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PubMed2000

An expert judgment model applied to estimating the safety effect of a bicycle facility.

This paper presents a risk index model that can be used for assessing the safety effect of countermeasures. The model estimates risk in a multiplicative way, which makes it possible to analyze the impact of different factors separately. Expert judgments are incorporated through a Bayesian error model. The variance of the risk estimate is determined by Monte-Carlo simulation. The model was applied to assess the safety effect of a new design of a bicycle crossing. The intent was to gain safety by raising the crossings to reduce vehicle speeds and by making the crossings more visible by painting them in a bright color. Before the implementations, bicyclists were riding on bicycle crossings of conventional Swedish type, i.e. similar to crosswalks but delineated by white squares rather than solid lines or zebra markings. Automobile speeds were reduced as anticipated. However, it seems as if the positive effect of this was more or less canceled out by increased bicycle speeds. The safety per bicyclist was still improved by approximately 20%. This improvement was primarily caused by an increase in bicycle flow, since the data show that more bicyclists at a given location seem to benefit their safety. The increase in bicycle flow was probably caused by the new layout of the crossings since bicyclists perceived them as safer and causing less delay. Some future development work is suggested. Pros and cons with the used methodology are discussed. The most crucial parameter to be added is probably a model describing the interaction between motorists and bicyclists, for example, how risk is influenced by the lateral position of the bicyclist in relation to the motorist. It is concluded that the interaction seems to be optimal when both groups share the roadway.

Acceleration↗

PubMed2002

Stimulus motion and retrospective time judgments.

The effect of stimulus motion on retrospective time judgments was investigated in four experiments. Subjects reproduced the duration of a 32-s interval which was filled by either a stationary or moving visual element presented on a computer monitor. In Experiments 1 and 4, the element moved horizontally back and forth, and in Experiments 2 and 3 it traced a circular pathway. In Experiments 1 and 2, the element moved at speeds of either 5 or 20 cm/s. In Experiment 3, it moved at a constant speed, alternating direction between clockwise and anti-clockwise rotation once every 1, 4, 8 or 16 s. In Experiment 4 the element moved at linear speeds of 1, 2, 4, 8 or 16 cm/s back and forth along a 16 cm horizontal path thereby alternating between left- and rightward motion-directions once every 16, 8, 4, 2 and 1 s, respectively. Temporal reproductions were not systematically influenced by stimulus speed. Rather, the pattern of results indicated a nonmonotonic relationship between remembered duration and the frequency of motion-direction changes; whereas remembered duration was unaffected by either infrequent or very frequent rates of changes, moderate rates of motion-changes lengthens remembered duration. These findings are discussed in relation to the change models of retrospective timing, and the claim that stimulus speed, as distinct from changes in the direction of stimulus motion, is not an important determinant of retrospective timing.

Adult↗

PubMed1999

Determinants of dentists' decisions to initiate dental implant treatment: a judgment analysis.

STATEMENT OF PROBLEM: Do psychosocial patient characteristics influence the decision of a dentist in recommending implant treatment? PURPOSE: This study assessed the importance that dental general practitioners attach to psychosocial patient characteristics when judging the suitability of these patients for dental implant treatment. METHOD AND MATERIAL: The judgment strategy of 30 Dutch dental practitioners was studied by using 2 tasks. Dentists first judged a series of written scenarios representing fictitious patients, each patient being characterized by 4 psychosocial aspects to determine the patients' suitability for implant treatment. The second task involved rank ordering 14 patient characteristics according to their importance in implant treatment decisions. RESULTS: Dentists judged the personal appearance of the patient and, to a lesser degree, the patient's socioeconomic status to influence decisions to treat. However, these characteristics are ranked as quite unimportant in decision making, whereas motivation, oral hygiene, and level of neuroticism were the most important patient characteristics. CONCLUSIONS: The results on the 2 tasks were clearly not in agreement. There was a substantial disagreement between what dentists say to be important characteristics (rank order task) and the characteristics they actually use to judge the suitability for implant treatment (scenario task). Moreover, it appeared that agreement among the dentists is quite low, especially for the scenario task.

