Patient versus physician preferences for lipid-lowering drug therapy: A discrete choice experiment.

BACKGROUND: The emergence of proprotein convertase subtilisin/kexin type 9 inhibitors offered dyslipidemia patients an alternative to statins for lipid-lowering treatment. Understanding patient and physician preferences for lipid-lowering drugs may promote shared decision-making and improve treatment outcomes. METHODS: This study utilized an online discrete choice experiment (DCE) to assess the relative importance (RI) of six attributes related to lipid-lowering drugs, including frequency of administration, mode of administration, reduction of low-density lipoprotein cholesterol (LDL-C) level, risk of myopathy, risk of liver damage, and out-of-pocket monthly cost. Respondents were recruited from dyslipidemia patients and cardiovascular physicians in China. A mixed logit model and latent class analysis were employed to estimate the preference coefficient, marginal willingness to pay (mWTP), and RI of attributes. Ethical approval has been obtained for this study. RESULTS: A total of 708 patients and 507 physicians participated in the survey. Patients prioritized the 'risk of liver damage' (RI = 23.6%) with 'mode of administration' (RI = 19.2%) and 'frequency of administration' (RI = 18.8%) following closely. Contrarily, physicians prioritized the 'reduction of LDL-C level' (RI = 33.5%), followed by 'risk of liver damage' (RI = 26.0%) and 'risk of myopathy' (RI = 16.1%). Patients placed a higher value on 'frequency of administration' (p < .001) and 'mode of administration' (p < .001) compared to physicians, while physicians valued 'reduction of LDL-C level' (p < .001) and 'risk of myopathy' (p = .012) more than patients. Physicians exhibited higher mWTP than patients for all attributes except frequency and mode of administration. The LCA revealed three distinct patient classes: focus on oral administration, focus on hepatic safety and frequency and focus on hepatic safety and cost. Likewise, three physician classes were identified: frequency-insensitive, efficacy-focused and safety-focused. CONCLUSIONS: The preferences for lipid-lowering drug therapy differed between patients and physicians in China. Physicians should take into account patients' preferences and provide personalized treatment when they formulate lipid-lowering treatment plans. PATIENT OR PUBLIC CONTRIBUTION: Patients participated in the questionnaire design process. They engaged in a focus group discussion to determine attributes and levels and also participated in a pilot survey to assess the comprehensibility of the questionnaires. Additionally, patients were involved in the DCE survey to express their preferences. The findings of patient preference for lipid-lowering drug therapy will promote shared decision-making and optimize the treatment regimen.

Differences in Discounting Behavior and Brain Responses for Food and Money Reward.

Most neuroeconomic research seeks to understand how value influences decision-making. The influence of reward type is less well understood. We used functional magnetic resonance imaging (fMRI) to investigate delay discounting of primary (i.e., food) and secondary rewards (i.e., money) in 28 healthy, normal-weighted participants (mean age = 26.77; 18 females). To decipher differences in discounting behavior between reward types, we compared how well-different option-based statistical models (exponential, hyperbolic discounting) and attribute-wise heuristic choice models (intertemporal choice heuristic, dual reasoning and implicit framework theory, trade-off model) captured the reward-specific discounting behavior. Contrary to our hypothesis of different strategies for different rewards, we observed comparable discounting behavior for money and food (i.e., exponential discounting). Higher k values for food discounting suggest that individuals decide more impulsive if confronted with food. The fMRI revealed that money discounting was associated with enhanced activity in the right dorsolateral prefrontal cortex, involved in executive control; the right dorsal striatum, associated with reward processing; and the left hippocampus, involved in memory encoding/retrieval. Food discounting, instead, was associated with higher activity in the left temporoparietal junction suggesting social reinforcement of food decisions. Although our findings do not confirm our hypothesis of different discounting strategies for different reward types, they are in line with the notion that reward types have a significant influence on impulsivity with primary rewards leading to more impulsive choices.

Attribute latencies causally shape intertemporal decisions.

