How Framing Bias Impacts Preferences for Innovation in Bone Tissue Engineering.

It is currently unknown if surgeons and biomaterial scientists &or tissue engineers (BS&orTE) process and evaluate information in similar or different (un)biased ways. For the gold standard of surgery to move "from bench to bedside," there must naturally be synergies between these key stakeholders' perspectives. Because only a small number of biomaterials and tissue engineering innovations have been translated into the clinic today, we hypothesized that this lack of translation is rooted in the psychology of surgeons and BS&orTE. Presently, both clinicians and researchers doubt the compatibility of surgery and research in their daily routines. This has led to the use of a metaphorical expression "squaring of the circle," which implies an unsolvable challenge. As bone tissue engineering belongs to the top five research areas in tissue engineering, we choose the field of bone defect treatment options for our bias study. Our study uses an online survey instrument for data capture such as incorporating a behavioral economics cognitive framing experiment methodology. Our study sample consisted of surgeons (n = 208) and BS&orTE (n = 59). And we used a convenience sampling method, with participants (conference attendants) being approached both in person and through email between October 22, 2022, and March 13, 2023. We find no distinct positive-negative cognitive framing differences by occupation. That is, any framing bias present in this surgical decision-making setting does not appear to differ significantly between surgeon and BS&orTE specialization. When we explored within-group differences by frames, we see statistically significant (p < 0.05) results for surgeons in the positive frame ranking autologous bone graft transplantation lower than surgeons in the negative frame. Furthermore, surgeons in the positive frame rank Ilizarov bone transport method higher than surgeons in the negative frame (p < 0.05).

Factors impacting informed consent in cosmetic breast augmentation.

BACKGROUND: For women who undergo cosmetic breast augmentation, their post-operative risk assessment may not match their pre-operative understanding of the involved risks and likelihood of revision surgeries. This may be due to the potential issues surrounding whether patients are being fully informed about all possible risks and related financial implications during the consent phases of patient/doctor consultation. METHODS: To explore comprehension, risk preference, and perceptions of breast augmentation procedure, we conducted a recorded online experiment with 178 women (18-40 years) who received varying amounts of risk-related information from two experienced breast surgeons in a hypothetical first consultation scenario. RESULTS: We find patient's age, self-rated health, income, education level, and openness to experience to be significant factors impacting initial breast augmentation risk preferences (before receiving any risk information). Further, more emotionally stable patients perceived greater breast augmentation risks, were less likely to recommend breast augmentation, and were more likely to acknowledge the likelihood for future revision surgery. After providing women with risk-related information we find increases in risk assessment in all treatment conditions, and that increased amounts of risk information do decrease women's willingness to recommend breast augmentation. But that increased risk information does not appear to increase women's assessment of the likelihood of future revision surgery. Finally, we find some participant individual differences (such as education level, having children, conscientiousness and emotional stability) appear to impact risk assessment post receiving risk information. CONCLUSION: Continuous improvement of the informed consent consultation process is vital to optimising patient outcomes efficiently and cost-effectively. Greater acknowledgement and emphasis on disclosure of related risks and financial burden when complications arise is also important. As such, future behavioural research is warranted into the factors impacting women's understanding both prior to and across the BA informed consent process.

Understanding the Reasons Why Men and Women Do Not Donate Gametes.

The global under-supply of sperm and oocyte donors is a serious concern for assisted reproductive medicine. Research has explored self-selected populations of gamete donors and their ex-post rationalisations of why they chose to donate. However, such studies may not provide the necessary insight into why the majority of people do not donate. Utilising the unique open form responses of a large sample (n = 1035) of online survey respondents, we examine the reasons participants cite when asked: "Why haven't you donated your sperm/eggs?." We categorise these responses into four core themes (conditional willingness, barriers, unconsidered, and conscientious objector) and eleven lower-order themes. We find that, on average, women are more conditionally willing (8.2% difference; p = 0.008) to participate in gamete donation than men. We also find that women are more likely than men to justify their non-donation based on their reproductive history (21.3% difference; p = 0.000) or kin selection and inclusive fitness (5.7% difference; p = 0.008). However, compared to women, men are more likely to validate their non-donation based on sociocultural or social norms (6% difference; p = 0.000) or religion (1.7% difference; p = 0.030). That so many of our study participants report in-principal willingness for future participation in gamete donation speaks to the need for increased research on understanding non-donor population preferences, motivations, and behaviours.

Cognitive and behavioural bias in advance care planning.