Analysis of Variance↗

PubMed1999

The temporal order judgment paradigm: subcortical attentional contribution under exogenous and endogenous cueing conditions.

The role of subcortical attentional processing was investigated under exogenous and endogenous cueing conditions. As retinotectal projections arise predominantly from the nasal retina i.e., temporal hemifield, subcortical attention should be distributed asymmetrically under monocular viewing conditions with a temporal hemifield advantage. We compared the results of monocular and binocular viewing conditions using a temporal order judgment (TOJ) paradigm. Subjects fixated a centrally located cross and two stimuli were presented with a variable onset asynchrony. Three experiments were conducted: no cue, exogenous cue and endogenous cue. Subjects reported which stimulus seemed to appear first. An effect consistent with subcortical processing was found under exogenous cueing conditions. No such effect was found under endogenous cueing conditions. We believe that subcortical attentional processing in response to an exogenous cue facilitates rapid shifts in attention towards environmental stimuli. We found no evidence for subcortical processing in voluntary directed attention and believe this process to be cortical in nature.

Adolescent↗

PubMed2001

Examining child sexual abuse evaluations: the types of information affecting expert judgment.

OBJECTIVE: There were two aims: First, to determine to what extent four variables, disclosure, doll play, affect and collateral information, affect the decision-making processes of child sexual abuse experts and lay persons when confronted with an abuse allegation, and second, to see how these two groups of raters might differ from one another. METHOD: A randomized block partially confounded factorial design was used. Participants made abuse likelihood and confidence ratings in response to six hypothetical cases of child sexual abuse, four of which had varying combinations of the four types of information and two of which were constant across all raters. Participants also completed attitudes and knowledge questionnaires. RESULTS: Disclosure and collateral information both had large effects on both rater groups. Doll play and affect had little or no effect on the decisions of either group. Experts were slightly more conservative in their judgments over all than students were. Experts also displayed more knowledge of the sexual abuse literature and more child-believing attitudes than their student counterparts. CONCLUSION: Concrete information such as disclosure statements and collateral information affected abuse decisions while inferential data such as doll play and affect did not. The goal of these evaluations may be the clarification of such concrete information and the inferential data may be used only to guide one's inquiry. This conclusion argues against the concern that experts might jump to conclusions of abuse merely based upon suggestive, symbolic material.

Adult↗

PubMed2001

A Web-based survey method for evaluating different components of uncertainty in relative health risk judgments.

Uncertainty permeates the process of risk assessment. It arises from recognized sources such as inadequacy of toxicological data, lack of exposure information, and imprecise identification of sensitive populations. In addition to these ambiguities, comparative risk exercises, which amount to risk assessment on a scale wider than that applied to single agents, also entail balancing community values, cost-benefit analyses, and other factors not directly tied to toxicology. Such exercises often convene evaluation panels to attempt a ranking of different stressors or stressor groups. The size of these panels is necessarily limited, and they usually strive to reach some form of consensus on ranking. Because ordinal assignments of risk are so difficult to achieve, they actually evolve into rating agendas in which stressors are categorized as high, medium, or low risks. Whether ranking or rating is its aim, this process, with its emphasis on agreement, usually overlooks two major components of uncertainty. One is variability among raters in assigning a score or category. The other is the degree of uncertainty they implicitly attach to their individual ratings. Both serve as guides to the scope and clarity of the available information. To gather more information about these critical but usually overlooked contributions to uncertainty, and, simultaneously, to query a broader sample of respondents, a survey method was designed to exploit the possibilities of electronic communication based on the World Wide Web. This method can secure risk ratings of selected stressors from many different samples of respondents. In addition, it can also provide information about the extent of ratings variability among risk assessors, individuals, or groups of respondents, about the bases of the ratings, and, concurrently, the confidence they place in their judgment. Comparative risk endeavors conducted in this format make their aims and content easy to modify. Data obtained by such a method can serve as pointers to new research initiatives, to regulator priorities, or to further iterations.

Data Collection↗

PubMed2001

The rush to judgment: Does the evidence support the enthusiasm over three-dimensional conformal radiation therapy and dose escalation in the treatment of prostate cancer?.

