Sample records for improve management decisions

  1. Improving Water Management Decision Support Tools Using NASA Satellite and Modeling Data

    NASA Astrophysics Data System (ADS)

    Toll, D. L.; Arsenault, K.; Nigro, J.; Pinheiro, A.; Engman, E. T.; Triggs, J.; Cosgrove, B.; Alonge, C.; Boyle, D.; Allen, R.; Townsend, P.; Ni-Meister, W.

    2006-05-01

    One of twelve Applications of National priority within NASA's Applied Science Program, the Water Management Program Element addresses concerns and decision making related to water availability, water forecast and water quality. The goal of the Water Management Program Element is to encourage water management organizations to use NASA Earth science data, models products, technology and other capabilities in their decision support tools for problem solving. The Water Management Program Element partners with Federal agencies, academia, private firms, and may include international organizations. This paper further describes the Water Management Program with the objective of informing the applications community of the potential opportunities for using NASA science products for problem solving. We will illustrate some ongoing and application Water Management projects evaluating and benchmarking NASA data with partnering federal agencies and their decision support tools: 1) Environmental Protection Agency for water quality; 2) Bureau of Reclamation for water supply, demand and forecast; and 3) NOAA National Weather Service for improved weather prediction. Examples of the types of NASA contributions to the these agency decision support tools include: 1) satellite observations within models assist to estimate water storage, i.e., snow water equivalent, soil moisture, aquifer volumes, or reservoir storages; 2) model derived products, i.e., evapotranspiration, precipitation, runoff, ground water recharge, and other 4-dimensional data assimilation products; 3) improve water quality, assessments by using improved inputs from NASA models (precipitation, evaporation) and satellite observations (e.g., temperature, turbidity, land cover) to nonpoint source models; and 4) water (i.e., precipitation) and temperature predictions from days to decades over local, regional and global scales.

  2. Health-care process improvement decisions: a systems perspective.

    PubMed

    Walley, Paul; Silvester, Kate; Mountford, Shaun

    2006-01-01

    The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.

  3. Improving IT Portfolio Management Decision Confidence Using Multi-Criteria Decision Making and Hypervariate Display Techniques

    ERIC Educational Resources Information Center

    Landmesser, John Andrew

    2014-01-01

    Information technology (IT) investment decision makers are required to process large volumes of complex data. An existing body of knowledge relevant to IT portfolio management (PfM), decision analysis, visual comprehension of large volumes of information, and IT investment decision making suggest Multi-Criteria Decision Making (MCDM) and…

  4. Behavioral medicine perspectives on the design of health information technology to improve decision-making, guideline adherence, and care coordination in chronic pain management.

    PubMed

    Midboe, Amanda M; Lewis, Eleanor T; Cronkite, Ruth C; Chambers, Dallas; Goldstein, Mary K; Kerns, Robert D; Trafton, Jodie A

    2011-03-01

    Development of clinical decision support systems (CDSs) has tended to focus on facilitating medication management. An understanding of behavioral medicine perspectives on the usefulness of a CDS for patient care can expand CDSs to improve management of chronic disease. The purpose of this study is to explore feedback from behavioral medicine providers regarding the potential for CDSs to improve decision-making, care coordination, and guideline adherence in pain management. Qualitative methods were used to analyze semi-structured interview responses from behavioral medicine stakeholders following demonstration of an existing CDS for opioid prescribing, ATHENA-OT. Participants suggested that a CDS could assist with decision-making by educating providers, providing recommendations about behavioral therapy, facilitating risk assessment, and improving referral decisions. They suggested that a CDS could improve care coordination by facilitating division of workload, improving patient education, and increasing consideration and knowledge of options in other disciplines. Clinical decision support systems are promising tools for improving behavioral medicine care for chronic pain.

  5. Has Lean improved organizational decision making?

    PubMed

    Simons, Pascale; Benders, Jos; Bergs, Jochen; Marneffe, Wim; Vandijck, Dominique

    2016-06-13

    Purpose - Sustainable improvement is likely to be hampered by ambiguous objectives and uncertain cause-effect relations in care processes (the organization's decision-making context). Lean management can improve implementation results because it decreases ambiguity and uncertainties. But does it succeed? Many quality improvement (QI) initiatives are appropriate improvement strategies in organizational contexts characterized by low ambiguity and uncertainty. However, most care settings do not fit this context. The purpose of this paper is to investigate whether a Lean-inspired change program changed the organization's decision-making context, making it more amenable for QI initiatives. Design/methodology/approach - In 2014, 12 professionals from a Dutch radiotherapy institute were interviewed regarding their perceptions of a Lean program in their organization and the perceived ambiguous objectives and uncertain cause-effect relations in their clinical processes. A survey (25 questions), addressing the same concepts, was conducted among the interviewees in 2011 and 2014. The structured interviews were analyzed using a deductive approach. Quantitative data were analyzed using appropriate statistics. Findings - Interviewees experienced improved shared visions and the number of uncertain cause-effect relations decreased. Overall, more positive (99) than negative Lean effects (18) were expressed. The surveys revealed enhanced process predictability and standardization, and improved shared visions. Practical implications - Lean implementation has shown to lead to greater transparency and increased shared visions. Originality/value - Lean management decreased ambiguous objectives and reduced uncertainties in clinical process cause-effect relations. Therefore, decision making benefitted from Lean increasing QI's sustainability.

  6. A novel medical information management and decision model for uncertain demand optimization.

    PubMed

    Bi, Ya

    2015-01-01

    Accurately planning the procurement volume is an effective measure for controlling the medicine inventory cost. Due to uncertain demand it is difficult to make accurate decision on procurement volume. As to the biomedicine sensitive to time and season demand, the uncertain demand fitted by the fuzzy mathematics method is obviously better than general random distribution functions. To establish a novel medical information management and decision model for uncertain demand optimization. A novel optimal management and decision model under uncertain demand has been presented based on fuzzy mathematics and a new comprehensive improved particle swarm algorithm. The optimal management and decision model can effectively reduce the medicine inventory cost. The proposed improved particle swarm optimization is a simple and effective algorithm to improve the Fuzzy interference and hence effectively reduce the calculation complexity of the optimal management and decision model. Therefore the new model can be used for accurate decision on procurement volume under uncertain demand.

  7. "Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

    PubMed

    Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

    2008-01-01

    Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

  8. Group decision-making techniques for natural resource management applications

    USGS Publications Warehouse

    Coughlan, Beth A.K.; Armour, Carl L.

    1992-01-01

    This report is an introduction to decision analysis and problem-solving techniques for professionals in natural resource management. Although these managers are often called upon to make complex decisions, their training in the natural sciences seldom provides exposure to the decision-making tools developed in management science. Our purpose is to being to fill this gap. We present a general analysis of the pitfalls of group problem solving, and suggestions for improved interactions followed by the specific techniques. Selected techniques are illustrated. The material is easy to understand and apply without previous training or excessive study and is applicable to natural resource management issues.

  9. Improved resource use decisions and actions through remote sensing

    NASA Technical Reports Server (NTRS)

    Hill-Rowley, R.; Boylan, M.; Enslin, W.; Vlasin, R. D.

    1975-01-01

    Operational uses of remote sensing for improving management decisions and actions concerning resource uses are considered in terms of first generation, or direct-action; and second generation or indirect, delayed-action applications. From among applications completed during 1974-75, seven case studies are offered in illustration of the many contrasts which can be drawn between first and second generation application studies. These include: (1) multi-agency river basin planning; (2) corridor assessment and route location for highway location together with improvement of county-level planning decisions; (3) improving timber management practices; (4) enforcement of new state statutes; (5) county-wide open space preservation; (6) land value reappraisal relative to property tax equalization; and (7) optimizing agri-business processing plant locations.

  10. Using real options analysis to support strategic management decisions

    NASA Astrophysics Data System (ADS)

    Kabaivanov, Stanimir; Markovska, Veneta; Milev, Mariyan

    2013-12-01

    Decision making is a complex process that requires taking into consideration multiple heterogeneous sources of uncertainty. Standard valuation and financial analysis techniques often fail to properly account for all these sources of risk as well as for all sources of additional flexibility. In this paper we explore applications of a modified binomial tree method for real options analysis (ROA) in an effort to improve decision making process. Usual cases of use of real options are analyzed with elaborate study on the applications and advantages that company management can derive from their application. A numeric results based on extending simple binomial tree approach for multiple sources of uncertainty are provided to demonstrate the improvement effects on management decisions.

  11. “Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management

    PubMed Central

    Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

    2008-01-01

    Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

  12. Information Technology Process Improvement Decision-Making: An Exploratory Study from the Perspective of Process Owners and Process Managers

    ERIC Educational Resources Information Center

    Lamp, Sandra A.

    2012-01-01

    There is information available in the literature that discusses information technology (IT) governance and investment decision making from an executive-level perception, yet there is little information available that offers the perspective of process owners and process managers pertaining to their role in IT process improvement and investment…

  13. 7 CFR 3052.405 - Management decision.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 7 Agriculture 15 2012-01-01 2012-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  14. 7 CFR 3052.405 - Management decision.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 7 Agriculture 15 2014-01-01 2014-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  15. 7 CFR 3052.405 - Management decision.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 15 2011-01-01 2011-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  16. 7 CFR 3052.405 - Management decision.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Management decision. 3052.405 Section 3052.405... and Pass-Through Entities § 3052.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  17. Improving the relevance and impact of decision support research: A co-production framework and water management case study

    NASA Astrophysics Data System (ADS)

    Smith, R.; Kasprzyk, J. R.; Dilling, L.; Basdekas, L.; Kaatz, L.

    2016-12-01

    In light of the unpredictable effects of climate change and population shifts, responsible resource management will require new types of information and strategies going forward. For water utilities, this means that water supply infrastructure systems must be expanded and/or managed for changes in overall supply and increased extremes. Utilities have begun seeking innovative tools and methods to support planning and decision making, but there are limited channels through which they can gain exposure to emerging tools from the research world, and for researchers to uptake important real-world planning and decision context. A transdisciplinary team of engineers, social and climate scientists, and water managers designed this study to develop and apply a co-production framework which explores the potential of an emerging decision support tool to enhance flexibility and adaptability in water utility planning. It also demonstrates how to improve the link between research and practice in the water sector. In this study we apply the co-production framework to the use of Multiobjective Evolutionary Algorithms (MOEAs). MOEAs have shown promise in being able to generate and evaluate new planning alternatives but they have had little testing or application in water utilities. Anchored by two workshops, this study (1) elicited input from water managers from six water suppliers on the Front Range of Colorado, USA, to create a testbed MOEA application, and (2) evaluated the managers' responses to multiobjective optimization results. The testbed consists of a Front Range-relevant hypothetical water supply model, the Borg MOEA, hydrology and demand scenarios, and a set of planning decisions and performance objectives that drive the link between the algorithm and the model. In this presentation we describe researcher-manager interactions at the initial workshop that served to establish relationships and provide in-depth information to researchers about regional water management

  18. 29 CFR 99.405 - Management decision.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 29 Labor 1 2013-07-01 2013-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  19. 29 CFR 99.405 - Management decision.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 1 2011-07-01 2011-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  20. 29 CFR 99.405 - Management decision.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 29 Labor 1 2012-07-01 2012-07-01 false Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  1. 29 CFR 99.405 - Management decision.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 29 Labor 1 2014-07-01 2013-07-01 true Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  2. 29 CFR 99.405 - Management decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 1 2010-07-01 2010-07-01 true Management decision. 99.405 Section 99.405 Labor Office of... Agencies and Pass-through Entities § 99.405 Management decision. (a) General. The management decision shall... the management decision, the Federal agency or pass-through entity may request additional information...

  3. Combined Goal Management Training and Mindfulness meditation improve executive functions and decision-making performance in abstinent polysubstance abusers.

    PubMed

    Alfonso, José P; Caracuel, Alfonso; Delgado-Pastor, Luis C; Verdejo-García, Antonio

    2011-08-01

    The clinical relevance of neuropsychological deficits in addicted individuals has fostered interest in treatment strategies aimed to effectively target executive and decision-making dysfunction. One of the best-validated interventions for executive dysfunction is Goal Management Training (GMT) (Robertson et al., 2005), an interactive program aimed at improving participants' organization and ability to achieve goals. Mindfulness-based meditation can complement GMT training in order to improve attentional scanning and "reading" of emotional signals involved in adaptive decision-making. In this pilot study we investigated the efficacy of a 7-week program including GMT+Mindfulness (GMT+MF), as compared to standard treatment alone (STx), for reducing executive and decision-making deficits in an outpatient sample of alcohol and polysubstance abusers. Eighteen participants were enrolled in the GMT+MF group, whereas 16 participants formed the STx group; both groups were matched for relevant demographic and clinical variables, and pre-treatment degree of executive dysfunction. Results showed that the individuals enrolled in GMT+MF significantly improved their performance on neuropsychological measures of working memory (Letter Number Sequencing), response inhibition (Stroop) and decision-making (Iowa Gambling Task) after the treatment; whereas individuals enrolled in STx alone failed to show significant changes. These preliminary results indicate that the GMT+MF intervention may be effective in reducing executive and decision-making deficits in polysubstance abusers, and they support future randomized controlled studies aimed at examining the extent to which these improvements may generalize to every day functioning and may affect the capacity of addicted individuals to achieve and maintain abstinence. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  4. Dissociated neural processing for decisions in managers and non-managers.

    PubMed

    Caspers, Svenja; Heim, Stefan; Lucas, Marc G; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

    2012-01-01

    Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing.

  5. Dissociated Neural Processing for Decisions in Managers and Non-Managers

    PubMed Central

    Caspers, Svenja; Heim, Stefan; Lucas, Marc G.; Stephan, Egon; Fischer, Lorenz; Amunts, Katrin; Zilles, Karl

    2012-01-01

    Functional neuroimaging studies of decision-making so far mainly focused on decisions under uncertainty or negotiation with other persons. Dual process theory assumes that, in such situations, decision making relies on either a rapid intuitive, automated or a slower rational processing system. However, it still remains elusive how personality factors or professional requirements might modulate the decision process and the underlying neural mechanisms. Since decision making is a key task of managers, we hypothesized that managers, facing higher pressure for frequent and rapid decisions than non-managers, prefer the heuristic, automated decision strategy in contrast to non-managers. Such different strategies may, in turn, rely on different neural systems. We tested managers and non-managers in a functional magnetic resonance imaging study using a forced-choice paradigm on word-pairs. Managers showed subcortical activation in the head of the caudate nucleus, and reduced hemodynamic response within the cortex. In contrast, non-managers revealed the opposite pattern. With the head of the caudate nucleus being an initiating component for process automation, these results supported the initial hypothesis, hinting at automation during decisions in managers. More generally, the findings reveal how different professional requirements might modulate cognitive decision processing. PMID:22927984

  6. 25 CFR 217.5 - Management decisions.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 25 Indians 1 2012-04-01 2011-04-01 true Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

  7. 38 CFR 41.405 - Management decision.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

  8. 25 CFR 217.5 - Management decisions.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 25 Indians 1 2013-04-01 2013-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

  9. 38 CFR 41.405 - Management decision.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

  10. 25 CFR 217.5 - Management decisions.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 25 Indians 1 2011-04-01 2011-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

  11. 38 CFR 41.405 - Management decision.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

  12. 25 CFR 217.5 - Management decisions.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 25 Indians 1 2014-04-01 2014-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

  13. 38 CFR 41.405 - Management decision.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

  14. 25 CFR 217.5 - Management decisions.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Management decisions. 217.5 Section 217.5 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR ENERGY AND MINERALS MANAGEMENT OF TRIBAL ASSETS OF UTE... Management decisions. In arriving at management decisions concerning the assets, the business committee shall...

  15. 38 CFR 41.405 - Management decision.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Management decision. 41... Entities § 41.405 Management decision. (a) General. The management decision shall clearly state whether or... completed corrective action, a timetable for follow-up should be given. Prior to issuing the management...

  16. Using decision analysis to support proactive management of emerging infectious wildlife diseases

    USGS Publications Warehouse

    Grant, Evan H. Campbell; Muths, Erin L.; Katz, Rachel A.; Canessa, Stefano; Adams, Michael J.; Ballard, Jennifer R.; Berger, Lee; Briggs, Cheryl J.; Coleman, Jeremy; Gray, Matthew J.; Harris, M. Camille; Harris, Reid N.; Hossack, Blake R.; Huyvaert, Kathryn P.; Kolby, Jonathan E.; Lips, Karen R.; Lovich, Robert E.; McCallum, Hamish I.; Mendelson, Joseph R.; Nanjappa, Priya; Olson, Deanna H.; Powers, Jenny G.; Richgels, Katherine L. D.; Russell, Robin E.; Schmidt, Benedikt R.; Spitzen-van der Sluijs, Annemarieke; Watry, Mary Kay; Woodhams, Douglas C.; White, C. LeAnn

    2017-01-01

    Despite calls for improved responses to emerging infectious diseases in wildlife, management is seldom considered until a disease has been detected in affected populations. Reactive approaches may limit the potential for control and increase total response costs. An alternative, proactive management framework can identify immediate actions that reduce future impacts even before a disease is detected, and plan subsequent actions that are conditional on disease emergence. We identify four main obstacles to developing proactive management strategies for the newly discovered salamander pathogen Batrachochytrium salamandrivorans (Bsal). Given that uncertainty is a hallmark of wildlife disease management and that associated decisions are often complicated by multiple competing objectives, we advocate using decision analysis to create and evaluate trade-offs between proactive (pre-emergence) and reactive (post-emergence) management options. Policy makers and natural resource agency personnel can apply principles from decision analysis to improve strategies for countering emerging infectious diseases.

  17. Commonality in Military Equipment. A Framework to Improve Acquisition Decisions

    DTIC Science & Technology

    2008-01-01

    Improving Acquisition Decisions Chopra, Sunil , and Peter Meindl, Supply Chain Management : Strategy, Planning, Operation, Upper Saddle River, N.J...Personnel Costs in Managing Suppliers and Ordering Parts. The effort to perform these activities may be reduced and simplified through a smaller supply ...a Combined MOS on Mechanic Supply Variability

  18. Using structured decision making to manage disease risk for Montana wildlife

    USGS Publications Warehouse

    Mitchell, Michael S.; Gude, Justin A.; Anderson, Neil J.; Ramsey, Jennifer M.; Thompson, Michael J.; Sullivan, Mark G.; Edwards, Victoria L.; Gower, Claire N.; Cochrane, Jean Fitts; Irwin, Elise R.; Walshe, Terry

    2013-01-01

    We used structured decision-making to develop a 2-part framework to assist managers in the proactive management of disease outbreaks in Montana, USA. The first part of the framework is a model to estimate the probability of disease outbreak given field observations available to managers. The second part of the framework is decision analysis that evaluates likely outcomes of management alternatives based on the estimated probability of disease outbreak, and applies managers' values for different objectives to indicate a preferred management strategy. We used pneumonia in bighorn sheep (Ovis canadensis) as a case study for our approach, applying it to 2 populations in Montana that differed in their likelihood of a pneumonia outbreak. The framework provided credible predictions of both probability of disease outbreaks, as well as biological and monetary consequences of management actions. The structured decision-making approach to this problem was valuable for defining the challenges of disease management in a decentralized agency where decisions are generally made at the local level in cooperation with stakeholders. Our approach provides local managers with the ability to tailor management planning for disease outbreaks to local conditions. Further work is needed to refine our disease risk models and decision analysis, including robust prediction of disease outbreaks and improved assessment of management alternatives.

  19. Integrating Water Quality and River Rehabilitation Management - A Decision-Analytical Perspective

    NASA Astrophysics Data System (ADS)

    Reichert, P.; Langhans, S.; Lienert, J.; Schuwirth, N.

    2009-04-01

    Integrative river management involves difficult decisions about alternative measures to improve their ecological state. For this reason, it seems useful to apply knowledge from the decision sciences to support river management. We discuss how decision-analytical elements can be employed for designing an integrated river management procedure. An important aspect of this procedure is to clearly separate scientific predictions of the consequences of alternatives from objectives to be achieved by river management. The key elements of the suggested procedure are (i) the quantitative elicitation of the objectives from different stakeholder groups, (ii) the compilation of the current scientific knowledge about the consequences of the effects resulting from suggested measures in the form of a probabilistic mathematical model, and (iii) the use of these predictions and valuations to prioritize alternatives, to uncover conflicting objectives, to support the design of better alternatives, and to improve the transparency of communication about the chosen management strategy. The development of this procedure led to insights regarding necessary steps to be taken for rational decision-making in river management, to guidelines about the use of decision-analytical techniques for performing these steps, but also to new insights about the application of decision-analytical techniques in general. In particular, the consideration of the spatial distribution of the effects of measures and the potential added value of connected rehabilitated river reaches leads to favoring measures that have a positive effect beyond a single river reach. As these effects only propagate within the river network, this results in a river basin oriented management concept as a consequence of a rational decision support procedure, rather than as an a priori management paradigm. There are also limitations to the support that can be expected from the decision-analytical perspective. It will not provide the

  20. Structured decision making as a framework for large-scale wildlife harvest management decisions

    USGS Publications Warehouse

    Robinson, Kelly F.; Fuller, Angela K.; Hurst, Jeremy E.; Swift, Bryan L.; Kirsch, Arthur; Farquhar, James F.; Decker, Daniel J.; Siemer, William F.

    2016-01-01

    Fish and wildlife harvest management at large spatial scales often involves making complex decisions with multiple objectives and difficult tradeoffs, population demographics that vary spatially, competing stakeholder values, and uncertainties that might affect management decisions. Structured decision making (SDM) provides a formal decision analytic framework for evaluating difficult decisions by breaking decisions into component parts and separating the values of stakeholders from the scientific evaluation of management actions and uncertainty. The result is a rigorous, transparent, and values-driven process. This decision-aiding process provides the decision maker with a more complete understanding of the problem and the effects of potential management actions on stakeholder values, as well as how key uncertainties can affect the decision. We use a case study to illustrate how SDM can be used as a decision-aiding tool for management decision making at large scales. We evaluated alternative white-tailed deer (Odocoileus virginianus) buck-harvest regulations in New York designed to reduce harvest of yearling bucks, taking into consideration the values of the state wildlife agency responsible for managing deer, as well as deer hunters. We incorporated tradeoffs about social, ecological, and economic management concerns throughout the state. Based on the outcomes of predictive models, expert elicitation, and hunter surveys, the SDM process identified management alternatives that optimized competing objectives. The SDM process provided biologists and managers insight about aspects of the buck-harvest decision that helped them adopt a management strategy most compatible with diverse hunter values and management concerns.

  1. Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review.

    PubMed

    Hemens, Brian J; Holbrook, Anne; Tonkin, Marita; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

    2011-08-03

    Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit. We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements. CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

  2. Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.

    PubMed

    Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

    2014-09-01

    Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.

  3. Decision space for health workforce management in decentralized settings: a case study in Uganda.

    PubMed

    Alonso-Garbayo, Alvaro; Raven, Joanna; Theobald, Sally; Ssengooba, Freddie; Nattimba, Milly; Martineau, Tim

    2017-11-01

    The aim of this paper is to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM. The study builds upon work undertaken by PERFORM Research Consortium in Uganda using action-research to strengthen human resources management in the health sector. To assess the decision space that managers have in six areas of HRM (e.g. policy, planning, remuneration and incentives, performance management, education and information) the study compares the roles allocated by Uganda's policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have. Results show that in some areas District Health Management Team (DHMT) members make decisions beyond their conferred authority while in others they do not use all the space allocated by policy. DHMT members operate close to the boundaries defined by public policy in planning, remuneration and incentives, policy and performance management. However, they make decisions beyond their conferred authority in the area of information and do not use all the space allocated by policy in the area of education. DHMTs' decision-making capacity to manage their workforce is influenced by their own perceived authority and sometimes it is constrained by decisions made at higher levels. We can conclude that decentralization, to improve workforce performance, needs to devolve power further down from district authorities onto district health managers. DHMTs need not only more power and authority to make decisions about their workforce but also more control over resources to be able to implement these decisions. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. Application of TOPSIS and VIKOR improved versions in a multi criteria decision analysis to develop an optimized municipal solid waste management model.

    PubMed

    Aghajani Mir, M; Taherei Ghazvinei, P; Sulaiman, N M N; Basri, N E A; Saheri, S; Mahmood, N Z; Jahan, A; Begum, R A; Aghamohammadi, N

    2016-01-15

    Selecting a suitable Multi Criteria Decision Making (MCDM) method is a crucial stage to establish a Solid Waste Management (SWM) system. Main objective of the current study is to demonstrate and evaluate a proposed method using Multiple Criteria Decision Making methods (MCDM). An improved version of Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) applied to obtain the best municipal solid waste management method by comparing and ranking the scenarios. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Besides, Viekriterijumsko Kompromisno Rangiranje (VIKOR) compromise solution method applied for sensitivity analyses. The proposed method can assist urban decision makers in prioritizing and selecting an optimized Municipal Solid Waste (MSW) treatment system. Besides, a logical and systematic scientific method was proposed to guide an appropriate decision-making. A modified TOPSIS methodology as a superior to existing methods for first time was applied for MSW problems. Applying this method in order to rank treatment methods is introduced as one contribution of the study. Next, 11 scenarios of MSW treatment methods are defined and compared environmentally and economically based on the waste management conditions. Results show that integrating a sanitary landfill (18.1%), RDF (3.1%), composting (2%), anaerobic digestion (40.4%), and recycling (36.4%) was an optimized model of integrated waste management. An applied decision-making structure provides the opportunity for optimum decision-making. Therefore, the mix of recycling and anaerobic digestion and a sanitary landfill with Electricity Production (EP) are the preferred options for MSW management. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. "Making Do" Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards.

    PubMed

    Wills, Celia E; Polivka, Barbara J; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

    2016-04-01

    This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of "making do" decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. © The Author(s) 2015.

  6. A decision support tool for adaptive management of native prairie ecosystems

    USGS Publications Warehouse

    Hunt, Victoria M.; Jacobi, Sarah; Gannon, Jill J.; Zorn, Jennifer E.; Moore, Clinton; Lonsdorf, Eric V.

    2016-01-01

    The Native Prairie Adaptive Management initiative is a decision support framework that provides cooperators with management-action recommendations to help them conserve native species and suppress invasive species on prairie lands. We developed a Web-based decision support tool (DST) for the U.S. Fish and Wildlife Service and the U.S. Geological Survey initiative. The DST facilitates cross-organizational data sharing, performs analyses to improve conservation delivery, and requires no technical expertise to operate. Each year since 2012, the DST has used monitoring data to update ecological knowledge that it translates into situation-specific management-action recommendations (e.g., controlled burn or prescribed graze). The DST provides annual recommendations for more than 10,000 acres on 20 refuge complexes in four U.S. states. We describe how the DST promotes the long-term implementation of the program for which it was designed and may facilitate decision support and improve ecological outcomes of other conservation efforts.

  7. Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making

    PubMed Central

    Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

    2016-01-01

    Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019

  8. Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

    PubMed

    Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

    1997-01-01

    This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

  9. Knowledge management in healthcare: towards 'knowledge-driven' decision-support services.

    PubMed

    Abidi, S S

    2001-09-01

    In this paper, we highlight the involvement of Knowledge Management in a healthcare enterprise. We argue that the 'knowledge quotient' of a healthcare enterprise can be enhanced by procuring diverse facets of knowledge from the seemingly placid healthcare data repositories, and subsequently operationalising the procured knowledge to derive a suite of Strategic Healthcare Decision-Support Services that can impact strategic decision-making, planning and management of the healthcare enterprise. In this paper, we firstly present a reference Knowledge Management environment-a Healthcare Enterprise Memory-with the functionality to acquire, share and operationalise the various modalities of healthcare knowledge. Next, we present the functional and architectural specification of a Strategic Healthcare Decision-Support Services Info-structure, which effectuates a synergy between knowledge procurement (vis-à-vis Data Mining) and knowledge operationalisation (vis-à-vis Knowledge Management) techniques to generate a suite of strategic knowledge-driven decision-support services. In conclusion, we argue that the proposed Healthcare Enterprise Memory is an attempt to rethink the possible sources of leverage to improve healthcare delivery, hereby providing a valuable strategic planning and management resource to healthcare policy makers.

  10. Decision Support for Ecosystem Management (Chapter 28)

    Treesearch

    Keith Reynolds; Jennifer Bjork; Rachel Riemann Hershey; Dan Schmoldt; John Payne; Susan King; Lee DeCola; Mark J. Twery; Pat Cunningham

    1999-01-01

    This chapter presents a management perspective on decision support for ecosystem management.The Introduction provides a brief historical overview of decision support technology as it has been used in natural resource management, discusses the role of decision support in ecosystem management as we see it, and summarizes the current state of the technology.

  11. Contingency Management and Deliberative Decision-Making Processes

    PubMed Central

    Regier, Paul S.; Redish, A. David

    2015-01-01

    Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation. PMID:26082725

  12. Contingency Management and Deliberative Decision-Making Processes.

    PubMed

    Regier, Paul S; Redish, A David

    2015-01-01

    Contingency management is an effective treatment for drug addiction. The current explanation for its success is rooted in alternative reinforcement theory. We suggest that alternative reinforcement theory is inadequate to explain the success of contingency management and produce a model based on demand curves that show how little the monetary rewards offered in this treatment would affect drug use. Instead, we offer an explanation of its success based on the concept that it accesses deliberative decision-making processes. We suggest that contingency management is effective because it offers a concrete and immediate alternative to using drugs, which engages deliberative processes, improves the ability of those deliberative processes to attend to non-drug options, and offsets more automatic action-selection systems. This theory makes explicit predictions that can be tested, suggests which users will be most helped by contingency management, and suggests improvements in its implementation.

  13. Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review.

    PubMed

    Roshanov, Pavel S; Misra, Shikha; Gerstein, Hertzel C; Garg, Amit X; Sebaldt, Rolf J; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

    2011-08-03

    The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes.

  14. Computerized clinical decision support systems for chronic disease management: A decision-maker-researcher partnership systematic review

    PubMed Central

    2011-01-01

    Background The use of computerized clinical decision support systems (CCDSSs) may improve chronic disease management, which requires recurrent visits to multiple health professionals, ongoing disease and treatment monitoring, and patient behavior modification. The objective of this review was to determine if CCDSSs improve the processes of chronic care (such as diagnosis, treatment, and monitoring of disease) and associated patient outcomes (such as effects on biomarkers and clinical exacerbations). Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for potentially eligible articles published up to January 2010. We included randomized controlled trials that compared the use of CCDSSs to usual practice or non-CCDSS controls. Trials were eligible if at least one component of the CCDSS was designed to support chronic disease management. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of relevant outcomes. Results Of 55 included trials, 87% (n = 48) measured system impact on the process of care and 52% (n = 25) of those demonstrated statistically significant improvements. Sixty-five percent (36/55) of trials measured impact on, typically, non-major (surrogate) patient outcomes, and 31% (n = 11) of those demonstrated benefits. Factors of interest to decision makers, such as cost, user satisfaction, system interface and feature sets, unique design and deployment characteristics, and effects on user workflow were rarely investigated or reported. Conclusions A small majority (just over half) of CCDSSs improved care processes in chronic disease management and some improved patient health. Policy makers, healthcare administrators, and practitioners should be aware that the evidence of CCDSS effectiveness is limited, especially with respect to the small number and size of studies measuring patient outcomes

  15. Multiobjective decision-making in integrated water management

    NASA Astrophysics Data System (ADS)

    Pouwels, I. H. M.; Wind, H. G.; Witter, V. J.

    1995-08-01

    Traditionally, decision-making by water authorities in the Netherlands is largely based on intuition. Their tasks were, after all, relatively few and straight-forward. The growing number of tasks, together with the new integrated approach on water management issues, however, induces water authorities to rationalise their decision process. In order to choose the most effective water management measures, the external effects of these measures need to be taken into account. Therefore, methods have been developed to incorporate these effects in the decision-making phase. Using analytical evaluation methods, the effects of various measures on the water system (physical and chemical quality, ecology and quantity) can be taken into consideration. In this manner a more cognitive way of choosing between alternative measures can be obtained. This paper describes an application of such a decision method on a river basin scale. Main topics, in this paper, are the extent to which uncertainties (in technical information and deficiencies in the techniques applied) limit the usefulness of these methods, and also the question whether these techniques can really be used to select measures that give maximum environmental benefit for minimum cost. It is shown that the influence of these restrictions on the validity of the outcome of the decision methods can be profound. Using these results, improvement of the methods can be realised.

  16. Integrated Forecast-Decision Systems For River Basin Planning and Management

    NASA Astrophysics Data System (ADS)

    Georgakakos, A. P.

    2005-12-01

    A central application of climatology, meteorology, and hydrology is the generation of reliable forecasts for water resources management. In principle, effective use of forecasts could improve water resources management by providing extra protection against floods, mitigating the adverse effects of droughts, generating more hydropower, facilitating recreational activities, and minimizing the impacts of extreme events on the environment and the ecosystems. In practice, however, realization of these benefits depends on three requisite elements. First is the skill and reliability of forecasts. Second is the existence of decision support methods/systems with the ability to properly utilize forecast information. And third is the capacity of the institutional infrastructure to incorporate the information provided by the decision support systems into the decision making processes. This presentation discusses several decision support systems (DSS) using ensemble forecasting that have been developed by the Georgia Water Resources Institute for river basin management. These DSS are currently operational in Africa, Europe, and the US and address integrated water resources and energy planning and management in river basins with multiple water uses, multiple relevant temporal and spatial scales, and multiple decision makers. The article discusses the methods used and advocates that the design, development, and implementation of effective forecast-decision support systems must bring together disciplines, people, and institutions necessary to address today's complex water resources challenges.

  17. “Making Do” Decisions: How Home Healthcare Personnel Manage Their Exposure to Home Hazards

    PubMed Central

    Wills, Celia E.; Polivka, Barbara J.; Darragh, Amy; Lavender, Steven; Sommerich, Carolyn; Stredney, Donald

    2016-01-01

    This study describes the decision-making processes home healthcare personnel (HHP) use to manage their personal health and safety when managing hazards in client homes. A professionally diverse national sample of 68 HHP participated in individual semi-structured interviews and focus group discussions, and described their decision making and strategies for hazard management in their work environments. HHP described 353 hazard management dilemmas within 394 specifically identified hazards, which were clustered within three broader categories: electrical/fire, slip/trip/lift, and environmental exposures. HHP described multiple types of “making do” decisions for hazard management solutions in which perceived and actual resource limitations constrained response options. A majority of hazard management decisions in the broader hazards categories (72.5%, 68.5%, and 63.5%, respectively) were classifiable as less than optimal. These findings stress the need for more support of HHPs, including comprehensive training, to improve HHP decision making and hazard management strategies, especially in context of resource constraints. PMID:26669605

  18. Integrating adaptive management and ecosystem services concepts to improve natural resource management: Challenges and opportunities

    USGS Publications Warehouse

    Epanchin-Niell, Rebecca S.; Boyd, James W.; Macauley, Molly K.; Scarlett, Lynn; Shapiro, Carl D.; Williams, Byron K.

    2018-05-07

    Executive Summary—OverviewNatural resource managers must make decisions that affect broad-scale ecosystem processes involving large spatial areas, complex biophysical interactions, numerous competing stakeholder interests, and highly uncertain outcomes. Natural and social science information and analyses are widely recognized as important for informing effective management. Chief among the systematic approaches for improving the integration of science into natural resource management are two emergent science concepts, adaptive management and ecosystem services. Adaptive management (also referred to as “adaptive decision making”) is a deliberate process of learning by doing that focuses on reducing uncertainties about management outcomes and system responses to improve management over time. Ecosystem services is a conceptual framework that refers to the attributes and outputs of ecosystems (and their components and functions) that have value for humans.This report explores how ecosystem services can be moved from concept into practice through connection to a decision framework—adaptive management—that accounts for inherent uncertainties. Simultaneously, the report examines the value of incorporating ecosystem services framing and concepts into adaptive management efforts.Adaptive management and ecosystem services analyses have not typically been used jointly in decision making. However, as frameworks, they have a natural—but to date underexplored—affinity. Both are policy and decision oriented in that they attempt to represent the consequences of resource management choices on outcomes of interest to stakeholders. Both adaptive management and ecosystem services analysis take an empirical approach to the analysis of ecological systems. This systems orientation is a byproduct of the fact that natural resource actions affect ecosystems—and corresponding societal outcomes—often across large geographic scales. Moreover, because both frameworks focus on

  19. Involving staff pharmacists in management decisions.

    PubMed

    Robinson, L A; Vanderveen, T W

    1977-03-01

    Various administrative techniques used to bring staff pharmacists in a decentralized, satellite pharmacy system into the managerial decision-making process are discussed. These techniques include a staff pharmacist on-call procedure to discourage absenteeism, and the concept of a head pharmacist to serve as a link with departmental administration. The head pharmacist works in the satelite pharmacy, is responsible for its daily operation and is the spokesman for the satellite. Active roles for the head pharmacist in the selection and evaluation of technicians are outlines. Management skills are developed in head pharmacists through a program of special classes and discussion groups. It is concluded that this program has improved the credibility of administrative decisions and has tapped an underused source of ideas and talent.

  20. Challenging the Academically Adrift: A New Decision-Making Tool to Help Improve Student Commitment to Academic Preparation

    ERIC Educational Resources Information Center

    Davis, Carolyn D.

    2013-01-01

    This paper describes research in progress concerning the development and use of a newly created tool, the Decision-Making Grid, which was designed to teach undergraduate management students to develop and use metacognitive regulation skills to improve decision-making by requiring students to construct improved decision-making models in a boundedly…

  1. [Hospital self-management policy in Chile: perceptions of decision-makers].

    PubMed

    Méndez, Claudio A; Miranda, Christian; Torres, M Cristina; Márquez, Myriam

    2013-01-01

    To learn the perceptions of decision-makers concerning the imple-men-t-ation stage of a hospital self-management policy in two highly complex hospitals in southern Chile. A descriptive, exploratory, qualitative study based on semi-structured in-depth interviews of decision-makers at the Regional Hospital of Valdivia and the Hospital San José de Osorno from August 2010 to December 2011. A convenience sample of 26 decision-makers was selected. The 26 interviews were recorded and transcribed verbatim. The information was analyzed using inductive content analysis. The interviewees consider the concept of self-management to be determined by autonomy in decision-making about resource allocation and the financing of health service delivery in the hospitals. They also stated that human resources and financing policies should be included to improve the implementation stage. They related weaknesses with the lack of organizational capabilities and managerial skills in the health teams implementing the changes. Conceptually, the hospital self-management policy is based on financial autonomy, and implementation is affected by persistent capacity gaps in policy design.

  2. Decision exploration lab: a visual analytics solution for decision management.

    PubMed

    Broeksema, Bertjan; Baudel, Thomas; Telea, Arthur G; Crisafulli, Paolo

    2013-12-01

    We present a visual analytics solution designed to address prevalent issues in the area of Operational Decision Management (ODM). In ODM, which has its roots in Artificial Intelligence (Expert Systems) and Management Science, it is increasingly important to align business decisions with business goals. In our work, we consider decision models (executable models of the business domain) as ontologies that describe the business domain, and production rules that describe the business logic of decisions to be made over this ontology. Executing a decision model produces an accumulation of decisions made over time for individual cases. We are interested, first, to get insight in the decision logic and the accumulated facts by themselves. Secondly and more importantly, we want to see how the accumulated facts reveal potential divergences between the reality as captured by the decision model, and the reality as captured by the executed decisions. We illustrate the motivation, added value for visual analytics, and our proposed solution and tooling through a business case from the car insurance industry.

  3. Decision making and senior management: the implementation of change projects covering clinical management in SUS hospitals.

    PubMed

    Pacheco, José Márcio da Cunha; Gomes, Romeu

    2016-08-01

    This paper analyses the decision making process for senior management in public hospitals that are a part of the National Health Service in Brazil (hereafter SUS) in relation to projects aimed at changing clinical management. The methodological design of this study is qualitative in nature taking a hermeneutics-dialectics perspective in terms of results. Hospital directors noted that clinical management projects changed the state of hospitals through: improving their organizations, mobilizing their staff in order to increase a sense of order and systemizing actions and available resources. Technical rationality was the principal basis used in the decision making process for managers. Due to the reality of many hospitals having fragmented organizations, this fact impeded the use of aspects related to rationality, such as economic and financial factors in the decision making process. The incremental model and general politics also play a role in this area. We concluded that the decision making process embraces a large array of factors including rational aspects such as the use of management techniques and the ability to analyze, interpret and summarize. It also incorporates subjective elements such as how to select values and dealing with people's working experiences. We recognized that management problems are wide in scope, ambiguous, complex and do not come with a lot of structure in practice.

  4. Making Financial Decisions. Financial Management Module. Operational Management Programme. Increasing Opportunities for Supervisors and Managers.

    ERIC Educational Resources Information Center

    Adamson, Jan; And Others

    One of a series of three self-instructional units, these materials are aimed at helping British hotel and catering managers improve profits and/or reduce costs in their areas of responsibility. Following a paragraph on how to use the unit and an introduction, section 1 covers control levels as the framework for making decisions. The section…

  5. Monitoring in the context of structured decision-making and adaptive management

    USGS Publications Warehouse

    Lyons, J.E.; Runge, M.C.; Laskowski, H.P.; Kendall, W.L.

    2008-01-01

    In a natural resource management setting, monitoring is a crucial component of an informed process for making decisions, and monitoring design should be driven by the decision context and associated uncertainties. Monitoring itself can play >3 roles. First, it is important for state-dependent decision-making, as when managers need to know the system state before deciding on the appropriate course of action during the ensuing management cycle. Second, monitoring is critical for evaluating the effectiveness of management actions relative to objectives. Third, in an adaptive management setting, monitoring provides the feedback loop for learning about the system; learning is sought not for its own sake but primarily to better achieve management objectives. In this case, monitoring should be designed to reduce the critical uncertainties in models of the managed system. The United States Geological Survey and United States Fish and Wildlife Service are conducting a large-scale management experiment on 23 National Wildlife Refuges across the Northeast and Midwest Regions. The primary management objective is to provide habitat for migratory waterbirds, particularly during migration, using water-level manipulations in managed wetlands. Key uncertainties are related to the potential trade-offs created by management for a specific waterbird guild (e.g., migratory shorebirds) and the response of waterbirds, plant communities, and invertebrates to specific experimental hydroperiods. We reviewed the monitoring program associated with this study, and the ways that specific observations fill >1 of the roles identified above. We used observations from our monitoring to improve state-dependent decisions to control undesired plants, to evaluate management performance relative to shallow-water habitat objectives, and to evaluate potential trade-offs between waterfowl and shorebird habitat management. With limited staff and budgets, management agencies need efficient monitoring

  6. Structuring decisions for managing threatened and endangered species in a changing climate.

    PubMed

    Gregory, Robin; Arvai, Joseph; Gerber, Leah R

    2013-12-01

    The management of endangered species under climate change is a challenging and often controversial task that incorporates input from a variety of different environmental, economic, social, and political interests. Yet many listing and recovery decisions for endangered species unfold on an ad hoc basis without reference to decision-aiding approaches that can improve the quality of management choices. Unlike many treatments of this issue, which consider endangered species management a science-based problem, we suggest that a clear decision-making process is equally necessary. In the face of new threats due to climate change, managers' choices about endangered species require closely linked analyses and deliberations that identify key objectives and develop measurable attributes, generate and compare management alternatives, estimate expected consequences and key sources of uncertainty, and clarify trade-offs across different dimensions of value. Several recent cases of endangered species conservation decisions illustrate our proposed decision-focused approach, including Gulf of Maine Atlantic salmon (Salmo salar) recovery framework development, Cultus Lake sockeye salmon (Oncorhynchus nerka) management, and Upper Columbia River white sturgeon (Acipenser transmontanus) recovery planning. Estructuración de Decisiones para Manejar Especies Amenazadas y en Peligro en un Clima Cambiante. © 2013 Society for Conservation Biology No claim to original US government works.

  7. Decision aids for multiple-decision disease management as affected by weather input errors.

    PubMed

    Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D

    2011-06-01

    Many disease management decision support systems (DSSs) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation, or estimation from off-site sources, may affect model calculations and management decision recommendations. The extent to which errors in weather inputs affect the quality of the final management outcome depends on a number of aspects of the disease management context, including whether management consists of a single dichotomous decision, or of a multi-decision process extending over the cropping season(s). Decision aids for multi-decision disease management typically are based on simple or complex algorithms of weather data which may be accumulated over several days or weeks. It is difficult to quantify accuracy of multi-decision DSSs due to temporally overlapping disease events, existence of more than one solution to optimizing the outcome, opportunities to take later recourse to modify earlier decisions, and the ongoing, complex decision process in which the DSS is only one component. One approach to assessing importance of weather input errors is to conduct an error analysis in which the DSS outcome from high-quality weather data is compared with that from weather data with various levels of bias and/or variance from the original data. We illustrate this analytical approach for two types of DSS, an infection risk index for hop powdery mildew and a simulation model for grass stem rust. Further exploration of analysis methods is needed to address problems associated with assessing uncertainty in multi-decision DSSs.

  8. Decision support system for drinking water management

    NASA Astrophysics Data System (ADS)

    Janža, M.

    2012-04-01

    The problems in drinking water management are complex and often solutions must be reached under strict time constrains. This is especially distinct in case of environmental accidents in the catchment areas of the wells that are used for drinking water supply. The beneficial tools that can help decision makers and make program of activities more efficient are decision support systems (DSS). In general they are defined as computer-based support systems that help decision makers utilize data and models to solve unstructured problems. The presented DSS was developed in the frame of INCOME project which is focused on the long-term stable and safe drinking water supply in Ljubljana. The two main water resources Ljubljana polje and Barje alluvial aquifers are characterized by a strong interconnection of surface and groundwater, high vulnerability, high velocities of groundwater flow and pollutant transport. In case of sudden pollution, reactions should be very fast to avoid serious impact to the water supply. In the area high pressures arising from urbanization, industry, traffic, agriculture and old environmental burdens. The aim of the developed DSS is to optimize the activities in cases of emergency water management and to optimize the administrative work regarding the activities that can improve groundwater quality status. The DSS is an interactive computer system that utilizes data base, hydrological modelling, and experts' and stakeholders' knowledge. It consists of three components, tackling the different abovementioned issues in water management. The first one utilizes the work on identification, cleaning up and restoration of illegal dumpsites that are a serious threat to the qualitative status of groundwater. The other two components utilize the predictive capability of the hydrological model and scenario analysis. The user interacts with the system by a graphical interface that guides the user step-by-step to the recommended remedial measures. Consequently, the

  9. Adaptive management for improving species conservation across the captive-wild spectrum

    USGS Publications Warehouse

    Canessa, Stefano; Guillera-Arroita, Gurutzeta; Lahoz-Monfort, José J.; Southwell, Darren M; Armstrong, Doug P.; Chadès, Iadine; Lacy, Robert C; Converse, Sarah J.

    2016-01-01

    Conservation of endangered species increasingly envisages complex strategies that integrate captive and wild management actions. Management decisions in this context must be made in the face of uncertainty, often with limited capacity to collect information. Adaptive management (AM) combines management and monitoring, with the aim of updating knowledge and improving decision-making over time. We provide a guide for managers who may realize the potential of AM, but are unsure where to start. The urgent need for iterative management decisions, the existence of uncertainty, and the opportunity for learning offered by often highly-controlled captive environments create favorable conditions for AM. However, experiments and monitoring may be complicated by small sample sizes, and the ability to control the system, including stochasticity and observability, may be limited toward the wild end of the spectrum. We illustrate the key steps to implementing AM in threatened species management using four case studies, including the management of captive programs for cheetah (Acinonyx jubatus) and whooping cranes (Grus americana), of a translocation protocol for Arizona cliffroses Purshia subintegra and of ongoing supplementary feeding of reintroduced hihi (Notiomystis cincta) populations. For each case study, we explain (1) how to clarify whether the decision can be improved by learning (i.e. it is iterative and complicated by uncertainty) and what the management objectives are; (2) how to articulate uncertainty via alternative, testable hypotheses such as competing models or parameter distributions; (3) how to formally define how additional information can be collected and incorporated in future management decisions.

  10. Policy, practice and decision making for zoonotic disease management: water and Cryptosporidium.

    PubMed

    Austin, Zoë; Alcock, Ruth E; Christley, Robert M; Haygarth, Philip M; Heathwaite, A Louise; Latham, Sophia M; Mort, Maggie; Oliver, David M; Pickup, Roger; Wastling, Jonathan M; Wynne, Brian

    2012-04-01

    Decision making for zoonotic disease management should be based on many forms of appropriate data and sources of evidence. However, the criteria and timing for policy response and the resulting management decisions are often altered when a disease outbreak occurs and captures full media attention. In the case of waterborne disease, such as the robust protozoa, Cryptosporidium spp, exposure can cause significant human health risks and preventing exposure by maintaining high standards of biological and chemical water quality remains a priority for water companies in the UK. Little has been documented on how knowledge and information is translated between the many stakeholders involved in the management of Cryptosporidium, which is surprising given the different drivers that have shaped management decisions. Such information, coupled with the uncertainties that surround these data is essential for improving future management strategies that minimise disease outbreaks. Here, we examine the interplay between scientific information, the media, and emergent government and company policies to examine these issues using qualitative and quantitative data relating to Cryptosporidium management decisions by a water company in the North West of England. Our results show that political and media influences are powerful drivers of management decisions if fuelled by high profile outbreaks. Furthermore, the strength of the scientific evidence is often constrained by uncertainties in the data, and in the way knowledge is translated between policy levels during established risk management procedures. In particular, under or over-estimating risk during risk assessment procedures together with uncertainty regarding risk factors within the wider environment, was found to restrict the knowledge-base for decision-making in Cryptosporidium management. Our findings highlight some key current and future challenges facing the management of such diseases that are widely applicable to other

  11. A Decentralized Compositional Framework for Dependable Decision Process in Self-Managed Cyber Physical Systems

    PubMed Central

    Hou, Kun-Mean; Zhang, Zhan

    2017-01-01

    Cyber Physical Systems (CPSs) need to interact with the changeable environment under various interferences. To provide continuous and high quality services, a self-managed CPS should automatically reconstruct itself to adapt to these changes and recover from failures. Such dynamic adaptation behavior introduces systemic challenges for CPS design, advice evaluation and decision process arrangement. In this paper, a formal compositional framework is proposed to systematically improve the dependability of the decision process. To guarantee the consistent observation of event orders for causal reasoning, this work first proposes a relative time-based method to improve the composability and compositionality of the timing property of events. Based on the relative time solution, a formal reference framework is introduced for self-managed CPSs, which includes a compositional FSM-based actor model (subsystems of CPS), actor-based advice and runtime decomposable decisions. To simplify self-management, a self-similar recursive actor interface is proposed for decision (actor) composition. We provide constraints and seven patterns for the composition of reliability and process time requirements. Further, two decentralized decision process strategies are proposed based on our framework, and we compare the reliability with the static strategy and the centralized processing strategy. The simulation results show that the one-order feedback strategy has high reliability, scalability and stability against the complexity of decision and random failure. This paper also shows a way to simplify the evaluation for dynamic system by improving the composability and compositionality of the subsystem. PMID:29120357

  12. A Decentralized Compositional Framework for Dependable Decision Process in Self-Managed Cyber Physical Systems.

    PubMed

    Zhou, Peng; Zuo, Decheng; Hou, Kun-Mean; Zhang, Zhan

    2017-11-09

    Cyber Physical Systems (CPSs) need to interact with the changeable environment under various interferences. To provide continuous and high quality services, a self-managed CPS should automatically reconstruct itself to adapt to these changes and recover from failures. Such dynamic adaptation behavior introduces systemic challenges for CPS design, advice evaluation and decision process arrangement. In this paper, a formal compositional framework is proposed to systematically improve the dependability of the decision process. To guarantee the consistent observation of event orders for causal reasoning, this work first proposes a relative time-based method to improve the composability and compositionality of the timing property of events. Based on the relative time solution, a formal reference framework is introduced for self-managed CPSs, which includes a compositional FSM-based actor model (subsystems of CPS), actor-based advice and runtime decomposable decisions. To simplify self-management, a self-similar recursive actor interface is proposed for decision (actor) composition. We provide constraints and seven patterns for the composition of reliability and process time requirements. Further, two decentralized decision process strategies are proposed based on our framework, and we compare the reliability with the static strategy and the centralized processing strategy. The simulation results show that the one-order feedback strategy has high reliability, scalability and stability against the complexity of decision and random failure. This paper also shows a way to simplify the evaluation for dynamic system by improving the composability and compositionality of the subsystem.

  13. Merkel cell carcinoma: An algorithm for multidisciplinary management and decision-making.

    PubMed

    Prieto, Isabel; Pérez de la Fuente, Teresa; Medina, Susana; Castelo, Beatriz; Sobrino, Beatriz; Fortes, Jose R; Esteban, David; Cassinello, Fernando; Jover, Raquel; Rodríguez, Nuria

    2016-02-01

    Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. Therapeutic approach is often unclear, and considerable controversy exists regarding MCC pathogenesis and optimal management. Due to its rising incidence and poor prognosis, it is imperative to establish the optimal therapy for both the tumor and the lymph node basin, and for treatment to include sentinel node biopsy. Sentinel node biopsy is currently the most consistent predictor of survival for MCC patients, although there are conflicting views and a lack of awareness regarding node management. Tumor and node management involve different specialists, and their respective decisions and interventions are interrelated. No effective systemic treatment has been made available to date, and therefore patients continue to experience distant failure, often without local failure. This review aims to improve multidisciplinary decision-making by presenting scientific evidence of the contributions of each team member implicated in MCC management. Following this review of previously published research, the authors conclude that multidisciplinary team management is beneficial for care, and propose a multidisciplinary decision algorithm for managing this tumor. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Integrated climate and land change research to improve decision-making and resource management in Southern Africa: The SASSCAL approach

    NASA Astrophysics Data System (ADS)

    Helmschrot, J.; Olwoch, J. M.

