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In a dyadic game, strategic asymmetric dominance occurs when a player's preference for one strategy A relative to another B is systematically increased by the addition of a third strategy Z, strictly dominated by A but not by B. There are theoretical and empirical grounds for believing that this effect should decline over repetitions, and other grounds for believing, on the contrary, that it should persist. To investigate this question experimentally, 30 participant pairs played 50 rounds of one symmetric and two asymmetric 3 × 3 games each having one strategy strictly dominated by one other, and a control group played 2 × 2 versions of the same games with dominated strategies removed. The strategic asymmetric dominance effect was observed in the repeated-choice data: dominant strategies in the 3 × 3 versions were chosen more frequently than the corresponding strategies in the 2 × 2 versions. Time series analysis revealed a significant decline in the effect over repetitions in the symmetric game only. Supplementary verbal protocol analysis helped to clarify the players’ reasoning and to explain the results.
We examine strategic sophistication using eight two-person 3 × 3 one-shot games. To facilitate strategic thinking, we design a ‘structured’ environment where subjects first assign subjective values to the payoff pairs and state their beliefs about their counterparts’ probable strategies, before selecting their own strategies in light of those deliberations. Our results show that a majority of strategy choices are inconsistent with the equilibrium prediction, and that only just over half of strategy choices constitute best responses to subjects’ stated beliefs. Allowing for other-regarding considerations increases best responding significantly, but the increase is rather small. We further compare patterns of strategies with those made in an ‘unstructured’ environment in which subjects are not specifically directed to think strategically. Our data suggest that structuring the pre-decision deliberation process does not affect strategic sophistication.
This paper presents the results of new research on two sarsen stones, known as the Cuckoo Stone and Tor Stone, both former standing stones that lie on opposite banks of the River Avon and straddle the eastern border of the Stonehenge and Avebury World Heritage Site. Geochemical analysis indicates that both stones were probably transported to their present site from West Woods on the Marlborough Downs in north Wiltshire, a source that likely also supplied the large sarsen monoliths at Stonehenge. The paper examines the geological conditions necessary for the formation of sarsen across the site of the present-day Salisbury Plain to address the apparent absence of natural sarsen in the area. The results are integrated with those of archaeological fieldwork from nearby contemporaneous sites to suggest that the Cuckoo Stone and Tor Stone were probably introduced into the Stonehenge landscape in the early part of the Late Neolithic period, ie, contemporary with Phase 1 of Stonehenge and some 400–500 years before the construction of the principal sarsen settings at the monument. Visibility analysis indicates that the two stones were probably intervisible and likely to have formed part of a planned landscape and were positioned to create a formal portal to the Stonehenge area on either bank of the River Avon.
Florentín Giménez (1925–2021) stands as one of the most prolific Paraguayan composers. Published in six Cancioneros (‘Songbooks’), his more than 800 canciones populares (‘folkloric or folk-style songs’) testify to his productivity and distinctive approach to this particular genre. Based on the examination of his six published Cancioneros, along with an analysis of Giménez’s musical recordings and personal interviews with the composer, this article first provides biographical context and introduces these songs through a series of representative cultural themes that emphasize some of Giménez’s ideas about musical and extra-musical expressions of cultural identity and Paraguayan nationalism. Following a discussion of Giménez’s vocal compositions, the article focuses on the composer’s self-proclaimed musical advocacy, and highlights three of his most iconic and widely known songs: ‘Así canta mi patria’ (‘Thus My Country Sings’), ‘Ka’aguype’ (‘In the Forest’) in the Guaraní language, and ‘Muy cerca de ti’ (‘Very Near You’). By considering these three Paraguayan folk-style songs, I aim to demonstrate that throughout his career, Giménez’s music has become illustrative of a cultural identity informed by Paraguayan music and socially imagined ideas, including the sentiment of nationalism, which he expresses through a profound admiration for his country.
With the announcement of the health technology assessment (HTA) review in Australia, a HTA Summit was organized by ISPOR Australia in November 2022. The aim of the Summit was to provide a forum for industry, academia, and patients to share ideas and find common ground with respect to HTA policy, processes, and methods. Topics were determined by a Steering Committee and included: managing uncertainty; patient engagement; second order effects; genetics, genomics and precision medicines; conditional listing; and real-world evidence. Presentations on each topic were conducted by industry and non-industry experts. Breakout sessions led by facilitators were also held for each topic with members of the audience.
