Despite proportional information being ubiquitous, there is not a standard account of proportional reasoning. Part of the difficulty is that there are several apparent contradictions: in some contexts, proportion is easy and privileged, while in others it is difficult and ignored. One possibility is that although we see similarities across tasks requiring proportional reasoning, people approach them with different strategies. We test this hypothesis by implementing strategies computationally and quantitatively comparing them with Bayesian tools, using data from continuous (e.g., pie chart) and discrete (e.g., dots) stimuli and preschoolers, 2nd and 5th graders, and adults. Overall, people\'s comparisons of highly regular and continuous proportion are better fit by proportion strategy models, but comparisons of discrete proportion are better fit by a numerator comparison model. These systematic differences in strategies suggest that there is not a single, simple explanation for behavior in terms of success or failure, but rather a variety of possible strategies that may be chosen in different contexts.

BACKGROUND: Women Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles.
OBJECTIVE: To explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy\'s values and principles.
METHODS: Women who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women\'s experiences according to the Strategy\'s values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported.
RESULTS: The survey was completed by 1750 women. A proportion of women perceived the Strategy\'s values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period.
CONCLUSIONS: Despite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women\'s access to and experiences of care across the entire maternity episode.

BACKGROUND: Helsinki University Hospital has developed a digital care pathway (DCP) for people with multiple sclerosis (MS) to improve the care quality. DCP was designed for especially newly diagnosed patients to support adaptation to a chronic disease.
OBJECTIVE: This study investigated the MS DCP user behavior and its impact on patient education-mediated changes in health care use, patient-perceived impact of MS on psychological and physical functional health, and patient satisfaction.
METHODS: We collected data from the service launch in March 2020 until the end of 2022 (observation period). The number of users, user logins, and their timing and messages sent were collected. The association of the DCP on health care use was studied in a case-control setting in which patients were allowed to freely select whether they wanted to use the service (DCP group n=63) or not (control group n=112). The number of physical and remote appointments either to a doctor, nurse, or other services were considered in addition to emergency department visits and inpatient days. The follow-up time was 1 year (study period). Furthermore, a subgroup of 36 patients was recruited to fill out surveys on net promoter score (NPS) at 3, 6, and 12 months, and their physical and psychological functional health (Multiple Sclerosis Impact Scale) at 0, 3, 6, and 12 months.
RESULTS: During the observation period, a total of 225 patients had the option to use the service, out of whom 79.1% (178/225) logged into the service. On average, a user of the DCP sent 6.8 messages and logged on 7.4 times, with 72.29% (1182/1635) of logins taking place within 1 year of initiating the service. In case-control cohorts, no statistically significant differences between the groups were found for physical doctors\' appointments, remote doctors\' contacts, physical nurse appointments, remote nurse contacts, emergency department visits, or inpatient days. However, the MS DCP was associated with a 2.05 (SD 0.48) visit increase in other services, within 1 year from diagnosis. In the prospective DCP-cohort, no clinically significant change was observed in the physical functional health between the 0 and 12-month marks, but psychological functional health was improved between 3 and 6 months. Patient satisfaction improved from the NPS index of 21 (favorable) at the 3-month mark to the NPS index of 63 (excellent) at the 12-month mark.
CONCLUSIONS: The MS DCP has been used by a majority of the people with MS as a complementary service to regular operations, and we find high satisfaction with the service. Psychological health was enhanced during the use of MS DCP. Our results indicate that DCPs hold great promise for managing chronic conditions such as MS. Future studies should explore the potential of DCPs in different health care settings and patient subgroups.

UNASSIGNED: Age-based stereotype threat (ABST), the concern of being judged according to a negative age stereotype may lead to underperformance in the stereotype domain. The present study aims to replicate the negative effect of ABST on episodic memory. Importantly, we further examine openness to experience as a potential buffer of the ABST effect as well as the role that different memory strategies may play in episodic memory performance.
UNASSIGNED: Seventy-five older adults were randomly assigned to the ABST condition or the control condition before taking a word-stem cued recall memory task. They learned word-lists with either a repetition strategy, low resource demanding but less efficient, or a mental imagery strategy, high resource demanding but more efficient. Openness was measured with the Big-5 personality questionnaire.
UNASSIGNED: ABST reduced memory performance and disrupted more the recall of words learned with the imagery strategy. The results also showed that openness predicted recall performance associated with the imagery strategy only in the threatened group.
UNASSIGNED: These results indicated that a high level in openness may disrupt the negative effect of ABST by improving the capacity of threatened people to execute efficient, resource demanding memory strategies. This finding supports the idea that contextual factors as well as individual characteristics such as personality, need to be considered when assessing episodic memory in aging.