Intertemporal choices - decisions that play out over time - pervade our life. Thus, how people make intertemporal choices is a fundamental question. Here, we investigate the role of attribute latency (the time between when people start to process different attributes) in shaping intertemporal preferences using five experiments with choices between smaller-sooner and larger-later rewards. In the first experiment, we identify attribute latencies using mouse-trajectories and find that they predict individual differences in choices, response times, and changes across time constraints. In the other four experiments we test the causal link from attribute latencies to choice, staggering the display of the attributes. This changes attribute latencies and intertemporal preferences. Displaying the amount information first makes people more patient, while displaying time information first does the opposite. These findings highlight the importance of intra-choice dynamics in shaping intertemporal choices and suggest that manipulating attribute latency may be a useful technique for nudging.

Gamification and motivation: Impact on delay discounting performance.

Delay discounting is a phenomenon strongly associated with impulsivity. However, in order for a measured discounting rate in an experiment to meaningfully generalize to choices made elsewhere in life, participants must provide thoughtful, engaged answers during the assessment. Classic discounting tasks may not optimize intrinsic motivation or enjoyment, and a participant who is disengaged from the task is likely to behave in a way that provides a biased estimate of their discounting function. We assessed degree of delay discounting in a task intended to vary level of participant motivation. This was accomplished by introducing varying levels of gamification, the application of game design principles to a non-game context. Experiment 1 compared three versions of the delay discounting task with differing degrees of gamification and compared performance and task enjoyment across those variations, while Experiment 2 used two conditions (one gamified, one not). Participants found more gamified versions of the task more enjoyable than the other conditions, without producing substantial between-group differences in most cases. Thus, more polished task gameplay can provide a more enjoyable experience for participants without undermining delay discounting effects commonly reported in the literature. We also found that in all experimental conditions, higher levels of interest in or enjoyment of the task tended to be associated with more rapid discounting. This may suggest that low task motivation may result in less impulsive choice and suggests that participants who find delay discounting experiments sufficiently boring may bias assessments of value across delays.

Food and beverage selection in children's sports arenas in Norway: a cross-sectional study.

OBJECTIVE: To assess the selection of foods and beverages in children's sports arenas in Norway. DESIGN: A cross-sectional study design with a digital questionnaire was used. Descriptive statistics were used to present the results. Moreover, Pearson's χ2 tests examined the factors that could aid in distinguishing clubs with healthy or unhealthy consumables. SETTING: Children's sports clubs in Norway. PARTICIPANTS: Representatives from 301 children's sports clubs in Norway answered the questionnaire between September and November 2021. RESULTS: In total, 89·4% of the participating sports clubs (n 301) offered soda drinks with sugar. Most of the sports clubs (88 %) reported to offer batter-based cakes such as pancakes and waffles and 63·8 % offered cakes. Furthermore, 47·5% sold hot dishes with processed meat, such as hamburgers and hot dogs. More than 80% of the sports clubs offered sweets and snacks, while 44·5% did not offer fruits, vegetables and/or berries. Notably, the important factors that distinguished sports clubs with healthier food selections from those with unhealthier selections were the presence of guidelines for the food offered and purchase agreements with food suppliers. CONCLUSIONS: Educational, governmental guidelines for the promotion of healthy eating and establishing agreements with suppliers of healthier foods could help to overcome barriers to unhealthy food selection.

Between choices and decisions. Genetics in homoparental families through surrogacy in Argentina. / Entre elecciones y decisiones. La genética en familias homoparentales por gestación por sustitución en Argentina.

Comprehensive access to medically assisted reproduction procedures and techniques in Argentina has been assured by National Law No. 26,862 since 2013. This Law does not include surrogacy procedures, and the lack of specific regulation shifts practices to a paralegal setting. In this context, planned parenthood by male couples through surrogacy is performed through actions that convey demands for access rights and active State policies. For these couples, the argument is that surrogacy is the only option to have a child with a genetic bond with at least one of the two parents and recognize both filiatory bonds. This work results from field work in progress with parents from the Province of Buenos Aires running this practice in Argentina. Based on in-depth interviews, we attempted to rebuild personal experiences and analyze the meanings that the narratives construct regarding their parenting, the biological connections in establishing or defining family relationships, and the importance of genetics in constructing and maintaining affiliations.

