Instructions for think-aloud verbalizations may vary in their effects on individuals. For example, any additional cognitive load caused by verbalization may be more detrimental to novice participants (residents) than expert participants (attendings), since experts are able to increase working memory capacity by employing schemas developed via expertise (Kalyuga, Ayres, Chandler, & Sweller, 2003; Paas, Renkl, & Sweller, 2003). However, there is some evidence supporting that verbal protocol studies change the nature of cognitive processes only in the case of Level 3 verbalizations (Ericsson & Simon, 1993), in which participants must reflect when prompted (see Bannert & Mengelkamp, 2008, for a review). Decision-makingstyle. The discussion will now turn to the second variable, decision- makingstyle, describing both the general theory and its application in clinical contexts. Klein (1999) has proposed that individuals making decisions in their domain of expertise often utilize recognition-primed decision-making based on automatic processing and retrieval of past knowledge. This type of decision-making appears to rely primarily on System 1 pro- cesses, as discussed in dual-process models of cognition (see Evans, 2008, for a review). System 1 is characterized by its automatic, rapid, and unconscious nature; System 2, in contrast, is a controlled, slow, and conscious mode of thought (Evans, 2003; Kahneman & Frederick, 2002; Stanovich & West, 2000).
The dual process model (Evans, 2008) posits two types of decision-making, which may be ordered on a continuum from intuitive to analytical (Hammond, 1981). This work uses a dataset of nar- rated image-based clinical reasoning, col- lected from physicians as they diagnosed dermatological cases presented as images. Two annotators with training in cognitive psychology assigned each narrative a rat- ing on a four-point decision scale, from in- tuitive to analytical. This work discusses the annotation study, and makes contribu- tions for resource creation methodology and analysis in the clinical domain. 1 Introduction
This chapter attempts to demonstrate three main points: 1) the pre- and early-Islamic literary genres, while often providing the content of Ibn Ishaq’s Sira, do not by themselves adequately explain Ibn Ishaq’s choice of a sustained narrative; 2) the Biblical stories or texts with which Ibn Ishaq was familiar influenced his writing style; and 3) traces of Ibn Ishaq’s intent can be found in the Sira itself. The second point is vital because, as already discussed, narratives can help to shape and mold a tradition, Caliph al-Mansur knew and exploited literary genres to his benefit, and the Jewish and Christian communities present in the Abbasid Empire used narratives to help legitimize their own communities. However, looking to Biblical material for parallels in theme and style is a pointless endeavor if the non-Judeo-Christian, pre- or early- Islamic Arabic texts provided the same format and element of control as did the Biblical texts. Finally, if the thesis that Ibn Ishaq was attempting to control Muhammad’s image is correct, then there should be some evidence of this in the text itself. In this chapter, I will explore such
Decision 1. Study participants started with the first laptop and read scenario 1. This scenario described a 50 year-old patient who had high blood pressure, high cholesterol and diabetes who had recently been diag- nosed with atrial fibrillation. The patient’s symptoms were described. Two anticoagulant medications (dabi- gatran and warfarin) were presented, in a table with medication names, benefits, safety risks and clinical considerations such as blood and liver tests, frequency of dosing, and related dietary and activity restrictions. Study subjects were then advised to use the hearts like mine tool to conduct further research to evaluate the treatment options. When study participants indicated that they had sufficient information to select a treatment option, they were asked to complete a questionnaire that asked which medication they chose followed by 4 ques- tions regarding the participant’s confidence and ability to make the decision using a 4 point Likert-type scale with strongly agree scored as 4 and strongly disagree scored as 1. In the narrative condition, participants were asked to answer one additional question regarding the usefulness of the stories for decision-making (answered with the same Likert-type scale).
Results: The results of MANOVA indicated that there are significant differences between the decision-makingstyle of GIU and counselor clergymen and GWU in expediency, individuality and collectivity. It can be said that the decisionmakingstyle of the GWU in compared with the opponents in the two others group were more individualistic and less expedient.
I expected that members of this group, or other individuals from interracial families or couples would engage in this kind of border patrolling, or the kind I call “protective border patrolling.” Instead, I found little evidence to support this style of borderism, at least among strangers, with regards to mixed race individuals and partner choice. Protective border patrolling reflects a “been there, done that” perspective, in which people with firsthand or intimate knowledge of interracial relationships (familial or romantic) seek to protect others from strangers’ borderism. They may feel entitled or socially obligated to warn others about the hurdles or inconveniences of being in an interracial couple or family. They may not recognize the multiracial respondent as an existing member of an interracial family, volunteering advice and cautionary tales as a dissuasion. With the generally neutral intention to encourage such individuals to fully contemplate the social costs or consequences of being in an interracial relationship, protective border patrollers operate in more caring ways, as they want to shield interracial couples from malevolent border patrolling, a topic I turn to next.
