Age-appropriate BMI cut-offs for malnutrition among older adults in India.

With the increasing prevalence of obesity in India, body mass index (BMI) has garnered importance as a disease predictor. The current World Health Organization (WHO) body mass index (BMI) cut-offs may not accurately portray these health risks in older adults aged 60 years and above. This study aims to define age-appropriate cut-offs for older adults (60-74 years and 75 years and above) and compare the performance of these cut-offs with the WHO BMI cut-offs using cardio-metabolic conditions as outcomes. Using baseline data from the Longitudinal Ageing Study in India (LASI), classification and regression tree (CART) cross-sectional analysis was conducted to obtain age-appropriate BMI cut-offs based on cardio-metabolic conditions as outcomes. Logistic regression models were estimated to compare the association of the two sets of cut-offs with cardio-metabolic outcomes. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were estimated. Agreement with waist circumference, an alternate measure of adiposity, was conducted. For older adults aged 60-74 years and 75 years and above, the cut-off for underweight reduced from < 18.5 to < 17.4 and < 13.3 respectively. The thresholds for overweight and obese increased for older adults aged 60-74 years old from > = 25 to > 28.8 and > = 30 to > 33.7 respectively. For older adults aged 75 years and above, the thresholds decreased for both categories. The largest improvement in AUC was observed in older adults aged 75 years and above. The newly derived cut-offs also demonstrated higher sensitivity and specificity among all age-sex stratifications. There is a need to adopt greater rigidity in defining overweight/obesity among older adults aged 75 years and above, as opposed to older adults aged 60-74 years old among whom the thresholds need to be less conservative. Further stratification in the low risk category could also improve BMI classification among older adults. These age-specific thresholds may act as improved alternatives of the current WHO BMI thresholds and improve classification among older adults in India.

Selection of renewable energy development path for sustainable development using a fuzzy MCDM based on cumulative prospect theory: the case of Malaysia.

Malaysia's excessive energy consumption has led to the depletion of traditional energy reserves such as oil and natural gas. Although Malaysia has implemented multiple policies to achieve sustainable national energy development, the current results are unsatisfactory. As of 2022, only 2% of the country's electricity supply comes from renewable energy, which accounts for less than 30% of the energy structure. Malaysia must ensure energy security and diversified energy supply while ensuring sustainable energy development. This article uses the fuzzy multi-criteria decision-making(MCDM) method based on cumulative prospect theory to help decision-makers choose the most suitable renewable energy for sustainable development in Malaysia from four dimensions of technology, economy, society, and environment. The results show that solar power is the most suitable renewable energy for sustainable development, followed by biomass, wind, and hydropower, but the optimal alternative is sensitive to the prospect parameters. Finally, it was analyzed that efficiency, payback period, employment creation, and carbon dioxide (CO2) emissions are the most critical factors affecting the development of renewable energy in Malaysia under the four dimensions. Reasonable suggestions are proposed from policy review, green finance, public awareness, engineering education, and future energy. This research provides insightful information that can help Malaysian decision-makers scientifically formulate Sustainable development paths for renewable energy, analyze the problems encountered in the current stage of renewable energy development, and provide recommendations for Malaysia's future renewable energy transition and sustainable development.

Confidence level based complex polytopic fuzzy Einstein aggregation operators and their application to decision-making process.

A complex Polytopic fuzzy set (CPoFS) extends a Polytopic fuzzy set (PoFS) by handling vagueness with degrees that range from real numbers to complex numbers within the unit disc. This extension allows for a more nuanced representation of uncertainty. In this research, we develop Complex Polytopic Fuzzy Sets (CPoFS) and establish basic operational laws of CPoFS. Leveraging these laws, we introduce new operators under a confidence level, including the confidence complex Polytopic fuzzy Einstein weighted geometric aggregation (CCPoFEWGA) operator, the confidence complex Polytopic fuzzy Einstein ordered weighted geometric aggregation (CCPoFEOWGA) operator, the confidence complex Polytopic fuzzy Einstein hybrid geometric aggregation (CCPoFEHGA) operator, the induced confidence complex Polytopic fuzzy Einstein ordered weighted geometric aggregation (I-CCPoFEOWGA) operator and the induced confidence complex Polytopic fuzzy Einstein hybrid geometric aggregation (I-CCPoFEHGA) operator, enhancing decision-making precision in uncertain environments. We also investigate key properties of these operators, including monotonicity, boundedness, and idempotency. With these operators, we create an algorithm designed to solve multiattribute decision-making problems in a Polytopic fuzzy environment. To demonstrate the effectiveness of our proposed method, we apply it to a numerical example and compare its flexibility with existing methods. This comparison will underscore the advantages and enhancements of our approach, showing its efficiency in managing complex decision-making scenarios. Through this, we aim to demonstrate how our method provides superior performance and adaptability across different situations.

Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study.

BACKGROUND: Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders. METHODS: Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes "Shadow of the past," reflecting past experiences, and "Shadow of the future," reflecting future imaginaries, building upon the existing "Narrative Framework." RESULTS: The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The "Shadow of the present" was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future. CONCLUSIONS: This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.

Recent studies show that women with psychiatric disorders are more likely to experience unintended pregnancies. However, the underlying reasons are not fully understood. Understanding those reasons is important to provide better healthcare. Our study explored how women with psychiatric disorders make decisions about family planning.We had conversations with different groups of women­women with unintended pregnancies, women without children, and women with intended pregnancies­through focus group discussions. We partnered with the Dutch mental health organization MIND to capture diverse opinions. Key themes and categories in the discussions were identified and organized.We found four main themes: "Shadow of the past" showed how past events, trauma, and lack of knowledge about parenting affect family planning. "Shadow of the present" revealed different feelings about family planning, the importance of the awareness of psychiatric disorders, and uncertainty about decisions. "Shadow of the future" included thoughts about becoming a mother, the impact of social influences, and concerns about passing on psychiatric disorders. "Reflections on the decision" showed how psychiatric disorders, experiences with motherhood, and feelings of regret, grief and relief had an influence on family planning decisions.In conclusion, our study highlighted the complexity of family planning decisions for women with psychiatric disorders. Past experiences and societal influences, like stigma, play a big role. These insights show the need for personalized family planning support for women with psychiatric disorders.

Establishment and validation of a predictive nomogram for polyuria during general anesthesia in thoracic surgery.

BACKGROUND: To develop and evaluate a predictive nomogram for polyuria during general anesthesia in thoracic surgery. METHODS: A retrospective study was designed and performed. The whole dataset was used to develop the predictive nomogram and used a stepwise algorithm to screen variables. The stepwise algorithm was based on Akaike's information criterion (AIC). Multivariable logistic regression analysis was used to develop the nomogram. The receiver operating characteristic (ROC) curve was used to evaluate the model's discrimination ability. The Hosmer-Lemeshow (HL) test was performed to check if the model was well calibrated. Decision curve analysis (DCA) was performed to measure the nomogram's clinical usefulness and net benefits. P < 0.05 was considered to indicate statistical significance. RESULTS: The sample included 529 subjects who had undergone thoracic surgery. Fentanyl use, gender, the difference between mean arterial pressure at admission and before the operation, operation type, total amount of fluids and blood products transfused, blood loss, vasopressor, and cisatracurium use were identified as predictors and incorporated into the nomogram. The nomogram showed good discrimination ability on the receiver operating characteristic curve (0.6937) and is well calibrated using the Hosmer-Lemeshow test. Decision curve analysis demonstrated that the nomogram was clinically useful. CONCLUSIONS: Individualized and precise prediction of intraoperative polyuria allows for better anesthesia management and early prevention optimization.

Cosine similarity and distance measures for p , q - quasirung orthopair fuzzy sets: Applications in investment decision-making.

Similarity measures and distance measures are used in a variety of domains, such as data clustering, image processing, retrieval of information, and recognizing patterns, in order to measure the degree of similarity or divergence between elements or datasets. p , q - quasirung orthopair fuzzy ( p , q - QOF) sets are a novel improvement in fuzzy set theory that aims to properly manage data uncertainties. Unfortunately, there is a lack of research on similarity and distance measure between p , q - QOF sets. In this paper, we investigate different cosine similarity and distance measures between to p , q - quasirung orthopair fuzzy sets ( p , q - ROFSs). Firstly, the cosine similarity measure and the Euclidean distance measure for p , q - QOFSs are defined, followed by an exploration of their respective properties. Given that the cosine measure does not satisfy the similarity measure axiom, a method is presented for constructing alternative similarity measures for p , q - QOFSs. The structure is based on the suggested cosine similarity and Euclidean distance measures, which ensure adherence to the similarity measure axiom. Furthermore, we develop a cosine distance measure for p , q - QOFSs that connects similarity and distance measurements. We then apply this technique to decision-making, taking into account both geometric and algebraic perspectives. Finally, we present a practical example that demonstrates the proposed justification and efficacy of the proposed method, and we conclude with a comparison to existing approaches.