En Argentina desde 2013 existe la Ley Nacional 26.862 de acceso integral a los procedimientos y técnicas de reproducción médicamente asistida (TRA). Esta no incluye los procedimientos de gestación por sustitución (GS) y la ausencia de regulación específica mueve las prácticas a un escenario de paralegalidad. En este contexto, las paternidades planificadas por parejas de varones a través de GS se llevan adelante mediante acciones que vehiculizan demandas de derechos de acceso y políticas activas del Estado. Para estas parejas el argumento es que la GS representa la única opción para tener un/a hijo/a con vínculo genético con al menos uno de los dos padres y poder reconocer ambos vínculos filiatorios. El presente trabajo es el resultado de un trabajo de campo en proceso con padres de Buenos Aires que están llevando adelante esta práctica en Argentina. A partir de entrevistas en profundidad intentamos reconstruir las experiencias personales y analizar los sentidos que construyen las narrativas respecto de sus parentalidades, las conexiones biológicas en la creación o definición de los lazos familiares y analizamos la importancia de la genética en la construcción y mantenimiento de vínculos filiatorios.

Action Selection in Everyday Activities: The Opportunistic Planning Model.

While action selection strategies in well-defined domains have received considerable attention, little is yet known about how people choose what to do next in ill-defined tasks. In this contribution, we shed light on this issue by considering everyday tasks, which in many cases have a multitude of possible solutions (e.g., it does not matter in which order the items are brought to the table when setting a table) and are thus categorized as ill-defined problems. Even if there are no hard constraints on the ordering of subtasks in everyday activities, our research shows that people exhibit specific preferences. We propose that these preferences arise from bounded rationality, that is, people only have limited knowledge and processing power available, which results in a preference to minimize the overall physical and cognitive effort. In the context of everyday activities, this can be achieved by (a) taking properties of the spatial environment into account to use them to one's advantage, and (b) employing a stepwise-optimal action selection strategy. We present the Opportunistic Planning Model as an explanatory cognitive model, which instantiates these assumptions, and show that the model is able to generalize to new everyday tasks, outperforming machine learning models such as neural networks during generalization.

I want to be safe: understanding the main drivers behind vaccination choice throughout the pandemic.

BACKGROUND: Despite being a major advancement in modern medicine, vaccines face widespread hesitancy and refusal, posing challenges to immunization campaigns. The COVID-19 pandemic accentuated vaccine hesitancy, emphasizing the pivotal role of beliefs in efficacy and safety on vaccine acceptance rates. This study explores the influence of efficacy and safety perceptions on vaccine uptake in Italy during the pandemic. METHODS: We administered a 70-item questionnaire to a representative sample of 600 Italian speakers. Participants were tasked with assessing the perceived effectiveness and safety of each vaccine dose, along with providing reasons influencing their vaccination choices. Additionally, we conducted an experimental manipulation, exploring the effects of four framing messages that emphasized safety and/or efficacy on participants' willingness to receive a hypothetical fourth vaccine dose. Furthermore, participants were asked about their level of trust in the scientific community and public authorities, as well as their use of different information channels for obtaining COVID-19-related information. RESULTS: Our study reveals a dynamic shift in vaccine efficacy and safety perceptions throughout the COVID-19 pandemic, potentially influencing vaccination compliance. Initially perceived as more effective than safe, this assessment reversed by the time of the third dose. Beliefs regarding safety, rather than efficacy, played a significant role in anticipating future vaccinations (e.g., the booster dose). Safety-focused messages positively affected vaccination intent, while efficacy-focused messages showed limited impact. We also observed a changing trend in reasons for vaccination, with a decline in infection-related reasons and an increase in social related ones. Furthermore, trust dynamics evolved differently for public authorities and the scientific community. CONCLUSIONS: Vaccine perception is a dynamic process shaped by evolving factors like efficacy and safety perceptions, trust levels, and individual motivations. Our study sheds light on the complex dynamics that underlie the perception of vaccine safety and efficacy, and their impact on willingness to vaccinate. We discuss these results in light of bounded rationality, loss aversion and classic utility theory.

Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment.

