Skitka, Linda J.
This study clarified that automation bias is something unique to automated decision making contexts, and is not the result of a general tendency toward complacency. By comparing performance on exactly the same events on the same tasks with and without an automated decision aid, we were able to determine that at least the omission error part of automation bias is due to the unique context created by having an automated decision aid, and is not a phenomena that would occur even if people were not in an automated context. However, this study also revealed that having an automated decision aid did lead to modestly improved performance across all non-error events. Participants in the non- automated condition responded with 83.68% accuracy, whereas participants in the automated condition responded with 88.67% accuracy, across all events. Automated decision aids clearly led to better overall performance when they were accurate. People performed almost exactly at the level of reliability as the automation (which across events was 88% reliable). However, also clear, is that the presence of less than 100% accurate automated decision aids creates a context in which new kinds of errors in decision making can occur. Participants in the non-automated condition responded with 97% accuracy on the six "error" events, whereas participants in the automated condition had only a 65% accuracy rate when confronted with those same six events. In short, the presence of an AMA can lead to vigilance decrements that can lead to errors in decision making.
Sullivan, Thomas J; Chino, Masamichi; Ehrhardt, Joachim; Shershakov, Vyacheslav
This paper discusses a collaborative project (1) to demonstrate the feasibility and benefit of a system seeking early review, in a 'quasi peer review' mode, of nuclear accident plume and dose assessment predictions by four major international nuclear accident emergency response systems before release of calculations to respective national authorities followed by (2) sharing these results with responsible national/international authorities, (3) development of an affordable/accessible system to distribute results to countries without prediction capabilities and (4) utilisation for exercises and collaboration studies. The project exploits Internet browser technology and low-cost PC hardware, incorporates an Internet node, with access control, for depositing a minimal set of XML-based graphics files for presentation in an identical map format. Side-by-side viewing and televideo conferencing will permit rapid evaluation, data elaboration and recalculation (if necessary) and should produce strong consensus among decision makers. Successful completion affords easy utilisation by national/international organisations and non-nuclear states at risk of trans-boundary incursion.
Sullivan, T J; Chino, M; Ehrhardt, J; Shershakov, V
This paper discusses a collaborative project whose purpose is (1) to demonstrate the technical feasibility and mutual benefit of a system seeking early review or preview, in a ''quasi peer review'' mode, of nuclear accident plume and dose assessment predictions by four major international nuclear accident emergency response systems before release of their calculations to their respective national authorities followed by (2) sharing these results with responsible international authorities. The extreme sensitivity of the general public to any nuclear accident information has been a strong motivation to seek peer review prior to public release. Another intended objective of this work is (3) the development of an affordable/accessible system for distribution of prediction results to countries having no prediction capabilities and (4) utilization of the link for exercises and collaboration studies. The project exploits the Internet as a ubiquitous communications medium, browser technology as a simple, user friendly interface, and low-cost PC level hardware. The participants are developing a web based dedicated node with ID and password access control, where the four systems can deposit a minimal set of XML-based data and graphics files, which are then displayed in a common identical map format. Side-by-side viewing and televideo conferencing will permit rapid evaluation, correction or elaboration of data, recalculation (if necessary) and should produce a strong level of consensus to assist international decision makers. Successful completion of this work could lead to easy utilization by national and international organizations, such as the IAEA and WHO, as well as by non-nuclear states at risk of a trans-boundary incursion on their territory.
Background In Japan, there is no decision-making guide regarding long-term tube feeding that specifically targets individuals making decisions on behalf of cognitively impaired older persons (substitute decision makers). The objective of this study was to describe the development and evaluation of such a decision aid. Methods In this before-and-after study, participants comprised substitute decision makers for 13 cognitively impaired inpatients aged 65 years and older who were being considered for placement of a percutaneous endoscopic gastrostomy tube in acute care hospitals and mixed-care hospitals in Japan. Questionnaires were used to compare substitute decision makers’ knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to a decision aid. The acceptability of the decision aid was also assessed. Paired t-tests were used to compare participants’ knowledge and decisional conflict scores before and after using the decision aid. Results Substitute decision makers showed significantly increased knowledge (P < .001) and decreased decisional conflict (P < .01) regarding long-term tube feeding after using the decision aid. All substitute decision makers found the decision aid helpful and acceptable. Conclusions The decision aid facilitated the decision-making process of substitute decision makers by decreasing decisional conflict and increasing knowledge. PMID:24495735
Naruse, Makoto; Berthel, Martin; Drezet, Aurélien; Huant, Serge; Aono, Masashi; Hori, Hirokazu; Kim, Song-Ju
Decision making is critical in our daily lives and for society in general and is finding evermore practical applications in information and communication technologies. Herein, we demonstrate experimentally that single photons can be used to make decisions in uncertain, dynamically changing environments. Using a nitrogen-vacancy in a nanodiamond as a single-photon source, we demonstrate the decision-making capability by solving the multi-armed bandit problem. This capability is directly and immediately associated with single-photon detection in the proposed architecture, leading to adequate and adaptive autonomous decision making. This study makes it possible to create systems that benefit from the quantum nature of light to perform practical and vital intelligent functions.