Methods
Discussions were recorded during the event and a thematic analysis was performed.
Results
The following themes were identified from the event.
• There was a strong sentiment that participants enjoyed the opportunity to discuss ideas and work toward solutions.
• There was a consistent theme that many of the issues arising in HTA were due to a lack of communication between sponsors, evaluators, patients, and decision makers.
• It was noted that HTA encompasses several technical terms that have different meanings among various stakeholders.
• There was a clear consensus that patients should be involved in HTA earlier and throughout the process.
• HTA reform can help drive better access to real-world evidence.
• To improve the efficiency of the process, uncertainty could be reframed as risk management, which incorporates the effect of uncertainty in the funding decision.
• HTA includes policies, processes, and methods and is used as a tool by decision makers to make informed funding decisions. It was noted on several occasions during the Summit that funding decisions have a political element that should be separated from the HTA process.
Conclusions
It is possible to achieve better collaboration between industry, academic, and patient groups with respect to HTA reform. To promote more collaborative work a consistent conflict of interest definition would be helpful.
Until recently, the influence of basal liquid water on the evolution of buried glaciers in Mars' mid latitudes was assumed to be negligible because the latter stages of Mars' Amazonian period (3 Ga to present) have long been thought to have been similarly cold and dry to today. Recent identifications of several landforms interpreted as eskers associated with these young (100s Ma) glaciers calls this assumption into doubt. They indicate basal melting (at least locally and transiently) of their parent glaciers. Although rare, they demonstrate a more complex mid-to-late Amazonian environment than was previously understood. Here, we discuss several open questions posed by the existence of glacier-linked eskers on Mars, including on their global-scale abundance and distribution, the drivers and dynamics of melting and drainage, and the fate of meltwater upon reaching the ice margin. Such questions provide rich opportunities for collaboration between the Mars and Earth cryosphere research communities.
Trolley problems have been used in the development of moral theory and the psychological study of moral judgments and behavior. Most of this research has focused on people from the West, with implicit assumptions that moral intuitions should generalize and that moral psychology is universal. However, cultural differences may be associated with differences in moral judgments and behavior. We operationalized a trolley problem in the laboratory, with economic incentives and real-life consequences, and compared British and Chinese samples on moral behavior and judgment. We found that Chinese participants were less willing to sacrifice one person to save five others, and less likely to consider such an action to be right. In a second study using three scenarios, including the standard scenario where lives are threatened by an on-coming train, fewer Chinese than British participants were willing to take action and sacrifice one to save five, and this cultural difference was more pronounced when the consequences were less severe than death.
Theories of trust distinguish general trust in situations of social uncertainty from assurance-based trust in committed, long-term relationships. This study investigates European-Japanese differences using the Centipede game, in which two players choose between cooperation and defection. The game models repeated reciprocal interactions, necessitating assurance-based trust to sustain cooperation. We included game conditions offering players the option of purchasing commitment-enhancing tools to increase social certainty. Japanese participants were more cooperative than Europeans, confirming higher assurance-based trust, and also purchased more commitment-enhancing tools, demonstrating their preferences for social certainty. Purchase of commitment-enhancing tools improved cooperativeness in both groups. However, if co-players refused tool purchase, the Japanese appeared to interpret this as non-cooperative intent and cooperativeness in the respective games decreased.
Bias Blind Spot (BBS) is the phenomenon that people tend to perceive themselvesas less susceptible to biases than others. In three pre-registered experiments(overall N = 969), we replicated two experiments of the first demonstration ofthe phenomenon by Pronin et al. (2002). We found support of the BBS hypotheses,with effects in line with findings in the original study: Participants ratedthemselves as less susceptible to biases than others (d =–1.00 [–1.33, –0.67]). Deviating from the original, wefound an unexpected effect that participants rated themselves as having fewershortcomings (d = –0.34 [–0.46, –0.23]),though there was support for the target’s main premise that BBS wasstronger for biases than for shortcomings (d = –0.43[–0.56, –0.29]). Extending the replications, we found that beliefsin own free will were positively associated with BBS (r ∼0.17–0.22) and that beliefs in both own and general free will werepositively associated with self-other asymmetry related to personal shortcomings(r ∼ 0.16–0.24). Materials, datasets, andcode are available on https://osf.io/3df5s/.
