Artificial intelligence promotes shared decision-making through recommending tests to febrile pediatric outpatients

BACKGROUND:To promote the shared decision-making(SDM)between patients and doctors in pediatric outpatient departments,this study was designed to validate artificial intelligence(AI)-initiated medical tests for children with fever.METHODS:We designed an AI model,named Xiaoyi,to suggest necessary tests for a febrile child before visiting a pediatric outpatient clinic.We calculated the sensitivity,specificity,and F1 score to evaluate the efficacy of Xiaoyi’s recommendations.The patients were divided into the rejection and acceptance groups.Then we analyzed the rejected examination items in order to obtain the corresponding reasons.RESULTS:We recruited a total of 11,867 children with fever who had used Xiaoyi in outpatient clinics.The recommended examinations given by Xiaoyi for 10,636(89.6%)patients were qualified.The average F1 score reached 0.94.A total of 58.4%of the patients accepted Xiaoyi’s suggestions(acceptance group),and 41.6%refused(rejection group).Imaging examinations were rejected by most patients(46.7%).The tests being time-consuming were rejected by 2,133 patients(43.2%),including rejecting pathogen studies in 1,347 patients(68.5%)and image studies in 732 patients(31.8%).The difficulty of sampling was the main reason for rejecting routine tests(41.9%).CONCLUSION:Our model has high accuracy and acceptability in recommending medical tests to febrile pediatric patients,and is worth promoting in facilitating SDM.

Decision-Making in Driver-Automation Shared Control:A Review and Perspectives

Shared control schemes allow a human driver to work with an automated driving agent in driver-vehicle systems while retaining the driver’s abilities to control.The human driver,as an essential agent in the driver-vehicle shared control systems,should be precisely modeled regarding their cognitive processes,control strategies,and decision-making processes.The interactive strategy design between drivers and automated driving agents brings an excellent challenge for human-centric driver assistance systems due to the inherent characteristics of humans.Many open-ended questions arise,such as what proper role of human drivers should act in a shared control scheme?How to make an intelligent decision capable of balancing the benefits of agents in shared control systems?Due to the advent of these attentions and questions,it is desirable to present a survey on the decision making between human drivers and highly automated vehicles,to understand their architectures,human driver modeling,and interaction strategies under the driver-vehicle shared schemes.Finally,we give a further discussion on the key future challenges and opportunities.They are likely to shape new potential research directions.

Older Patients’ Involvement in Shared Decision-Making—A Systematic Review

Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

Greater awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado,United States:Real-world data

BACKGROUND There is a lack of studies and educational programs focused on biosimilars and shared decision-making among patients diagnosed with various rheumatic diseases.AIM To improve knowledge and awareness of biosimilars and shared decision-making among patients attending rheumatology practices in Colorado as well as to assess a rheumatology patient’s interest in discussing biosimilars as well as shared decision-making with others(e.g.,medical professionals,family members,friends).METHODS Our goal was to work with 80 rheumatology teams in Colorado.We developed and distributed 2000 multi-page brochures to each participating office and later conducted an online anonymous survey.RESULTS There were a total of 49(2.5%)rheumatology patients who responded to our survey.After reading our educational booklet,many survey respondents identified the correct answer in most questions focused on biosimilars or shared decision-making.Our survey results suggest that patients attending rheumatology practices in Colorado are generally not involved in discussions with their providers regarding treatment plans or options.The improvement in scores after reading our educational materials was statistically significant for biosimilars and shared decision-making.CONCLUSION Overall,the level of knowledge and awareness of biosimilars and shared decisionmaking among patients attending rheumatology practices in Colorado was low.More educational programs as well as follow up trainings to measure changes in knowledge and awareness regarding biosimilars and shared decision-making among patients attending rheumatology practices are recommended.

NORMAL FAMILIES AND SHARED VALUES OF HOLOMORPHIC FUNCTIONS

Let F be a family of holomorphic functions in a domain D, k be a positive integer, a, b（≠0）, c（≠0） and d be finite complex numbers. If, for each f∈F, all zeros of f-d have multiplicity at least k, f^（k） = a whenever f=0, and f=c whenever f^（k） = b, then F is normal in D. This result extends the well-known normality criterion of Miranda and improves some results due to Chen-Fang, Pang and Xu. Some examples are provided to show that our result is sharp.

