How social influence can undermine the wisdom of crowd effect

Social groups can be remarkably smart and knowledgeable when their averaged judgements are compared with the judgements of individuals. Already Galton [Galton F (1907) Nature 75:7] found evidence that the median estimate of a group can be more accurate than estimates of experts. This wisdom of crowd effect was recently supported by examples from stock markets, political elections, and quiz shows [Surowiecki J (2004) The Wisdom of Crowds]. In contrast, we demonstrate by experimental evidence (N = 144) that even mild social influence can undermine the wisdom of crowd effect in simple estimation tasks. In the experiment, subjects could reconsider their response to factual questions after having received average or full information of the responses of other subjects. We compare subjects' convergence of estimates and improvements in accuracy over five consecutive estimation periods with a control condition, in which no information about others' responses was provided. Although groups are initially "wise," knowledge about estimates of others narrows the diversity of opinions to such an extent that it undermines the wisdom of crowd effect in three different ways. The "social influence effect" diminishes the diversity of the crowd without improvements of its collective error. The "range reduction effect" moves the position of the truth to peripheral regions of the range of estimates so that the crowd becomes less reliable in providing expertise for external observers. The "confidence effect" boosts individuals' confidence after convergence of their estimates despite lack of improved accuracy. Examples of the revealed mechanism range from misled elites to the recent global financial crisis.     

应用Delphi法确定护士处方权实施的促进因素研究

[目的]探讨我国护士处方权实施的促进因素。[方法]采用自行设计的问卷,应用Delphi法对20名护理专家进行护士处方权实施的促进因素的两轮专家咨询。[结果]经两轮咨询后形成专家一致性意见,专家对所列条目认同率较高,最终确定促进因素共43条,其中包括一级指标4个,二级指标10个,三级指标29个。[结论]应用Delphi法确定的护士处方权实施的促进因素,专家积极性高、权威程度高、协调性好、结果可靠,且内容具有较好的信度和效度;建议相关部门促进我国护士处方权的实施应从政策、教育、管理、实践四方面入手。     

以学生为主体的授课方式的实践与评析

提高教学质量已经成为我国高等教育的核心任务和战略重点.本文以预防医学专业本科学生为研究对象,尝试对环境健康学课程的教学方法进行改革,实施以学生为主体的授课方式,取得了良好的效果,也发现了一些存在的问题.本文就本次理论课程授课方式的改革尝试进行了总结,以期为今后更好地促进教学改革提供思路和经验.     

基于影响因子分析我国护理学期刊学术影响力变化趋势

目的:从影响因子角度定量分析我国护理学期刊学术影响力变化趋势。方法:采用文献计量法、比较研究法,统计《中国科技期刊引证报告》核心版近10年收录护理学期刊的影响因子最大值、最小值和平均值等。结果:《中国科技期刊引证报告》核心版收录的护理学期刊影响因子平均值从2000年的0.1735上升到2009年的0.5621;最高值从2000年的0.373上升到2009年1.485,最低值从2000年的0.075上升到2009年的0.106;高影响力(影响因子≥1.0)期刊数量基本没变,但所占百分比逐渐减小。结论:我国护理学期刊质量和数量均逐年提高,且增长速度较快;学术影响力呈上升趋势,但仍然较弱,需加大期刊建设力度和提高护理人员的科研能力,以促进护理学科向纵深发展。     

An 11‐country study to benchmark the implementation of recommended nutrition policies by national governments using the Healthy Food Environment Policy Index, 2015‐2018

The Healthy Food Environment Policy Index (Food‐EPI) aims to assess the extent of implementation of recommended food environment policies by governments compared with international best practices and prioritize actions to fill implementation gaps. The Food‐EPI was applied in 11 countries across six regions (2015‐2018). National public health nutrition panels (n = 11‐101 experts) rated the extent of implementation of 47 policy and infrastructure support good practice indicators by their government(s) against best practices, using an evidence document verified by government officials. Experts identified and prioritized actions to address implementation gaps. The proportion of indicators at “very low if any,” “low,” “medium,” and “high” implementation, overall Food‐EPI scores, and priority action areas were compared across countries. Inter‐rater reliability was good (GwetAC2 = 0.6‐0.8). Chile had the highest proportion of policies (13%) rated at “high” implementation, while Guatemala had the highest proportion of policies (83%) rated at “very low if any” implementation. The overall Food‐EPI score was “medium” for Australia, England, Chile, and Singapore, while “very low if any” for Guatemala. Policy areas most frequently prioritized included taxes on unhealthy foods, restricting unhealthy food promotion and front‐of‐pack labelling. The Food‐EPI was found to be a robust tool and process to benchmark governments' progress to create healthy food environments.     

Organizational analysis of maternal mortality reduction programs in Madagascar

Little is known about the organizational factors involved in policy creation and programs implementation aimed at reducing maternal mortality in Madagascar. A qualitative case study was performed to investigate organizational factors influencing the health system's capacity to elaborate and implement maternal mortality reduction programs. Semi-structured interviews were conducted with 53 participants. A conceptual framework based on Gamson's coalition theory and Hinings and Greenwood's archetypes concept was used. Three major conclusions emerge: the Ministry of Health is a poor leader in the development of national strategies, due to its dependency on external financial resources and expertise, and because of poor transmission of key information from the field; at a meso level (regions and districts), the capacity to adapt programs is highly dependent on the collaboration with NGOs; at the micro level, there are few incentives provided to field workers to participate in a collective effort and little attempt to exploit complementarities between scare resources. The Madagascar health system should consider the need for improvement in data analysis capacity, and implementing behavior-changing tools suitable for stimulating providers who work inside and outside the health care system, to participate to a coordinated collective effort.     

Explaining Michigan: developing an ex post theory of a quality improvement program

Context: Understanding how and why programs work—not simply whether they work—is crucial. Good theory is indispensable to advancing the science of improvement. We argue for the usefulness of ex post theorization of programs. Methods: We propose an approach, located within the broad family of theory‐oriented methods, for developing ex post theories of interventional programs. We use this approach to develop an ex post theory of the Michigan Intensive Care Unit (ICU) project, which attracted international attention by successfully reducing rates of central venous catheter bloodstream infections (CVC‐BSIs). The procedure used to develop the ex post theory was (1) identify program leaders’ initial theory of change and learning from running the program; (2) enhance this with new information in the form of theoretical contributions from social scientists; (3) synthesize prior and new information to produce an updated theory. Findings: The Michigan project achieved its effects by (1) generating isomorphic pressures for ICUs to join the program and conform to its requirements; (2) creating a densely networked community with strong horizontal links that exerted normative pressures on members; (3) reframing CVC‐BSIs as a social problem and addressing it through a professional movement combining “grassroots” features with a vertically integrating program structure; (4) using several interventions that functioned in different ways to shape a culture of commitment to doing better in practice; (5) harnessing data on infection rates as a disciplinary force; and (6) using “hard edges.” Conclusions: Updating program theory in the light of experience from program implementation is essential to improving programs’ generalizability and transferability, although it is not a substitute for concurrent evaluative fieldwork. Future iterations of programs based on the Michigan project, and improvement science more generally, may benefit from the updated theory present here.