    2017-12-01

    The ability of countries in southern Africa to jointly respond to climate challenges with scientifically informed and evidence-based actions and policy decisions remains low due to limited scientific research capacity and infrastructure. The Southern African Science Service Centre for Climate Change and Adaptive Land Management (SASSCAL; www.sasscal.org) addresses this gap by implementing a high-level framework to guide research and innovation investments in climate change and adaptive land management interventions in Southern Africa. With a strong climate service component as cross-cutting topic, SASSCAL's focus is to improve the understanding of climate and land management change impacts on the natural and socio-economic environment in Southern Africa. The paper presents a variety of SASSCAL driven activities which contribute to better understand climate and long-term environmental change dynamics at various temporal and spatial scales in Southern Afrika and how these activities are linked to support research and decision-making to optimize agricultural practices as well as sustainable environmental and water resources management. To provide consistent and reliable climate information for Southern Africa, SASSCAL offers various climate services ranging from real-time climate observation across the region utilizing the SASSCAL WeatherNet to regional climate change analysis and modelling efforts at seasonal-to-decadal timescales using climate data from various sources. SASSCAL also offers the current state of the environment in terms of recent data on changes in the environment that are necessary for setting appropriate adaptation strategies . The paper will further demonstrate how these services are utilized for interdisciplinary research on the impact of climate change on natural resources and socio-economic development in the SASSCAL countries and how this knowledge can be effectively used to mitigate and adapt to climate change by informed decision-making from

  15. Decisions about weight management: a synthesis of qualitative studies of obesity.

    PubMed

    Brown, I; Gould, J

    2011-04-01

    There is a high non-attendance and dropout attrition from weight management interventions for adults with obesity. Patient dissatisfaction with consultations involving decisions about interventions may be a factor. A systematic review was undertaken of qualitative studies reporting perceptions, experiences, contexts and influences for adults facing, or reflecting on, weight management. The aim was to synthesize a generic model of influences on decision-making about weight management for adult patients. Electronic database and hand searches identified 29 qualitative studies involving 1387 participants (mean age 45.3 years; mean BMI 37.1 kg m(-2) ; 79.9% women). Seven overarching themes were inductively derived from extracted data spanning: cultural identity; social structures such as gender; responses to obesity stigma; previous weight loss experiences; personal motivators and barriers; social support; and practical resources. A model is presented in the paper. Improving decisions about weight management requires attention to how diffuse cultural and psycho-social factors, such as obesity stigma, influence patient choices. Reflection on experiences of previous attempts at weight loss is also essential, as are practical resource factors - particularly for less affluent groups. Considering these factors along with more established theories of individual psychological motivations and barriers may help to improve initial participation and retention within interventions. © 2011 The Authors. Clinical Obesity © 2011 International Association for the Study of Obesity.

  16. The impact of geographic information systems on emergency management decision making at the U.S. Department of Homeland Security

    NASA Astrophysics Data System (ADS)

    King, Steven Gray

    Geographic information systems (GIS) reveal relationships and patterns from large quantities of diverse data in the form of maps and reports. The United States spends billions of dollars to use GIS to improve decisions made during responses to natural disasters and terrorist attacks, but precisely how GIS improves or impairs decision making is not known. This research examined how GIS affect decision making during natural disasters, and how GIS can be more effectively used to improve decision making for emergency management. Using a qualitative case study methodology, this research examined decision making at the U.S. Department of Homeland Security (DHS) during a large full-scale disaster exercise. This study indicates that GIS provided decision makers at DHS with an outstanding context for information that would otherwise be challenging to understand, especially through the integration of multiple data sources and dynamic three-dimensional interactive maps. Decision making was hampered by outdated information, a reliance on predictive models based on hypothetical data rather than actual event data, and a lack of understanding of the capabilities of GIS beyond cartography. Geospatial analysts, emergency managers, and other decision makers who use GIS should take specific steps to improve decision making based on GIS for disaster response and emergency management.

  17. Structured decision making for managing pneumonia epizootics in bighorn sheep

    USGS Publications Warehouse

    Sells, Sarah N.; Mitchell, Michael S.; Edwards, Victoria L.; Gude, Justin A.; Anderson, Neil J.

    2016-01-01

    Good decision-making is essential to conserving wildlife populations. Although there may be multiple ways to address a problem, perfect solutions rarely exist. Managers are therefore tasked with identifying decisions that will best achieve desired outcomes. Structured decision making (SDM) is a method of decision analysis used to identify the most effective, efficient, and realistic decisions while accounting for values and priorities of the decision maker. The stepwise process includes identifying the management problem, defining objectives for solving the problem, developing alternative approaches to achieve the objectives, and formally evaluating which alternative is most likely to accomplish the objectives. The SDM process can be more effective than informal decision-making because it provides a transparent way to quantitatively evaluate decisions for addressing multiple management objectives while incorporating science, uncertainty, and risk tolerance. To illustrate the application of this process to a management need, we present an SDM-based decision tool developed to identify optimal decisions for proactively managing risk of pneumonia epizootics in bighorn sheep (Ovis canadensis) in Montana. Pneumonia epizootics are a major challenge for managers due to long-term impacts to herds, epistemic uncertainty in timing and location of future epizootics, and consequent difficulty knowing how or when to manage risk. The decision tool facilitates analysis of alternative decisions for how to manage herds based on predictions from a risk model, herd-specific objectives, and predicted costs and benefits of each alternative. Decision analyses for 2 example herds revealed that meeting management objectives necessitates specific approaches unique to each herd. The analyses showed how and under what circumstances the alternatives are optimal compared to other approaches and current management. Managers can be confident that these decisions are effective, efficient, and

  18. Nurse manager cognitive decision-making amidst stress and work complexity.

    PubMed

    Shirey, Maria R; Ebright, Patricia R; McDaniel, Anna M

    2013-01-01

      The present study provides insight into nurse manager cognitive decision-making amidst stress and work complexity.   Little is known about nurse manager decision-making amidst stress and work complexity. Because nurse manager decisions have the potential to impact patient care quality and safety, understanding their decision-making processes is useful for designing supportive interventions.   This qualitative descriptive study interviewed 21 nurse managers from three hospitals to answer the research question: What decision-making processes do nurse managers utilize to address stressful situations in their nurse manager role? Face-to-face interviews incorporating components of the Critical Decision Method illuminated expert-novice practice differences. Content analysis identified one major theme and three sub-themes.   The present study produced a cognitive model that guides nurse manager decision-making related to stressful situations. Experience in the role, organizational context and situation factors influenced nurse manager cognitive decision-making processes.   Study findings suggest that chronic exposure to stress and work complexity negatively affects nurse manager health and their decision-making processes potentially threatening individual, patient and organizational outcomes.   Cognitive decision-making varies based on nurse manager experience and these differences have coaching and mentoring implications. This present study contributes a current understanding of nurse manager decision-making amidst stress and work complexity. © 2012 Blackwell Publishing Ltd.

  19. Integrating environmental monitoring with cumulative effects management and decision making.

    PubMed

    Cronmiller, Joshua G; Noble, Bram F

    2018-05-01

    Cumulative effects (CE) monitoring is foundational to emerging regional and watershed CE management frameworks, yet monitoring is often poorly integrated with CE management and decision-making processes. The challenges are largely institutional and organizational, more so than scientific or technical. Calls for improved integration of monitoring with CE management and decision making are not new, but there has been limited research on how best to integrate environmental monitoring programs to ensure credible CE science and to deliver results that respond to the more immediate questions and needs of regulatory decision makers. This paper examines options for the integration of environmental monitoring with CE frameworks. Based on semistructured interviews with practitioners, regulators, and other experts in the Lower Athabasca, Alberta, Canada, 3 approaches to monitoring system design are presented. First, a distributed monitoring system, reflecting the current approach in the Lower Athabasca, where monitoring is delegated to different external programs and organizations; second, a 1-window system in which monitoring is undertaken by a single, in-house agency for the purpose of informing management and regulatory decision making; third, an independent system driven primarily by CE science and understanding causal relationships, with knowledge adopted for decision support where relevant to specific management questions. The strengths and limitations of each approach are presented. A hybrid approach may be optimal-an independent, nongovernment, 1-window model for CE science, monitoring, and information delivery-capitalizing on the strengths of distributed, 1-window, and independent monitoring systems while mitigating their weaknesses. If governments are committed to solving CE problems, they must invest in the long-term science needed to do so; at the same time, if science-based monitoring programs are to be sustainable over the long term, they must be responsive to

  20. Integrating modeling, monitoring, and management to reduce critical uncertainties in water resource decision making.

    PubMed

    Peterson, James T; Freeman, Mary C

    2016-12-01

    Stream ecosystems provide multiple, valued services to society, including water supply, waste assimilation, recreation, and habitat for diverse and productive biological communities. Managers striving to sustain these services in the face of changing climate, land uses, and water demands need tools to assess the potential effectiveness of alternative management actions, and often, the resulting tradeoffs between competing objectives. Integrating predictive modeling with monitoring data in an adaptive management framework provides a process by which managers can reduce model uncertainties and thus improve the scientific bases for subsequent decisions. We demonstrate an integration of monitoring data with a dynamic, metapopulation model developed to assess effects of streamflow alteration on fish occupancy in a southeastern US stream system. Although not extensive (collected over three years at nine sites), the monitoring data allowed us to assess and update support for alternative population dynamic models using model probabilities and Bayes rule. We then use the updated model weights to estimate the effects of water withdrawal on stream fish communities and demonstrate how feedback in the form of monitoring data can be used to improve water resource decision making. We conclude that investment in more strategic monitoring, guided by a priori model predictions under alternative hypotheses and an adaptive sampling design, could substantially improve the information available to guide decision-making and management for ecosystem services from lotic systems. Published by Elsevier Ltd.

  1. Using Modern Digital Photography Tools to Guide Management Decisions on Forested Land

    ERIC Educational Resources Information Center

    Craft, Brandon; Barlow, Rebecca; Kush, John; Hemard, Charles

    2016-01-01

    Forestland management depends on assessing changes that occur over time. Long-term photo point monitoring is a low-cost method for documenting these changes. Using forestry as an example, this article highlights the idea that long-term photo point monitoring can be used to improve many types of land management decision making. Guidance on…

  2. Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

    PubMed

    Whellan, David J; Cohen, Elizabeth J; Matchar, David B; Califf, Robert M

    2002-07-01

    Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations. To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM. Qualitative survey. Forty-seven healthcare systems (n = 22) and managed care organizations (n = 25) were randomly selected. Decision makers were identified and interviewed between January 1, 2000, and March 31, 2000. We limited quantitative analysis to tabulations of suitable responses, without statistical testing. Responses were organized around 3 themes: models for DM, implementation strategies, and measurements of success. Of 47 decision makers surveyed, 42 (89%) reported that their organizations currently have (75%) or are working to develop (14%) DM programs. Although the goals of DM programs were similar, organizations took a variety of approaches to achieving these ends. There were typically 3 steps in implementing a DM program: analysis of patient data, external analysis, and organizational analysis. Decision makers believed that DM programs had only achieved partial success in reaching the 2 main goals of improved quality of care and cost savings. Given the variety of DM programs, there is a need to develop a classification scheme to allow for better comparison between programs. Further quantitative studies of decision makers' opinions would be helpful in developing programs and in designing necessary studies of patient management strategies.

  3. Factual Approach in Decision Making - the Prerequisite of Success in Quality Management

    NASA Astrophysics Data System (ADS)

    Kučerová, Marta; Škůrková Lestyánszka, Katarína

    2013-12-01

    In quality management system as well as in other managerial systems, effective decisions must be always based on the data and information analysis, i.e. based on facts, in accordance with the factual approach principle in quality management. It is therefore necessary to measure and collect the data and information about processes. The article presents the results of a conducted survey, which was focused on application of factual approach in decision making. It also offers suggestions for improvements of application of the principle in business practice. This article was prepared using the research results of VEGA project No. 1/0229/08 "Perspectives of the quality management development in relation to the requirements of market in the Slovak Republic".

  4. 43 CFR 4190.1 - Effect of wildfire management decisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

  5. 43 CFR 4190.1 - Effect of wildfire management decisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

  6. 43 CFR 4190.1 - Effect of wildfire management decisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

  7. 43 CFR 4190.1 - Effect of wildfire management decisions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 2 2014-10-01 2014-10-01 false Effect of wildfire management decisions... ALASKA Effect of Wildfire Management Decisions § 4190.1 Effect of wildfire management decisions. (a... on the public lands are at substantial risk of wildfire due to drought, fuels buildup, or other...

  8. Resolving future fire management conflicts using multicriteria decision making.

    PubMed

    Driscoll, Don A; Bode, Michael; Bradstock, Ross A; Keith, David A; Penman, Trent D; Price, Owen F

    2016-02-01

    Management strategies to reduce the risks to human life and property from wildfire commonly involve burning native vegetation. However, planned burning can conflict with other societal objectives such as human health and biodiversity conservation. These conflicts are likely to intensify as fire regimes change under future climates and as growing human populations encroach farther into fire-prone ecosystems. Decisions about managing fire risks are therefore complex and warrant more sophisticated approaches than are typically used. We applied a multicriteria decision making approach (MCDA) with the potential to improve fire management outcomes to the case of a highly populated, biodiverse, and flammable wildland-urban interface. We considered the effects of 22 planned burning options on 8 objectives: house protection, maximizing water quality, minimizing carbon emissions and impacts on human health, and minimizing declines of 5 distinct species types. The MCDA identified a small number of management options (burning forest adjacent to houses) that performed well for most objectives, but not for one species type (arboreal mammal) or for water quality. Although MCDA made the conflict between objectives explicit, resolution of the problem depended on the weighting assigned to each objective. Additive weighting of criteria traded off the arboreal mammal and water quality objectives for other objectives. Multiplicative weighting identified scenarios that avoided poor outcomes for any objective, which is important for avoiding potentially irreversible biodiversity losses. To distinguish reliably among management options, future work should focus on reducing uncertainty in outcomes across a range of objectives. Considering management actions that have more predictable outcomes than landscape fuel management will be important. We found that, where data were adequate, an MCDA can support decision making in the complex and often conflicted area of fire management. © 2015

  9. Improving the Emergency Manager’s Hurricane Evacuation Decision Making Through Serious Gaming

    DTIC Science & Technology

    2016-06-17

    Serious Gaming Hayley J. Davison Reynolds, Maxwell H. Perlman Darren P. Wilson MIT Lincoln Laboratory DHS Science and Technology Directorate...transfer it to an actual evacuation event. Through this work, a web-based, ‘serious gaming ’ approach was used to develop hurricane evacuation decision...training for the emergency manager. This paper describes the iterative design approach to developing a training game and collect initial feedback

  10. Nurse Managers' Decisions: Fast and Favoring Remediation

    PubMed Central

    Effken, Judith A.; Verran, Joyce A.; Logue, Melanie D.; Hsu, Ya-Chuan

    2010-01-01

    How do nurse managers make decisions about quality issues on their units? We asked 10 nurse managers in 3 Arizona hospitals to describe how they resolved a recent quality issue. The managers tended to use a linear, but cognitively expensive strategy, often jumping from problem to solution without a clear goal and selecting solutions biased toward remedial education. Decision support tools should help managers think more systemically, systematically and efficiently, while encouraging consideration of more alternatives to reach targeted goals. PMID:20305465

  11. A dataset of human decision-making in teamwork management.

    PubMed

    Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

    2017-01-17

    Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members' capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches.

  12. A dataset of human decision-making in teamwork management

    PubMed Central

    Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

    2017-01-01

    Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members’ capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches. PMID:28094787

  13. A dataset of human decision-making in teamwork management

    NASA Astrophysics Data System (ADS)

    Yu, Han; Shen, Zhiqi; Miao, Chunyan; Leung, Cyril; Chen, Yiqiang; Fauvel, Simon; Lin, Jun; Cui, Lizhen; Pan, Zhengxiang; Yang, Qiang

    2017-01-01

    Today, most endeavours require teamwork by people with diverse skills and characteristics. In managing teamwork, decisions are often made under uncertainty and resource constraints. The strategies and the effectiveness of the strategies different people adopt to manage teamwork under different situations have not yet been fully explored, partially due to a lack of detailed large-scale data. In this paper, we describe a multi-faceted large-scale dataset to bridge this gap. It is derived from a game simulating complex project management processes. It presents the participants with different conditions in terms of team members' capabilities and task characteristics for them to exhibit their decision-making strategies. The dataset contains detailed data reflecting the decision situations, decision strategies, decision outcomes, and the emotional responses of 1,144 participants from diverse backgrounds. To our knowledge, this is the first dataset simultaneously covering these four facets of decision-making. With repeated measurements, the dataset may help establish baseline variability of decision-making in teamwork management, leading to more realistic decision theoretic models and more effective decision support approaches.

  14. An information system to improve financial management, resource allocation and activity planning: evaluation results.

    PubMed

    Ruland, C M; Ravn, I H

    2001-01-01

    An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals. To evaluate CLASSICA, a Decision Support System (DSS), that assists nurse managers in financial management, resource allocation, staffing, and activity planning. Using a pre-post test design with control units, CLASSICA was evaluated in four test units. Baseline data and simultaneous parallel measures were collected prior to system implementation at test sites and control units. Using expense reports, staffing and financial statistics, surveys, interviews with nurse managers, and logs as data sources, CLASSICA was evaluated on: cost reduction, quality of management information; usefulness as decision support for improved financial management and decision-making; user satisfaction; and ease of use. Evaluation results showed a 41% reduction in expenditures for overtime and extra hours as compared to a 1.8% reduction in control units during the same time period. Users reported a significant improvement in management information; nurse managers stated that they had gained control over costs. The system helped them analyze the relationships between patient activity staffing, and cost of care. Users reported high satisfaction with the system, the information and decision support it provided, and its ease of use. These results suggest that CLASSICA is a DSS that successfully assists nurse managers in cost effective management of their units.

  15. An Integrated Web-based Decision Support System in Disaster Risk Management

    NASA Astrophysics Data System (ADS)

    Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

    2012-04-01

    Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact

  16. The effect of scientific evidence on conservation practitioners' management decisions.

    PubMed

    Walsh, Jessica C; Dicks, Lynn V; Sutherland, William J

    2015-02-01

    A major justification of environmental management research is that it helps practitioners, yet previous studies show it is rarely used to inform their decisions. We tested whether conservation practitioners focusing on bird management were willing to use a synopsis of relevant scientific literature to inform their management decisions. This allowed us to examine whether the limited use of scientific information in management is due to a lack of access to the scientific literature or whether it is because practitioners are either not interested or unable to incorporate the research into their decisions. In on-line surveys, we asked 92 conservation managers, predominantly from Australia, New Zealand, and the United Kingdom, to provide opinions on 28 management techniques that could be applied to reduce predation on birds. We asked their opinions before and after giving them a summary of the literature about the interventions' effectiveness. We scored the overall effectiveness and certainty of evidence for each intervention through an expert elicitation process-the Delphi method. We used the effectiveness scores to assess the practitioners' level of understanding and awareness of the literature. On average, each survey participant changed their likelihood of using 45.7% of the interventions after reading the synopsis of the evidence. They were more likely to implement effective interventions and avoid ineffective actions, suggesting that their intended future management strategies may be more successful than current practice. More experienced practitioners were less likely to change their management practices than those with less experience, even though they were not more aware of the existing scientific information than less experienced practitioners. The practitioners' willingness to change their management choices when provided with summarized scientific evidence suggests that improved accessibility to scientific information would benefit conservation management

  17. COMMAND-AND-CONTROL AND MANAGEMENT DECISION MAKING,

    DTIC Science & Technology

    Reports that the development of command-and-con trol systems in support of decision making and action taking has been accomplished by military...methods applicable to management systems. Concludes that the command-and-control type system for top management decision making is a man-machine system having as its core an on going, dynamic operation. (Author)

  18. Evaluating a multispecies adaptive management framework: Must uncertainty impede effective decision-making?

    USGS Publications Warehouse

    Smith, David R.; McGowan, Conor P.; Daily, Jonathan P.; Nichols, James D.; Sweka, John A.; Lyons, James E.

    2013-01-01

    Application of adaptive management to complex natural resource systems requires careful evaluation to ensure that the process leads to improved decision-making. As part of that evaluation, adaptive policies can be compared with alternative nonadaptive management scenarios. Also, the value of reducing structural (ecological) uncertainty to achieving management objectives can be quantified.A multispecies adaptive management framework was recently adopted by the Atlantic States Marine Fisheries Commission for sustainable harvest of Delaware Bay horseshoe crabs Limulus polyphemus, while maintaining adequate stopover habitat for migrating red knots Calidris canutus rufa, the focal shorebird species. The predictive model set encompassed the structural uncertainty in the relationships between horseshoe crab spawning, red knot weight gain and red knot vital rates. Stochastic dynamic programming was used to generate a state-dependent strategy for harvest decisions given that uncertainty. In this paper, we employed a management strategy evaluation approach to evaluate the performance of this adaptive management framework. Active adaptive management was used by including model weights as state variables in the optimization and reducing structural uncertainty by model weight updating.We found that the value of information for reducing structural uncertainty is expected to be low, because the uncertainty does not appear to impede effective management. Harvest policy responded to abundance levels of both species regardless of uncertainty in the specific relationship that generated those abundances. Thus, the expected horseshoe crab harvest and red knot abundance were similar when the population generating model was uncertain or known, and harvest policy was robust to structural uncertainty as specified.Synthesis and applications. The combination of management strategy evaluation with state-dependent strategies from stochastic dynamic programming was an informative approach to

  19. Simulation and Modeling Efforts to Support Decision Making in Healthcare Supply Chain Management

    PubMed Central

    Lazarova-Molnar, Sanja

    2014-01-01

    Recently, most healthcare organizations focus their attention on reducing the cost of their supply chain management (SCM) by improving the decision making pertaining processes' efficiencies. The availability of products through healthcare SCM is often a matter of life or death to the patient; therefore, trial and error approaches are not an option in this environment. Simulation and modeling (SM) has been presented as an alternative approach for supply chain managers in healthcare organizations to test solutions and to support decision making processes associated with various SCM problems. This paper presents and analyzes past SM efforts to support decision making in healthcare SCM and identifies the key challenges associated with healthcare SCM modeling. We also present and discuss emerging technologies to meet these challenges. PMID:24683333

  20. [Decision-making process and health management councils: theoretical approaches].

    PubMed

    Wendhausen, Agueda; Cardoso, Sandra de Mello

    2007-01-01

    With the institutionalization of participation in health, through conferences and management councils at national, state, municipal and local levels, a process of democratization is initiated in the health area. However, in relation to the health councils in particular, there is still much to be done, including improving the quality of the decision-making process. This work aims to place the decision-making process in its theoretical context in terms of participatory democracy, elements which make up, factors which influence its development, and finally, to explore some possibilities of this theoretical basis to analyze the practices of the health councils in the area of health. It is hoped that it will make a theoretical contribution to the analyses carried out in this area, in order to provide a decision-making process that is more inclusive in terms of participation.

  1. Time Management and the Military Decision Making Process

    DTIC Science & Technology

    1992-12-18

    This monograph analyzes the military decision making process in terms of time management in order to determine if a timeline will expedite the...process. The monograph begins by establishing the importance of time and time management in planning. This section provides a general discussion of time, an...Perhaps using some of the techniques that other armies use will facilitate time management .... Time management , Decision making, Timeline, Mission analysis, Wargaming, Courses of action, OPORD, Brigade OPS.

  2. Decision-making, sensitivity to reward, and attrition in weight-management

    PubMed Central

    Koritzky, Gilly; Dieterle, Camille; Rice, Chantelle; Jordan, Katie; Bechara, Antoine

    2014-01-01

    Objective Attrition is a common problem in weight-management. Understanding the risk factors for attrition should enhance professionals’ ability to increase completion rates and improve health outcomes for more individuals. We propose a model that draws upon neuropsychological knowledge on reward-sensitivity in obesity and overeating to predict attrition. Design & Methods 52 participants in a weight-management program completed a complex decision-making task.Decision-making characteristics – including sensitivity to reward – were further estimated using a quantitative model. Impulsivity and risk-taking measures were also administered. Results Consistent with the hypothesis that sensitivity to reward predicted attrition, program dropouts had higher sensitivity to reward than completers (p < 0.03). No differences were observed between completers and dropouts in initial BMI, age, employment status, or the number of prior weight-loss attempts (p ≥ 0.07). Completers had a slightly higher education level than dropouts, but its inclusion in the model did not increase predictive power. Impulsivity, delay of gratification, and risk-taking did not predict attrition, either. Conclusions Findings link attrition in weight-management to the neural mechanisms associated with reward-seeking and related influences on decision-making. Individual differences in the magnitude of response elicited by rewards may account for the relative difficulty experienced by dieters in adhering to treatment. PMID:24771588

  3. The economic value of drought information: Application to water resources management decisions in Spain

    NASA Astrophysics Data System (ADS)

    Garrote, Luis; Sordo, Alvaro; Iglesias, Ana

    2016-04-01

    Information is valuable when it improves decision-making (e.g., actions can be adjusted to better suit the situation at hand) and enables the mitigation of damage. However, quantifying the value of information is often difficult. Here we explore a general approach to understand the economic value of drought information for water managers framing our approach in the precautionary principle that reminds us that uncertainty is not a reason to postpone or avoid action. We explore how decision making can disregard uncertain effects, taking a short-term approach and focusing instead on the certain costs and benefits of taking action. Two main questions arise: How do we know that advanced drought information is actually helping decisions?; and What is the value of information in the decision process? The approach is applied to several regulated water resources systems in Spain. It first views drought information as a factor in the decision process which can be used by water managers to reduce uncertainty. Second, the value of drought information is the expected gain in a decision outcome (utility) from using additional information. Finally, the gains of improved information are compared with the information collection costs. Here we estimate the value by taking into account the accuracy of the drought information, the subjective probabilities about the value, analyzed as Bayesian probabilities, and the ability or skill of the stakeholders to apply the drought information to modify their actions. Since information may be considered a public good (non-rivalry and non-excludability), it may justify public policy in the provision of information, considering social costs and benefits. The application of the framework to the Spanish case studies shows that information benefits exceeds to costs when drought frequency is 20-40% above normal values; below these values uncertainty in the decisions dominate the results; above these values, the management decisions are limited even

  4. Conflict Management and Decision Making. Symposium.

    ERIC Educational Resources Information Center

    2002

    This symposium on conflict management and decision making is comprised of three papers. "Two Approaches to Conflict Management in Teams: A Case Study" (Mychal Coleman, Gary N. McLean) describes a study that provided conflict management training to two employee teams using the traditional lecture method and cooperative learning (CL).…

  5. NED-2: A decision support system for integrated forest ecosystem management

    Treesearch

    Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

    2005-01-01

    NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

  6. NED-2: a decision support system for integrated forest ecosystem management

    Treesearch

    Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

    2005-01-01

    NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

  7. Multimedia educational aids for improving consumer knowledge about illness management and treatment decisions: a review of randomized controlled trials.

    PubMed

    Jeste, Dilip V; Dunn, Laura B; Folsom, David P; Zisook, Dan

    2008-01-01

    Psychiatric practice is becoming increasingly more complex in terms of the available treatment options, use of new technologies for assessments, and a need for psychiatric patients and their caregivers to be familiar with general medical procedures. This trend will only intensify in the years to come. Routine methods of providing information relevant to clinical decision making about healthcare evaluations or management are often suboptimal. Relatively little research has been done on enhancing the capacity of psychiatric patients and the caregivers to make truly informed decisions about management. In this paper, we review studies that compared the effects of multimedia (video- or computer-based) educational aids with those of routine procedures to inform healthcare consumers about medical evaluations or management. Although most of these investigations were conducted in non-psychiatric patients, the results should be relevant for psychiatric practice of tomorrow. We searched MEDLINE, PsycINFO, and CINAHL bibliographic databases. Randomized controlled trials that used objective measures of knowledge or understanding of the information provided were selected. Studies were rated as positive if the multimedia educational aid resulted in a greater improvement in knowledge or understanding than the control condition. The quality of each study was also rated using a newly developed Scale for Assessing Scientific Quality of Investigations (SASQI). A total of 37 randomized controlled trials were identified. Nearly two-thirds of the studies (23/37) in diverse patient populations and for varied medical assessments and treatments reported that multimedia educational aids produced better understanding of information compared to routine methods. SASQI scores for the positive and negative studies were comparable, suggesting that lower quality was not related to positive findings. In conclusion, multimedia educational aids hold promise for improving the provision of complex

  8. Improving Project Management Using Formal Models and Architectures

    NASA Technical Reports Server (NTRS)

    Kahn, Theodore; Sturken, Ian

    2011-01-01

    This talk discusses the advantages formal modeling and architecture brings to project management. These emerging technologies have both great potential and challenges for improving information available for decision-making. The presentation covers standards, tools and cultural issues needing consideration, and includes lessons learned from projects the presenters have worked on.

  9. Trade-off decisions in distribution utility management

    NASA Astrophysics Data System (ADS)

    Slavickas, Rimas Anthony

    As a result of the "unbundling" of traditional monopolistic electricity generation and transmission enterprises into a free-market economy, power distribution utilities are faced with very difficult decisions pertaining to electricity supply options and quality of service to the customers. The management of distribution utilities has become increasingly complex, versatile, and dynamic to the extent that conventional, non-automated management tools are almost useless and obsolete. This thesis presents a novel and unified approach to managing electricity supply options and quality of service to customers. The technique formulates the problem in terms of variables, parameters, and constraints. An advanced Mixed Integer Programming (MIP) optimization formulation is developed together with novel, logical, decision-making algorithms. These tools enable the utility management to optimize various cost components and assess their time-trend impacts, taking into account the intangible issues such as customer perception, customer expectation, social pressures, and public response to service deterioration. The above concepts are further generalized and a Logical Proportion Analysis (LPA) methodology and associated software have been developed. Solutions using numbers are replaced with solutions using words (character strings) which more closely emulate the human decision-making process and advance the art of decision-making in the power utility environment. Using practical distribution utility operation data and customer surveys, the developments outlined in this thesis are successfully applied to several important utility management problems. These involve the evaluation of alternative electricity supply options, the impact of rate structures on utility business, and the decision of whether to continue to purchase from a main grid or generate locally (partially or totally) by building Non-Utility Generation (NUG).

  10. Managing wildfire events: risk-based decision making among a group of federal fire managers

    Treesearch

    Robyn S. Wilson; Patricia L. Winter; Lynn A. Maguire; Timothy Ascher

    2011-01-01

    Managing wildfire events to achieve multiple management objectives involves a high degree of decision complexity and uncertainty, increasing the likelihood that decisions will be informed by experience-based heuristics triggered by available cues at the time of the decision. The research reported here tests the prevalence of three risk-based biases among 206...

  11. Using Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.

    PubMed

    Effken, Judith A; Brewer, Barbara B; Logue, Melanie D; Gephart, Sheila M; Verran, Joyce A

    2011-10-01

    To better understand the environmental constraints on nurse managers that impact their need for and use of decision support tools, we conducted a Cognitive Work Analysis (CWA). A complete CWA includes system analyses at five levels: work domain, decision-making procedures, decision-making strategies, social organization/collaboration, and worker skill level. Here we describe the results of the Work Domain Analysis (WDA) portion in detail then integrate the WDA with other portions of the CWA, reported previously, to generate a more complete picture of the nurse manager's work domain. Data for the WDA were obtained from semi-structured interviews with nurse managers, division directors, CNOs, and other managers (n = 20) on 10 patient care units in three Arizona hospitals. The WDA described the nurse manager's environment in terms of the constraints it imposes on the nurse manager's ability to achieve targeted outcomes through organizational goals and priorities, functions, processes, as well as work objects and resources (e.g., people, equipment, technology, and data). Constraints were identified and summarized through qualitative thematic analysis. The results highlight the competing priorities, and external and internal constraints that today's nurse managers must satisfy as they try to improve quality and safety outcomes on their units. Nurse managers receive a great deal of data, much in electronic format. Although dashboards were perceived as helpful because they integrated some data elements, no decision support tools were available to help nurse managers with planning or answering "what if" questions. The results suggest both the need for additional decision support to manage the growing complexity of the environment, and the constraints the environment places on the design of that technology if it is to be effective. Limitations of the study include the small homogeneous sample and the reliance on interview data targeting safety and quality. Copyright © 2011

  12. Towards ethical decision support and knowledge management in neonatal intensive care.

    PubMed

    Yang, L; Frize, M; Eng, P; Walker, R; Catley, C

    2004-01-01

    Recent studies in neonatal medicine, clinical nursing, and cognitive psychology have indicated the need to augment current decision-making practice in neonatal intensive care units with computerized, intelligent decision support systems. Rapid progress in artificial intelligence and knowledge management facilitates the design of collaborative ethical decision-support tools that allow clinicians to provide better support for parents facing inherently difficult choices, such as when to withdraw aggressive treatment. The appropriateness of using computers to support ethical decision-making is critically analyzed through research and literature review. In ethical dilemmas, multiple diverse participants need to communicate and function as a team to select the best treatment plan. In order to do this, physicians require reliable estimations of prognosis, while parents need a highly useable tool to help them assimilate complex medical issues and address their own value system. Our goal is to improve and structuralize the ethical decision-making that has become an inevitable part of modern neonatal care units. The paper contributes to clinical decision support by outlining the needs and basis for ethical decision support and justifying the proposed development efforts.

  13. Hospital management training and improvement in managerial skills: Serbian experience.

    PubMed

    Supic, Zorica Terzic; Bjegovic, Vesna; Marinkovic, Jelena; Milicevic, Milena Santric; Vasic, Vladimir

    2010-06-01

    The purpose of this study was to analyze the improvement of managerial skills of hospitals' top managers after a specific management training programme, and to explore possible predictors and relations. The study was conducted during the years 2006 and 2007 with cohort of 107 managers from 20 Serbian general hospitals. The managers self-assessed the improvement in their managerial skills before and after the training programme. After the training programme, all managers' skills had improved. The biggest improvement was in the following skills: organizing daily activities, motivating and guiding others, supervising the work of others, group discussion, and situation analysis. The least improved were: applying creative techniques, working well with peers, professional self-development, written communication, and operational planning. Identified predictors of improvement were: shorter years of managerial experience, type of manager, type of profession, and recognizing the importance of the managerial skills in oral communication, evidence-based decision making, and supervising the work of others. Specific training programme related to strategic management can increase managerial competencies, which are an important source of competitive advantage for organizations. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Decision-support systems for forest management

    Treesearch

    H. Michael Rauscher

    2005-01-01

    The basic concept of sustainable development, formulated in the Brundtland report and applied to forest management by the Montreal Process, has focused attention on the need for formal decision processes (Brundtland. 1987). The application of decision theory is essential because meeting the needs of the present without compromising the ability of future generations to...

  15. Experiencing cancer treatment decision-making in managed care.

    PubMed

    Wenzel, Jennifer; Shaha, Maya

    2008-09-01

    This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.

  16. Application of decision science to resilience management in Jamaica Bay

    USGS Publications Warehouse

    Eaton, Mitchell; Fuller, Angela K.; Johnson, Fred A.; Hare, M. P.; Stedman, Richard C.; Sanderson, E.W.; Solecki, W. D.; Waldman, J.R.; Paris, A. S.

    2016-01-01

    This book highlights the growing interest in management interventions designed to enhance the resilience of the Jamaica Bay socio-ecological system. Effective management, whether the focus is on managing biological processes or human behavior or (most likely) both, requires decision makers to anticipate how the managed system will respond to interventions (i.e., via predictions or projections). In systems characterized by many interacting components and high uncertainty, making probabilistic predictions is often difficult and requires careful thinking not only about system dynamics, but also about how management objectives are specified and the analytic method used to select the preferred action(s). Developing a clear statement of the problem(s) and articulation of management objectives is often best achieved by including input from managers, scientists and other stakeholders affected by the decision through a process of joint problem framing (Marcot and others 2012; Keeney and others 1990). Using a deliberate, coherent and transparent framework for deciding among management alternatives to best meet these objectives then ensures a greater likelihood for successful intervention. Decision science provides the theoretical and practical basis for developing this framework and applying decision analysis methods for making complex decisions under uncertainty and risk.

  17. 43 CFR 1610.6 - Management decision review by Congress.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... respect to a tract of 100,000 acres or more, shall be reported by the Secretary to Congress before it can... 43 Public Lands: Interior 2 2012-10-01 2012-10-01 false Management decision review by Congress... Resource Management Planning § 1610.6 Management decision review by Congress. The Federal Land Policy and...

  18. 43 CFR 1610.6 - Management decision review by Congress.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... respect to a tract of 100,000 acres or more, shall be reported by the Secretary to Congress before it can... 43 Public Lands: Interior 2 2013-10-01 2013-10-01 false Management decision review by Congress... Resource Management Planning § 1610.6 Management decision review by Congress. The Federal Land Policy and...

  19. 43 CFR 1610.6 - Management decision review by Congress.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... respect to a tract of 100,000 acres or more, shall be reported by the Secretary to Congress before it can... 43 Public Lands: Interior 2 2011-10-01 2011-10-01 false Management decision review by Congress... Resource Management Planning § 1610.6 Management decision review by Congress. The Federal Land Policy and...

  20. Use of structured decision making to identify monitoring variables and management priorities for salt marsh ecosystems

    USGS Publications Warehouse

    Neckles, Hilary A.; Lyons, James E.; Guntenspergen, Glenn R.; Shriver, W. Gregory; Adamowicz, Susan C.

    2015-01-01

    Most salt marshes in the USA have been degraded by human activities, and coastal managers are faced with complex choices among possible actions to restore or enhance ecosystem integrity. We applied structured decision making (SDM) to guide selection of monitoring variables and management priorities for salt marshes within the National Wildlife Refuge System in the northeastern USA. In general, SDM is a systematic process for decomposing a decision into its essential elements. We first engaged stakeholders in clarifying regional salt marsh decision problems, defining objectives and attributes to evaluate whether objectives are achieved, and developing a pool of alternative management actions for achieving objectives. Through this process, we identified salt marsh attributes that were applicable to monitoring National Wildlife Refuges on a regional scale and that targeted management needs. We then analyzed management decisions within three salt marsh units at Prime Hook National Wildlife Refuge, coastal Delaware, as a case example of prioritizing management alternatives. Values for salt marsh attributes were estimated from 2 years of baseline monitoring data and expert opinion. We used linear value modeling to aggregate multiple attributes into a single performance score for each alternative, constrained optimization to identify alternatives that maximized total management benefits subject to refuge-wide cost constraints, and used graphical analysis to identify the optimal set of alternatives for the refuge. SDM offers an efficient, transparent approach for integrating monitoring into management practice and improving the quality of management decisions.

  1. Invited review: Helping dairy farmers to improve economic performance utilizing data-driving decision support tools.

    PubMed

    Cabrera, V E

    2018-01-01

    The objective of this review paper is to describe the development and application of a suite of more than 40 computerized dairy farm decision support tools contained at the University of Wisconsin-Madison (UW) Dairy Management website http://DairyMGT.info. These data-driven decision support tools are aimed to help dairy farmers improve their decision-making, environmental stewardship and economic performance. Dairy farm systems are highly dynamic in which changing market conditions and prices, evolving policies and environmental restrictions together with every time more variable climate conditions determine performance. Dairy farm systems are also highly integrated with heavily interrelated components such as the dairy herd, soils, crops, weather and management. Under these premises, it is critical to evaluate a dairy farm following a dynamic integrated system approach. For this approach, it is crucial to use meaningful data records, which are every time more available. These data records should be used within decision support tools for optimal decision-making and economic performance. Decision support tools in the UW-Dairy Management website (http://DairyMGT.info) had been developed using combination and adaptation of multiple methods together with empirical techniques always with the primary goal for these tools to be: (1) highly user-friendly, (2) using the latest software and computer technologies, (3) farm and user specific, (4) grounded on the best scientific information available, (5) remaining relevant throughout time and (6) providing fast, concrete and simple answers to complex farmers' questions. DairyMGT.info is a translational innovative research website in various areas of dairy farm management that include nutrition, reproduction, calf and heifer management, replacement, price risk and environment. This paper discusses the development and application of 20 selected (http://DairyMGT.info) decision support tools.

  2. Stakeholder views of management and decision support tools to integrate climate change into Great Lakes Lake Whitefish management

    USGS Publications Warehouse

    Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.

    2016-01-01

    Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.

  3. A formalized approach to making effective natural resource management decisions for Alaska National Parks

    USGS Publications Warehouse

    MacCluskie, Margaret C.; Romito, Angela; Peterson, James T.; Lawler, James P.

    2015-01-01

    A fundamental goal of the National Park Service (NPS) is the long-term protection and management of resources in the National Park System. Reaching this goal requires multiple approaches, including the conservation of essential habitats and the identification and elimination of potential threats to biota and habitats. To accomplish these goals, the NPS has implemented the Alaska Region Vital Signs Inventory and Monitoring (I&M) Program to monitor key biological, chemical, and physical components of ecosystems at more than 270 national parks. The Alaska Region has four networks—Arctic, Central, Southeast, and Southwest. By monitoring vital signs over large spatial and temporal scales, park managers are provided with information on the status and trajectory of park resources as well as a greater understanding and insight into the ecosystem dynamics. While detecting and quantifying change is important to conservation efforts, to be useful for formulating remedial actions, monitoring data must explicitly relate to management objectives and be collected in such a manner as to resolve key uncertainties about the dynamics of the system (Nichols and Williams 2006). Formal decision making frameworks (versus more traditional processes described below) allow for the explicit integration of monitoring data into decision making processes to improve the understanding of system dynamics, thereby improving future decisions (Williams 2011).

  4. A novel computer based expert decision making model for prostate cancer disease management.

    PubMed

    Richman, Martin B; Forman, Ernest H; Bayazit, Yildirim; Einstein, Douglas B; Resnick, Martin I; Stovsky, Mark D

    2005-12-01

    We propose a strategic, computer based, prostate cancer decision making model based on the analytic hierarchy process. We developed a model that improves physician-patient joint decision making and enhances the treatment selection process by making this critical decision rational and evidence based. Two groups (patient and physician-expert) completed a clinical study comparing an initial disease management choice with the highest ranked option generated by the computer model. Participants made pairwise comparisons to derive priorities for the objectives and subobjectives related to the disease management decision. The weighted comparisons were then applied to treatment options to yield prioritized rank lists that reflect the likelihood that a given alternative will achieve the participant treatment goal. Aggregate data were evaluated by inconsistency ratio analysis and sensitivity analysis, which assessed the influence of individual objectives and subobjectives on the final rank list of treatment options. Inconsistency ratios less than 0.05 were reliably generated, indicating that judgments made within the model were mathematically rational. The aggregate prioritized list of treatment options was tabulated for the patient and physician groups with similar outcomes for the 2 groups. Analysis of the major defining objectives in the treatment selection decision demonstrated the same rank order for the patient and physician groups with cure, survival and quality of life being more important than controlling cancer, preventing major complications of treatment, preventing blood transfusion complications and limiting treatment cost. Analysis of subobjectives, including quality of life and sexual dysfunction, produced similar priority rankings for the patient and physician groups. Concordance between initial treatment choice and the highest weighted model option differed between the groups with the patient group having 59% concordance and the physician group having only 42

  5. Improving performance with clinical decision support.

    PubMed

    Brailer, D J; Goldfarb, S; Horgan, M; Katz, F; Paulus, R A; Zakrewski, K

    1996-07-01

    CADU/CIS (Clinical and Administrative Decision-support Utility and Clinical Information System) is a clinical decision-support workstation that allows large volumes of clinical information systems data to be analyzed in a timely and user-friendly fashion. CARE PROCESS MEASUREMENT: For any given disease, subgroups of patients are identified, and automated, customized "clinical pathways" are generated. For each subgroup, the best practice norms for use of test and therapies are identified. Practice style variations are then compared to outcomes to focus inquiry on decisions that significantly affect outcomes. INTESTINAL OBSTRUCTION: Graduate Health Systems, a multisite integrated provider in the Philadelphia area, has used CADU/CIS to improve quality problems, reduce treatment-intensity variations, and improve clinical participation in care process evaluation and decision making. A task force selected intestinal obstruction without hernia as its first study because of the related high-volume and high-morbidity complications. Use of a ten-step method for clinical performance improvement showed that the intravenous administration of unnecessary fluids to 104 patients with intestinal obstruction induced congestive heart failure (CHF) in 5 patients. Task force members and other practicing physicians are now developing guidelines and other interventions aimed at fluid use. Indeed, the task force used CADU/CIS to identify an additional 250 patients in one year whose conditions were complicated by CHF. A clinical decision support tool can be instrumental in detecting problems with important clinical and economic implications, identifying their important underlying causes, tracking the associated tests and therapies, and monitoring interventions.

  6. Thresholds for conservation and management: structured decision making as a conceptual framework

    USGS Publications Warehouse

    Nichols, James D.; Eaton, Mitchell J.; Martin, Julien; Edited by Guntenspergen, Glenn R.

    2014-01-01

    changes in system dynamics. They are frequently incorporated into ecological models used to project system responses to management actions. Utility thresholds are components of management objectives and are values of state or performance variables at which small changes yield substantial changes in the value of the management outcome. Decision thresholds are values of system state variables at which small changes prompt changes in management actions in order to reach specified management objectives. Decision thresholds are derived from the other components of the decision process.We advocate a structured decision making (SDM) approach within which the following components are identified: objectives (possibly including utility thresholds), potential actions, models (possibly including ecological thresholds), monitoring program, and a solution algorithm (which produces decision thresholds). Adaptive resource management (ARM) is described as a special case of SDM developed for recurrent decision problems that are characterized by uncertainty. We believe that SDM, in general, and ARM, in particular, provide good approaches to conservation and management. Use of SDM and ARM also clarifies the distinct roles of ecological thresholds, utility thresholds, and decision thresholds in informed decision processes.

  7. Knowledge-Based Information Management in Decision Support for Ecosystem Management

    Treesearch

    Keith Reynolds; Micahel Saunders; Richard Olson; Daniel Schmoldt; Michael Foster; Donald Latham; Bruce Miller; John Steffenson; Lawrence Bednar; Patrick Cunningham

    1995-01-01

    The Pacific Northwest Research Station (USDA Forest Service) is developing a knowledge-based information management system to provide decision support for watershed analysis in the Pacific Northwest region of the U.S. The decision support system includes: (1) a GIS interface that allows users to graphically navigate to specific provinces and watersheds and display a...

  8. Practice management companies improve practices' financial position.

    PubMed

    Dupell, T

    1997-11-01

    To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

  9. Perceptions of risk, risk aversion, and barriers to adoption of decision support systems and integrated pest management: an introduction.

    PubMed

    Gent, David H; De Wolf, Erick; Pethybridge, Sarah J

    2011-06-01

    Rational management of plant diseases, both economically and environmentally, involves assessing risks and the costs associated with both correct and incorrect tactical management decisions to determine when control measures are warranted. Decision support systems can help to inform users of plant disease risk and thus assist in accurately targeting events critical for management. However, in many instances adoption of these systems for use in routine disease management has been perceived as slow. The under-utilization of some decision support systems is likely due to both technical and perception constraints that have not been addressed adequately during development and implementation phases. Growers' perceptions of risk and their aversion to these perceived risks can be reasons for the "slow" uptake of decision support systems and, more broadly, integrated pest management (IPM). Decision theory provides some tools that may assist in quantifying and incorporating subjective and/or measured probabilities of disease occurrence or crop loss into decision support systems. Incorporation of subjective probabilities into IPM recommendations may be one means to reduce grower uncertainty and improve trust of these systems because management recommendations could be explicitly informed by growers' perceptions of risk and economic utility. Ultimately though, we suggest that an appropriate measure of the value and impact of decision support systems is grower education that enables more skillful and informed management decisions independent of consultation of the support tool outputs.

  10. Shared decision-making in epilepsy management.

    PubMed

    Pickrell, W O; Elwyn, G; Smith, P E M

    2015-06-01

    Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Decision Support System for an efficient irrigation water management in semi arid environment

    NASA Astrophysics Data System (ADS)

    Khan, M. A.; Islam, M.; Hafeez, M. M.; Flugel, W. A.

    2009-12-01

    A significant increase in agricultural productivity over the last few decades has protected the world from episodes of hunger and food shortages. Water management in irrigated agriculture was instrumental in achieving those gains. Water resources are under high pressure due to rapid population growth and increased competition among various sectors. Access to reliable data on water availability, quantity and quality can provide the necessary foundation for sound management of water resources. There are many traditional methods for matching water demand and supply, however imbalances between demand and supply remain inevitable. It is possible to reduce the imbalances considerably through development of appropriate irrigation water management tool that take into account various factors such as soil type, irrigation water supply, and crop water demand. All components of water balance need to be understood and quantified for efficient and sustainable management of water resources. Application of an intelligent Decision Support System (DSS) is becoming significant. A DSS incorporates knowledge and expertise within the decision support framework. It is an integrated set of data, functions, models and other relevant information that efficiently processes input data, simulates models and displays the results in a user friendly format. It helps in decision-making process, to analyse the problem and explore various scenarios to make the most appropriate decision for water management. This paper deals with the Coleambally Irrigation Area (CIA) located in Murrumbidgee catchment, NSW, Australia. An Integrated River Information System called Coleambally IRIS has been developed to improve the irrigation water management ranging from farm to sub-system and system level. It is a web-based information management system with a focus on time series and geospatial hydrological, climatic and remote sensing data including land cover class, surface temperature, soil moisture, Normalized

  12. Shared Decision-Making in the Management of Congenital Vascular Malformations.

    PubMed

    Horbach, Sophie E R; Ubbink, Dirk T; Stubenrouch, Fabienne E; Koelemay, Mark J W; van der Vleuten, Carine J M; Verhoeven, Bas H; Reekers, Jim A; Schultze Kool, Leo J; van der Horst, Chantal M A M

    2017-03-01

    In shared decision-making, clinicians and patients arrive at a joint treatment decision, by incorporating best available evidence and the patients' personal values and preferences. Little is known about the role of shared decision-making in managing patients with congenital vascular malformations, for which preference-sensitive decision-making seems obvious. The authors investigated preferences regarding decision-making and current shared decision-making behavior during physician-patient encounters. In two Dutch university hospitals, adults and children with congenital vascular malformations facing a treatment-related decision were enrolled. Before the consultation, patients (or parents of children) expressed their preference regarding decision-making (Control Preferences Scale). Afterward, participants completed shared decision-making-specific questionnaires (nine-item Shared Decision-Making Questionnaire, CollaboRATE, and satisfaction), and physicians completed the Shared Decision-Making Questionnaire-Physician questionnaire. Consultations were audiotaped and patient involvement was scored by two independent researchers using the five-item Observing Patient Involvement instrument. All questionnaire results were expressed on a scale of 0 to 100 (optimum shared decision-making). Fifty-five participants (24 parents and 31 adult patients) were included. Two-thirds preferred the shared decision-making approach (Control Preferences Scale). Objective five-item Observing Patient Involvement scores were low (mean ± SD, 31 ± 15), whereas patient and physician Shared Decision-Making Questionnaire scores were high, with means of 68 ± 18 and 68 ± 19, respectively. The median CollaboRATE score was 93. There was no clear relationship between shared decision-making and satisfaction scores. Although adults and parents of children with vascular malformations express a strong desire for shared decision-making, objective shared decision-making behavior is still lacking, most

  13. Moving data off the shelf and into action: an intervention to improve data-informed decision making in Côte d'Ivoire.

    PubMed

    Nutley, Tara; Gnassou, Léontine; Traore, Moussa; Bosso, Abitche Edwige; Mullen, Stephanie

    2014-01-01

    Improving a health system requires data, but too often they are unused or under-used by decision makers. Without interventions to improve the use of data in decision making, health systems cannot meet the needs of the populations they serve. In 2008, in Côte d'Ivoire, data were largely unused in health decision-making processes. To implement and evaluate an intervention to improve the use of data in decision making in Cote d'Ivoire. From 2008 to 2012, Cote d'Ivoire sought to improve the use of national health data through an intervention that broadens participation in and builds links between data collection and decision-making processes; identifies information needs; improves data quality; builds capacity to analyze, synthesize, and interpret data; and develops policies to support data use. To assess the results, a Performance of Routine Information System Management Assessment was conducted before and after the intervention using a combination of purposeful and random sampling. In 2008, the sample consisted of the central level, 12 districts, and 119 facilities, and in 2012, the sample consisted of the central level, 20 districts, and 190 health facilities. To assess data use, we developed dichotomous indicators: discussions of analysis findings, decisions taken based on the analysis, and decisions referred to upper management for action. We aggregated the indicators to generate a composite, continuous index of data use. From 2008 to 2012, the district data-use score increased from 40 to 70%; the facility score remained the same - 38%. The central score is not reported, because of a methodological difference in the two assessments. The intervention improved the use of data in decision making at the district level in Côte d'Ivoire. This study provides an example of, and guidance for, implementing a large-scale intervention to improve data-informed decision making.

  14. Improving accountability in vaccine decision-making.

    PubMed

    Timmis, James Kenneth; Black, Steven; Rappuoli, Rino

    2017-11-01

    Healthcare decisions, in particular those affecting entire populations, should be evidence-based and taken by decision-makers sharing broad alignment with affected stakeholders. However, criteria, priorities and procedures for decision-making are sometimes non-transparent, frequently vary considerably across equivalent decision-bodies, do not always consider the broader benefits of new health-measures, and therefore do not necessarily adequately represent the relevant stakeholder-spectrum. Areas covered: To address these issues in the context of the evaluation of new vaccines, we have proposed a first baseline set of core evaluation criteria, primarily selected by members of the vaccine research community, and suggested their implementation in vaccine evaluation procedures. In this communication, we review the consequences and utility of stakeholder-centered core considerations to increase transparency in and accountability of decision-making procedures, in general, and of the benefits gained by their inclusion in Multi-Criteria-Decision-Analysis tools, exemplified by SMART Vaccines, specifically. Expert commentary: To increase effectiveness and comparability of health decision outcomes, decision procedures should be properly standardized across equivalent (national) decision bodies. To this end, including stakeholder-centered criteria in decision procedures would significantly increase their transparency and accountability, support international capacity building to improve health, and reduce societal costs and inequity resulting from suboptimal health decision-making.

  15. Spatial education: improving conservation delivery through space-structured decision making

    USGS Publications Warehouse

    Moore, Clinton T.; Shaffer, Terry L.; Gannon, Jill J.

    2013-01-01

    Adaptive management is a form of structured decision making designed to guide management of natural resource systems when their behaviors are uncertain. Where decision making can be replicated across units of a landscape, learning can be accelerated, and biological processes can be understood in a larger spatial context. Broad-based partnerships among land management agencies, exemplified by Landscape Conservation Cooperatives (conservation partnerships created through the U.S. Department of the Interior), are potentially ideal environments for implementing spatially structured adaptive management programs.