Hospital Staff Perspectives on the Drivers and Challenges in Implementing a Virtual Rehabilitation Ward: Qualitative Study.

Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood. Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery. Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework. Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families. Conclusions: In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW.

Integrating evidence and causal mapping of help-seeking behaviour of migrant women with postpartum depression in Shanghai, China: a scoping review protocol.

INTRODUCTION: The estimated prevalence of postpartum depression (PPD) worldwide, in China, and Shanghai is 17.2%, 18.0% and 23.2%, respectively. In 2021, Shanghai housed a population of 3.2 million childbearing-age migrant women, most of whom migrated to the city with their husbands for economic reasons. There is a general lack of help-seeking behaviour for mental disorders in China due to the perceived risk of social stigmatisation. In Shanghai, 70% of women did not seek professional help for perinatal mental health problems. We aim to gather information from multiple perspectives, such as the migrant women with PPD and perinatal depression (PND), their caregivers, health service providers and communities, to understand the help-seeking behaviour of postpartum migrant women with PPD or PND in China. METHODS AND ANALYSIS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for Scoping Reviews will guide this review. A bilingual research librarian developed a comprehensive search strategy to retrieve published and unpublished English and Chinese studies involving factors influencing women's PPD or PND help-seeking behaviour in China. This literature includes perceptions, views, patterns, acceptance and refusal, tendencies, probability, service accessibility and utilisation, and facts. We will search PubMed, Embase, Web of Science and CINAHL for English literature and CINKI for Chinese literature. Backward and forward snowball approaches will be used to identify additional relevant papers from the reference lists of selected papers. Two independent reviewers will screen the title and abstract and review the full text of selected papers to identify eligible articles for data extraction. We will build a Microsoft Access database to record the extracted data. The results will be presented in tables and a causal map to demonstrate the relationships between extracted variables and help-seeking behaviours for PPD and PND. A conceptual simulation model will be formulated based on the information from the literature to validate the logic of the relationships between variables, identify knowledge gaps and gain insights into potential intervention approaches. Experts and stakeholders will be invited to critique and comment on the results during group model building (GMB) workshops in Shanghai. These comments will be essential to validate the findings, receive feedback and obtain additional insights. ETHICS AND DISSEMINATION: The literature review component of our study does not require ethical approval because the information and data collected will be obtained from publicly available sources and will not involve human subjects. Our collaborating research partner, International Peach Maternal Child Hospital, obtained the IRB approval (GKLW-A-2023-020-01) for screening and enrolling participants in GMB workshops. Stanford University received IRB approval under protocol number 67 419. The full review will be presented at a relevant conference and submitted to a peer-reviewed scientific journal for publication to report findings.

Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review.

OBJECTIVE: This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment. METHODS: Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley's methodological framework was adapted for this scoping review. Two reviewers screened the abstracts and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated. RESULTS: Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge. CONCLUSION: Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists. IMPACT: The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.

Transferability of Effective Consultation Skills for Decision-Making Support in the Voluntary Surrender of Older Adult Drivers' Licences in Super-Aged Japan.

INTRODUCTION: Previously, we identified eight effective consultation skills to support decision-making in the voluntary surrender of older adult drivers' licences in super-aged Japan. This study aimed to clarify the transferability of these skills. METHODS: We collected text data by interviewing 11 safe-driving counsellors (four police officers, four clerical staff and three nurses) in the License Division of the National Police Agency from February to March 2022. Interviews were semi-structured and conducted by telephone or email. During the interview, participants were asked to recall their experiences as counsellors providing decision-making support to older drivers and to compare their experiences with the eight consultation skills. We analysed the content of the responses by quantitative text analysis with KH Coder 3 software. RESULTS: As a characteristic of the words and phrases used by counsellors in their narratives about consultation skills, the most frequently extracted words from among 3147 words were think, parties and family, and promote had the highest mediation centrality. The eight subgraphs were 'Respecting the will of relevant parties from their standpoint is natural', 'Listening attentively and empathetically to relevant parties is effective', 'Presenting objective data to guide decisions is successful', 'Showing cognitive functioning test results is often effective', 'Counselors with medical expertise can elicit positive counseling outcomes', 'Intervention by medical or police counselors facilitates the decision to surrender voluntarily', 'Counseling skills need to be improved' and 'A diagram of the 8 skills is helpful for inexperienced counselors'. CONCLUSION: The results suggest that the eight consultation skills have similarities and are transferable. This transferability might contribute to practical application or cohort follow-up study research. These skills can be incorporated into counsellor training, and counsellors can be expected to use these skills in the future. Regardless of the safe-driving counsellor's years of experience, the skills can help them provide uniform and accurate support in decision-making regarding the voluntary surrender of older adult drivers' licences. These skills are a promising approach to help older adults lead safe and secure lives as they age.

