To risk or not: The impact of socioeconomic status on preschoolers' risky decision-making for gains and losses.

Disparities in socioeconomic status (SES) may affect individuals' risk preferences, which have important developmental consequences across the lifespan. Yet, previous research has shown inconsistent associations between SES and risky decision-making, and little is known about how this link develops from a young age. The current research is among the first to examine how SES influences preschoolers' risky decisions in both gain and loss frames. Across two studies, children aged 5 to 6 years (total N = 309, 154 boys) were asked to choose between certain and risky options. The risky option was more advantageous, equal to, or less advantageous than the certain option. Study 1 revealed that in the loss frame, high-SES children (n = 84, 44 boys) chose more risky options and were more sensitive to the expected value compared to low-SES children (n = 78, 42 boys), especially when the risk was more advantageous. However, this SES difference was not significant in the gain frame. Supporting the potential causal link between SES and risky decision-making, Study 2 further found that experimentally increasing low-SES children's (n = 68, 30 boys) status by providing additional resources increased their risk-seeking behavior in the loss frame. Overall, our findings suggest an interaction between environmental cues (gain vs. loss) and early life circumstances (SES) in shaping children's risk preferences. RESEARCH HIGHLIGHTS: This research is among the first to examine how school backgrounds and experimentally manipulated SES influence preschoolers' risk preferences in gain and loss frames. Children were more risk-seeking for losses than for gains; this framing effect was stronger in higher-SES than lower-SES children. Lower-SES children exhibited fewer risk-seeking behaviors and decreased sensitivity to the expected value of options for losses, but not for gains. A temporary boost in SES increased children's risk-seeking behavior, but not sensitivity to expected values.

Understanding the Impact of Communicating Uncertainty About COVID-19 in the News: Randomized Between-Subjects Factorial Experiment.

BACKGROUND: Whether and how the uncertainty about a public health crisis should be communicated to the general public have been important and yet unanswered questions arising over the past few years. As the most threatening contemporary public health crisis, the COVID-19 pandemic has renewed interest in these unresolved issues by both academic scholars and public health practitioners. OBJECTIVE: The aim of this study was to investigate the impact of communicating uncertainty about COVID-19-related threats and solutions on individuals' risk perceptions and misinformation vulnerability, as well as the sequential impact of these effects on health information processing and preventative behavioral intentions. METHODS: A 2×2 (threat uncertainty [presence vs absence]×solution uncertainty [presence vs absence]) full-fractional between-subjects online experiment was conducted with 371 Chinese adults. Focusing on the discussion of whether the asymptomatic cases detected during the COVID-19 pandemic would further lead to an uncontrolled pandemic, news articles were manipulated in terms of whether the infectiousness of asymptomatic cases and the means to control the transmission are presented in terms of their certainty or uncertainty. Participants were randomly assigned to one of the four experimental conditions, being instructed to read one news article. After reading the news article assigned, participants were asked to respond to a series of questions to assess their cognitive and behavioral responses. RESULTS: Individuals were more susceptible to believing false COVID-19-related information when a certain threat and uncertain solution were framed in the news article. Moreover, individuals' perceptions of crisis severity increased when exposed to news information containing uncertain solutions. Both misinformation vulnerability and perceived severity were positively associated with information processing. Information seeking was positively associated with protective behavioral intention, whereas information avoidance was negatively associated with protective behavioral intention. CONCLUSIONS: Our findings imply that uncertainty, depending on its aspect, can be effectively communicated to the public during an emerging public health crisis. These results have theoretical and practical implications for health communicators and journalists. Given its limited influence on individuals' cognitive and behavioral responses, uncertainty related to a health threat should be disseminated to meet the public's expectation of information transparency. However, caution is advised when communicating uncertainty related to potential solutions, as this factor exhibited a mixed impact on individual responses during a crisis.

Scenario development for safety assessment in deep geologic disposal of high-level radioactive waste and spent nuclear fuel: A review.