Naruse, Makoto; Berthel, Martin; Drezet, Aurélien; Huant, Serge; Aono, Masashi; Hori, Hirokazu; Kim, Song-Ju
Decision making is critical in our daily lives and for society in general and is finding evermore practical applications in information and communication technologies. Herein, we demonstrate experimentally that single photons can be used to make decisions in uncertain, dynamically changing environments. Using a nitrogen-vacancy in a nanodiamond as a single-photon source, we demonstrate the decision-making capability by solving the multi-armed bandit problem. This capability is directly and immediately associated with single-photon detection in the proposed architecture, leading to adequate and adaptive autonomous decision making. This study makes it possible to create systems that benefit from the quantum nature of light to perform practical and vital intelligent functions.
Naruse, Makoto; Berthel, Martin; Drezet, Aurélien; Huant, Serge; Aono, Masashi; Hori, Hirokazu; Kim, Song-Ju
Decision making is critical in our daily lives and for society in general and is finding evermore practical applications in information and communication technologies. Herein, we demonstrate experimentally that single photons can be used to make decisions in uncertain, dynamically changing environments. Using a nitrogen-vacancy in a nanodiamond as a single-photon source, we demonstrate the decision-making capability by solving the multi-armed bandit problem. This capability is directly and immediately associated with single-photon detection in the proposed architecture, leading to adequate and adaptive autonomous decision making. This study makes it possible to create systems that benefit from the quantum nature of light to perform practical and vital intelligent functions. PMID:26278007
Kaneklides, Ann L.
Underscores the importance of informed decision making through accurate anticipation of cost incurrence in light of changing economic and environmental conditions. Explains the concepts of cost accounting, full allocation of costs, the selection of an allocation base, the allocation of indirect costs, depreciation, and implications for community…
Vano, J. A.
Being trained as a scientist provides many valuable tools needed to address society's most pressing environmental issues. It does not, however, provide training on one of the most critical for translating science into action: the ability to engage decision makers. Engagement means different things to different people and what is appropriate for one project might not be for another. However, recent reports have emphasized that for research to be most useful to decision making, engagement should happen at the beginning and throughout the research process. There are an increasing number of boundary organizations (e.g., NOAA's Regional Integrated Sciences and Assessment program, U.S. Department of the Interior's Climate Science Centers) where engagement is encouraged and rewarded, and scientists are learning, often through trial and error, how to effectively include decision makers (a.k.a. stakeholders, practitioners, resource managers) in their research process. This presentation highlights best practices and practices to avoid when scientists engage decision makers, a list compiled through the personal experiences of both scientists and decision makers and a literature review, and how this collective knowledge could be shared, such as through a recent session and role-playing exercise given at the Northwest Climate Science Center's Climate Boot Camp. These ideas are presented in an effort to facilitate conversations about how the science community (e.g., AGU researchers) can become better prepared for effective collaborations with decision makers that will ultimately result in more actionable science.
Isaac, E K
Decision makers are most influenced by the impact on the whole, while budget preparers often concentrate on the upcoming fiscal year or on daily operations. This difference in approach becomes obvious in the budget process. Remember that your budget proposal is only one segment of the overall financial plan. Be aware of the goals of the governing body and of your CEO in projecting outcomes. Look to other disciplines to understand how they influence decision makers for funds. Resistance to this approach will neither enhance nor promote our competitive skills. We must think as financial planners to achieve our financial goals.
Jones, Andrew; Calvin, Katherine; Lamarque, Jean -Francois
The need for regional- and local-scale climate information is increasing rapidly as decision makers seek to anticipate and manage a variety of context-specific climate risks over the next several decades. Furthermore, global climate models are not developed with these user needs in mind, and they typically operate at resolutions that are too coarse to provide information that could be used to support regional and local decisions.