The second author led the study’s interdisciplinary research team, and the fourth author was a member of the project advi- sory group. The first author is a psychiatrist who has previously worked in the Victorian healthcare system. Interviews were conducted by non-clinical qualitative researchers employed on the study under the supervision of the second author. In the first section participants were asked to provide an account of their experiences of being diagnosed and living with a mental illness, or of supporting a diagnosed family member. In the second section participants were prompted to speak about a range of research-related themes. Themes included diagnosis, hospi- talisation, involuntary and voluntary treatments, experiences of making decisions about treatment, or supporting others to make decisions and ideas about recovery. The combination of an unstructured ‘your story’ component and a clarifying section allowed us to identify congruities and divergences in how concepts such as self, agency and illness appeared in different contexts. 19
Besides linguistic features, three additional groups of features were included, with an eye towards application. Demographic features were gender and professional status, while cognitive features were physician confidence in diagnosis and correctness of the final diagnosis. Difficulty features consisted of an expert-assigned rank of diagnostic case difficulty, and the percent of correct diagnoses given by physicians for each image, calculated on the development data only. In an instructional system, a trainee could input a demographic profile, and the system could also collect performance data over time, while also taking into account stored information on case difficulty when available. This information could then be used in modeling of decisionstyle in spoken or written diagnostic narratives.
of consciousness. Joyce finds his narrative voice in A Portrait, and this narrative voice brings focus to the character’s soul, his present and his past all combined into one cohesive perspective. For example, in Dubliners, the narrator focalizes on Mr. Duffy in “A Painful Case,” and at the end of the story, the narrator reveals his thoughts: “He waited for some minutes listening. He could hear nothing: the night was perfectly silent. He listened again: perfectly silent. He felt that he was alone” (114). Although the reader knows Mr. Duffy’s thoughts, a distance in the point of view exists in Dubliners that does not exist in A Portrait. In A Portrait, the narrator intimately explains Stephen’s innermost thoughts: “With a sudden moment she bowed his head and joined her lips to his and he read the meaning of her movements in her frank uplifted eyes. It was too much for him. He closed his eyes, surrendering himself to her, body and mind, conscious of nothing in the world but the dark pressure of their softly parting lips” (108). Joyce lifts the distance by the time he writes the novel. Benstock asserts, “Mr. Duffy’s predicament is diagnostic of the frustrated, untold tales that the Joycean narrative tells in Dubliners, in sharp contradistinction to the constant packaging of personal narratives that are the property and hallmark of Stephen Dedalus in A Portrait of the Artist as a Young Man” (559). While Joyce intimately reveals the consciousness of Stephen Dedalus in A Portrait, “Dubliners is a reality without consciousness” (Malamud 135). Therefore, in a comparison of the structure and point of view of the two texts, Joyce’s transition becomes apparent. He commits to the soul of his
office. 48 There were some clear advantages to strengthening the education division; according to OMB it would repair ―overdue‖ management improvements, maintain coordination with social services, and would not disrupt any other departments. The disadvantages, though few, were substantial. Strengthening education in HEW meant disappointing and antagonizing ―the NEA and other elementary and secondary education groups that strongly support cabinet-level status for education.‖ It would also do nothing to change the number of programs that were placing heavy demands on coordination and policy development in HEW. 49 The final recommendation of OMB was for the President to support a broad department; it ranked a strengthened division of education and a narrow department second and third respectively. The recommendation read: ―Indicate preference for a new department including education and other human development activities,‖ with the stipulation that the President, ―defer a final decision on the three structural options but note that the broad department seems very promising in view of the challenges associated with education.‖ 50
In the present study, the type of setting where participants were assessed was a blend of outpatient care and specialty clinics. Because these two settings differ substantially, there is no clear choice for the best starting base rate (i.e., there are no published data about recommended starting base rates for blended settings). We do know that a base rate of 6% is currently recommended for outpatient settings (Geller et al., 2002; Youngstrom et al., 2005) and that a base rate between 15 and 17% is recommended for specialty outpatient services (Biederman et al., 1996). Taking into account prevalence estimates found in the literature and base rate information for the present sample which was approximately 18%, a starting base rate of 12% was agreed upon for the present project. This process is an example of making an educated guess based on the literature and any specific information one can obtain from his/her clinical setting. Future studies should investigate base rates for blended settings as it represents an important consideration in using the nomogram or any actuarial assessment methodologies.