NORMAL FAMILIES OF MEROMORPHIC FUNCTIONS WITH SHARED VALUES

We obtain some normality criteria of families of meromorphic functions sharing values related to Hayman conjecture, which improves some earlier related results.

Key elements and checklist of shared decisionmaking conversation on life-sustaining treatment in emergency:a multispecialty study from China

BACKGROUND:Shared decision-making(SDM)has broad application in emergencies.Most published studies have focused on SDM for a certain disease or expert opinions on future research gaps without revealing the full picture or detailed guidance for clinical practice.This study is to investigate the optimal application of SDM to guide life-sustaining treatment(LST)in emergencies.METHODS:This study was a prospective two-round Delphi consensus-seeking survey among multiple stakeholders at the China Consortium of Elite Teaching Hospitals for Residency Education.Participants were identified based on their expertise in medicine,law,administration,medical education,or patient advocacy.All individual items and questions in the questionnaire were scored using a 5-point Likert scale,with responses ranging from"very unimportant"(a score of 1)to"extremely important"(a score of 5).The percentages of the responses that had scores of 4-5on the 5-point Likert scale were calculated.A Kendall’s W coefficient was calculated to evaluate the consensus of experts.RESULTS:A two-level framework consisting of 4 domains and 22 items as well as a ready-touse checklist for the informed consent process for LST was established.An acceptable Kendall’s W coefficient was achieved.CONCLUSION:A consensus-based framework supporting SDM during LST in an emergency department can inform the implementation of guidelines for clinical interventions,research studies,medical education,and policy initiatives.

Normal Families of Holomorphic Functions Concerning Shared a Polynomial

In this paper,we study normal families of holomorphic function concerning shared a polynomial.Let F be a family of holomorphic functions in a domain D,k(2)be a positive integer,K be a positive number andα(z)be a polynomial of degree p(p 1).For each f∈F and z∈D,if f and f sharedα(z)CM and|f(k)(z)|K whenever f(z)-α(z)=0 in D, then F is normal in D.

A Concept Analysis of Decision-Making by Families in Critical Life Situations

Background: In 2017, the elderly made up 27.3% of Japan’s population, accounting for 57.2% of all ambulance trips. When an elderly person is in a critical life situation, it is difficult to ascertain their decisions about treatment choices, and for family members who become surrogate decision-makers, this is a grave responsibility. Aim: This study aimed to shed light on the constructs that support decision-making by family members and medical staff in critical situations, and to investigate decision-making by families of the elderly in critical situations. Method: We selected 29 papers published in Japan and elsewhere that focused on families involved in treatment decisions in critical life situations and analyzed them using Rodgers’ concept analysis approach. Results: From 475 codes, we extracted six attributes, four antecedents, and four consequences. The unusual setting of the “critical care unit”, lack of time, and unstable psychological state are all considered by family members making treatment decisions, along with the patient’s prognosis, their relationship with the patient, conjecture about the patient’s wishes, and taking other family member’s views into account. Medical staff supports the family throughout the process, through provision of treatment, preparing family members to face reality, empathizing with the difficulty of decision-making, building relationships with family members, monitoring the decision-making process, and being attentive to family members’ feelings until the end. Conclusion: Our results indicate the importance of advance confirmation of patients’ wishes, and the role played by cultural context and family relations in decision-making by family members of the elderly.

Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.

Normal families and shared values of meromorphic functions

We studied the normality conditions in families of meromorphic functions, improved the results of Fang and Zalcman [Fang ML, Zalcman L, Normal families and shared values of meromorphic functions, Computational Methods and Function Theory, 2001, 1 (1): 289-299], and generalized two new normality criterions. Let F be a family of meromorphic functions in a domain D, a a non-zero finite complex number, B a positive real number, and k and m two positive integers satisfying m>2k+4. If every function denoted by f belonging to F has only zeros with multiplicity at least k and satisfies f m(z)f (k)(z)=a??f (k)(z)?≤B or f m(z)f (k)(z)=a??f (z)?≥B, then F is normal in D.