Radiation and radioactive substances result in the production of radioactive wastes which require safe management and disposal to avoid risks to human health and the environment. To ensure permanent safe disposal, the performance of a deep geological repository for radioactive waste is assessed against internationally agreed risk-based standards. Assessing postclosure safety of the future system's evolution includes screening of features, events, and processes (FEPs) relevant to the situation, their subsequent development into scenarios, and finally the development and execution of safety assessment (SA) models. Global FEP catalogs describe important natural and man-made repository system features and identify events and processes that may affect these features into the future. By combining FEPs, many of which are uncertain, different possible future system evolution scenarios are derived. Repository licensing should consider both the reference or "base" evolution as well as alternative futures that may lead to radiation release, pollution, or exposures. Scenarios are used to derive and consider both base and alternative evolutions, often through production of scenario-specific SA models and the recombination of their results into an assessment of the risk of harm. While the FEP-based scenario development process outlined here has evolved somewhat since its development in the 1980s, the fundamental ideas remain unchanged. A spectrum of common approaches is given here (e.g., bottom-up vs. top-down scenario development, probabilistic vs. bounding handling of uncertainty), related to how individual numerical models for possible futures are converted into a determination as to whether the system is safe (i.e., how aleatoric uncertainty and scenarios are integrated through bounding or Monte Carlo approaches).

Foreign Language Learners' Uncertainty Experiences and Uncertainty Management.

Uncertainty is unavoidable in life; it is also an indispensable characteristic of educational settings. The process of learning a foreign language naturally involves interaction and coconstruction of knowledge. During this process, students may encounter uncertainty from a variety of sources, including the course, context, friends, or the teacher. Besides, to communicate meaningfully, the mutual effort of both the listener and the speaker is needed to deal with uncertainty. Considering this, the present study makes an effort to comprehend how learners appreciate and manage uncertainty in language learning environments. Although uncertainty is considered a multidisciplinary research topic, a limited number of studies are found in the literature which examine how students experience uncertainty and how they react to it. Regarding foreign language learning, related research focused on a specific form of uncertainty, Tolerance of Ambiguity, which is conceptualized as a cognitive style. In-class pen-and-paper surveys, reflective journals, video recordings, and stimulated recall interviews were the instruments used to gather data. The findings demonstrate that language learners frequently encounter uncertainty during the language learning process due to course-related, cognitive, and social factors, and learners may appreciate uncertainty in both positive and negative ways. Additionally, learners' emotional reactions to uncertainty depend on their positive or negative appraisals of uncertain situations. By recognizing and embracing uncertainty, language learners will adapt to it and be able to handle it through a variety of techniques. The results suggest that learners employ a variety of strategies, such as reducing, maintaining, and resolving uncertainty as well as ignoring uncertainty.

COVID-19-related uncertainty: fertility staff experiences of its sources, processing, responses, and consequences.

