Creating accessibility in academic negotiations.

The process of evaluating and negotiating a tenure-track job offer is unstructured and highly variable, making it susceptible to bias and inequitable outcomes. We outline common aspects of and recommendations for negotiating an academic job offer in the life sciences to support equitable recruitment of diverse faculty.

Hippo signaling does it again: arbitrating cardiac fibroblast identity and activation.

The Hippo pathway is an evolutionarily conserved kinase cascade that is fundamental for tissue development, homeostasis, and regeneration. In the developing mammalian heart, Hippo signaling regulates cardiomyocyte numbers and organ size. While cardiomyocytes in the adult heart are largely postmitotic, Hippo deficiency can increase proliferation of these cells and affect cardiac regenerative capacity. Recent studies have also shown that resident cardiac fibroblasts play a critical role in disease responsiveness and healing, and in this issue of Genes and Development, Xiao and colleagues (pp. 1491-1505) demonstrate that Hippo signaling also integrates the activity of fibroblasts in the heart. They show that Hippo signaling normally maintains the cardiac fibroblast in a resting state and, conversely, its inactivation during disease-related stress results in a spontaneous transition toward a myofibroblast state that underlies fibrosis and ventricular remodeling. This phenotypic switch is associated with increased cytokine signaling that promotes nonautonomous resident fibroblast and myeloid cell activation.

Learning rules of engagement for social exchange within and between groups.

Globalizing economies and long-distance trade rely on individuals from different cultural groups to negotiate agreement on what to give and take. In such settings, individuals often lack insight into what interaction partners deem fair and appropriate, potentially seeding misunderstandings, frustration, and conflict. Here, we examine how individuals decipher distinct rules of engagement and adapt their behavior to reach agreements with partners from other cultural groups. Modeling individuals as Bayesian learners with inequality aversion reveals that individuals, in repeated ultimatum bargaining with responders sampled from different groups, can be more generous than needed. While this allows them to reach agreements, it also gives rise to biased beliefs about what is required to reach agreement with members from distinct groups. Preregistered behavioral (N = 420) and neuroimaging experiments (N = 49) support model predictions: Seeking equitable agreements can lead to overly generous behavior toward partners from different groups alongside incorrect beliefs about prevailing norms of what is appropriate in groups and cultures other than one's own.

Understanding the first-offer conundrum: How buyer offers impact sale price and impasse risk in 26 million eBay negotiations.

How low is the ideal first offer? Prior to any negotiation, decision-makers must balance a crucial tradeoff between two opposing effects. While lower first offers benefit buyers by anchoring the price in their favor, an overly ambitious offer increases the impasse risk, thus potentially precluding an agreement altogether. Past research with simulated laboratory or classroom exercises has demonstrated either a first offer's anchoring benefits or its impasse risk detriments, while largely ignoring the other effect. In short, there is no empirical answer to the conundrum of how low an ideal first offer should be. Our results from over 26 million incentivized real-world negotiations on eBay document (a) a linear anchoring effect of buyer offers on sales price, (b) a nonlinear, quartic effect on impasse risk, and (c) specific offer values with particularly low impasse risks but high anchoring benefits. Integrating these findings suggests that the ideal buyer offer lies at 80% of the seller's list price across all products-although this value ranges from 33% to 95% depending on the type of product, demand, and buyers' weighting of price versus impasse risk. We empirically amend the well-known midpoint bias, the assumption that buyer and seller eventually meet in the middle of their opening offers, and find evidence for a "buyer bias." Product demand moderates the (non)linear effects, the ideal buyer offer, and the buyer bias. Finally, we apply machine learning analyses to predict impasses and present a website with customizable first-offer advice configured to different products, prices, and buyers' risk preferences.

Spiritual over physical formidability determines willingness to fight and sacrifice through loyalty in cross-cultural populations.