Tracheostomy Decision Making and Counseling: Comparing Providers' and Caregivers' Perspectives and Perceptions.

Background: The decision to place a tracheostomy in children is complex and involves factors beyond the medical procedure, including quality of life, values, and goals. Providers play an important role in counseling caregivers and guiding them through the decision-making process. There are no established guidelines for tracheostomy counseling, leading to variations in practice. Additionally, how caregivers receive information differs from how providers believe they deliver it. Although studies have explored caregivers' and providers' viewpoints, none have examined them concurrently. Background: The primary aim of this exploratory study is to investigate differences between providers' and caregivers' perceptions of tracheostomy counseling and their perspectives regarding the decision-making process. Design: Semi-structured interviews were conducted with both caregivers and providers for children being evaluated for a tracheostomy. Qualitative analysis was applied to the interview transcripts to identify emergent themes. Subsequently, a comparative analysis was performed to compare these themes between caregivers and healthcare providers. Results: A total of 33 interviews were conducted, involving 16 caregivers and 17 providers. Notably, caregivers provided personal descriptions of their children in 81% of cases, whereas only 35% of providers did so. Concerns and fears for the children were expressed by 69% of caregivers and 59% of providers. In contrast, 75% of caregivers discussed their hopes and dreams for their children, compared with only 29% of providers. When it came to priorities, 69% of caregivers emphasized growth and development, and 38% mentioned discharge home, as opposed to 29% and 47% among providers, respectively. Conclusion: In conclusion, our study highlights a disconnect between caregivers and healthcare providers regarding tracheostomy counseling. These differing perspectives underscore the need for improved communication and understanding between the two groups. Recognizing these differences can help providers tailor their counseling approaches to better align with the values and priorities of families when making decisions about tracheostomy.

Decision making for people living with HIV/AIDS using the theory of innovation diffusion model at the Western Provident Association Turen Foundation.

OBJECTIVES: To describe how people living with HIV/AIDS (PLWHA) make decisions using the diffusion of innovation theory model. Decisions occur when individual decision makers engage in activities that guide choices to adopt or reject a particular innovation. METHODS: This is a descriptive analysis research using a survey method. Data collection was carried out using a decision making questionnaire. The subjects in this research were HIV/AIDS sufferers (PLWHA) who lived in Turen, Indonesia. The number of research subjects was 36 respondents obtained using the purposive sampling technique on January 2023. RESULTS: The research design used the correlation method with a cross sectional approach and the Spearman correlation coefficient statistical test. The research results show significance (2-tailed) of 0.934 (p>0.05). The correlation coefficient results are negative. Where the direction of the correlation produces showed a very weak relationship with a value of 0.014 and the results of the analysis between variables are not the same. This is because the persuasion stage was not tested in the analysis. Research shows that 8 (22.2%) patients rejected the decision making of PLWHA using the diffusion of innovation theory model at the Western Provident Association Turen Foundation, Turen, Indonesia, while 28 (77.7%) patients accepted it. It can be concluded that the majority of decisions made by HIV/AIDS patients at the ADIS Turen Peduli Warga Foundation are accepted. CONCLUSION: Knowledge of HIV/AIDS sufferers is at a good level, their decision making is mostly accepted and there is a meaningful relationship between knowledge and decision making in using a chatbot innovation. The suggestion from the research is that this chatbot innovation can be a source of further research and help provide education for PLWHA patients in everyday life.

Quantitative vs. Qualitative Outcomes: A Longitudinal Study of Risk and Ambiguity in Monetary and Medical Decision-Making.