STUDY QUESTION: What are fertility staff experiences of managing COVID-19-related uncertainty after fertility clinics re-opened? SUMMARY ANSWER: Staff identified many COVID-19-related uncertainty sources, the main being the COVID-19 health threat, to which most clinics and staff responded effectively by implementing safety protocols and building strong collaborative environments that facilitated the acquisition and application of information to guide organizational responses during a rapidly changing situation, but with costs for staff and patients. WHAT IS KNOWN ALREADY: COVID-19 created significant disruption in fertility care delivery, including temporary clinic closure and treatment delay. Patients experienced significant distress, including concerns regarding the impact of COVID-19 and its vaccine on fertility and pregnancy. Multiple studies show that COVID-19-related uncertainty is a major threat and burden for healthcare staff, but this has not been investigated in reproductive medicine. STUDY DESIGN, SIZE, DURATION: A cross-sectional, online mixed-method bilingual (English, Spanish) survey (active 25 January-23 May 2021) was distributed to fertility staff across the UK, Latin America, and Africa. PARTICIPANTS/MATERIALS, SETTING, METHODS: Eligibility criteria were being a healthcare worker at a fertility clinic that had re-opened since its COVID-19-related closure, 18 years of age or older and ability to respond in English or Spanish. The survey was created in English, translated to Spanish, made available using Qualtrics, and consisted of four parts: (i) background and physical and mental wellbeing, (ii) open-ended questions regarding COVID-19 uncertainty, (iii) appraisal items regarding perceptions and impact of uncertainty, and (iv) changes in the workplace. The British Fertility Society and the African Network and Registry of Assisted Reproduction circulated the survey across the UK and Africa via email hyperlinks and social media platforms. The Argentinian Society of Reproductive Medicine and the Latin American Network of Assisted Reproduction distributed the survey across Latin America in the same manner. Thematic analysis was performed on responses from open-ended question to produce basic codes. Deductive coding grouped sub-themes across questions into themes related to the theory of uncertainty management. Descriptive statistics and repeated measures analysis of variance were used on the quantitative data. MAIN RESULTS AND THE ROLE OF CHANCE: In total, 382 staff consented to the survey, 107 did not complete (28% attrition), and 275 completed. Sixty-three percent were women, 69% were physicians, and 79% worked at private clinics. Thematic analysis produced 727 codes, organized in 92 sub-themes, and abstracted into 18 themes and one meta-theme reflecting that uncertainty is stressful but manageable. The types of uncertainties related to the threat of COVID-19 (20.6%), unpredictability of the future (19.5%), failure of communication (11.4%), and change in the workplace (8.4%). Staff appraisals of negative and positive impact of uncertainty were significantly lower (P < 0.001) than appraisals of stress, controllability, and having what it takes to cope with uncertainty. To process uncertainty, clinics focused on information dissemination (30.8%) and building a collaborative work environment (5.8%), while staff employed proactive coping (41.8%) and emotional and cognitive processing (9.6%). Main organizational responses consisted on work restructuring (41.3%, e.g. safety protocols), adapting to adversity (9.5%, e.g. supplies, preparation), and welfare support (13.8%), though staff perceived lack of support (17.5%). Negative consequences of uncertainty were worse self- and patient welfare (12.1%) and worse communication due to virtual medicine and use of mask (9.6%). Positive consequences were work improvements (8.3%), organizational adaptation (8.3%), improved relationships (5.6%), and individual adaptation (3.2%). Ninety-two percent of participants thought changes experienced in the workplace due to COVID-19 were negative, 9.1% nor negative nor positive, and 14.9% positive. Most staff thought that their physical (92.4%) and mental health (89.5%) were good to excellent. LIMITATIONS, REASONS FOR CAUTION: Participants were self-selected, and most were physicians and embryologists working at private clinics based in Latin America. The study did not account for how variability in national and regional COVID-19 policy shaped staff experiences of uncertainty. WIDER IMPLICATIONS OF THE FINDINGS: To address COVID-19 uncertainty, clinics need to promote collaborative (clinic, staff, patients) processing of uncertainty, clear team coordination and communication, organizational flexibility, and provision of support to staff and patients, with an emphasis on cognitive coping to decrease threat of and increase tolerance to uncertainty. Uncertainty management interventions bespoke to fertility care that integrate these components may increase clinics resilience to COVID-19-related and other types of uncertainty. STUDY FUNDING/COMPETING INTERESTS: Cardiff University funded this research. S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, speaker fees from Access Fertility, SONA-Pharm LLC, Meridiano Congress International, and Gedeon Richter, and grants from Merck Serono Ltd. F.Z.-H. reports speaker fees from Ferring Pharmaceuticals A/S and that he is a chair of the Latin American Registry of ART, Committee of Ethic and Public Policies, and Chilean Society of Obstetrics and Gynecology and a vice chair of the International Committee for monitoring ART. K.A., N.C., G.B., and J.B. report no conflict in relation to this work. TRIAL REGISTRATION NUMBER: N/A.

Managing Uncertainty for and With Family: Communication Strategies and Motivations in Familial Uncertainty Management for Hereditary Cancer.