  16. Recent advances in applying decision science to managing national forests

    USGS Publications Warehouse

    Marcot, Bruce G.; Thompson, Matthew P.; Runge, Michael C.; Thompson, Frank R.; McNulty, Steven; Cleaves, David; Tomosy, Monica; Fisher, Larry A.; Andrew, Bliss

    2012-01-01

    Management of federal public forests to meet sustainability goals and multiple use regulations is an immense challenge. To succeed, we suggest use of formal decision science procedures and tools in the context of structured decision making (SDM). SDM entails four stages: problem structuring (framing the problem and defining objectives and evaluation criteria), problem analysis (defining alternatives, evaluating likely consequences, identifying key uncertainties, and analyzing tradeoffs), decision point (identifying the preferred alternative), and implementation and monitoring the preferred alternative with adaptive management feedbacks. We list a wide array of models, techniques, and tools available for each stage, and provide three case studies of their selected use in National Forest land management and project plans. Successful use of SDM involves participation by decision-makers, analysts, scientists, and stakeholders. We suggest specific areas for training and instituting SDM to foster transparency, rigor, clarity, and inclusiveness in formal decision processes regarding management of national forests.

  17. Optical Coherence Tomography-Guided Decisions in Retinoblastoma Management.

    PubMed

    Soliman, Sameh E; VandenHoven, Cynthia; MacKeen, Leslie D; Héon, Elise; Gallie, Brenda L

    2017-06-01

    Assess the role of handheld optical coherence tomography (OCT) in guiding management decisions during diagnosis, treatment, and follow-up of eyes affected by retinoblastoma. Retrospective, noncomparative, single-institution case series. All children newly diagnosed with retinoblastoma from January 2011 to December 2015 who had an OCT session during their active treatment at The Hospital for Sick Children (SickKids) in Toronto, Canada. The OCT sessions for fellow eyes of unilateral retinoblastoma without any suspicious lesion and those performed more than 6 months after the last treatment were excluded. Data collected included age at presentation, sex, family history, RB1 mutation status, 8th edition TNMH cancer staging and International Intraocular Retinoblastoma Classification (IIRC), and number of OCT sessions per eye. Details of each session were scored for indication-related details (informative or not) and assessed for guidance (directive or not), diagnosis (staging changed, new tumors found or excluded), treatment (modified, stopped, or modality shifted), or follow-up modified. Frequency of OCT-guided management decisions, stratified by indication and type of guidance (confirmatory vs. influential). Sixty-three eyes of 44 children had 339 OCT sessions over the course of clinical management (median number of OCT scans per eye, 5; range, 1-15). The age at presentation and presence of a heritable RB1 mutation significantly correlated with an increased number of OCT sessions. Indications included evaluation of post-treatment scar (55%) or fovea (16%), and posterior pole scanning for new tumors (11%). Of all sessions, 92% (312/339) were informative; 19 of 27 noninformative sessions had large, elevated lesions; of these, 14 of 19 were T2a or T2b (IIRC group C or D) eyes. In 94% (293/312) of the informative sessions, OCT directed treatment decisions (58%), diagnosis (16%), and follow-up (26%). Optical coherence tomography influenced and changed management from pre

  18. Application of expert systems in project management decision aiding

    NASA Technical Reports Server (NTRS)

    Harris, Regina; Shaffer, Steven; Stokes, James; Goldstein, David

    1987-01-01

    The feasibility of developing an expert systems-based project management decision aid to enhance the performance of NASA project managers was assessed. The research effort included extensive literature reviews in the areas of project management, project management decision aiding, expert systems technology, and human-computer interface engineering. Literature reviews were augmented by focused interviews with NASA managers. Time estimation for project scheduling was identified as the target activity for decision augmentation, and a design was developed for an Integrated NASA System for Intelligent Time Estimation (INSITE). The proposed INSITE design was judged feasible with a low level of risk. A partial proof-of-concept experiment was performed and was successful. Specific conclusions drawn from the research and analyses are included. The INSITE concept is potentially applicable in any management sphere, commercial or government, where time estimation is required for project scheduling. As project scheduling is a nearly universal management activity, the range of possibilities is considerable. The INSITE concept also holds potential for enhancing other management tasks, especially in areas such as cost estimation, where estimation-by-analogy is already a proven method.

  19. Online decision support system for surface irrigation management

    NASA Astrophysics Data System (ADS)

    Wang, Wenchao; Cui, Yuanlai

    2017-04-01

    Irrigation has played an important role in agricultural production. Irrigation decision support system is developed for irrigation water management, which can raise irrigation efficiency with few added engineering services. An online irrigation decision support system (OIDSS), in consist of in-field sensors and central computer system, is designed for surface irrigation management in large irrigation district. Many functions have acquired in OIDSS, such as data acquisition and detection, real-time irrigation forecast, water allocation decision and irrigation information management. The OIDSS contains four parts: Data acquisition terminals, Web server, Client browser and Communication system. Data acquisition terminals are designed to measure paddy water level, soil water content in dry land, ponds water level, underground water level, and canals water level. A web server is responsible for collecting meteorological data, weather forecast data, the real-time field data, and manager's feedback data. Water allocation decisions are made in the web server. Client browser is responsible for friendly displaying, interacting with managers, and collecting managers' irrigation intention. Communication system includes internet and the GPRS network used by monitoring stations. The OIDSS's model is based on water balance approach for both lowland paddy and upland crops. Considering basic database of different crops water demands in the whole growth stages and irrigation system engineering information, the OIDSS can make efficient decision of water allocation with the help of real-time field water detection and weather forecast. This system uses technical methods to reduce requirements of user's specialized knowledge and can also take user's managerial experience into account. As the system is developed by the Browser/Server model, it is possible to make full use of the internet resources, to facilitate users at any place where internet exists. The OIDSS has been applied in

  20. Wildfire Decision Making Under Uncertainty

    NASA Astrophysics Data System (ADS)

    Thompson, M.

    2013-12-01

    Decisions relating to wildfire management are subject to multiple sources of uncertainty, and are made by a broad range of individuals, across a multitude of environmental and socioeconomic contexts. In this presentation I will review progress towards identification and characterization of uncertainties and how this information can support wildfire decision-making. First, I will review a typology of uncertainties common to wildfire management, highlighting some of the more salient sources of uncertainty and how they present challenges to assessing wildfire risk. This discussion will cover the expanding role of burn probability modeling, approaches for characterizing fire effects, and the role of multi-criteria decision analysis, and will provide illustrative examples of integrated wildfire risk assessment across a variety of planning scales. Second, I will describe a related uncertainty typology that focuses on the human dimensions of wildfire management, specifically addressing how social, psychological, and institutional factors may impair cost-effective risk mitigation. This discussion will encompass decision processes before, during, and after fire events, with a specific focus on active management of complex wildfire incidents. An improved ability to characterize uncertainties faced in wildfire management could lead to improved delivery of decision support, targeted communication strategies, and ultimately to improved wildfire management outcomes.

  1. 43 CFR 4.416 - Appeals of wildfire management decisions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 43 Public Lands: Interior 1 2012-10-01 2011-10-01 true Appeals of wildfire management decisions. 4.416 Section 4.416 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT HEARINGS... Board of Land Appeals § 4.416 Appeals of wildfire management decisions. The Board must decide appeals...

  2. 43 CFR 4.416 - Appeals of wildfire management decisions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 43 Public Lands: Interior 1 2013-10-01 2013-10-01 false Appeals of wildfire management decisions. 4.416 Section 4.416 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT... Board of Land Appeals § 4.416 Appeals of wildfire management decisions. The Board must decide appeals...

  3. 43 CFR 4.416 - Appeals of wildfire management decisions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 43 Public Lands: Interior 1 2014-10-01 2014-10-01 false Appeals of wildfire management decisions. 4.416 Section 4.416 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT... Board of Land Appeals § 4.416 Appeals of wildfire management decisions. The Board must decide appeals...

  4. 43 CFR 4.416 - Appeals of wildfire management decisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 43 Public Lands: Interior 1 2011-10-01 2011-10-01 false Appeals of wildfire management decisions. 4.416 Section 4.416 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT... Board of Land Appeals § 4.416 Appeals of wildfire management decisions. The Board must decide appeals...

  5. 43 CFR 4.416 - Appeals of wildfire management decisions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 43 Public Lands: Interior 1 2010-10-01 2010-10-01 false Appeals of wildfire management decisions. 4.416 Section 4.416 Public Lands: Interior Office of the Secretary of the Interior DEPARTMENT... Board of Land Appeals § 4.416 Appeals of wildfire management decisions. The Board must decide appeals...

  6. Project Manager Performance and the Decision to Backsource the Project Management Office

    ERIC Educational Resources Information Center

    Lively, William R.

    2014-01-01

    This paper reviews a management decision of an Information Technology Outsource (ITO) provider to backshore the management oversight of its Project Management Office (PMO) after only one year of offshore operations. Governance is a term used in project management to refer to management oversight. The review is a quantitative analysis of existing…

  7. Self-managing teams: a strategy for quality improvement.

    PubMed

    Feifer, Chris; Nocella, Kiki; DeArtola, Ignacio; Rowden, Suzanne; Morrison, Stephen

    2003-01-01

    Organizations are impacted by their environments, and health care settings are no different. Individuals charged with improving a practice are often impeded by environmental barriers, including incomplete information for decision making. One strategy to empower an organization for change is to form a self-managing team. This paper discusses the self-managing team concept and uses a case study to illustrate its application in primary care. Factors contributing to team success are presented as a guide, and a reminder--there is more to an effective team than gathering people in a room.

  8. Intraoperative blood glucose management: impact of a real-time decision support system on adherence to institutional protocol.

    PubMed

    Nair, Bala G; Grunzweig, Katherine; Peterson, Gene N; Horibe, Mayumi; Neradilek, Moni B; Newman, Shu-Fang; Van Norman, Gail; Schwid, Howard A; Hao, Wei; Hirsch, Irl B; Patchen Dellinger, E

    2016-06-01

    Poor perioperative glycemic management can lead to negative surgical outcome. Improved compliance to glucose control protocol could lead to better glucose management. An Anesthesia Information Management System based decision support system-Smart Anesthesia Manager™ (SAM) was used to generate real-time reminders to the anesthesia providers to closely adhere to our institutional glucose management protocol. Compliance to hourly glucose measurements and correct insulin dose adjustments was compared for the baseline period (12 months) without SAM and the intervention period (12 months) with SAM decision support. Additionally, glucose management parameters were compared for the baseline and intervention periods. A total of 1587 cases during baseline and 1997 cases during intervention met the criteria for glucose management (diabetic patients or non-diabetic patients with glucose level >140 mg/dL). Among the intervention cases anesthesia providers chose to use SAM reminders 48.7 % of the time primarily for patients who had diabetes, higher HbA1C or body mass index, while disabling the system for the remaining cases. Compliance to hourly glucose measurement and correct insulin doses increased significantly during the intervention period when compared with the baseline (from 52.6 to 71.2 % and from 13.5 to 24.4 %, respectively). In spite of improved compliance to institutional protocol, the mean glucose levels and other glycemic management parameters did not show significant improvement with SAM reminders. Real-time electronic reminders improved intraoperative compliance to institutional glucose management protocol though glycemic parameters did not improve even when there was greater compliance to the protocol.

  9. Collective Decision Making in Organizations.

    ERIC Educational Resources Information Center

    Svenning, Lynne L.

    Based on the assumption that educators can adopt new patterns of organization and management to improve the quality of decision and change in education, this paper attempts to make decision theory and small group process theory relevant to practical decision situations confronting educational managers. Included are (1) a discussion of the…

  10. Help in making fuel management decisions.

    Treesearch

    Peter J. Roussopoulos; Von J. Johnson

    1975-01-01

    Describes how to compare predictions of fuel hazard for Northeastern logging slash with a number of fuel hazard "standards." This system provides objective criteria for making fuel management decisions.

  11. Defining and Measuring Decision-Making for the Management of Trauma Patients.

    PubMed

    Madani, Amin; Gips, Amanda; Razek, Tarek; Deckelbaum, Dan L; Mulder, David S; Grushka, Jeremy R

    Effective management of trauma patients is heavily dependent on sound judgment and decision-making. Yet, current methods for training and assessing these advanced cognitive skills are subjective, lack standardization, and are prone to error. This qualitative study aims to define and characterize the cognitive and interpersonal competencies required to optimally manage injured patients. Cognitive and hierarchical task analyses for managing unstable trauma patients were performed using qualitative methods to map the thoughts, behaviors, and practices that characterize expert performance. Trauma team leaders and board-certified trauma surgeons participated in semistructured interviews that were transcribed verbatim. Data were supplemented with content from published literature and prospectively collected field notes from observations of the trauma team during trauma activations. The data were coded and analyzed using grounded theory by 2 independent reviewers. A framework was created based on 14 interviews with experts (lasting 1-2 hours each), 35 field observations (20 [57%] blunt; 15 [43%] penetrating; median Injury Severity Score 20 [13-25]), and 15 literary sources. Experts included 11 trauma surgeons and 3 emergency physicians from 7 Level 1 academic institutions in North America (median years in practice: 12 [8-17]). Twenty-nine competencies were identified, including 17 (59%) related to situation awareness, 6 (21%) involving decision-making, and 6 (21%) requiring interpersonal skills. Of 40 potential errors that were identified, root causes were mapped to errors in situation awareness (20 [50%]), decision-making (10 [25%]), or interpersonal skills (10 [25%]). This study defines cognitive and interpersonal competencies that are essential for the management of trauma patients. This framework may serve as the basis for novel curricula to train and assess decision-making skills, and to develop quality-control metrics to improve team and individual performance

  12. Fuzzy Multicriteria Decision Analysis for Adaptive Watershed Management

    NASA Astrophysics Data System (ADS)

    Chang, N.

    2006-12-01

    The dramatic changes of societal complexity due to intensive interactions among agricultural, industrial, and municipal sectors have resulted in acute issues of water resources redistribution and water quality management in many river basins. Given the fact that integrated watershed management is more a political and societal than a technical challenge, there is a need for developing a compelling method leading to justify a water-based land use program in some critical regions. Adaptive watershed management is viewed as an indispensable tool nowadays for providing step-wise constructive decision support that is concerned with all related aspects of the water consumption cycle and those facilities affecting water quality and quantity temporally and spatially. Yet the greatest challenge that decision makers face today is to consider how to leverage ambiguity, paradox, and uncertainty to their competitive advantage of management policy quantitatively. This paper explores a fuzzy multicriteria evaluation method for water resources redistribution and subsequent water quality management with respect to a multipurpose channel-reservoir system--the Tseng- Wen River Basin, South Taiwan. Four fuzzy operators tailored for this fuzzy multicriteria decision analysis depict greater flexibility in representing the complexity of various possible trade-offs among management alternatives constrained by physical, economic, and technical factors essential for adaptive watershed management. The management strategies derived may enable decision makers to integrate a vast number of internal weirs, water intakes, reservoirs, drainage ditches, transfer pipelines, and wastewater treatment facilities within the basin and bring up the permitting issue for transboundary diversion from a neighboring river basin. Experience gained indicates that the use of different types of fuzzy operators is highly instructive, which also provide unique guidance collectively for achieving the overarching goals

  13. Risk manager formula for success: Influencing decision making.

    PubMed

    Midgley, Mike

    2017-10-01

    Providing the ultimate decision makers with a quantitative risk analysis based on thoughtful assessment by the organization's experts enables an efficient decision. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  14. SMARTE: IMPROVING REVITALIZATION DECISIONS (BERLIN, GERMANY)

    EPA Science Inventory

    The U.S.-German Bilateral Working Group is developing Site-specific Management Approaches and Redevelopment Tools (SMART). In the U.S., the SMART compilation is housed in a web-based, decision support tool called SMARTe. All tools within SMARTe that are developed specifically for...

  15. Engaging stakeholders for adaptive management using structured decision analysis

    USGS Publications Warehouse

    Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

    2009-01-01

    Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

  16. [Allocation decisions of health insurance rehabilitation managers--An explorative case study concerning stroke rehabilitation].

    PubMed

    Hasenbein, U; Wallesch, C-W

    2003-12-01

    We investigated processes of and subjective reasons for resource allocation in three out of four rehabilitation specialists of a regional office of a major health insurance. Decisions of health insurance personnel include approval of and duration of rehabilitation treatment and choice of clinical provider. Insurance specialists are mainly involved in documentation and coordination, whereas decisions mainly follow expert recommendations, mainly of the medical service. Allocation is based primarily on somatic impairment and disability, psychosocial function, motivation and rehabilitation potential are regarded as secondary. Goals and expected results of rehabilitation are neither individually defined nor their achievement evaluated. Decision processes are dominated by routines and agreements. Only exceptionally, defined rules and procedures are applied. Active case management is hampered by a highly specialized internal structure of the investigated insurance fund. The optimal fulfillment of individual requirements for a limited-time rehabilitation treatment is the central criterion for decision making. However, the specialists lack detailed information concerning appropriateness, quality and efficacy of rehabilitation providers, especially when taking patient-related variables into account. Instead, they trust that only high-quality institutions are contracted. Systematic control and feedback of rehabilitation results is not available. The surveyed rehabilitation managers do not include cost aspects in their decision-making. They would regard this as alien to a member- and patient-oriented policy. Improvement potentials with respect to rehabilitation case management are being reviewed.

  17. Improving Leadership Through Better Decision Making: Fostering Critical Thinking

    DTIC Science & Technology

    1997-03-01

    AU/ACSC/0506/97-03 IMPROVING LEADERSHIP THROUGH BETTER DECISION MAKING : FOSTERING CRITICAL THINKING A Research Paper Presented To The Research...xx-xx-1997 to xx-xx-1997 4. TITLE AND SUBTITLE Improving Leadership Through Better Decision Making : Fostering Critical Thinking Unclassified 5a...purpose. That purpose is to make the best decision about what to believe or do. Figure 1 provides a visual representation of the critical thinking

  18. Using perceptions as evidence to improve conservation and environmental management.

    PubMed

    Bennett, Nathan James

    2016-06-01

    The conservation community is increasingly focusing on the monitoring and evaluation of management, governance, ecological, and social considerations as part of a broader move toward adaptive management and evidence-based conservation. Evidence is any information that can be used to come to a conclusion and support a judgment or, in this case, to make decisions that will improve conservation policies, actions, and outcomes. Perceptions are one type of information that is often dismissed as anecdotal by those arguing for evidence-based conservation. In this paper, I clarify the contributions of research on perceptions of conservation to improving adaptive and evidence-based conservation. Studies of the perceptions of local people can provide important insights into observations, understandings and interpretations of the social impacts, and ecological outcomes of conservation; the legitimacy of conservation governance; and the social acceptability of environmental management. Perceptions of these factors contribute to positive or negative local evaluations of conservation initiatives. It is positive perceptions, not just objective scientific evidence of effectiveness, that ultimately ensure the support of local constituents thus enabling the long-term success of conservation. Research on perceptions can inform courses of action to improve conservation and governance at scales ranging from individual initiatives to national and international policies. Better incorporation of evidence from across the social and natural sciences and integration of a plurality of methods into monitoring and evaluation will provide a more complete picture on which to base conservation decisions and environmental management. © 2016 Society for Conservation Biology.

  19. Intelligent Model Management in a Forest Ecosystem Management Decision Support System

    Treesearch

    Donald Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mark Twery; H. Michael Rauscher; Peter Knopp; Scott Thomasma; Mayukh Dass; Hajime Uchiyama

    2002-01-01

    Decision making for forest ecosystem management can include the use of a wide variety of modeling tools. These tools include vegetation growth models, wildlife models, silvicultural models, GIS, and visualization tools. NED-2 is a robust, intelligent, goal-driven decision support system that integrates tools in each of these categories. NED-2 uses a blackboard...

  20. Self-management priority setting and decision-making in adults with multimorbidity: A narrative review of literature

    PubMed Central

    Bratzke, Lisa C.; Muehrer, Rebecca J.; Kehl, Karen A.; Lee, Kyoung Suk; Ward, Earlise C.; Kwekkeboom, Kristine L.

    2014-01-01

    Objectives The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making in among adults with multimorbidity. Design A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. Data sources A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Review methods Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors and processes of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Results Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals’ self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Conclusions Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision

  1. Self-management priority setting and decision-making in adults with multimorbidity: a narrative review of literature.

    PubMed

    Bratzke, Lisa C; Muehrer, Rebecca J; Kehl, Karen A; Lee, Kyoung Suk; Ward, Earlise C; Kwekkeboom, Kristine L

    2015-03-01

    The purpose of this narrative review was to synthesize current research findings related to self-management, in order to better understand the processes of priority setting and decision-making among adults with multimorbidity. A narrative literature review was undertaken, synthesizing findings from published, peer-reviewed empirical studies that addressed priority setting and/or decision-making in self-management of multimorbidity. A search of PubMed, PsychINFO, CINAHL and SocIndex databases was conducted from database inception through December 2013. References lists from selected empirical studies and systematic reviews were evaluated to identify any additional relevant articles. Full text of potentially eligible articles were reviewed and selected for inclusion if they described empirical studies that addressed priority setting or decision-making in self-management of multimorbidity among adults. Two independent reviewers read each selected article and extracted relevant data to an evidence table. Processes and factors of multimorbidity self-management were identified and sorted into categories of priority setting, decision-making, and facilitators/barriers. Thirteen articles were selected for inclusion; most were qualitative studies describing processes, facilitators, and barriers of multimorbidity self-management. The findings revealed that patients prioritize a dominant chronic illness and re-prioritize over time as conditions and treatments change; that multiple facilitators (e.g. support programs) and barriers (e.g. lack of financial resources) impact individuals' self-management priority setting and decision-making ability; as do individual beliefs, preferences, and attitudes (e.g., perceived personal control, preferences regarding treatment). Health care providers need to be cognizant that individuals with multimorbidity engage in day-to-day priority setting and decision-making among their multiple chronic illnesses and respective treatments. Researchers

  2. Fast Tracking Data to Informed Decisions: An Advanced Information System to Improve Environmental Understanding and Management (Invited)

    NASA Astrophysics Data System (ADS)

    Minsker, B. S.; Myers, J.; Liu, Y.; Bajcsy, P.

    2010-12-01

    Emerging sensing and information technology are rapidly creating a new paradigm for environmental research and management, in which data from multiple sensors and information sources can guide real-time adaptive observation and decision making. This talk will provide an overview of emerging cyberinfrastructure and three case studies that illustrate their potential: combined sewer overflows in Chicago, hypoxia in Corpus Christi Bay, Texas, and sustainable agriculture in Illinois. An advanced information system for real-time decision making and visual geospatial analytics will be presented as an example of cyberinfrastructure that enables easier implementation of numerous real-time applications.

  3. Clinical decision support tool for Co-management signalling.

    PubMed

    Horta, Alexandra Bayão; Salgado, Cátia; Fernandes, Marta; Vieira, Susana; Sousa, João M; Papoila, Ana Luísa; Xavier, Miguel

    2018-05-01

    Co-management between internists and surgeons of selected patients is becoming one of the pillars of modern clinical management in large hospitals. Defining the patients to be co-managed is essential. The aim of this study is to create a decision tool using real-world patient data collected in the preoperative period, to support the decision on which patients should have the co-management service offered. Data was collected from the electronic clinical health records of patients who had an International Classification of Diseases, 9th edition (ICD-9) code of colorectal surgery during the period between January 2012 and October 2014 in a 200 bed private teaching hospital in Lisbon. ICD-9 codes of colorectal surgery [48.5 and 48.6 (anterior rectal resection and abdominoperineal resection), 45.7 (partial colectomy), 45.8 (Total Colectomy), and 45.9 (Bowel Anastomosis)] were used. Only patients above 18 years old were considered. Patients with more than one procedure were excluded from the study. From these data the authors investigated the construction of predictive models using logistic regression and Takagi-Sugeno fuzzy modelling. Data contains information obtained from the clinical records of a cohort of 344 adult patients. Data from 398 emergent and elective surgeries were collected, from which 54 were excluded because they were second procedures for the same patients. Four preoperative variables were identified as being the most predictive of co-management, in multivariable regression analysis. The final model performed well after being internally validated (0.81 AUC, 77% accuracy, 74% sensitivity, 78% specificity, 93% negative predictive value). The results indicate that the decision process can be more objective and potentially automated. The authors developed a prediction model based on preoperative characteristics, in order to support the decision for the co-management of surgical patients in the postoperative ward setting. The model is a simple bedside

  4. Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

    PubMed

    Horne, Avril C; Szemis, Joanna M; Webb, J Angus; Kaur, Simranjit; Stewardson, Michael J; Bond, Nick; Nathan, Rory

    2018-03-01

    One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

  5. Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles

    NASA Astrophysics Data System (ADS)

    Horne, Avril C.; Szemis, Joanna M.; Webb, J. Angus; Kaur, Simranjit; Stewardson, Michael J.; Bond, Nick; Nathan, Rory

    2018-03-01

    One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

  6. Use of ultrasonography to make management decisions

    USDA-ARS?s Scientific Manuscript database

    Transrectal ultrasonography has been available for making management decisions since the mid 1980’s. This technology allows for the real-time visualization of internal structures (i.e. ovary and fetus) that are otherwise difficult to evaluate. The use of this technology in making reproductive manag...

  7. Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

    PubMed

    Holmes-Rovner, Margaret; Nelson, Wendy L; Pignone, Michael; Elwyn, Glyn; Rovner, David R; O'Connor, Annette M; Coulter, Angela; Correa-de-Araujo, Rosaly

    2007-01-01

    This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.

  8. Clinical Decision Support Knowledge Management: Strategies for Success.

    PubMed

    Khalifa, Mohamed; Alswailem, Osama

    2015-01-01

    Clinical Decision Support Systems have been shown to increase quality of care, patient safety, improve adherence to guidelines for prevention and treatment, and avoid medication errors. Such systems depend mainly on two types of content; the clinical information related to patients and the medical knowledge related to the specialty that informs the system rules and alerts. At King Faisal Specialist Hospital and Research Center, Saudi Arabia, the Health Information Technology Affairs worked on identifying best strategies and recommendations for successful CDSS knowledge management. A review of literature was conducted to identify main areas of challenges and factors of success. A qualitative survey was used over six months' duration to collect opinions, experiences and suggestions from both IT and healthcare professionals. Recommendations were categorized into ten main topics that should be addressed during the development and implementation of CDSS knowledge management tools in the hospital.

  9. Research on Group Decision-Making Mechanism of Internet Emergency Management

    NASA Astrophysics Data System (ADS)

    Xie, Kefan; Chen, Gang; Qian, Wu; Shi, Zhao

    With the development of information technology, internet has become a popular term and internet emergency has an intensive influence on people's life. This article offers a short history of internet emergency management. It discusses the definition, characteristics, and factor of internet emergency management. A group decision-making mechanism of internet emergency is presented based on the discussion. The authors establish a so-called Rough Set Scenario Flow Graphs (RSSFG) of group decision-making mechanism of internet emergency management and make an empirical analysis based on the RSSFG approach. The experimental results confirm that this approach is effective in internet emergency decision-making.

  10. Analysis and Management of Animal Populations: Modeling, Estimation and Decision Making

    USGS Publications Warehouse

    Williams, B.K.; Nichols, J.D.; Conroy, M.J.

    2002-01-01

    This book deals with the processes involved in making informed decisions about the management of animal populations. It covers the modeling of population responses to management actions, the estimation of quantities needed in the modeling effort, and the application of these estimates and models to the development of sound management decisions. The book synthesizes and integrates in a single volume the methods associated with these themes, as they apply to ecological assessment and conservation of animal populations. KEY FEATURES * Integrates population modeling, parameter estimation and * decision-theoretic approaches to management in a single, cohesive framework * Provides authoritative, state-of-the-art descriptions of quantitative * approaches to modeling, estimation and decision-making * Emphasizes the role of mathematical modeling in the conduct of science * and management * Utilizes a unifying biological context, consistent mathematical notation, * and numerous biological examples

  11. From Data to Improved Decisions: Operations Research in Healthcare Delivery.

    PubMed

    Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

    2017-11-01

    The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

  12. Small Groups' Ecological Reasoning While Making an Environmental Management Decision.

    ERIC Educational Resources Information Center

    Hogan, Kathleen

    2002-01-01

    Explores the ideas and reasoning students use to make a collaborative environmental management decision. Compares students' discussions with scientists' guidelines for making environmental management decisions. Finds that whereas across groups students touched on all of the themes that scientists consider to be important for making environmental…

  13. Frequencies of decision making and monitoring in adaptive resource management

    PubMed Central

    Johnson, Fred A.

    2017-01-01

    Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management

  14. Frequencies of decision making and monitoring in adaptive resource management

    USGS Publications Warehouse

    Williams, Byron K.; Johnson, Fred A.

    2017-01-01

    Adaptive management involves learning-oriented decision making in the presence of uncertainty about the responses of a resource system to management. It is implemented through an iterative sequence of decision making, monitoring and assessment of system responses, and incorporating what is learned into future decision making. Decision making at each point is informed by a value or objective function, for example total harvest anticipated over some time frame. The value function expresses the value associated with decisions, and it is influenced by system status as updated through monitoring. Often, decision making follows shortly after a monitoring event. However, it is certainly possible for the cadence of decision making to differ from that of monitoring. In this paper we consider different combinations of annual and biennial decision making, along with annual and biennial monitoring. With biennial decision making decisions are changed only every other year; with biennial monitoring field data are collected only every other year. Different cadences of decision making combine with annual and biennial monitoring to define 4 scenarios. Under each scenario we describe optimal valuations for active and passive adaptive decision making. We highlight patterns in valuation among scenarios, depending on the occurrence of monitoring and decision making events. Differences between years are tied to the fact that every other year a new decision can be made no matter what the scenario, and state information is available to inform that decision. In the subsequent year, however, in 3 of the 4 scenarios either a decision is repeated or monitoring does not occur (or both). There are substantive differences in optimal values among the scenarios, as well as the optimal policies producing those values. Especially noteworthy is the influence of monitoring cadence on valuation in some years. We highlight patterns in policy and valuation among the scenarios, and discuss management

  15. Decision Aids for Multiple-Decision Disease Management as Affected by Weather Input Errors

    USDA-ARS?s Scientific Manuscript database

    Many disease management decision support systems (DSS) rely, exclusively or in part, on weather inputs to calculate an indicator for disease hazard. Error in the weather inputs, typically due to forecasting, interpolation or estimation from off-site sources, may affect model calculations and manage...

  16. Improving the integration of recreation management with management of other natural resources by applying concepts of scale from ecology.

    PubMed

    Morse, Wayde C; Hall, Troy E; Kruger, Linda E

    2009-03-01

    In this article, we examine how issues of scale affect the integration of recreation management with the management of other natural resources on public lands. We present two theories used to address scale issues in ecology and explore how they can improve the two most widely applied recreation-planning frameworks. The theory of patch dynamics and hierarchy theory are applied to the recreation opportunity spectrum (ROS) and the limits of acceptable change (LAC) recreation-planning frameworks. These frameworks have been widely adopted internationally, and improving their ability to integrate with other aspects of natural resource management has significant social and conservation implications. We propose that incorporating ecologic criteria and scale concepts into these recreation-planning frameworks will improve the foundation for integrated land management by resolving issues of incongruent boundaries, mismatched scales, and multiple-scale analysis. Specifically, we argue that whereas the spatially explicit process of the ROS facilitates integrated decision making, its lack of ecologic criteria, broad extent, and large patch size decrease its usefulness for integration at finer scales. The LAC provides explicit considerations for weighing competing values, but measurement of recreation disturbances within an LAC analysis is often done at too fine a grain and at too narrow an extent for integration with other recreation and resource concerns. We suggest that planners should perform analysis at multiple scales when making management decisions that involve trade-offs among competing values. The United States Forest Service is used as an example to discuss how resource-management agencies can improve this integration.

  17. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

    PubMed

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-09-01

    Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

  18. Decision support models for solid waste management: Review and game-theoretic approaches

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Karmperis, Athanasios C., E-mail: athkarmp@mail.ntua.gr; Army Corps of Engineers, Hellenic Army General Staff, Ministry of Defence; Aravossis, Konstantinos

    Highlights: ► The mainly used decision support frameworks for solid waste management are reviewed. ► The LCA, CBA and MCDM models are presented and their strengths, weaknesses, similarities and possible combinations are analyzed. ► The game-theoretic approach in a solid waste management context is presented. ► The waste management bargaining game is introduced as a specific decision support framework. ► Cooperative and non-cooperative game-theoretic approaches to decision support for solid waste management are discussed. - Abstract: This paper surveys decision support models that are commonly used in the solid waste management area. Most models are mainly developed within three decisionmore » support frameworks, which are the life-cycle assessment, the cost–benefit analysis and the multi-criteria decision-making. These frameworks are reviewed and their strengths and weaknesses as well as their critical issues are analyzed, while their possible combinations and extensions are also discussed. Furthermore, the paper presents how cooperative and non-cooperative game-theoretic approaches can be used for the purpose of modeling and analyzing decision-making in situations with multiple stakeholders. Specifically, since a waste management model is sustainable when considering not only environmental and economic but also social aspects, the waste management bargaining game is introduced as a specific decision support framework in which future models can be developed.« less

  19. The Shared Decision Making Frontier: a Feasibility and Usability Study for Managing Non-Critical Chronic Illness by Combining Behavioural & Decision Theory with Online Technology.

    PubMed

    Russell, Amina; Van Woensel, William; Abidi, Samina Raza

    2015-01-01

    The objective of this study is to determine if shared decisions for managing non-critical chronic illness, made through an online biomedical technology intervention, us feasible and usable. The technology intervention incorporates behavioural and decision theories to increase patient engagement, and ultimately long term adherence to health behaviour change. We devised the iheart web intervention as a "proof of concept" in five phases. The implementation incorporates the Vaadin web application framework, Drools, EclipseLink and a MySQL database. Two-thirds of the study participants favoured the technology intervention, based on Likert-scale questions from a post-study questionnaire. Qualitative analysis of think aloud feedback, video screen captures and open-ended questions from the post-study questionnaire uncovered six main areas or themes for improvement. We conclude that online shared decisions for managing a non-critical chronic illness are feasible and usable through the iheart web intervention.

  20. Leveraging human decision making through the optimal management of centralized resources

    NASA Astrophysics Data System (ADS)

    Hyden, Paul; McGrath, Richard G.

    2016-05-01

    Combining results from mixed integer optimization, stochastic modeling and queuing theory, we will advance the interdisciplinary problem of efficiently and effectively allocating centrally managed resources. Academia currently fails to address this, as the esoteric demands of each of these large research areas limits work across traditional boundaries. The commercial space does not currently address these challenges due to the absence of a profit metric. By constructing algorithms that explicitly use inputs across boundaries, we are able to incorporate the advantages of using human decision makers. Key improvements in the underlying algorithms are made possible by aligning decision maker goals with the feedback loops introduced between the core optimization step and the modeling of the overall stochastic process of supply and demand. A key observation is that human decision-makers must be explicitly included in the analysis for these approaches to be ultimately successful. Transformative access gives warfighters and mission owners greater understanding of global needs and allows for relationships to guide optimal resource allocation decisions. Mastery of demand processes and optimization bottlenecks reveals long term maximum marginal utility gaps in capabilities.

  1. Robust Decision Making for Improved Mission Assurance

    DTIC Science & Technology

    2014-06-01

    Technology Team (STT) proposed and was approved to receive funding for a set of four research projects advancing foundational decision science and... technology over a three year period of performance. At the time it was approved, the initiative involved 27 collaborating scientists and engineers from five...Appendix E. Sensors Directorate Technologies for Robust Decision Making for Improved Mission Assurance

  2. Autonomous Task Management and Decision Support Tools

    NASA Technical Reports Server (NTRS)

    Burian, Barbara

    2017-01-01

    For some time aircraft manufacturers and researchers have been pursuing mechanisms for reducing crew workload and providing better decision support to the pilots, especially during non-normal situations. Some previous attempts to develop task managers or pilot decision support tools have not resulted in robust and fully functional systems. However, the increasing sophistication of sensors and automated reasoners, and the exponential surge in the amount of digital data that is now available create a ripe environment for the development of a robust, dynamic, task manager and decision support tool that is context sensitive and integrates information from a wide array of on-board and off aircraft sourcesa tool that monitors systems and the overall flight situation, anticipates information needs, prioritizes tasks appropriately, keeps pilots well informed, and is nimble and able to adapt to changing circumstances. This presentation will discuss the many significant challenges and issues associated with the development and functionality of such a system for use on the aircraft flight deck.

  3. Shared Decisions That Count.

    ERIC Educational Resources Information Center

    Schlechty, Phillip C.

    1993-01-01

    Advocates of participatory leadership, site-based management, and decentralization often assume that changing decision-making group composition will automatically improve the quality of decisions being made. Stakeholder satisfaction does not guarantee quality results. This article offers a framework for moving the decision-making discussion from…

  4. SMARTE: IMPROVING REVITALIZATION DECISIONS - OCTOBER 3, 2006

    EPA Science Inventory

    SMARTe (Sustainable Management Approaches and Revitalization Tools -electronic) is a web-based decision support tool being developed by the Office of Research and Development (ORD) in partnership with the Office of Brownfields Cleanup and Revitalization (OBCR), the Interstate Tec...

  5. Evaluate the ability of clinical decision support systems (CDSSs) to improve clinical practice.

    PubMed

    Ajami, Sima; Amini, Fatemeh

    2013-01-01

    Prevalence of new diseases, medical science promotion and increase of referring to health care centers, provide a good situation for medical errors growth. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors' offices, nursing homes, pharmacies, and patients' homes. According to the Institute of Medicine (IOM), 98,000 people die every year from preventable medical errors. In 2010 from all referred medical error records to Iran Legal Medicine Organization, 46/5% physician and medical team members were known as delinquent. One of new technologies that can reduce medical errors is clinical decision support systems (CDSSs). This study was unsystematic-review study. The literature was searched on evaluate the "ability of clinical decision support systems to improve clinical practice" with the help of library, books, conference proceedings, data bank, and also searches engines available at Google, Google scholar. For our searches, we employed the following keywords and their combinations: medical error, clinical decision support systems, Computer-Based Clinical Decision Support Systems, information technology, information system, health care quality, computer systems in the searching areas of title, keywords, abstract, and full text. In this study, more than 100 articles and reports were collected and 38 of them were selected based on their relevancy. The CDSSs are computer programs, designed for help to health care careers. These systems as a knowledge-based tool could help health care manager in analyze evaluation, improvement and selection of effective solutions in clinical decisions. Therefore, it has a main role in medical errors reduction. The aim of this study was to express ability of the CDSSs to improve

  6. Decision support system for nursing management control

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ernst, C.J.

    A knowledge representation approach for expert systems supporting decision processes in business is proposed. A description of a knowledge representation schema using a logic programming metalanguage is described, then the role of such a schema in a management expert system is demonstrated through the problem of nursing management control in hospitals. 18 references.

  7. IDESSA: An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas

    NASA Astrophysics Data System (ADS)

    Meyer, Hanna; Authmann, Christian; Dreber, Niels; Hess, Bastian; Kellner, Klaus; Morgenthal, Theunis; Nauss, Thomas; Seeger, Bernhard; Tsvuura, Zivanai; Wiegand, Kerstin

    2017-04-01

    Bush encroachment is a syndrome of land degradation that occurs in many savannas including those of southern Africa. The increase in density, cover or biomass of woody vegetation often has negative effects on a range of ecosystem functions and services, which are hardly reversible. However, despite its importance, neither the causes of bush encroachment, nor the consequences of different resource management strategies to combat or mitigate related shifts in savanna states are fully understood. The project "IDESSA" (An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas) aims to improve the understanding of the complex interplays between land use, climate patterns and vegetation dynamics and to implement an integrative monitoring and decision-support system for the sustainable management of different savanna types. For this purpose, IDESSA follows an innovative approach that integrates local knowledge, botanical surveys, remote-sensing and machine-learning based time-series of atmospheric and land-cover dynamics, spatially explicit simulation modeling and analytical database management. The integration of the heterogeneous data will be implemented in a user oriented database infrastructure and scientific workflow system. Accessible via web-based interfaces, this database and analysis system will allow scientists to manage and analyze monitoring data and scenario computations, as well as allow stakeholders (e. g. land users, policy makers) to retrieve current ecosystem information and seasonal outlooks. We present the concept of the project and show preliminary results of the realization steps towards the integrative savanna management and decision-support system.

  8. Supporting health care professionals to improve the processes of shared decision making and self-management in a web-based intervention: randomized controlled trial.

    PubMed

    Sassen, Barbara; Kok, Gerjo; Schepers, Jan; Vanhees, Luc

    2014-10-21

    Research to assess the effect of interventions to improve the processes of shared decision making and self-management directed at health care professionals is limited. Using the protocol of Intervention Mapping, a Web-based intervention directed at health care professionals was developed to complement and optimize health services in patient-centered care. The objective of the Web-based intervention was to increase health care professionals' intention and encouraging behavior toward patient self-management, following cardiovascular risk management guidelines. A randomized controlled trial was used to assess the effect of a theory-based intervention, using a pre-test and post-test design. The intervention website consisted of a module to help improve professionals' behavior, a module to increase patients' intention and risk-reduction behavior toward cardiovascular risk, and a parallel module with a support system for the health care professionals. Health care professionals (n=69) were recruited online and randomly allocated to the intervention group (n=26) or (waiting list) control group (n=43), and invited their patients to participate. The outcome was improved professional behavior toward health education, and was self-assessed through questionnaires based on the Theory of Planned Behavior. Social-cognitive determinants, intention and behavior were measured pre-intervention and at 1-year follow-up. The module to improve professionals' behavior was used by 45% (19/42) of the health care professionals in the intervention group. The module to support the health professional in encouraging behavior toward patients was used by 48% (20/42). The module to improve patients' risk-reduction behavior was provided to 44% (24/54) of patients. In 1 of every 5 patients, the guideline for cardiovascular risk management was used. The Web-based intervention was poorly used. In the intervention group, no differences in social-cognitive determinants, intention and behavior were found

  9. Uncertainty forecasts improve weather-related decisions and attenuate the effects of forecast error.

    PubMed

    Joslyn, Susan L; LeClerc, Jared E

    2012-03-01

    Although uncertainty is inherent in weather forecasts, explicit numeric uncertainty estimates are rarely included in public forecasts for fear that they will be misunderstood. Of particular concern are situations in which precautionary action is required at low probabilities, often the case with severe events. At present, a categorical weather warning system is used. The work reported here tested the relative benefits of several forecast formats, comparing decisions made with and without uncertainty forecasts. In three experiments, participants assumed the role of a manager of a road maintenance company in charge of deciding whether to pay to salt the roads and avoid a potential penalty associated with icy conditions. Participants used overnight low temperature forecasts accompanied in some conditions by uncertainty estimates and in others by decision advice comparable to categorical warnings. Results suggested that uncertainty information improved decision quality overall and increased trust in the forecast. Participants with uncertainty forecasts took appropriate precautionary action and withheld unnecessary action more often than did participants using deterministic forecasts. When error in the forecast increased, participants with conventional forecasts were reluctant to act. However, this effect was attenuated by uncertainty forecasts. Providing categorical decision advice alone did not improve decisions. However, combining decision advice with uncertainty estimates resulted in the best performance overall. The results reported here have important implications for the development of forecast formats to increase compliance with severe weather warnings as well as other domains in which one must act in the face of uncertainty. PsycINFO Database Record (c) 2012 APA, all rights reserved.

  10. Decision Support for Environmental Management of Industrial ...

    EPA Pesticide Factsheets

    Non-hazardous solid materials from industrial processes, once regarded as waste and disposed in landfills, offer numerous environmental and economic advantages when put to beneficial uses (BUs). Proper management of these industrial non-hazardous secondary materials (INSM) requires estimates of their probable environmental impacts among disposal as well as BU options. The U.S. Environmental Protection Agency (EPA) has recently approved new analytical methods (EPA Methods 1313–1316) to assess leachability of constituents of potential concern in these materials. These new methods are more realistic for many disposal and BU options than historical methods, such as the toxicity characteristic leaching protocol. Experimental data from these new methods are used to parameterize a chemical fate and transport (F&T) model to simulate long-term environmental releases from flue gas desulfurization gypsum (FGDG) when disposed of in an industrial landfill or beneficially used as an agricultural soil amendment. The F&T model is also coupled with optimization algorithms, the Beneficial Use Decision Support System (BUDSS), under development by EPA to enhance INSM management. The objective of this paper is to demonstrate the methodologies and encourage similar applications to improve environmental management and BUs of INSM through F&T simulation coupled with optimization, using realistic model parameterization.

  11. Improving management of type 2 diabetes - findings of the Type2Care clinical audit.

    PubMed

    Barlow, John; Krassas, George

    2013-01-01

    Type 2 diabetes was responsible for 5.8% of the total disease burden in Australia in 2010. Despite advances in clinical management many type 2 diabetes (T2D) patients have suboptimal glycaemic control. Using quantitative questionnaires, general practitioners prospectively evaluated their management of 761 T2D patients at two time points, 6 months apart. Following the first audit, GPs received feedback and a decision support tool. Patients were then re-audited to assess if the intervention altered management. The use of annual cycle of care plans significantly increased by 12% during the audit. General practitioner performance improved across all measures with the greatest gains being in the use of care plans and measuring and meeting targets for microalbumin. Glycaemic control was well managed in this cohort (mean HbA1c 6.9% for both audit cycles). The Type2Care clinical audit provided decision support tools and diabetes registers that improved the delivery of care to patients with T2D.

  12. Anesthesia information management system-based near real-time decision support to manage intraoperative hypotension and hypertension.

    PubMed

    Nair, Bala G; Horibe, Mayumi; Newman, Shu-Fang; Wu, Wei-Ying; Peterson, Gene N; Schwid, Howard A

    2014-01-01

    Intraoperative hypotension and hypertension are associated with adverse clinical outcomes and morbidity. Clinical decision support mediated through an anesthesia information management system (AIMS) has been shown to improve quality of care. We hypothesized that an AIMS-based clinical decision support system could be used to improve management of intraoperative hypotension and hypertension. A near real-time AIMS-based decision support module, Smart Anesthesia Manager (SAM), was used to detect selected scenarios contributing to hypotension and hypertension. Specifically, hypotension (systolic blood pressure <80 mm Hg) with a concurrent high concentration (>1.25 minimum alveolar concentration [MAC]) of inhaled drug and hypertension (systolic blood pressure >160 mm Hg) with concurrent phenylephrine infusion were detected, and anesthesia providers were notified via "pop-up" computer screen messages. AIMS data were retrospectively analyzed to evaluate the effect of SAM notification messages on hypotensive and hypertensive episodes. For anesthetic cases 12 months before (N = 16913) and after (N = 17132) institution of SAM messages, the median duration of hypotensive episodes with concurrent high MAC decreased with notifications (Mann Whitney rank sum test, P = 0.031). However, the reduction in the median duration of hypertensive episodes with concurrent phenylephrine infusion was not significant (P = 0.47). The frequency of prolonged episodes that lasted >6 minutes (sampling period of SAM), represented in terms of the number of cases with episodes per 100 surgical cases (or percentage occurrence), declined with notifications for both hypotension with >1.25 MAC inhaled drug episodes (δ = -0.26% [confidence interval, -0.38% to -0.11%], P < 0.001) and hypertension with phenylephrine infusion episodes (δ = -0.92% [confidence interval, -1.79% to -0.04%], P = 0.035). For hypotensive events, the anesthesia providers reduced the inhaled drug concentrations to <1.25 MAC 81% of

  13. Contribution of systematic reviews to management decisions.

    PubMed

    Cook, Carly N; Possingham, Hugh P; Fuller, Richard A

    2013-10-01

    Systematic reviews comprehensively summarize evidence about the effectiveness of conservation interventions. We investigated the contribution to management decisions made by this growing body of literature. We identified 43 systematic reviews of conservation evidence, 23 of which drew some concrete conclusions relevant to management. Most reviews addressed conservation interventions relevant to policy decisions; only 35% considered practical on-the-ground management interventions. The majority of reviews covered only a small fraction of the geographic and taxonomic breadth they aimed to address (median = 13% of relevant countries and 16% of relevant taxa). The likelihood that reviews contained at least some implications for management tended to increase as geographic coverage increased and to decline as taxonomic breadth increased. These results suggest the breadth of a systematic review requires careful consideration. Reviews identified a mean of 312 relevant primary studies but excluded 88% of these because of deficiencies in design or a failure to meet other inclusion criteria. Reviews summarized on average 284 data sets and 112 years of research activity, yet the likelihood that their results had at least some implications for management did not increase as the amount of primary research summarized increased. In some cases, conclusions were elusive despite the inclusion of hundreds of data sets and years of cumulative research activity. Systematic reviews are an important part of the conservation decision making tool kit, although we believe the benefits of systematic reviews could be significantly enhanced by increasing the number of reviews focused on questions of direct relevance to on-the-ground managers; defining a more focused geographic and taxonomic breadth that better reflects available data; including a broader range of evidence types; and appraising the cost-effectiveness of interventions. © 2013 The Authors. Conservation Biology published by Wiley

  14. A Multi-criterial Decision Support System for Forest Management

    Treesearch

    Donald Nute; Geneho Kim; Walter D. Potter; Mark J. Twery; H. Michael Rauscher; Scott Thomasma; Deborah Bennett; Peter Kollasch

    1999-01-01

    We describe a research project that has as its goal development of a full-featured decision support system for managing forested land to satisfy multiple criteria represented as timber, wildlife, water, ecological, and wildlife objectives. The decision process proposed for what was originally conceived of as a Northeast Decision Model (NED) includes data acquisition,...

  15. Assessing the Role and Impact of Geospatial Data for Wildland Fire Management Decisions

    NASA Astrophysics Data System (ADS)

    Klein, E. A.; Lev, S. M.

    2016-12-01

    The 2015 Wildland and Fire Science and Technology Task Force Final Report, produced by the National Science and Technology Council, Committee on Environment, Natural Resources, and Sustainability, Subcommittee on Disaster Reduction, highlighted the increasing frequency of large wildfires and the growing demand for science to inform critical resource decisions to manage, mitigate, respond to, and recover from wildland fires. Federal spending on fire suppression from 2005-2015 has more than doubled despite policy changes that prioritize the mitigation of fire risks through the use of fuel treatments, prescribed fire, and management of naturally occurring wildfires to protect life and property. Fire suppression policies over the last century have created forests primed for severe fire, and in the face of a changing climate, the benefits of re-introducing fire into once fire-resilient ecosystems are clear. There are a range of complex factors and regional variation associated with wildland fire risk that complicate our understanding and effective management of this hazard. Data derived from Earth-observing (EO) systems and networks are a crucial input for managers when making decisions about fire suppression and fuel management. EO data can also be used to develop pre- and post-fire metrics that can aid in the evaluating the effectiveness of wildland fire management decisions. A value-tree method for mapping the role of EO systems and networks in delivering societal benefit through key Federal objectives related to wildland fire management will be presented. The value-tree methodology utilizes input from subject matter experts to assess the availability and usability of data and data products and to evaluate the impact of individual EO data inputs for achieving wildland fire management objectives. The results provide a qualitative assessment of the value of the data for the objectives described and identify critical gaps and continuity issues associated with

  16. Markov decision processes in natural resources management: observability and uncertainty

    USGS Publications Warehouse

    Williams, Byron K.

    2015-01-01

    The breadth and complexity of stochastic decision processes in natural resources presents a challenge to analysts who need to understand and use these approaches. The objective of this paper is to describe a class of decision processes that are germane to natural resources conservation and management, namely Markov decision processes, and to discuss applications and computing algorithms under different conditions of observability and uncertainty. A number of important similarities are developed in the framing and evaluation of different decision processes, which can be useful in their applications in natural resources management. The challenges attendant to partial observability are highlighted, and possible approaches for dealing with it are discussed.

  17. Development of an Electronic Medical Record-Based Clinical Decision Support Tool to Improve HIV Symptom Management

    PubMed Central

    Tsevat, Joel; Justice, Amy C.; Mrus, Joseph M.; Levin, Forrest; Kozal, Michael J.; Mattocks, Kristin; Farber, Steven; Rogers, Michelle; Erdos, Joseph; Brandt, Cynthia; Kudel, Ian; Braithwaite, Ronald

    2009-01-01

    Abstract Common symptoms associated with HIV disease and its management are often underrecognized and undertreated. A clinical decision support tool for symptom management was developed within the Veterans Health Administration electronic medical record (EMR), aiming at increasing provider awareness of and response to common HIV symptoms. Its feasibility was studied in March to May 2007 by implementing it within a weekly HIV clinic, comparing a 4-week intervention period with a 4-week control period. Fifty-six patients and their providers participated in the study. Patients' perceptions of providers' awareness of their symptoms, proportion of progress notes mentioning any symptom(s) and proportion of care plans mentioning any symptom(s) were measured. The clinical decision support tool used portable electronic “tablets” to elicit symptom information at the time of check-in, filtered, and organized that information into a concise and clinically relevant EMR note available at the point of care, and facilitated clinical responses to that information. It appeared to be well accepted by patients and providers and did not substantially impact workflow. Although this pilot study was not powered to detect effectiveness, 25 (93%) patients in the intervention group reported that their providers were very aware of their symptoms versuas 27 (75%) control patients (p = 0.07). The proportion of providers' notes listing symptoms was similar in both periods; however, there was a trend toward including a greater number of symptoms in intervention period progress notes. The symptom support tool seemed to be useful in clinical HIV care. The Veterans Health Administration EMR may be an effective “laboratory” for developing and testing decision supports. PMID:19538046

  18. Improving Hazardous Waste Remediation and Restoration Decisions Using Ecosystem Services

    EPA Science Inventory

    Hazardous site management in the US includes remediation of contaminated environmental media and restoration of injured natural resources. Site remediation decisions are informed by ecological risk assessment (ERA), while restoration and compensation decisions are informed by the...