Background: We explore cognitive and behavioural biases that influence individual's willingness to engage advance care planning (ACP). Because contexts for the initiation of ACP discussions can be so different, our objective in this study was to identify specific groups, particular preferences or uniform behaviours, that may be prone to cognitive bias in the ACP decision process. Method: We collected data from the Australian general public (n = 1253), as well as general practitioners (GPs) and nurses (n = 117) including demographics, stated preference for ACP decision-making; six cognitive bias tests commonly used in Behavioural Economics; and a framing experiment in the context of ACP. Results: Compared to GPs (M = 57.6 years, SD = 17.2) and the general public (58.1 years, SD = 14.56), nurses on average recommend ACP discussions with patients occur approximately 15 years earlier (M = 42.9 years, SD = 23.1; p < 0.0001 in both cases). There is a positive correlation between the age of the general population and the preferred age for the initial ACP discussion (ρ = 0.368, p < 0.001). Our shared decision-making analysis shows the mean share of doctor's ACP input is viewed to be approximately 40% by the general public, significantly higher than health professionals (GPs and nurses), who believe doctors should only contribute approximately 20% input. The general public show varying relationships (all p < 0.05) for both first ACP discussion, and shared decision-making for five of six cognitive tests. However, for health professionals, only those who exhibit confirmation bias show differences (8.4% higher; p = 0.035) of patient's input. Our framing experiment results show that positive versus negative framing can result in as much as 4.9-7.0% shift in preference for factors most relevant to ACP uptake. Conclusion: Understanding how GPs, nurses and patients perceive, engage and choose to communicate ACP and how specific groups, particular preferences or uniform behaviours, may be prone to cognitive bias in the decision process is of critical importance for increasing future uptake and efficient future healthcare provision.

Cognitive Bias and Therapy Choice in Breast Reconstruction Surgery Decision-Making.

BACKGROUND: Understanding how medical experts and their patients process and transfer information is of critical importance for efficient health care provision. Behavioral economics has explored similar credence markets where economic incentives, information asymmetry, and cognitive bias can impact patient and surgeon choice. The aim of the current study is to explore how framing and behavioral bias affect elective restorative surgery decision-making, such as breast reconstruction following cancer treatment. METHODS: The authors' study uses a cross-sectional survey data set of specialist surgeons (n = 53), breast care nurses (n = 101), and former or current breast cancer patients (n = 689). Data collected include participant demographics, medical history, a battery of cognitive bias tests, and a behavioral framing experiment. RESULTS: This study finds statistically significant differences in breast reconstruction surgery preference by patients and nurses when decision options are framed in different ways (i.e., positively versus negatively). The authors' analysis of surgeons, nurses, and patients shows no statistically significant difference across eight common forms of cognitive bias. Rather, the authors find that the behavioral biases are prevalent to the same extent in each group. This may indicate that differences in experience and education seem not to mitigate biases that may affect patient choices and medical professional's recommendations. The authors' multivariate analysis identifies patient age (p < 0.0001), body mass index, and self-perceived health (p < 0.05) as negative correlates for choice of implant-based reconstruction. CONCLUSION: For surgeons, nurses, and patients, the authors find uniform evidence of cognitive bias; more specifically, for patients and nurses, the authors find inconsistency in preference for type of surgical therapy chosen when alternative procedures are framed in different ways (i.e., framing bias).

Exploring Surgeons', Nurses', and Patients' Information Seeking Behavior on Medical Innovations: The Case of 3D Printed Biodegradable Implants in Breast Reconstruction.

Objectives: To explore information seeking behavior on medical innovations. Background: While autologous and alloplastic options for breast reconstruction are well established, it is the advent of the combination of 3D printing technology and the biocompatible nature of a highly porous biodegradable implants that offers new treatment options for the future. While this type of prosthesis is not yet clinically available understanding how patients, surgeons, and nurses take up new medical innovations is of critical importance for efficient healthcare provision. Materials and Methods: Using the largest ever combined sample of breast cancer patients (n = 689), specialist surgeons (n = 53), and breast care nurses (n = 101), we explore participants preference for a new surgical treatment concept rooted in 3D printed and biodegradable implant technologies in the context of breast reconstruction. Results: We find that patients overwhelmingly favor information from a successful patient of the proposed new technology when considering transitioning. Surgeons and nurses instead favor regulatory body advice, peer-reviewed journals, and witnessing the procedure performed (either in person or online). But while 1 in 4 nurses nominated talking to a successful patient as an information source, not a single surgeon chose the same. Our multinomial logit analysis exploring patient preference (controlling for individual differences) showed statistically significant results for both the type of surgical treatment and choice to undergo reconstruction. Women who underwent a type of mastectomy procedure (compared with lumpectomy patients) were more likely to choose a former patient than a surgeon for seeking information relating to a new breast implant technology. Further, women who chose to undergo a reconstruction procedure, compared with those who did not, where more likely to prefer a surgeon for information relating to a new breast implant technology, rather than a successful patient. For medical professionals, we find no statistically significant relationship between medical professionals' preference and their age, nor the number of other medical professionals they work with daily, nor the average number of breast procedures performed in their practice on a weekly basis. Conclusions: As our findings show large variation exists (both within our patient group and compared with medical professionals) in where individuals favor information on new medical innovations, future behavioral research is warranted.