Across 11 studies involving six countries from four continents (n = 3,285), we extend insights from field investigations in conflict zones to offline and online surveys to show that personal spiritual formidability-the conviction and immaterial resources (values, strengths of beliefs, character) of a person to fight-is positively associated with the will to fight and sacrifice for others. The physical formidability of groups in conflict has long been promoted as the primary factor in human decisions to fight or flee in times of conflict. Here, studies in Spain, Iraq, Lebanon, Palestine, and Morocco reveal that personal spiritual formidability, a construct distinct from religiosity, is more strongly associated with the willingness to fight and make costly self-sacrifices for the group than physical formidability. A follow-on study among cadets of the US Air Force Academy further indicates that this effect is mediated by a stronger loyalty to the group, a finding replicated in a separate study with a European sample. The results demonstrate that personal spiritual formidability is a primary determinant of the will to fight across cultures, and this individual-level factor, propelled by loyal bonds made with others, disposes citizens and combatants to fight at great personal risk.

Neuromechanical Strategies for Obstacle Negotiation during Overground Locomotion following Incomplete Spinal Cord Injury in Adult Cats.

Following incomplete spinal cord injury in animals, including humans, substantial locomotor recovery can occur. However, functional aspects of locomotion, such as negotiating obstacles, remains challenging. We collected kinematic and electromyography data in 10 adult cats (5 males, 5 females) before and at weeks 1-2 and 7-8 after a lateral mid-thoracic hemisection on the right side of the cord while they negotiated obstacles of three different heights. Intact cats always cleared obstacles without contact. At weeks 1-2 after hemisection, the ipsilesional right hindlimb contacted obstacles in ∼50% of trials, triggering a stumbling corrective reaction or absent responses, which we termed Other. When complete clearance occurred, we observed exaggerated ipsilesional hindlimb flexion when crossing the obstacle with contralesional Left limbs leading. At weeks 7-8 after hemisection, the proportion of complete clearance increased, Other responses decreased, and stumbling corrective reactions remained relatively unchanged. We found redistribution of weight support after hemisection, with reduced diagonal supports and increased homolateral supports, particularly on the left contralesional side. The main neural strategy for complete clearance in intact cats consisted of increased knee flexor activation. After hemisection, ipsilesional knee flexor activation remained, but it was insufficient or more variable as the limb approached the obstacle. Intact cats also increased their speed when stepping over an obstacle, an increase that disappeared after hemisection. The increase in complete clearance over time after hemisection paralleled the recovery of muscle activation patterns or new strategies. Our results suggest partial recovery of anticipatory control through neuroplastic changes in the locomotor control system.SIGNIFICANCE STATEMENT Most spinal cord injuries (SCIs) are incomplete and people can recover some walking functions. However, the main challenge for people with SCIs that do recover a high level of function is to produce a gait that can adjust to everyday occurrences, such as turning, stepping over an obstacle, etc. Here, we use the cat model to answer two basic questions: How does an animal negotiate an obstacle after an incomplete SCI and why does it fail to safely clear it? We show that the inability to clear an obstacle is because of improper activation of muscles that flex the knee. Animals recover a certain amount of function thanks to new strategies and changes within the nervous system.

Price negotiation and pricing of anticancer drugs in China: An observational study.