  19. Healthcare managers' decision making: findings of a small scale exploratory study.

    PubMed

    Macdonald, Jackie; Bath, Peter A; Booth, Andrew

    2008-12-01

    Managers who work in publicly funded healthcare organizations are an understudied group. Some of the influences on their decisions may be unique to healthcare. This study considers how to integrate research knowledge effectively into healthcare managers' decision making, and how to manage and integrate information that will include community data. This first phase in a two-phase mixed methods research study used a qualitative, multiple case studies design. Nineteen semi-structured interviews were undertaken using the critical incident technique. Interview transcripts were analysed using the NatCen Framework. One theme represented ;information and decisions'. Cases were determined to involve complex multi-level, multi-situational decisions with participants in practical rather than ceremonial work roles. Most considered organizational knowledge in the first two decision phases and external knowledge, including research, in the third phase. All participants engaged in satisficing to some degree.

  20. Decision problems in management of construction projects

    NASA Astrophysics Data System (ADS)

    Szafranko, E.

    2017-10-01

    In a construction business, one must oftentimes make decisions during all stages of a building process, from planning a new construction project through its execution to the stage of using a ready structure. As a rule, the decision making process is made more complicated due to certain conditions specific for civil engineering. With such diverse decision situations, it is recommended to apply various decision making support methods. Both, literature and hands-on experience suggest several methods based on analytical and computational procedures, some less and some more complex. This article presents the methods which can be helpful in supporting decision making processes in the management of civil engineering projects. These are multi-criteria methods, such as MCE, AHP or indicator methods. Because the methods have different advantages and disadvantages, whereas decision situations have their own specific nature, a brief summary of the methods alongside some recommendations regarding their practical applications has been given at the end of the paper. The main aim of this article is to review the methods of decision support and their analysis for possible use in the construction industry.

  1. Development of Asset Management Decision Support Tools for Power Equipment

    NASA Astrophysics Data System (ADS)

    Okamoto, Tatsuki; Takahashi, Tsuguhiro

    Development of asset management decision support tools become very intensive in order to reduce maintenance cost of power equipment due to the liberalization of power business. This article reviews some aspects of present status of asset management decision support tools development for power equipment based on the papers published in international conferences, domestic conventions, and several journals.

  2. Implementation of quality improvement techniques for management and technical processes in the ACRV project

    NASA Technical Reports Server (NTRS)

    Raiman, Laura B.

    1992-01-01

    Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

  3. Implementation of quality improvement techniques for management and technical processes in the ACRV project

    NASA Astrophysics Data System (ADS)

    Raiman, Laura B.

    1992-12-01

    Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

  4. Information in medical decision making: how consistent is our management?

    PubMed

    Lorence, Daniel P; Spink, Amanda; Jameson, Robert

    2002-01-01

    The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

  5. Factors of accepting pain management decision support systems by nurse anesthetists

    PubMed Central

    2013-01-01

    Background Pain management is a critical but complex issue for the relief of acute pain, particularly for postoperative pain and severe pain in cancer patients. It also plays important roles in promoting quality of care. The introduction of pain management decision support systems (PM-DSS) is considered a potential solution for addressing the complex problems encountered in pain management. This study aims to investigate factors affecting acceptance of PM-DSS from a nurse anesthetist perspective. Methods A questionnaire survey was conducted to collect data from nurse anesthetists in a case hospital. A total of 113 questionnaires were distributed, and 101 complete copies were returned, indicating a valid response rate of 89.3%. Collected data were analyzed by structure equation modeling using the partial least square tool. Results The results show that perceived information quality (γ=.451, p<.001), computer self-efficacy (γ=.315, p<.01), and organizational structure (γ=.210, p<.05), both significantly impact nurse anesthetists’ perceived usefulness of PM-DSS. Information quality (γ=.267, p<.05) significantly impacts nurse anesthetists’ perceptions of PM-DSS ease of use. Furthermore, both perceived ease of use (β=.436, p<.001, R2=.487) and perceived usefulness (β=.443, p<.001, R2=.646) significantly affected nurse anesthetists’ PM-DSS acceptance (R2=.640). Thus, the critical role of information quality in the development of clinical decision support system is demonstrated. Conclusions The findings of this study enable hospital managers to understand the important considerations for nurse anesthetists in accepting PM-DSS, particularly for the issues related to the improvement of information quality, perceived usefulness and perceived ease of use of the system. In addition, the results also provide useful suggestions for designers and implementers of PM-DSS in improving system development. PMID:23360305

  6. A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations.

    PubMed

    Carnero, María Carmen; Gómez, Andrés

    2016-04-23

    decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.

  7. Insect pest management decisions in food processing facilities

    USDA-ARS?s Scientific Manuscript database

    Pest management decision making in food processing facilities such as flour mills, rice mills, human and pet food manufacturing facilities, distribution centers and warehouses, and retail stores is a challenging undertaking. Insect pest management programs require an understanding of the food facili...

  8. Voice, perceived fairness, agency trust, and acceptance of management decisions among Minnesota anglers

    USGS Publications Warehouse

    Schroeder, Susan A.; Fulton, David C.

    2017-01-01

    Although researchers agree that public participation in natural resource decision making is critical to institutional acceptance by stakeholders and the general public, the processes to gain public perceptions of fairness, agency trust, and acceptance of management decisions are not clear. Using results from a mail survey of Minnesota resident anglers, we used structural equation modeling to examine how instrumental versus symbolic motives related to anglers’ perceptions of agency fairness, trustworthiness, and ultimately acceptance of fisheries management decisions. We applied laboratory research on relationships among procedural fairness, trust, and management acceptance, and then tested models incorporating anglers’ perceptions of voice for anglers and nonanglers in management decisions. Results suggested that trust fully mediated the relationship between procedural fairness and management acceptance. Angler perceptions of angler and nonangler voice both related to views of procedural fairness, but angler voice was more strongly related and was also significantly related to acceptance of management decisions.

  9. Managing Decisions on Changes in the Virtual Enterprise Evolution

    NASA Astrophysics Data System (ADS)

    Drissen-Silva, Marcus Vinicius; Rabelo, Ricardo José

    VE evolution deals with problems that happen during the VE operation and that put on risk planned results. This requires the application of problem-solving mechanisms to guarantee the construction of a new but feasible VE plan. Grounded on Project Management and Decision Support Systems foundations, this paper proposes a distributed collaborative decision support system to manage the VE evolution. Its main rationale is that VE’s members are autonomous and hence that all the affected partners should discuss about the necessary changes on the current VE’s plan. In the proposed approach, this discussion is guided by a decision protocol, and the impact of decisions can be evaluated. Results of a first prototype implementation are presented and discussed, with a special focus on the part which regulates the argumentation, voting and comparison of possible solutions.

  10. Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

    PubMed

    Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

    2009-10-08

    Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized

  11. Information management to enable personalized medicine: stakeholder roles in building clinical decision support

    PubMed Central

    2009-01-01

    Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent

  12. The Climate-Agriculture-Modeling and Decision Tool (CAMDT) for Climate Risk Management in Agriculture

    NASA Astrophysics Data System (ADS)

    Ines, A. V. M.; Han, E.; Baethgen, W.

    2017-12-01

    Advances in seasonal climate forecasts (SCFs) during the past decades have brought great potential to improve agricultural climate risk managements associated with inter-annual climate variability. In spite of popular uses of crop simulation models in addressing climate risk problems, the models cannot readily take seasonal climate predictions issued in the format of tercile probabilities of most likely rainfall categories (i.e, below-, near- and above-normal). When a skillful SCF is linked with the crop simulation models, the informative climate information can be further translated into actionable agronomic terms and thus better support strategic and tactical decisions. In other words, crop modeling connected with a given SCF allows to simulate "what-if" scenarios with different crop choices or management practices and better inform the decision makers. In this paper, we present a decision support tool, called CAMDT (Climate Agriculture Modeling and Decision Tool), which seamlessly integrates probabilistic SCFs to DSSAT-CSM-Rice model to guide decision-makers in adopting appropriate crop and agricultural water management practices for given climatic conditions. The CAMDT has a functionality to disaggregate a probabilistic SCF into daily weather realizations (either a parametric or non-parametric disaggregation method) and to run DSSAT-CSM-Rice with the disaggregated weather realizations. The convenient graphical user-interface allows easy implementation of several "what-if" scenarios for non-technical users and visualize the results of the scenario runs. In addition, the CAMDT also translates crop model outputs to economic terms once the user provides expected crop price and cost. The CAMDT is a practical tool for real-world applications, specifically for agricultural climate risk management in the Bicol region, Philippines, having a great flexibility for being adapted to other crops or regions in the world. CAMDT GitHub: https://github.com/Agro-Climate/CAMDT

  13. Improving technical information use: what can be learnt from a manager's perspective?

    PubMed

    Jacobson, C; Lisle, A; Carter, R W; Hockings, M T

    2013-07-01

    Conservation practice reportedly suffers from low use of technical information. Understanding of factors that affect the influence of technical information on management decision-making is limited. We sought to identify leverage points for improved technical information dissemination in the New South Wales Parks and Wildlife Service, Australia, given the significant recent investments in monitoring and evaluation that had been made. We did so by exploring the inter-relationships between factors affecting the influence of different information types on management decisions. Results indicate that managers have a high inclination toward adaptive behavior, given they operate in an information poor environment. The most influential types of information were those that enabled interaction between information provider and recipient (e.g., staff experience and expertise). An analysis of the concordance in individuals' responses for different information types showed that neither accessibility nor organizational expectation of use was aligned with influence on decision-making. Alignment of responses also varied by work area. Raising expectations of information use or increasing access to particular types of information is therefore unlikely to result in an increase in influence on management decision-making. Rather than focussing on matching accessibility and expected use of particular information types, our results indicate that technical information uptake is best supported through existing peer networks tailored to specific work areas.

  14. Interdisciplinary Collaborative Learning: Using Decision Analysts to Enhance Undergraduate International Management Education

    ERIC Educational Resources Information Center

    Palocsay, Susan W.; White, Marion M.; Zimmerman, D. Kent

    2004-01-01

    This article describes an experiential learning activity designed to promote the development of decision-making skills in international management students at the undergraduate level. Students from an undergraduate management science course in decision analysis served as consultants on a case assigned to teams in an international management class.…

  15. Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings

    PubMed Central

    Kuntz, Jennifer L.; Safford, Monika M.; Singh, Jasvinder A.; Phansalkar, Shobha; Slight, Sarah P.; Her, Qoua Liang; Lapointe, Nancy Allen; Mathews, Robin; O’Brien, Emily; Brinkman, William B.; Hommel, Kevin; Farmer, Kevin C.; Klinger, Elissa; Maniam, Nivethietha; Sobko, Heather J.; Bailey, Stacy C.; Cho, Insook; Rumptz, Maureen H.; Vandermeer, Meredith L.; Hornbrook, Mark C.

    2018-01-01

    Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate. PMID:25264309

  16. Use of ultrasonography to make reproductive management decisions

    USDA-ARS?s Scientific Manuscript database

    Transrectal ultrasonography has been available for making management decisions since the mid 1980’s. This technology allows for the real-time visualization of internal structures (i.e. ovary and fetus) that are otherwise difficult to evaluate. The use of this technology in making reproductive manag...

  17. Improving management decision processes through centralized communication linkages

    NASA Technical Reports Server (NTRS)

    Simanton, D. F.; Garman, J. R.

    1985-01-01

    Information flow is a critical element to intelligent and timely decision-making. At NASA's Johnson Space Center the flow of information is being automated through the use of a centralized backbone network. The theoretical basis of this network, its implications to the horizontal and vertical flow of information, and the technical challenges involved in its implementation are the focus of this paper. The importance of the use of common tools among programs and some future concerns related to file transfer, graphics transfer, and merging of voice and data are also discussed.

  18. Decision-making in product portfolios of pharmaceutical research and development--managing streams of innovation in highly regulated markets.

    PubMed

    Jekunen, Antti

    2014-01-01

    Decision-making is a core function of any drug development firm. Developing drugs demands a firm to be highly innovative, while at the same time the activity is strictly regulated. Successful drug development offers the right to apply for a long-term patent that confers exclusive marketing rights. This article addresses the issue of what constitutes an adequate portfolio of drugs for a drug development firm and how it might be managed successfully. The paper investigates decision-making in the industry and specifically in the development of oncology drugs from various perspectives: the need for decisions, their timing, decision-making at the project level, the optimal portfolio, tools for portfolio analysis, the evaluation of patents, and finally the importance of the drug portfolio. Drug development decisions as important organizational elements should get more emphasis, and decisions in drug portfolio using modern decision-making methods should be used more widely than what currently happens. Structured, informed decisions would help avoiding late terminations of drugs in Phase III development. An improved research and development pipeline and drug portfolio management are the major elements in the general strategy targeting success.

  19. Improving risk management: from lame excuses to principled practice.

    PubMed

    Paté-Cornell, Elisabeth; Cox, Louis Anthony

    2014-07-01

    The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management. © 2014 Society for Risk Analysis.

  20. The Watershed and River Systems Management Program: Decision Support for Water- and Environmental-Resource Management

    NASA Astrophysics Data System (ADS)

    Leavesley, G.; Markstrom, S.; Frevert, D.; Fulp, T.; Zagona, E.; Viger, R.

    2004-12-01

    Increasing demands for limited fresh-water supplies, and increasing complexity of water-management issues, present the water-resource manager with the difficult task of achieving an equitable balance of water allocation among a diverse group of water users. The Watershed and River System Management Program (WARSMP) is a cooperative effort between the U.S. Geological Survey (USGS) and the Bureau of Reclamation (BOR) to develop and deploy a database-centered, decision-support system (DSS) to address these multi-objective, resource-management problems. The decision-support system couples the USGS Modular Modeling System (MMS) with the BOR RiverWare tools using a shared relational database. MMS is an integrated system of computer software that provides a research and operational framework to support the development and integration of a wide variety of hydrologic and ecosystem models, and their application to water- and ecosystem-resource management. RiverWare is an object-oriented reservoir and river-system modeling framework developed to provide tools for evaluating and applying water-allocation and management strategies. The modeling capabilities of MMS and Riverware include simulating watershed runoff, reservoir inflows, and the impacts of resource-management decisions on municipal, agricultural, and industrial water users, environmental concerns, power generation, and recreational interests. Forecasts of future climatic conditions are a key component in the application of MMS models to resource-management decisions. Forecast methods applied in MMS include a modified version of the National Weather Service's Extended Streamflow Prediction Program (ESP) and statistical downscaling from atmospheric models. The WARSMP DSS is currently operational in the Gunnison River Basin, Colorado; Yakima River Basin, Washington; Rio Grande Basin in Colorado and New Mexico; and Truckee River Basin in California and Nevada.

  1. Decision-making in ileocecal Crohn's disease management: surgery versus pharmacotherapy.

    PubMed

    Eshuis, Emma J; Stokkers, Pieter Cf; Bemelman, Willem A

    2010-04-01

    Ileocecal Crohn's disease (CD) can be treated medically as well as surgically. Both treatment modalities have been improved markedly in the last two decades, making CD more manageable. However, multidisciplinary research, addressing issues such as timing of surgery or medical treatment versus surgery, is scarce. Particularly in limited ileocecal CD, ileocolic resection might be a good alternative to long-term medical therapy. This review discusses the evidence on medical and surgical treatment options for ileocecal CD. It provides an aid in decision-making by discussing a treatment algorithm that can be used until further evidence on treatment is available.

  2. Using basic geographic information systems functionality to support sustainable forest management decision making and post-decision assessments

    Treesearch

    Ronald E. McRoberts; R. James Barbour; Krista M. Gebert; Greg C. Liknes; Mark D. Nelson; Dacia M. Meneguzzo; et al.

    2006-01-01

    Sustainable management of natural resources requires informed decision making and post-decision assessments of the results of those decisions. Increasingly, both activities rely on analyses of spatial data in the forms of maps and digital data layers. Fortunately, a variety of supporting maps and data layers rapidly are becoming available. Unfortunately, however, user-...

  3. Water Management Decisions within a Changing Hydrologic Environment

    NASA Astrophysics Data System (ADS)

    Wegner, D. L.

    2013-12-01

    Across the United States and around the world we are facing unprecedented demands on our surface and ground water. Increasing population demands coupled with maintaining water quality, supporting species and ecosystem services, distribution of supply, hydrologic variability associated with changing climatic conditions - all require us to look more rigorously at the intersection of policy, management and science. The water supply and hydroelectric constituencies has embraced the concept of Adaptive Management in balancing the needs of resources, people, economies and providing ecosystem support. In its infancy Adaptive Management was employed as a way to move forward on dam operation and reservoir management decisions while recognizing the unknowns of how up or downstream physical and biological elements of freshwater systems would respond. River science at the time was not mature or expansive enough to address the interrelated and complex impacts of the nuances of changing operations of dams. Adaptive Management, the concept, made good sense and has provided a framework to inform management and policy decisions while keeping the door open for integrating new knowledge into a management matrix - the essence of adaptation. The application of Adaptive Management principles has continued to expand as water management demands increase. The application and reality of the use of Adaptive Management has had variable success. In the United States we have over 25 federal agencies that have water in their mission statements. Combine this with 50 states with their own water management requirements, Native American Tribes, and countless watershed and local water supply constraints and you get a sense of the challenge associated with collaborating and addressing water management issues. Without having a set of national water objectives and goals (a National Water Policy) it is up to the collaboration and integration of the multiple water silos with appropriate science. It is

  4. Integrated analysis for population estimation, management impact evaluation, and decision-making for a declining species

    USGS Publications Warehouse

    Crawford, Brian A.; Moore, Clinton; Norton, Terry M.; Maerz, John C.

    2018-01-01

    A challenge for making conservation decisions is predicting how wildlife populations respond to multiple, concurrent threats and potential management strategies, usually under substantial uncertainty. Integrated modeling approaches can improve estimation of demographic rates necessary for making predictions, even for rare or cryptic species with sparse data, but their use in management applications is limited. We developed integrated models for a population of diamondback terrapins (Malaclemys terrapin) impacted by road-associated threats to (i) jointly estimate demographic rates from two mark-recapture datasets, while directly estimating road mortality and the impact of management actions deployed during the study; and (ii) project the population using population viability analysis under simulated management strategies to inform decision-making. Without management, population extirpation was nearly certain due to demographic impacts of road mortality, predators, and vegetation. Installation of novel flashing signage increased survival of terrapins that crossed roads by 30%. Signage, along with small roadside barriers installed during the study, increased population persistence probability, but the population was still predicted to decline. Management strategies that included actions targeting multiple threats and demographic rates resulted in the highest persistence probability, and roadside barriers, which increased adult survival, were predicted to increase persistence more than other actions. Our results support earlier findings showing mitigation of multiple threats is likely required to increase the viability of declining populations. Our approach illustrates how integrated models may be adapted to use limited data efficiently, represent system complexity, evaluate impacts of threats and management actions, and provide decision-relevant information for conservation of at-risk populations.

  5. Development of transportation asset management decision support tools : final report.

    DOT National Transportation Integrated Search

    2017-08-09

    This study developed a web-based prototype decision support platform to demonstrate the benefits of transportation asset management in monitoring asset performance, supporting asset funding decisions, planning budget tradeoffs, and optimizing resourc...

  6. Management Data for Selection Decisions in Building Library Collections.

    ERIC Educational Resources Information Center

    Hamaker, Charles A.

    1992-01-01

    Discusses the use of library management data, particularly circulation data, in making selection decisions for library collection development based on experiences at Louisiana State University. Development of a collection based on actual use rather than perceived research needs is considered, and the decision-making process for serials…

  7. The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self-management

    PubMed Central

    Heisler, Michele; Bouknight, Reynard R; Hayward, Rodney A; Smith, Dylan M; Kerr, Eve A

    2002-01-01

    OBJECTIVE Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients' diabetes self-management. This study assessed the influence of patients' evaluation of their physicians' participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management. DESIGN We surveyed 2,000 patients receiving diabetes care across 25 Veterans' Affairs facilities. We measured patients' evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; α = 0.96), rating of providers' communication with a 5-item scale (Provider Communication [PCOM]; α = 0.93), understanding of diabetes self-care with an 8-item scale (α = 0.90), and patients' completion of diabetes self-care activities (self-management) in 5 domains (α = 0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding. RESULTS Sixty-six percent of the sample completed the surveys (N = 1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P < .01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized β: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized β: 0.10; P = .004). Understanding was strongly and independently associated with self-management (standardized β: 0.25; P < .001). CONCLUSION For these patients, ratings of providers' communication effectiveness were more important than a

  8. System Sketch: A Visualization Tool to Improve Community Decision Making

    EPA Science Inventory

    Making decisions in coastal and estuarine management requires a comprehensive understanding of the linkages between environmental, social, and economic systems. SystemSketch is a web-based scoping tool designed to assist resource managers in characterizing their systems, explorin...

  9. Bayesian inference and decision theory - A framework for decision making in natural resource management

    USGS Publications Warehouse

    Dorazio, R.M.; Johnson, F.A.

    2003-01-01

    Bayesian inference and decision theory may be used in the solution of relatively complex problems of natural resource management, owing to recent advances in statistical theory and computing. In particular, Markov chain Monte Carlo algorithms provide a computational framework for fitting models of adequate complexity and for evaluating the expected consequences of alternative management actions. We illustrate these features using an example based on management of waterfowl habitat.

  10. Structured decision making as a conceptual framework to identify thresholds for conservation and management

    USGS Publications Warehouse

    Martin, J.; Runge, M.C.; Nichols, J.D.; Lubow, B.C.; Kendall, W.L.

    2009-01-01

    Thresholds and their relevance to conservation have become a major topic of discussion in the ecological literature. Unfortunately, in many cases the lack of a clear conceptual framework for thinking about thresholds may have led to confusion in attempts to apply the concept of thresholds to conservation decisions. Here, we advocate a framework for thinking about thresholds in terms of a structured decision making process. The purpose of this framework is to promote a logical and transparent process for making informed decisions for conservation. Specification of such a framework leads naturally to consideration of definitions and roles of different kinds of thresholds in the process. We distinguish among three categories of thresholds. Ecological thresholds are values of system state variables at which small changes bring about substantial changes in system dynamics. Utility thresholds are components of management objectives (determined by human values) and are values of state or performance variables at which small changes yield substantial changes in the value of the management outcome. Decision thresholds are values of system state variables at which small changes prompt changes in management actions in order to reach specified management objectives. The approach that we present focuses directly on the objectives of management, with an aim to providing decisions that are optimal with respect to those objectives. This approach clearly distinguishes the components of the decision process that are inherently subjective (management objectives, potential management actions) from those that are more objective (system models, estimates of system state). Optimization based on these components then leads to decision matrices specifying optimal actions to be taken at various values of system state variables. Values of state variables separating different actions in such matrices are viewed as decision thresholds. Utility thresholds are included in the objectives

  11. Coordinated management of combined sewer overflows by means of environmental decision support systems.

    PubMed

    Murla, Damian; Gutierrez, Oriol; Martinez, Montse; Suñer, David; Malgrat, Pere; Poch, Manel

    2016-04-15

    During heavy rainfall, the capacity of sewer systems and wastewater treatment plants may be surcharged producing uncontrolled wastewater discharges and a depletion of the environmental quality. Therefore there is a need of advanced management tools to tackle with these complex problems. In this paper an environmental decision support system (EDSS), based on the integration of mathematical modeling and knowledge-based systems, has been developed for the coordinated management of urban wastewater systems (UWS) to control and minimize uncontrolled wastewater spills. Effectiveness of the EDSS has been tested in a specially designed virtual UWS, including two sewers systems, two WWTP and one river subjected to typical Mediterranean rain conditions. Results show that sewer systems, retention tanks and wastewater treatment plants improve their performance under wet weather conditions and that EDSS can be very effective tools to improve the management and prevent the system from possible uncontrolled wastewater discharges. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. A Near Real-time Decision Support System Improving Forest Management in the Tropics

    NASA Astrophysics Data System (ADS)

    Tabor, K.; Musinsky, J.; Ledezma, J.; Rasolohery, A.; Mendoza, E.; Kistler, H.; Steininger, M.; Morton, D. C.; Melton, F. S.; Manwell, J.; Koenig, K.

    2013-12-01

    Conservation International (CI) has a decade of experience developing near real-time fire and deforestation monitoring and forecasting systems that channel monitoring information from satellite observations directly to national and sub-national government agencies, Non-Government Organizations (NGOs), and local communities. These systems are used to strengthen forest surveillance and monitoring, fire management and prevention, protected areas management and sustainable land use planning. With support from a NASA Wildland Fires grant, in September 2013 CI will launch a brand new near real-time alert system (FIRECAST) to better meet the outstanding needs and challenges users face in addressing ecosystem degradation from wildland fire and illegal forest activities. Outreach efforts and user feedback have indicated the need for seasonal fire forecasts for effective land use planning, faster alert delivery to enhance response to illegal forest activities, and expanded forest monitoring capabilities that enable proactive responses and that strengthen forest conservation and sustainable development actions. The new FIRECAST system addresses these challenges by integrating the current fire alert and deforestation systems and adding improved ecological forecasting of fire risk; expanding data exchange capabilities with mobile technologies; and delivering a deforestation alert product that can inform policies related to land use management and Reduced Emissions from Deforestation and forest Degradation (REDD+). In addition to demonstrating the capabilities of this new real-time alert system, we also highlight how coordination with host-country institutions enhances the system's capacity to address the implementation needs of REDD+ forest carbon projects, improve tropical forest management, strengthen environmental law enforcement, and facilitate the uptake of near real-time satellite monitoring data into business practices of these national/sub-national institutions.

  13. Development, deployment and usability of a point-of-care decision support system for chronic disease management using the recently-approved HL7 decision support service standard.

    PubMed

    Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight

    2007-01-01

    Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.

  14. Integrating fisheries approaches and household utility models for improved resource management.

    PubMed

    Milner-Gulland, E J

    2011-01-25

    Natural resource management is littered with cases of overexploitation and ineffectual management, leading to loss of both biodiversity and human welfare. Disciplinary boundaries stifle the search for solutions to these issues. Here, I combine the approach of management strategy evaluation, widely applied in fisheries, with household utility models from the conservation and development literature, to produce an integrated framework for evaluating the effectiveness of competing management strategies for harvested resources against a range of performance metrics. I demonstrate the strengths of this approach with a simple model, and use it to examine the effect of manager ignorance of household decisions on resource management effectiveness, and an allocation tradeoff between monitoring resource stocks to reduce observation uncertainty and monitoring users to improve compliance. I show that this integrated framework enables management assessments to consider household utility as a direct metric for system performance, and that although utility and resource stock conservation metrics are well aligned, harvest yield is a poor proxy for both, because it is a product of household allocation decisions between alternate livelihood options, rather than an end in itself. This approach has potential far beyond single-species harvesting in situations where managers are in full control; I show that the integrated approach enables a range of management intervention options to be evaluated within the same framework.

  15. A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations.

    PubMed

    Dotson, G Scott; Hudson, Naomi L; Maier, Andrew

    2015-01-01

    Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management.

  16. A decision support framework for characterizing and managing dermal exposures to chemicals during Emergency Management and Operations

    PubMed Central

    Dotson, G. Scott; Hudson, Naomi L.; Maier, Andrew

    2016-01-01

    Emergency Management and Operations (EMO) personnel are in need of resources and tools to assist in understanding the health risks associated with dermal exposures during chemical incidents. This article reviews available resources and presents a conceptual framework for a decision support system (DSS) that assists in characterizing and managing risk during chemical emergencies involving dermal exposures. The framework merges principles of three decision-making techniques: 1) scenario planning, 2) risk analysis, and 3) multicriteria decision analysis (MCDA). This DSS facilitates dynamic decision making during each of the distinct life cycle phases of an emergency incident (ie, preparedness, response, or recovery) and identifies EMO needs. A checklist tool provides key questions intended to guide users through the complexities of conducting a dermal risk assessment. The questions define the scope of the framework for resource identification and application to support decision-making needs. The framework consists of three primary modules: 1) resource compilation, 2) prioritization, and 3) decision. The modules systematically identify, organize, and rank relevant information resources relating to the hazards of dermal exposures to chemicals and risk management strategies. Each module is subdivided into critical elements designed to further delineate the resources based on relevant incident phase and type of information. The DSS framework provides a much needed structure based on contemporary decision analysis principles for 1) documenting key questions for EMO problem formulation and 2) a method for systematically organizing, screening, and prioritizing information resources on dermal hazards, exposures, risk characterization, and management. PMID:26312660

  17. DECISION SUPPORT FRAMEWORK FOR STORMWATER MANAGEMENT IN URBAN WATERSHEDS

    EPA Science Inventory

    To assist stormwater management professionals in planning for best management practices (BMPs) implementation, the U.S. Environmental Protection Agency (USEPA) is developing a decision support system for placement of BMPs at strategic locations in urban watersheds. This tool wil...

  18. Pest management in Douglas-fir seed orchards: a microcomputer decision method

    Treesearch

    James B. Hoy; Michael I. Haverty

    1988-01-01

    The computer program described provides a Douglas-fir seed orchard manager (user) with a quantitative method for making insect pest management decisions on a desk-top computer. The decision system uses site-specific information such as estimates of seed crop size, insect attack rates, insecticide efficacy and application costs, weather, and crop value. At sites where...

  19. Robust Decision Making Approach to Managing Water Resource Risks (Invited)

    NASA Astrophysics Data System (ADS)

    Lempert, R.

    2010-12-01

    The IPCC and US National Academies of Science have recommended iterative risk management as the best approach for water management and many other types of climate-related decisions. Such an approach does not rely on a single set of judgments at any one time but rather actively updates and refines strategies as new information emerges. In addition, the approach emphasizes that a portfolio of different types of responses, rather than any single action, often provides the best means to manage uncertainty. Implementing an iterative risk management approach can however prove difficult in actual decision support applications. This talk will suggest that robust decision making (RDM) provides a particularly useful set of quantitative methods for implementing iterative risk management. This RDM approach is currently being used in a wide variety of water management applications. RDM employs three key concepts that differentiate it from most types of probabilistic risk analysis: 1) characterizing uncertainty with multiple views of the future (which can include sets of probability distributions) rather than a single probabilistic best-estimate, 2) employing a robustness rather than an optimality criterion to assess alternative policies, and 3) organizing the analysis with a vulnerability and response option framework, rather than a predict-then-act framework. This talk will summarize the RDM approach, describe its use in several different types of water management applications, and compare the results to those obtained with other methods.

  20. Decision-making in product portfolios of pharmaceutical research and development – managing streams of innovation in highly regulated markets

    PubMed Central

    Jekunen, Antti

    2014-01-01

    Decision-making is a core function of any drug development firm. Developing drugs demands a firm to be highly innovative, while at the same time the activity is strictly regulated. Successful drug development offers the right to apply for a long-term patent that confers exclusive marketing rights. This article addresses the issue of what constitutes an adequate portfolio of drugs for a drug development firm and how it might be managed successfully. The paper investigates decision-making in the industry and specifically in the development of oncology drugs from various perspectives: the need for decisions, their timing, decision-making at the project level, the optimal portfolio, tools for portfolio analysis, the evaluation of patents, and finally the importance of the drug portfolio. Drug development decisions as important organizational elements should get more emphasis, and decisions in drug portfolio using modern decision-making methods should be used more widely than what currently happens. Structured, informed decisions would help avoiding late terminations of drugs in Phase III development. An improved research and development pipeline and drug portfolio management are the major elements in the general strategy targeting success. PMID:25364229

  1. Development of a decision aid for energy resource management for the Navajo Nation incorporating environmental cultural values

    NASA Astrophysics Data System (ADS)

    Necefer, Len Edward

    Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided

  2. A Toolbox to Improve Algorithms for Insulin-Dosing Decision Support

    PubMed Central

    Donsa, K.; Plank, J.; Schaupp, L.; Mader, J. K.; Truskaller, T.; Tschapeller, B.; Höll, B.; Spat, S.; Pieber, T. R.

    2014-01-01

    Summary Background Standardized insulin order sets for subcutaneous basal-bolus insulin therapy are recommended by clinical guidelines for the inpatient management of diabetes. The algorithm based GlucoTab system electronically assists health care personnel by supporting clinical workflow and providing insulin-dose suggestions. Objective To develop a toolbox for improving clinical decision-support algorithms. Methods The toolbox has three main components. 1) Data preparation: Data from several heterogeneous sources is extracted, cleaned and stored in a uniform data format. 2) Simulation: The effects of algorithm modifications are estimated by simulating treatment workflows based on real data from clinical trials. 3) Analysis: Algorithm performance is measured, analyzed and simulated by using data from three clinical trials with a total of 166 patients. Results Use of the toolbox led to algorithm improvements as well as the detection of potential individualized subgroup-specific algorithms. Conclusion These results are a first step towards individualized algorithm modifications for specific patient subgroups. PMID:25024768

  3. Clinical Decision Making in the Management of Patients With Cervicogenic Dizziness: A Case Series.

    PubMed

    Jung, Francis C; Mathew, Sherin; Littmann, Andrew E; MacDonald, Cameron W

    2017-11-01

    Study Design Case series. Background Although growing recognition of cervicogenic dizziness (CGD) is emerging, there is still no gold standard for the diagnosis of CGD. The purpose of this case series is to describe the clinical decision making utilized in the management of 7 patients presenting with CGD. Case Description Patients presenting with neck pain and accompanying subjective symptoms, including dizziness, unsteadiness, light-headedness, and visual disturbance, were selected. Clinical evidence of a temporal relationship between neck pain and dizziness, with or without sensorimotor disturbances, was assessed. Clinical decision making followed a 4-step process, informed by the current available best evidence. Outcome measures included the numeric rating scale for dizziness and neck pain, the Dizziness Handicap Inventory, Patient-Specific Functional Scale, and global rating of change. Outcomes Seven patients (mean age, 57 years; range, 31-86 years; 7 female) completed physical therapy management at an average of 13 sessions (range, 8-30 sessions) over a mean of 7 weeks. Clinically meaningful improvements were observed in the numeric rating scale for dizziness (mean difference, 5.7; 95% confidence interval [CI]: 4.0, 7.5), neck pain (mean difference, 5.4; 95% CI: 3.8, 7.1), and the Dizziness Handicap Inventory (mean difference, 32.6; 95% CI: 12.9, 52.2) at discontinuation. Patients also demonstrated overall satisfaction via the Patient-Specific Functional Scale (mean difference, 9) and global rating of change (mean, +6). Discussion This case series describes the physical therapist decision making, management, and outcomes in patients with CGD. Further investigation is warranted to develop a valid clinical decision-making guideline to inform management of patients with CGD. Level of Evidence Diagnosis, therapy, level 4. J Orthop Sports Phys Ther 2017;47(11):874-884. Epub 9 Oct 2017. doi:10.2519/jospt.2017.7425.

  4. Review of experimental studies in social psychology of small groups when an optimal choice exists and application to operating room management decision-making.

    PubMed

    Prahl, Andrew; Dexter, Franklin; Braun, Michael T; Van Swol, Lyn

    2013-11-01

    Because operating room (OR) management decisions with optimal choices are made with ubiquitous biases, decisions are improved with decision-support systems. We reviewed experimental social-psychology studies to explore what an OR leader can do when working with stakeholders lacking interest in learning the OR management science but expressing opinions about decisions, nonetheless. We considered shared information to include the rules-of-thumb (heuristics) that make intuitive sense and often seem "close enough" (e.g., staffing is planned based on the average workload). We considered unshared information to include the relevant mathematics (e.g., staffing calculations). Multiple studies have shown that group discussions focus more on shared than unshared information. Quality decisions are more likely when all group participants share knowledge (e.g., have taken a course in OR management science). Several biases in OR management are caused by humans' limited abilities to estimate tails of probability distributions in their heads. Groups are more susceptible to analogous biases than are educated individuals. Since optimal solutions are not demonstrable without groups sharing common language, only with education of most group members can a knowledgeable individual influence the group. The appropriate model of decision-making is autocratic, with information obtained from stakeholders. Although such decisions are good quality, the leaders often are disliked and the decisions considered unjust. In conclusion, leaders will find the most success if they do not bring OR management operational decisions to groups, but instead act autocratically while obtaining necessary information in 1:1 conversations. The only known route for the leader making such decisions to be considered likable and for the decisions to be considered fair is through colleagues and subordinates learning the management science.

  5. CEOS Contributions to Informing Energy Management and Policy Decision Making Using Space-Based Earth Observations

    NASA Technical Reports Server (NTRS)

    Eckman, Richard S.

    2009-01-01

    Earth observations are playing an increasingly significant role in informing decision making in the energy sector. In renewable energy applications, space-based observations now routinely augment sparse ground-based observations used as input for renewable energy resource assessment applications. As one of the nine Group on Earth Observations (GEO) societal benefit areas, the enhancement of management and policy decision making in the energy sector is receiving attention in activities conducted by the Committee on Earth Observation Satellites (CEOS). CEOS has become the "space arm" for the implementation of the Global Earth Observation System of Systems (GEOSS) vision. It is directly supporting the space-based, near-term tasks articulated in the GEO three-year work plan. This paper describes a coordinated program of demonstration projects conducted by CEOS member agencies and partners to utilize Earth observations to enhance energy management end-user decision support systems. I discuss the importance of engagement with stakeholders and understanding their decision support needs in successfully increasing the uptake of Earth observation products for societal benefit. Several case studies are presented, demonstrating the importance of providing data sets in formats and units familiar and immediately usable by decision makers. These projects show the utility of Earth observations to enhance renewable energy resource assessment in the developing world, forecast space-weather impacts on the power grid, and improve energy efficiency in the built environment.

  6. Nurse managers' decision-making in daily unit operation in peri-operative settings: a cross-sectional descriptive study.

    PubMed

    Siirala, Eriikka; Peltonen, Laura-Maria; Lundgrén-Laine, Heljä; Salanterä, Sanna; Junttila, Kristiina

    2016-09-01

    To describe the tactical and the operational decisions made by nurse managers when managing the daily unit operation in peri-operative settings. Management is challenging as situations change rapidly and decisions are constantly made. Understanding decision-making in this complex environment helps to develop decision support systems to support nurse managers' operative and tactical decision-making. Descriptive cross-sectional design. Data were collected from 20 nurse managers with the think-aloud method during the busiest working hours and analysed using thematic content analysis. Nurse managers made over 700 decisions; either ad hoc (n = 289), near future (n = 268) or long-term (n = 187) by nature. Decisions were often made simultaneously with many interruptions. Ad hoc decisions covered staff allocation, ensuring adequate staff, rescheduling surgical procedures, confirmation tangible resources and following-up the daily unit operation. Decisions in the near future were: planning of surgical procedures and tangible resources, and planning staff allocation. Long-term decisions were: human recourses, nursing development, supplies and equipment, and finances in the unit. Decision-making was vulnerable to interruptions, which sometimes complicated the managing tasks. The results can be used when planning decision support systems and when defining the nurse managers' tasks in peri-operative settings. © 2016 John Wiley & Sons Ltd.

  7. Shared decision-making in medication management: development of a training intervention

    PubMed Central

    Stead, Ute; Morant, Nicola; Ramon, Shulamit

    2017-01-01

    Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training. PMID:28811918

  8. Shared decision-making in medication management: development of a training intervention.

    PubMed

    Stead, Ute; Morant, Nicola; Ramon, Shulamit

    2017-08-01

    Shared decision-making is a collaborative process in which clinicians and patients make treatment decisions together. Although it is considered essential to patient-centred care, the adoption of shared decision-making into routine clinical practice has been slow, and there is a need to increase implementation. This paper describes the development and delivery of a training intervention to promote shared decision-making in medication management in mental health as part of the Shared Involvement in Medication Management Education (ShIMME) project. Three stakeholder groups (service users, care coordinators and psychiatrists) received training in shared decision-making, and their feedback was evaluated. The programme was mostly well received, with all groups rating interaction with peers as the best aspect of the training. This small-scale pilot shows that it is feasible to deliver training in shared decision-making to several key stakeholders. Larger studies will be required to assess the effectiveness of such training.

  9. Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

    PubMed

    Padilha, J M; Sousa, P A F; Pereira, F M S

    2018-03-01

    To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.

  10. Restoring and Managing Gulf of Mexico Fisheries: A Path Toward Creative Decision-Making

    EPA Science Inventory

    This chapter introduces decision analysis concepts with examples for managing fisheries. Decision analytic methods provide useful tools for structuring environmental management problems and separating technical judgments from preference judgments to better weigh the prospects fro...

  11. Improving Adolescent Judgment and Decision Making

    PubMed Central

    Dansereau, Donald F.; Knight, Danica K.; Flynn, Patrick M.

    2013-01-01

    Human judgment and decision making (JDM) has substantial room for improvement, especially among adolescents. Increased technological and social complexity “ups the ante” for developing impactful JDM interventions and aids. Current explanatory advances in this field emphasize dual processing models that incorporate both experiential and analytic processing systems. According to these models, judgment and decisions based on the experiential system are rapid and stem from automatic reference to previously stored episodes. Those based on the analytic system are viewed as slower and consciously developed. These models also hypothesize that metacognitive (self-monitoring) activities embedded in the analytic system influence how and when the two systems are used. What is not included in these models is the development of an intersection between the two systems. Because such an intersection is strongly suggested by memory and educational research as the basis of wisdom/expertise, the present paper describes an Integrated Judgment and Decision-Making Model (IJDM) that incorporates this component. Wisdom/expertise is hypothesized to contain a collection of schematic structures that can emerge from the accumulation of similar episodes or repeated analytic practice. As will be argued, in comparisons to dual system models, the addition of this component provides a broader basis for selecting and designing interventions to improve adolescent JDM. Its development also has implications for generally enhancing cognitive interventions by adopting principles from athletic training to create automated, expert behaviors. PMID:24391350

  12. IMPROVED SCIENCE AND DECISION SUPPORT FOR MANAGING WATERSHED NUTRIENT LOADS

    EPA Science Inventory

    The proposed research addresses two critical gaps in the TMDL process: (1) the inadequacy of presently existing receiving water models to accurately simulate nutrient-sediment-water interactions and fixed plants; and (2) the lack of decision-oriented optimization f...

  13. Managing costs, managing benefits: employer decisions in local health care markets.

    PubMed

    Christianson, Jon B; Trude, Sally

    2003-02-01

    To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. This is an observational study with data collection over a six-year period. The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.

  14. Consensus oriented fuzzified decision support for oil spill contingency management.

    PubMed

    Liu, Xin; Wirtz, Kai W

    2006-06-30

    Studies on multi-group multi-criteria decision-making problems for oil spill contingency management are in their infancy. This paper presents a second-order fuzzy comprehensive evaluation (FCE) model to resolve decision-making problems in the area of contingency management after environmental disasters such as oil spills. To assess the performance of different oil combat strategies, second-order FCE allows for the utilization of lexical information, the consideration of ecological and socio-economic criteria and the involvement of a variety of stakeholders. On the other hand, the new approach can be validated by using internal and external checks, which refer to sensitivity tests regarding its internal setups and comparisons with other methods, respectively. Through a case study, the Pallas oil spill in the German Bight in 1998, it is demonstrated that this approach can help decision makers who search for an optimal strategy in multi-thread contingency problems and has a wider application potential in the field of integrated coastal zone management.

  15. Game Methods of Collective Decision Making in Management Consulting.

    ERIC Educational Resources Information Center

    Prigozhin, Arkadii Il'ich

    1991-01-01

    Explores former Soviet management consultants' increased use of social psychological game methods. Identifies such games as means of involving segments of client organizations in accomplishing shared tasks. Proposes a "practical" business game, designed to shape the process of formulating new management decisions at a radical level.…

  16. Trust between managers and physicians in community hospitals: the effects of power over hospital decisions.

    PubMed

    Succi, M J; Lee, S Y; Alexander, J A

    1998-01-01

    Trust is a key element of effective work relationships between managers and physicians. Despite its importance, little is known about the factors that promote trust between these two professional groups. We examine whether manager and physician power over hospital decisions fosters manager-physician trust. We expect that with more power, managers and physicians will have greater control to enforce decisions that benefit the interests of both groups. Subsequently, they may gain confidence that their interests are supported and have more trust for each other. We test proposed hypotheses with data collected in a national study of chief executive officers and physician leaders in community hospitals in 1993. Findings indicate that power of managers and physicians over hospital decisions is related to manager-physician trust. Consistent with our expectations, physicians perceive greater trust between the two groups when they hold more power in four separate decision-making areas. Our hypotheses, however, are only partially supported in the manager sample. The relationship between power and trust holds in only one decision area: cost/quality management. Our findings have important implications for physician integration in hospitals. A direct implication is that physicians should be given the opportunity to influence hospital decisions. New initiatives, such as task force committees with open membership or open forums on hospital management, allow physicians a more substantial involvement in decisions. Such initiatives will give physicians more "voice" in hospital decision making, thus creating opportunities for physicians to express their interests and play a more active role in the pursuit of the hospital's mission and objectives.

  17. Sport Management Career Decision-Making Self-Efficacy

    ERIC Educational Resources Information Center

    Lumpkin, Angela; Franco, Dan; Multon, Karen; Achen, Rebecca M.

    2017-01-01

    Grounded in a social cognitive theoretical perspective, this study explores the career decision-making self-efficacy (CDSE) and vocational identity development process for college students interested or majoring in sport management. While a popular undergraduate major, little research has investigated the specific factors that influence different…

  18. Facilitating adaptive management in the Chesapeake Bay Watershed through the use of online decision support tools

    USGS Publications Warehouse

    Mullinx, Cassandra; Phillips, Scott; Shenk, Kelly; Hearn, Paul; Devereux, Olivia

    2009-01-01

    The Chesapeake Bay Program (CBP) is attempting to more strategically implement management actions to improve the health of the Nation’s largest estuary. In 2007 the U.S. Geological Survey (USGS) and U.S. Environmental Protection Agency (USEPA) CBP office began a joint effort to develop a suite of Internetaccessible decision-support tools and to help meet the needs of CBP partners to improve water quality and habitat conditions in the Chesapeake Bay and its watersheds. An adaptive management framework is being used to provide a structured decision process for information and individual tools needed to implement and assess practices to improve the condition of the Chesapeake Bay ecosystem. The Chesapeake Online Adaptive Support Toolkit (COAST) is a collection of web-based analytical tools and information, organized in an adaptive management framework, intended to aid decisionmakers in protecting and restoring the integrity of the Bay ecosystem. The initial version of COAST is focused on water quality issues. During early and mid- 2008, initial ideas for COAST were shared and discussed with various CBP partners and other potential user groups. At these meetings, test cases were selected to help improve understanding of the types of information and analytical functionality that would be most useful for specific partners’ needs. These discussions added considerable knowledge about the nature of decisionmaking for Federal, State, local and nongovernmental partners. Version 1.0 of COAST, released in early winter of 2008, will be further reviewed to determine improvements needed to address implementation and assessment of water quality practices. Future versions of COAST may address other aspects of ecosystem restoration, including restoration of habitat and living resources and maintaining watershed health.

  19. Integrating info-gap decision theory with robust population management: a case study using the Mountain Plover.

    PubMed

    van der Burg, Max Post; Tyre, Andrew J

    2011-01-01

    Wildlife managers often make decisions under considerable uncertainty. In the most extreme case, a complete lack of data leads to uncertainty that is unquantifiable. Information-gap decision theory deals with assessing management decisions under extreme uncertainty, but it is not widely used in wildlife management. So too, robust population management methods were developed to deal with uncertainties in multiple-model parameters. However, the two methods have not, as yet, been used in tandem to assess population management decisions. We provide a novel combination of the robust population management approach for matrix models with the information-gap decision theory framework for making conservation decisions under extreme uncertainty. We applied our model to the problem of nest survival management in an endangered bird species, the Mountain Plover (Charadrius montanus). Our results showed that matrix sensitivities suggest that nest management is unlikely to have a strong effect on population growth rate, confirming previous analyses. However, given the amount of uncertainty about adult and juvenile survival, our analysis suggested that maximizing nest marking effort was a more robust decision to maintain a stable population. Focusing on the twin concepts of opportunity and robustness in an information-gap model provides a useful method of assessing conservation decisions under extreme uncertainty.

  20. Evaluation of a rule base for decision making in general practice.

    PubMed Central

    Essex, B; Healy, M

    1994-01-01

    BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

  1. Portfolio Decision Analysis Framework for Value-Focused Ecosystem Management

    PubMed Central

    Convertino, Matteo; Valverde, L. James

    2013-01-01

    Management of natural resources in coastal ecosystems is a complex process that is made more challenging by the need for stakeholders to confront the prospect of sea level rise and a host of other environmental stressors. This situation is especially true for coastal military installations, where resource managers need to balance conflicting objectives of environmental conservation against military mission. The development of restoration plans will necessitate incorporating stakeholder preferences, and will, moreover, require compliance with applicable federal/state laws and regulations. To promote the efficient allocation of scarce resources in space and time, we develop a portfolio decision analytic (PDA) framework that integrates models yielding policy-dependent predictions for changes in land cover and species metapopulations in response to restoration plans, under different climate change scenarios. In a manner that is somewhat analogous to financial portfolios, infrastructure and natural resources are classified as human and natural assets requiring management. The predictions serve as inputs to a Multi Criteria Decision Analysis model (MCDA) that is used to measure the benefits of restoration plans, as well as to construct Pareto frontiers that represent optimal portfolio allocations of restoration actions and resources. Optimal plans allow managers to maintain or increase asset values by contrasting the overall degradation of the habitat and possible increased risk of species decline against the benefits of mission success. The optimal combination of restoration actions that emerge from the PDA framework allows decision-makers to achieve higher environmental benefits, with equal or lower costs, than those achievable by adopting the myopic prescriptions of the MCDA model. The analytic framework presented here is generalizable for the selection of optimal management plans in any ecosystem where human use of the environment conflicts with the needs of

  2. Portfolio Decision Analysis Framework for Value-Focused Ecosystem Management.

    PubMed

    Convertino, Matteo; Valverde, L James

    2013-01-01

    Management of natural resources in coastal ecosystems is a complex process that is made more challenging by the need for stakeholders to confront the prospect of sea level rise and a host of other environmental stressors. This situation is especially true for coastal military installations, where resource managers need to balance conflicting objectives of environmental conservation against military mission. The development of restoration plans will necessitate incorporating stakeholder preferences, and will, moreover, require compliance with applicable federal/state laws and regulations. To promote the efficient allocation of scarce resources in space and time, we develop a portfolio decision analytic (PDA) framework that integrates models yielding policy-dependent predictions for changes in land cover and species metapopulations in response to restoration plans, under different climate change scenarios. In a manner that is somewhat analogous to financial portfolios, infrastructure and natural resources are classified as human and natural assets requiring management. The predictions serve as inputs to a Multi Criteria Decision Analysis model (MCDA) that is used to measure the benefits of restoration plans, as well as to construct Pareto frontiers that represent optimal portfolio allocations of restoration actions and resources. Optimal plans allow managers to maintain or increase asset values by contrasting the overall degradation of the habitat and possible increased risk of species decline against the benefits of mission success. The optimal combination of restoration actions that emerge from the PDA framework allows decision-makers to achieve higher environmental benefits, with equal or lower costs, than those achievable by adopting the myopic prescriptions of the MCDA model. The analytic framework presented here is generalizable for the selection of optimal management plans in any ecosystem where human use of the environment conflicts with the needs of

  3. The impact of management science on political decision making

    NASA Technical Reports Server (NTRS)

    White, M. J.

    1971-01-01

    The possible impact on public policy and organizational decision making of operations research/management science (OR/MS) is discussed. Criticisms based on the assumption that OR/MS will have influence on decision making and criticisms based on the assumption that it will have no influence are described. New directions in the analysis of analysis and in thinking about policy making are also considered.

  4. The Impact of Research on Decision-Making by Practitioners and Managers.

    ERIC Educational Resources Information Center

    Smith, Chris Selby

    The impact of research and development (R&D) on decision making and managers in vocational education and training (VET) was examined through a review of recent Australian studies in VET and health care. The framework adopted to analyze the relationships between R&D and decision making distinguished between the decision-making domain, the…

  5. Critical care nurses' decision making: sedation assessment and management in intensive care.

    PubMed

    Aitken, Leanne M; Marshall, Andrea P; Elliott, Rosalind; McKinley, Sharon

    2009-01-01

    This study was designed to examine the decision making processes that nurses use when assessing and managing sedation for a critically ill patient, specifically the attributes and concepts used to determine sedation needs and the influence of a sedation guideline on the decision making processes. Sedation management forms an integral component of the care of critical care patients. Despite this, there is little understanding of how nurses make decisions regarding assessment and management of intensive care patients' sedation requirements. Appropriate nursing assessment and management of sedation therapy is essential to quality patient care. Observational study. Nurses providing sedation management for a critically ill patient were observed and asked to think aloud during two separate occasions for two hours of care. Follow-up interviews were conducted to collect data from five expert critical care nurses pre- and postimplementation of a sedation guideline. Data from all sources were integrated, with data analysis identifying the type and number of attributes and concepts used to form decisions. Attributes and concepts most frequently used related to sedation and sedatives, anxiety and agitation, pain and comfort and neurological status. On average each participant raised 48 attributes related to sedation assessment and management in the preintervention phase and 57 attributes postintervention. These attributes related to assessment (pre, 58%; post, 65%), physiology (pre, 10%; post, 9%) and treatment (pre, 31%; post, 26%) aspects of care. Decision making in this setting is highly complex, incorporating a wide range of attributes that concentrate primarily on assessment aspects of care. Clinical guidelines should provide support for strategies known to positively influence practice. Further, the education of nurses to use such guidelines optimally must take into account the highly complex iterative process and wide range of data sources used to make decisions.

  6. SMARTE: IMPROVING REVITALIZATION DECISIONS - PRESENTATION IN NRMRL SEMINAR SERIES

    EPA Science Inventory

    SMARTe (Sustainable Management Approaches and Revitalization Tools-electribuc) is an open-source, web-based, decision-support system for developing and evaluating alternative reuse scenarios for potentially contaminated sites (e.g., brownfields). It is being developed collaborati...

  7. SMARTE: IMPROVING REVITALIZATION DECISIONS - PRESENTATION FOR ETV INTERNATIONAL FORUM

    EPA Science Inventory

    SMARTe (Sustainable Management Approaches and Revitalization Tools - electronic) is an open-source, web-based, decision-support system for developing and evaluating alternative reuse scenarios for potentially contaminated sites (e.g., brownfields). It is being developed collabora...