The management of uncertainty is integral to health and illness. Individuals manage uncertainty about their health through communication enmeshed in family systems, but existing theorizing focuses on individuals without accounting for family processes. An iterative qualitative analysis of 42 dyadic, family interviews (N = 84) revealed (a) moments in the context of hereditary cancer that involved individual-centered and familial uncertainty appraisal and management, (b) family members' communication strategies to prompt relatives to engage familial uncertainty, and (c) the communicative (re)creation and negotiation of family models for uncertainty management. The findings illuminate tensions that individuals encounter across their lifespan as they appraise and manage uncertainty about hereditary cancer risks. This study extends uncertainty management theory to encompass familial uncertainty management and contributes insights useful for the management of hereditary cancer.

Measuring the Uncertainty in the Original and Negation of Evidence Using Belief Entropy for Conflict Data Fusion.

Dempster-Shafer (DS) evidence theory is widely used in various fields of uncertain information processing, but it may produce counterintuitive results when dealing with conflicting data. Therefore, this paper proposes a new data fusion method which combines the Deng entropy and the negation of basic probability assignment (BPA). In this method, the uncertain degree in the original BPA and the negation of BPA are considered simultaneously. The degree of uncertainty of BPA and negation of BPA is measured by the Deng entropy, and the two uncertain measurement results are integrated as the final uncertainty degree of the evidence. This new method can not only deal with the data fusion of conflicting evidence, but it can also obtain more uncertain information through the negation of BPA, which is of great help to improve the accuracy of information processing and to reduce the loss of information. We apply it to numerical examples and fault diagnosis experiments to verify the effectiveness and superiority of the method. In addition, some open issues existing in current work, such as the limitations of the Dempster-Shafer theory (DST) under the open world assumption and the necessary properties of uncertainty measurement methods, are also discussed in this paper.

Uncertainty Management and Decision Making: Parents' Experiences During their First Visit to a Multidisciplinary Clinic for their Child's Vascular Anomaly.

PURPOSE: To gain a better understanding of parental decision making in situations of uncertainty and multidisciplinary care, we explored parents' decision-making experiences while seeking care for their child's vascular anomaly at a multidisciplinary clinic at a large Midwestern children's hospital. DESIGN AND METHODS: We collected data using semi-structured interviews with 29 parents after they met with multiple specialists for the care of their child's vascular anomaly. RESULTS: The findings revealed parents' attempts to manage decision-related uncertainty about their child's vascular anomaly included seeking information, avoiding information, and seeking support from the specialists. Parents described how information management both facilitated and obstructed decision making. CONCLUSIONS: Overall, the study reveals several benefits and challenges of making decisions about the management of uncertain childhood conditions, like vascular anomalies, in a multidisciplinary context. The information-rich environment produces information-management dilemmas that challenge parents' decision making efforts. Therefore, parents relied on the support of the team of specialists to make decisions about their child's treatment. PRACTICE IMPLICATIONS: The study offers practical implications concerning the barriers of autonomy in decision making. Healthcare professionals should acknowledge the potential for parents' to have shifting information and decision-making goals and preferences, and should explicitly support parents throughout the decision-making process.

[Use of health information on the internet: personal and motivational influencing factors]. / Nutzung von Gesundheitsinformationen im Internet: personenbezogene und motivationale Einflussfaktoren.

BACKGROUND AND OBJECTIVES: Taking an active role in healthcare requires comprehensive health knowledge. One's own online search for health information can contribute to an appropriate information base. Therefore, it seems essential to determine the extent to which online services and health apps are currently used in Germany as well as to analyze which personal and motivational factors influence whether and how often the German public search for health information online or use health apps. METHODS: We conducted an online survey among the German public in a sample stratified by demographic characteristics (N = 3000). The questionnaire measured the health-related use of the Internet and health apps as well as possible personal and motivational factors. The relevance of these factors for explaining the Internet use for health-related purposes was determined by regression analyses. RESULTS: While health-related information searches using the Internet are widespread in Germany, health apps are used less frequently. In particular health information platforms are most frequently used to search for information on disease symptoms. Turning to the Internet for health-related purposes is mainly influenced by motivational factors. Having current health problems and possessing information-seeking skills are particularly influential factors for an individual's Internet use. CONCLUSIONS: In order to unfold the potential associated with health-related online information-seeking behaviors, it is necessary that people are motivated and feel competent to gather online information themselves. In particular, the corresponding skills need to be promoted in order to reduce the risk of increasing informational, health, and social disparities.