BACKGROUND: While China has implemented reimbursement-linked drug price negotiation annually since 2017, emphasizing value-based pricing to achieve a value-based strategic purchase of medical insurance, whether drug prices became better aligned with clinical value after price negotiation has not been sufficiently established. This study aimed to assess the changes in prices and their relationship with the clinical value of anticancer drugs after the implementation of price negotiations in China. METHODS AND FINDINGS: In this observational study, anticancer drug indications that were negotiated successfully between 2017 and 2022 were identified through National Reimbursement Drug Lists (NRDL) of China. We excluded extensions of indications for drugs already listed in the NRDL, indications for pediatric use, and indications lacking corresponding clinical trials. We identified pivotal clinical trials for included indications by consulting review reports or drug labels issued by the Center for Drug Evaluation, National Medical Products Administration. We calculated treatment costs as outcome measures based on publicly available prices and collected data on clinical value including safety, survival, quality of life, and overall response rate (ORR) from publications of pivotal clinical trials. The associations between drug costs and clinical value, both before and after negotiation, were analyzed using regression analyses. We also examined whether price negotiation has led to a reduction in the variation of treatment costs for a given value. We included 103 anticancer drug indications, primarily for the treatment of blood cancer, lung cancer, and breast cancer, with 76 supported by randomized controlled trials and 27 supported by single-arm clinical trials. The median treatment costs over the entire sample have been reduced from US$34,460.72 (interquartile range (IQR): 19,990.49 to 55,441.66) to US$13,688.79 (IQR: 7,746.97 to 21,750.97) after price negotiation (P < 0.001). Before price negotiation, each additional month of survival gained was associated with an increase in treatment costs of 3.4% (95% confidence interval (CI) [2.1, 4.8], P < 0.001) for indications supported by randomized controlled trials, and a 10% increase in ORR was associated with a 6.0% (95% CI [1.6, 10.3], P = 0.009) increase in treatment costs for indications supported by single-arm clinical trials. After price negotiation, the associations between costs and clinical value may not have changed significantly, but the variation of drug costs for a given value was reduced. Study limitations include the lack of transparency in official data, missing data on clinical value, and a limited sample size. CONCLUSIONS: In this study, we found that the implementation of price negotiation in China has led to drug pricing better aligned with clinical value for anticancer drugs even after substantial price reductions. The achievements made in China could shed light on the price regulation in other countries, particularly those with limited resources and increasing drug expenditures.

Third-party arbitration and forgiving strategies increase cooperation when perception errors are common.

Humans cooperate in groups in which mutual monitoring is common, and this provides the possibility of third-party arbitration. Third-party arbitration stabilizes reciprocity in at least two ways: first, when it is accurate, it reduces the frequency of misunderstandings resulting from perception errors, and second, even when it is inaccurate, it provides a public signal that allows pairs to align their expectations about how to behave after errors occur. Here, we describe experiments that test for these two effects. We find that in an iterated, sequential Prisoner's Dilemma game with errors, players with the highest average payoffs are those who make use of third-party arbitration and who also employ forgiving strategies. The combination of these two behaviours reduces the detrimental effects of errors on reciprocity, resulting in more cooperation.

Can Generalized Cost-Effectiveness Analysis Leverage Meaningful Use of Novel Value Elements in Pharmacoeconomics to Inform Medicare Drug Price Negotiation?

OBJECTIVES: Decision makers considering using cost-effectiveness analysis (CEA) to inform health-technology assessment must contend with documented and controversial shortfalls of CEA, including its assumption of disease severity independence and static pricing. ISPOR has recently introduced novel value elements besides direct healthcare cost and effectiveness for the patient, and these should be captured in CEA. Although novel value elements advance our understanding of "what" should be measured (value of hope, severity of disease, health equity, etc), there is limited direction on "how" to measure them in conventional CEA. Furthermore, with Medicare empowered to set drug prices under the Inflation Reduction Act, it is not clear what role CEA might have on where prices are set, given objections to the quality-adjusted life year in conventional approaches. METHODS: We critically reviewed the evidence for expanding conventional CEA methods to a more generalized approach of generalized CEA (GCEA). RESULTS: GCEA accounts for methods that address objections to the quality-adjusted life year and incorporate novel value elements. Although GCEA offers advantages, it also requires further research to develop "off-the-shelf" resources to help inform, for example, maximum fair price in the context of Medicare drug price negotiation. CONCLUSIONS: Should a shift toward GCEA reveal that the societal value of novel medicines exceeds their market-based costs, which will raise the key question of what market failure Medicare negotiation is meant to solve, if any, and therefore what the appropriate role of such negotiation might be to maximize the value society might garner from the development of novel medicines.

Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study.

Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.

Financial Viability of the No Surprises Act Independent Dispute Resolution Process: Radiology and Other Hospital-Based Specialties.

