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A carbon tax is widely accepted as the most effective policy for curbing carbon emissions but is controversial because it imposes costs on consumers. An alternative, ‘nudge,’ approach promises smaller benefits but with much lower costs. However, nudges aimed at reducing carbon emissions could have a pernicious indirect effect if they offer the promise of a ‘quick fix’ and thereby undermine support for policies of greater impact. Across six experiments, including one conducted with individuals involved in policymaking, we show that introducing a green energy default nudge diminishes support for a carbon tax. We propose that nudges decrease support for substantive policies by providing false hope that problems can be tackled without imposing considerable costs. Consistent with this account, we show that by minimizing the perceived economic cost of the tax and disclosing the small impact of the nudge, eliminates crowding-out without diminishing support for the nudge.Behavioural interventions aimed at curbing carbon emissions are inexpensive and easy to implement but can offer the false promise of a quick fix. Across six experiments, the authors show that exposure to a green energy nudge diminishes support for carbon taxes.

The demand for remote assessment tools has increased, yet there is a lack of standardized adaptations for remote administration. This pilot study investigates the equivalency of in-person and remote cognitive assessments using the NIH Toolbox Cognition Battery (NIHTB-CB) among children aged 7 to 17 years. Forty-seven children (51.1% female; M age = 12.26, SD age = 3.23) were assessed in two formats: in-person at a study site and remotely from home, with the order of assessments counterbalanced. The NIHTB-CB was used for in-person evaluations, while a newly developed version, the NIH Toolbox Participant/Examiner (NIHTB-P/E) App , was used for remote assessments through built-in teleconferencing features. The results showed considerable consistency between in-person and remote scores across all NIHTB-CB tests. Certain differences were noted, including longer test durations for remote assessments and potential practice effects on some measures. Overall, preliminary findings from this pilot study support thefeasibility of administering the NIHTB-CB remotely using the NIHTB-P/E App, providing a viable option to traditional in-person cognitive assessments in pediatric populations.

Background Effective antiretroviral treatment has transformed HIV into a manageable chronic condition. In Tanzania, about 1.7 million people are living with HIV (PLWH), with 79% achieving viral suppression. Patient-Reported Outcome Measures (PROMs) evaluate key outcomes that matter most for PLWH and are an essential tool to evaluate and improve health system performance. Research is needed to adapt and test PROMs to increase their use in HIV care in many low- and middle-income countries including Tanzania. Since 2019, Northwestern University and Muhimbili University of Health and Allied Sciences (MUHAS) have led an NIH-funded Fogarty D43 grant to build Patient-Centered Outcomes Research (PCOR) capacity in Tanzania. We report on the results of a workshop to strengthen capacity in PROMs development, adaptation and psychometric validation for improving health outcomes for PLWH in Tanzania. Methods The three-day in-person workshop featured expert-led instruction and practical exercises on PROMs selection, development, adaptation, validity testing, factor analysis, and manuscript writing. We applied Kirkpatrick Framework (Level 1-reaction, Level 2-knowledge, and Level 3-use) for workshop evaluation. Participants completed pre-workshop surveys on goals, experience, confidence, and knowledge, followed by a post-workshop survey to assess satisfaction (Level 1), knowledge changes (Level 2), and plans for use (Level 3), along with feedback. Results Twenty-seven participants (44.4% male) attended the workshop, with 92% stating it met workshop goals and 87.5% reporting personal goal fulfillment (Level 1). There was a significant increase in knowledge and confidence ratings across all topics ( p  <.001) (Level 2). Knowledge ratings rose from a mean of 0.44 (SD = 0.68) to 2.55 (SD = 0.56) while confidence increased from 0.47 (SD = 0.72) to 2.55 (SD = 0.56). Correct answer rates on knowledge assessments also improved and all attendees reported plans to use the skills in future research. Qualitative feedback indicated high enthusiasm for the course and increased confidence in applying the learned skills to current or future research (Level 3). Conclusions The workshop effectively strengthened capacity of attendees to adapt and validate PROMs for use in research and care in Tanzania. Plans are in place to incorporate this training into formal MUHAS courses. Similar workshops are needed to further enhance PROMs research capacity in the region for future application both in research and clinical care of PLWH.