Sex differences in sexual attraction for aesthetics, resources and personality across age.

Because sexual attraction is a key driver of human mate choice and reproduction, we descriptively assess relative sex differences in the level of attraction individuals expect in the aesthetic, resource, and personality characteristics of potential mates. As a novelty we explore how male and female sexual attractiveness preference changes across age, using a dataset comprising online survey data for over 7,000 respondents across a broad age distribution of individuals between 18 and 65 years. In general, we find that both males and females show similar distribution patterns in their preference responses, with statistically significant sex differences within most of the traits. On average, females rate age, education, intelligence, income, trust, and emotional connection around 9 to 14 points higher than males on our 0-100 scale range. Our relative importance analysis shows greater male priority for attractiveness and physical build, compared to females, relative to all other traits. Using multiple regression analysis, we find a consistent statistical sex difference (males relative to females) that decreases linearly with age for aesthetics, while the opposite is true for resources and personality, with females exhibiting a stronger relative preference, particularly in the younger aged cohort. Exploring non-linearity in sex difference with contour plots for intelligence and attractiveness across age (mediated by age) indicates that sex differences in attractiveness preferences are driven by the male cohort (particularly age 30 to 40) for those who care about the importance of age, while intelligence is driven by females caring relatively more about intelligence for those who see age as very important (age cohort 40 to 55). Overall, many of our results indicate distinct variations within sex at key life stages, which is consistent with theories of selection pressure. Moreover, results also align with theories of parental investment, the gender similarities hypothesis, and mutual mate choice-which speaks to the fact that the broader discipline of evolutionary mate choice research in humans still contains considerable scope for further inquiry towards a unified theory, particularly when exploring sex-difference across age.

Exploring the impact of terminology differences in blood and organ donor decision making.

Because the global shortage of blood and organ donors across all medical markets is a serious concern for health care provision, we aim in this study to better understand decisions (not) to participate in these two forms of medical donation, which can save or prolong another's life. Using unique responses from over 1,000 online survey respondents, we compare the reasons given for the donation decision given by blood and/or registered organ donors versus non-donors. To do so, we categorize responses based on five dimensions of language choice: egocentric (referring to self), social, moral, positively emotional, and negatively emotional. Our results reveal statistically significant differences between blood donors and non-donors in the use of all five categories. With respect to organ donation, we find statistically significant differences between donors and non-donors in the use of social, moral and positive emotional terms but not in the use of egocentric or negatively emotional justifications. Such results suggest that the 'gift of life' terminology used universally to market to potential blood and organ donors may only be relevant in the blood donation market and unlikely to incentivize or change organ donation behaviour.

Pharmacist Compliance With Therapeutic Guidelines on Diagnosis and Treatment Provision.