  8. Improving integrated waste management at the regional level: the case of Lombardia.

    PubMed

    Rigamonti, Lucia; Falbo, Alida; Grosso, Mario

    2013-09-01

    The article summarises the main results of the 'Gestione Rifiuti in Lombardia: Analisi del ciclo di vita' (Waste management in Lombardia region: Life cycle assessment; GERLA) project. Life cycle assessment (LCA) has been selected by Regione Lombardia as a strategic decision support tool in the drafting of its new waste management programme. The goal was to use the life cycle thinking approach to assess the current regional situation and thus to give useful strategic indications for the future waste management. The first phase of the study consisted of the LCA of the current management of municipal waste in the Lombardia region (reference year: 2009). The interpretation of such results has allowed the definition of four possible waste management scenarios for the year 2020, with the final goal being to improve the environmental performance of the regional system. The results showed that the current integrated waste management of Lombardia region is already characterised by good energy and environmental performances. However, there is still room for further improvement: actions based, on the one hand, on a further increase in recycling rates and, on the other hand, on a series of technological modifications, especially in food waste and residual waste management, can be undertaken to improve the overall system.

  9. Managing Costs, Managing Benefits: Employer Decisions in Local Health Care Markets

    PubMed Central

    Christianson, Jon B; Trude, Sally

    2003-01-01

    Objectives To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems. Data Sources/Study Setting. Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities. Study Design This is an observational study with data collection over a six-year period. Data Collection/Extraction Methods The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions. Principal Findings The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results. Conclusions General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions. PMID:12650371

  10. Improving Information Products for System 2 Decision Support

    ERIC Educational Resources Information Center

    Gibson, Neal

    2010-01-01

    The creation, maintenance, and management of Information Product (IP) systems that are used by organizations for complex decisions represent a unique set of challenges. These challenges are compounded when the purpose of such a systems is also for knowledge creation and dissemination. Information quality research to date has focused mainly upon…

  11. Watershed forest management using decision support technology

    Treesearch

    Mark Twery; Robert Northrop

    2004-01-01

    Using innovative partnerships and a variety of decision support tools, we identified the needs and goals of Baltimore, Maryland, for their reservoir properties containing over 17000 forested acres; developed a management plan; determined the information necessary to evaluate conditions, processes, and context; chose tools to use; collected, organized, and analyzed data...

  12. Evidence-based management - healthcare manager viewpoints.

    PubMed

    Janati, Ali; Hasanpoor, Edris; Hajebrahimi, Sakineh; Sadeghi-Bazargani, Homayoun

    2018-06-11

    Purpose Hospital manager decisions can have a significant impact on service effectiveness and hospital success, so using an evidence-based approach can improve hospital management. The purpose of this paper is to identify evidence-based management (EBMgt) components and challenges. Consequently, the authors provide an improving evidence-based decision-making framework. Design/methodology/approach A total of 45 semi-structured interviews were conducted in 2016. The authors also established three focus group discussions with health service managers. Data analysis followed deductive qualitative analysis guidelines. Findings Four basic themes emerged from the interviews, including EBMgt evidence sources (including sub-themes: scientific and research evidence, facts and information, political-social development plans, managers' professional expertise and ethical-moral evidence); predictors (sub-themes: stakeholder values and expectations, functional behavior, knowledge, key competencies and skill, evidence sources, evidence levels, uses and benefits and government programs); EBMgt barriers (sub-themes: managers' personal characteristics, decision-making environment, training and research system and organizational issues); and evidence-based hospital management processes (sub-themes: asking, acquiring, appraising, aggregating, applying and assessing). Originality/value Findings suggest that most participants have positive EBMgt attitudes. A full evidence-based hospital manager is a person who uses all evidence sources in a six-step decision-making process. EBMgt frameworks are a good tool to manage healthcare organizations. The authors found factors affecting hospital EBMgt and identified six evidence sources that healthcare managers can use in evidence-based decision-making processes.

  13. Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

    PubMed

    Siegfried, Alexa; Heffernan, Megan; Kennedy, Mallory; Meit, Michael

    To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. Leadership from 324 unique state, local, and tribal public health departments in the United States. Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

  14. Using computer software to improve group decision-making.

    PubMed

    Mockler, R J; Dologite, D G

    1991-08-01

    This article provides a review of some of the work done in the area of knowledge-based systems for strategic planning. Since 1985, with the founding of the Center for Knowledge-based Systems for Business Management, the project has focused on developing knowledge-based systems (KBS) based on these models. In addition, the project also involves developing a variety of computer and non-computer methods and techniques for assisting both technical and non-technical managers and individuals to do decision modelling and KBS development. This paper presents a summary of one segment of the project: a description of integrative groupware useful in strategic planning. The work described here is part of an ongoing research project. As part of this project, for example, over 200 non-technical and technical business managers, most of them working full-time during the project, developed over 160 KBS prototype systems in conjunction with MBA course in strategic planning and management decision making. Based on replies to a survey of this test group, 28 per cent of the survey respondents reported their KBS were used at work, 21 per cent reportedly received promotions, pay rises or new jobs based on their KBS development work, and 12 per cent reported their work led to participation in other KBS development projects at work. All but two of the survey respondents reported that their work on the KBS development project led to a substantial increase in their job knowledge or performance.

  15. Science-based natural resource management decisions: what are they?

    Treesearch

    T.J. Mills; T.M. Quigley; F.J. Everest

    2001-01-01

    While many people interested in natural resources management propose science-based decisions, it is not clear what “science-based” means. Science-based decisions are those that result from the full and complete consideration of the relevant science information. We offer five guidelines to focus the scientist’s contributions to science-based decisionmaking and use the...

  16. Mobile task management tool that improves workflow of an acute general surgical service.

    PubMed

    Foo, Elizabeth; McDonald, Rod; Savage, Earle; Floyd, Richard; Butler, Anthony; Rumball-Smith, Alistair; Connor, Saxon

    2015-10-01

    Understanding and being able to measure constraints within a health system is crucial if outcomes are to be improved. Current systems lack the ability to capture decision making with regard to tasks performed within a patient journey. The aim of this study was to assess the impact of a mobile task management tool on clinical workflow within an acute general surgical service by analysing data capture and usability of the application tool. The Cortex iOS application was developed to digitize patient flow and provide real-time visibility over clinical decision making and task performance. Study outcomes measured were workflow data capture for patient and staff events. Usability was assessed using an electronic survey. There were 449 unique patient journeys tracked with a total of 3072 patient events recorded. The results repository was accessed 7792 times. The participants reported that the application sped up decision making, reduced redundancy of work and improved team communication. The mode of the estimated time the application saved participants was 5-9 min/h of work. Of the 14 respondents, nine discarded their analogue methods of tracking tasks by the end of the study period. The introduction of a mobile task management system improved the working efficiency of junior clinical staff. The application allowed capture of data not previously available to hospital systems. In the future, such data will contribute to the accurate mapping of patient journeys through the health system. © 2015 Royal Australasian College of Surgeons.

  17. Continuous improvement in the Industrial and Management Systems Engineering programme at Kuwait University

    NASA Astrophysics Data System (ADS)

    Aldowaisan, Tariq; Allahverdi, Ali

    2016-07-01

    This paper describes the process employed by the Industrial and Management Systems Engineering programme at Kuwait University to continuously improve the programme. Using a continuous improvement framework, the paper demonstrates how various qualitative and quantitative analyses methods, such as hypothesis testing and control charts, have been applied to the results of four assessment tools and other data sources to improve performance. Important improvements include the need to reconsider two student outcomes as they were difficult to implement in courses. In addition, through benchmarking and the engagement of Alumni and Employers, key decisions were made to improve the curriculum and enhance employability.

  18. Using multi-species occupancy models in structured decision making on managed lands

    USGS Publications Warehouse

    Sauer, John R.; Blank, Peter J.; Zipkin, Elise F.; Fallon, Jane E.; Fallon, Frederick W.

    2013-01-01

    Land managers must balance the needs of a variety of species when manipulating habitats. Structured decision making provides a systematic means of defining choices and choosing among alternative management options; implementation of a structured decision requires quantitative approaches to predicting consequences of management on the relevant species. Multi-species occupancy models provide a convenient framework for making structured decisions when the management objective is focused on a collection of species. These models use replicate survey data that are often collected on managed lands. Occupancy can be modeled for each species as a function of habitat and other environmental features, and Bayesian methods allow for estimation and prediction of collective responses of groups of species to alternative scenarios of habitat management. We provide an example of this approach using data from breeding bird surveys conducted in 2008 at the Patuxent Research Refuge in Laurel, Maryland, evaluating the effects of eliminating meadow and wetland habitats on scrub-successional and woodland-breeding bird species using summed total occupancy of species as an objective function. Removal of meadows and wetlands decreased value of an objective function based on scrub-successional species by 23.3% (95% CI: 20.3–26.5), but caused only a 2% (0.5, 3.5) increase in value of an objective function based on woodland species, documenting differential effects of elimination of meadows and wetlands on these groups of breeding birds. This approach provides a useful quantitative tool for managers interested in structured decision making.

  19. Improving energy efficiency via smart building energy management systems. A comparison with policy measures

    DOE PAGES

    Rocha, Paula; Siddiqui, Afzal; Stadler, Michael

    2014-12-09

    In this study, to foster the transition to more sustainable energy systems, policymakers have been approving measures to improve energy efficiency as well as promoting smart grids. In this setting, building managers are encouraged to adapt their energy operations to real-time market and weather conditions. Yet, most fail to do so as they rely on conventional building energy management systems (BEMS) that have static temperature set points for heating and cooling equipment. In this paper, we investigate how effective policy measures are at improving building-level energy efficiency compared to a smart BEMS with dynamic temperature set points. To this end,more » we present an integrated optimisation model mimicking the smart BEMS that combines decisions on heating and cooling systems operations with decisions on energy sourcing. Using data from an Austrian and a Spanish building, we find that the smart BEMS results in greater reduction in energy consumption than a conventional BEMS with policy measures.« less

  20. Benefit cost models to support pavement management decisions.

    DOT National Transportation Integrated Search

    2012-06-01

    A critical role of pavement management is to provide decision makers with estimates of the required budget level to achieve specific steady-state network conditions, and to recommend the best allocation of available budget among competing needs for m...

  1. Clinical performance improvement series. Classic CQI integrated with comprehensive disease management as a model for performance improvement.

    PubMed

    Joshi, M S; Bernard, D B

    1999-08-01

    In recent years, health and disease management has emerged as an effective means of delivering, integrating, and improving care through a population-based approach. Since 1997 the University of Pennsylvania Health System (UPHS) has utilized the key principles and components of continuous quality improvement (CQI) and disease management to form a model for health care improvement that focuses on designing best practices, using best practices to influence clinical decision making, changing processes and systems to deploy and deliver best practices, and measuring outcomes to improve the process. Experience with 28 programs and more than 14,000 patients indicates significant improvement in outcomes, including high physician satisfaction, increased patient satisfaction, reduced costs, and improved clinical process and outcome measures across multiple diseases. DIABETES DISEASE MANAGEMENT: In three months a UPHS multidisciplinary diabetes disease management team developed a best practice approach for the treatment of all patients with diabetes in the UPHS. After the program was pilot tested in three primary care physician sites, it was then introduced progressively to additional practice sites throughout the health system. The establishment of the role of the diabetes nurse care managers (certified diabetes educators) was central to successful program deployment. Office-based coordinators ensure incorporation of the best practice protocols into routine flow processes. A disease management intranet disseminates programs electronically. Outcomes of the UPHS health and disease management programs so far demonstrate success across multiple dimensions of performance-service, clinical quality, access, and value. The task of health care leadership today is to remove barriers and enable effective implementation of key strategies, such as health and disease management. Substantial effort and resources must be dedicated to gain physician buy-in and achieve compliance. The

  2. Recent advances in applying decision science to managing national forests

    Treesearch

    Bruce G. Marcot; Matthew P. Thompson; Michael C. Runge; Frank R. Thompson; Steven McNulty; David Cleaves; Monica Tomosy; Larry A. Fisher; Andrew Bliss

    2012-01-01

    Management of federal public forests to meet sustainability goals and multiple use regulations is an immense challenge. To succeed, we suggest use of formal decision science procedures and tools in the context of structured decision making (SDM). SDM entails four stages: problem structuring (framing the problem and defining objectives and evaluation criteria), problem...

  3. Insights into water managers' perception and handling of uncertainties - a study of the role of uncertainty in practitioners' planning and decision-making

    NASA Astrophysics Data System (ADS)

    Höllermann, Britta; Evers, Mariele

    2017-04-01

    Planning and decision-making under uncertainty is common in water management due to climate variability, simplified models, societal developments, planning restrictions just to name a few. Dealing with uncertainty can be approached from two sites, hereby affecting the process and form of communication: Either improve the knowledge base by reducing uncertainties or apply risk-based approaches to acknowledge uncertainties throughout the management process. Current understanding is that science more strongly focusses on the former approach, while policy and practice are more actively applying a risk-based approach to handle incomplete and/or ambiguous information. The focus of this study is on how water managers perceive and handle uncertainties at the knowledge/decision interface in their daily planning and decision-making routines. How they evaluate the role of uncertainties for their decisions and how they integrate this information into the decision-making process. Expert interviews and questionnaires among practitioners and scientists provided an insight into their perspectives on uncertainty handling allowing a comparison of diverse strategies between science and practice as well as between different types of practitioners. Our results confirmed the practitioners' bottom up approach from potential measures upwards instead of impact assessment downwards common in science-based approaches. This science-practice gap may hinder effective uncertainty integration and acknowledgement in final decisions. Additionally, the implementation of an adaptive and flexible management approach acknowledging uncertainties is often stalled by rigid regulations favouring a predict-and-control attitude. However, the study showed that practitioners' level of uncertainty recognition varies with respect to his or her affiliation to type of employer and business unit, hence, affecting the degree of the science-practice-gap with respect to uncertainty recognition. The level of working

  4. A risk-based approach to flood management decisions in a nonstationary world

    NASA Astrophysics Data System (ADS)

    Rosner, Ana; Vogel, Richard M.; Kirshen, Paul H.

    2014-03-01

    Traditional approaches to flood management in a nonstationary world begin with a null hypothesis test of "no trend" and its likelihood, with little or no attention given to the likelihood that we might ignore a trend if it really existed. Concluding a trend exists when it does not, or rejecting a trend when it exists are known as type I and type II errors, respectively. Decision-makers are poorly served by statistical and/or decision methods that do not carefully consider both over- and under-preparation errors, respectively. Similarly, little attention is given to how to integrate uncertainty in our ability to detect trends into a flood management decision context. We show how trend hypothesis test results can be combined with an adaptation's infrastructure costs and damages avoided to provide a rational decision approach in a nonstationary world. The criterion of expected regret is shown to be a useful metric that integrates the statistical, economic, and hydrological aspects of the flood management problem in a nonstationary world.

  5. Improving the Slum Planning Through Geospatial Decision Support System

    NASA Astrophysics Data System (ADS)

    Shekhar, S.

    2014-11-01

    In India, a number of schemes and programmes have been launched from time to time in order to promote integrated city development and to enable the slum dwellers to gain access to the basic services. Despite the use of geospatial technologies in planning, the local, state and central governments have only been partially successful in dealing with these problems. The study on existing policies and programmes also proved that when the government is the sole provider or mediator, GIS can become a tool of coercion rather than participatory decision-making. It has also been observed that local level administrators who have adopted Geospatial technology for local planning continue to base decision-making on existing political processes. In this juncture, geospatial decision support system (GSDSS) can provide a framework for integrating database management systems with analytical models, graphical display, tabular reporting capabilities and the expert knowledge of decision makers. This assists decision-makers to generate and evaluate alternative solutions to spatial problems. During this process, decision-makers undertake a process of decision research - producing a large number of possible decision alternatives and provide opportunities to involve the community in decision making. The objective is to help decision makers and planners to find solutions through a quantitative spatial evaluation and verification process. The study investigates the options for slum development in a formal framework of RAY (Rajiv Awas Yojana), an ambitious program of Indian Government for slum development. The software modules for realizing the GSDSS were developed using the ArcGIS and Community -VIZ software for Gulbarga city.

  6. Artificial intelligence based decision support for trumpeter swan management

    USGS Publications Warehouse

    Sojda, Richard S.

    2002-01-01

    The number of trumpeter swans (Cygnus buccinator) breeding in the Tri-State area where Montana, Idaho, and Wyoming come together has declined to just a few hundred pairs. However, these birds are part of the Rocky Mountain Population which additionally has over 3,500 birds breeding in Alberta, British Columbia, Northwest Territories, and Yukon Territory. To a large degree, these birds seem to have abandoned traditional migratory pathways in the flyway. Waterfowl managers have been interested in decision support tools that would help them explore simulated management scenarios in their quest towards reaching population recovery and the reestablishment of traditional migratory pathways. I have developed a decision support system to assist biologists with such management, especially related to wetland ecology. Decision support systems use a combination of models, analytical techniques, and information retrieval to help develop and evaluate appropriate alternatives. Swan management is a domain that is ecologically complex, and this complexity is compounded by spatial and temporal issues. As such, swan management is an inherently distributed problem. Therefore, the ecological context for modeling swan movements in response to management actions was built as a multiagent system of interacting intelligent agents that implements a queuing model representing swan migration. These agents accessed ecological knowledge about swans, their habitats, and flyway management principles from three independent expert systems. The agents were autonomous, had some sensory capability, and could respond to changing conditions. A key problem when developing ecological decision support systems is empirically determining that the recommendations provided are valid. Because Rocky Mountain trumpeter swans have been surveyed for a long period of time, I was able to compare simulated distributions provided by the system with actual field observations across 20 areas for the period 1988

  7. Neural signatures of experience-based improvements in deterministic decision-making

    PubMed Central

    Tremel, Joshua J.; Laurent, Patryk A.; Wolk, David A.; Wheeler, Mark E.; Fiez, Julie A.

    2016-01-01

    Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. PMID:27523644

  8. Analysis of the risk management decisionmaking processes and the decision support systems in the wildland fire agencies

    Treesearch

    Patrick Withen

    2007-01-01

    This paper offers an analysis of the strengths, weaknesses, opportunities, and threats in the risk management process, decision support systems (DSSs), and other types of decisionmaking, including recognition primed decisionmaking, bricolage with the goal of improving DSSs and decisionmaking. DSSs may be thought of as any technology or knowledge that is used as an aid...

  9. INTEGRATED WATERSHED MANAGEMENT: LINKING SCIENCE TO DECISION MAKING

    EPA Science Inventory

    This paper describes some of the challenges and benefits of taking an integrated watershed approach to achieving Clean Water Act (CWA) and Safe Drinking Water Act (SDWA) goals, and some of the activities in EPA to facilitate watershed management decision making.

  10. Insurance Contract Analysis for Company Decision Support in Acquisition Management

    NASA Astrophysics Data System (ADS)

    Chernovita, H. P.; Manongga, D.; Iriani, A.

    2017-01-01

    One of company activities to retain their business is marketing the products which include in acquisition management to get new customers. Insurance contract analysis using ID3 to produce decision tree and rules to be decision support for the insurance company. The decision tree shows 13 rules that lead to contract termination claim. This could be a guide for the insurance company in acquisition management to prevent contract binding with these contract condition because it has a big chance for the customer to terminate their insurance contract before its expired date. As the result, there are several strong points that could be the determinant of contract termination such as: 1) customer age whether too young or too old, 2) long insurance period (above 10 years), 3) big insurance amount, 4) big amount of premium charges, and 5) payment method.

  11. Decision analysis framing study; in-valley drainage management strategies for the western San Joaquin Valley, California

    USGS Publications Warehouse

    Presser, Theresa S.; Jenni, Karen E.; Nieman, Timothy; Coleman, James

    2010-01-01

    Constraints on drainage management in the western San Joaquin Valley and implications of proposed approaches to management were recently evaluated by the U.S. Geological Survey (USGS). The USGS found that a significant amount of data for relevant technical issues was available and that a structured, analytical decision support tool could help optimize combinations of specific in-valley drainage management strategies, address uncertainties, and document underlying data analysis for future use. To follow-up on USGS's technical analysis and to help define a scientific basis for decisionmaking in implementing in-valley drainage management strategies, this report describes the first step (that is, a framing study) in a Decision Analysis process. In general, a Decision Analysis process includes four steps: (1) problem framing to establish the scope of the decision problem(s) and a set of fundamental objectives to evaluate potential solutions, (2) generation of strategies to address identified decision problem(s), (3) identification of uncertainties and their relationships, and (4) construction of a decision support model. Participation in such a systematic approach can help to promote consensus and to build a record of qualified supporting data for planning and implementation. In December 2008, a Decision Analysis framing study was initiated with a series of meetings designed to obtain preliminary input from key stakeholder groups on the scope of decisions relevant to drainage management that were of interest to them, and on the fundamental objectives each group considered relevant to those decisions. Two key findings of this framing study are: (1) participating stakeholders have many drainage management objectives in common; and (2) understanding the links between drainage management and water management is necessary both for sound science-based decisionmaking and for resolving stakeholder differences about the value of proposed drainage management solutions. Citing

  12. A decision analysis approach for risk management of near-earth objects

    NASA Astrophysics Data System (ADS)

    Lee, Robert C.; Jones, Thomas D.; Chapman, Clark R.

    2014-10-01

    Risk management of near-Earth objects (NEOs; e.g., asteroids and comets) that can potentially impact Earth is an important issue that took on added urgency with the Chelyabinsk event of February 2013. Thousands of NEOs large enough to cause substantial damage are known to exist, although only a small fraction of these have the potential to impact Earth in the next few centuries. The probability and location of a NEO impact are subject to complex physics and great uncertainty, and consequences can range from minimal to devastating, depending upon the size of the NEO and location of impact. Deflecting a potential NEO impactor would be complex and expensive, and inter-agency and international cooperation would be necessary. Such deflection campaigns may be risky in themselves, and mission failure may result in unintended consequences. The benefits, risks, and costs of different potential NEO risk management strategies have not been compared in a systematic fashion. We present a decision analysis framework addressing this hazard. Decision analysis is the science of informing difficult decisions. It is inherently multi-disciplinary, especially with regard to managing catastrophic risks. Note that risk analysis clarifies the nature and magnitude of risks, whereas decision analysis guides rational risk management. Decision analysis can be used to inform strategic, policy, or resource allocation decisions. First, a problem is defined, including the decision situation and context. Second, objectives are defined, based upon what the different decision-makers and stakeholders (i.e., participants in the decision) value as important. Third, quantitative measures or scales for the objectives are determined. Fourth, alternative choices or strategies are defined. Fifth, the problem is then quantitatively modeled, including probabilistic risk analysis, and the alternatives are ranked in terms of how well they satisfy the objectives. Sixth, sensitivity analyses are performed in

  13. The Wildland Fire Decision Support System: Integrating science, technology, and fire management

    Treesearch

    Morgan Pence; Tom Zimmerman

    2011-01-01

    Federal agency policy requires documentation and analysis of all wildland fire response decisions. In the past, planning and decision documentation for fires were completed using multiple unconnected processes, yielding many limitations. In response, interagency fire management executives chartered the development of the Wildland Fire Decision Support System (WFDSS)....

  14. Decision-Making in Management of the Complex Trauma Patient: Changing the Mindset of the non-trauma Surgeon.

    PubMed

    Sonesson, Linda; Boffard, Kenneth; Lundberg, Lars; Rydmark, Martin; Karlgren, Klas

    2018-01-16

    European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military. Design-based research using combined methods including interviews, reviews of authentic trauma cases, and video-recorded resuscitations performed at a high-volume civilian academic trauma center. Several educational dilemmas were identified: (1) thinking physiologically, (2) the application of damage control resuscitation and surgery, (3) differing priorities and time management, (4) impact of environment, (5) managing limited resources, (6) lack of general surgical skills, (7) different cultural behavior, and (8) ethical issues. The challenges presented, and the educational domains identified, constitute a basis for improved development of education and training in complex surgical decision-making. This study contributes new knowledge about the mindset required for decision-making in patients with complex multisystem trauma and competing priorities of care. This is, especially important in countries having a low intensity of trauma in both military and civilian environments, and consequential limited skills, and lack of expertise. Guidelines focused on the same decision-making process, using virtual patients and blended learning, can be developed.

  15. Data Management & Decision Making. Technical Report No. 14.

    ERIC Educational Resources Information Center

    Speedie, Stuart M.; Sanders, Susan

    "Data Management and Decision Making" is a set of instructional materials designed to teach practicing and potential educational administrators about the uses of operations research in educational administration. It consists of five units--"Operations Research in Education,""PERT/CPM: A Planning and Analysis…

  16. Dynamic decision making for dam-break emergency management - Part 1: Theoretical framework

    NASA Astrophysics Data System (ADS)

    Peng, M.; Zhang, L. M.

    2013-02-01

    An evacuation decision for dam breaks is a very serious issue. A late decision may lead to loss of lives and properties, but a very early evacuation will incur unnecessary expenses. This paper presents a risk-based framework of dynamic decision making for dam-break emergency management (DYDEM). The dam-break emergency management in both time scale and space scale is introduced first to define the dynamic decision problem. The probability of dam failure is taken as a stochastic process and estimated using a time-series analysis method. The flood consequences are taken as functions of warning time and evaluated with a human risk analysis model (HURAM) based on Bayesian networks. A decision criterion is suggested to decide whether to evacuate the population at risk (PAR) or to delay the decision. The optimum time for evacuating the PAR is obtained by minimizing the expected total loss, which integrates the time-related probabilities and flood consequences. When a delayed decision is chosen, the decision making can be updated with available new information. A specific dam-break case study is presented in a companion paper to illustrate the application of this framework to complex dam-breaching problems.

  17. The Association of Patient Chronic Disease Burden and Self-Management Requirements With Shared Decision Making in Primary Care Visits

    PubMed Central

    Drum, Melinda; Cooper, Lisa A.

    2014-01-01

    Background: Shared decision making (SDM) is associated with positive health outcomes and may be particularly relevant for patients with chronic disease. Objectives: To investigate whether (1) patients with chronic diseases, particularly those requiring self-management, are more likely to engage in SDM behaviors than patients without chronic diseases and (2) patients with chronic diseases are more likely to have their physicians engage them in SDM. Design: A cross-sectional study of patients who were enrolled in a randomized controlled trial to improve patient–physician communication. Participants: Adult patients with hypertension at community health clinics in Baltimore, Maryland. Approach: We used multivariable regression models to examine the associations of the following predictor variables: (1) chronic disease burden and (2) diseases requiring self-management with the following outcome variables measuring SDM components: (1) patient information sharing, (2) patient decision making, and (3) physician SDM facilitation. Key Results: Patients with greater chronic disease burden and more diseases requiring self-management reported more information sharing (β = .07, P = .03 and β = .12, P = .046, respectively) and decision making (β = .06, P = .02 and β = .21, P < .001) as did patients who reported poor general health. Physician facilitation of SDM was not associated with chronic disease burden or with diseases requiring self-management but was associated with higher patient income. Conclusions: Patients with chronic diseases, particularly those requiring self-management, may be more likely to engage in SDM behaviors, but physicians may not be more likely to engage such patients in SDM. Targeting patients with chronic disease for SDM may improve health outcomes among the chronically ill, particularly among vulnerable patients (eg, minorities, low-income patients) who suffer disproportionately from such conditions. PMID:26640812

  18. Making decisions in complex landscapes: Headwater stream management across multiple federal agencies

    USGS Publications Warehouse

    Katz, Rachel; Grant, Evan H. Campbell; Runge, Michael C.; Connery, Bruce; Crockett, Marquette; Herland, Libby; Johnson, Sheela; Kirk, Dawn; Wofford, Jeb; Bennett, Rick; Nislow, Keith; Norris, Marian; Hocking, Daniel; Letcher, Benjamin; Roy, Allison

    2014-01-01

    Headwater stream ecosystems are vulnerable to numerous threats associated with climate and land use change. In the northeastern US, many headwater stream species (e.g., brook trout and stream salamanders) are of special conservation concern and may be vulnerable to climate change influences, such as changes in stream temperature and streamflow. Federal land management agencies (e.g., US Fish and Wildlife Service, National Park Service, USDA Forest Service, Bureau of Land Management and Department of Defense) are required to adopt policies that respond to climate change and may have longer-term institutional support to enforce such policies compared to state, local, non-governmental, or private land managers. However, federal agencies largely make management decisions in regards to headwater stream ecosystems independently. This fragmentation of management resources and responsibilities across the landscape may significantly impede the efficiency and effectiveness of conservation actions, and higher degrees of collaboration may be required to achieve conservation goals. This project seeks to provide an example of cooperative landscape decision-making to address the conservation of headwater stream ecosystems. We identified shared and contrasting objectives of each federal agency and potential collaboration opportunities that may increase efficient and effective management of headwater stream ecosystems in two northeastern US watersheds. These workshops provided useful insights into the adaptive capacity of federal institutions to address threats to headwater stream ecosystems. Our ultimate goal is to provide a decision-making framework and analysis that addresses large-scale conservation threats across multiple stakeholders, as a demonstration of cooperative landscape conservation for aquatic ecosystems. Additionally, we aim to provide new scientific knowledge and a regional perspective to resource managers to help inform local management decisions.

  19. Show Me My Health Plans: Using a Decision Aid to Improve Decisions in the Federal Health Insurance Marketplace

    PubMed Central

    Politi, Mary C.; Kuzemchak, Marie D.; Liu, Jingxia; Barker, Abigail R.; Peters, Ellen; Ubel, Peter A.; Kaphingst, Kimberly A.; McBride, Timothy; Kreuter, Matthew W.; Shacham, Enbal; Philpott, Sydney E.

    2017-01-01

    Introduction Since the Affordable Care Act was passed, more than 12 million individuals have enrolled in the health insurance marketplace. Without support, many struggle to make an informed plan choice that meets their health and financial needs. Methods We designed and evaluated a decision aid, Show Me My Health Plans (SMHP), that provides education, preference assessment, and an annual out-of-pocket cost calculator with plan recommendations produced by a tailored, risk-adjusted algorithm incorporating age, gender, and health status. We evaluated whether SMHP compared to HealthCare.gov improved health insurance decision quality and the match between plan choice, needs, and preferences among 328 Missourians enrolling in the marketplace. Results Participants who used SMHP had higher health insurance knowledge (LS-Mean = 78 vs. 62; P < 0.001), decision self-efficacy (LS-Mean = 83 vs. 75; P < 0.002), confidence in their choice (LS-Mean = 3.5 vs. 2.9; P < 0.001), and improved health insurance literacy (odds ratio = 2.52, P <0.001) compared to participants using HealthCare.gov. Those using SMHP were 10.3 times more likely to select a silver- or gold-tier plan (P < 0.0001). Discussion SMHP can improve health insurance decision quality and the odds that consumers select an insurance plan with coverage likely needed to meet their health needs. This study represents a unique context through which to apply principles of decision support to improve health insurance choices. PMID:28804780

  20. Implementing information technology to improve workplace health: a web-based information needs assessment of managers in Fraser Health, British Columbia.

    PubMed

    Sandhu, Jag S; Anderson, Keith; Keen, Dave; Yassi, Annalee

    2005-01-01

    A web-based questionnaire-survey was administered primarily to determine what information is useful to managers in Fraser Health, of British Columbia to support decision-making for workplace health and safety. The results indicated that managers prefer electronic quarterly reports, with targets, goals, and historical trends rated as "very important." Over 85.7% "agree" that if information was readily available in the "most beneficial" format, they would be able to improve workplace health. Recommendations include that managers be presented with clear and concise workplace health reports that facilitate analysis for decision-making.

  1. The medical decision model and decision maker tools for management of radiological and nuclear incidents.

    PubMed

    Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M

    2014-06-01

    Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.

  2. Neural signatures of experience-based improvements in deterministic decision-making.

    PubMed

    Tremel, Joshua J; Laurent, Patryk A; Wolk, David A; Wheeler, Mark E; Fiez, Julie A

    2016-12-15

    Feedback about our choices is a crucial part of how we gather information and learn from our environment. It provides key information about decision experiences that can be used to optimize future choices. However, our understanding of the processes through which feedback translates into improved decision-making is lacking. Using neuroimaging (fMRI) and cognitive models of decision-making and learning, we examined the influence of feedback on multiple aspects of decision processes across learning. Subjects learned correct choices to a set of 50 word pairs across eight repetitions of a concurrent discrimination task. Behavioral measures were then analyzed with both a drift-diffusion model and a reinforcement learning model. Parameter values from each were then used as fMRI regressors to identify regions whose activity fluctuates with specific cognitive processes described by the models. The patterns of intersecting neural effects across models support two main inferences about the influence of feedback on decision-making. First, frontal, anterior insular, fusiform, and caudate nucleus regions behave like performance monitors, reflecting errors in performance predictions that signal the need for changes in control over decision-making. Second, temporoparietal, supplementary motor, and putamen regions behave like mnemonic storage sites, reflecting differences in learned item values that inform optimal decision choices. As information about optimal choices is accrued, these neural systems dynamically adjust, likely shifting the burden of decision processing from controlled performance monitoring to bottom-up, stimulus-driven choice selection. Collectively, the results provide a detailed perspective on the fundamental ability to use past experiences to improve future decisions. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. Decision Support Systems (DSSs) For Contaminated Land Management - Gaps And Challenges

    EPA Science Inventory

    A plethora of information is available when considering decision support systems for risk-based management of contaminated land. Broad issues of what is contaminated land, what is a brownfield, and what is remediation are discussed in EU countries and the U.S. Making decisions ...

  4. Improved Modeling of Three-Point Estimates for Decision Making: Going Beyond the Triangle

    DTIC Science & Technology

    2016-03-01

    OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND THE TRIANGLE by Daniel W. Mulligan March 2016 Thesis Advisor: Mark Rhoades...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE IMPROVED MODELING OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND...unlimited IMPROVED MODELING OF THREE-POINT ESTIMATES FOR DECISION MAKING: GOING BEYOND THE TRIANGLE Daniel W. Mulligan Civilian, National

  5. Toward patient-centered, personalized and personal decision support and knowledge management: a survey.

    PubMed

    Leong, T-Y

    2012-01-01

    This paper summarizes the recent trends and highlights the challenges and opportunities in decision support and knowledge management for patient-centered, personalized, and personal health care. The discussions are based on a broad survey of related references, focusing on the most recent publications. Major advances are examined in the areas of i) shared decision making paradigms, ii) continuity of care infrastructures and architectures, iii) human factors and system design approaches, iv) knowledge management innovations, and v) practical deployment and change considerations. Many important initiatives, projects, and plans with promising results have been identified. The common themes focus on supporting the individual patients who are playing an increasing central role in their own care decision processes. New collaborative decision making paradigms and information infrastructures are required to ensure effective continuity of care. Human factors and usability are crucial for the successful development and deployment of the relevant systems, tools, and aids. Advances in personalized medicine can be achieved through integrating genomic, phenotypic and other biological, individual, and population level information, and gaining useful insights from building and analyzing biological and other models at multiple levels of abstraction. Therefore, new Information and Communication Technologies and evaluation approaches are needed to effectively manage the scale and complexity of biomedical and health information, and adapt to the changing nature of clinical decision support. Recent research in decision support and knowledge management combines heterogeneous information and personal data to provide cost-effective, calibrated, personalized support in shared decision making at the point of care. Current and emerging efforts concentrate on developing or extending conventional paradigms, techniques, systems, and architectures for the new predictive, preemptive, and

  6. Evaluation of obstetricians' surgical decision making in the management of uterine rupture.

    PubMed

    Eze, Justus Ndulue; Anozie, Okechukwu Bonaventure; Lawani, Osaheni Lucky; Ndukwe, Emmanuel Okechukwu; Agwu, Uzoma Maryrose; Obuna, Johnson Akuma

    2017-06-08

    Uterine rupture is an obstetric calamity with surgery as its management mainstay. Uterine repair without tubal ligation leaves a uterus that is more prone to repeat rupture while uterine repair with bilateral tubal ligation (BTL) or (sub)total hysterectomy predispose survivors to psychosocial problems like marital disharmony. This study aims to evaluate obstetricians' perspectives on surgical decision making in managing uterine rupture. A questionnaire-based cross-sectional study of obstetricians at the 46th annual scientific conference of Society of Gynaecology and Obstetrics of Nigeria in 2012. Data was analysed by descriptive and inferential statistics. Seventy-nine out of 110 obstetricians (71.8%) responded to the survey, of which 42 (53.2%) were consultants, 60 (75.9%) practised in government hospitals and 67 (84.8%) in urban hospitals, and all respondents managed women with uterine rupture. Previous cesarean scars and injudicious use of oxytocic are the commonest predisposing causes, and uterine rupture carries very high incidences of maternal and perinatal mortality and morbidity. Uterine repair only was commonly performed by 38 (48.1%) and uterine repair with BTL or (sub) total hysterectomy by 41 (51.9%) respondents. Surgical management is guided mainly by patients' conditions and obstetricians' surgical skills. Obstetricians' distribution in Nigeria leaves rural settings starved of specialist for obstetric emergencies. Caesarean scars are now a rising cause of ruptures. The surgical management of uterine rupture and obstetricians' surgical preferences vary and are case scenario-dependent. Equitable redistribution of obstetricians and deployment of medical doctors to secondary hospitals in rural settings will make obstetric care more readily available and may reduce the prevalence and improve the outcome of uterine rupture. Obstetrician's surgical decision-making should be guided by the prevailing case scenario and the ultimate aim should be to avert

  7. Designing a Decision Support System (DSS) for Academic Library Managers Using Preprogrammed Application Software on a Microcomputer.

    ERIC Educational Resources Information Center

    McDonald, Joseph

    1986-01-01

    Focusing on management decisions in academic libraries, this article compares management information systems (MIS) with decision support systems (DSS) and discusses the decision-making process, information needs of library managers, sources of data, reasons for choosing microcomputer, preprogrammed application software, prototyping a system, and…

  8. National Aeronautics and Space Administration: Leadership and Systems Needed to Effect Financial Management Improvements

    DTIC Science & Technology

    2002-03-20

    financial reporting requirements-an unqualified opinion on its financial statements, no material internal control weaknesses, and financial management systems that are in substantial compliance the requirements of the Federal Financial Management Improvement Act (FFMIA). This implied that NASA not only could generate reliable information once a year for external financial reporting purposes but also could provide accurate, reliable information for day-today decision-making. In contrast with the unqualified or clean audit opinions of its previous

  9. Phenology for science, resource management, decision making, and education

    USGS Publications Warehouse

    Nolan, V.P.; Weltzin, J.F.

    2011-01-01

    Fourth USA National Phenology Network (USA-NPN) Research Coordination Network (RCN) Annual Meeting and Stakeholders Workshop; Milwaukee, Wisconsin, 21-22 September 2010; Phenology, the study of recurring plant and animal life cycle events, is rapidly emerging as a fundamental approach for understanding how ecological systems respond to environmental variation and climate change. The USA National Phenology Network (USA-NPN; http://www.usanpn.org) is a large-scale network of governmental and nongovernmental organizations, academic institutions, resource management agencies, and tribes. The network is dedicated to conducting and promoting repeated and integrated plant and animal phenological observations, identifying linkages with other relevant biological and physical data sources, and developing and distributing the tools to analyze these data at local to national scales. The primary goal of the USA-NPN is to improve the ability of decision makers to design strategies for climate adaptation.

  10. Phenology for Science, Resource Management, Decision Making, and Education

    NASA Astrophysics Data System (ADS)

    Nolan, Vivian P.; Weltzin, Jake F.

    2011-01-01

    Fourth USA National Phenology Network (USA-NPN) Research Coordination Network (RCN) Annual Meeting and Stakeholders Workshop; Milwaukee, Wisconsin, 21-22 September 2010; Phenology, the study of recurring plant and animal life cycle events, is rapidly emerging as a fundamental approach for understanding how ecological systems respond to environmental variation and climate change. The USA National Phenology Network (USA-NPN; http://www.usanpn.org) is a large-scale network of governmental and nongovernmental organizations, academic institutions, resource management agencies, and tribes. The network is dedicated to conducting and promoting repeated and integrated plant and animal phenological observations, identifying linkages with other relevant biological and physical data sources, and developing and distributing the tools to analyze these data at local to national scales. The primary goal of the USA-NPN is to improve the ability of decision makers to design strategies for climate adaptation.

  11. Effects of documentation-based decision support on chronic disease management.

    PubMed

    Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Yu, D Tony; McColgan, Kerry E; Volk, Lynn A; Tsurikova, Ruslana; Melnikas, Andrea J; Einbinder, Jonathan S; Middleton, Blackford

    2010-12-01

    To evaluate whether a new documentation-based clinical decision support system (CDSS) is effective in addressing deficiencies in the care of patients with coronary artery disease (CAD) and diabetes mellitus (DM). Controlled trial randomized by physician. We assigned primary care physicians (PCPs) in 10 ambulatory practices to usual care or the CAD/DM Smart Form for 9 months. The primary outcome was the proportion of deficiencies in care that were addressed within 30 days after a patient visit. The Smart Form was used for 5.6% of eligible patients. In the intention-to-treat analysis, patients of intervention PCPs had a greater proportion of deficiencies addressed within 30 days of a visit compared with controls (11.4% vs 10.1%, adjusted and clustered odds ratio =1.14; 95% confidence interval, 1.02-1.28; P = .02). Differences were more pronounced in the "on-treatment" analysis: 17.0% of deficiencies were addressed after visits in which the Smart Form was used compared with 10.6% of deficiencies after visits in which it was not used (P <.001). Measures that improved included documentation of smoking status and prescription of antiplatelet agents when appropriate. Overall use of the CAD/DM Smart Form was low, and improvements in management were modest. When used, documentation-based decision support shows promise, and future studies should focus on refining such tools, integrating them into current electronic health record platforms, and promoting their use, perhaps through organizational changes to primary care practices.

  12. Decision-support systems for natural-hazards and land-management issues

    USGS Publications Warehouse

    Dinitz, Laura; Forney, William; Byrd, Kristin

    2012-01-01

    Scientists at the USGS Western Geographic Science Center are developing decision-support systems (DSSs) for natural-hazards and land-management issues. DSSs are interactive computer-based tools that use data and models to help identify and solve problems. These systems can provide crucial support to policymakers, planners, and communities for making better decisions about long-term natural hazards mitigation and land-use planning.

  13. Formal and informal decision making on water management at the village level: A case study from the Office du Niger irrigation scheme (Mali)

    NASA Astrophysics Data System (ADS)

    Vandersypen, Klaartje; Keita, Abdoulaye C. T.; Coulibaly, Y.; Raes, D.; Jamin, J.-Y.

    2007-06-01

    Water Users Associations (WUAs) are all too often considered a panacea for improving water management in irrigation schemes. Where grassroots movements are absent, they are usually imposed on farmers by national governments, NGOs, and international donors, without fully considering existing forms of organization. This also happened in the Office du Niger irrigation scheme in Mali, where after a partial irrigation management transfer, WUAs were created to fill the resulting power vacuum. This paper demonstrates that, despite active efforts to organize farmers in WUAs, informal patterns of decision making remain dominant. Given the shortcomings of these informal patterns, WUAs could provide a much-needed platform for institutionalizing collective action, on the condition that farmers accept them. Therefore WUAs should adopt some crucial characteristics of informal patterns of decision making while avoiding their weaknesses. First, making use of the existing authority of village leadership and the central management can improve the credibility of WUAs. Second, allowing flexibility in procedures and rules can make them more appropriate for dealing with collective action problems that are typically temporary and specific. Last, formalizing the current pattern of conflict management and sanctioning might enhance its sphere of action and tackle the current absence of firm engagement with respect to some informal management decisions. In addition, WUAs should represent and be accountable to all farmers, including those residing outside the village community.

  14. Do educational interventions improve nurses' clinical decision making and judgement? A systematic review.

    PubMed

    Thompson, Carl; Stapley, Sally

    2011-07-01

    Despite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions. A systematic review. Electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL and PsycINFO, Social Sciences Citation Index, OpenSIGLE conference proceedings and hand searching nursing journals. Studies published since 1960, reporting any educational intervention that aimed to improve nurses' clinical judgements or decision making were included. Studies were assessed for relevance and quality. Data extracted included study design; educational setting; the nature of participants; whether the study was concerned with the clinical application of skills or the application of theory; the type of decision targeted by the intervention (e.g. diagnostic reasoning) and whether the evaluation of the intervention focused on efficacy or effectiveness. A narrative approach to study synthesis was used due to heterogeneity in interventions, study samples, outcomes and settings and incomplete reporting of effect sizes. From 5262 initial citations 24 studies were included in the review. A variety of educational approaches were reported. Study quality and content reporting was generally poor. Pedagogical theories were widely used but use of decision theory (with the exception of subjective expected utility theory implicit in decision analysis) was rare. The effectiveness and efficacy of interventions was mixed. Educational interventions to improve nurses' judgements and decisions are complex and the evidence from comparative studies does little to reduce the uncertainty about 'what works'. Nurse educators need to pay attention to decision, as well as pedagogical, theory in the design of interventions. Study design and

  15. Studies on Interpretive Structural Model for Forest Ecosystem Management Decision-Making

    NASA Astrophysics Data System (ADS)

    Liu, Suqing; Gao, Xiumei; Zen, Qunying; Zhou, Yuanman; Huang, Yuequn; Han, Weidong; Li, Linfeng; Li, Jiping; Pu, Yingshan

    Characterized by their openness, complexity and large scale, forest ecosystems interweave themselves with social system, economic system and other natural ecosystems, thus complicating both their researches and management decision-making. According to the theories of sustainable development, hierarchy-competence levels, cybernetics and feedback, 25 factors have been chosen from human society, economy and nature that affect forest ecosystem management so that they are systematically analyzed via developing an interpretive structural model (ISM) to reveal their relationships and positions in the forest ecosystem management. The ISM consists of 7 layers with the 3 objectives for ecosystem management being the top layer (the seventh layer). The ratio between agricultural production value and industrial production value as the bases of management decision-making in forest ecosystems becomes the first layer at the bottom because it has great impacts on the values of society and the development trends of forestry, while the factors of climatic environments, intensive management extent, management measures, input-output ratio as well as landscape and productivity are arranged from the second to sixth layers respectively.

  16. Improving decision making in crisis.

    PubMed

    Higgins, Guy; Freedman, Jennifer

    2013-01-01

    The most critical activity during emergencies or crises is making decisions about what to do next. This paper provides insights into the challenges that people face in making decisions at any time, but particularly during emergencies and crises. It also introduces the reader to the concept of different sense-making/decision-making domains, the human behaviours that can adversely affect decision making - decision derailers - and ways in which emergency responders can leverage this knowledge to make better decisions. While the literature on decision making is extensive, this paper is focused on those aspects that apply particularly to decision making in emergencies or times of crisis.

  17. Integrating Indigenous Traditional, Local and Scientific Knowledge for Improved Management, Policy and Decision-Making in Reindeer Husbandry in the Russian Arctic

    NASA Technical Reports Server (NTRS)

    Maynard, Nancy G.; Yurchak, Boris; Turi, Johan Mathis; Mathiesen, Svein D.; Aissi-Wespi, Rita L.

    2004-01-01

    As scientists and policy-makers from both indigenous and non-indigenous communities begin to build closer partnerships to address common sustainability issues such as the health impacts of climate change and anthropogenic activities, it becomes increasingly important to create shared information management systems which integrate all relevant factors for optimal information sharing and decision-making. This paper describes a new GIs-based system being designed to bring local and indigenous traditional knowledge together with scientific data and information, remote sensing, and information technologies to address health-related environment, weather, climate, pollution and land use change issues for improved decision/policy-making for reindeer husbandry. The system is building an easily-accessible archive of relevant current and historical, traditional, local and remotely-sensed and other data and observations for shared analysis, measuring, and monitoring parameters of interest. Protection of indigenous culturally sensitive information will be respected through appropriate data protocols. A mechanism which enables easy information sharing among all participants, which is real time and geo-referenced and which allows interconnectivity with remote sites is also being designed into the system for maximum communication among partners. A preliminary version of our system will be described for a Russian reindeer test site, which will include a combination of indigenous knowledge about local conditions and issues, remote sensing and ground-based data on such parameters as the vegetation state and distribution, snow cover, temperature, ice condition, and infrastructure.

  18. Improved management of community-acquired pneumonia in the emergency department.

    PubMed

    Julián-Jiménez, Agustín; Palomo de los Reyes, María José; Parejo Miguez, Raquel; Laín-Terés, Natividad; Cuena-Boy, Rafael; Lozano-Ancín, Agustín

    2013-06-01

    To determine the impact of implementing clinical practice guidelines (CPGs) in the treatment of community-acquired pneumonia (CAP) in the emergency department (ED) by analyzing case management decisions (admission or discharge, appropriateness and timeliness of antibiotic therapy, complementary tests) and the consequent results (clinical stabilization time, length of hospital stay, re-admission to ED and mortality). A prospective, observational, descriptive, comparative study carried out from 1st January 2008 to 1st August 2009 in two phases: before and after the implementation of the "Management of CAP in ED" SEMES-SEPAR (Spanish Society of Emergency Medicine - Spanish Society of Pneumology and Thoracic Surgery) clinical practice guidelines from 2008. Two hundred adult patients treated in the ED with a diagnosis of CAP were included in the study, both in the pre-intervention and post-intervention groups. The application of the guidelines increased the administration of early and appropriate antibiotic therapy (P<.001) and shortened both the total antibiotic therapy (P<.001) and the intravenous antibiotic therapy (P=.042) times. Time to clinical stabilization (P=.027), length of hospital stay (1.14 days, P=.01), intra-hospital mortality (P=.004) and total 30-day mortality (P=.044) were all reduced. Assessment with the Pneumonia Severity Index (PSI) and biomarkers aided in appropriate decision-making concerning admission/discharge (P<.001). The implementation of the SEMES-SEPAR 2008 guidelines, along with the use of PSI and biomarkers, significantly improved the entire treatment process of CAP. This benefitted both patients and the system by reducing mortality and improving the results of other patient management factors. Copyright © 2012 SEPAR. Published by Elsevier España, S.L. All rights reserved.

  19. User-centered design to improve clinical decision support in primary care.

    PubMed

    Brunner, Julian; Chuang, Emmeline; Goldzweig, Caroline; Cain, Cindy L; Sugar, Catherine; Yano, Elizabeth M

    2017-08-01

    A growing literature has demonstrated the ability of user-centered design to make clinical decision support systems more effective and easier to use. However, studies of user-centered design have rarely examined more than a handful of sites at a time, and have frequently neglected the implementation climate and organizational resources that influence clinical decision support. The inclusion of such factors was identified by a systematic review as "the most important improvement that can be made in health IT evaluations." (1) Identify the prevalence of four user-centered design practices at United States Veterans Affairs (VA) primary care clinics and assess the perceived utility of clinical decision support at those clinics; (2) Evaluate the association between those user-centered design practices and the perceived utility of clinical decision support. We analyzed clinic-level survey data collected in 2006-2007 from 170 VA primary care clinics. We examined four user-centered design practices: 1) pilot testing, 2) provider satisfaction assessment, 3) formal usability assessment, and 4) analysis of impact on performance improvement. We used a regression model to evaluate the association between user-centered design practices and the perceived utility of clinical decision support, while accounting for other important factors at those clinics, including implementation climate, available resources, and structural characteristics. We also examined associations separately at community-based clinics and at hospital-based clinics. User-centered design practices for clinical decision support varied across clinics: 74% conducted pilot testing, 62% conducted provider satisfaction assessment, 36% conducted a formal usability assessment, and 79% conducted an analysis of impact on performance improvement. Overall perceived utility of clinical decision support was high, with a mean rating of 4.17 (±.67) out of 5 on a composite measure. "Analysis of impact on performance

  20. The use of multi-criteria decision analysis to tackle waste management problems: a literature review.

    PubMed

    Achillas, Charisios; Moussiopoulos, Nicolas; Karagiannidis, Avraam; Banias, Georgias; Perkoulidis, George

    2013-02-01

    Problems in waste management have become more and more complex during recent decades. The increasing volumes of waste produced and social environmental consciousness present prominent drivers for environmental managers towards the achievement of a sustainable waste management scheme. However, in practice, there are many factors and influences - often mutually conflicting - criteria for finding solutions in real-life applications. This paper presents a review of the literature on multi-criteria decision aiding in waste management problems for all reported waste streams. Despite limitations, which are clearly stated, most of the work published in this field is reviewed. The present review aims to provide environmental managers and decision-makers with a thorough list of practical applications of the multi-criteria decision analysis techniques that are used to solve real-life waste management problems, as well as the criteria that are mostly employed in such applications according to the nature of the problem under study. Moreover, the paper explores the advantages and disadvantages of using multi-criteria decision analysis techniques in waste management problems in comparison to other available alternatives.

  1. Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

    USDA-ARS?s Scientific Manuscript database

    Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...

  2. Decision support systems for ecosystem management: An evaluation of existing systems

    Treesearch

    H. Todd Mowrer; Klaus Barber; Joe Campbell; Nick Crookston; Cathy Dahms; John Day; Jim Laacke; Jim Merzenich; Steve Mighton; Mike Rauscher; Rick Sojda; Joyce Thompson; Peter Trenchi; Mark Twery

    1997-01-01

    This report evaluated 24 computer-aided decision support systems (DSS) that can support management decision-making in forest ecosystems. It compares the scope of each system, spatial capabilities, computational methods, development status, input and output requirements, user support availability, and system performance. Questionnaire responses from the DSS developers (...

  3. Clonidine improved laboratory-measured decision-making performance in abstinent heroin addicts.

    PubMed

    Zhang, Xiao-Li; Wang, Gui-Bin; Zhao, Li-Yan; Sun, Li-Li; Wang, Jun; Wu, Ping; Lu, Lin; Shi, Jie

    2012-01-01

    Impulsivity refers to a wide spectrum of actions characterized by quick and nonplanned reactions to external and internal stimuli, without taking into account the possible negative consequences for the individual or others, and decision-making is one of the biologically dissociated impulsive behaviors. Changes in impulsivity may be associated with norepinephrine. Various populations of drug addicts all performed impulsive decision making, which is a key risk factor in drug dependence and relapse. The present study investigated the effects of clonidine, which decreased norepinephrine release through presynaptic alpha-2 receptor activation, on the impaired decision-making performance in abstinent heroin addicts. Decision-making performance was assessed using the original version of Iowa Gambling Task (IGT). Both heroin addicts and normal controls were randomly assigned to three groups receiving clonidine, 0, 75 µg or 150 µg orally under double blind conditions. Psychiatric symptoms, including anxiety, depression and impulsivity, were rated on standardized scales. Heroin addicts reported higher scores on the Barratt Impulsiveness Scale and exhibited impaired decision-making on the IGT. A single high-dose of clonidine improved the decision-making performance in heroin addicts. Our results suggest clonidine may have a potential therapeutic role in heroin addicts by improving the impaired impulsive decision-making. The current findings have important implications for behavioral and pharmacological interventions targeting decision-making in heroin addiction.