BACKGROUND. The federal No Surprises Act (NSA), designed to eliminate surprise medical billing for out-of-network (OON) care for circumstances beyond patients' control, established the independent dispute resolution (IDR) process to settle clinician-payer payment disputes for OON care. OBJECTIVE. The purpose of our study was to assess the fraction of OON claims for which radiologists and other hospital-based specialists can expect to at least break even when challenging payer-determined payments through the NSA IDR process, as a measure of the process's financial viability. METHODS. This retrospective study extracted claims from a national commercial database (Optum's deidentified Clinformatics Data Mart) for hospital-based specialties occurring on the same day as in-network emergency department (ED) visits or inpatient stays from January 2017 to December 2021. OON claims were identified. OON claims batching was simulated using IDR rules. Maximum potential recovered payments from the IDR process were estimated as the difference between the charges and the allowed amount. The percentages of claims for which the maximum potential payment and one-quarter of this amount (a more realistic payment recovery estimate) would exceed IDR fees were determined, using US$150 and US$450 fee thresholds to approximate the range of final 2024 IDR fees. These values represented the percentage of OON claims that would be financially viable candidates for IDR submission. RESULTS. Among 76,221,264 claims for hospital-based specialties associated with in-network ED visits or inpatient stays, 1,482,973 (1.9%) were OON. The maximum potential payment exceeded fee thresholds of US$150 and US$450 for 55.0% and 32.1%, respectively, of batched OON claims for radiologists and 76.8% and 61.3% of batched OON claims for all other hospital-based specialties combined. At payment of one-quarter of that amount, these values were 26.9% and 10.6%, respectively, for radiologists and 56.6% and 38.4% for all other hospital-based specialties combined. CONCLUSION. The IDR process would be financially unviable for a substantial fraction of OON claims for hospital-based specialists (more so for radiology than for other such specialties). CLINICAL IMPACT. Although the NSA enacted important patient protections, IDR fees limit clinicians' opportunities to dispute payer-determined payments and potentially undermine their bargaining power in contract negotiations. Therefore, IDR rulemaking may negatively impact patient access to in-network care.

Embracing Complexity: A Review of Negotiation Research.

In this review, we identify emerging trends in negotiation scholarship that embrace complexity, finding moderators of effects that were initially described as monolithic, examining the nuances of social interaction, and studying negotiation as it occurs in the real world. We also identify areas in which research is lacking and call for scholarship that offers practical advice. All told, the existing research highlights negotiation as an exciting context for examining human behavior, characterized by features such as strong emotions, an intriguing blend of cooperation and competition, the presence of fundamental issues such as power and group identity, and outcomes that deeply affect the trajectory of people's personal and professional lives.

Self-concept mediates the relationships between childhood traumatic experiences and adolescent depression in both clinical and community samples.

BACKGROUND: Childhood trauma is a pivotal risk factor for adolescent depression. While the association between childhood trauma and depression is well-established, the mediating role of self-concept has not been acknowledged. Specifically, limited attention has been paid to how childhood maltreatment impacts adolescent depression through physical and social self-concept, both in clinical and community samples. This study aims to investigate how distinct and cumulative childhood trauma affects adolescent depression, as well as the potential mediating role of self-concept in their relationships. METHODS: We recruited 227 depressed adolescents (dataset 1, 45 males, age = 15.34 ± 1.96) and 574 community adolescents (dataset 2, 107 males, age = 16.79 ± 0.65). Each participant was assessed on five subtypes of childhood trauma severity, cumulative trauma index, physical and social self-concept, and depression. Mediation models were tested separately in the clinical and community samples. RESULTS: Clinically depressed adolescents experienced a higher level of trauma severity, a greater number of trauma subtypes, and had lower levels of physical and social self-concept compared to community adolescents. Analyses on childhood trauma severity and cumulative trauma index jointly indicated that physical and social self-concept played mediation roles in the relationships between childhood trauma experiences and depression. Moreover, the mediating effects of self-concept were stronger in depressed adolescents when compared to community samples. CONCLUSIONS: Our findings suggest that physical and social self-concept play mediating roles in the pathway linking childhood trauma and adolescent depression, particularly in clinically depressed individuals.