In a recent article in this journal, Duijf claims to have proved that team reasoning can be viewed as a payoff transformation. His formalization mimics team reasoning but ignores its essential agency switch. The possibility of such a payoff transformation was never in doubt, does not imply that team reasoning can be viewed as a payoff transformation, and makes no sense in a game in which payoffs represent players’ utilities. A theorem is proved here that a simpler and more intuitive payoff transformation can mimic any theory that predicts what strategies players will choose in a well-defined game.
This study examined the effectiveness of an integrated care pathway (ICP), including a medication algorithm, to treat agitation associated with dementia.
Design:
Analyses of data (both prospective and retrospective) collected during routine clinical care.
Setting:
Geriatric Psychiatry Inpatient Unit.
Participants:
Patients with agitation associated with dementia (n = 28) who were treated as part of the implementation of the ICP and those who received treatment-as-usual (TAU) (n = 28) on the same inpatient unit before the implementation of the ICP. Two control groups of patients without dementia treated on the same unit contemporaneously to the TAU (n = 17) and ICP groups (n = 36) were included to account for any secular trends.
Intervention:
ICP.
Measurements:
Cohen Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory Questionnaire (NPIQ), and assessment of motor symptoms were completed during the ICP implementation. Chart review was used to obtain length of inpatient stay and rates of psychotropic polypharmacy.
Results:
Patients in the ICP group experienced a reduction in their scores on the CMAI and NPIQ and no changes in motor symptoms. Compared to the TAU group, the ICP group had a higher chance of an earlier discharge from hospital, a lower rate of psychotropic polypharmacy, and a lower chance of having a fall during hospital stay. In contrast, these outcomes did not differ between the two control groups.
Conclusions:
These preliminary results suggest that an ICP can be used effectively to treat agitation associated with dementia in inpatients. A larger randomized study is needed to confirm these results.
This systematic review aimed to provide a synthesis of the evidence relating to how the provision of vitamin D supplements influences oral health status. An electronic database search was performed across six databases using a standardised search strategy. The PICO framework (Population, Intervention, Comparison, Outcome) was used to define the review question. The screening and selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses process (PRISMA). The quality of reporting was assessed using Consolidated Standards of Reporting Trials (CONSORT) guidelines, and the bias was assessed using the revised Cochrane tool RoB2. A total of 1812 studies were retrieved. 1427 studies were excluded due to unmet inclusion criteria. Full texts of seventy-five potential studies were retrieved and ultimately six studies met the inclusion criteria. There were limitations in the quality of reporting of studies (between 49 % and 73 %). 70 % of the risk of bias items were in the low risks category. Vitamin D interventions varied with respect to dosage and duration. Qualitative syntheses identified significantly better oral health outcomes. Heterogeneity of study design, intervention and outcomes precluded quantitative synthesis. Few clinical trials investigated the effect of vitamin D supplementation on oral health. There is considerable heterogeneity among studies interventions and oral health outcomes. Quality of reporting of studies has limitations and there is evidence of study biases. Nonetheless, qualitative synthesis of the evidence suggests that vitamin D supplements improve oral health outcomes, particularly periodontal health. Calcium may also play a significant role. Further high-quality trials are required of comparable vitamin D supplements with similar oral health outcomes focused to inform quantitative synthesis of the evidence.
Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations.
Methods
This study is based on 15 963 mother–child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques.
Results
Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased.
Conclusions
This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.
Improving long-term outcomes like target lesions revascularizations (TLRs) is a focus for endovascular interventions aimed at treating symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a paclitaxel-eluting drug-eluting stent (DES) was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent in the IMPERIAL trial, a global, randomized controlled study. This budget-impact evaluation investigated cost-savings from Eluvia-use when compared with Zilver PTX, relying on the 12- to 24-month outcomes from the IMPERIAL trial.