Importance: Misuse and overselling of over-the-counter pharmaceuticals poses a major burden on both private and public health expenditures. Objective: To seek evidence on whether over-the-counter medication dispensing behavior complies or conflicts with the protocols indicated in practice standards and guidelines of a national professional pharmacy organization. Design, Setting, and Participants: This quality improvement study was undertaken in 205 pharmacies in the wider Brisbane, Australia, area. Two standardized patient (SP) scenarios were developed to evaluate noncompliant behavior. Data collection for scenario 1 was conducted between November 23 and December 9, 2016. Data collection for scenario 2 was conducted between September 1 and 28, 2017. A 2-sample test of proportions and a probit regression model were used to evaluate the likelihood of noncompliant treatments and overtreatments in each case scenario. Statistical analysis was performed from January 30 to June 21, 2018, and revised in May 2019. Main Outcomes and Measures: Outcomes were the observed likelihood of noncompliant treatments and overtreatments. Noncompliance is defined as treatments not complying with practice standards and guidelines set by the professional pharmacy society. Noncompliant treatments include undertreatment (patient did not receive necessary treatment) and overtreatments (patient was supplied with more than sufficient treatments) in both scenarios. Results: In scenario 1, 9 trained female SPs visited 89 pharmacies to request emergency hormonal contraception from pharmacy staff. In 45 cases, SPs reported having unprotected intercourse within the last 24 hours (case 1A), and in 44 cases, SPs reported having unprotected intercourse more than 72 hours ago (case 1B), which is past the efficacy threshold of over-the-counter emergency hormonal contraception. In scenario 2, 11 SPs (5 male and 6 female) visited 150 pharmacies (154 visits in total) to request treatment for family members or a partner with symptoms indicating bacterial conjunctivitis (case 2A; n = 73) or viral conjunctivitis (case 2B; n = 81). In scenario 1-dispensing emergency hormonal contraception when physician referral is recommended-21 of 44 pharmacists (47.7%) in case 1B violated the recommendation by selling the over-the-counter medication. With the inclusion of both no physician referral and emergency hormonal contraception sold, this rate increased to 79.5% (35 of 44 pharmacists). In scenario 2-1 case each of bacterial and viral conjunctivitis-overtreatment occurred in 55 of 154 cases (35.7%). In both scenarios, 140 of 243 pharmacies (57.6%) followed dispensing behavior compliant with the protocol, while 76 of 243 pharmacies (31.3%) involved some form of overtreatment or overselling of medication. Some evidence of an association between sex of SP and pharmacist was also found. Conclusions and Relevance: Although the market for dispensing over-the-counter medication in Australia is regulated, relatively high rates of overtreatment and some cases of undertreatment were observed in this study. Given the unintended adverse effects, including overuse of antibiotics and corticosteroids, these observations suggest the advisability of regulatory intervention ensuring compliance with professional protocols.

Clinical vs. exclusively online sperm donors: what's the difference?

BACKGROUND/OBJECTIVES: As the growth of the internet and commercial connection websites increasingly facilitates sperm donation outside of clinical (formal) settings, studies looking into informal (online) donor psychology and behaviour are both extremely warranted and currently under-researched. This study's aim was to identify key differences between informal donor males with a history of clinical donation, and those who exclusively participate in the informal market. METHODS: The study utilises (N = 112) current informal sperm donors' demographics and personality traits taken from registered members of the connection website PrideAngel (Nov-Dec 2016). This study conducts probit multivariate and interaction analysis of socioeconomic and personality factors to explore key differences in males who have chosen to exclusively donate through connection websites and those with a clinical history. RESULTS: Results from this sample show that exclusively informal donors are more likely to be in some form of committed relationship. Exclusively informal males are also more likely to identify as a sexuality other than heterosexual (e.g. gay, bisexual or asexual). Also, exclusively informal participants exhibit higher average scores for the personality trait agreeableness. CONCLUSIONS: Overall, this study demonstrates key differences in the relationship status, sexuality and personality traits of a new and burgeoning group of males and their reproductive psychology and behaviour.

Man, Woman, "Other": Factors Associated with Nonbinary Gender Identification.

Using a unique dataset of 7479 respondents to the online Australian Sex Survey (July-September 2016), we explored factors relevant for individuals who self-identify as one of the many possible nonbinary gender options (i.e., not man or woman). Our results identified significant sex differences in such factors; in particular, a positive association between female height, higher educational levels, and greater same-sex attraction (female-female) versus a negative effect of lower income levels and more offspring. With respect to sex similarities, older males and females, heterosexuals, those with lower educational levels, and those living outside capital cities were all more likely to identify as the historically dichotomous gender options. These factors associated with nonbinary gender identification were also more multifaceted for females than for males, although our interaction terms demonstrated that younger females (relative to younger males) and nonheterosexuals (relative to heterosexuals) were more likely to identify as nonbinary. These effects were reversed, however, in the older cohort. Because gender can have such significant lifetime impacts for both the individual and society as a whole, our findings strongly suggest the need for further research into factors that impact gender diversity.

Longitudinal qualitative evaluation of pharmacist integration into the urgent care setting.