INTRODUCTION: Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention. OBJECTIVE: This analysis aims to understand potential users' preferences for LA-PrEP, with audience segmentation. DESIGN: Willingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men's Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). Conditional and mixed logit models were run; the final model was a dummy-coded mixed logit that interacted with the opt-out. SETTING: US national online sample. RESULTS: Among 2506 MSM respondents, most (75%) indicated a willingness to use LA-PrEP versus daily oral PrEP versus no PrEP. Respondents were averse to side effects and increasing costs and preferred increasing levels of protection. Respondents preferred a 2-hour time to obtain LA-PrEP vs 1 hour, with a strong aversion to 3 hours. Overall, there was an aversion to opting out of LA-PrEP, with variations: those with only one partner, no/other insurance or who were Black, Indigenous or People of Colour were significantly less likely to prefer LA-PrEP, while those who were Hispanic/Latino, college educated and <40 years significantly preferred LA-PrEP. CONCLUSIONS: A large proportion of MSM expressed a preference for LA-PrEP over daily oral pills. Most respondents chose LA-PrEP regardless of cost, clinic time, side effects or protection level; however, preferences varied by sociodemographics. These varied groups likely require tailored intervention strategies to achieve maximum LA-PrEP uptake and persistence.

Neurocomputational mechanisms involved in adaptation to fluctuating intentions of others.

Humans frequently interact with agents whose intentions can fluctuate between competition and cooperation over time. It is unclear how the brain adapts to fluctuating intentions of others when the nature of the interactions (to cooperate or compete) is not explicitly and truthfully signaled. Here, we use model-based fMRI and a task in which participants thought they were playing with another player. In fact, they played with an algorithm that alternated without signaling between cooperative and competitive strategies. We show that a neurocomputational mechanism with arbitration between competitive and cooperative experts outperforms other learning models in predicting choice behavior. At the brain level, the fMRI results show that the ventral striatum and ventromedial prefrontal cortex track the difference of reliability between these experts. When attributing competitive intentions, we find increased coupling between these regions and a network that distinguishes prediction errors related to competition and cooperation. These findings provide a neurocomputational account of how the brain arbitrates dynamically between cooperative and competitive intentions when making adaptive social decisions.

Choice impulsivity after repeated social stress is associated with increased perineuronal nets in the medial prefrontal cortex.

Repeated stress can predispose to substance abuse. However, behavioral and neurobiological adaptations that link stress to substance abuse remain unclear. This study investigates whether intermittent social defeat (ISD), a stress protocol that promotes drug-seeking behavior, alters intertemporal decision-making and cortical inhibitory function in the medial prefrontal cortex (mPFC). Male long evans rats were trained in a delay discounting task (DDT) where rats make a choice between a fast (1 s) small reward (1 sugar pellet) and a large reward (3 sugar pellets) that comes with a time delay (10 s or 20 s). A decreased preference for delayed rewards was used as an index of choice impulsivity. Rats were exposed to ISD and tested in the DDT 24 h after each stress episode, and one- and two-weeks after the last stress episode. Immunohistochemistry was performed in rat's brains to evaluate perineuronal nets (PNNs) and parvalbumin GABA interneurons (PV) labeling as markers of inhibitory function in mPFC. ISD significantly decreased the preference for delayed large rewards in low impulsive, but not high impulsive, animals. ISD also increased the density of PNNs in the mPFC. These results suggest that increased choice impulsivity and cortical inhibition predispose animals to seek out rewards after stress.

How do animals weigh conflicting information about reward sources over time? Comparing dynamic averaging models.

Optimal foraging theory suggests that animals make decisions which maximize their food intake per unit time when foraging, but the mechanisms animals use to track the value of behavioral alternatives and choose between them remain unclear. Several models for how animals integrate past experience have been suggested. However, these models make differential predictions for the occurrence of spontaneous recovery of choice: a behavioral phenomenon in which a hiatus from the experimental environment results in animals reverting to a behavioral allocation consistent with a reward distribution from the more distant past, rather than one consistent with their most recently experienced distribution. To explore this phenomenon and compare these models, three free-operant experiments with rats were conducted using a serial reversal design. In Phase 1, two responses (A and B) were baited with pellets on concurrent variable interval schedules, favoring option A. In Phase 2, lever baiting was reversed to favor option B. Rats then entered a delay period, where they were maintained at weight in their home cages and no experimental sessions took place. Following this delay, preference was assessed using initial responding in test sessions where levers were presented, but not baited. Models were compared in performance, including an exponentially weighted moving average, the Temporal Weighting Rule, and variants of these models. While the data provided strong evidence of spontaneous recovery of choice, the form and extent of recovery was inconsistent with the models under investigation. Potential interpretations are discussed in relation to both the decision rule and valuation functions employed.