  4. Emergency department management of syncope: need for standardization and improved risk stratification.

    PubMed

    Thiruganasambandamoorthy, Venkatesh; Taljaard, Monica; Stiell, Ian G; Sivilotti, Marco L A; Murray, Heather; Vaidyanathan, Aparna; Rowe, Brian H; Calder, Lisa A; Lang, Eddy; McRae, Andrew; Sheldon, Robert; Wells, George A

    2015-08-01

    Variations in emergency department (ED) syncope management have not been well studied. The goals of this study were to assess variations in management, and emergency physicians' risk perception and disposition decision making. We conducted a prospective study of adults with syncope in six EDs in four cities over 32 months. We collected patient characteristics, ED management, disposition, physicians' prediction probabilities at index presentation and followed patients for 30 days for serious outcomes: death, myocardial infarction (MI), arrhythmia, structural heart disease, pulmonary embolism, significant hemorrhage, or procedural interventions. We used descriptive statistics, ROC curves, and regression analyses. We enrolled 3662 patients: mean age 54.3 years, and 12.9 % were hospitalized. Follow-up data were available for 3365 patients (91.9 %) and 345 patients (10.3 %) suffered serious outcomes: 120 (3.6 %) after ED disposition including 48 patients outside the hospital. After accounting for differences in patient case mix, the rates of ED investigations and disposition were significantly different (p < 0.0001) across the four study cities; as were the rates of 30-day serious outcomes (p < 0.0001) and serious outcomes after ED disposition (p = 0.0227). There was poor agreement between physician risk perception and both observed event rates and referral patterns (p < 0.0001). Only 76.7 % (95 % CI 68.1-83.6) of patients with serious outcomes were appropriately referred. There are large and unexplained differences in ED syncope management. Moreover, there is poor agreement between physician risk perception, disposition decision making, and serious outcomes after ED disposition. A valid risk-stratification tool might help standardize ED management and improve disposition decision making.

  5. Patient and caregiver perspectives on decision support for symptom and quality of life management during cancer treatment: Implications for eHealth.

    PubMed

    Cooley, Mary E; Nayak, Manan M; Abrahm, Janet L; Braun, Ilana M; Rabin, Michael S; Brzozowski, Jane; Lathan, Christopher; Berry, Donna L

    2017-08-01

    Adequate symptom and quality-of-life (SQL) management is a priority during cancer treatment. eHealth is a timely way to enhance patient-engagement, facilitate communication, and improve health outcomes. The objectives of this study were to describe patient and caregivers' perspectives for providing, processing, and managing SQL data to enhance communication and identify desired components for decision support. Data were collected from 64 participants through questionnaires and focus groups. Analysis was conducted using NVivo. Open and axial coding was completed, grouping commonalities and large constructs into nodes to identify and synthesize themes. Face-to-face meetings with clinicians were the prime time to communicate, and patients strove to understand treatment options and the effect on SQL by bringing caregivers to their visits, taking notes, tracking symptoms, and creating portable health records. Patients/caregivers struggled to self-manage their symptoms and were uncertain when to contact clinicians when experiencing uncontrolled symptoms. Most participants identified eHealth solutions for decision support. However, 38% of participants (n = 24) rarely used computers and identified non-eHealth options for decision support. Core components for both eHealth and non-eHealth systems were access to (1) cancer information, (2) medical records, (3) peer support, and (4) improved support and understanding on when to contact clinicians. Patients were faced with an overwhelming amount of information and relied on their caregivers to help navigate the complexities of cancer care and self-manage SQL. Health technologies can provide informational support; however, decision support needs to span multiple venues to avoid increasing disparities caused by a digital divide. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Supporting Coral Reef Ecosystem Management Decisions Appropriate to Climate Change

    NASA Astrophysics Data System (ADS)

    Hendee, J. C.; Fletcher, P.; Shein, K. A.

    2013-05-01

    There has been a perception that the myriad of environmental information products derived from satellite and other instrumental sources means ipso facto that there is a direct use for them by environmental managers. Trouble is, as information providers, for the most part we don't really know what decisions managers face daily, nor is it a trivial matter to ascertain the effect of management decisions on the environment, at least in a time frame that facilitates timely maintenance and enhancement of decision support software. To bridge this gap in understanding, we conducted a Needs Assessment (using methodology from the NOAA/Coastal Services Center's Product Design and Evaluation training program) from December, 2011 through May, 2012, in which we queried 15 resource managers in southeast Florida to identify the types of climate data and information products they needed to understand the effects of climate change in their region of purview, and how best these products should be delivered and subsequently enhanced or corrected. Our intent has been to develop a suite of software and information products customized specifically for environmental managers. This report summarizes our success to date, including a report on the development of software for gathering and presenting specific types of climate data, and a narrative about how some U.S. government sponsored efforts, such as Giovanni and TerraVis, as well as non-governmental sponsored efforts such as Marxan, Zonation, SimCLIM, and other off-the-shelf software might be customized for use in specific regions.

  7. Results from three years on the prairie - improving management through volunteer-collected data

    NASA Astrophysics Data System (ADS)

    Hadley, N.; Force, A.; Holsinger, K.

    2017-12-01

    Citizen science is a nascent and diversifying field with the ability to support wide-ranging outcomes from volunteer education and empowerment to data-driven decisions. Adventure Scientists is a nonprofit organization that focuses on the latter. We approach citizen science through a solutions-oriented lens, in which quality data can influence decisions leading to improved policy, land management and business practices. All our work is interdisciplinary, as we collaborate with partners in government, academia, industry and nonprofits to help fill their data collection needs. In addressing our partners' data needs, it is critical that we align any newfound knowledge with tangible outcomes. Therefore, our projects and partnerships incorporate concrete theories of change and involve the collaborations and relationships necessary to support decision-making. In this presentation, we will highlight Landmark, a landscape-scale project spanning 30,000 acres of North American prairie in Montana, to illustrate one example of a partnership that resulted in improved management from our volunteer-collected data. This was a multi-year citizen science project, where we assisted the American Prairie Reserve's effort to create the largest grasslands and wildlife protected area in the continental U.S. Our partners identified a need to better understand the extent and diversity of wildlife inhabiting and migrating through the space. To provide this enhanced understanding, we helped design and implement a program to collect key wildlife data on the prairie. We recruited, trained and managed specialized volunteers from the outdoor adventure community. Volunteers were responsible for collecting data year-round on animals moving through the landscape to support their management and protection. After three years of data collection and over 19,000 wildlife observations made while monitoring 29 species, the grasslands preserve is now moving forward with an expansive wildlife dataset to

  8. Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.

    PubMed

    Laleci Erturkmen, Gokce Banu; Yuksel, Mustafa; Sarigul, Bunyamin; Lilja, Mikael; Chen, Rong; Arvanitis, Theodoros N

    2018-01-01

    Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.

  9. Improved Management of Water and Natural Resources Requires Open, Cognizant, Adaptive Science and Policy

    NASA Astrophysics Data System (ADS)

    Glynn, P. D.; Voinov, A. A.; Shapiro, C. D.; Jenni, K. E.

    2017-12-01

    Water issues impact the availability and use of other natural resources as well as environmental conditions. In an increasingly populated hyper-connected world, water issues are increasingly "wicked problems": complex problems with high uncertainties and no independent observers. Water is essential to life, and life affects water quality and availability. Scientists, managers, decision-makers, and the greater public all have a stake in improving the management of water resources. In turn, they are part of the systems that they are studying, deciding on, affecting, or trying to improve. Governance of water issues requires greater accessibility, traceability, and accountability (ATA) in science and policy. Water-related studies and decision-making need transdisciplinary science, inclusive participatory processes, and consideration and acceptance of multiple perspectives. Biases, Beliefs, Heuristics, and Values (BBHV) shape much of our perceptions and knowledge, and inevitably, affect both science and policy. Understanding the role of BBHV is critical to (1) understanding individual and group judgments and choices, (2) recognizing potential differences between societal "wants" and societal "needs", and (3) identifying "winners" and "losers" of policy decisions. Societal acceptance of proposed policies and actions can be fostered by enhancing participatory processes and by providing greater ATA in science, in policy, and in development of the laws, rules, and traditions that constrain decision-making. An adaptive science-infused governance framework is proposed that seeks greater cognizance of the role of BBHV in shaping science and policy choices and decisions, and that also seeks "Open Traceable Accountable Policy" to complement "Open Science". We discuss the limitations of the governance that we suggest, as well as tools and approaches to help implementation.

  10. Voice, Collaboration and School Culture: Creating a Community for School Improvement. Evaluation of the Pioneer SCBM Schools, Hawaii's School/Community-Based Management Initiative. Executive Summary.

    ERIC Educational Resources Information Center

    Izu, Jo Ann; And Others

    Site-based management is designed to bring decision making to the school level and involve all stakeholders in a process that will result ultimately in improved student outcomes. Enacted into law in June 1989, Hawaii's School/Community-Based Management Initiative (SCBM) is part of a national trend toward decentralizing decision making and…

  11. Multi-criteria decision making to support waste management: A critical review of current practices and methods.

    PubMed

    Goulart Coelho, Lineker M; Lange, Liséte C; Coelho, Hosmanny Mg

    2017-01-01

    Solid waste management is a complex domain involving the interaction of several dimensions; thus, its analysis and control impose continuous challenges for decision makers. In this context, multi-criteria decision-making models have become important and convenient supporting tools for solid waste management because they can handle problems involving multiple dimensions and conflicting criteria. However, the selection of the multi-criteria decision-making method is a hard task since there are several multi-criteria decision-making approaches, each one with a large number of variants whose applicability depends on information availability and the aim of the study. Therefore, to support researchers and decision makers, the objectives of this article are to present a literature review of multi-criteria decision-making applications used in solid waste management, offer a critical assessment of the current practices, and provide suggestions for future works. A brief review of fundamental concepts on this topic is first provided, followed by the analysis of 260 articles related to the application of multi-criteria decision making in solid waste management. These studies were investigated in terms of the methodology, including specific steps such as normalisation, weighting, and sensitivity analysis. In addition, information related to waste type, the study objective, and aspects considered was recorded. From the articles analysed it is noted that studies using multi-criteria decision making in solid waste management are predominantly addressed to problems related to municipal solid waste involving facility location or management strategy.

  12. Linking Effective Project Management to Business Strategy in Oil and Gas Industry through Decision-making Processes

    NASA Astrophysics Data System (ADS)

    Adeleke, Adeyinka

    The construction project in the oil and gas industry covers the entire spectrum of hydrocarbon production from the wellhead (upstream) to downstream facilities. In each of these establishments, the activities in a construction project include: consulting, studies, front-end engineering, detail engineering, procurement, program management, construction, installation, commissioning and start-up. Efficient management of each of the activities involved in construction projects is one of the driving forces for the successful completion of the project. Optimizing the crucial factors in project management during each phase of a project in an oil and gas industry can assist managers to maximize the use of available resources and drive the project to successful conclusions. One of these factors is the decision-making process in the construction project. Current research effort investigated the relationship between decision-making processes and business strategy in oil and gas industry using employee surveys. I recruited employees of different races, age group, genders, and years of experience in order understand their influence on the implementation of the decision-making process in oil and gas industry through a quantitative survey. Decision-making was assessed using five decision measures: (a) rational, (b) intuitive, (c) dependent, (d) avoidant, and (e) spontaneous. The findings indicated gender, age, years of work experience and job titles as primary variables with a negative relationship with decision-making approach for employees working in a major oil and gas industry. The study results revealed that the two most likely decision-making methods in oil and gas industry include: making a decision in a logical and systematic way and seek assistance from others when making a decision. Additionally, the two leading management approaches to decision-making in the oil and gas industry include: decision analysis is part of organization culture and management is committed to

  13. The relationship between patient data and pooled clinical management decisions.

    PubMed

    Ludbrook, G I; O'Loughlin, E J; Corcoran, T B; Grant, C

    2013-01-01

    A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P >0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient

  14. Combination of uncertainty theories and decision-aiding methods for natural risk management in a context of imperfect information

    NASA Astrophysics Data System (ADS)

    Tacnet, Jean-Marc; Dupouy, Guillaume; Carladous, Simon; Dezert, Jean; Batton-Hubert, Mireille

    2017-04-01

    In mountain areas, natural phenomena such as snow avalanches, debris-flows and rock-falls, put people and objects at risk with sometimes dramatic consequences. Risk is classically considered as a combination of hazard, the combination of the intensity and frequency of the phenomenon, and vulnerability which corresponds to the consequences of the phenomenon on exposed people and material assets. Risk management consists in identifying the risk level as well as choosing the best strategies for risk prevention, i.e. mitigation. In the context of natural phenomena in mountainous areas, technical and scientific knowledge is often lacking. Risk management decisions are therefore based on imperfect information. This information comes from more or less reliable sources ranging from historical data, expert assessments, numerical simulations etc. Finally, risk management decisions are the result of complex knowledge management and reasoning processes. Tracing the information and propagating information quality from data acquisition to decisions are therefore important steps in the decision-making process. One major goal today is therefore to assist decision-making while considering the availability, quality and reliability of information content and sources. A global integrated framework is proposed to improve the risk management process in a context of information imperfection provided by more or less reliable sources: uncertainty as well as imprecision, inconsistency and incompleteness are considered. Several methods are used and associated in an original way: sequential decision context description, development of specific multi-criteria decision-making methods, imperfection propagation in numerical modeling and information fusion. This framework not only assists in decision-making but also traces the process and evaluates the impact of information quality on decision-making. We focus and present two main developments. The first one relates to uncertainty and imprecision

  15. The path dependence of district manager decision-space in Ghana

    PubMed Central

    Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

    2016-01-01

    The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970–85); (2) Strengthening District Health Systems Initiative (1986–93); (3) health sector reform planning and creation of the Ghana Health Service (1994–96) and (4) health sector reform implementation (1997–2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of

  16. The path dependence of district manager decision-space in Ghana.

    PubMed

    Kwamie, Aku; van Dijk, Han; Ansah, Evelyn K; Agyepong, Irene Akua

    2016-04-01

    The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970-85); (2) Strengthening District Health Systems Initiative (1986-93); (3) health sector reform planning and creation of the Ghana Health Service (1994-96) and (4) health sector reform implementation (1997-2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-space. However, the latter half of period 4 witnessed district manager decision-space contraction. Formalization of Ghana Health Service structures influenced by self-reinforcing tendencies towards centralized decision-making, national and donor shifts in health sector financing, and changes in key policy actors all worked to the detriment of the district health system, reversing early gains from bottom-up development of the district health system. Policy feedback mechanisms have been influenced by historical and contemporary sequencing of local government and health sector decentralization. An initial act of administrative decentralization, followed by incomplete political and fiscal decentralization has ensured that the balance of power has

  17. A multi-criteria decision analysis assessment of waste paper management options.

    PubMed

    Hanan, Deirdre; Burnley, Stephen; Cooke, David

    2013-03-01

    The use of Multi-criteria Decision Analysis (MCDA) was investigated in an exercise using a panel of local residents and stakeholders to assess the options for managing waste paper on the Isle of Wight. Seven recycling, recovery and disposal options were considered by the panel who evaluated each option against seven environmental, financial and social criteria. The panel preferred options where the waste was managed on the island with gasification and recycling achieving the highest scores. Exporting the waste to the English mainland for incineration or landfill proved to be the least preferred options. This research has demonstrated that MCDA is an effective way of involving community groups in waste management decision making. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Patient understanding of diabetes self-management: participatory decision-making in diabetes care.

    PubMed

    Quinn, Charlene C; Royak-Schaler, Renee; Lender, Dan; Steinle, Nanette; Gadalla, Shahinaz; Zhan, Min

    2011-05-01

    Our aim was to determine whether patient participation in decision-making about diabetes care is associated with understanding of diabetes self-management and subsequent self-care practices. We also identified issues that would impact messaging for use in mobile diabetes communication. A cross-sectional observational study was conducted with type 2 diabetes patients (n = 81) receiving their care at the University of Maryland Joslin Diabetes Center. A convenience sample of patients were eligible to participate if they were aged 25-85 years, had type 2 diabetes, spoke English, and visited their physician diabetes manager within the past 6 months. In-person patient interviews were conducted at the time of clinic visits to assess patient understanding of diabetes management, self-care practices, and perceptions of participation in decision-making about diabetes care. African Americans reported fewer opportunities to participate in decision-making than Caucasians, after controlling for education [mean difference (MD) = -2.4, p = .02]. This association became insignificant after controlling for patient-physician race concordance (MD = -1.5, p = .21). Patient understanding of self-care was predicted by having greater than high school education (MD = 3.6, p = .001) and having physicians who involved them in decision-making about their care. For each unit increase in understanding of diabetes self-care, the mean patient self-care practice score increased by 0.16 (p = .003), after adjustment for patient race and education. Patient participation in decision-making is associated with better understanding of care. Participation in decision-making plays a key role in patient understanding of diabetes self-management and subsequent self-care practices. Patients with limited education need specific instruction in foot care, food choices, and monitoring hemoglobin A1c. © 2011 Diabetes Technology Society.

  19. Physician decision-making in the management of work related upper extremity injuries.

    PubMed

    Szekeres, Mike; Macdermid, Joy C; Katchky, Adam; Grewal, Ruby

    2018-05-22

    Physicians working in a tertiary care injured worker clinic are faced with clinical decision-making that must balance the needs of patients and society in managing complex clinical problems that are complicated by the work-workplace context. The purpose of this study is to describe and characterize the decision-making process of upper extremity specialized surgeons when managing injured workers within a specialized worker's compensation clinic. Surgeons were interviewed in a semi-structured manner. Following each interview, the surgeon was also observed in a clinic visit during a new patient assessment, allowing observation of the interactional patterns between surgeon and patient, and comparison of the process described in the interview to what actually occurred during clinic visits. The primary central theme emerging from the surgeon interviews and the clinical observation was the focus on the importance of comprehensive assessment to make the first critical decision: an accurate diagnosis. Two subthemes were also found. The first of these involved the decision whether to proceed to management strategies or to continue with further investigation if the correct diagnosis is uncertain. Once the central theme of diagnosis was achieved, a second subtheme was highlighted; selecting appropriate management options, given the complexities of managing the injured worker, the workplace, and the compensation board. This study illustrates that upper extremity surgeons rely on their training and experience with upper extremity conditions to follow a sequential but iterative decision-making process to provide a more definitive diagnosis and treatment plan for workers with injuries that are often complex. The surgeons are challenged by the context which takes them out of their familiar zone of typical clinical practice to deal with the interactions between the injury, worker, work, workplace and insurer.

  20. Multicriteria Decision Framework for Cybersecurity Risk Assessment and Management.

    PubMed

    Ganin, Alexander A; Quach, Phuoc; Panwar, Mahesh; Collier, Zachary A; Keisler, Jeffrey M; Marchese, Dayton; Linkov, Igor

    2017-09-05

    Risk assessors and managers face many difficult challenges related to novel cyber systems. Among these challenges are the constantly changing nature of cyber systems caused by technical advances, their distribution across the physical, information, and sociocognitive domains, and the complex network structures often including thousands of nodes. Here, we review probabilistic and risk-based decision-making techniques applied to cyber systems and conclude that existing approaches typically do not address all components of the risk assessment triplet (threat, vulnerability, consequence) and lack the ability to integrate across multiple domains of cyber systems to provide guidance for enhancing cybersecurity. We present a decision-analysis-based approach that quantifies threat, vulnerability, and consequences through a set of criteria designed to assess the overall utility of cybersecurity management alternatives. The proposed framework bridges the gap between risk assessment and risk management, allowing an analyst to ensure a structured and transparent process of selecting risk management alternatives. The use of this technique is illustrated for a hypothetical, but realistic, case study exemplifying the process of evaluating and ranking five cybersecurity enhancement strategies. The approach presented does not necessarily eliminate biases and subjectivity necessary for selecting countermeasures, but provides justifiable methods for selecting risk management actions consistent with stakeholder and decisionmaker values and technical data. Published 2017. This article is a U.S. Government work and is in the public domain in the U.S.A.

  1. The role of infectious disease impact in informing decision-making for animal health management in aquaculture systems in Bangladesh.

    PubMed

    Garza, Maria; Mohan, Chadag Vishnumurthy; Rahman, Meezanur; Wieland, Barbara; Häsler, Barbara

    2018-03-20

    improvement of surveillance and diagnostic systems. Improved systems along with evidence on disease impact could inform the prioritisation of diseases and resource allocation for disease control in Bangladesh. Further, this evidence needs to be used to advise decisions to have a true value, for which establishing and strengthening communication pathways and processes is critical to make systematic use of the information and improve animal health management. In the light of future threats to Bangladesh such as climate change, increasing population density and demand for animal source foods, it is crucial to strengthen animal health management systems to reduce livelihoods vulnerability, food insecurity and the likelihood of disease emergence. Copyright © 2018 Elsevier B.V. All rights reserved.

  2. A Drought Cyberinfrastructure System for Improving Water Resource Management and Policy Making

    NASA Astrophysics Data System (ADS)

    AghaKouchak, Amir

    2015-04-01

    Development of reliable monitoring and prediction indices and tools are fundamental to drought preparedness, management, and response decision making. This presentation provides an overview of the Global Integrated Drought Monitoring and Prediction System (GIDMaPS) which offers near real-time drought information using both remote sensing observations and model simulations. Designed as a cyberinfrastructure system, GIDMaPS provides drought information based on a wide range of model simulations and satellite observations from different space agencies. Numerous indices have been developed for drought monitoring based on various indicator variables (e.g., precipitation, soil moisture, water storage). Defining droughts based on a single variable (e.g., precipitation, soil moisture or runoff) may not be sufficient for reliable risk assessment and decision making. GIDMaPS provides drought information based on multiple indices including Standardized Precipitation Index (SPI), Standardized Soil Moisture Index (SSI) and the Multivariate Standardized Drought Index (MSDI) which combines SPI and SSI probabilistically. In other words, MSDI incorporates the meteorological and agricultural drought conditions for overall characterization of droughts, and better management and distribution of water resources among and across different users. The seasonal prediction component of GIDMaPS is based on a persistence model which requires historical data and near-past observations. The seasonal drought prediction component is designed to provide drought information for water resource management, and short-term decision making. In this presentation, both monitoring and prediction components of GIDMaPS will be discussed, and the results from several major droughts including the 2013 Namibia, 2012-2013 United States, 2011-2012 Horn of Africa, and 2010 Amazon Droughts will be presented. The presentation will highlight how this drought cyberinfrastructure system can be used to improve water

  3. GIS-based spatial decision support system for grain logistics management

    NASA Astrophysics Data System (ADS)

    Zhen, Tong; Ge, Hongyi; Jiang, Yuying; Che, Yi

    2010-07-01

    Grain logistics is the important component of the social logistics, which can be attributed to frequent circulation and the great quantity. At present time, there is no modern grain logistics distribution management system, and the logistics cost is the high. Geographic Information Systems (GIS) have been widely used for spatial data manipulation and model operations and provide effective decision support through its spatial database management capabilities and cartographic visualization. In the present paper, a spatial decision support system (SDSS) is proposed to support policy makers and to reduce the cost of grain logistics. The system is composed of two major components: grain logistics goods tracking model and vehicle routing problem optimization model and also allows incorporation of data coming from external sources. The proposed system is an effective tool to manage grain logistics in order to increase the speed of grain logistics and reduce the grain circulation cost.

  4. Crisis management: an extended reference framework for decision makers.

    PubMed

    Carone, Alessandro; Iorio, Luigi Di

    2013-01-01

    The paper discusses a reference framework for capabilities supporting effective crisis management. This framework has been developed by joining experiences in the field and knowledge of organisational models for crisis management, and executives' empowerment, coaching and behavioural analysis. The paper is aimed at offering further insight to executives on critical success factors and means for managing crisis situations by extending the scope of analysis to human behaviour, to emotions and fears and their correlation with decision making. It is further intended to help familiarise them and to facilitate approaching a path towards emotional awareness.

  5. Introduction to Decision Support Systems for Risk Based Management of Contaminated Sites

    EPA Science Inventory

    A book on Decision Support Systems for Risk-based Management of contaminated sites is appealing for two reasons. First, it addresses the problem of contaminated sites, which has worldwide importance. Second, it presents Decision Support Systems (DSSs), which are powerful comput...

  6. Analysis of Stakeholder's Behaviours for an Improved Management of an Agricultural Coastal Region in Oman

    NASA Astrophysics Data System (ADS)

    Khatri, Ayisha Al; Jens, Grundmann; der Weth Rüdiger, van; Niels, Schütze

    2015-04-01

    Al Batinah coastal area is the main agricultural region in Oman. Agriculture is concentrated in Al Batinah, because of more fertile soils and easier access to water in the form of groundwater compared to other administrative areas in the country. The region now is facing a problem as a result of over abstraction of fresh groundwater for irrigation from the main aquifer along the coast. This enforces the inflow of sea water into the coastal aquifer and causes salinization of the groundwater. As a consequence the groundwater becomes no longer suitable for irrigation which impacts the social and economical situation of farmers as well as the environment. Therefore, the existing situation generates conflicts between different stakeholders regarding water availability, sustainable aquifer management, and profitable agricultural production in Al Batinah region. Several management measures to maintain the groundwater aquifer in the region, were implemented by the government. However, these solutions showed only limited successes for the existing problem. The aim of this study now is to evaluate the implementation potential of several management interventions and their combinations by analysing opinions and responses of all relevant stakeholders in the region. This is done in order to identify potential conflicts among stakeholders to a participatory process within the frame of an integrated water resources management and to support decision makers in taking more informed decisions. Questionnaires were designed for collecting data from different groups of stakeholders e.g. water professionals, farmers from the study area and decision makers of different organizations and ministries. These data were analysed statistically for each group separately as well as regarding relations amongst groups by using the SPSS (Statistical Package for Social Science) software package. Results show, that the need to improve the situation is supported by all groups. However, significant

  7. Decision Support Systems for Research and Management in Advanced Life Support

    NASA Technical Reports Server (NTRS)

    Rodriquez, Luis F.

    2004-01-01

    Decision support systems have been implemented in many applications including strategic planning for battlefield scenarios, corporate decision making for business planning, production planning and control systems, and recommendation generators like those on Amazon.com(Registered TradeMark). Such tools are reviewed for developing a similar tool for NASA's ALS Program. DSS are considered concurrently with the development of the OPIS system, a database designed for chronicling of research and development in ALS. By utilizing the OPIS database, it is anticipated that decision support can be provided to increase the quality of decisions by ALS managers and researchers.

  8. Knowledge Requirements and Management in Expert Decision Support Systems for (Military) Situation Assessment

    DTIC Science & Technology

    1983-08-01

    constitutes a fundamental problem in many decision making processes. In business management we face this problem when determining the status of an...Tehiical Report 576 ( 1 ) 4 KNOWLEDGE REQUIREMENTS AND MANAGEMENT IN EXPERT DECISION SUPPORT SYSTEMS FOR (MILITARY) SITUATION ASSESSMENT MOOM sen...accomplished under contract for the Department of the Army The Israel Institute of Business Research Technical review by Robert H. Sasmor Joseph M

  9. Patient factors that influence clinicians' decision making in self-management support: A clinical vignette study.

    PubMed

    Bos-Touwen, Irene D; Trappenburg, Jaap C A; van der Wulp, Ineke; Schuurmans, Marieke J; de Wit, Niek J

    2017-01-01

    Self-management support is an integral part of current chronic care guidelines. The success of self-management interventions varies between individual patients, suggesting a need for tailored self-management support. Understanding the role of patient factors in the current decision making of health professionals can support future tailoring of self-management interventions. The aim of this study is to identify the relative importance of patient factors in health professionals' decision making regarding self-management support. A factorial survey was presented to primary care physicians and nurses. The survey consisted of clinical vignettes (case descriptions), in which 11 patient factors were systematically varied. Each care provider received a set of 12 vignettes. For each vignette, they decided whether they would give this patient self-management support and whether they expected this support to be successful. The associations between respondent decisions and patient factors were explored using ordered logit regression. The survey was completed by 60 general practitioners and 80 nurses. Self-management support was unlikely to be provided in a third of the vignettes. The most important patient factor in the decision to provide self-management support as well as in the expectation that self-management support would be successful was motivation, followed by patient-provider relationship and illness perception. Other factors, such as depression or anxiety, education level, self-efficacy and social support, had a small impact on decisions. Disease, disease severity, knowledge of disease, and age were relatively unimportant factors. This is the first study to explore the relative importance of patient factors in decision making and the expectations regarding the provision of self-management support to chronic disease patients. By far, the most important factor considered was patient's motivation; unmotivated patients were less likely to receive self-management support

  10. Development of a requirements management system for technical decision - making processes in the geological disposal project

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hiroyoshi Ueda; Katsuhiko Ishiguro; Kazumi Kitayama

    2007-07-01

    NUMO (Nuclear Waste Management Organization of Japan) has a responsibility for implementing geological disposal of vitrified HLW (High-Level radioactive Waste) in the Japanese nuclear waste management programme. Its staged siting procedure was initiated in 2002 by an open call for volunteer sites. Careful management strategy and methodology for the technical decision-making at every milestone are required to prepare for the volunteer site application and the site investigation stages after that. The formal Requirement Management System (RMS) is planned to support the computerized implementation of the specific management methodology, termed the NUMO Structured Approach (NSA). This planned RMS will help formore » comprehensive management of the decision-making processes in the geological disposal project, change management towards the anticipated project deviations, efficient project driving such as well programmed R and D etc. and structured record-keeping regarding the past decisions, which leads to soundness of the project in terms of the long-term continuity. The system should have handling/management functions for the database including the decisions/requirements in the project in consideration, their associated information and the structures composed of them in every decision-making process. The information relating to the premises, boundary conditions and time plan of the project should also be prepared in the system. Effective user interface and efficient operation on the in-house network are necessary. As a living system for the long-term formal use, flexibility to updating is indispensable. In advance of the formal system development, two-year activity to develop the preliminary RMS was already started. The purpose of this preliminary system is to template the decision/requirement structure, prototype the decision making management and thus show the feasibility of the innovative RMS. The paper describes the current status of the development, focusing on

  11. Ethical decision making in pain management: a conceptual framework

    PubMed Central

    Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

    2018-01-01

    Introduction The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician–patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding “last-ditch” treatments of severe pain; and 6) failure to be accountable and equitable. Objective The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. Methods This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. Discussion We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory

  12. Ethical decision making in pain management: a conceptual framework.

    PubMed

    Carvalho, Ana Sofia; Martins Pereira, Sandra; Jácomo, António; Magalhães, Susana; Araújo, Joana; Hernández-Marrero, Pablo; Costa Gomes, Carlos; Schatman, Michael E

    2018-01-01

    The practice and study of pain management pose myriad ethical challenges. There is a consensual opinion that adequate management of pain is a medical obligation rooted in classical Greek practice. However, there is evidence that patients often suffer from uncontrolled and unnecessary pain. This is inconsistent with the leges artis, and its practical implications merit a bioethical analysis. Several factors have been identified as causes of uncontrolled and unnecessary pain, which deprive patients from receiving appropriate treatments that theoretically they have the right to access. Important factors include (with considerable regional, financial, and cultural differences) the following: 1) failure to identify pain as a priority in patient care; 2) failure to establish an adequate physician-patient relationship; 3) insufficient knowledge regarding adequate prescription of analgesics; 4) conflicting notions associated with drug-induced risk of tolerance and fear of addiction; 5) concerns regarding "last-ditch" treatments of severe pain; and 6) failure to be accountable and equitable. The aim of this article was to establish that bioethics can serve as a framework for addressing these challenging issues and, from theoretical to practical approaches, bioethical reflection can contextualize the problem of unrelieved pain. This article is organized into three parts. First, we illustrate that pain management and its undertreatment are indeed ethical issues. The second part describes possible ethical frameworks that can be combined and integrated to better define the ethical issues in pain management. Finally, we discuss possible directions forward to improve ethical decision making in pain management. We argue that 1) the treatment of pain is an ethical obligation, 2) health science schools, especially medical training institutions, have the duty to teach pain management in a comprehensive fashion, and 3) regulatory measures, which prevent patients from access to opioid

  13. Visualising Pareto-optimal trade-offs helps move beyond monetary-only criteria for water management decisions

    NASA Astrophysics Data System (ADS)

    Hurford, Anthony; Harou, Julien

    2014-05-01

    Water related eco-system services are important to the livelihoods of the poorest sectors of society in developing countries. Degradation or loss of these services can increase the vulnerability of people decreasing their capacity to support themselves. New approaches to help guide water resources management decisions are needed which account for the non-market value of ecosystem goods and services. In case studies from Brazil and Kenya we demonstrate the capability of many objective Pareto-optimal trade-off analysis to help decision makers balance economic and non-market benefits from the management of existing multi-reservoir systems. A multi-criteria search algorithm is coupled to a water resources management simulator of each basin to generate a set of Pareto-approximate trade-offs representing the best case management decisions. In both cases, volume dependent reservoir release rules are the management decisions being optimised. In the Kenyan case we further assess the impacts of proposed irrigation investments, and how the possibility of new investments impacts the system's trade-offs. During the multi-criteria search (optimisation), performance of different sets of management decisions (policies) is assessed against case-specific objective functions representing provision of water supply and irrigation, hydropower generation and maintenance of ecosystem services. Results are visualised as trade-off surfaces to help decision makers understand the impacts of different policies on a broad range of stakeholders and to assist in decision-making. These case studies show how the approach can reveal unexpected opportunities for win-win solutions, and quantify the trade-offs between investing to increase agricultural revenue and negative impacts on protected ecosystems which support rural livelihoods.

  14. Merging economics and epidemiology to improve the prediction and management of infectious disease.

    PubMed

    Perrings, Charles; Castillo-Chavez, Carlos; Chowell, Gerardo; Daszak, Peter; Fenichel, Eli P; Finnoff, David; Horan, Richard D; Kilpatrick, A Marm; Kinzig, Ann P; Kuminoff, Nicolai V; Levin, Simon; Morin, Benjamin; Smith, Katherine F; Springborn, Michael

    2014-12-01

    Mathematical epidemiology, one of the oldest and richest areas in mathematical biology, has significantly enhanced our understanding of how pathogens emerge, evolve, and spread. Classical epidemiological models, the standard for predicting and managing the spread of infectious disease, assume that contacts between susceptible and infectious individuals depend on their relative frequency in the population. The behavioral factors that underpin contact rates are not generally addressed. There is, however, an emerging a class of models that addresses the feedbacks between infectious disease dynamics and the behavioral decisions driving host contact. Referred to as "economic epidemiology" or "epidemiological economics," the approach explores the determinants of decisions about the number and type of contacts made by individuals, using insights and methods from economics. We show how the approach has the potential both to improve predictions of the course of infectious disease, and to support development of novel approaches to infectious disease management.

  15. E-Estuary: Developing a Decision-support System for Coastal Management in the Conterminous United States

    EPA Science Inventory

    Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The United States Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E...

  16. Improved CLARAty Functional-Layer/Decision-Layer Interface

    NASA Technical Reports Server (NTRS)

    Estlin, Tara; Rabideau, Gregg; Gaines, Daniel; Johnston, Mark; Chouinard, Caroline; Nessnas, Issa; Shu, I-Hsiang

    2008-01-01

    Improved interface software for communication between the CLARAty Decision and Functional layers has been developed. [The Coupled Layer Architecture for Robotics Autonomy (CLARAty) was described in Coupled-Layer Robotics Architecture for Autonomy (NPO-21218), NASA Tech Briefs, Vol. 26, No. 12 (December 2002), page 48. To recapitulate: the CLARAty architecture was developed to improve the modularity of robotic software while tightening coupling between planning/execution and basic control subsystems. Whereas prior robotic software architectures typically contained three layers, the CLARAty contains two layers: a decision layer (DL) and a functional layer (FL).] Types of communication supported by the present software include sending commands from DL modules to FL modules and sending data updates from FL modules to DL modules. The present software supplants prior interface software that had little error-checking capability, supported data parameters in string form only, supported commanding at only one level of the FL, and supported only limited updates of the state of the robot. The present software offers strong error checking, and supports complex data structures and commanding at multiple levels of the FL, and relative to the prior software, offers a much wider spectrum of state-update capabilities.

  17. Improving Aquatic Plant Management in the California Sacramento-San Joaquin Delta

    NASA Technical Reports Server (NTRS)

    Bubenheim, David L.; Potter, Chris

    2018-01-01

    Management of aquatic weeds in complex watersheds and river systems present many challenges to assessment, planning and implementation of management practices for floating and submerged aquatic invasive plants. The Delta Region Areawide Aquatic Weed Project (DRAAWP), a USDA sponsored area-wide project, is working to enhance planning, decision-making and operational efficiency in the California Sacramento-San Joaquin Delta. Satellite and airborne remote sensing are used map (area coverage and biomass), direct operations, and assess management impacts on plant communities. Archived satellite records going are used to review results from previous climate and management events and aide in developing long-term strategies. Modeling at local and watershed scales provides insight into land-use effects on water quality. Plant growth models informed by remote sensing are being applied spatially across the Delta to balance location and type of aquatic plant, growth response to altered environments, phenology, environmental regulations, and economics in selection of management practices. Initial utilization of remote sensing tools developed for mapping of aquatic invasive weeds improved operational efficiency by focusing limited chemical use to strategic areas with high plant-control impact and incorporating mechanical harvesting when chemical use is restricted. These assessment methods provide a comprehensive and quantitative view of aquatic invasive plants communities in the California Delta, both spatial and temporal, informed by ecological understanding with the objective of improving management and assessment effectiveness.

  18. Improving Smallholder Farmer Biosecurity in the Mekong Region Through Change Management.

    PubMed

    Young, J R; Evans-Kocinski, S; Bush, R D; Windsor, P A

    2015-10-01

    Transboundary animal diseases including foot-and-mouth disease and haemorrhagic septicaemia remain a major constraint for improving smallholder large ruminant productivity in the Mekong region, producing negative impacts on rural livelihoods and compromising efforts to reduce poverty and food insecurity. The traditional husbandry practices of smallholders largely exclude preventive health measures, increasing risks of disease transmission. Although significant efforts have been made to understand the social aspects of change development in agricultural production, attention to improving the adoption of biosecurity has been limited. This study reviews smallholder biosecurity risk factors identified in the peer-reviewed literature and from field research observations conducted in Cambodia and Laos during 2006-2013, considering these in the context of a change management perspective aimed at improving adoption of biosecurity measures. Motivation for change, resistance to change, knowledge management, cultural dimensions, systems theory and leadership are discussed. Due to geographical, physical and resource variability, the implementation of biosecurity interventions suitable for smallholders is not a 'one size fits all'. Smallholders should be educated in biosecurity principles and empowered to make personal decisions rather than adopt prescribed pre-defined interventions. Biosecurity interventions should be aligned with smallholder farmer motivations, preferably offering clear short-term risk management benefits that elicit interest from smallholders. Linking biosecurity and disease control with improved livestock productivity provides opportunities for sustainable improvements in livelihoods. Participatory research and extension that improves farmer knowledge and practices offers a pathway to elicit sustainable broad-scale social change. However, examples of successes need to be communicated both at the 'evidence-based level' to influence regional policy

  19. Factors that influence producer decisions to implement management strategies.

    PubMed

    Field, Thomas G

    2014-12-01

    Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.

  20. Improving the 'how' and 'what' decisions of elite table tennis players.

    PubMed

    Raab, Markus; Masters, Rich S W; Maxwell, Jonathan P

    2005-06-01

    Training methods in sport usually focus on improving either technical or tactical aspects of performance, ignoring the fact that successful performance requires the athlete to simultaneously decide what movement to perform and how it should be executed. Young elite table tennis players were trained, in a first phase, to improve their forehand and backhand movements and, in a second phase, to make a tactical switch between forehand and backhand movements. Half of the players took part in behavioral training focusing on how to perform the required movements, whereas half received additional video feedback about their technical and tactical performance (decision training). The results indicate that improvements of how decisions (techniques) and what decisions (tactics) can occur as a consequence of combining technical and tactical training. These results were stable in delayed Post-test analyses of competitive matches. It was concluded that a combination of both technical and tactical training is beneficial to elite table tennis performers, particularly during early seasonal training programs.

  1. Using social-network research to improve outcomes in natural resource management.

    PubMed

    Groce, Julie E; Farrelly, Megan A; Jorgensen, Bradley S; Cook, Carly N

    2018-05-08

    The conservation and management of natural resources operates within social-ecological systems, in which resource users are embedded in social and environmental contexts that influence their management decisions. Characterizing social networks of resource users has received growing interest as an approach for understanding social influences on decision-making, and social network analysis (SNA) has emerged as a useful technique to explore these relationships. In this review, we synthesize how SNA has been used in studies of natural resource management. To present our findings, we developed a theory of change which outlines the influence between social networks and social processes (e.g., interactions between individuals), which in turn influence social outcomes (e.g., decisions or actions) that impact environmental outcomes (e.g., improved condition). Our review of 85 studies demonstrate frequent use of descriptive methods to characterize social processes, yet few studies considered social outcomes or examined network structure relative to environmental outcomes. Only 4 studies assessed network interventions intended to impact relevant processes or outcomes. The heterogeneity in case studies, methods, and analyses preclude general lessons. Thus, we offer a typology of appropriate measures for each stage of our theory of change, to structure and progress our learning about the role of social networks in achieving environmental outcomes. In addition, we suggest shifts in research foci towards intervention studies, to aid in understanding causality and inform the design of conservation initiatives. We also identify the need for developing clearer justification and guidance around the proliferation of network measures. The use of SNA in natural resource management is expanding rapidly, thus now is the ideal time for the conservation community to build a more rigorous evidence base to demonstrate the extent to which social networks can play a role in achieving desired

  2. Developing an Environmental Decision Support System for Stream Management: the STREAMES Experience

    NASA Astrophysics Data System (ADS)

    Riera, J.; Argerich, A.; Comas, J.; Llorens, E.; Martí, E.; Godé, L.; Pargament, D.; Puig, M.; Sabater, F.

    2005-05-01

    Transferring research knowledge to stream managers is crucial for scientifically sound management. Environmental decision support systems are advocated as an effective means to accomplish this. STREAMES (STream REAach Management: an Expert System) is a decision tree based EDSS prototype developed within the context of an European project as a tool to assist water managers in the diagnosis of problems, detection of causes, and selection of management strategies for coping with stream degradation issues related mostly to excess nutrient availability. STREAMES was developed by a team of scientists, water managers, and experts in knowledge engineering. Although the tool focuses on management at the stream reach scale, it also incorporates a mass-balance catchment nutrient emission model and a simple GIS module. We will briefly present the prototype and share our experience in its development. Emphasis will be placed on the process of knowledge acquisition, the design process, the pitfalls and benefits of the communication between scientists and managers, and the potential for future development of STREAMES, particularly in the context of the EU Water Framework Directive.

  3. Achieving a Risk-Informed Decision-Making Environment at NASA: The Emphasis of NASA's Risk Management Policy

    NASA Technical Reports Server (NTRS)

    Dezfuli, Homayoon

    2010-01-01

    This slide presentation reviews the evolution of risk management (RM) at NASA. The aim of the RM approach at NASA is to promote an approach that is heuristic, proactive, and coherent across all of NASA. Risk Informed Decision Making (RIDM) is a decision making process that uses a diverse set of performance measures along with other considerations within a deliberative process to inform decision making. RIDM is invoked for key decisions such as architecture and design decisions, make-buy decisions, and budget reallocation. The RIDM process and how it relates to the continuous Risk Management (CRM) process is reviewed.

  4. Preparing for a decision support system.

    PubMed

    Callan, K

    2000-08-01

    The increasing pressure to reduce costs and improve outcomes is driving the health care industry to view information as a competitive advantage. Timely information is required to help reduce inefficiencies and improve patient care. Numerous disparate operational or transactional information systems with inconsistent and often conflicting data are no longer adequate to meet the information needs of integrated care delivery systems and networks in competitive managed care environments. This article reviews decision support system characteristics and describes a process to assess the preparedness of an organization to implement and use decision support systems to achieve a more effective, information-based decision process. Decision support tools included in this article range from reports to data mining.

  5. Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

    Treesearch

    Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

    2017-01-01

    Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

  6. Managing resources in NHS dentistry: the views of decision-makers in primary care organisations.

    PubMed

    Holmes, R D; Donaldson, C; Exley, C; Steele, J G

    2008-09-27

    To investigate priority setting and decision-making in primary care organisations and to determine how resources are managed in order to meet the oral health needs of local populations. This is a qualitative study. The purposive sample comprised twelve dental public health consultants and six senior finance representatives from contrasting care systems across the United Kingdom. Participants completed a written information sheet followed by a recorded semi-structured telephone interview. Conversations were professionally transcribed verbatim and analysed independently by two investigators using the constant comparative method. The emergent themes focused upon: the role of participants in decision-making; professional relationships; managing change; information needs; and identifying and managing priorities. There was wide interpretation with respect to participants' roles and perceived information needs for decision-making and commissioning. A unifying factor was the importance placed by participants upon trust and the influence of individuals on the success of relationships forged between primary care organisations and general dental practitioners. To facilitate decision-making in primary care organisations, commissioners and managers could engage further with practitioners and incorporate them into commissioning and resource allocation processes. Greater clarity is required regarding the role of dental public health consultants within primary care organisations and commissioning decisions.

  7. The Effect of Shared Decision-Making on the Improvement in Teachers' Job Development

    ERIC Educational Resources Information Center

    Chi Keung, Cheng

    2008-01-01

    Background: Teacher Participation in decision-making is one of the recommendations of school-based management and one of the key characteristics of an effective school. Although teacher participation in decision making is claimed to be correlated with their affective outcome, few researchers have been attempted to verify the predictive…

  8. Transforming clinical practice guidelines and clinical pathways into fast-and-frugal decision trees to improve clinical care strategies.

    PubMed

    Djulbegovic, Benjamin; Hozo, Iztok; Dale, William

    2018-02-27

    Contemporary delivery of health care is inappropriate in many ways, largely due to suboptimal Q5 decision-making. A typical approach to improve practitioners' decision-making is to develop evidence-based clinical practice guidelines (CPG) by guidelines panels, who are instructed to use their judgments to derive practice recommendations. However, mechanisms for the formulation of guideline judgments remains a "black-box" operation-a process with defined inputs and outputs but without sufficient knowledge of its internal workings. Increased explicitness and transparency in the process can be achieved by implementing CPG as clinical pathways (CPs) (also known as clinical algorithms or flow-charts). However, clinical recommendations thus derived are typically ad hoc and developed by experts in a theory-free environment. As any recommendation can be right (true positive or negative), or wrong (false positive or negative), the lack of theoretical structure precludes the quantitative assessment of the management strategies recommended by CPGs/CPs. To realize the full potential of CPGs/CPs, they need to be placed on more solid theoretical grounds. We believe this potential can be best realized by converting CPGs/CPs within the heuristic theory of decision-making, often implemented as fast-and-frugal (FFT) decision trees. This is possible because FFT heuristic strategy of decision-making can be linked to signal detection theory, evidence accumulation theory, and a threshold model of decision-making, which, in turn, allows quantitative analysis of the accuracy of clinical management strategies. Fast-and-frugal provides a simple and transparent, yet solid and robust, methodological framework connecting decision science to clinical care, a sorely needed missing link between CPGs/CPs and patient outcomes. We therefore advocate that all guidelines panels express their recommendations as CPs, which in turn should be converted into FFTs to guide clinical care. © 2018 John Wiley

  9. Visualization support for risk-informed decision making when planning and managing software developments

    NASA Technical Reports Server (NTRS)

    Feather, Martin S.; Kiper, James D.; Menzies, Tim

    2005-01-01

    Key decisions are made in the early stages of planning and management of software developments. The information basis for these decisions is often a mix of analogy with past developments, and the best judgments of domain experts. Visualization of this information can support to such decision making by clarifying the status of the information and yielding insights into the ramifications of that information vis-a-vis decision alternatives.

  10. 77 FR 12877 - Record of Decision for the General Management Plan/Abbreviated Final Environmental Impact...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-02

    ... Decision for the General Management Plan/Abbreviated Final Environmental Impact Statement for New River... Abbreviated Final Environmental Impact Statement for the General Management Plan for New River Gorge National... Record of Decision can be downloaded from the NPS Planning, Environment and Public Comment (PEPC) Web...

  11. Towards decision support for waiting lists: an operations management view.

    PubMed

    Vissers, J M; Van Der Bij, J D; Kusters, R J

    2001-06-01

    This paper considers the phenomenon of waiting lists in a healthcare setting, which is characterised by limitations on the national expenditure, to explore the potentials of an operations management perspective. A reference framework for waiting list management is described, distinguishing different levels of planning in healthcare--national, regional, hospital and process--that each contributes to the existence of waiting lists through managerial decision making. In addition, different underlying mechanisms in demand and supply are distinguished, which together explain the development of waiting lists. It is our contention that within this framework a series of situation specific models should be designed to support communication and decision making. This is illustrated by the modelling of the demand for cataract treatment in a regional setting in the south-eastern part of the Netherlands. An input-output model was developed to support decisions regarding waiting lists. The model projects the demand for treatment at a regional level and makes it possible to evaluate waiting list impacts for different scenarios to meet this demand.

  12. Analysis of the decision-making process of nurse managers: a collective reflection.

    PubMed

    Eduardo, Elizabete Araujo; Peres, Aida Maris; de Almeida, Maria de Lourdes; Roglio, Karina de Dea; Bernardino, Elizabeth

    2015-01-01

    to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories. qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis. data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model. the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that influence and determine right decisions.

  13. Decision making in trauma settings: simulation to improve diagnostic skills.

    PubMed

    Murray, David J; Freeman, Brad D; Boulet, John R; Woodhouse, Julie; Fehr, James J; Klingensmith, Mary E

    2015-06-01

    received higher scores when managing heuristic scenarios but were less effective when managing the scenarios that require a more analytic approach. Simulation can be used to provide teams with decision-making experiences in trauma settings and could be used to improve diagnostic skills as well as study the decision-making process.

  14. The Evidential Basis of Decision Making in Plant Disease Management.

    PubMed

    Hughes, Gareth

    2017-08-04

    The evidential basis for disease management decision making is provided by data relating to risk factors. The decision process involves an assessment of the evidence leading to taking (or refraining from) action on the basis of a prediction. The primary objective of the decision process is to identify-at the time the decision is made-the control action that provides the best predicted end-of-season outcome, calculated in terms of revenue or another appropriate metric. Data relating to disease risk factors may take a variety of forms (e.g., continuous, discrete, categorical) on measurement scales in a variety of units. Log 10 -likelihood ratios provide a principled basis for the accumulation of evidence based on such data and allow predictions to be made via Bayesian updating of prior probabilities.

  15. A Semantic Approach with Decision Support for Safety Service in Smart Home Management

    PubMed Central

    Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

    2016-01-01

    Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate. PMID:27527170

  16. A Semantic Approach with Decision Support for Safety Service in Smart Home Management.

    PubMed

    Huang, Xiaoci; Yi, Jianjun; Zhu, Xiaomin; Chen, Shaoli

    2016-08-03

    Research on smart homes (SHs) has increased significantly in recent years because of the convenience provided by having an assisted living environment. The functions of SHs as mentioned in previous studies, particularly safety services, are seldom discussed or mentioned. Thus, this study proposes a semantic approach with decision support for safety service in SH management. The focus of this contribution is to explore a context awareness and reasoning approach for risk recognition in SH that enables the proper decision support for flexible safety service provision. The framework of SH based on a wireless sensor network is described from the perspective of neighbourhood management. This approach is based on the integration of semantic knowledge in which a reasoner can make decisions about risk recognition and safety service. We present a management ontology for a SH and relevant monitoring contextual information, which considers its suitability in a pervasive computing environment and is service-oriented. We also propose a rule-based reasoning method to provide decision support through reasoning techniques and context-awareness. A system prototype is developed to evaluate the feasibility, time response and extendibility of the approach. The evaluation of our approach shows that it is more effective in daily risk event recognition. The decisions for service provision are shown to be accurate.

  17. Automation in future air traffic management: effects of decision aid reliability on controller performance and mental workload.

    PubMed

    Metzger, Ulla; Parasuraman, Raja

    2005-01-01

    Future air traffic management concepts envisage shared decision-making responsibilities between controllers and pilots, necessitating that controllers be supported by automated decision aids. Even as automation tools are being introduced, however, their impact on the air traffic controller is not well understood. The present experiments examined the effects of an aircraft-to-aircraft conflict decision aid on performance and mental workload of experienced, full-performance level controllers in a simulated Free Flight environment. Performance was examined with both reliable (Experiment 1) and inaccurate automation (Experiment 2). The aid improved controller performance and reduced mental workload when it functioned reliably. However, detection of a particular conflict was better under manual conditions than under automated conditions when the automation was imperfect. Potential or actual applications of the results include the design of automation and procedures for future air traffic control systems.

  18. Evaluating the best available social science for natural resource management decision-making

    Treesearch

    Susan Charnley; Courtney Carothers; Terre Satterfield; Arielle Levine; Melissa R. Poe; Karma Norman; Jamie Donatuto; Sara Jo Breslow; Michael B. Mascia; Phillip S. Levin; Xavier Basurto; Christina C. Hicks; Carlos García-Quijano; Kevin St. Martin

    2017-01-01

    Increasing recognition of the human dimensions of natural resource management issues, and of social and ecological sustainability and resilience as being inter-related, highlights the importance of applying social science to natural resource management decision-making. Moreover, a number of laws and regulations require natural resource management agencies to consider...