Incomplete Information Management Using an Improved Belief Entropy in Dempster-Shafer Evidence Theory.

Quantifying uncertainty is a hot topic for uncertain information processing in the framework of evidence theory, but there is limited research on belief entropy in the open world assumption. In this paper, an uncertainty measurement method that is based on Deng entropy, named Open Deng entropy (ODE), is proposed. In the open world assumption, the frame of discernment (FOD) may be incomplete, and ODE can reasonably and effectively quantify uncertain incomplete information. On the basis of Deng entropy, the ODE adopts the mass value of the empty set, the cardinality of FOD, and the natural constant e to construct a new uncertainty factor for modeling the uncertainty in the FOD. Numerical example shows that, in the closed world assumption, ODE can be degenerated to Deng entropy. An ODE-based information fusion method for sensor data fusion is proposed in uncertain environments. By applying it to the sensor data fusion experiment, the rationality and effectiveness of ODE and its application in uncertain information fusion are verified.

Deng Entropy Weighted Risk Priority Number Model for Failure Mode and Effects Analysis.

Failure mode and effects analysis (FMEA), as a commonly used risk management method, has been extensively applied to the engineering domain. A vital parameter in FMEA is the risk priority number (RPN), which is the product of occurrence (O), severity (S), and detection (D) of a failure mode. To deal with the uncertainty in the assessments given by domain experts, a novel Deng entropy weighted risk priority number (DEWRPN) for FMEA is proposed in the framework of Dempster-Shafer evidence theory (DST). DEWRPN takes into consideration the relative importance in both risk factors and FMEA experts. The uncertain degree of objective assessments coming from experts are measured by the Deng entropy. An expert's weight is comprised of the three risk factors' weights obtained independently from expert's assessments. In DEWRPN, the strategy of assigning weight for each expert is flexible and compatible to the real decision-making situation. The entropy-based relative weight symbolizes the relative importance. In detail, the higher the uncertain degree of a risk factor from an expert is, the lower the weight of the corresponding risk factor will be and vice versa. We utilize Deng entropy to construct the exponential weight of each risk factor as well as an expert's relative importance on an FMEA item in a state-of-the-art way. A case study is adopted to verify the practicability and effectiveness of the proposed model.

Exploratory Research Focusing on Oral Cancer Prevention: Challenges of Dealing With Informational and Cognitive Barriers.

Oral cancer is a considerable public health problem, and a low level of awareness and knowledge about this tumor and its risk factors is prevalent. To gain a profound understanding of risks groups and to identify suitable communication strategies for a prevention campaign in Northern Germany, an exploratory research was realized. In semistructured face-to-face interviews, the participants of the study (n = 28) described their individual oral cancer-related perceptions and information-seeking behaviors. A computer-assisted qualitative data analysis showed a vague but also deterring picture of cancer combined with restricted attitudes toward the topic and an inactive or even avoiding information behavior. Four underlying cognitive patterns of self-distancing were identified: (a) optimistic bias, (b) fatalism, (c) hedonism, and (d) pragmatism. The main challenge of oral cancer prevention is to deal with the target groups' informational and cognitive barriers.

A Novel Uncertainty Management Approach for Air Combat Situation Assessment Based on Improved Belief Entropy.

Uncertain information exists in each procedure of an air combat situation assessment. To address this issue, this paper proposes an improved method to address the uncertain information fusion of air combat situation assessment in the Dempster-Shafer evidence theory (DST) framework. A better fusion result regarding the prediction of military intention can be helpful for decision-making in an air combat situation. To obtain a more accurate fusion result of situation assessment, an improved belief entropy (IBE) is applied to preprocess the uncertainty of situation assessment information. Data fusion of assessment information after preprocessing will be based on the classical Dempster's rule of combination. The illustrative example result validates the rationality and the effectiveness of the proposed method.

