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M L DeKay

Publications and source records attributed to M L DeKay.

8 recordsLinked to original sources
PubMed2000

Categorizing risks for risk ranking.

Any practical process of risk ranking must group hazards into a manageable number of categories. Defining such categories requires value choices that can have important implications for the rankings that result. Most risk-management organizations will find it useful to begin defining categories in terms of environmental loadings or initiating events. However, the resulting categories typically need to be modified in light of other considerations. Risk-ranking projects can benefit from considering several alternative categorization strategies and drawing upon elements of each in developing their final categorization of risks. In principle, conducting multiple ranking exercises by using different categorizations could be interesting and useful. In practice, agencies are unlikely to have either the resources or patience to do this, but other groups in society might. Done well, such additional independent rankings could add valuable inputs to democratic risk-management decision making.

Air Pollution, Indoor↗
PubMed1997

Euthanasia among US critical care nurses. Practices, attitudes, and social and professional correlates.

OBJECTIVES: The authors sought to identify associations between critical care nurses' self-reported participation in euthanasia, their social and professional characteristics, and their attitudes toward end-of-life care. METHODS: Data were collected through an anonymous mail survey of 1,560 US critical care nurses, of whom 1,139 (73%) responded. Nurses were asked to report whether they had received requests to engage in euthanasia and whether they had engaged in euthanasia. In addition, nurses were asked to respond to items assessing their attitudes toward end-of-life care. RESULTS: Of 852 nurses who identified themselves as practicing exclusively in adult intensive care units, 164 (19%) reported that they had engaged in euthanasia, 650 (76%) reported that they had not engaged in euthanasia, and 38 (4%) could not be classified. Only 30% of respondents believed that euthanasia is unethical. Logistic regression indicated that older nurses, more religious nurses, nurses practicing in cardiac care units, and nurses with less favorable attitudes toward euthanasia were significantly less likely to report having engaged in euthanasia, although the effects of age and religious beliefs appear to have been mediated by attitudes. CONCLUSIONS: These results help explain why some US critical care nurses engaged in euthanasia despite legal and professional prohibitions against it. Because critical care nurses may have a special understanding of the needs of critically ill patients, these results may indicate that current guidelines for end-of-life care are inadequate.

Adult↗
PubMed1996

Cost-effectiveness analysis in a setting of budget constraints--is it equitable?

BACKGROUND: One of the promises of cost-effective analysis is that it can demonstrate how to maximize health benefits attainable within a specific limited budget. Many people argue, however, that when there are budget limitations, the use of cost-effectiveness analysis leads to health care policies that are inequitable. METHODS: We asked prospective jurors, medical ethicists, and experts in medical decision making to choose between two screening tests for a population at low risk for colon cancer. One test was more cost effective than the other but because of budget constraints was too expensive to be given to everyone in the population. With the use of the more effective test for only half the population, 1100 lives could be saved at the same cost as that of saving 1000 lives with the use of the less effective test for the entire population. RESULTS: Fifty-six percent of the prospective jurors, 53 percent of the medical ethicists, and 41 percent of the experts in medical decision making recommended offering the less effective screening test to everyone, even though 100 more lives would have been saved by offering the more expensive test to only a portion of the population. Most of the study participants justified this recommendation on the basis of equity. A smaller number stated either that it was not politically feasible to offer a test to only half the population or that the additional benefit of the more expensive test (100 more lives saved) was too small to justify offering it to only a portion of the public. CONCLUSIONS: People place greater importance on equity than is reflected by cost-effectiveness analysis. Even many experts in medical decision making -- those often responsible for conducting cost-effectiveness analyses -- expressed discomfort with some of its implications. Basing health care priorities on cost effectiveness may not be possible without incorporating explicit considerations of equity into cost-effectiveness analyses or the process used to develop health care policies on the basis of such analyses.

Colonic Neoplasms↗
PubMed1994

Aggregating social behavior into person models: perceiver-induced consistency.