Efficacious decision-making relies heavily on what nurses know about a patient, the nurse’s ability to engage a patient in discussion about his/her needs, and the nurse’s ability to engage others 6,26,42 . For these participants, the ability to engage others was especially crucial and well demonstrated. They verbalized and demonstrated during observations the exchange of information between several health care disciplines, not just senior nurses with whom they worked. Although participants in this study demonstrated being at a point of knowing 10 as they paid attention to cues gathered from the patient, such as vital signs, and cues from their own intuition (eg 'he didn’t look right'), these nurses still recounted the necessity to engage others, including their directors of nursing. When they did so, there was not clear evidence that reflection on EBP was taking place; rather, the novice nurses verbalized relying on co-workers’ opinions and judgments.
There are 5 styles of decision-making, i.e. rational, intuitive, dependent, spontaneous, and avoidant styles. In the rational decisionmakingstyle, a person is aware of all the solutions and knows the outcome of each decision and can arrange and organize the results of decisionmaking in terms of prior- ity (maximum benefit). Intuitive decisionmakingstyle is the process of subconscious decisionmaking, which is the result of gathered experiences. In the dependent decisionmakingstyle, decision maker relies on the beliefs of others and has a passive role. Spontaneous decisionmakingstyle suggests urgent conditions under which a person makes an immediate decision within minimum time without premeditation. In the avoidant decisionmaking process, decision maker tends to avoid making any decisions as much as possible (Hadiza- deh Moghaddam & Tehrani 2009).
Several forces have contributed to the resistance to change from traditional approaches. Part of the resistance came from the healthcare providers, accustomed to functioning independently relying on their own clinical judgementand seldom depending on protocols based on big data. The other problems stemmed from the nature of the healthcare system. Under-investment in information technology by a majority of healthcare stakeholders resulted in use of older information systems, possessing limited ability in standardizing and consolidating data. Concern for privacy also created challenges in easy sharing of data among different providers or facilities. Lack of procedures for integrating data or communicating findings in a single hospital or pharmaceutical company often resulted in important information remaining soiled within a department of group.(1)
Ethics requires a critical evaluation of assumptions and arguments about norms and values; what should be done and what should not. Practitioners should practice ethically, and the professions should be at the forefront of applied ethics. There are four principles, patient autonomy, beneficence, non-maleficence and justice, which are guides to ethical day- to-day practice. Patient autonomy: autonomy means self-rule by persons of their thoughts and actions. Patient auton- omy requires the practitioner to realise that patients have the right to be involved in decision-making on their own be- half. Beneficence refers to the duty of the practitioner to do the best for the patient. The benefits of breast-feeding are many, and the eventual outcome on health enormous. Nevertheless, health-care workers are diffident in promoting breast-feeding, and readily accept excuses for not breast-feeding, contrary to the principle of beneficence. Non- maleficence refers to the duty of the practitioner not to do harm; it requires the practitioner to withhold harmful thera- pies; Vitamin E, for example, has been proven to be ineffective as an antioxidant in humans, and large doses have been proven to increase mortality. Yet these are the doses available in supermarkets and “Health shops”. Nutritionists should actively advise against harmful “dietary supplementation”. Distributive justice requires every patient to have an equal opportunity to obtain appropriate therapy. There are relatively few nutritionists and dieticians in South Africa, and indeed in the entire African continent, but proportionately even fewer in the areas of greatest need. A case illustrates the application of these ethical principles to show how they can be applied to our daily practice. Using these four prin- ciples is a practical approach to solving ethical dilemmas.
athletes to perform at the highest level possible. This is done by making the winnings of the top performer notably higher than for athletes that finish in sixth or seventh place, and far greater than the winnings of the people whose performance leaves them in the middle of the pack. Relating this framework to the business environment, Tournament theory suggests that the level of compensation received by executives/upper management in large firms is used to motivate employees at lower levels to aspire to be promoted to such a position. By making the reward for being promoted very high, firms are able to create a competitive environment that motivates young managers to work very hard in hopes of being chosen for promotion. This leads to higher firm performance as the firm receives a higher level of output from all the young managers who are vying for the promotion, but only has to reward a few of them in the future with costly executive compensation packages (Neilson 2007).
I wish to express my sincere gratitude to my research advisor, Dr. Keith O. Pascoe, for his guidance during the course of this project. I would also like to thank the members of my committee, Dr. Davon Kennedy, Dr. Alfons Baumstark, and Dr. Jerry Smith for their time and cooperation. I would like to extend my gratitude to my laboratory colleague, Maria Nagy, for her guidance throughout the project. I would also like to thank the Chemistry Department for making such a tight knit network, which truly makes it a joy to come to school. I would like to extend my personal appreciation to Dr. Alfons Baumstark, for the encouragement, advice, support, and assigning loads of homework, which kept me busy every night.