How do decision-makers choose between alternatives offering outcomes that are not easily quantifiable? Previous literature on decisions under uncertainty focused on alternatives with quantifiable outcomes, for example monetary lotteries. In such scenarios, decision-makers make decisions based on success chance, outcome magnitude, and individual preferences for uncertainty. It is not clear, however, how individuals construct subjective values when outcomes are not directly quantifiable. To explore how decision-makers choose when facing non-quantifiable outcomes, we focus here on medical decisions with qualitative outcomes. Specifically, we ask whether decision-makers exhibit the same attitudes towards two types of uncertainty - risk and ambiguity - across domains with quantitative and qualitative outcomes. To answer this question, we designed an online decision-making task where participants made binary choices between alternatives offering either guaranteed lower outcomes or potentially higher outcomes that are associated with some risk and ambiguity. The outcomes of choices were either different magnitudes of monetary gains or levels of improvement in a medical condition. We recruited 429 online participants and repeated the survey in two waves, which allowed us to compare the between-domain attitude consistency with within-domain consistency, over time. We found that risk and ambiguity attitudes were moderately correlated across domains. Over time, risk attitudes had slightly higher correlations compared to across domains, while in ambiguity over-time correlations were slightly weaker. These findings are consistent with the conceptualization of risk attitude as more trait-like, and ambiguity attitudes as more state-like. We discuss the implications and applicability of our novel modeling approach to broader contexts with non-quantifiable outcomes.

Best practices for acceptability of GM crops field trials conclusions: lessons for Africa.

The ability to transfer information about the performance, safety, and environmental impacts of a genetically modified (GM) crop from confined field trials (CFTs) conducted in one location to another is increasingly gaining importance in biosafety regulatory assessment and decision-making. The CFT process can be expensive, time-consuming, and logistically challenging. Data transportability can help overcome these challenges by allowing the use of data obtained from CFTs conducted in one country to inform regulatory decision-making in another country. Applicability of transported CFT data would be particularly beneficial to the public sector product developers and small enterprises that develop innovative GM events but cannot afford to replicate redundant CFTs, as well as regulatory authorities seeking to improve the deployment of limited resources. This review investigates case studies where transported CFT data have successfully been applied in biosafety assessment and decision-making, with an outlook of how African countries could benefit from a similar approach.

Inconsistent advice by ChatGPT influences decision making in various areas.

The ChatGPT technology is increasingly becoming a part of our daily lives and is starting to be utilized in various decision-making contexts. The current study builds upon prior research, demonstrating that people's moral decision-making is influenced by ChatGPT across three perspectives, as evidenced by two studies (total n = 1925). The findings suggested that ChatGPT advice impacted decision-making similarly to expert advice, although not all decisions were susceptible to influence, particularly those based on negative emotions. Additionally, ChatGPT advice affected decisions beyond moral judgments, but no effect was observed when the advice recommended immediate low rewards. Moreover, individuals with a higher tendency for personal fear of invalidity were more likely to be influenced by both expert and AI advice, but this was not related to trust in AI.

Assessing patient perception and preferences for outcomes in lung cancer resection surgery: a cross-sectional study.

Background: Surgical resection is the primary treatment for early-stage lung cancer, but little is known about the outcomes that truly matter to patients. This aim of our study was to identify the aspects of postoperative outcomes that matter most to patients undergoing lung cancer surgery and explore the influence of clinical and demographic factors on their importance ratings. Methods: We performed a cross-sectional study of patients undergoing lung resection for non-small cell lung cancer at our institution from November 2021 to May 2022. Patients were surveyed using a self-developed questionnaire and the European Organisation for Research and Treatment of Cancer core health-related quality of life questionnaire (EORTC QLQ-C30) prior to surgery. Ordinal logistic regression was performed to determine associations between individual patient factors and outcome importance ratings. Results: Forty patients completed the survey during the study period. Patients prioritized oncologic outcomes, with 95% rating R0 resection and cancer recurrence as "very important". Other important factors included overall survival (90%), postoperative complications (e.g., myocardial infarction: 92.5%, infection: 87.5%), and the need for reoperation (82.5%). Health-related quality of life factors, such as chronic pain (77.5%) and the ability to return to normal physical and exercise levels (75%), were also highly valued. Certain patient clinical and demographic factors demonstrated significant associations with importance placed on certain outcomes. Preoperative health-related quality of life scores did not influence outcome importance ratings. Conclusions: This study provides insights into the outcomes that matter most to patients undergoing lung cancer surgery. Oncologic outcomes and postoperative complications were prioritized, while scar-related factors were less important. Patient preferences varied based on demographic and clinical factors. Understanding these preferences can enhance shared decision-making and improve patient-centered care in thoracic surgical oncology.