Quantifying preferences for urea cycle disorder treatments using a discrete choice experiment.

AIMS: Urea cycle disorders (UCDs) can cause ammonia accumulation and central nervous system toxicity. Nitrogen-binding medications can be efficacious, but certain attributes may negatively impact adherence. This study sought to quantify the administration-related attributes influencing overall prescription selection and patient adherence. METHODS: A web-based, quantitative survey including discrete choice experiment (DCE) methodology captured responses from health care providers for patients with UCDs. A series of hypothetical treatment profile sets with attributes such as route of administration, taste/odor, preparation instructions, packaging, dose measurement, and weight use restrictions were presented. From 16 sets of 3 hypothetical product profiles, respondents evaluated attributes most preferred for prescription selection or patient adherence. Attributes assumed a higher overall preference if relative importance (RI) scores were >16.67% (the value if all attributes were of equal importance). Preference weight scores were assessed. A nine-point Likert scale assessed respondent attitudes, such as satisfaction. RESULTS: A total of 51 respondents completed the survey. Respondents reported dissatisfaction with current treatments (mean [SD] = 5.4 [1.7]). For prescription selection, four attributes achieved RI >16.67%: taste/odor (24%), weight restrictions (21%), preparation instructions (18%), and route of administration (17%). For adherence, three attributes related to administration achieved RI >16.67%: taste/odor (28%), preparation instructions (21%), and route of administration (17%). Preference weights for "taste/odor masked" were higher than "not taste/odor masked" for prescription selection (mean [SD]; 1.52 [1.10] vs -1.52 [1.10]) and treatment adherence (73.8 [55.2] vs -73.8 [55.2]). LIMITATIONS: This study contained a relatively small sample size. Survey respondent selection, the use of hypothetical product profiles, and exclusion of non-pharmacologic treatment options could have contributed to potential biases. CONCLUSIONS: Among attributes tested, taste/odor was the most important attribute influencing overall preference for both prescribing and patient adherence, with taste/odor masking preferred. Optimizing nitrogen-binding medications through masking taste/odor may support improved patient adherence and outcomes in UCDs.

Aesthetic preference for artificially selected color variant affects mate choice copying behavior in female Poecilia latipinna.

Three experiments were conducted examining whether an artificially selected "gold" color variant in female "models" affects mate choice copying behavior in sailfin mollies (Poecilia latipinna). Experiment I consisted of a pair of female preference assays, first assessing preference for male body size, followed by a mate choice copying assay that paired a model female with the smaller, non-preferred male from the initial preference test. Female subjects were divided into three groups that used either a wildtype female model, an artificially selected "gold" variant (cultivated within the aquarium fish trade) model, or control wherein no model was presented. Results showed females consistently copied the model's choice, switching preferences from the larger to smaller male when paired with a model regardless of color. In the second experiment wildtype females were presented with a pair of size-matched dummy males both of which paired with model females (one gold and the other wild type). Subjects consistently preferred the male previously paired with the gold- over the male with the wildtype-model, suggesting pre-existing sensory/perceptual biases may have affected their mate choice copying behavior. Previous studies have offered evidence for the spread of novel traits in males via sensory exploitation. However, these results indicate such biases may influence courtship behavior in circumstances where the novel trait is expressed in females as well. For the third experiment, wildtype females were presented with a choice between gold vs wildtype dummy males, the results of which revealing significant preferences for gold. In a follow-up assay pairing a wild type model with the non-preferred wildtype male, females maintained their preference for gold males despite the conflicting social driver of mate choice copying. These data offer evidence for the existence of a perceptual/cognitive bias in the context of mate choice copying, favoring the gold phenotype and/or novelty in general.

Population coding of strategic variables during foraging in freely moving macaques.