IntroductionDeficits in decision-making (DM) can lead to adverse outcomes across multiple domains such as financial management and medical care. By hindering such DM abilities, cognitive impairment (CI) often affects quality of life. Routine screening for CI, however, does not include systematic and comprehensive assessment of DM ability. While there are many DM measures, there is considerable heterogeneity in what constructs are measured and the populations in which they have been validated. This scoping review protocol details the proposed comprehensive examination of published literature on DM measures used in adults aged 45 years and older.Methods and analysisArksey and O’Malley’s (2005) scoping review methodology framework will guide the current scoping review. We will systematically search Embase (Elsevier), MEDLINE (Ovid), PsycINFO (Ebsco), Cochrane Library (Wiley), Web of Science (Clarivate) and Scopus (Elsevier) to identify the studies meeting our eligibility criteria. We will review literature published between January 2018 and November 2023. Following best practice recommendations, a two-stage study selection process will be applied. First, titles and abstracts will be independently reviewed by two reviewers based on our eligibility criteria. Second, full texts will be screened and data will be extracted only from the articles included after the full review. The results of the current scoping review will be reported in adherence to PRISMA-Scr guidelines.Ethics and disseminationThis study does not require ethics approval as the scoping review methodology involves reviewing results from publicly available published materials. Results of the scoping review will be submitted for publication in a peer-reviewed journal.Trial registration numberNIA grant number 1U24AG082022-01.

Advances in medical testing and widespread access to the internet have made it easier than ever to obtain information. Yet, when it comes to some of the most important decisions in life, people often choose to remain ignorant for a variety of psychological and economic reasons. We design and validate an information preferences scale to measure an individual’s desire to obtain or avoid information that may be unpleasant but could improve future decisions. The scale measures information preferences in three domains that are psychologically and materially consequential: consumer finance, personal characteristics, and health. In three studies incorporating responses from over 2,300 individuals, we present tests of the scale’s reliability and validity. We show that the scale predicts a real decision to obtain (or avoid) information in each of the domains as well as decisions from out-of-sample, unrelated domains. Across settings, many respondents prefer to remain in a state of active ignorance even when information is freely available. Moreover, we find that information preferences are a stable trait but that an individual’s preference for information can differ across domains. This paper was accepted by Yuval Rottenstreich, judgment and decision making .

The term food noise has been recently popularized by individuals managing their weight or adhering to specific diets for health reasons. Anecdotal evidence from patients and clinical observations suggests that food noise involves constant preoccupation with food-related decisions—such as which foods to eat, caloric intake, macronutrient balance, and meal timing—which can become intrusive and unpleasant. Food noise also appears to affect cognitive burden and quality of life, and is being cited as one reason weight-loss attempts fail. The increase in public discourse about food noise has highlighted its potential significance, yet a formal clinical definition and method of measurement of food noise are lacking. Herein, we define food noise through clinical and patient anecdotes, describe initial research validating a food noise questionnaire, and outline future research directions. The formal definition of food noise is persistent thoughts about food that are perceived by the individual as being unwanted and/or dysphoric and may cause harm to the individual, including social, mental, or physical problems. Food noise is distinguished from routine food-related thoughts by its intensity and intrusiveness, resembling rumination. We describe our initial research developing the Ro Allison Indiana Dhurandhar- Food Noise Inventory (RAID-FN Inventory) to measure food noise. We also outline future areas of research, including exploring the prevalence and physiological underpinnings of food noise and the role of cultural and sociodemographic factors. The effects of glucagon-like peptide 1 (GLP-1) receptor agonists on food noise, the potential role of food noise in weight management and metabolic health, understanding food noise’s impact on health outcomes and quality of life, the stigma associated with food noise, and the potential influence of food noise on public health policies are discussed. Future research should aim to refine definitions, improve measurement tools, and evaluate therapeutic strategies for managing food noise.

Aims A primary advantage of IRT-based patient-reported outcome measures such as PROMIS short forms and computer-adaptive tests is that each estimate of the latent trait comes with a standard error. Such measurement error needs to be acknowledged, in particular when monitoring individual patients over time. In this study, we use plausible values to account for measurement error and analyze the probability of true within-individual change. Methods We use a longitudinal, observational study of stable and exacerbated COPD patients ( N  = 185), providing PROMIS Physical Function and Fatigue T -scores over 3 months. At each measurement, we imputed 1000 plausible values from the scores’ posterior distribution. These were then used to calculate probability of true change using a pre-specified threshold such as minimally important difference supported by the literature, or Δ T - s c o r e > 0. We demonstrate assessment of change in individuals and in groups, across different measures (Short Forms and CATs), and at various levels of confidence. Results Using plausible value imputation and with 95% certainty, 47.5% of participants in the exacerbated group reported less fatigue, compared with 26.5% of participants in the stable group. Comparison of Short Forms and CATs suggests that CATs have better ability to detect change compared to short forms. We also illustrate this method using an individual’s probability of change at different time points. Conclusion Plausible values offer a flexible way to include measurement error in analysis of individuals and on sample level. Assessment of probability of true change can complement existing distribution-based approaches and facilitates interpretation of improvement or decline.