PURPOSE: To discuss the assumptions behind and current clinical evidence on three-dimensional conformal radiation therapy (3D-CRT) and dose escalation in the treatment of prostate cancer. METHODS: We first define 3D-CRT in comparison to standard radiation therapy and discuss the assumptions on which the technology of 3D-CRT and dose escalation are based. We then examine the evidence on the benefits and limitations from the current most commonly cited studies on dose-escalation trials to treat prostate cancer. RESULTS: The assumption that 3D-CRT can provide a tighter margin around the tumor area to allow for dose escalation is not yet proven by studies that show continual difficulty in defining the planning treatment volume because of extrinsic and intrinsic difficulties, such as imaging variabilities and patient and organ movement. Current short-term dose-escalation studies on the use of 3D-CRT to treat prostate cancer are limited in their ability to prove that increasing dose improves survival and does not incur potential long-term complications to normal tissue. CONCLUSION: Although 3D-CRT is a promising technology that many radiation oncologists and clinics are quickly adopting to treat such tumors as prostate cancer, the long-term evidence on the benefits and limitations of this technology is still lacking. Until we have solid long-term evidence on the true clinical potential of this new technology, let us not rush to judgment, but exercise caution, diligence, and thoughtfulness in using this new technology to treat our patients.

Clinical Trials as Topic↗

PubMed2001

Reinstatement of acquisition performance by the presentation of the outcome after extinction in causality judgments.

Two experiments were conducted with the aim of exploring reinstatement after extinction using a causality judgment task in human beings. In Experiment 1, participants learned first that a fictitious medicine produced a side-effect. The medicine was then presented in extinction. Re-exposure to the side-effect by itself before the test reinstated acquisition performance. Reinstatement was greater when exposure took place in the test context than when it took place in a different context. Experiment 2 replicated reinstatement in a situation that ensured equivalent extinction for the different groups before the test.

Journal Article↗

PubMed2000

An inference modeling of human visual judgment of sagittal jaw-base relationships based on cephalometry: part II.

In a clinical situation, visual judgment of sagittal jaw-base relationships is described and handled as fuzzy terms, such as "slight" skeletal 3 tendency or "relatively severe" skeletal 2. The purpose of this study was to develop an inference system in order to be able to describe the degree of certainty for sagittal skeletal discrepancy automatically and in a mathematical way. Orthodontic records of 137 adult female patients were judged by 3 orthodontists. Based on these data and the multiple regression model described in Part I of this study, we developed an inference system that consisted of 2 membership functions and 6 incorporating rules. The performance reliability of the system was tested for 175 female adult cases by 7 orthodontic experts. In 97% (170 of 175) of the cases, the orthodontic experts agreed with advice proposed by the inference system. We conclude that the current model is an effective means of deriving the opinion of an experienced clinician from a cephalometric tracing and provides an interesting insight into how orthodontists are influenced by the face when attempting to judge the sagittal relationship clinically. In addition, the current system would be an initial stage in the development of the decision-making system for the orthodontic diagnosis and treatment planning.

Adult↗

PubMed2003

Semantically convergent and semantically divergent priming in the cerebral hemispheres: lexical decision and semantic judgment.

The effects of semantically divergent and semantically convergent priming on the processing of lexical ambiguity by the two cerebral hemispheres were examined in two visual hemifield experiments. The experiments investigated the ability of the right hemisphere (RH) and the left hemisphere (LH) to summate activation from two single word primes followed by a laterally presented ambiguous target word. In a lexical decision task (experiment 1), the two priming words were either both related to the dominant meaning of the target (new, fresh-NOVEL), or to the subordinate meaning (story, book-NOVEL), or to one dominant and one subordinate meaning (new, story-NOVEL). Results indicated that the LH benefited most from semantically convergent primes that converged onto the dominant meaning of the ambiguous target word, whereas the RH benefited most from semantically mixed (divergent) primes, that diverge on alternate meanings of the ambiguous target word. We used the same stimuli in a semantic relatedness judgment task (experiment 2), and found that the facilitation in the RH was significantly larger when the primes were mixed than when both primes converged on a single (i.e. either dominant or subordinate) meaning of the to-be-presented target word. In contrast, the only facilitation found in the LH was when the two primes were associated with a single meaning (either dominant or subordinate) of the to-be-presented target word. When the primes were mixed, there was no facilitation in the LH. These results support previous findings indicating that during word recognition, the RH activates a broader range of related meanings than the LH, including alternate meanings of ambiguous words. Thus, by summating activation for seemingly incongruous elements, the RH may be critically involved in at least one important component of verbal creativity.