  19. Management of the geriatric trauma patient at risk of death: therapy withdrawal decision making.

    PubMed

    Trunkey, D D; Cahn, R M; Lenfesty, B; Mullins, R

    2000-01-01

    The management of geriatric injured patients admitted to a trauma center includes the selective decision to provide comfort care only, including withdrawal of therapy, and a choice to not use full application of standard therapies. The decision makers in this process include multiple individuals in addition to the patient. Retrospective review of documentation by 2 blinded reviewers of the cohort of patients over a recent 5-year period (1993-1997). Trauma service of a level I trauma center. A convenience sample of patients aged 65 years and older who died, and whose medical record was available for review. Patients were categorized as having withdrawal of therapy, and documentation in the medical record of who made the assessment decisions and recommendations, and to what extent the processes of care were documented. Among 87 geriatric trauma patients who died, 47 had documentation interpreted as indicating a decision was made to withdraw therapy. In only a few circumstances was the patient capable of actively participating in these decisions. The other individuals involved in recommendations for withdrawal of therapy were, in order of prevalence, the treating trauma surgeon, family members (as proxy reporting the patient's preferences), or a second physician. Documentation regarding the end-of-life decisions was often fragmentary, and in some cases ambiguous. Copies of legal advance directives were rarely available in the medical record, and ethics committee participation was used only once. Withdrawal of therapy is a common event in the terminal care of geriatric injured patients. The process for reaching a decision regarding withdrawal of therapy is complex because in most circumstances patients' injuries preclude their full participation. Standards for documentation of essential information, including patients' preferences and decision-making ability, should be developed to improve the process and assist with recording these complicated decisions that often

  20. Applications of Satellite Data to Support Improvements in Irrigation and Groundwater Management in California

    NASA Technical Reports Server (NTRS)

    Melton, Forrest S.

    2017-01-01

    In agricultural regions around the world, threats to water supplies from drought and groundwater depletion are driving increased demand for tools to advance agricultural water use efficiency and support sustainable groundwater management. Satellite mapping of evapotranspiration (ET) from irrigated agricultural lands can provide agricultural producers and water resource managers with information that can be used to both optimize ag water use and improve estimates of groundwater withdrawals for irrigation. We describe the development of two remote sensing-based tools for ET mapping in California, including important lessons in terms of system design, partnership development, and transition to operations. For irrigation management, the integration of satellite data and surface sensor networks to provide timely delivery of information on crop water requirements can make irrigation scheduling more practical, convenient, and accurate.Developed through a partnership between NASA and the CA Department of Water Resources, the Satellite Irrigation Management Support (SIMS) framework integrates satellite data with information from agricultural weather networks to map crop canopy development and crop water requirements at the scale of individual fields. Information is distributed to agricultural producers and water managers via a web-based interface and web data services. SIMS also provides an API that facilitates integration with other irrigation decision support tools, such as CropManage and IrriQuest. Field trials using these integrated tools have shown that they can be used to sustain yields while improving water use efficiency and nutrient management. For sustainable groundwater management, the combination of satellite-derived estimates of ET and data on surface water deliveries for irrigation can increase the accuracy of estimates of groundwater pumping. We are developing an OpenET platform to facilitate access to ET data from multiple models and accelerate operational

  1. Applications of Satellite Data to Support Improvements in Irrigation and Groundwater Management in California

    NASA Astrophysics Data System (ADS)

    Melton, F. S.; Huntington, J. L.; Johnson, L.; Guzman, A.; Morton, C.; Zaragoza, I.; Dexter, J.; Rosevelt, C.; Michaelis, A.; Nemani, R. R.; Cahn, M.; Temesgen, B.; Trezza, R.; Frame, K.; Eching, S.; Grimm, R.; Hall, M.

    2017-12-01

    In agricultural regions around the world, threats to water supplies from drought and groundwater depletion are driving increased demand for tools to advance agricultural water use efficiency and support sustainable groundwater management. Satellite mapping of evapotranspiration (ET) from irrigated agricultural lands can provide agricultural producers and water resource managers with information that can be used to both optimize ag water use and improve estimates of groundwater withdrawals for irrigation. We describe the development of two remote sensing-based tools for ET mapping in California, including important lessons in terms of system design, partnership development, and transition to operations. For irrigation management, the integration of satellite data and surface sensor networks to provide timely delivery of information on crop water requirements can make irrigation scheduling more practical, convenient, and accurate. Developed through a partnership between NASA and the CA Department of Water Resources, the Satellite Irrigation Management Support (SIMS) framework integrates satellite data with information from agricultural weather networks to map crop canopy development and crop water requirements at the scale of individual fields. Information is distributed to agricultural producers and water managers via a web-based interface and web data services. SIMS also provides an API that facilitates integration with other irrigation decision support tools, such as CropManage and IrriQuest. Field trials using these integrated tools have shown that they can be used to sustain yields while improving water use efficiency and nutrient management. For sustainable groundwater management, the combination of satellite-derived estimates of ET and data on surface water deliveries for irrigation can increase the accuracy of estimates of groundwater pumping. We are developing an OpenET platform to facilitate access to ET data from multiple models and accelerate operational

  2. Decision support tools to support the operations of traffic management centers (TMC)

    DOT National Transportation Integrated Search

    2011-01-31

    The goal of this project is to develop decision support tools to support traffic management operations based on collected intelligent transportation system (ITS) data. The project developments are in accordance with the needs of traffic management ce...

  3. The Ebb and Flow of Airborne Pathogens: Monitoring and Use in Disease Management Decisions.

    PubMed

    Mahaffee, Walter F; Stoll, Rob

    2016-05-01

    Perhaps the earliest form of monitoring the regional spread of plant disease was a group of growers gathering together at the market and discussing what they see in their crops. This type of reporting continues to this day through regional extension blogs, by crop consultants and more formal scouting of sentential plots in the IPM PIPE network (http://www.ipmpipe.org/). As our knowledge of plant disease epidemiology has increased, we have also increased our ability to detect and monitor the presence of pathogens and use this information to make management decisions in commercial production systems. The advent of phylogenetics, next-generation sequencing, and nucleic acid amplification technologies has allowed for development of sensitive and accurate assays for pathogen inoculum detection and quantification. The application of these tools is beginning to change how we manage diseases with airborne inoculum by allowing for the detection of pathogen movement instead of assuming it and by targeting management strategies to the early phases of the epidemic development when there is the greatest opportunity to reduce the rate of disease development. While there are numerous advantages to using data on inoculum presence to aid management decisions, there are limitations in what the data represent that are often unrecognized. In addition, our understanding of where and how to effectively monitor airborne inoculum is limited. There is a strong need to improve our knowledge of the mechanisms that influence inoculum dispersion across scales as particles move from leaf to leaf, and everything in between.

  4. Approach of Decision Making Based on the Analytic Hierarchy Process for Urban Landscape Management

    NASA Astrophysics Data System (ADS)

    Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

    2013-03-01

    This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.

  5. Approach of decision making based on the analytic hierarchy process for urban landscape management.

    PubMed

    Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

    2013-03-01

    This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.

  6. An Evaluation on Factors Influencing Decision making for Malaysia Disaster Management: The Confirmatory Factor Analysis Approach

    NASA Astrophysics Data System (ADS)

    Zubir, S. N. A.; Thiruchelvam, S.; Mustapha, K. N. M.; Che Muda, Z.; Ghazali, A.; Hakimie, H.

    2017-12-01

    For the past few years, natural disaster has been the subject of debate in disaster management especially in flood disaster. Each year, natural disaster results in significant loss of life, destruction of homes and public infrastructure, and economic hardship. Hence, an effective and efficient flood disaster management would assure non-futile efforts for life saving. The aim of this article is to examine the relationship between approach, decision maker, influence factor, result, and ethic to decision making for flood disaster management in Malaysia. The key elements of decision making in the disaster management were studied based on the literature. Questionnaire surveys were administered among lead agencies at East Coast of Malaysia in the state of Kelantan and Pahang. A total of 307 valid responses had been obtained for further analysis. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were carried out to analyse the measurement model involved in the study. The CFA for second-order reflective and first-order reflective measurement model indicates that approach, decision maker, influence factor, result, and ethic have a significant and direct effect on decision making during disaster. The results from this study showed that decision- making during disaster is an important element for disaster management to necessitate a successful collaborative decision making. The measurement model is accepted to proceed with further analysis known as Structural Equation Modeling (SEM) and can be assessed for the future research.

  7. Diagnostic decision-making and strategies to improve diagnosis.

    PubMed

    Thammasitboon, Satid; Cutrer, William B

    2013-10-01

    required to effectively address cognitive processing errors. Researchers in various areas, including patient safety/quality improvement, decision-making, and problem solving, must work together to make medical diagnosis more reliable. © 2013 Mosby, Inc. All rights reserved.

  8. Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition.

    PubMed

    Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

    2016-01-01

    Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems.

  9. Improved wound management at lower cost: a sensible goal for Australia.

    PubMed

    Norman, Rosana E; Gibb, Michelle; Dyer, Anthony; Prentice, Jennifer; Yelland, Stephen; Cheng, Qinglu; Lazzarini, Peter A; Carville, Keryln; Innes-Walker, Karen; Finlayson, Kathleen; Edwards, Helen; Burn, Edward; Graves, Nicholas

    2016-06-01

    Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  10. Imaging informatics-based multimedia ePR system for data management and decision support in rehabilitation research

    NASA Astrophysics Data System (ADS)

    Wang, Ximing; Verma, Sneha; Qin, Yi; Sterling, Josh; Zhou, Alyssa; Zhang, Jeffrey; Martinez, Clarisa; Casebeer, Narissa; Koh, Hyunwook; Winstein, Carolee; Liu, Brent

    2013-03-01

    With the rapid development of science and technology, large-scale rehabilitation centers and clinical rehabilitation trials usually involve significant volumes of multimedia data. Due to the global aging crisis, millions of new patients with age-related chronic diseases will produce huge amounts of data and contribute to soaring costs of medical care. Hence, a solution for effective data management and decision support will significantly reduce the expenditure and finally improve the patient life quality. Inspired from the concept of the electronic patient record (ePR), we developed a prototype system for the field of rehabilitation engineering. The system is subject or patient-oriented and customized for specific projects. The system components include data entry modules, multimedia data presentation and data retrieval. To process the multimedia data, the system includes a DICOM viewer with annotation tools and video/audio player. The system also serves as a platform for integrating decision-support tools and data mining tools. Based on the prototype system design, we developed two specific applications: 1) DOSE (a phase 1 randomized clinical trial to determine the optimal dose of therapy for rehabilitation of the arm and hand after stroke.); and 2) NEXUS project from the Rehabilitation Engineering Research Center(RERC, a NIDRR funded Rehabilitation Engineering Research Center). Currently, the system is being evaluated in the context of the DOSE trial with a projected enrollment of 60 participants over 5 years, and will be evaluated by the NEXUS project with 30 subjects. By applying the ePR concept, we developed a system in order to improve the current research workflow, reduce the cost of managing data, and provide a platform for the rapid development of future decision-support tools.

  11. Making business decisions using trend information

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Prevette, S.S., Westinghouse Hanford, Richland, WA

    1997-11-24

    Performance Measures, and the trend information that results from their analyses, can help managers in their decision making process. The business decisions that are to be discussed are: Assignment of limited Resources, Funding, Budget; Contractor Rewards/Incentives; Where to focus Process Improvement, Reengineering efforts; When to ask ``What Happened?!!``; Determine if a previous decision was effectively implemented. Trending can provide an input for rational Business Decisions. Key Element is determination of whether or not a significant trend exists - segregating Common Cause from Special Cause. The Control Chart is the tool for accomplishment of trending and determining if you are meetingmore » your Business Objectives. Eliminate Numerical Targets; the goal is Significant Improvement. Profound Knowledge requires integrating data results with gut feeling.« less

  12. Decision support for patient care: implementing cybernetics.

    PubMed

    Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A

    2004-01-01

    The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.

  13. Impact of electronic health record clinical decision support on the management of pediatric obesity.

    PubMed

    Shaikh, Ulfat; Berrong, Jeanette; Nettiksimmons, Jasmine; Byrd, Robert S

    2015-01-01

    Clinicians vary significantly in their adherence to clinical guidelines for overweight/obesity. This study assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. The study team programmed a point-of-care alert linked to a checklist and standardized documentation templates to appear during health maintenance visits for overweight/obese children in an outpatient teaching clinic and compared outcomes through medical record reviews of 574 (287 control and 287 intervention) visits. The results demonstrated a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity. Although clinical guideline adherence increased significantly, it was far from universal. It is unknown if modest improvements in adherence to clinical guidelines translate to improvements in children's health. However, this intervention was relatively easy to implement and produced measurable improvements in health care delivery. © 2014 by the American College of Medical Quality.

  14. The Organizational Decision Making Climate of Issues Management Programs: A Case Study.

    ERIC Educational Resources Information Center

    Wills, Sandra

    A study examined the decision making climate of organizations that are using issues management and what type of model of issues management is followed--theorists have been attempting to define issues management since it began appearing 20 year ago. Subjects, 112 males and 30 females who were professionals working in the area of issues management…

  15. A Decision-Making Model For Managing or Regenerating Southern Upland Hardwoods

    Treesearch

    K. Kyle Cunningham; Andrew W. Ezell; Keith L. Belli; John D. Hodges

    2004-01-01

    A decision-making model for managing or regenerating southern upland hardwoods is being created for three physiographic provinces including the Cumberland Plateau, Western Highland Rim, and Upper Coastal Plain. The model performs a stand evaluation, from a silvicultural standpoint, and declares a stand as being either manageable or in need of regeneration. Model...

  16. Stakeholder engagement in dredged material management decisions.

    PubMed

    Collier, Zachary A; Bates, Matthew E; Wood, Matthew D; Linkov, Igor

    2014-10-15

    Dredging and disposal issues often become controversial with local stakeholders because of their competing interests. These interests tend to manifest themselves in stakeholders holding onto entrenched positions, and deadlock can result without a methodology to move the stakeholder group past the status quo. However, these situations can be represented as multi-stakeholder, multi-criteria decision problems. In this paper, we describe a case study in which multi-criteria decision analysis was implemented in a multi-stakeholder setting in order to generate recommendations on dredged material placement for Long Island Sound's Dredged Material Management Plan. A working-group of representatives from various stakeholder organizations was formed and consulted to help prioritize sediment placement sites for each dredging center in the region by collaboratively building a multi-criteria decision model. The resulting model framed the problem as several alternatives, criteria, sub-criteria, and metrics relevant to stakeholder interests in the Long Island Sound region. An elicitation of values, represented as criteria weights, was then conducted. Results show that in general, stakeholders tended to agree that all criteria were at least somewhat important, and on average there was strong agreement on the order of preferences among the diverse groups of stakeholders. By developing the decision model iteratively with stakeholders as a group and soliciting their preferences, the process sought to increase stakeholder involvement at the front-end of the prioritization process and lead to increased knowledge and consensus regarding the importance of site-specific criteria. Published by Elsevier B.V.

  17. Estimation of potential maximum biomass of trout in Wyoming streams to assist management decisions

    USGS Publications Warehouse

    Hubert, W.A.; Marwitz, T.D.; Gerow, K.G.; Binns, N.A.; Wiley, R.W.

    1996-01-01

    Fishery managers can benefit from knowledge of the potential maximum biomass (PMB) of trout in streams when making decisions on the allocation of resources to improve fisheries. Resources are most likely to he expended on streams with high PMB and with large differences between PMB and currently measured biomass. We developed and tested a model that uses four easily measured habitat variables to estimate PMB (upper 90th percentile of predicted mean bid mass) of trout (Oncorhynchus spp., Salmo trutta, and Salvelinus fontinalis) in Wyoming streams. The habitat variables were proportion of cover, elevation, wetted width, and channel gradient. The PMB model was constructed from data on 166 stream reaches throughout Wyoming and validated on an independent data set of 50 stream reaches. Prediction of PMB in combination with estimation of current biomass and information on habitat quality can provide managers with insight into the extent to which management actions may enhance trout biomass.

  18. Human health improvement in Sub-Saharan Africa through integrated management of arthropod transmitted diseases and natural resources.

    PubMed

    Baumgärtner, J; Bieri, M; Buffoni, G; Gilioli, G; Gopalan, H; Greiling, J; Tikubet, G; Van Schayk, I

    2001-01-01

    A concept of an ecosystem approach to human health improvement in Sub-Saharan Africa is presented here. Three factors mainly affect the physical condition of the human body: the abiotic environment, vector-transmitted diseases, and natural resources. Our concept relies on ecological principles embedded in a social context and identifies three sets of subsystems for study and management: human disease subsystems, natural resource subsystems, and decision-support subsystems. To control human diseases and to secure food from resource subsystems including livestock or crops, integrated preventive approaches are preferred over exclusively curative and sectorial approaches. Environmental sustainability - the basis for managing matter and water flows - contributes to a healthy human environment and constitutes the basis for social sustainability. For planning and implementation of the human health improvement scheme, participatory decision-support subsystems adapted to the local conditions need to be designed through institutional arrangements. The applicability of this scheme is demonstrated in urban and rural Ethiopia.

  19. Outsourced Investment Management: An Overview for Institutional Decision-Makers

    ERIC Educational Resources Information Center

    Griswold, John S.; Jarvis, William F.

    2013-01-01

    Outsourcing of investment management is a growing trend among institutional investors. With a broad range of institutions using or exploring the outsourced chief investment officer (OCIO) model, portfolio size is no longer the determining factor driving the outsourcing decision. For all but the largest institutional investors--those with deep…

  20. E-Estuary: Developing a Decision Support System for Coastal Management in the Conterminous United States (IAHR)

    EPA Science Inventory

    Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

  1. The interaction of patient race, provider bias, and clinical ambiguity on pain management decisions.

    PubMed

    Hirsh, Adam T; Hollingshead, Nicole A; Ashburn-Nardo, Leslie; Kroenke, Kurt

    2015-06-01

    Although racial disparities in pain care are widely reported, much remains to be known about the role of provider and contextual factors. We used computer-simulated patients to examine the influence of patient race, provider racial bias, and clinical ambiguity on pain decisions. One hundred twenty-nine medical residents/fellows made assessment (pain intensity) and treatment (opioid and nonopioid analgesics) decisions for 12 virtual patients with acute pain. Race (black/white) and clinical ambiguity (high/low) were manipulated across vignettes. Participants completed the Implicit Association Test and feeling thermometers, which assess implicit and explicit racial biases, respectively. Individual- and group-level analyses indicated that race and ambiguity had an interactive effect on providers' decisions, such that decisions varied as a function of ambiguity for white but not for black patients. Individual differences across providers were observed for the effect of race and ambiguity on decisions; however, providers' implicit and explicit biases did not account for this variability. These data highlight the complexity of racial disparities and suggest that differences in care between white and black patients are, in part, attributable to the nature (ie, ambiguity) of the clinical scenario. The current study suggests that interventions to reduce disparities should differentially target patient, provider, and contextual factors. This study examined the unique and collective influence of patient race, provider racial bias, and clinical ambiguity on providers' pain management decisions. These results could inform the development of interventions aimed at reducing disparities and improving pain care. Copyright © 2015 American Pain Society. Published by Elsevier Inc. All rights reserved.

  2. Principles of Classroom Management: A Professional Decision-Making Model, 7th Edition

    ERIC Educational Resources Information Center

    Levin, James; Nolan, James F.

    2014-01-01

    This text takes a decision-making model approach to classroom management. It provides teachers with a very practical system to influence students to choose to behave productively and to strive for academic success. This widely used text presents an array of decision-making options that guide teachers in developing positive, pro-social classroom…

  3. Multicriteria Decision Analysis of Freshwater Resource Management in Southwestern Bangladesh

    NASA Astrophysics Data System (ADS)

    Peters, C.; Baroud, H.; Hornberger, G. M.

    2016-12-01

    Freshwater resources in coastal Bangladesh fluctuate with extreme periods of shortage and abundance. Bangladeshis have adapted to these alternating periods but are still plagued with scarce drinking water resources due to pond water pathogens, salinity of groundwater, and arsenic contamination. The success of attempts to correct the problem of unsafe drinking water have varied across the southern Bangladesh as a result of physical and social factors. We use a multicriteria decision analysis (MCDA) to explore the various physical and social factors that influence decisions about freshwater technologies and management schemes in southern Bangladesh. To determine the best freshwater technologies and management schemes, we examine four alternatives, including managed aquifer recharge (MAR), pond sand filter (PSF), rain water harvesting (RWH), and tubewells (TW). Criteria are grouped into four categories (environmental, technical, social, and economic) and weighting of social factors will be determined by community surveys, non-governmental organizations (NGO) opinions, and academic interviews. Social data include regional water quality perceptions, perceptions of management/technology success, MAR community surveys, and interviews with NGO partners. Environmental and technical feasibility factors are determined from regional water quality data, geospatial information, land use/land change, and regional stratigraphy. Survey data suggest a wide range of criteria based on location and stakeholder perception. MAR and PSF technologies likely have the greatest environmental and technical potential for success but are highly influenced by community dynamics, individual perspective, and NGO involvement. RWH solutions are used frequently and are successful at reducing the water security threats of contamination by pathogens, arsenic, and salts. This MCDA informs us of community and stakeholder water resource decisions, specifically related to their objectives and preferences.

  4. Risk preferences in strategic wildfire decision making: a choice experiment with U.S. wildfire managers.

    PubMed

    Wibbenmeyer, Matthew J; Hand, Michael S; Calkin, David E; Venn, Tyron J; Thompson, Matthew P

    2013-06-01

    Federal policy has embraced risa management as an appropriate paradigm for wildfire management. Economic theory suggests that over repeated wildfire events, potential economic costs and risas of ecological damage are optimally balanced when management decisions are free from biases, risa aversion, and risa seeking. Of primary concern in this article is how managers respond to wildfire risa, including the potential effect of wildfires (on ecological values, structures, and safety) and the likelihood of different fire outcomes. We use responses to a choice experiment questionnaire of U.S. federal wildfire managers to measure attitudes toward several components of wildfire risa and to test whether observed risa attitudes are consistent with the efficient allocation of wildfire suppression resources. Our results indicate that fire managers' decisions are consistent with nonexpected utility theories of decisions under risa. Managers may overallocate firefighting resources when the likelihood or potential magnitude of damage from fires is low, and sensitivity to changes in the probability of fire outcomes depends on whether probabilities are close to one or zero and the magnitude of the potential harm. © 2012 Society for Risk Analysis.

  5. Managing for climate change on protected areas: An adaptive management decision making framework.

    PubMed

    Tanner-McAllister, Sherri L; Rhodes, Jonathan; Hockings, Marc

    2017-12-15

    Current protected area management is becoming more challenging with advancing climate change and current park management techniques may not be adequate to adapt for effective management into the future. The framework presented here provides an adaptive management decision making process to assist protected area managers with adapting on-park management to climate change. The framework sets out a 4 step process. One, a good understanding of the park's context within climate change. Secondly, a thorough understanding of the park management systems including governance, planning and management systems. Thirdly, a series of management options set out as an accept/prevent change style structure, including a systematic assessment of those options. The adaptive approaches are defined as acceptance of anthropogenic climate change impact and attempt to adapt to a new climatic environment or prevention of change and attempt to maintain current systems under new climatic variations. Last, implementation and monitoring of long term trends in response to ecological responses to management interventions and assessing management effectiveness. The framework addresses many issues currently with park management in dealing with climate change including the considerable amount of research focussing on 'off-reserve' strategies, and threats and stress focused in situ park management. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Contrasting RCC, RVU, and ABC for managed care decisions. A case study compares three widely used costing methods and finds one superior.

    PubMed

    West, T D; Balas, E A; West, D A

    1996-08-01

    To obtain cost data needed to improve managed care decisions and negotiate profitable capitation contracts, most healthcare provider organizations use one of three costing methods: the ratio-of-costs-to-charges method, the relative value unit method, or the activity-based costing method. Although the ratio-of-costs to charges is used by a majority of provider organizations, a case study that applied these three methods in a renal dialysis clinic found that the activity-based costing method provided the most accurate cost data. By using this costing method, healthcare financial managers can obtain the data needed to make optimal decisions regarding resource allocation and cost containment, thus assuring the longterm financial viability of their organizations.

  7. Decision Support for Resilient Communities: EPA’s Watershed Management Optimization Support Tool

    EPA Science Inventory

    The U.S. EPA Atlantic Ecology Division is releasing version 3 of the Watershed Management Optimization Support Tool (WMOST v3) in February 2018. WMOST is a decision-support tool that facilitates integrated water resources management (IWRM) by communities and watershed organizati...

  8. APPLICATION OF THE US DECISION SUPPORT TOOL FOR MATERIALS AND WASTE MANAGEMENT

    EPA Science Inventory

    EPA¿s National Risk Management Research Laboratory has led the development of a municipal solid waste decision support tool (MSW-DST). The computer software can be used to calculate life-cycle environmental tradeoffs and full costs of different waste management plans or recycling...

  9. Improving productivity through more effective time management.

    PubMed

    Arnold, Edwin; Pulich, Marcia

    2004-01-01

    Effective time management has become increasingly important for managers as they seek to accomplish objectives in today's organizations, which have been restructured for efficiency while employing fewer people. Managers can improve their ability to manage time effectively by examining their attitudes toward time, analyzing time-wasting behaviors, and developing better time management skills. Managers can improve their performance and promotion potential with more effective time utilization. Strategies for improving time management skills are presented.

  10. A combined disease management and process modeling approach for assessing and improving care processes: a fall management case-study.

    PubMed

    Askari, Marjan; Westerhof, Richard; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E; Abu-Hanna, Ameen

    2013-10-01

    To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study. We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees. The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid. The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. A cumulative energy demand indicator (CED), life cycle based, for industrial waste management decision making.

    PubMed

    Puig, Rita; Fullana-I-Palmer, Pere; Baquero, Grau; Riba, Jordi-Roger; Bala, Alba

    2013-12-01

    Life cycle thinking is a good approach to be used for environmental decision-support, although the complexity of the Life Cycle Assessment (LCA) studies sometimes prevents their wide use. The purpose of this paper is to show how LCA methodology can be simplified to be more useful for certain applications. In order to improve waste management in Catalonia (Spain), a Cumulative Energy Demand indicator (LCA-based) has been used to obtain four mathematical models to help the government in the decision of preventing or allowing a specific waste from going out of the borders. The conceptual equations and all the subsequent developments and assumptions made to obtain the simplified models are presented. One of the four models is discussed in detail, presenting the final simplified equation to be subsequently used by the government in decision making. The resulting model has been found to be scientifically robust, simple to implement and, above all, fulfilling its purpose: the limitation of waste transport out of Catalonia unless the waste recovery operations are significantly better and justify this transport. Copyright © 2013. Published by Elsevier Ltd.

  12. Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

    Treesearch

    Erin K. Noonan-Wright; Tonja S. Opperman

    2015-01-01

    In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

  13. Methods to assess landscape-scale risk of bark beetle infestation to support forest management decisions

    Treesearch

    T. L. Shore; A. Fall; W. G. Riel; J. Hughes; M. Eng

    2010-01-01

    The objective of our paper is to provide practitioners with suggestions on how to select appropriate methods for risk assessment of bark beetle infestations at the landscape scale in order to support their particular management decisions and to motivate researchers to refine novel risk assessment methods. Methods developed to assist and inform management decisions for...

  14. Multi-criteria decision analysis for waste management in Saharawi refugee camps

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Garfi, M.; Tondelli, S.; Bonoli, A.

    2009-10-15

    The aim of this paper is to compare different waste management solutions in Saharawi refugee camps (Algeria) and to test the feasibility of a decision-making method developed to be applied in particular conditions in which environmental and social aspects must be considered. It is based on multi criteria analysis, and in particular on the analytic hierarchy process (AHP), a mathematical technique for multi-criteria decision making (Saaty, T.L., 1980. The Analytic Hierarchy Process. McGraw-Hill, New York, USA; Saaty, T.L., 1990. How to Make a Decision: The Analytic Hierarchy Process. European Journal of Operational Research; Saaty, T.L., 1994. Decision Making for Leaders:more » The Analytic Hierarchy Process in a Complex World. RWS Publications, Pittsburgh, PA), and on participatory approach, focusing on local community's concerns. The research compares four different waste collection and management alternatives: waste collection by using three tipper trucks, disposal and burning in an open area; waste collection by using seven dumpers and disposal in a landfill; waste collection by using seven dumpers and three tipper trucks and disposal in a landfill; waste collection by using three tipper trucks and disposal in a landfill. The results show that the second and the third solutions provide better scenarios for waste management. Furthermore, the discussion of the results points out the multidisciplinarity of the approach, and the equilibrium between social, environmental and technical impacts. This is a very important aspect in a humanitarian and environmental project, confirming the appropriateness of the chosen method.« less

  15. Shared decision making and medication management in the recovery process.

    PubMed

    Deegan, Patricia E; Drake, Robert E

    2006-11-01

    Mental health professionals commonly conceptualize medication management for people with severe mental illness in terms of strategies to increase compliance or adherence. The authors argue that compliance is an inadequate construct because it fails to capture the dynamic complexity of autonomous clients who must navigate decisional conflicts in learning to manage disorders over the course of years or decades. Compliance is rooted in medical paternalism and is at odds with principles of person-centered care and evidence-based medicine. Using medication is an active process that involves complex decision making and a chance to work through decisional conflicts. It requires a partnership between two experts: the client and the practitioner. Shared decision making provides a model for them to assess a treatment's advantages and disadvantages within the context of recovering a life after a diagnosis of a major mental disorder.

  16. Big-Data Based Decision-Support Systems to Improve Clinicians’ Cognition

    PubMed Central

    Roosan, Don; Samore, Matthew; Jones, Makoto; Livnat, Yarden; Clutter, Justin

    2016-01-01

    Complex clinical decision-making could be facilitated by using population health data to inform clinicians. In two previous studies, we interviewed 16 infectious disease experts to understand complex clinical reasoning. For this study, we focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. We found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians’ cognition to deal with complex problems. These cognitive strategies could be supported by population health data, and all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records. Our findings provide directions for task allocation and design of decision-support applications for health care industry development of Big data based decision-support systems. PMID:27990498

  17. Improving Primary Care Provider Practices in Youth Concussion Management.

    PubMed

    Arbogast, Kristy B; Curry, Allison E; Metzger, Kristina B; Kessler, Ronni S; Bell, Jeneita M; Haarbauer-Krupa, Juliet; Zonfrillo, Mark R; Breiding, Matthew J; Master, Christina L

    2017-08-01

    Primary care providers are increasingly providing youth concussion care but report insufficient time and training, limiting adoption of best practices. We implemented a primary care-based intervention including an electronic health record-based clinical decision support tool ("SmartSet") and in-person training. We evaluated consequent improvement in 2 key concussion management practices: (1) performance of a vestibular oculomotor examination and (2) discussion of return-to-learn/return-to-play (RTL/RTP) guidelines. Data were included from 7284 primary care patients aged 0 to 17 years with initial concussion visits between July 2010 and June 2014. We compared proportions of visits pre- and post-intervention in which the examination was performed or RTL/RTP guidelines provided. Examinations and RTL/RTP were documented for 1.8% and 19.0% of visits pre-intervention, respectively, compared with 71.1% and 72.9% post-intervention. A total of 95% of post-intervention examinations were documented within the SmartSet. An electronic clinical decision support tool, plus in-person training, may be key to changing primary care provider behavior around concussion care.

  18. Staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in quality improvement: a focus group discussion study at two hospital settings in Sweden.

    PubMed

    Hvitfeldt-Forsberg, Helena; Mazzocato, Pamela; Glaser, Daniel; Keller, Christina; Unbeck, Maria

    2017-06-06

    To explore healthcare staffs' and managers' perceptions of how and when discrete event simulation modelling can be used as a decision support in improvement efforts. Two focus group discussions were performed. Two settings were included: a rheumatology department and an orthopaedic section both situated in Sweden. Healthcare staff and managers (n=13) from the two settings. Two workshops were performed, one at each setting. Workshops were initiated by a short introduction to simulation modelling. Results from the respective simulation model were then presented and discussed in the following focus group discussion. Categories from the content analysis are presented according to the following research questions: how and when simulation modelling can assist healthcare improvement? Regarding how, the participants mentioned that simulation modelling could act as a tool for support and a way to visualise problems, potential solutions and their effects. Regarding when, simulation modelling could be used both locally and by management, as well as a pedagogical tool to develop and test innovative ideas and to involve everyone in the improvement work. Its potential as an information and communication tool and as an instrument for pedagogic work within healthcare improvement render a broader application and value of simulation modelling than previously reported. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Analysis of ETMS Data Quality for Traffic Flow Management Decisions

    NASA Technical Reports Server (NTRS)

    Chatterji, Gano B.; Sridhar, Banavar; Kim, Douglas

    2003-01-01

    The data needed for air traffic flow management decision support tools is provided by the Enhanced Traffic Management System (ETMS). This includes both the tools that are in current use and the ones being developed for future deployment. Since the quality of decision support provided by all these tools will be influenced by the quality of the input ETMS data, an assessment of ETMS data quality is needed. Motivated by this desire, ETMS data quality is examined in this paper in terms of the unavailability of flight plans, deviation from the filed flight plans, departure delays, altitude errors and track data drops. Although many of these data quality issues are not new, little is known about their extent. A goal of this paper is to document the magnitude of data quality issues supported by numerical analysis of ETMS data. Guided by this goal, ETMS data for a 24-hour period were processed to determine the number of aircraft with missing flight plan messages at any given instant of time. Results are presented for aircraft above 18,000 feet altitude and also at all altitudes. Since deviation from filed flight plan is also a major cause of trajectory-modeling errors, statistics of deviations are presented. Errors in proposed departure times and ETMS-generated vertical profiles are also shown. A method for conditioning the vertical profiles for improving demand prediction accuracy is described. Graphs of actual sector counts obtained using these vertical profiles are compared with those obtained using the Host data for sectors in the Fort Worth Center to demonstrate the benefit of preprocessing. Finally, results are presented to quantify the extent of data drops. A method for propagating track positions during ETMS data drops is also described.

  20. Multi-criteria decision models for forestry and natural resources management: an annotated bibliography

    Treesearch

    Joseph E. de Steiguer; Leslie Liberti; Albert Schuler; Bruce Hansen

    2003-01-01

    Foresters and natural resource managers must balance conflicting objectives when developing land-management plans. Conflicts may encompass economic, environmental, social, cultural, technical, and aesthetic objectives. Selecting the best combination of management uses from numerous objectives is difficult and challenging. Multi-Criteria Decision Models (MCDM) provide a...

  1. Integrative evaluation for sustainable decisions of urban wastewater system management under uncertainty

    NASA Astrophysics Data System (ADS)

    Hadjimichael, A.; Corominas, L.; Comas, J.

    2017-12-01

    With sustainable development as their overarching goal, urban wastewater system (UWS) managers need to take into account multiple social, economic, technical and environmental facets related to their decisions. In this complex decision-making environment, uncertainty can be formidable. It is present both in the ways the system is interpreted stochastically, but also in its natural ever-shifting behavior. This inherent uncertainty suggests that wiser decisions would be made under an adaptive and iterative decision-making regime. No decision-support framework has been presented in the literature to effectively addresses all these needs. The objective of this work is to describe such a conceptual framework to evaluate and compare alternative solutions for various UWS challenges within an adaptive management structure. Socio-economic aspects such as externalities are taken into account, along with other traditional criteria as necessary. Robustness, reliability and resilience analyses test the performance of the system against present and future variability. A valuation uncertainty analysis incorporates uncertain valuation assumptions in the decision-making process. The framework is demonstrated with an application to a case study presenting a typical problem often faced by managers: poor river water quality, increasing population, and more stringent water quality legislation. The application of the framework made use of: i) a cost-benefit analysis including monetized environmental benefits and damages; ii) a robustness analysis of system performance against future conditions; iii) reliability and resilience analyses of the system given contextual variability; and iv) a valuation uncertainty analysis of model parameters. The results suggest that the installation of bigger volumes would give rise to increased benefits despite larger capital costs, as well as increased robustness and resilience. Population numbers appear to affect the estimated benefits most, followed by

  2. Decision support frameworks and tools for conservation

    USGS Publications Warehouse

    Schwartz, Mark W.; Cook, Carly N.; Pressey, Robert L.; Pullin, Andrew S.; Runge, Michael C.; Salafsky, Nick; Sutherland, William J.; Williamson, Matthew A.

    2018-01-01

    The practice of conservation occurs within complex socioecological systems fraught with challenges that require transparent, defensible, and often socially engaged project planning and management. Planning and decision support frameworks are designed to help conservation practitioners increase planning rigor, project accountability, stakeholder participation, transparency in decisions, and learning. We describe and contrast five common frameworks within the context of six fundamental questions (why, who, what, where, when, how) at each of three planning stages of adaptive management (project scoping, operational planning, learning). We demonstrate that decision support frameworks provide varied and extensive tools for conservation planning and management. However, using any framework in isolation risks diminishing potential benefits since no one framework covers the full spectrum of potential conservation planning and decision challenges. We describe two case studies that have effectively deployed tools from across conservation frameworks to improve conservation actions and outcomes. Attention to the critical questions for conservation project planning should allow practitioners to operate within any framework and adapt tools to suit their specific management context. We call on conservation researchers and practitioners to regularly use decision support tools as standard practice for framing both practice and research.

  3. Disaster Management with a Next Generation Disaster Decision Support System

    NASA Astrophysics Data System (ADS)

    Chen, Y.

    2015-12-01

    As populations become increasingly concentrated in large cities, the world is experiencing an inevitably growing trend towards the urbanisation of disasters. Scientists have contributed significant advances in understanding the geophysical causes of natural hazards and have developed sophisticated tools to predict their effects; while, much less attention has been devoted to tools that increase situational awareness, facilitate leadership, provide effective communication channels and data flow and enhance the cognitive abilities of decision makers and first responders. In this paper, we envisioned the capabilities of a next generation disaster decision support system and hence proposed a state-of-the-art system architecture design to facilitate the decision making process in natural catastrophes such as flood and bushfire by utilising a combination of technologies for multi-channel data aggregation, disaster modelling, visualisation and optimisation. Moreover, we put our thoughts into action by implementing an Intelligent Disaster Decision Support System (IDDSS). The developed system can easily plug in to external disaster models and aggregate large amount of heterogeneous data from government agencies, sensor networks, and crowd sourcing platforms in real-time to enhance the situational awareness of decision makers and offer them a comprehensive understanding of disaster impacts from diverse perspectives such as environment, infrastructure and economy, etc. Sponsored by the Australian Government and the Victorian Department of Justice (Australia), the system was built upon a series of open-source frameworks (see attached figure) with four key components: data management layer, model application layer, processing service layer and presentation layer. It has the potential to be adopted by a range of agencies across Australian jurisdictions to assist stakeholders in accessing, sharing and utilising available information in their management of disaster events.

  4. Spatially explicit multi-criteria decision analysis for managing vector-borne diseases

    PubMed Central

    2011-01-01

    The complex epidemiology of vector-borne diseases creates significant challenges in the design and delivery of prevention and control strategies, especially in light of rapid social and environmental changes. Spatial models for predicting disease risk based on environmental factors such as climate and landscape have been developed for a number of important vector-borne diseases. The resulting risk maps have proven value for highlighting areas for targeting public health programs. However, these methods generally only offer technical information on the spatial distribution of disease risk itself, which may be incomplete for making decisions in a complex situation. In prioritizing surveillance and intervention strategies, decision-makers often also need to consider spatially explicit information on other important dimensions, such as the regional specificity of public acceptance, population vulnerability, resource availability, intervention effectiveness, and land use. There is a need for a unified strategy for supporting public health decision making that integrates available data for assessing spatially explicit disease risk, with other criteria, to implement effective prevention and control strategies. Multi-criteria decision analysis (MCDA) is a decision support tool that allows for the consideration of diverse quantitative and qualitative criteria using both data-driven and qualitative indicators for evaluating alternative strategies with transparency and stakeholder participation. Here we propose a MCDA-based approach to the development of geospatial models and spatially explicit decision support tools for the management of vector-borne diseases. We describe the conceptual framework that MCDA offers as well as technical considerations, approaches to implementation and expected outcomes. We conclude that MCDA is a powerful tool that offers tremendous potential for use in public health decision-making in general and vector-borne disease management in particular

  5. Improving numeracy through values affirmation enhances decision and STEM outcomes

    PubMed Central

    Peters, Ellen; Tompkins, Mary Kate; Schley, Dan; Meilleur, Louise; Sinayev, Aleksander; Tusler, Martin; Wagner, Laura; Crocker, Jennifer

    2017-01-01

    Greater numeracy has been correlated with better health and financial outcomes in past studies, but causal effects in adults are unknown. In a 9-week longitudinal study, undergraduate students, all taking a psychology statistics course, were randomly assigned to a control condition or a values-affirmation manipulation intended to improve numeracy. By the final week in the course, the numeracy intervention (statistics-course enrollment combined with values affirmation) enhanced objective numeracy, subjective numeracy, and two decision-related outcomes (financial literacy and health-related behaviors). It also showed positive indirect-only effects on financial outcomes and a series of STEM-related outcomes (course grades, intentions to take more math-intensive courses, later math-intensive courses taken based on academic transcripts). All decision and STEM-related outcome effects were mediated by the changes in objective and/or subjective numeracy and demonstrated similar and robust enhancements. Improvements to abstract numeric reasoning can improve everyday outcomes. PMID:28704410

  6. Stakeholders’ Perspectives on Postmastectomy Breast Reconstruction: Recognizing Ways to Improve Shared Decision Making

    PubMed Central

    Hasak, Jessica M.; Myckatyn, Terence M.; Grabinski, Victoria F.; Philpott, Sydney E.; Parikh, Rajiv P.

    2017-01-01

    Background: Postmastectomy breast reconstruction (PMBR) is an elective, preference-sensitive decision made during a stressful, time-pressured period after a cancer diagnosis. Shared decision making (SDM) can improve decision quality about preference-sensitive choices. Stakeholders’ perspectives on ways to support PMBR decision-making were explored. Methods: Forty semi-structured interviews with stakeholders (20 postmastectomy patients, 10 PMBR surgeons, 10 PMBR nurses) were conducted. Clinicians were recruited from diverse practices across the United States. Patients were recruited using purposive sampling with varying PMBR experiences, including no reconstruction. The interview guide was based on an implementation research framework. Themes were identified using grounded theory approach, based on frequency and emotive force conveyed. Results: Engagement in SDM was variable. Some patients wanted more information about PMBR from clinicians, particularly about risks. Some clinicians acknowledged highlighting benefits and downplaying risks. Many patients felt pressured to make a choice by their clinicians. Clinicians who successfully engaged patients through decisions often used outside resources to supplement conversations. Conclusions: Patient–clinician trust was critical to high-quality decisions, and many patients expressed decision regret when they were not engaged in PMBR discussions. Patients often perceived a race- or age-related bias in clinician information sharing. Interventions to support SDM may enhance decision quality and reduce decision regret about PMBR, ultimately improving patient-centered care for women with breast cancer. PMID:29263969

  7. Using Personality Data to Make Decisions about Global Managers

    ERIC Educational Resources Information Center

    Ramesh, Anuradha; Hazucha, Joy F.; Bank, Jurgen

    2008-01-01

    A major challenge that decisions makers face in multi-national organizations is how to compare managers from different parts of the globe. This challenge is both psychometric and practical. We draw on the cross-cultural psychology literature to propose a three-step framework to compare personality data from different countries. The first step…

  8. The Decision Making Trial and Evaluation Laboratory (Dematel) and Analytic Network Process (ANP) for Safety Management System Evaluation Performance

    NASA Astrophysics Data System (ADS)

    Rolita, Lisa; Surarso, Bayu; Gernowo, Rahmat

    2018-02-01

    In order to improve airport safety management system (SMS) performance, an evaluation system is required to improve on current shortcomings and maximize safety. This study suggests the integration of the DEMATEL and ANP methods in decision making processes by analyzing causal relations between the relevant criteria and taking effective analysis-based decision. The DEMATEL method builds on the ANP method in identifying the interdependencies between criteria. The input data consists of questionnaire data obtained online and then stored in an online database. Furthermore, the questionnaire data is processed using DEMATEL and ANP methods to obtain the results of determining the relationship between criteria and criteria that need to be evaluated. The study cases on this evaluation system were Adi Sutjipto International Airport, Yogyakarta (JOG); Ahmad Yani International Airport, Semarang (SRG); and Adi Sumarmo International Airport, Surakarta (SOC). The integration grades SMS performance criterion weights in a descending order as follow: safety and destination policy, safety risk management, healthcare, and safety awareness. Sturges' formula classified the results into nine grades. JOG and SMG airports were in grade 8, while SOG airport was in grade 7.

  9. Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention.

    PubMed

    Lobach, David F; Johns, Ellis B; Halpenny, Barbara; Saunders, Toni-Ann; Brzozowski, Jane; Del Fiol, Guilherme; Berry, Donna L; Braun, Ilana M; Finn, Kathleen; Wolfe, Joanne; Abrahm, Janet L; Cooley, Mary E

    2016-11-08

    Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care. The objective of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care. This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived from clinical practice guidelines into a rules engine that used Web services to communicate with the end-user application. Unit testing of algorithms was conducted using a stack-traversal tree-spanning methodology to identify all possible permutations of pathways through each algorithm, to validate accuracy. In Phase 3, we evaluated clinical use of the system among patients and HCPs in the two clinics via observations, structured interviews, and questionnaires. In Phase 1, 13 patients and 5 HCPs engaged in two rounds of formative testing, and suggested improvements leading to revisions until overall usability scores met a priori benchmarks. In Phase 2, symptom management algorithms contained between 29 and 1425 decision nodes, resulting in 19 to 3194 unique pathways per algorithm. Unit testing required 240 person-hours, and integration testing required 40 person-hours. In Phase 3, both patients and HCPs found the system usable and acceptable, and offered suggestions for improvements. A rule-based CDS system for complex symptom management was systematically developed and tested. The

  10. Improving "At-Action" Decision-Making in Team Sports through a Holistic Coaching Approach

    ERIC Educational Resources Information Center

    Light, Richard L.; Harvey, Stephen; Mouchet, Alain

    2014-01-01

    This article draws on Game Sense pedagogy and complex learning theory (CLT) to make suggestions for improving decision-making ability in team sports by adopting a holistic approach to coaching with a focus on decision-making "at-action". It emphasizes the complexity of decision-making and the need to focus on the game as a whole entity,…

  11. Testing the robustness of management decisions to uncertainty: Everglades restoration scenarios.

    PubMed

    Fuller, Michael M; Gross, Louis J; Duke-Sylvester, Scott M; Palmer, Mark

    2008-04-01

    To effectively manage large natural reserves, resource managers must prepare for future contingencies while balancing the often conflicting priorities of different stakeholders. To deal with these issues, managers routinely employ models to project the response of ecosystems to different scenarios that represent alternative management plans or environmental forecasts. Scenario analysis is often used to rank such alternatives to aid the decision making process. However, model projections are subject to uncertainty in assumptions about model structure, parameter values, environmental inputs, and subcomponent interactions. We introduce an approach for testing the robustness of model-based management decisions to the uncertainty inherent in complex ecological models and their inputs. We use relative assessment to quantify the relative impacts of uncertainty on scenario ranking. To illustrate our approach we consider uncertainty in parameter values and uncertainty in input data, with specific examples drawn from the Florida Everglades restoration project. Our examples focus on two alternative 30-year hydrologic management plans that were ranked according to their overall impacts on wildlife habitat potential. We tested the assumption that varying the parameter settings and inputs of habitat index models does not change the rank order of the hydrologic plans. We compared the average projected index of habitat potential for four endemic species and two wading-bird guilds to rank the plans, accounting for variations in parameter settings and water level inputs associated with hypothetical future climates. Indices of habitat potential were based on projections from spatially explicit models that are closely tied to hydrology. For the American alligator, the rank order of the hydrologic plans was unaffected by substantial variation in model parameters. By contrast, simulated major shifts in water levels led to reversals in the ranks of the hydrologic plans in 24.1-30.6% of

  12. Multi-criteria multi-stakeholder decision analysis using a fuzzy-stochastic approach for hydrosystem management

    NASA Astrophysics Data System (ADS)

    Subagadis, Y. H.; Schütze, N.; Grundmann, J.

    2014-09-01

    The conventional methods used to solve multi-criteria multi-stakeholder problems are less strongly formulated, as they normally incorporate only homogeneous information at a time and suggest aggregating objectives of different decision-makers avoiding water-society interactions. In this contribution, Multi-Criteria Group Decision Analysis (MCGDA) using a fuzzy-stochastic approach has been proposed to rank a set of alternatives in water management decisions incorporating heterogeneous information under uncertainty. The decision making framework takes hydrologically, environmentally, and socio-economically motivated conflicting objectives into consideration. The criteria related to the performance of the physical system are optimized using multi-criteria simulation-based optimization, and fuzzy linguistic quantifiers have been used to evaluate subjective criteria and to assess stakeholders' degree of optimism. The proposed methodology is applied to find effective and robust intervention strategies for the management of a coastal hydrosystem affected by saltwater intrusion due to excessive groundwater extraction for irrigated agriculture and municipal use. Preliminary results show that the MCGDA based on a fuzzy-stochastic approach gives useful support for robust decision-making and is sensitive to the decision makers' degree of optimism.

  13. Sustainable water management under future uncertainty with eco-engineering decision scaling

    USGS Publications Warehouse

    Poff, N LeRoy; Brown, Casey M; Grantham, Theodore E.; Matthews, John H; Palmer, Margaret A.; Spence, Caitlin M; Wilby, Robert L.; Haasnoot, Marjolijn; Mendoza, Guillermo F; Dominique, Kathleen C; Baeza, Andres

    2015-01-01

    Managing freshwater resources sustainably under future climatic and hydrological uncertainty poses novel challenges. Rehabilitation of ageing infrastructure and construction of new dams are widely viewed as solutions to diminish climate risk, but attaining the broad goal of freshwater sustainability will require expansion of the prevailing water resources management paradigm beyond narrow economic criteria to include socially valued ecosystem functions and services. We introduce a new decision framework, eco-engineering decision scaling (EEDS), that explicitly and quantitatively explores trade-offs in stakeholder-defined engineering and ecological performance metrics across a range of possible management actions under unknown future hydrological and climate states. We illustrate its potential application through a hypothetical case study of the Iowa River, USA. EEDS holds promise as a powerful framework for operationalizing freshwater sustainability under future hydrological uncertainty by fostering collaboration across historically conflicting perspectives of water resource engineering and river conservation ecology to design and operate water infrastructure for social and environmental benefits.

  14. Sustainable water management under future uncertainty with eco-engineering decision scaling

    NASA Astrophysics Data System (ADS)

    Poff, N. Leroy; Brown, Casey M.; Grantham, Theodore E.; Matthews, John H.; Palmer, Margaret A.; Spence, Caitlin M.; Wilby, Robert L.; Haasnoot, Marjolijn; Mendoza, Guillermo F.; Dominique, Kathleen C.; Baeza, Andres

    2016-01-01

    Managing freshwater resources sustainably under future climatic and hydrological uncertainty poses novel challenges. Rehabilitation of ageing infrastructure and construction of new dams are widely viewed as solutions to diminish climate risk, but attaining the broad goal of freshwater sustainability will require expansion of the prevailing water resources management paradigm beyond narrow economic criteria to include socially valued ecosystem functions and services. We introduce a new decision framework, eco-engineering decision scaling (EEDS), that explicitly and quantitatively explores trade-offs in stakeholder-defined engineering and ecological performance metrics across a range of possible management actions under unknown future hydrological and climate states. We illustrate its potential application through a hypothetical case study of the Iowa River, USA. EEDS holds promise as a powerful framework for operationalizing freshwater sustainability under future hydrological uncertainty by fostering collaboration across historically conflicting perspectives of water resource engineering and river conservation ecology to design and operate water infrastructure for social and environmental benefits.

  15. Is economic valuation of ecosystem services useful to decision-makers? Lessons learned from Australian coastal and marine management.

    PubMed

    Marre, Jean-Baptiste; Thébaud, Olivier; Pascoe, Sean; Jennings, Sarah; Boncoeur, Jean; Coglan, Louisa

    2016-08-01

    Economic valuation of ecosystem services is widely advocated as being useful to support ecosystem management decision-making. However, the extent to which it is actually used or considered useful in decision-making is poorly documented. This literature blindspot is explored with an application to coastal and marine ecosystems management in Australia. Based on a nation-wide survey of eighty-eight decision-makers representing a diversity of management organizations, the perceived usefulness and level of use of economic valuation of ecosystem services, in support of coastal and marine management, are examined. A large majority of decision-makers are found to be familiar with economic valuation and consider it useful - even necessary - in decision-making, although this varies across groups of decision-makers. However, most decision-makers never or rarely use economic valuation. The perceived level of importance and trust in estimated dollar values differ across ecosystem services, and are especially high for values that relate to commercial activities. A number of factors are also found to influence respondent's use of economic valuation. Such findings concur with conclusions from other studies on the usefulness and use of ESV in environmental management decision-making. They also demonstrate the strength of the survey-based approach developed in this application to examine this issue in a variety of contexts. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review.

    PubMed

    Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Lane, Haylee; Haines, Terry P

    2017-11-14

    It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1

  17. Clinical Equipoise and Shared Decision-making in Pulmonary Nodule Management. A Survey of American Thoracic Society Clinicians.

    PubMed

    Iaccarino, Jonathan M; Simmons, James; Gould, Michael K; Slatore, Christopher G; Woloshin, Steven; Schwartz, Lisa M; Wiener, Renda Soylemez

    2017-06-01

    the evidence for pulmonary nodule evaluation to be strong, most clinicians were willing to enroll patients in randomized trials to compare nodule management strategies in all risk categories (low risk, 87.6%; moderate risk, 89.7%; high risk, 63.0%). Consistent with guideline recommendations, clinicians embrace multiple options for pulmonary nodule evaluation and many are open to shared decision-making. Clinicians support the need for randomized clinical trials to strengthen the evidence for nodule evaluation, which will further improve decision-making.

  18. Development and impact of computerised decision support systems for clinical management of depression: A systematic review.