BACKGROUND: While healthcare organizations in several countries are embracing Value-Based Health Care (VBHC), there are limited insights into how to achieve this paradigm shift. This study examines the decade-long (2012-2023) change towards VBHC in a pioneering Dutch university hospital.
METHODS: Through retrospective, complexity-informed process research, we study how a Dutch university hospital\'s strategy to implement VBHC evolved, how implementation outcomes unfolded, and the underlying logic behind these developments. Data include the hospital\'s internal documents (n = 10,536), implementation outcome indicators (n = 4), a survey among clinicians (n = 47), and interviews with individuals contributing to VBHC at the hospital level (n = 20).
RESULTS: The change towards VBHC is characterized by three sequential strategies. Initially, the focus was on deep change through local, tailored implementation of multiple VBHC elements. The strategy then transitioned to a hospital-wide program aimed at evolutionary change on a large scale, emphasizing the integration of VBHC into mainstream IT and policies. Recognizing the advantages and limitations of both strategies, the hospital currently adopts a \"hybrid\" strategy. This strategy delicately combines deep and broad change efforts. The strategy evolved based on accumulated insights, contextual developments and shifts in decision-makers. The complexity of change was downplayed in plans and stakeholder communication. By the end of 2023, 68 (sub)departments engaged in VBHC, enabled to discuss patients\' responses to Patient Reported Outcomes Measures (PROMs) during outpatient care. However, clinicians\' use of PROMs data showed limitations. While pioneers delved deeper into VBHC, laggards have yet to initiate it.
CONCLUSIONS: VBHC does not lend itself to linear planning and is not easily scalable. While there appears to be no golden standard for implementation, blending local and larger-scale actions appears advantageous. Local, deep yet harmonized and system-integrated changes culminate in large scale transformation. Embracing complexity and focusing on the ultimate aims of (re)institutionalization and (re)professionalization are crucial.

Village Health Workers (VHWs) in Zimbabwe complement the healthcare staff in primary health care delivery. In 2015 the Ministry of Health streamlined services offered by the VHWs with the VHW Strengthening Plan to improve the effectiveness of the program. However, these continue to offer services not addressing the current and emerging health problems. This three-phased study seeks to develop strategies to improve the effectiveness and efficiency of VHWs in service delivery. Systematic literature review shall be used to develop a conceptual framework to guide the development of VHWs service delivery strategies. Exploratory sequential mixed methods design shall explore VHWs roles in primary health care. A survey in the first stage shall collect qualitative data from 45 purposely selected healthcare workers and VHWs using interviews and then thematically analyzed with MAXQDA. The variables generated will have a cross-sectional survey used to collect quantitative data from 134 VHWs and analyzed on SPSS. The SWOT and basic logic models shall be used to develop strategies validated by the Delphi Technique and Key Stakeholders. Informed consent will be maintained in the study with findings published in journals and presentation symposiums. This protocol was approved by the University of Venda Research Ethics Committee (Registration FHS/23/pH/11/0709).

Landfill is an important means of municipal solid waste treatment. Previous studies have shown that the combination of \"cut-off wall and pumping well\" technology is an effective measure to deal with the leachate emission reduction and pollution control of landfill, and has been widely used in plain areas. However, for landfills in hilly areas with complex terrain and geological conditions, there is still a lack of clear and referable ideas and operational strategies for leachate emission reduction and pollution control. In this study, we proposed strategies for determining the position and depth of cut-off walls and pumping wells and reasonable combinations of the cut-off wall depth and pumping quantity for leachate reduction and pollution prevention of landfills in hilly areas. The determination of leachate reduction and pollution control strategy need to be achieved in two stages, qualitative and quantitative: (1) In the qualitative stage, the natural conditions (Weathering degree, groundwater flow characteristics, topography condition, hydrometeor condition, and aquifer thickness) and engineering conditions (Operation status, landfill location, and excavation status) of the study area are analysed in detail, and then the depth range and location of the cut-off wall and pumping well are determined. (2) In the quantitative stage, we need to quantify the combination of the cut-off wall depth and pumping quantity by using profile particle tracing and pollutant transport modelling. A reasonable cut-off wall depth needs to control the leakage of pollutants inside the wall, and a reasonable pumping quantity needs to ensure that the depth of the pollutant distribution is equivalent to the depth of the separation line, which separates the water flow towards the pumping well and the water flow downstream. (3) The effectiveness of the leachate reduction and prevention strategies proposed in this study was verified through an example of a landfill in Northeast China. This study provides a reference and operation method for leachate emission reduction and pollution control of landfills in hilly areas.

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BACKGROUND: In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention.
OBJECTIVE: To summarize and share the application experience of the emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV.
METHODS: The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed.
RESULTS: Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of \"hepatic hilum area dissection priority, liver posterior separation first\". The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications.
CONCLUSIONS: The emerging strategy of \"hepatic hilum area dissection priority, liver posterior separation first\" is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.

This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.