Adolescent↗

PubMed2003

Right hemisphere control of visuospatial attention: line-bisection judgments evaluated with high-density electrical mapping and source analysis.

The "line-bisection" task has proven an especially useful clinical tool for assessment of spatial neglect syndrome in neurological patients. Here, we investigated the neural processes involved in performing this task by recording high-density event-related potentials from 128 scalp electrodes in normal observers. We characterized a robust net negative potential from 170-400 ms poststimulus presentation that correlates with line-bisection judgments. Topographic mapping shows three distinct phases to this negativity. The first phase (approximately 170-190 ms) has a scalp distribution exclusively over the right parieto-occipital and lateral occipital scalp, consistent with generators in the region of the right temporo-parietal junction and right lateral occipital cortices. The second phase (approximately 190-240 ms) sees the emergence of a second negative focus over the right central parietal scalp, consistent with subsequent involvement of right superior parietal cortices. In the third phase (approximately 240-400 ms), the topography becomes dominated by this right central parietal negativity. Inverse source modeling confirmed that right hemisphere lateral occipital, inferior parietal, and superior parietal regions were the likeliest generators of the bulk of the activity associated with this effect. The line stimuli were also presented at three contrast levels (3, 25, and 100%) in order to manipulate both the latency of stimulus processing and the relative contributions from magnocellular and parvocellular inputs. Through this manipulation, we show that the line-bisection effect systematically tracks/follows the latency of the N1 component, which is considered a temporal marker for object processing in the ventral visual stream. This pattern of effects suggests that this task invokes an allocentric (object-based) form of visuospatial attention. Further, at 3% contrast, the line-bisection effect was equivalent to the effects seen at higher contrast levels, suggesting that parvocellular inputs are not necessary for successful performance of this task.

Adult↗

PubMed2003

fMRI of emotional responses to odors: influence of hedonic valence and judgment, handedness, and gender.

Previous positron emission tomography studies of right-handed individuals show that the left orbitofrontal cortex is dominant during emotional processing of odors. We collected functional magnetic resonance imaging data from 28 subjects to study this network as a function of odor hedonic valence (pleasant vs. unpleasant), active hedonic judgments versus passive sensation of hedonically charged odors, handedness, and gender. Two functional runs were performed, with pleasant and unpleasant odors presented in different epochs. In the first run, subjects passively smelled odorants, whereas in the second run they rated degree of odor pleasantness or unpleasantness by using a "finger-span" technique that simulated a visual rating scale. Electrodermal and plethysmography responses were simultaneously recorded to control for covert, physiological manifestations of the emotional response. The piriform-amygdala area and ventral insula were activated more for unpleasant than pleasant odors. More extreme ratings were also associated with higher electrodermal amplitude, suggesting that activation stemmed more from emotional or hedonic intensity than valence, and that unpleasant odors induced more arousal than pleasant odors. Unpleasant odors activated the left ventral insula in right-handers and the right ventral insula in left-handers, suggesting lateralized processing of emotional odors as a function of handedness. Active decisions about odor pleasantness induced specific left orbitofrontal cortex activation, implicating the role of this area in the conscious assessment of the emotional quality of odors. Finally, left orbitofrontal cortex was more active in women than men, potentially in relation to women's well-documented advantage in odor identification.

Adult↗

PubMed1992

The technology assessment and practice guidelines forum. A modified group judgment method.

This article describes a new group-judgment process, modified from the consensus development approach of the U.S. National Institutes of Health. It is called the "forum" method, a shorthand term for "technology assessment and practice guidelines forum." This approach is aimed at (a) describing the current state of knowledge of the technology under study; (b) developing practice guidelines for the use of the technology; and (c) providing information for insurers, consumers, policymakers, and others. A pilot study was conducted focusing on total parenteral nutrition. The validity of the process and of the recommendations and their acceptability were evaluated in a survey of participants and a selected group of nonparticipants. Based on the survey results, the forum method appears to be a valuable method for assessing technologies, defining their clinical role, and developing practice guidelines.