"I Am Uncertain About What My Uncertainty Even Is": Men's Uncertainty and Information Management of Their BRCA-Related Cancer Risks.

Men with a germline pathogenic BRCA1 or BRCA2 variant have increased risks for developing breast, pancreatic, prostate, and melanoma cancers, but little is known about how they understand and manage their cancer risks. This study examines how men with BRCA-related cancer risks manage uncertainty and information about their risks. Twenty-five men who were either a BRCA carrier or have a BRCA-positive first-degree family member that put the participant at 50% chance of also being a BRCA carrier were interviewed for this study. Using uncertainty management theory as a theoretical framework, this study demonstrates that men manage uncertainty by seeking information from female family members, websites, and healthcare providers, and are under-informed about their cancer risks. Further, in handling their information, men prefer information about cancer risk percentages and screening recommendations in the form of lists presented to them via websites, printed literature, proactive healthcare providers, and an identifiable male spokesperson. Finally, men used BRCA-related cancer risk information to make decisions about whether or not to engage in screening and prevention, manage their BRCA-related cancer risks, and overall family well-being-yet often at the expense of their own individual risks. Implications for genetic counseling and family conversations are discussed.

A Review of the Bayesian Occupancy Filter.

Autonomous vehicle systems are currently the object of intense research within scientific and industrial communities; however, many problems remain to be solved. One of the most critical aspects addressed in both autonomous driving and robotics is environment perception, since it consists of the ability to understand the surroundings of the vehicle to estimate risks and make decisions on future movements. In recent years, the Bayesian Occupancy Filter (BOF) method has been developed to evaluate occupancy by tessellation of the environment. A review of the BOF and its variants is presented in this paper. Moreover, we propose a detailed taxonomy where the BOF is decomposed into five progressive layers, from the level closest to the sensor to the highest abstractlevelofriskassessment. Inaddition,wepresentastudyofimplementedusecasestoprovide a practical understanding on the main uses of the BOF and its taxonomy.

Deciding to institutionalize: caregiving crisis, intergenerational communication, and uncertainty management for elders and their children in Shanghai.

This phenomenological study integrated crisis theory, social identity theory, and uncertainty management theory to conceptualize the decision-making process around institutionalization among nursing home residents and their children in Shanghai. I conducted face-to-face, semistructured interviews with 12 dyads of matched elders and their children (N = 24). The findings suggest that caregiving crises triggered intergenerational communication about caregiving alternatives and new arrangements, although each generation had different stances and motivations. Children finalized the decision by helping their parents to manage the uncertainties pertaining to institutionalization. This study sheds light on caregiving decision-making dynamics for the increasing aging population across cultures.

Family support in the transition to adulthood in Portugal--its effects on identity capital development, uncertainty management and psychological well-being.

In a familistic southern European society such as the Portuguese, the family has historically played a prominent role in supporting the negotiation of transition pathways into adulthood. The present study aimed at capturing (1) the relative weight of parental financial support and autonomy support in contributing to the youngsters' psychological well-being (PWB), and (2) the mediating role of identity capital and uncertainty management in this relationship. A total of 620 participants completed measures of parental support, identity capital, uncertainty management and PWB. Autonomy support was found to be the strongest predictor of PWB, both directly and indirectly through its effects on identity capital and the use of target focused uncertainty management strategies. Conversely, financial support evidenced only a minor indirect impact through the mediation of tangible identity capital. Autonomy stimulation may constitute one of the most developmentally determinant family challenges in assisting the process of coming of age in Portugal.

Parental uncertainty in illness: managing uncertainty surrounding an "orphan" illness.