PURPOSE: To describe the most effective model for managing, educating, and training pharmacist advanced clinical practitioners (ACPs) in the urgent care center (UCC) setting, role evolution and how to measure their effectiveness. PARTICIPANTS AND METHODS: Ethical approval was obtained to perform a qualitative longitudinal cohort study in three sites, with three pharmacists in each trained as ACPs from 2016 to 2017. ACP role, location, management, mentorship, and supervision were locally determined. ACPs attended focus groups (FGs) at 1 and 3 months (sites 1-3), 6 and 12 months (site 1 only), and the UCC staff were interviewed once with a topic guide regarding training, integration, role, and impact. Verbatim transcriptions were analyzed thematically. RESULTS: Eight ACP FGs and 24 stakeholder interviews produced major themes of communication, management, education and training, role, and outcomes. Effective education, training, and integration required communication of role to address concerns regarding salary differentials, supportive management structure, and multi-professional learning. ACPs reported that the model of workplace training, experiential learning, and university-based education was appropriate. Training was better located in the minor injuries and general practitioner areas. Recommended measures of effectiveness included patient satisfaction and workload transfer. CONCLUSION: The education and training model was appropriate. Communication and management require careful consideration to ensure effective integration and role development. Pharmacists were better located initially in the minor illness rather than major trauma areas. Quality of patient experience resulting from the new role was important in addition to reassurance that the role represented a positive contribution to workload.

Do Men and Women Know What They Want? Sex Differences in Online Daters' Educational Preferences.

Using a unique cross-sectional data set of dating website members' educational preferences for potential mates ( N = 41,936), we showed that women were more likely than men to stipulate educational preferences at all ages. When members indifferent to educational level were excluded, however, the specificity of men's and women's preferences did differ for different age groups. That is, whereas women expressed more refined educational preferences during their years of maximum fertility, their demand specificity decreased with age. Men's specificity, in contrast, remained stable until the 40s, when it was greater than that of postreproductive women, and then was higher during their peak years of career-earnings potential. Further, when individuals' level of education was controlled for, women (compared with men) were more likely to state a higher minimum preference for educational level in a potential mate.

Online sperm donors: the impact of family, friends, personality and risk perception on behaviour.

As informal sperm donation becomes more prevalent worldwide, understanding donor psychology and interactions is critical in providing effective policy, equitable legislative frameworks and frontline health support to an ever-growing number of global participants. We analyse data of informal sperm donors who were members of the connection website PrideAngel to identify the role and effect of several factors, e.g. kinship, social networks, personality, and risk perception, on behaviour. A key strength of the study is the ability to analyse various factors, such as the level and history of informal donation, risk concerns, number of women to whom donations are informally made and the number of offspring. Our results indicate donors who have also been active in formal clinical settings (compared with those who exclusively donate informally), donate to more women in the informal market and realise more offspring. Donor's sexual orientation also affects activity. From a personality perspective, conscientiousness provides comparative advantage. It is possible this characteristic provides positive externalities, as more conscientious men may be more efficient or organised in a market that requires increased cooperation and communication. The importance of kin and social networks seems to affect frequency of donation only, possibly representing a time constraint (or opportunity cost).

Preference Versus Choice in Online Dating.

This study explores factors that influence matches of online dating participants' stated preference for particular characteristics in a potential partner and compares these with the characteristics of the online daters actually contacted. The nature of online dating facilitates exploration of the differences between stated preference and actual choice by participants, as online daters willingly provide a range of demographics on their ideal partner. Using data from the Australian dating website RSVP, we analyze 219,013 contact decisions. We conduct a multivariate analysis using the number of matched variables between the participants' stated preference and the characteristics of the individuals contacted. We find that factors such as a person's age, their education level, and a more social personality all increase the number of factors they choose in a potential partner that match their original stated preference. Males (relative to females) appear to match fewer characteristics when contacting potential love interests. Conversely, age interaction effects demonstrate that males in their late 60's are increasingly more selective (than females) regarding who they contact. An understanding of how technology (the Internet) is impacting human mating patterns and the psychology behind the participants informs the wider social science of human behavior in large-scale decision settings.

What women want in their sperm donor: A study of more than 1000 women's sperm donor selections.

Reproductive medicine and commercial sperm banking have facilitated an evolutionary shift in how women are able to choose who fathers their offspring, by notionally expanding women's opportunity set beyond former constraints. This study analyses 1546 individual reservations of semen by women from a private Australian assisted reproductive health facility across a ten year period from 2006 to 2015. Using the time that each sample was available at the facility until reservation, we explore women's preference for particular male characteristics. We find that younger donors, and those who hold a higher formal education compared to those with no academic qualifications are more quickly selected for reservation by women. Both age and education as proxies for resources are at the centre of Parental Investment theory, and our findings further build on this standard evolutionary construct in relation to female mate preferences. Reproductive medicine not only provides women the opportunity to become a parent, where previously they would not have been able to, it also reveals that female preference for resources of their potential mate (sperm donor) remain, even when the notion of paternal investment becomes redundant. These findings build on behavioural science's understanding of large-scale decisions and human behaviour in reproductive medical settings.