Two experiments explored the role of perceivers (judges) in aggregating social behavior into impressions. In Experiment 1, it was predicted and found that judges influence impressions (i.e., eye-of-the-beholder effects) not only because they disagree on how to interpret single acts but because they aggregate multiple acts in unique ways to arrive at idiosyncratic impressions. Using D. A. Kenny's (1991) general model of accuracy and consensus, it was found that judges perceived much greater consistency in the behavior of targets across situations when they were asked to aggregate the behavior than when they were not. Differential interpretation of single acts did not change as a function of aggregating behavior. This aggregation process was characterized as the construction of models of persons. In Experiment 2, the concept of person models was explored further, and it was argued that perceivers develop these models on the basis of what is viewed as the central concept of a target. For any given target, a limited number of models can be identified, and different perceivers develop different models. The particular model formed has implications for the perceiver's underlying memory representation and the perceived personality profile of the target.

Adult↗
PubMed1990

Representational momentum in memory for pitch.

When a visual pattern is displayed at successively different orientations such that a rotation or translation is implied, an observer's memory for the final position is displaced forward. This phenomenon of representational momentum shares some similarities with physical momentum. For instance, the amount of memory shift is proportional to the implied velocity of the inducing display; representational momentum is specifically proportional to the final, not the average, velocity; representational momentum follows a continuous stopping function for the first 250 ms or so of the retention interval. In a previous paper (Kelly & Freyd, 1987) we demonstrated a forward memory asymmetry using implied changes in pitch, for subjects without formal musical training. In the current paper we replicate our earlier finding and show that the forward memory asymmetry occurs for subjects with formal musical training as well (Experiment 1). We then show the structural similarity between representational momentum in memory for pitch with previous reports of parametric effects using visual stimuli. We report a velocity effect for auditory momentum (Experiment 2), we demonstrate specifically that the velocity effect depends on the implied acceleration (Experiment 3), and we show that the stopping function for auditory momentum is qualitatively the same as that for visual momentum (Experiment 4). We consider the implications of these results for theories of mental representation.

Adult↗
PubMedDate not supplied

Further explorations of medical decisions for individuals and for groups.

BACKGROUND: Important discrepancies between clinical practice and health policy may be related to the ways in which physicians and others make decisions about individuals and groups. Previous research has found that physicians and laypersons asked to consider an individual patient generally make different decisions than those asked to consider a group of comparable patients, but this discrepancy has not been observed in more recent studies. This study was designed to explore possible reasons for these findings. METHODS: Prospective jurors (N = 1,013) each made a recommendation regarding a risky treatment for an incurable blood condition. Perspective (individual vs group) was crossed with uncertainty frame (probability vs frequency) and response wording (original vs revised) in a 2 x 2 x 2 between-participants design. RESULTS: When the strength of participants' recommendations was considered, the effects of perspective, uncertainty frame, and response wording were not statistically significant. When recommendations were dichotomized, participants in the revised-response-wording conditions were more likely to recommend treatment to the group than to the individual. CONCLUSIONS: These results conflict with previous findings for this scenario and suggest that reported differences between decisions for individuals and decisions for groups are not robust.

Adolescent↗
PubMedDate not supplied

Is the defensive use of diagnostic tests good for patients, or bad?

Physicians sometimes order diagnostic tests to reduce the risk of malpractice liability. The authors develop an expected-utility model that links a rational physician's concerns about malpractice liability to increases in the use of diagnostic tests and use this model to assess the effects of defensive testing on patients' interests. To do so, they adapt the threshold approach to clinical decision making to incorporate the physician's interests, focusing on 1) the effect of the physician's expected liability risks and 2) the effect of any expected liability reduction due to diagnostic testing. Surprisingly, the mere existence of liability risks is often sufficient to widen the range of disease probabilities for which diagnostic testing is the preferred clinical strategy. If testing reduces the physician's expected liability risks, the testing range is widened further. For some disease probabilities, testing is preferred by the physician even though it is not in the patient's best interests. When tests are performed in such instances, utility is transferred from the patient to the physician and the physician's insurer. Although the defensive use of diagnostic tests improves clinical outcomes for some patients, it worsens clinical outcomes for others. Moreover, defensive testing worsens the expected outcomes of all patients whose clinical strategies are changed. Physicians should realize that defensive testing necessarily reduces the overall quality of patient care.

Decision Making↗