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This chapter provides an overview of economic and behavioral economic approaches to behavior change. The chapter begins with a description of the traditional or neoclassical economic view of decision-making using expected utility theory as its basis. Attempts by an external party (e.g., a government or agency) to change behavior are viewed as justifiable in a limited number of circumstances, such as when there are externalities or coordination failures. When behavior change is warranted, neoclassical economics has focused on four options: provide information, increase incentives, reduce prices, or increase subsidies, or impose regulations. To be successful, the approach must change the net benefits of the promoted behavior. The chapter then describes the rationale behind behavioral economic approaches to behavior change, emphasizing the role that “nudges” play in behavior change. Examples are provided of common heuristics and associated decision errors that can result, and how nudges are designed to overcome these decision errors. The underlying rationale and steps for developing nudges are summarized. Current evidence suggests that some nudges can be effective in changing behavior, but more research is needed to demonstrate the effectiveness of many nudge strategies. The chapter concludes with a discussion of the likely long-term impact of nudges in the field of behavior change.
‘Munchausen's syndrome by proxy’ characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she ‘lied’). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not ‘proven’ that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.
This chapter explores current research on how young people make judgements about the information they encounter. There will be a discussion on why some young people appear to trust, without question, online information whilst others show remarkable powers of insight and critique. Evidence on how this might affect their physical and mental well-being will be provided. Why this is important both in educational and political terms is discussed. There will then be an exploration of the approaches that can be employed to help young people develop a more discerning approach to engaging with the information they see, hear and read in any context.
The discussion put forward here is based upon a synthesis of research findings involving three groups of young people from the UK – 16–17-year-olds, at a secondary school, 18–19-year-old university students in their first undergraduate year and finally 18–24-year-old men recruited for an experiment, mostly undergraduates – all carried out in the UK. For the first two groups there was a concern voiced by teachers and academic tutors respectively that their students exhibited a noticeable lack of the necessary capabilities to make well-calibrated judgements in order to select good-quality information to support their work for assignments. The 16–17-year-olds were working towards gaining their Extended Project Qualification (EPQ)1 – a mini-dissertation in addition to their A-level study. Walton et al. (2018a) provide a comprehensive reflection of these studies. The 18–19-year-olds were working towards completing their first assignment and had to find good quality information about a sporting issue of their choice (see Walton and Hepworth, 2011; 2013 for a more detailed account). These two groups are quite similar in their context and we will see that their comments and experiences and our analyses align in an encouraging way. How? They both appear to indicate that most (but by no means all) students present with remarkably poor capabilities in making judgements about information, which prevent them from making the most suitable choices. The third group were recruited to find out whether the cognitive process of information discernment has a physiological component. Why? We wanted to find out whether being good at information discernment is related to positive responses to stress.
In cheese, a negative oxidation-reduction (redox) potential is required for the stability of aroma, especially that associated with volatile sulphur compounds. To control the redox potential during ripening, redox agents were added to the salted curd of Cheddar cheese before pressing. The control cheese contained only salt, while different oxidising or reducing agents were added with the NaCl to the experimental cheeses. KIO3 (at 0·05, 0·1 and 1%, w/w) was used as the oxidising agent while cysteine (at 2%, w/w) and Na2S2O4 (at 0·05 and 0·1%, w/w) were used as reducing agents. During ripening the redox potential of the cheeses made with the reducing agents did not differ significantly from the control cheese (Eh ≈ −120 mV) while the cheeses made with 0·1 and 0·05% KIO3 had a significantly higher and positive redox potential in the first month of ripening. Cheese made with 1% KIO3 had positive values of redox potential throughout ripening but no starter lactic acid bacteria survived in this cheese; however, numbers of starter organisms in all other cheeses were similar. Principal component analysis (PCA) of the volatile compounds clearly separated the cheeses made with the reducing agents from cheeses made with the oxidising agents at 2 month of ripening. Cheeses with reducing agents were characterized by the presence of sulphur compounds whereas cheeses made with KIO3 were characterized mainly by aldehydes. At 6 month of ripening, separation by PCA was less evident. These findings support the hypothesis that redox potential could be controlled during ripening and that this parameter has an influence on the development of cheese flavour.
The emergence of new empirical evidence and ethical debate about families created by assisted reproduction has called into question the current regulatory frameworks that govern reproductive donation in many countries. In this multidisciplinary book, social scientists, ethicists and lawyers offer fresh perspectives on the current challenges facing the regulation of reproductive donation and suggest possible ways forward. They address questions such as: what might people want to know about the circumstances of their conception? Should we limit the number of children donors can produce? Is it wrong to pay donors or to reward them with cut-price fertility treatments? Is overseas surrogacy exploitative of women from poor communities? Combining the latest empirical research with analysis of ethics, policy and legislation, the book focuses on the regulation of gamete and embryo donation and surrogacy at a time when more people are considering assisted reproduction and when new techniques and policies are underway.
The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care.
Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems.
The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur.
We examined the effect on civil sections and the rate of appeals against them of the amendments made to the Mental Health Act 1983 as a result of the Mental Health Act 2007. We gathered data for the year before and after the introduction of these changes.
We found increased use of Section 2 (56.8% before and 65.8% after (P < 0.001)) and decreased use of Section 3 (39.5% before and 31.2% after (P < 0.001)). The number of appeals against civil sections decreased (697 before and 692 after) but there was an 8.0% increase in the proportion of appeals to mental health tribunals. There was a decrease in admissions under these sections (817 before and 733 after).
These changes may be unintended consequences of the new law, resulting in increased workloads for psychiatrists and costs to the National Health Service.