Ethical failures in UK higher education have recently made the news but are not a recent development. University decision-makers can, in order to adopt an ethical way of reasoning, resort to several ethical traditions. This article focuses, through the use of concrete examples, on three which have had a significant impact in recent higher…
American Dietetic Association, Chicago, IL.
This guide is designed specifically to assist decision makers in business and industry, including chief executive officers, benefits managers, human resource directors, wellness coordinators, and owners of small businesses, in understanding how diet and nutrition affect employees and the company. It addresses the concerns of both small and large…
Garcia-Retamero, Rocio; Dhami, Mandeep K
The present study aimed to (a) demonstrate the effect of positive-negative framing on experienced criminal justice decision makers, (b) examine the debiasing effect of visually structured risk messages, and (c) investigate whether risk perceptions mediate the debiasing effect of visual aids on decision making. In two phases, 60 senior police officers estimated the accuracy of a counterterrorism technique in identifying whether a known terror suspect poses an imminent danger and decided whether they would recommend the technique to policy makers. Officers also rated their confidence in this recommendation. When information about the effectiveness of the counterterrorism technique was presented in a numerical format, officers' perceptions of accuracy and recommendation decisions were susceptible to the framing effect: The technique was perceived to be more accurate and was more likely to be recommended when its effectiveness was presented in a positive than in a negative frame. However, when the information was represented visually using icon arrays, there were no such framing effects. Finally, perceptions of accuracy mediated the debiasing effect of visual aids on recommendation decisions. We offer potential explanations for the debiasing effect of visual aids and implications for communicating risk to experienced, professional decision makers.
Donald, Kathleen M.; Carlisle, Jane M.
Presents the Diverse Decision Makers, a humorous classification of student career decision-making characteristics which can be used to stimulate group discussion in career planning workshops. The use of humor provides students with a different perspective to their problem and suggests some of the underlying difficulties in decision making. (JAC)
FAmily CEntered (FACE) advance care planning: Study design and methods for a patient-centered communication and decision-making intervention for patients with HIV/AIDS and their surrogate decision-makers.
Kimmel, Allison L; Wang, Jichuan; Scott, Rachel K; Briggs, Linda; Lyon, Maureen E
Although the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has become a chronic illness, disease-specific advance care planning has not yet been evaluated for the palliative care needs of adults with HIV/AIDS. This prospective, longitudinal, randomized, two-arm controlled clinical trial aims to test the efficacy of FAmily CEntered advance care planning among adults living with AIDS and/or HIV with co-morbidities on congruence in treatment preferences, healthcare utilization, and quality of life. The FAmily CEntered intervention arm is two face-to-face sessions with a trained, certified facilitator: Session 1) Disease-Specific Advance Care Planning Respecting Choices Interview; Session 2) Completion of advance directive. The Healthy Living Control arm is: Session 1) Developmental/Relationship History; Session 2) Nutrition. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention. A total of 288 patient/surrogate dyads will be enrolled from five hospital-based, out-patient clinics in Washington, District of Columbia. Participants will be HIV positive and ≥ 21 years of age; surrogates will be ≥ 18 years of age. Exclusion criteria are homicidality, suicidality, psychosis, and impaired cognitive functioning. We hypothesize that this intervention will enhance patient-centered communication with a surrogate decision-maker about end of life treatment preferences over time, enhance patient quality of life and decrease health care utilization. We further hypothesize that this intervention will decrease health disparities for Blacks in completion of advance directives. If proposed aims are achieved, the benefits of palliative care, particularly increased treatment preferences about end-of-life care and enhanced quality of life, will be extended to people living with AIDS.
Arora, Amit; Cummings, Laura; Crome, Peter
With vast improvements in healthcare in recent decades, people are living longer but often with higher rates of morbidity and chronic illnesses. This has resulted in a higher proportion of the population who may benefit from early end-of-life 'conversation and planning', but also gives healthcare professionals more time during which these discussions are relevant, as people live longer with their chronic diseases. A survey conducted by Lifshitz et al (Isr J Health Policy Res 5:6, 2016) sought to assess physician awareness and willingness to discuss designating a proxy decision-maker with patients, in order to aid end-of-life care in the event that the patient is rendered unable to make or communicate these decisions later in life. Their article suggests that proxy decision-maker designation is only one aspect of end-of-life care; a challenging area littered with ethical and moral dilemmas. Without early, open and frank discussions with patients regarding their wishes at the end of life, proxy decision-makers may be in no better position than physicians or a court appointed proxy to make decisions in the patients' best interests/benefits. This commentary also touches upon the use of health and care passports being developed or in early phases in the United Kingdom, and whether these may be utilised in the field of palliative care in Israel.