UNLABELLED: Parents of children with complex chronic illnesses experience substantial uncertainty that is heightened when the condition is an "orphan" illness not belonging to one medical specialty. The current study explores uncertainty experienced by parents of children with "orphan" illnesses requiring multidisciplinary care. METHOD: Participant-observations over 13 months (n=200) were combined with questionnaire data (n=55) to assess parental uncertainty at a multidisciplinary pediatric clinic. RESULTS: Five unique types of uncertainty emerged from a grounded analysis (Glaser & Strauss, 1967), revealing 11 interrelated uncertainties these parents experience. Findings can help providers understand parents' uncertainty and assist in family-centered decision-making.

Personal Health Planning in Adult-Child Former Caregivers of Parents Living With Dementia.

PURPOSE: To examine how former caregivers for parents living with dementia engage in personal health planning. DESIGN: An inductive, qualitative study. SETTING: Virtual, audio-recorded, semi-structured interviews. PARTICIPANTS: Thirty-two midlife former primary caregivers for parents who died following advanced dementia 3 months to 3 years prior. METHOD: Participants responded to a series of open-ended interview prompts. Interview recordings were transcribed and evaluated by a trained, diverse team to generate Consensual Qualitative Research (CQR) domains and categories. RESULTS: Caregivers developed health planning outlooks (ie, mindsets regarding willingness and ability to engage in personal health planning) that guided health planning activities (ie, engaging in a healthy lifestyle, initiating cognitive/genetic testing, maintaining independence and aging in place, ensuring financial and legal security). An agentic outlook involved feeling capable of engaging in health planning activities and arose when caregivers witnessed the impact and feasibility of their parents' health planning. Anxiety-inducing and present-focused outlooks arose when caregivers faced barriers (eg, low self-efficacy, lack of social support, perception that parent's health planning did not enhance quality of life) and concluded that personal health planning would not be valuable or feasible. CONCLUSION: Caregiving for a parent living with dementia (PLWD) shapes former caregivers' personal health planning. Interventions should support former caregivers who have developed low self-efficacy or pessimistic views on healthy aging to support them in addressing health planning activities.

Clinical advantages of incorporating predicted weekly anatomy in IMPT optimization with reduced setup error.

BACKGROUND: In head and neck (H&N) cancer treatment, a conventional setup error (SE) of 3mm is often used in robust optimization (cRO3mm). However, cRO3mm may lead to excessive radiation doses to organs at risk (OARs) and does not purposefully compensate for interfractional anatomy variations. PURPOSE: This study introduces a method using predicted images from an anatomical model and a reduced 1mm SE uncertainty for robust optimization (aRO1mm), aiming to decrease the dose to OARs without affecting the coverage of the clinical target volume (CTV). METHODS: This retrospective study involved 10 nasopharynx radiotherapy patients. Validation CT scans (vCT) from treatment weeks 1 to 6 were analyzed. A predictive anatomical model, designed to capture the average anatomical changes over time, provided predicted CT images for weeks 1, 3, and 5. We compared three optimization scenarios: (1) aRO1mm, using three predicted images with 1mm setup shift and 3% range uncertainty, (2) cRO3mm, with a robust 3mm setup shift and 3% range uncertainty, and (3) cRO1mm, a robust 1mm setup shift and 3% range uncertainty. The accumulated dose to CTVs and serial organs was evaluated under these uncertainties, while parallel OARs were assessed using the accumulated nominal dose (without errors). RESULTS: The accumulated volume receiving 94% of the prescribed dose (V94) for CTVs in cRO3mm exceeded 98%, meeting the clinical goal. For high-risk CTV, the minimum V94 was 96.44% in aRO1mm and 94.05% in cRO1mm. For low-risk CTV, these values were 97.68% in aRO1mm and 97.15% in cRO1mm. When comparing aRO1mm to cRO3mm on OARs, aRO1mm reduced normal tissue complication probability (NTCP) for grade ≥ $\ge$ 2 xerostomia and dysphagia by averages of 3.67% and 1.54%, respectively. CONCLUSION: aRO1mm lowers the radiation dose to OARs compared to the traditional approach, while maintaining adequate dose coverage on the target area. This method offers an improved strategy for managing uncertainties in radiation therapy planning for H&N cancer, enhancing treatment effectiveness.