Methods
A budget-impact model comparing Eluvia and Zilver PTX was developed from the Australian public healthcare payer, and an individual hospital perspective, with a 5-year time-horizon. Observed trial results were applied to each year's incident population and associated costs, and no extrapolation was conducted. The analysis used publicly available Australian national hospital cost data, population estimates, procedural statistics, epidemiological literature, and data from public hospital audits to verify eligible population for endovascular procedures (EVP) including DES. All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020).
Results
Assuming 80-percent EVP eligibility, and a DES-use range of 10–28 percent, the 5-year model estimated potential national savings of AUD 4.3–12.1 million (M) [USD 3–8.3M] to the public healthcare payer, driven by reduced TLRs from Eluvia-use compared with Zilver-PTX. The model projected potential national savings of AUD 33.1–92.6M (USD 22.8–63.9M) to individual hospitals through reduced hospital bed days for adverse events (AE). The model forecasted 14,428–40,399 treated patients; 1,499–4,198 fewer TLRs; and 16,515–46,243 fewer hospital days for AE. At a state level, projected hospital savings were: New South Wales AUD 10.9–30.7M [USD 7.5–21.1M]; Victoria AUD 8.4–23.4M [USD 5.8–16.1M]; Queensland AUD 6.5–18.3M [USD 4.5–12.6M]; Western Australia AUD 3.4–9.5M [USD 2.3–6.5M]; South Australia AUD 2.3–6.4M [USD 1.6–4.4M].
Conclusions
Treatment of symptomatic lower-limb PAD with the Eluvia DES could lead to potential savings for the Australian healthcare system, at the national, state, and the local hospital level, based on improved patient outcomes.
Seismic-reflection surveys of the Isle Royale sub-basin, central Lake Superior, reveal two large end moraines and associated glacial sediments deposited during the last cycle of the Laurentide Ice Sheet in the basin. The Isle Royale moraines directly overlie bedrock and are cored with dense, acoustically massive till intercalated down-ice with acoustically stratified outwash. Till and outwash are overlain by glacial varves, a lower red unit and an upper gray unit.
The maximum extent of late Younger Dryas-age readvance into the western Lake Superior basin is uncertain, but it was probably controlled by both ice dynamics and climate. Our data indicate that during retreat from the maximum, the ice paused just long enough to construct the outer of the two moraines, >100 m high, and then retreated to the inner moraine, during which time most of the lower glacial-lacustrine sequence (red varves) was deposited. Retreat from the inner moraine coincided with a marked flux of icebergs at the calving margin and a change to gray varves. Rapid retreat may be related to both an influx of meltwater from Glacial Lake Agassiz about 10,500 cal yr BP and retreat of the calving margin down an adverse slope into the Isle Royale sub-basin.
To assess if patients follow-up with discharge advice after psychiatric assessment and discharge from Emergency Department (ED).
Method:
All patients with psychiatric complaint who presented at three ED's in Edmonton, Alberta, Canada were identified via ED Information System (EDIS). Patients presenting complaint were entered onto the EDIS by Triage Nurse along with demographic information. All charts were reviewed and clinical data was obtained. Patients who were assessed by Psychiatry and discharged home were contacted via telephone to determine if they followed-up with discharge advice of psychiatry team.
Results:
A total of 1420 patients have been identified during April and May 2008.Chart review has been completed. Data entry and follow-up is in progress. Preliminary data of 250 patients is presented here. 55% were male. Mean age 37 years (SD 12). 47% presented voluntarily. Psychiatry was consulted for 53% of patients. The presenting complaint was “Suicidal Ideation” in 29% and “Bizarre behaviour” in 24%. Primary diagnoses for those seen by Psychiatry were mood disorder (30%) and psychotic disorder (26%). Out of those seen by Psychiatry 36% were admitted. 44% of those admitted by psychiatry were diagnosed with psychotic disorder followed by mood disorder in 31%. The patients who were discharged home by Psychiatry were advised to follow up with their family doctor 7%, psychiatrist 15%, outpatient psychiatry services 16% and addiction services 16%.
Conclusion:
This is the first report of outcome of discharge advice and will help in developing and planning community follow-up system for psychiatric patients.