Gonzales, L. M.; Wood, C.; Boland, M. A.
Geoscientists and decision makers often use different words to describe the same thing. The American Geosciences Institute has developed a consistent definition for the geosciences (Wilson, 2014); however this definition often varies from how decision maker groups at the national, state, local, and regional levels often categorize geoscience topics. Where geoscientists may to refer to "geoscience," decision makers may use terms like "energy," "environment," and "natural resources." How may the geoscience community provide geoscience information to decision makers in a context they understand while at the same time providing a simple, yet consistent representation of all that the geosciences include? The American Geoscience Institute's (AGI's) Critical Issues program's main goal is to connect decision makers at all levels with decision-relevant, impartial, expert information from across the geosciences. The program uses a multi-faceted approach to reach different decision maker groups, including policy makers and government employees at the federal, state and local level. We discuss the challenges the Critical Issues program has overcome in representing the geosciences to decision makers in a cohesive fashion such that decision makers can access the information they need, while at the same time becoming aware of the breadth of information the geosciences has to offer, and the value of including geoscience in the decision-making process. References: Wilson, C.E. (2014) Status of the Geoscience Workforce 2014. American Geological Institute. Alexandria, VA.
A study in Wake County, North Carolina, designed to determine how racist structural barriers influence role perceptions of Black decision makers, identified the following discriminators of role perceptions: 1) officials' perceptions of themselves as decision makers or decision influencers; 2) age; 3) racial composition of organization; 4)…
and a larger subject group. 1-2 Adaptive Decision Aiding 1-2 The primary function of ADDAM is not simply to model the decision maker’s behavior...maximum expected utility (OEVMAXEU) during the course of the test session was the primary measure of decision performance. As a group, the aided...in Chapter 3. The primary function of ADDAM is not simply to model the decision maker’s behavior but to provide a basis for decision aiding. Once
Clavel, Nathalie; De coster, Carolyn; Pomey, Marie-Pascale; Sanmartin, Claudia; Bohm, Éric; Dunbar, Michael J.; Frank, CY; Hawker, Gillian; Noseworthy, Tom
Background: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. Objective: While our previous research focused on the appropriateness of TJR from clinical and patient perspectives, this study is aimed at understanding decision-makers' perspectives. Methods: Using a semi-structured guide, we interviewed a convenience sample of decision-makers in four Canadian provinces (Alberta, Manitoba, Nova Scotia and Quebec) between February and March 2013. For the purposes of this study, a decision-maker was defined as a manager, institutional leader or policy maker. Results: Fifteen interviews were conducted with decision-makers at ministry (n = 3), regional (n = 6) and institutional levels (n = 8). Decision-makers see themselves as having a key role in the appropriateness discourse, that of optimizing resource allocation and efficient delivery of services for TJR, to improve population outcomes. Conclusion: The decision-makers' view of appropriateness recognizes the importance of the clinical view, but it offers a very different input into the appropriateness discourse, more closely aligned with appropriateness of setting, which refers to cost-effectiveness considerations. PMID:27027795
Kopstein, Felix F.; Seidel, Robert J.
The computer's potential for education, and most particularly for instruction, is contingent on the development of a class of instructional decision models (formal instructional strategies) that interact with the student through appropriate peripheral equipment (man-machine interfaces). Computer hardware and software by themselves should not be…
Ligon, Glynn D.
Professionals responsible for educational research, evaluation, and statistics have sought to provide timely and useful information to decision makers. Regardless of the evaluation model, research design, or statistical methodology employed, informing the decision making process with quality, reliable data is a basic goal. The definition of…
Brighouse, Harry; Ladd, Helen F.; Loeb, Susanna; Swift, Adam
This article articulates a framework suitable for use when making decisions about education policy. Decision makers should establish what the feasible options are and evaluate them in terms of their contribution to the development, and distribution, of educational goods in children, balanced against the negative effect of policies on important…
The long history of outdoor education does little to alleviate the fears of many parents, teachers, principals and superintendents who believe that outdoor education is too risky. These decision makers often lack both the knowledge to make informed decisions and the time and resources to investigate their assumptions. Pair these circumstances with…
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Decision makers, notifications, and additional information. 39.4 Section 39.4 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AID TO STATES FOR ESTABLISHMENT, EXPANSION, AND IMPROVEMENT,...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Decision makers, notifications, and additional information. 39.4 Section 39.4 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AID FOR THE ESTABLISHMENT, EXPANSION, AND IMPROVEMENT, OR...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Decision makers, notifications, and additional information. 39.4 Section 39.4 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AID FOR THE ESTABLISHMENT, EXPANSION, AND IMPROVEMENT, OR...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Decision makers, notifications, and additional information. 39.4 Section 39.4 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) AID FOR THE ESTABLISHMENT, EXPANSION, AND IMPROVEMENT, OR...