INTRODUCTION Timely detection and tracking of Alzheimer's disease (AD) ‐related cognitive decline has become a public health priority. We investigated whether the NIH Toolbox for Assessment of Neurological and Behavioral Function—Cognition Battery (NIHTB‐CB) detects AD‐related cognitive decline. METHODS N = 171 participants (age 76.5 ± 8; 53% female, 34% Aβ‐positive) from the ARMADA study completed the NIHTB‐CB at baseline, 12 months, and 24 months. Linear mixed‐effect models correcting for demographics were used to examine cross‐sectional and longitudinal NIHTB‐CB scores in individuals across the clinical AD spectrum. RESULTS Compared to Aβ‐negative healthy controls, Aβ‐positive individuals with amnestic MCI or mild AD performed worse on all NIHTB‐CB measures and showed an accelerated decline in processing speed, working memory, and auditory word comprehension tests. DISCUSSION These findings support the use of the NIHTB‐CB in early AD, but also imply that the optimal NIHTB‐CB composite score to detect change over time may differ across clinical stages of AD. Future directions include replication of these findings in larger and more demographically diverse samples. Highlights We examined NIH Toolbox—Cognition Battery scores across the clinical AD spectrum. All NIH Toolbox tests detected cross‐sectional cognitive impairment in MCI‐to‐mild AD. Three NIH Toolbox tests captured further decline over time in MCI‐to‐mild AD. The NIH Toolbox can facilitate timely detection of AD‐related cognitive decline.

Patient-reported outcome measures are crucial for informed medical decisions and evaluating treatments. However, they can be burdensome for patients and sometimes lack the reliability clinicians need for clear clinical interpretations. We aimed to assess the extent to which applying alternative stopping rules can increase reliability for clinical use while minimizing the burden of computerized adaptive tests (CATs). CAT simulations were conducted on 3 adult item banks in the NIH Toolbox for Assessment of Neurological and Behavioral Function Emotion Battery; the item banks were in the Negative Affect subdomain (ie, Anger Affect, Fear Affect, and Sadness) and contained at least 8 items. In the originally applied NIH Toolbox CAT stopping rules, the CAT was stopped if the score SE reached <0.3 before 12 items were administered. We first contrasted this with a SE-change rule in a planned simulation analysis. We then contrasted the original rules with fixed-length CATs (4-12 items), a reduction of the maximum number of items to 8, and other modifications in post hoc analyses. Burden was measured by the number of items administered per simulation, precision by the percentage of assessments yielding reliability cutoffs (0.85, 0.90, and 0.95), and accurate score recovery by the root mean squared error between the generating θ and the CAT-estimated \"expected a posteriori\"-based θ. In general, relative to the original rules, the alternative stopping rules slightly decreased burden while also increasing the proportion of assessments achieving high reliability for the adult banks; however, the SE-change rule and fixed-length CATs with 8 or fewer items also notably increased assessments yielding reliability <0.85. Among the alternative rules explored, the reduced maximum stopping rule best balanced precision and parsimony, presenting another option beyond the original rules. Our findings demonstrate the challenges in attempting to reduce test burden while also achieving score precision for clinical use. Stopping rules should be modified in accordance with the context of the study population and the purpose of the study.

Cognitive impairment (CI) and related conditions are known to affect decision-making (DM), particularly in older adult populations. The intersection of CI and DM ability is crucial in end-of-life (EoL) care, where there is a confluence of heterogenous preferences and values often across different constituents (e.g., healthcare providers, family members, and proxies). Standardized questionnaires are necessary to characterize patients' EoL decisions, preferences, and readiness, but the extent of available measures is widely unknown. This scoping review aims to summarize the current state of the literature regarding EoL decision-making measures. This effort supports the development of the Advancing Reliable Measurement in Cognitive Aging and Decision-making Ability (ARMCADA) research initiative, which seeks to develop a decision-making battery for use in older adults. Following the Arksey and O'Malley framework, we conducted a scoping review for multiple domains of DM in studies published between January 2018 and November 2023. Any paper that assessed or characterized DM in participants 45 years and older was extracted for the DM domain, population characteristics, and DM measures. An initial search identified 16,286 articles, of which 705 were classified as assessing DM. Of those, 34 articles included measures of the EoL domain, and 28 unique measures were identified. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the Decisional Conflict Scale (DCS), and the Decision Regret Scale (DRS) were the only assessments used more than once in the scoping review. Many studies assessed clinical populations, including those with CI/dementia (12%), cancer (24%), and chronic conditions (16%). Findings show that measures used at the end of life emphasize decisional preferences, efficacy, and conflict. Overall, this review highlights the lack of DM ability measures that can assess older adults' capacity to make decisions regarding EoL-specific issues (e.g., life-sustaining treatment and pain management).