Normal Families of Meromorphic Functions and Shared Set

In this paper,we study the normality criterion for families of meromorphic functions concerning shared set depending on f∈F.Let F be a family of meromorphic functions in the unit disc A.For each f∈F,all zeros of f have multiplicity at least 2 and there exist nonzero complex numbers b_f,c_f satisfying(i) b_f/c_f is a constant;(ii) min{σ(0,b_f),σ(0,c_f),σ(b_f,c_f)} ≥m for some m > 0;(iii) E_f'(S_f)■ E_f(S_f),where S_f = {b_f,c_f}.Then F is normal in A.At the same time,the corresponding results are also proved.The results in this paper improve and generalize the related results

Normal Families and Shared Functions

Let k be a positive integer,let h be a holomorphic function in a domain D,h■0and let F be a family of nonvanishing meromorphic functions in D.If each pair of functions f and q in F,f^((k)) and g^((k)) share h in D,then F is normal in D.

Shared Hyperplanes and Normal Families of Holomorphic Curves

In theorem LP [1], Liu proves the theorem when N = 2, but it can’t be ex-tended to the general case in his proof. So we consider the condition that the families of holomorphic curves share eleven hyperplanes, and we get the theorem 1.1.

Normal families related to shared sets

We studied the normality criterion for families of meromorphic functions related to shared sets.Let F be a family of meromorphic functions on the unit disc Δ,a and b be distinct non-zero values,S={a,b},and k be a positive integer.If for every f∈F,i) the zeros of f(z) have a multiplicity of at least k+1,and ii) f(k)(S)■f(S),then F is normal on Δ.At the same time,the corresponding results of normal function are also proved.

Normality Criteria of Meromorphic Functions Concerning Shared Analytic Function

In this paper, we use Pang-Zalcman lemma to investigate the normal family of meromorphic functions concerning shared analytic function, which improves some earlier related results.

Normal Criteria and Shared Values by Differential Polynomials

For a family of meromorphic functions on a domain D, it is discussed whether F is normal on D if for every pair functions f(z),g∈F , f'–afnand g'–agn share value d on D when n=2,3, where a, b are two complex numbers, a≠0,∞,b≠∞.Finally, the following result is obtained:Let F be a family of meromorphic functions in D, all of whose poles have multiplicity at least 4 , all of whose zeros have multiplicity at least 2. Suppose that there exist two functions a(z) not idendtically equal to zero, d(z) analytic in D, such that for each pair of functions f and in F , f'–a(z)f2 and g'–a(z)g2 share the function d(z) . If a(z) has only a multiple zeros and f(z)≠∞ whenever a(z)=0 , then F is normal in D.

Literature Review on Shared Book Reading

This paper first introduced shared-book reading as good family activity for early childhood.A series of related experi ments and findings were then examined.The author went on to analyze three influential factors of shared book reading and its de velopmental,emotional and learning difficulty’s value.Finally,comments and suggestions were made to future researchers of the same field.

Prioritizing the efforts:lived experiences of family when taking care of people with cancer

Objective:Cancer has one of the highest disease mortality rates.Families are very important in the treatment of people with cancer.By using a phenomenological design,this study aimed to explore the experience of families in caring for a person with cancer and to identify the needs of these families.Methods:First,eight interviews were under taken with family members selected through a purposive sampling method.Then,another three interviews were conducted for data validation.The collected data were analyzed using the framework method of analysis.Results:The core theme,“Prioritizing the efforts:Being aware of the best we could do for our family,”reflected family’s experiences of caring for a person with cancer and was underpinned by five themes:“Decisions to make,”“Keeping up the good support,”“Acknowledging the others’contributions,”“Assisting my family to alleviate the disease,”and“Adapting to the current situation.”Conclusions:The results suggest that building mutual trust and communication between family and healthcare professionals is vital in decision-making for people with cancer.Family may also work with the person in fulfilling their needs,without disregarding the needs of the family.When suppor ting the needs of people with diabetes,the family requires appropriate information,and thus,healthcare professionals wisely select which information can help the family make a decision regarding the treatment.After administering the treatment and providing information for people with cancer and their family,asking for feedback is required for evaluation.

配偶对员工绿色行为的影响:基于溢出-交叉模型的分析

如何激发员工绿色行为成为新时代学界和组织实践关切的议题。本研究基于溢出交叉理论(spillover-crossover model,SCM)框架,构建配偶与员工绿色行为关系的理论模型。采用动态追踪、滞后配对的方案获取80对双职工夫妻样本,结果显示:配偶绿色行为通过提升工作家庭人际资本化进而影响员工绿色行为;配偶绿色知识分享意愿和能力显著强化上述关系,分享意愿和能力水平越高,二者间关系越强。研究扩展了绿色行为研究范式,从家庭视角为组织绿色管理提供有益启示。