Until now, it has been difficult to examine the neural bases of foraging in naturalistic environments because previous approaches have relied on restrained animals performing trial-based foraging tasks. Here we allowed unrestrained monkeys to freely interact with concurrent reward options while we wirelessly recorded population activity in the dorsolateral prefrontal cortex. The animals decided when and where to forage based on whether their prediction of reward was fulfilled or violated. This prediction was not solely based on a history of reward delivery, but also on the understanding that waiting longer improves the chance of reward. The task variables were continuously represented in a subspace of the high-dimensional population activity, and this compressed representation predicted the animal's subsequent choices better than the true task variables and as well as the raw neural activity. Our results indicate that monkeys' foraging strategies are based on a cortical model of reward dynamics as animals freely explore their environment.

Nurses' preferences regarding MenACWY conjugate vaccines attributes: a discrete choice experiment in Spain.

OBJECTIVES: Immunisation against preventable diseases as meningitis is crucial from a public health perspective to face challenges posed by these infections. Nurses hold a great responsibility for these programs, which highlights the importance of understanding their preferences and needs to improve the success of campaigns. This study aimed to investigate nurses' preferences regarding Meningococcus A, C, W, and Y (MenACWY) conjugate vaccines commercialised in Spain. STUDY DESIGN: A national-level discrete choice experiment (DCE) was conducted. METHODS: A literature review and a focus group informed the DCE design. Six attributes were included: pharmaceutical form, coadministration evidence, shelf-life, package contents, single-doses per package, and package volume. Conditional logit models quantified preferences and relative importance (RI). RESULTS: Thirty experienced primary care nurses participated in this study. Evidence of coadministration with other vaccines was the most important attribute (RI = 43.78%), followed by package size (RI = 22.17%), pharmaceutical form (RI = 19.07%), and package content (RI = 11.80%). There was a preference for evidence of coadministration with routine vaccines (odds ratio [OR] = 2.579, 95% confidence interval [95%CI] = 2.210-3.002), smaller volumes (OR = 1.494, 95%CI = 1.264-1.767), liquid formulations (OR = 1.283, 95%CI = 1.108-1.486) and package contents including only vial/s (OR = 1.283, 95%CI = 1.108-1.486). No statistical evidence was found for the remaining attributes. CONCLUSIONS: Evidence of coadministration with routine vaccines, easy-to-store packages, and fully liquid formulations were drivers of nurses' preferences regarding MenACWY conjugate vaccines. These findings provide valuable insights for decision-makers to optimize current campaigns.

Please don't throw me in the briar patch! Empirical evidence on the role of instructional cues on eco-label usage in fish consumption decisions.

While contributing to the conservation of natural fish stocks, the aquaculture sector imposes environmental repercussions. The growing popularity of colour-graded eco-labels in promoting pro-environmental practices in food production underscores the need for scientific insights into consumer responses to such labels, particularly with the imminent prospect of a harmonized European labelling framework. The existing literature, although limited and divergent, advocates for real-life testing with fresh, perishable food products, emphasizing the inadequacy of standalone labels and the necessity for complementary measures. Furthermore, the mechanisms underlying how consumers process multi-coloured Front-of-Pack (FOP) labels remain ambiguous, with uncertainties regarding induced consumption shifts stemming from both deliberate information processing and less deliberate associations. This article presents findings from a randomized control trial conducted in a simulated fishmonger store in Derio, Bizkaia, Spain, involving 200 consumers. Participants selected various sea bass products out of multiple options. This task was subject to a 2 (Enviroscore: with vs without) x 2 (Supporting info on Enviroscore: with vs without) between-subject design, resulting in four treatment groups. A 16% increase in the likelihood of selecting lower-impact products was observed. Notably, this effect was evident only in the absence of supporting information on Enviroscore, and the observed impact could not be attributed to any indirect attention effect. In conclusion, Enviroscore exhibits potential in steering consumer choices toward more environmentally friendly aquaculture fish options, even in physical retail settings. However, these effects may be rooted in unconscious responses rather than deliberate environmental considerations, raising questions about the suitability of envisaged policy orientations encompassing disaggregated environmental, nutritional, animal welfare, and social welfare scores. Generalization of these findings warrants validation through further research encompassing a more comprehensive range of products.