Negotiating Work and Family Spheres: The Dyadic Effects of Flexible Work Arrangements on Fertility Among Dual-Earner Heterosexual Couples.

Academics and policymakers have suggested making flexible work arrangements (FWAs) the default in workplaces to promote a family-friendly workplace culture conducive to having and raising children. However, systematic research investigating how FWAs, as a long-term approach to negotiating work-family spheres, are related to fertility among dual-earner heterosexual couples is limited. Drawing on the linked-lives perspective, we theorize the relationship between FWAs and fertility among couples and potential variation depending on the interplay of both spouses' work and family characteristics. We test our hypotheses using longitudinal couple-level dyadic data in the United Kingdom (2010-2022). We find that although FWA availability alone is unrelated to fertility, wives' (not husbands') FWA use is significantly associated with a higher probability of experiencing a first birth. Moreover, the effect of wives' FWA use is particularly pronounced when both spouses work in professional and managerial occupations and when husbands contribute a larger proportion of income and at least equal housework. This study reveals a gendered effect of FWAs on fertility across work-family arrangements, deepening our understanding of couple-level dynamics in the fertility process.

'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education.

INTRODUCTION: Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. METHODS: Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. FINDINGS: Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. DISCUSSION: The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.

The die-hards, negotiators and migrants: Portraits of doctors' career pathways through specialisation.

INTRODUCTION: Global workforce shortages in medical specialties strain healthcare systems, jeopardising patient outcomes. Enhancing recruitment strategies by supporting professional identity (PI) development may be one way to address this workforce gap-yet little research has explored this topic. The goal of the current study was to explore specialty-specific recruitment through considering PI. As proposed causes of workforce shortages in anatomical pathology (AP) bear similarities to many other specialties, this study uses the field of AP as a model for specialist PI development and asks: (1) why, how and when do doctors choose to pursue AP training and (2) what can be learned from this for recruitment to AP and other specialties? METHODS: A qualitative research approach was undertaken using narrative inquiry. Interviews with junior doctors interested in AP, AP registrars and AP consultants from Australia and New Zealand were interpreted as stories via 're-storying'. Narrative synthesis of participants' collective stories identified chronological key events (i.e. 'turning points') in choosing AP. RESULTS: Narrative synthesis resulted in identification of three portraits entering medical specialist training: (1) die-hards, deciding upon initial exposure; (2) negotiators, choosing after comparing specialties; and (3) migrants, seeking to move away from non-pathology specialties. The negotiators and migrants cemented their decision to pursue AP as a postgraduate doctor, whereas the die-hards made this decision during medical school. CONCLUSIONS: Given the similarities in portrait traits between AP and other specialties across the literature, our results suggest ways to support specialty recruitment using PI development. We propose a medical specialist recruitment framework to support the PI development of doctors with die-hard, negotiator and migrant traits. Use of this framework could enhance current specialty-specific recruitment approaches, particularly in fields challenged by workforce shortages.

'False hope' in assisted reproduction: the normative significance of the external outlook and moral negotiation.

Despite the frequent invocation of 'false hope' and possible related moral concerns in the context of assisted reproduction technologies, a focused ethical and conceptual problematisation of this concept seems to be lacking. We argue that an invocation of 'false hope' only makes sense if the fulfilment of a desired outcome (eg, a successful fertility treatment) is impossible, and if it is attributed from an external perspective. The evaluation incurred by this third party may foreclose a given perspective from being an object of hope. However, this evaluation is not a mere statistical calculation or observation based on probabilities but is dependent on several factors that should be acknowledgeable as morally relevant. This is important because it allows room for, and encourages, reasoned disagreement and moral negotiation. Accordingly, the object of hope itself, whether or not based on socially embedded desires or practices, can be a topic of debate.