Predicting the number of IT staff needed in hospitals of Isfahan University of Medical Sciences based on modeling in 2023: A descriptive-analytical study.

Background and Aims: Considering the increasing use of information technology (IT) and the need of the implementation of related projects, the lack of IT specialists in the health system is one of the major challenges that require planning and foreseeing. This study was conducted with the aim of predicting the number of required IT personnel in hospitals of Isfahan University of Medical Sciences based on the modeling of identified and weighed influential factors in 2023. Method: First, Delphi method and multi-criteria decision-making (MCDM) using the Expository Posthaste Effective Resemblant Tool (ExPERT) were conducted to identify and weigh the components that affect IT staff's workload in hospitals. Then, the model for predicting the required number of IT personnel for the involved hospitals was developed. In all stages, the obtained information and results were checked and confirmed using experts' opinions in Focus Group Discussions. Results: Twenty-one hospitals (57%) out of 37 hospitals are facing a shortage of IT personnel. This varies from 0.5 to 1.6 personnel in different hospitals. Thirteen hospitals (35%) were reported to have adequate IT staffing and three hospitals (8%) had excess IT staffing. Conclusion: This study provided a predictive model for required IT staff in hospitals using MCDM through ExPERT which can be used in cases where the use of workload-based methods such as Workload Indicators of Staffing Need is complex or time-consuming.

Evaluating ChatGPT's moral competence in health care-related ethical problems.

Objectives: Artificial intelligence tools such as Chat Generative Pre-trained Transformer (ChatGPT) have been used for many health care-related applications; however, there is a lack of research on their capabilities for evaluating morally and/or ethically complex medical decisions. The objective of this study was to assess the moral competence of ChatGPT. Materials and methods: This cross-sectional study was performed between May 2023 and July 2023 using scenarios from the Moral Competence Test (MCT). Numerical responses were collected from ChatGPT 3.5 and 4.0 to assess individual and overall stage scores, including C-index and overall moral stage preference. Descriptive analysis and 2-sided Student's t-test were used for all continuous data. Results: A total of 100 iterations of the MCT were performed and moral preference was found to be higher in the latter Kohlberg-derived arguments. ChatGPT 4.0 was found to have a higher overall moral stage preference (2.325 versus 1.755) when compared to ChatGPT 3.5. ChatGPT 4.0 was also found to have a statistically higher C-index score in comparison to ChatGPT 3.5 (29.03 ± 11.10 versus 19.32 ± 10.95, P =.0000275). Discussion: ChatGPT 3.5 and 4.0 trended towards higher moral preference for the latter stages of Kohlberg's theory for both dilemmas with C-indices suggesting medium moral competence. However, both models showed moderate variation in C-index scores indicating inconsistency and further training is recommended. Conclusion: ChatGPT demonstrates medium moral competence and can evaluate arguments based on Kohlberg's theory of moral development. These findings suggest that future revisions of ChatGPT and other large language models could assist physicians in the decision-making process when encountering complex ethical scenarios.

Player selection in football by integrated SWARA-VIKOR methods under fuzzy environment.

This study aims to provide an objective evaluation and selection of the most suitable players for the Turkish National Football Team by using multi-criteria decision-making methods, specifically Stepwise Weight Assessment Ratio Analysis (SWARA) and VIsekriterijumsko KOmpromisno Rangiranje (VIKOR) based on neutrosophic numbers. In the initial step of the study, the important criteria for player selection were determined, and a total of 21 and 26 criteria were identified for goalkeeper and players, respectively. Agility, reflexes and jumping ability are very important for goalkeeper whereas marking, passing ability, agility, dribbling, and footwork are the most important criteria for players. The performances of the players were evaluated due to these criteria and finally the Turkish National Football Team was established scientifically because of the best player selection. This decision-making process will be more beneficial in making more informed and effective decisions in the national team's player selection process. The success of the team can be improved by providing an objective and systematic player selection approach.