Johnson, Fred A.; Eaton, Mitchell J.; Williams, James H.; Jensen, Gitte H.; Madsen, Jesper
Traditional conservation curricula and training typically emphasizes only one part of systematic decision making (i.e., the science), at the expense of preparing conservation practitioners with critical skills in values-setting, working with decision makers and stakeholders, and effective problem framing. In this article we describe how the application of decision science is relevant to conservation problems and suggest how current and future conservation practitioners can be trained to be better decision makers. Though decision-analytic approaches vary considerably, they all involve: (1) properly formulating the decision problem; (2) specifying feasible alternative actions; and (3) selecting criteria for evaluating potential outcomes. Two approaches are available for providing training in decision science, with each serving different needs. Formal education is useful for providing simple, well-defined problems that allow demonstrations of the structure, axioms and general characteristics of a decision-analytic approach. In contrast, practical training can offer complex, realistic decision problems requiring more careful structuring and analysis than those used for formal training purposes. Ultimately, the kinds and degree of training necessary depend on the role conservation practitioners play in a decision-making process. Those attempting to facilitate decision-making processes will need advanced training in both technical aspects of decision science and in facilitation techniques, as well as opportunities to apprentice under decision analysts/consultants. Our primary goal should be an attempt to ingrain a discipline for applying clarity of thought to all decisions.
Mazikana, Peter C.
Intended to highlight those aspects of the archival field that government officials should be aware of, this report on the Records and Archives Management Programme (RAMP) outlines the major principles of records management and archives administration, identifies the information needs of the decision makers, and assesses the ways in which records…
Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the
Miller, R E; Golaszewski, T J
Health newsletters are an important component of worksite wellness, and human resource program managers believe these publications motivate employees and promote health services. Research has identified employee segments more likely to read health newsletters as well as how these publications may contribute to better medical self-care decision making. Even so, virtually no data exist on the factors contributing to newsletter selection and purchase except proprietary, anecdotal information collected by commercial vendors. Therefore, the purpose of this research was to investigate how newsletter features are rated by decision makers and determine factors predicting intent to purchase a health newsletter.
bodies and ship contours BRLT ratings, the decision-maker keeps produced in this way are quite striking, working on a goal point or reference point and...graphic functions but are multicriteria aspirations are often contra- not specifically European. Cinematic dictory and cannot be achieved simulta...above a certain threshold, then more of Hamburg. Starting from a bare minimum information and aiding are of little use, of assumptions (e.g., rigidity
Water resource management decisions often involve multiple parties engaged in contentious negotiations that try to navigate through complex combinations of legal, social, hydrologic, financial, and engineering considerations. The standard approach for resolving these issues is some form of multi-party negotiation, a formal court decision, or a combination of the two. In all these cases, the role of the decision maker(s) is to choose and implement the best option that fits the needs and wants of the community. However, each path to a decision carries the risk of technical and/or financial infeasibility as well as the possibility of unintended consequences. To help reduce this risk, decision makers often rely on some type of predictive analysis from which they can evaluate the projected consequences of their decisions. Typically, decision makers are supported in the analysis process by trusted advisors who engage in the analysis as well as the day to day tasks associated with multi-party negotiations. In the case of water resource management, the analysis is frequently a numerical model or set of models that can simulate various management decisions across multiple systems and output results that illustrate the impact on areas of concern. Thus, in order to communicate scientific knowledge to the decision makers, the quality of the communication between the analysts, the trusted advisor, and the decision maker must be clear and direct. To illustrate this concept, a multi-attribute decision analysis matrix will be used to outline the value of computer model-based collaborative negotiation approaches to guide water resources decision making and communication with decision makers. In addition, the critical role of the trusted advisor and other secondary participants in the decision process will be discussed using examples from recent water negotiations.
Smythe, K.D.; Bernabo, J.C.; Carter, T.B.; Jutro, P.R.