Consensus Development Conferences, NIH as Topic↗

PubMed1996

Dissociable contributions of the two cerebral hemispheres to judgments of line orientation.

A previous study of the performance of men with chronic unilateral focal brain lesions (due to wartime missile injury) on a standard test of line orientation suggested a left hemisphere (LH) as well as a right hemisphere (RH) contribution to visuospatial processing. The present study was designed to fractionate the variables that could underlie this unexpected finding and thereby to tease out the mechanisms involved in LH as compared with RH processing. A simpler ("purer") version of the standard line orientation task was used, as were two other versions in which matching in an array and matching with distractors were measured. The findings confirmed the hypothesis of RH involvement in the purer task of metric measurement and suggested that the LH has an important role in keeping track decisions and updating decisions in more complex aspects of line orientation judgment.

Aged↗

PubMed2000

Last judgment: the visionary biology of J.B.S. Haldane.

This paper seeks to reinterpret the life and work of J.B.S. Haldane by focusing on an illuminating but largely ignored essay he published in 1927, "The Last Judgment" - the sequel to his better known work, Daedalus (1924). This astonishing essay expresses a vision of the human future over the next 40,000.000 years, one that revises and updates Wellsian futurism with the long implications of the "new biology" for human destiny. That vision served as a kind of lifelong credo, one that infused and informed his diverse scientific work, political activities, and popular writing, and that gave unity and coherence to his remarkable career.

Biology↗

PubMed1997

Using the Judgments of Physician Examiners in Setting the Standards for a National Multi-center High Stakes OSCE.

In 1994 and 1995, the Medical Council of Canada used an innovative approach to set the pass mark on its large scale, multi-center national OSCE which is designed to assess basic clinical and communication skills in physicians in Canada after 15 months of post-graduate medical training. The goal of this article is to describe the new approach and to present the experience with the method during its first two years of operation. The approach utilizes the global judgments of the physician examiners at each station to identify the candidates with borderline performances. The scores of the candidates whose performances are judged to be borderline are summed for each station, yielding an initial passing score for all stations and then the examination as a whole. The latter score is then adjusted upward one standard error of measurement for the final passing score and is used as one of the criteria to pass the examination. Based on the results to date, the new approach has worked well. The advantages, disadvantages and areas of possible refinement for the approach are reviewed.

Journal Article↗

PubMed1999

The aesthetics of clinical judgment: exploring the link between diagnostic elegance and effective resource utilization.

Many physicians assert that new cost-control mechanisms inappropriately interfere with clinical decision-making. They claim that high costs arise from poorly practiced medicine, and argue that effective utilization of resources is best promoted by advancing the scientific and ethical ideals of medicine. However, the claim is not warranted by empirical evidence. In this essay, I show how it rests upon aesthetic considerations associated with diagnostic elegance. I first consider scientific rationality generally. After a review of analytical empiricist and socio-historical approaches in the philosophy of science, a form of Kant's aesthetic is used to explain how scientific discovery and justification are linked, and to show how meta-theoretical considerations associated with the goals and method of science work together with exemplars of practice. This analysis enables us to understand how the ideals of medicine as a science guide the initial patient history and physical exam in such a way that a parsimonious use of tests is indicated. Aesthetic considerations unite the basic scientific and ethical commitments of the modern medical paradigm and are central for rightly understanding clinical judgment.

Cost Control↗

PubMed1998

The fallibility of medical judgment as a consequence of the inexactness of observations.

The paper attempts to give an account of the fallibility of medical judgments without recourse to the incompleteness of scientific knowledge. It is argued that because of the inexactness of observations and thus the existence of borderline cases any theory applied for explanation and predicition will produce some false results. This state of affairs is independent of the nature of a theory, i.e., it applies both for non-probabilistic and for probabilistic theories. Some epistemological issues and consequences with regard to a better understanding of clinical reasoning are discussed and the view is compared with the theory of medical fallibility of Gorovitz and MacIntyre.

Decision Making↗