S. cases in the International Crisis Behavior (ICB) data set, and examined how these decision-making variables compared with structural factors in shaping crisis outcomes. The results reveal that when controlling for structural factors such as conflict setting and power discrepancy, foreign policy decision-making variables related to leaders' traits, advisory structure, and the political context shaped the severity and centrality of violence employed by the United States. We conclude that including decision-making variables alongside structural variables will enhance the quality of data analysis in the areas of conflict studies and foreign policy analysis. [ABSTRACT FROM AUTHOR]

Existing research suggests people with stronger moral character traits are more inclined to ethical investing. We take a moral foundations framing approach that synthesizes framing theory and moral foundations theory to investigate whether a moral state of mind created by moral foundations frames can also increase retail investors' ethical investment intention. We also hypothesize how this moral foundations framing effect is moderated by the perceived return performance of the ethical fund. We test our hypotheses through two online experiments with retail investors in the United States. Study 1 demonstrates that the moral foundations framing effect varies by moral foundation. Focusing on the Fairness foundation, Study 2 shows that the framing effect is stronger under the win-win dual objective condition, relative to a conflict of interest condition. This stronger effect indicates that the moral foundations framing effect appears to be more effective when the investor perceives that ethical investments are financially lucrative. Our study provides preliminary evidence for the potential of the moral foundations framing approach and contributes to scholarship in both business ethics and ethical investing. [ABSTRACT FROM AUTHOR]

The research is focused on the role of big data analytics in logistics of transportation in multinational companies across the world. It shows new opportunities for current supply chain practices, while adding operational excellence and value. A survey was carried out among staff members of multinational companies from the Americas, and Europe. For the statistical investigation of survey data, an equation modeling was used. Results reveal that demand management, seller rating, and vendor satisfaction are the most important factors. The study also found that analytics affect efficiency, operational excellence, customer service, and cost savings in the supply chain industry. The goal is to reduce the gap between demand management and supply chain management by improving customer satisfaction, visibility, and visibility. The big data can produce substantial value-added and monetary gains for companies and will quickly become common throughout the industry. [ABSTRACT FROM AUTHOR]

Introduction: With increasing restrictions on abortion across the United States, we sought to understand whether people seeking abortion would consider ending their pregnancy on their own if unable to access a facility-based abortion. Methods: From January to June 2019, we surveyed patients seeking abortion at 4 facilities in 3 US states. We explored consideration of self-managed abortion (SMA) using responses to the question: "Would you consider ending this pregnancy on your own if you are unable to obtain care at a health care facility?" We used multivariable Poisson regression to assess associations between individual sociodemographic, pregnancy and care-seeking characteristics and prevalence of considering SMA. In bivariate Poisson models, we also explored whether consideration of SMA differed by specific obstacles to abortion care. Results: One-third (34%) of 741 participants indicated they would definitely or probably consider ending the pregnancy on their own if unable to obtain care at a facility. Consideration of SMA was higher among those who reported no health insurance (adjusted prevalence ratio [aPR] = 1.66; 95% Confidence Interval [CI] 1.12–2.44), described the pregnancy as unintended (aPR = 1.53; 95% CI 1.08–2.16), were seeking abortion due to concerns about their own physical or mental health (aPR = 1.50, 95% CI 1.02, 2.20), or experienced obstacles that delayed their abortion care seeking (aPR = 2.26, 95% CI 1.49, 3.40). Compared to those who would not consider SMA, participants who would consider SMA expressed higher difficulty finding an abortion facility (35 vs. 27%, p = 0.019), figuring out how to get to the clinic (29 vs 21%, p = 0.021) and needing multiple clinic visits (23 vs 17%, p = 0.044). Conclusions.: One in three people seeking facility-based abortion would consider SMA if unable to obtain abortion care at a facility. As abortion access becomes increasingly restricted in the US, SMA may become more common. Future research should continue to monitor people's consideration and use of SMA and ensure that they have access to safe and effective methods. [ABSTRACT FROM AUTHOR]

Little is known about how parent health literacy contributes to health-related outcomes for children with autism. This mixed-methods study included 82 U.S. parents of a child with autism 2–5 years-old and sought to describe (1) health literacy dimensions, (2) how health literacy influences services use, and (3) health literacy improvement strategies. Results showed: autism information was accessed from multiple sources; understanding autism information involved "doing your own research"; autism information empowered decision-making; health literacy facilitated behavioral services use; health literacy influenced medication use; family and system characteristics also affected services use; autism education remains needed; services information is needed across the diagnostic odyssey; and greater scientific information accessibility would increase uptake. Findings demonstrate how parent health literacy affects services use. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the level of preparedness among Japanese American older adults for life's end by examining their knowledge, preferences, and arrangements for end-of-life issues. A total of 248 community dwelling Japanese Americans aged 50 and older participated in the study. The cross-sectional survey results indicated that participants believed they were well-informed about end-of-life issues and well-prepared for their lives' end. While most participants were in favor of making end-of-life arrangements, particularly with regard to making a will/living trust, creating an advance health care directive, appointing a health care agent, and funeral planning, relatively few favored life-prolonging treatment or planning for organ donation. They placed a high value on natural death and family-centered decision-making processes. These findings highlight the importance of awareness and cultural humility for social workers when providing culturally informed services at life's end to diverse Americans, including Japanese American older adults and their families. [ABSTRACT FROM AUTHOR]

Decision‐making is central to restoration practice, from the framing of objectives to the employment of tools and strategies. Yet, it remains largely unclear how decisions are made during restoration and this limits understanding of how restoration managers design and implement restoration projects and what restoration approaches may be most effective. This is true for tallgrass prairies in the Midwestern United States, which are commonly restored through seed sowing. To understand how managers make decisions during prairie restoration, we used a mixed‐methods approach including interviews, a focus group, and an online survey, to ask managers about: restoration objectives, factors influencing seed mix design, tools and resources used in seed mix design, seeding methods, and monitoring. Respondents considered biodiversity the most important restoration objective, and the most important biodiversity measures were species richness and functional group diversity. Seed mix design was influenced by seed availability. We identified 141 taxa that managers would like to use in restoration, but cannot due to factors like cost, availability, or problems with germination or establishment. Managers most frequently used their own experience and consultation with other practitioners to guide seed mix design; and commonly used tools developed within their organization. Most managers agreed that monitoring was important for assessing restoration outcomes, but were unable to devote enough time to monitoring. These findings illustrate opportunities for partnerships, among restoration managers, and among managers, seed producers, and researchers. [ABSTRACT FROM AUTHOR]

An experiment examined decision-making processes among nonclinical participants with low or high levels of OCD symptomatology (N = 303). To better simulate the decision environments that are most likely to be problematic for clients with OCD, we employed decision tasks that incorporated "black swan" options that have a very low probability but involve substantial loss. When faced with a choice between a safer option that involved no risk of loss or a riskier alternative with a very low probability of substantial loss, most participants chose the safer option regardless of OCD symptom level. However, when faced with choices between options that had similar expected values to the previous choices, but where each option had some low risk of a substantial loss, there was a significant shift towards riskier decisions. These effects were stronger when the task involved a contamination based, health-relevant decision task as compared to one with financial outcomes. The results suggest that both low and high symptom OC participants approach decisions involving risk-free options and decisions involving risky alternatives in qualitatively different ways. There was some evidence that measures of impulsivity were better predictors of the shift to risky decision making than OCD symptomatology. [ABSTRACT FROM AUTHOR]