    PubMed

    Triñanes, Yolanda; Atienza, Gerardo; Louro-González, Arturo; de-las-Heras-Liñero, Elena; Alvarez-Ariza, María; Palao, Diego J

    2015-01-01

    One of the proposals for improving clinical practice is to introduce computerised decision support systems (CDSS) and integrate these with electronic medical records. Accordingly, this study sought to systematically review evidence on the effectiveness of CDSS in the management of depression. A search was performed in Medline, EMBASE and PsycInfo, in order to do this. The quality of quantitative studies was assessed using the SIGN method, and qualitative studies using the CASPe checklist. Seven studies were identified (3 randomised clinical trials, 3 non-randomised trials, and one qualitative study). The CDSS assessed incorporated content drawn from guidelines and other evidence-based products. In general, the CDSS had a positive impact on different aspects, such as the screening and diagnosis, treatment, improvement in depressive symptoms and quality of life, and referral of patients. The use of CDSS could thus serve to optimise care of depression in various scenarios by providing recommendations based on the best evidence available and facilitating decision-making in clinical practice. Copyright © 2014 SEP y SEPB. Published by Elsevier España. All rights reserved.

  19. Beyond the lab: observations on the process by which science successfully informs management and policy decisions

    NASA Astrophysics Data System (ADS)

    Flores, S.

    2012-12-01

    Scientific findings inform management decisions and policy products through various ways, these include: synthesis reports, white papers, in-person and web-based seminars (webinars), communication from specialized staff, and seminal peer-reviewed journal articles. Scientists are often told that if they want their science to inform management decisions and policy products that they must: clearly and simply articulate discreet pieces of scientific information and avoid attaching advocacy messages to the science; however, solely relying on these tenants does not ensure that scientific products will infuse the realms of management and policy. The process by which science successfully informs management decisions and policy products rarely begins at the time the results come out of the lab, but rather, before the research is carried out. Having an understanding of the political climate, management needs, agency research agendas, and funding limitations, as well as developing a working relationship with the intended managers and policy makers are key elements to developing the kind of science results and products that often make an impact in the management and policy world. In my presentation I will provide case-studies from California (USA) to highlight the type of coastal, ocean and climate science that has been successful in informing management decisions and policy documents, as well as provide a state-level agency perspective on the process by which this occurs.

  20. Management of carbon across sectors and scales: Insights from land use decision making

    NASA Astrophysics Data System (ADS)

    Dilling, L.; Failey, E. L.

    2008-12-01

    Carbon management is increasingly becoming a topic of interest among policy circles and business entrepreneurs alike. In the United States, while no binding regulatory framework exists, carbon management is nonetheless being pursued both by voluntary actions at a variety of levels, from the individual to the national level, and through mandatory policies at state and local levels. Controlling the amount of carbon dioxide in the atmosphere for climate purposes will ultimately require a form of governance that will ensure that the actions taken and being rewarded financially are indeed effective with respect to the global atmosphere on long time scales. Moreover, this new system of governance will need to interface with existing governance structures and decision criteria that have been established to arbitrate among various societal values and priorities. These existing institutions and expressed values will need to be examined against those proposed for effective carbon governance, such as the permanence of carbon storage, the additionality of credited activities, and the prevention of leakage, or displacement of prohibited activities to another region outside the governance boundary. The latter issue suggests that interactions among scales of decision making and governance will be extremely important in determining the ultimate success of any future system of carbon governance. The goal of our study is to understand the current context of land use decision making in different sectors and examine the potential for future carbon policy to be effective given this context. This study examined land use decision making in the U.S. state of Colorado from a variety of ownership perspectives, including US Federal land managers, individual private owners, and policy makers involved in land use at a number of different scales. This paper will report on the results of interviews with land managers and provide insight into the policy context for carbon management through land

  1. Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review.

    PubMed

    Staszewska, Anna; Zaki, Pearl; Lee, Joon

    2017-10-06

    Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious

  2. Evaluation of computerized decision support for oral anticoagulation management based in primary care.

    PubMed

    Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

    1996-09-01

    Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

  3. E-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task.

    PubMed

    Prahl, Andrew; Dexter, Franklin; Swol, Lyn Van; Braun, Michael T; Epstein, Richard H

    2015-09-01

    For many problems in operating room and anesthesia group management, there are tasks with optimal decisions, and yet experienced personnel tend to make decisions that are worse or no better than random chance. Such decisions include staff scheduling, case scheduling, moving cases among operating rooms, and choosing patient arrival times. In such settings, operating room management leadership decision-making should typically be autocratic rather than participative. Autocratic-style decision-making calls for managers to solicit and consider feedback from stakeholders in the decision outcome but to make the decision themselves using their expert knowledge and the facts received. For this to be effective, often the manager will obtain expert advice from outside the organization (e.g., health system). In this narrative review, we evaluate the advantages and disadvantages of using prompt asynchronous written communication (i.e., e-mail) as a communication channel for such interaction between a decision-maker (manager) and advisor. A detailed Appendix (Supplemental Digital Content, http://links.lww.com/AA/B72) lists each observational and experimental result. We find that the current ubiquitous role of e-mail for such communication is appropriate. Its benefits include improved time management via asynchronicity, low cognitive load (e.g., relative to Web conferencing), the ability to hide undesirable and irrelevant cues (e.g., physical appearance), the appropriateness of adding desirable cues (e.g., titles and degrees), the opportunity to provide written expression of confidence, and the ability for the advisor to demonstrate the answer for the decision-maker. Given that the manager is e-mailing an advisor whose competence the manager trusts, it is unnecessary to use a richer communication channel to develop trust. Finally, many of the limitations of e-mail can be rectified through training. We expect that decades from now, e-mail (i.e., asynchronous writing) between an

  4. Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data

    PubMed Central

    2011-01-01

    Background No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. Methods A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Results Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments

  5. Event-based knowledge elicitation of operating room management decision-making using scenarios adapted from information systems data.

    PubMed

    Dexter, Franklin; Wachtel, Ruth E; Epstein, Richard H

    2011-01-07

    No systematic process has previously been described for a needs assessment that identifies the operating room (OR) management decisions made by the anesthesiologists and nurse managers at a facility that do not maximize the efficiency of use of OR time. We evaluated whether event-based knowledge elicitation can be used practically for rapid assessment of OR management decision-making at facilities, whether scenarios can be adapted automatically from information systems data, and the usefulness of the approach. A process of event-based knowledge elicitation was developed to assess OR management decision-making that may reduce the efficiency of use of OR time. Hypothetical scenarios addressing every OR management decision influencing OR efficiency were created from published examples. Scenarios are adapted, so that cues about conditions are accurate and appropriate for each facility (e.g., if OR 1 is used as an example in a scenario, the listed procedure is a type of procedure performed at the facility in OR 1). Adaptation is performed automatically using the facility's OR information system or anesthesia information management system (AIMS) data for most scenarios (43 of 45). Performing the needs assessment takes approximately 1 hour of local managers' time while they decide if their decisions are consistent with the described scenarios. A table of contents of the indexed scenarios is created automatically, providing a simple version of problem solving using case-based reasoning. For example, a new OR manager wanting to know the best way to decide whether to move a case can look in the chapter on "Moving Cases on the Day of Surgery" to find a scenario that describes the situation being encountered. Scenarios have been adapted and used at 22 hospitals. Few changes in decisions were needed to increase the efficiency of use of OR time. The few changes were heterogeneous among hospitals, showing the usefulness of individualized assessments. Our technical advance is the

  6. A queueing model of pilot decision making in a multi-task flight management situation

    NASA Technical Reports Server (NTRS)

    Walden, R. S.; Rouse, W. B.

    1977-01-01

    Allocation of decision making responsibility between pilot and computer is considered and a flight management task, designed for the study of pilot-computer interaction, is discussed. A queueing theory model of pilot decision making in this multi-task, control and monitoring situation is presented. An experimental investigation of pilot decision making and the resulting model parameters are discussed.

  7. Greenhouse gas emissions control in integrated municipal solid waste management through mixed integer bilevel decision-making.

    PubMed

    He, Li; Huang, G H; Lu, Hongwei

    2011-10-15

    Recent studies indicated that municipal solid waste (MSW) is a major contributor to global warming due to extensive emissions of greenhouse gases (GHGs). However, most of them focused on investigating impacts of MSW on GHG emission amounts. This study presents two mixed integer bilevel decision-making models for integrated municipal solid waste management and GHG emissions control: MGU-MCL and MCU-MGL. The MGU-MCL model represents a top-down decision process, with the environmental sectors at the national level dominating the upper-level objective and the waste management sectors at the municipal level providing the lower-level objective. The MCU-MGL model implies a bottom-up decision process where municipality plays a leading role. Results from the models indicate that: the top-down decisions would reduce metric tonne carbon emissions (MTCEs) by about 59% yet increase about 8% of the total management cost; the bottom-up decisions would reduce MTCE emissions by about 13% but increase the total management cost very slightly; on-site monitoring and downscaled laboratory experiments are still required for reducing uncertainty in GHG emission rate from the landfill facility. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. An integrated modeling approach to support management decisions of coupled groundwater-agricultural systems under multiple uncertainties

    NASA Astrophysics Data System (ADS)

    Hagos Subagadis, Yohannes; Schütze, Niels; Grundmann, Jens

    2015-04-01

    The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational frameworks. Such integrative research to link different knowledge domains faces several practical challenges. Such complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. A fuzzy-stochastic multiple criteria decision analysis tool was developed in this study to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrated physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approach is applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structure. Results from the developed method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach has enabled to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. Sensitivity analysis applied within the developed tool has shown that the decision makers' risk aversion and risk taking attitude may yield in different ranking of decision alternatives. The developed approach can be applied to address the complexities and uncertainties inherent in water resources systems to support management decisions, while serving as a platform for stakeholder participation.

  9. Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design.

    PubMed

    Islam, Roosan; Weir, Charlene R; Jones, Makoto; Del Fiol, Guilherme; Samore, Matthew H

    2015-11-30

    Clinical experts' cognitive mechanisms for managing complexity have implications for the design of future innovative healthcare systems. The purpose of the study is to examine the constituents of decision complexity and explore the cognitive strategies clinicians use to control and adapt to their information environment. We used Cognitive Task Analysis (CTA) methods to interview 10 Infectious Disease (ID) experts at the University of Utah and Salt Lake City Veterans Administration Medical Center. Participants were asked to recall a complex, critical and vivid antibiotic-prescribing incident using the Critical Decision Method (CDM), a type of Cognitive Task Analysis (CTA). Using the four iterations of the Critical Decision Method, questions were posed to fully explore the incident, focusing in depth on the clinical components underlying the complexity. Probes were included to assess cognitive and decision strategies used by participants. The following three themes emerged as the constituents of decision complexity experienced by the Infectious Diseases experts: 1) the overall clinical picture does not match the pattern, 2) a lack of comprehension of the situation and 3) dealing with social and emotional pressures such as fear and anxiety. All these factors contribute to decision complexity. These factors almost always occurred together, creating unexpected events and uncertainty in clinical reasoning. Five themes emerged in the analyses of how experts deal with the complexity. Expert clinicians frequently used 1) watchful waiting instead of over- prescribing antibiotics, engaged in 2) theory of mind to project and simulate other practitioners' perspectives, reduced very complex cases into simple 3) heuristics, employed 4) anticipatory thinking to plan and re-plan events and consulted with peers to share knowledge, solicit opinions and 5) seek help on patient cases. The cognitive strategies to deal with decision complexity found in this study have important

  10. An Evolutionary Complex Systems Decision-Support Tool for the Management of Operations

    NASA Astrophysics Data System (ADS)

    Baldwin, J. S.; Allen, P. M.; Ridgway, K.

    2011-12-01

    This research aimed to add both to the development of complex systems thinking in the subject area of Operations and Production Management and to the limited number of applications of computational models and simulations from the science of complex systems. The latter potentially offer helpful decision-support tools for operations and production managers. A mechanical engineering firm was used as a case study where a combined qualitative and quantitative methodological approach was employed to extract the required data from four senior managers. Company performance measures as well as firm technologies, practices and policies, and their relation and interaction with one another, were elicited. The data were subjected to an evolutionary complex systems model resulting in a series of simulations. The findings included both reassuring and some unexpected results. The simulation based on the CEO's opinions led the most cohesive and synergistic collection of practices describing the firm, closely followed by the Marketing and R&D Managers. The Manufacturing Manager's responses led to the most extreme evolutionary trajectory where the integrity of the entire firm came into question particularly when considering how employees were utilised. By drawing directly from the opinions and views of managers rather than from logical 'if-then' rules and averaged mathematical representations of agents that characterise agent-based and other self-organisational models, this work builds on previous applications by capturing a micro-level description of diversity and a learning effect that has been problematical not only in terms of theory but also in application. This approach can be used as a decision-support tool for operations and other managers providing a forum with which to explore a) the strengths, weaknesses and consequences of different decision-making capacities within the firm; b) the introduction of new manufacturing technologies, practices and policies; and, c) the

  11. How Decision Support Systems Can Benefit from a Theory of Change Approach.

    PubMed

    Allen, Will; Cruz, Jennyffer; Warburton, Bruce

    2017-06-01

    Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

  12. How Decision Support Systems Can Benefit from a Theory of Change Approach

    NASA Astrophysics Data System (ADS)

    Allen, Will; Cruz, Jennyffer; Warburton, Bruce

    2017-06-01

    Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

  13. A Peer-Led Decision Support Intervention Improves Decision Outcomes in Black Women with Breast Cancer

    PubMed Central

    Wallington, Sherrie F.; Willey, Shawna C.; Hampton, Regina M.; Lucas, W.; Jennings, Y.; Horton, S.; Muzeck, N.; Cocilovo, C.; Isaacs, C.

    2013-01-01

    Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model—TALK Back!© A follow-up assessment assessed participants’ acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p=.000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. PMID:23576067

  14. Improving Agricultural Water Resources Management Using Ground-based Infrared Thermometry

    NASA Astrophysics Data System (ADS)

    Taghvaeian, S.

    2014-12-01

    Irrigated agriculture is the largest user of freshwater resources in arid/semi-arid parts of the world. Meeting rapidly growing demands in food, feed, fiber, and fuel while minimizing environmental pollution under a changing climate requires significant improvements in agricultural water management and irrigation scheduling. Although recent advances in remote sensing techniques and hydrological modeling has provided valuable information on agricultural water resources and their management, real improvements will only occur if farmers, the decision makers on the ground, are provided with simple, affordable, and practical tools to schedule irrigation events. This presentation reviews efforts in developing methods based on ground-based infrared thermometry and thermography for day-to-day management of irrigation systems. The results of research studies conducted in Colorado and Oklahoma show that ground-based remote sensing methods can be used effectively in quantifying water stress and consequently triggering irrigation events. Crop water use estimates based on stress indices have also showed to be in good agreement with estimates based on other methods (e.g. surface energy balance, root zone soil water balance, etc.). Major challenges toward the adoption of this approach by agricultural producers include the reduced accuracy under cloudy and humid conditions and its inability to forecast irrigation date, which is a critical knowledge since many irrigators need to decide about irrigations a few days in advance.

  15. Sustainable MSD prevention: management for continuous improvement between prevention and production. Ergonomic intervention in two assembly line companies.

    PubMed

    Caroly, S; Coutarel, F; Landry, A; Mary-Cheray, I

    2010-07-01

    To increase output and meet customers' needs, companies have turned to the development of production management systems: Kaizen, one piece flow, Kanban, etc. The aim of such systems is to accelerate decisions, react to environmental issues and manage various productions. In the main, this type of management system has led to the continuous improvement of production performance. Consequently, such production management systems can have unexpected negative effects on operators' health and safety. Conversely, regulation and control systems focusing on work-related risks have obliged firms to implement health and safety management systems such as OHSAS 18001. The purpose of this type of system, also based on continuous improvement, is to reduce risks, facilitate work-related activities and identify solutions in terms of equipment and tools. However, the prevention actions introduced through health and safety systems often result in other unexpected and unwanted effects on production. This paper shows how companies can improve the way they are run by taking into account both types of management system. Copyright 2010 Elsevier Ltd. All rights reserved.

  16. Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates.

    PubMed

    Memon, M; Kay, J; Ginsberg, L; Simunovic, N; Bak, K; Lapner, P; Ayeni, O R

    2018-01-01

    The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. Level IV, systematic review of level II to IV

  17. Decision-making and evacuation planning for flood risk management in the Netherlands.

    PubMed

    Kolen, Bas; Helsloot, Ira

    2014-07-01

    A traditional view of decision-making for evacuation planning is that, given an uncertain threat, there is a deterministic way of defining the best decision. In other words, there is a linear relation between threat, decision, and execution consequences. Alternatives and the impact of uncertainties are not taken into account. This study considers the 'top strategic decision-making' for mass evacuation owing to flooding in the Netherlands. It reveals that the top strategic decision-making process itself is probabilistic because of the decision-makers involved and their crisis managers (as advisers). The paper concludes that deterministic planning is not sufficient, and it recommends probabilistic planning that considers uncertainties in the decision-making process itself as well as other uncertainties, such as forecasts, citizens responses, and the capacity of infrastructure. This results in less optimistic, but more realistic, strategies and a need to pay attention to alternative strategies. © 2014 The Author(s). Disasters © Overseas Development Institute, 2014.

  18. Facilitating Decision Making, Re-Use and Collaboration: A Knowledge Management Approach for System Self-Awareness

    DTIC Science & Technology

    2009-10-01

    FACILITATING DECISION MAKING, RE-USE AND COLLABORATION: A KNOWLEDGE MANAGEMENT APPROACH FOR SYSTEM SELF- AWARENESS Shelley P. Gallup, Douglas J... Information Systems Experimentation (DISE) Group Naval Postgraduate School, Monterey, CA 93943 Keywords: Program self- awareness , decision making...decision makers express in obtaining constant awareness of what is going on in their domains of decision making because information that is needed

  19. Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

    PubMed

    Fraser, Kimberly D; Estabrooks, Carole; Allen, Marion; Strang, Vicki

    2009-03-01

    Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor. The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

  20. Risk communication, geoethics and decision science issues in Japan's disaster management system

    NASA Astrophysics Data System (ADS)

    Sugimoto, M.

    2014-12-01

    Issues in Japan's disaster management system were revealed by the 2011 Tohoku earthquake and tsunami, and by the Fukushima Dai-ichi nuclear power station accident. Many important decisions were based on scientific data, but appear not to have sufficiently considered the uncertainties of the data and the societal aspects of the problems. The issues that arose show the need for scientists to appropriately deal with risk communication and geoethics and issues. This paper discusses necessity of education for risk communication, geoethics and decisions science in school before students become sicentific decision makers in future.

  1. E-estuary: A Decision Support System for Coastal Water and Ecosystem Management in the US (CZ09)

    EPA Science Inventory

    Ready access to geographic information is needed to support management decisions for estuaries at local, state, regional, and national scales. The U.S. Environmental Protection Agency (US EPA) is developing e-Estuary, a decision-support system for coastal management. E-Estuary ...

  2. Use of evidence-based management in healthcare administration decision-making.

    PubMed

    Guo, Ruiling; Berkshire, Steven D; Fulton, Lawrence V; Hermanson, Patrick M

    2017-07-03

    Purpose The purpose of this paper is to examine whether healthcare leaders use evidence-based management (EBMgt) when facing major decisions and what types of evidence healthcare administrators consult during their decision-making. This study also intends to identify any relationship that might exist among adoption of EBMgt in healthcare management, attitudes towards EBMgt, demographic characteristics and organizational characteristics. Design/methodology/approach A cross-sectional study was conducted among US healthcare leaders. Spearman's correlation and logistic regression were performed using the Statistical Package for the Social Sciences (SPSS) 23.0. Findings One hundred and fifty-four healthcare leaders completed the survey. The study results indicated that 90 per cent of the participants self-reported having used an EBMgt approach for decision-making. Professional experiences (87 per cent), organizational data (84 per cent) and stakeholders' values (63 per cent) were the top three types of evidence consulted daily and weekly for decision-making. Case study (75 per cent) and scientific research findings (75 per cent) were the top two types of evidence consulted monthly or less than once a month. An exploratory, stepwise logistic regression model correctly classified 75.3 per cent of all observations for a dichotomous "use of EBMgt" response variable using three independent variables: attitude towards EBMgt, number of employees in the organization and the job position. Spearman's correlation indicated statistically significant relationships between healthcare leaders' use of EBMgt and healthcare organization bed size ( r s = 0.217, n = 152, p < 0.01), attitude towards EBMgt ( r s = 0.517, n = 152, p < 0.01), and the number of organization employees ( r s = 0.195, n = 152, p = 0.016). Originality/value This study generated new research findings on the practice of EBMgt in US healthcare administration decision-making.

  3. 78 FR 32442 - Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and North Carolina

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-30

    ....YP0000] Record of Decision for the General Management Plan, Blue Ridge Parkway, Virginia and North... the availability of the Record of Decision (ROD) for the General Management Plan (GMP) for Blue Ridge... will provide a better balance between traditional parkway experiences and modern-day management...

  4. Preparing Students for Front-Line Management: Non-Routine Day-to-Day Decisions

    ERIC Educational Resources Information Center

    Clydesdale, Greg; Tan, John

    2009-01-01

    Purpose: This paper attempts to reduce the gap between management education and practice. It emphasises day-to-day decisions that middle and lower level managers make. The purpose is to provide an education framework embodying a flexible approach to interpretation and solution creation, suitable for situations of ambiguity and uncertainty.…

  5. Decision support and disease management: a logic engineering approach.

    PubMed

    Fox, J; Thomson, R

    1998-12-01

    This paper describes the development and application of PROforma, a unified technology for clinical decision support and disease management. Work leading to the implementation of PROforma has been carried out in a series of projects funded by European agencies over the past 13 years. The work has been based on logic engineering, a distinct design and development methodology that combines concepts from knowledge engineering, logic programming, and software engineering. Several of the projects have used the approach to demonstrate a wide range of applications in primary and specialist care and clinical research. Concurrent academic research projects have provided a sound theoretical basis for the safety-critical elements of the methodology. The principal technical results of the work are the PROforma logic language for defining clinical processes and an associated suite of software tools for delivering applications, such as decision support and disease management procedures. The language supports four standard objects (decisions, plans, actions, and enquiries), each of which has an intuitive meaning with well-understood logical semantics. The development toolset includes a powerful visual programming environment for composing applications from these standard components, for verifying consistency and completeness of the resulting specification and for delivering stand-alone or embeddable applications. Tools and applications that have resulted from the work are described and illustrated, with examples from specialist cancer care and primary care. The results of a number of evaluation activities are included to illustrate the utility of the technology.

  6. Demonstration of the application of traffic management center decision support tools.

    DOT National Transportation Integrated Search

    2013-03-01

    Decision support tools were developed in previous Florida Department of Transportation (FDOT) : research projects to allow for better analysis and visualization of historical traffic and incident : data, in support of incident management and traffic ...

  7. Decision making for wildfires: A guide for applying a risk management process at the incident level

    Treesearch

    Mary A. Taber; Lisa M. Elenz; Paul G. Langowski

    2013-01-01

    This publication focuses on the thought processes and considerations surrounding a risk management process for decision making on wildfires. The publication introduces a six element risk management cycle designed to encourage sound risk-informed decision making in accordance with Federal wildland fire policy, although the process is equally applicable to non-Federal...

  8. Patient Decision Aids Improve Decision Quality and Patient Experience and Reduce Surgical Rates in Routine Orthopaedic Care: A Prospective Cohort Study.

    PubMed

    Sepucha, Karen; Atlas, Steven J; Chang, Yuchiao; Dorrwachter, Janet; Freiberg, Andrew; Mangla, Mahima; Rubash, Harry E; Simmons, Leigh H; Cha, Thomas

    2017-08-02

    Patient decision aids are effective in randomized controlled trials, yet little is known about their impact in routine care. The purpose of this study was to examine whether decision aids increase shared decision-making when used in routine care. A prospective study was designed to evaluate the impact of a quality improvement project to increase the use of decision aids for patients with hip or knee osteoarthritis, lumbar disc herniation, or lumbar spinal stenosis. A usual care cohort was enrolled before the quality improvement project and an intervention cohort was enrolled after the project. Participants were surveyed 1 week after a specialist visit, and surgical status was collected at 6 months. Regression analyses adjusted for clustering of patients within clinicians and examined the impact on knowledge, patient reports of shared decision-making in the visit, and surgical rates. With 550 surveys, the study had 80% to 90% power to detect a difference in these key outcomes. The response rates to the 1-week survey were 70.6% (324 of 459) for the usual care cohort and 70.2% (328 of 467) for the intervention cohort. There was no significant difference (p > 0.05) in any patient characteristic between the 2 cohorts. More patients received decision aids in the intervention cohort at 63.6% compared with the usual care cohort at 27.3% (p = 0.007). Decision aid use was associated with higher knowledge scores, with a mean difference of 18.7 points (95% confidence interval [CI], 11.4 to 26.1 points; p < 0.001) for the usual care cohort and 15.3 points (95% CI, 7.5 to 23.0 points; p = 0.002) for the intervention cohort. Patients reported more shared decision-making (p = 0.009) in the visit with their surgeon in the intervention cohort, with a mean Shared Decision-Making Process score (and standard deviation) of 66.9 ± 27.5 points, compared with the usual care cohort at 62.5 ± 28.6 points. The majority of patients received their preferred treatment, and this did not differ

  9. Quality improvement and cost reduction realized by a purchaser through diabetes disease management.

    PubMed

    Snyder, James W; Malaskovitz, Joyce; Griego, Janet; Persson, Jeffrey; Flatt, Kristy

    2003-01-01

    This report documents the clinical improvements and costs experienced by a purchaser after introduction of a diabetes disease management program. A purchaser contracted with American Healthways, a disease management organization, to initiate a diabetes disease management program called Diabetes Decisions. Started in 1998, the program grew to include 662 participants. The results reported are based on the continuously participating population (12 months of participation in the program for the reporting year). Participants were entered into American Healthways' clinical information system and risk-stratified, and an individualized treatment plan was devised. Outbound telephone calls by specially trained nurses were a key intervention. Data were collected on key process measures, financial parameters, and participant satisfaction. By year 3, there were 422 continuously participating participants. From baseline to the third year of the program, significant increases in frequency of A1C testing (21.3% to 82.2%), dilated retinal exams (17.2% to 70.7%), and performance of foot exams (2.0% to 75.6%) were noted. For 166 participants with five A1C determinations, A1C values dropped from 8.89% to 7.88%. Participants experienced a 36% drop in inpatient costs. Without adjustment for medical inflation, total medical costs decreased by 26.8% from the baseline period, dropping to $268.63 per diabetes participant per month (PDPPM) by year 3, a gross savings of $98.49 PDPPM. After subtracting the fees paid to Diabetes Decisions, a net savings of $986,538 was realized. This yielded a return on investment of 3.37. By investing in a diabetes disease management program, a purchaser was able to realize significant improvements in clinical care, substantial cost savings, and a favorable return on investment.

  10. Using airborne geophysical surveys to improve groundwater resource management models

    USGS Publications Warehouse

    Abraham, Jared D.; Cannia, James C.; Peterson, Steven M.; Smith, Bruce D.; Minsley, Burke J.; Bedrosian, Paul A.

    2010-01-01

    Increasingly, groundwater management requires more accurate hydrogeologic frameworks for groundwater models. These complex issues have created the demand for innovative approaches to data collection. In complicated terrains, groundwater modelers benefit from continuous high‐resolution geologic maps and their related hydrogeologic‐parameter estimates. The USGS and its partners have collaborated to use airborne geophysical surveys for near‐continuous coverage of areas of the North Platte River valley in western Nebraska. The survey objectives were to map the aquifers and bedrock topography of the area to help improve the understanding of groundwater‐surface‐water relationships, leading to improved water management decisions. Frequency‐domain heliborne electromagnetic surveys were completed, using a unique survey design to collect resistivity data that can be related to lithologic information to refine groundwater model inputs. To render the geophysical data useful to multidimensional groundwater models, numerical inversion is necessary to convert the measured data into a depth‐dependent subsurface resistivity model. This inverted model, in conjunction with sensitivity analysis, geological ground truth (boreholes and surface geology maps), and geological interpretation, is used to characterize hydrogeologic features. Interpreted two‐ and three‐dimensional data coverage provides the groundwater modeler with a high‐resolution hydrogeologic framework and a quantitative estimate of framework uncertainty. This method of creating hydrogeologic frameworks improved the understanding of flow path orientation by redefining the location of the paleochannels and associated bedrock highs. The improved models reflect actual hydrogeology at a level of accuracy not achievable using previous data sets.

  11. Applying multi-criteria decision-making to improve the waste reduction policy in Taiwan.

    PubMed

    Su, Jun-Pin; Hung, Ming-Lung; Chao, Chia-Wei; Ma, Hwong-wen

    2010-01-01

    Over the past two decades, the waste reduction problem has been a major issue in environmental protection. Both recycling and waste reduction policies have become increasingly important. As the complexity of decision-making has increased, it has become evident that more factors must be considered in the development and implementation of policies aimed at resource recycling and waste reduction. There are many studies focused on waste management excluding waste reduction. This study paid more attention to waste reduction. Social, economic, and management aspects of waste treatment policies were considered in this study. Further, a life-cycle assessment model was applied as an evaluation system for the environmental aspect. Results of both quantitative and qualitative analyses on the social, economic, and management aspects were integrated via the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method into the comprehensive decision-making support system of multi-criteria decision-making (MCDM). A case study evaluating the waste reduction policy in Taoyuan County is presented to demonstrate the feasibility of this model. In the case study, reinforcement of MSW sorting was shown to be the best practice. The model in this study can be applied to other cities faced with the waste reduction problems.

  12. Lessons from COASST: How Does Citizen Science Contribute to Natural Resource Management & Decision-Making?

    NASA Astrophysics Data System (ADS)

    Metes, J.; Ballard, H. L.; Parrish, J.

    2016-12-01

    As many scholars and practitioners in the environmental field turn to citizen science to collect robust scientific data as well as engage with wider audiences, it is crucial to build a more complete understanding of how citizen science influences and affects different interests within a social-ecological system. This research investigates how federal, state, and tribal natural resource managers interact with data from the Coastal Observation & Seabird Survey Team (COASST) project—a citizen science program that trains participants to monitor species and abundance of beach-cast birds on the Pacific Northwest Coast. Fifteen coastal and fisheries managers who previously requested COASST data were interviewed about how and why they used data from the project and were asked to describe how information gained from COASST affected their management decisions. Results suggest that broadly, managers value and learn from the program's capacity to gather data spanning a wide spatial-temporal range. This contribution to baseline monitoring helps managers signal and track both short- and long-term environmental change. More specifically, managers use COASST data in conjunction with other professional monitoring programs, such as the National Marine Fisheries Observer Program, to build higher degrees of reliability into management decisions. Although managers offered diverse perspectives and experiences about what the role of citizen science in natural resource management generally should be, there was agreement that agencies on their own often lack personnel and funding required to sufficiently monitor many crucial resources. Additionally, managers strongly suggested that COASST and other citizen science projects increased public awareness and support for agency decision-making and policies, and indirect yet important contribution to natural resource management.

  13. 78 FR 39314 - Notice of Availability of the Decision Record for the Delta River Special Recreation Management...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-07-01

    ...The Bureau of Land Management (BLM) announces the availability of the Decision Record (DR) for the Delta River Special Recreation Management Area and East Alaska Resource Management Plan Amendment (Approved Plan). The BLM-Alaska State Director, Bud C. Cribley, signed the DR on March 29, 2013. The DR constitutes the final decision of the Department on the plan and is effective immediately.

  14. Integrated Data & Analysis in Support of Informed and Transparent Decision Making

    NASA Astrophysics Data System (ADS)

    Guivetchi, K.

    2012-12-01

    The California Water Plan includes a framework for improving water reliability, environmental stewardship, and economic stability through two initiatives - integrated regional water management to make better use of local water sources by integrating multiple aspects of managing water and related resources; and maintaining and improving statewide water management systems. The Water Plan promotes ways to develop a common approach for data standards and for understanding, evaluating, and improving regional and statewide water management systems, and for common ways to evaluate and select from alternative management strategies and projects. The California Water Plan acknowledges that planning for the future is uncertain and that change will continue to occur. It is not possible to know for certain how population growth, land use decisions, water demand patterns, environmental conditions, the climate, and many other factors that affect water use and supply may change by 2050. To anticipate change, our approach to water management and planning for the future needs to consider and quantify uncertainty, risk, and sustainability. There is a critical need for information sharing and information management to support over-arching and long-term water policy decisions that cross-cut multiple programs across many organizations and provide a common and transparent understanding of water problems and solutions. Achieving integrated water management with multiple benefits requires a transparent description of dynamic linkages between water supply, flood management, water quality, land use, environmental water, and many other factors. Water Plan Update 2013 will include an analytical roadmap for improving data, analytical tools, and decision-support to advance integrated water management at statewide and regional scales. It will include recommendations for linking collaborative processes with technical enhancements, providing effective analytical tools, and improving and sharing

  15. System for decision analysis support on complex waste management issues

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Shropshire, D.E.

    1997-10-01

    A software system called the Waste Flow Analysis has been developed and applied to complex environmental management processes for the United States Department of Energy (US DOE). The system can evaluate proposed methods of waste retrieval, treatment, storage, transportation, and disposal. Analysts can evaluate various scenarios to see the impacts to waste slows and schedules, costs, and health and safety risks. Decision analysis capabilities have been integrated into the system to help identify preferred alternatives based on a specific objectives may be to maximize the waste moved to final disposition during a given time period, minimize health risks, minimize costs,more » or combinations of objectives. The decision analysis capabilities can support evaluation of large and complex problems rapidly, and under conditions of variable uncertainty. The system is being used to evaluate environmental management strategies to safely disposition wastes in the next ten years and reduce the environmental legacy resulting from nuclear material production over the past forty years.« less

  16. Continuous quality improvement for the clinical decision unit.

    PubMed

    Mace, Sharon E

    2004-01-01

    Clinical decision units (CDUs) are a relatively new and growing area of medicine in which patients undergo rapid evaluation and treatment. Continuous quality improvement (CQI) is important for the establishment and functioning of CDUs. CQI in CDUs has many advantages: better CDU functioning, fulfillment of Joint Commission on Accreditation of Healthcare Organizations mandates, greater efficiency/productivity, increased job satisfaction, better performance improvement, data availability, and benchmarking. Key elements include a database with volume indicators, operational policies, clinical practice protocols (diagnosis specific/condition specific), monitors, benchmarks, and clinical pathways. Examples of these important parameters are given. The CQI process should be individualized for each CDU and hospital.

  17. [A computerised clinical decision-support system for the management of depression in Primary Care].

    PubMed

    Aragonès, Enric; Comín, Eva; Cavero, Myriam; Pérez, Víctor; Molina, Cristina; Palao, Diego

    Despite its clinical relevance and its importance as a public health problem, there are major gaps in the management of depression. Evidence-based clinical guidelines are useful to improve processes and clinical outcomes. In order to make their implementation easier these guidelines have been transformed into computerised clinical decision support systems. In this article, a description is presented on the basics and characteristics of a new computerised clinical guideline for the management of major depression, developed in the public health system in Catalonia. This tool helps the clinician to establish reliable and accurate diagnoses of depression, to choose the best treatment a priori according to the disease and the patient characteristics. It also emphasises the importance of systematic monitoring to assess the clinical course, and to adjust therapeutic interventions to the patient's needs at all times. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  18. Waste Management Decision-Making Process During a Homeland Security Incident Response

    EPA Pesticide Factsheets

    A step-by-step guide on how to make waste management-related decisions including how waste can be minimized, collected and treated, as well as where waste can be sent for staging, storage and final disposal.

  19. Benefit cost models to support pavement management decisions : executive summary report.

    DOT National Transportation Integrated Search

    2012-01-01

    A critical role of pavement management is to : provide decision makers with estimates of the : required budget level to achieve specific steadystate : network conditions, and to recommend the : best allocation of available budget among : competing ne...

  20. PAlliative Care in chronic Kidney diSease: the PACKS study--quality of life, decision making, costs and impact on carers in people managed without dialysis.

    PubMed

    Noble, Helen Rose; Agus, Ashley; Brazil, Kevin; Burns, Aine; Goodfellow, Nicola A; Guiney, Mary; McCourt, Fiona; McDowell, Cliona; Normand, Charles; Roderick, Paul; Thompson, Colin; Maxwell, A P; Yaqoob, M M

    2015-07-11

    The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK. In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists. The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

  1. The application of natural science data to land management decision-making

    NASA Technical Reports Server (NTRS)

    Williams, D. L.; Sharpe, C. P.; Rowe, P. G.

    1974-01-01

    A natural environmental analysis process which allows the decision maker to know the probable consequences of a decision prior to the act is developed. Emphasis is placed on the fit between the natural environment and the social, economic, and functional attributes of man's communities and the transition from nature in its present state to various forms and intensities of development. Applications of the analysis are examined. It is concluded that the analysis is a workable system for land use management.

  2. Application fields for the new Object Management Group (OMG) Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN) in the perioperative field.

    PubMed

    Wiemuth, M; Junger, D; Leitritz, M A; Neumann, J; Neumuth, T; Burgert, O

    2017-08-01

    Medical processes can be modeled using different methods and notations. Currently used modeling systems like Business Process Model and Notation (BPMN) are not capable of describing the highly flexible and variable medical processes in sufficient detail. We combined two modeling systems, Business Process Management (BPM) and Adaptive Case Management (ACM), to be able to model non-deterministic medical processes. We used the new Standards Case Management Model and Notation (CMMN) and Decision Management Notation (DMN). First, we explain how CMMN, DMN and BPMN could be used to model non-deterministic medical processes. We applied this methodology to model 79 cataract operations provided by University Hospital Leipzig, Germany, and four cataract operations provided by University Eye Hospital Tuebingen, Germany. Our model consists of 85 tasks and about 20 decisions in BPMN. We were able to expand the system with more complex situations that might appear during an intervention. An effective modeling of the cataract intervention is possible using the combination of BPM and ACM. The combination gives the possibility to depict complex processes with complex decisions. This combination allows a significant advantage for modeling perioperative processes.

  3. People and Decisions: Meeting the Information Needs of Managers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Blake, J.I.; LeMaster, E.

    2000-10-01

    The information needs of managers with respect to avian species at the SRS are identified. The process by which information is integrated into decision making are discussed. Numerous studies of upland bird species at SRS were conducted as part of the DOE Biodiversity Program. This information is being incorporated into biological assessments and plan through modeling and geographic information systems.

  4. Clinical factors affecting physicians' management decisions in cases of female partner abuse.

    PubMed

    Ferris, L E; Norton, P; Dunn, E V; Gort, E H

    1999-06-01

    This study determined which clinical factors influence Canadian primary care physicians' management decisions in cases of female partner abuse. We used a cross-sectional survey design and randomly sampled (n = 2,014) English-speaking Canadian physicians with a primary interest in family or general practice who were practicing in any of the 12 provinces and territories in Canada and who were active in private practice and registered to prescribe. Respondents completed a questionnaire that required them to score management decision plans in response to case scenarios illustrating typical office-based situations that might involve domestic violence. The response rate was 50.7% (n = 1,022). Using forward stepwise regression analysis, the strongest predictor of whether a physician endorsed a management plan in response to violence was whether the woman acknowledged or revealed the abuse. Male physicians were more likely than females to endorse talking with the suspected abuser if he was known to them, regardless of the quality of this patient-physician relationship with the abuser. Decisions about whether to deal with the abuse or the selection of a management plan are not dependent on the severity of the physical abuse and the emotional consequences. Whether a woman acknowledges or reveals the abuse, as well as whether both the male and female patients are in the physician's practice, are predictive of whether a physician's response to a case scenario involves dealing with spousal abuse and how he/she will address it.

  5. Disease management improves ESRD outcomes.

    PubMed

    Sands, J J

    2006-02-01

    Renal disease management organizations have reported achieving significant decreases in mortality and hospitalization in conjunction with cost savings, improved patient satisfaction and quality of life. Disease management organizations strive to fill existing gaps in care delivery through the standardized use of risk assessment, predictive modeling, evidence based guidelines and process and outcomes measurement. Patient self-management education and the provision of individual nurse care managers are also key program components. As we more fully measure clinical outcomes and total health-care costs including payments from all insurance and government entities, pharmacy costs and out-of-pocket expenditures, the full implications of disease management can be better defined. The results of this analysis will have a profound influence on United States healthcare policy. At present, current data suggests that the promise of disease management, improved care at reduced cost, can and is being realized in ESRD.

  6. NASA Earth Observations Informing Renewable Energy Management and Policy Decision Making

    NASA Technical Reports Server (NTRS)

    Eckman, Richard S.; Stackhouse, Paul W., Jr.

    2008-01-01

    The NASA Applied Sciences Program partners with domestic and international governmental organizations, universities, and private entities to improve their decisions and assessments. These improvements are enabled by using the knowledge generated from research resulting from spacecraft observations and model predictions conducted by NASA and providing these as inputs to the decision support and scenario assessment tools used by partner organizations. The Program is divided into eight societal benefit areas, aligned in general with the Global Earth Observation System of Systems (GEOSS) themes. The Climate Application of the Applied Sciences Program has as one of its focuses, efforts to provide for improved decisions and assessments in the areas of renewable energy technologies, energy efficiency, and climate change impacts. The goals of the Applied Sciences Program are aligned with national initiatives such as the U.S. Climate Change Science and Technology Programs and with those of international organizations including the Group on Earth Observations (GEO) and the Committee on Earth Observation Satellites (CEOS). Activities within the Program are funded principally through proposals submitted in response to annual solicitations and reviewed by peers.

  7. Improving shared decision-making in adolescents through antibiotic education.

    PubMed

    Ngadimon, I W; Islahudin, F; Mohamed Shah, N; Md Hatah, E; Makmor-Bakry, M

    2017-02-01

    Background Shared decision-making is vital in achieving desired drug therapy goals, especially with antibiotics, in view of the potential long-term reduction in drug resistance. However, shared decision-making is rarely practiced with adolescent patients. Objectives The aim of the study was to identify the effect antibiotic education has on willingness to engage in shared decision-making among adolescents in Malaysia. Setting Participants from secondary schools in Malaysia were enrolled with ethical approval. Method The adolescents answered a validated questionnaire, which included demographics, antibiotic knowledge, attitude towards antibiotic use, and the Control Preference Scale, which measures willingness to engage in shared decision-making. Afterwards, antibiotic education was delivered to participating students. Main outcome measure Knowledge about and attitude toward antibiotics were investigated. Results A total of 510 adolescents participated in the study. Knowledge of antibiotics significantly increased post education (pre 3.2 ± 1.8 vs. post 6.8 ± 2.1, p < 0.001), as did attitude score (pre 3.3 ± 1.7 vs. post 5.4 ± 1.9, p = 0.003). Interestingly, adolescents were less likely to be passively involved in shared decision-making post education (χ = 36.9, df = 2, p < 0.001). Adolescents who were more collaborative in shared decision-making had a significantly higher total antibiotics knowledge and attitude scores compared to those who were not collaborative (p = 0.003). Conclusion The present work demonstrates that antibiotic education improves knowledge, attitude, and willingness to engage in shared decision-making among adolescents. Antibiotic education can therefore be introduced as a strategy to reduce inappropriate antibiotic use.

  8. Evaluating Academic Journals without Impact Factors for Collection Management Decisions.

    ERIC Educational Resources Information Center

    Dilevko, Juris; Atkinson, Esther

    2002-01-01

    Discussion of evaluating academic journals for collection management decisions focuses on a methodological framework for evaluating journals not ranked by impact factors in Journal Citation Reports. Compares nonranked journals with ranked journals and then applies this framework to a case study in the field of medical science. (LRW)

  9. Use of decision support systems as a drought management tool

    USGS Publications Warehouse

    Frevert, D.; Lins, H.; ,

    2005-01-01

    Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.

  10. Military Service and Decision Quality in the Management of Knee Osteoarthritis.

    PubMed

    Henderson, Eric R; Titus, Alexander J; Keeney, Benjamin J; Goodney, Philip P; Lurie, Jon D; Ibrahim, Said A

    2018-05-18

    Decision quality measures the degree to which care decisions are knowledge-based and value-aligned. Because military service emphasizes hierarchy, command, and mandates some healthcare decisions, military service may attenuate patient autonomy in healthcare decisions and lower decision quality. VA is the nation's largest provider of orthopedic care. We compared decision quality in a sample of VA and non-VA patients seeking care for knee osteoarthritis. Our study sample consisted of patients newly referred to our orthopedic clinic for the management of knee osteoarthritis. None of the study patients were exposed to a knee osteoarthritis decision aid. Consenting patients were administered the Hip/Knee Decision Quality Instrument (HK-DQI). In addition, they were surveyed about decision-making preferences and demographics. We compared results to a non-VA cohort from our academic institution's arthroplasty database. The HK-DQI Knowledge Score was lower in the VA cohort (45%, SD = 22, n = 25) compared with the non-VA cohort (53%, SD = 21, n = 177) (p = 0.04). The Concordance Score was lower in the VA cohort (36%, SD = 49%) compared with the control cohort (70%, SD 46%) (p = 0.003). Non-VA patients were more likely to make a high-quality decision (p = 0.05). Non-VA patients were more likely to favor a shared decision-making process (p = 0.002). Decision quality is lower in Veterans with knee osteoarthritis compared with civilians, placing them at risk for lower treatment satisfaction and possibly unwarranted surgical utilization. Our future work will examine if this difference is from conditioned military service behaviors or confounding demographic factors, and if conventional shared decision-making techniques will correct this deficiency.

  11. Evaluating the impact of HIA on urban reconstruction decision-making. Who manages whose risks?

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bekker, Marleen P.M.; Putters, Kim; Grinten, Tom E.D. van der

    2005-10-15

    Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science ofmore » sociology and knowledge management. This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model 'City and Environment' that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIA was part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decision-making behaviour. Appropriate cognitive and social strategies are needed to avoid 'negative learning' in those the HIA seeks to influence.« less

  12. Management Design Theories

    NASA Astrophysics Data System (ADS)

    Pries-Heje, Jan; Baskerville, Richard L.

    This paper elaborates a design science approach for management planning anchored to the concept of a management design theory. Unlike the notions of design theories arising from information systems, management design theories can appear as a system of technological rules, much as a system of hypotheses or propositions can embody scientific theories. The paper illus trates this form of management design theories with three grounded cases. These grounded cases include a software process improvement study, a user involvement study, and an organizational change study. Collectively these studies demonstrate how design theories founded on technological rules can not only improve the design of information systems, but that these concepts have great practical value for improving the framing of strategic organi zational design decisions about such systems. Each case is either grounded in an empirical sense, that is to say, actual practice, or it is grounded to practices described extensively in the practical literature. Such design theories will help managers more easily approach complex, strategic decisions.

  13. Impact of a goal setting and decision support telephone coaching intervention on diet, psychosocial, and decision outcomes among people with type 2 diabetes.

    PubMed

    Swoboda, Christine M; Miller, Carla K; Wills, Celia E

    2017-07-01

    Evaluate a 16-week decision support and goal-setting intervention to compare diet quality, decision, and diabetes-related outcomes to a control group. Adults with type 2 diabetes (n=54) were randomly assigned to an intervention or control group. Intervention group participants completed one in-person motivational interviewing and decision support session followed by seven biweekly telephone coaching calls. Participants reported previous goal attempts and set diet- and/or physical activity-related goals during coaching calls. Control group participants received information about local health care resources on the same contact schedule. There was a significant difference between groups for diabetes empowerment (p=0.045). A significant increase in diet quality, diabetes self-efficacy, and diabetes empowerment, and a significant decrease in diabetes distress and depressive symptoms (all p≤0.05) occurred in the intervention group. Decision confidence to achieve diet-related goals significantly improved from baseline to week 8 but then declined at study end (both p≤0.05). Setting specific diet-related goals may promote dietary change, and telephone coaching can improve psychosocial outcomes related to diabetes self-management. Informed shared decision making can facilitate progressively challenging yet attainable goals tailored to individuals' lifestyle. Decision coaching may empower patients to improve self-management practices and reduce distress. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. A Decision-Support System for Sustainable Water Distribution System Planning.

    PubMed

    Freund, Alina; Aydin, Nazli Yonca; Zeckzer, Dirk; Hagen, Hans

    2017-01-01

    An interactive decision-support system (DSS) can help experts prepare water resource management plans for decision makers and stakeholders. The design of the proposed prototype incorporates visualization techniques such as circle views, grid layout, small multiple maps, and node simplification to improve the data readability of water distribution systems. A case study with three urban water management and sanitary engineering experts revealed that the proposed DSS is satisfactory, efficient, and effective.

  15. Cultural targeting and tailoring of shared decision making technology: a theoretical framework for improving the effectiveness of patient decision aids in culturally diverse groups.

    PubMed

    Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne

    2014-03-01

    Patient decision aids are known to positively impact outcomes critical to shared decision making (SDM), such as gist knowledge and decision preparedness. However, research on the potential improvement of these and other important outcomes through cultural targeting and tailoring of decision aids is very limited. This is the case despite extensive evidence supporting use of cultural targeting and tailoring to improve the effectiveness of health communications. Building on prominent psychological theory, we propose a two-stage framework incorporating cultural concepts into the design process for screening and treatment decision aids. The first phase recommends use of cultural constructs, such as collectivism and individualism, to differentially target patients whose cultures are known to vary on these dimensions. Decision aid targeting is operationalized through use of symbols and values that appeal to members of the given culture. Content dimensions within decision aids that appear particularly appropriate for targeting include surface level visual characteristics, language, beliefs, attitudes and values. The second phase of the framework is based on evidence that individuals vary in terms of how strongly cultural norms influence their approach to problem solving and decision making. In particular, the framework hypothesizes that differences in terms of access to cultural mindsets (e.g., access to interdependent versus independent self) can be measured up front and used to tailor decision aids. Thus, the second phase in the framework emphasizes the importance of not only targeting decision aid content, but also tailoring the information to the individual based on measurement of how strongly he/she is connected to dominant cultural mindsets. Overall, the framework provides a theory-based guide for researchers and practitioners who are interested in using cultural targeting and tailoring to develop and test decision aids that move beyond a "one-size fits all" approach

  16. Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

    PubMed Central

    2017-01-01

    A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

  17. Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

    PubMed

    Nantha, Yogarabindranath Swarna

    2017-11-01

    A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

  18. GLIMPSE: A decision support tool for simultaneously achieving our air quality management and climate change mitigation goals

    NASA Astrophysics Data System (ADS)

    Pinder, R. W.; Akhtar, F.; Loughlin, D. H.; Henze, D. K.; Bowman, K. W.

    2012-12-01

    Poor air quality, ecosystem damages, and climate change all are caused by the combustion of fossil fuels, yet environmental management often addresses each of these challenges separately. This can lead to sub-optimal strategies and unintended consequences. Here we present GLIMPSE -- a decision support tool for simultaneously achieving our air quality and climate change mitigation goals. GLIMPSE comprises of two types of models, (i) the adjoint of the GEOS-Chem chemical transport model, to calculate the relationship between emissions and impacts at high spatial resolution, and (ii) the MARKAL energy system model, to calculate the relationship between energy technologies and emissions. This presentation will demonstrate how GLIMPSE can be used to explore energy scenarios to better achieve both improved air quality and mitigate climate change. Second, this presentation will discuss how space-based observations can be incorporated into GLIMPSE to improve decision-making. NASA satellite products, namely ozone radiative forcing from the Tropospheric Emission Spectrometer (TES), are used to extend GLIMPSE to include the impact of emissions on ozone radiative forcing. This provides a much needed observational constraint on ozone radiative forcing.

  19. Impact of decision support in electronic medical records on lipid management in primary care.

    PubMed

    Gill, James M; Chen, Ying Xia; Glutting, Joseph J; Diamond, James J; Lieberman, Michael I

    2009-10-01

    Electronic decision-support tools may help to improve management of hyperlipidemia and other chronic diseases. This study examined the impact of lipid management tools integrated into an electronic medical record (EMR) in primary care practices. This randomized controlled trial was conducted in a national network of physicians who use an outpatient EMR. Adult primary care physicians were randomized by office to receive an electronic form that was embedded in the EMR. The form contained prompts regarding suboptimal care based on Adult Treatment Panel-III (ATP-III) guidelines, as well as reporting tools to identify patients outside of office visits whose lipid management was suboptimal. All active patients, ages 20-79 years, whose physicians participated in the study, were categorized as high, moderate, or low cardiovascular risk, and the proportion who were tested for hyperlipidemia, at lipid goal, and on lipid-lowering medications if not at goal were measured according to ATP-III guidelines. A total of 105 physicians from 25 offices and 64,150 patients were included in the study. Outcomes improved for most measures from before to 1 year after the intervention (November 1, 2005 to October 31, 2006). However, after controlling for confounding variables and for clustering in multilevel modeling, only up-to-date lipid testing for high-risk patients was statistically better in the intervention group as compared to the control group (adjusted odds ratio 15.0, P < 0.05). This study showed few differences in quality of lipid management after implementing an EMR-based disease management intervention in primary care settings. Future studies may need to examine more comprehensive interventions that include office staff in a team approach to care.

  20. Shared Care: A Quality Improvement Initiative to Optimize Primary Care Management of Constipation

    PubMed Central

    Vernacchio, Louis; Trudell, Emily; Antonelli, Richard; Nurko, Samuel; Leichtner, Alan M.; Lightdale, Jenifer R.

    2015-01-01

    BACKGROUND: Pediatric constipation is commonly managed in the primary care setting, where there is much variability in management and specialty referral use. Shared Care is a collaborative quality improvement initiative between Boston Children’s Hospital and the Pediatric Physician’s Organization at Children’s (PPOC), through which subspecialists provide primary care providers with education, decision-support tools, pre-referral management recommendations, and access to advice. We investigated whether Shared Care reduces referrals and improves adherence to established clinical guidelines. METHODS: We reviewed the primary care management of patients 1 to 18 years old seen by a Boston Children’s Hospital gastroenterologist and diagnosed with constipation who were referred from PPOC practices in the 6 months before and after implementation of Shared Care. Charts were assessed for patient factors and key components of management. We also tracked referral rates for all PPOC patients for 29 months before implementation and 19 months after implementation. RESULTS: Fewer active patients in the sample were referred after implementation (61/27 365 [0.22%] vs 90/27 792 [0.36%], P = .003). The duration of pre-referral management increased, and the rate of fecal impaction decreased after implementation. No differences were observed in documentation of key management recommendations. Analysis of medical claims showed no statistically significant change in referrals. CONCLUSIONS: A multifaceted initiative to support primary care management of constipation can alter clinical care, but changes in referral behavior and pre-referral management may be difficult to detect and sustain. Future efforts may benefit from novel approaches to provider engagement and systems integration. PMID:25896837