The project on Biodiversity Uncertainties and Research Needs (BURN) ensures the advancement of usable knowledge on biodiversity by obtaining input from decision makers on their priority information needs about biodiversity and then using this input to engage leading scientists in designing policy-relevant research. Decision makers had concerns about four issues: significance of biodiversity; status and trends of biodiversity; management for biodiversity; the linkage of social, cultural, economic, legal, and biological objectives. Leading scientists identified research required to address these needs and determined the probability of success. The diverse group of experts reached consensus on several fundamental issues, helping to clarify the role of biodiversity in land and resource management. Several features that should be incorporated into policy-relevant research plans and management strategies for biodiversity were identified: multidisciplinary and integrative, participatory with stakeholder involvement, hierarchical, and problem- and region-specific. Activities should be focused regionally within a global perspective. More specifically, the scientists recommended six priority research areas that should be pursued to address the information needs articulated by decision makers: (1) characterization of biodiversity, (2) environmental valuation, (3) management for sustainability-for humans and the environment (adaptive management), (4) information management strategies, (5) governance and stewardship issues, and (6) communication and outreach. Broad recommendations wee developed for each research area to provide direction for research planning and resource management strategies. The results will directly benefit those groups that require biodiversity research to address their needs-whether to develop policy, manage natural resources, or make other decisions affecting biodiversity. 11 refs., 1 fig., 5 tabs.
Cushing, J.B.; Wilson, T.; Brandt, L.; Gregg, V.; Spengler, S.; Borning, A.; Delcambre, L.; Bowker, G.; Frame, M.; Fulop, J.; Hert, C.; Hovy, E.; Jones, J.; Landis, E.; Schnase, J.L.; Schweik, C.; Sonntag, W.; ,
Resource managers often face significant information technology (IT) problems when integrating ecological or environmental information to make decisions. At a workshop sponsored by the NSF and USGS in December 2004, university researchers, natural resource managers, and information managers met to articulate IT problems facing ecology and environmental decision makers. Decision making IT problems were identified in five areas: 1) policy, 2) data presentation, 3) data gaps, 4) tools, and 5) indicators. To alleviate those problems, workshop participants recommended specific informatics research in modeling and simulation, data quality, information integration and ontologies, and social and human aspects. This paper reports the workshop findings, and briefly compares these with research that traditionally falls under the emerging eco-informatics rubric. ?? Springer-Verlag Berlin Heidelberg 2005.
Eureka Project, Sacramento, CA.
Designed to help educational policy makers understand student financial aid in California, this booklet covers the importance of aid, how it has changed, current programs, need analysis, packaging, public and student views, graduate aid, and politics and problems of aid. As student financial aid became a larger and more complex educational…
Sheridan, Michael F.; Cordoba, Gustavo
Knowledge Sharing and Collaboration in Volcanic Risk Mitigation at Galeras Volcano, Colombia; Pasto, Colombia, 6-11 July 2009; Galeras volcano, located in southwestern Colombia, imposes several hazards on the surrounding population: pyroclastic flows, lahars, ashfall, and shock waves. The current hazard map shows three zones: high, medium, and low (see A. D. Hurtado Artunduaga and G. P. Cortés Jiménez, J. Volcanol. Geotherm. Res., 77, 89-100, 1997). The pyroclastic flow hazard on this map defines the Zone of High Volcanic Hazard (ZAVA) for civil authorities. Current activity of Galeras has provoked two contentious issues related to hazard management: (1) Decision makers announce an evacuation order of ZAVA whenever the volcanic alert reaches a high level, and (2) the Colombian government initiated a relocation program for the inhabitants within ZAVA (Colombian Decrees-Laws 4106 and 3905). However, communities within ZAVA refuse to obey both the evacuation orders and the relocation process. To help resolve this situation, the University of Nariño (Colombia) and the State University of New York at Buffalo organized a workshop, which was sponsored by the U.S. National Science Foundation. A daily average of 92 people attended, including residents of ZAVA, decision makers, Colombian technical and scientific personnel, international scientists and researchers, students, and academics from the University of Nariño.
Cooley, Sarah R.; Jewett, Elizabeth B.; Reichert, Julie; Robbins, Lisa L.; Shrestha, Gyami; Wieczorek, Dan; Weisberg, Stephen B.
Much of the detailed, incremental knowledge being generated by current scientific research on ocean acidification (OA) does not directly address the needs of decision makers, who are asking broad questions such as: Where will OA harm marine resources next? When will this happen? Who will be affected? And how much will it cost? In this review, we use a series of mainly US-based case studies to explore the needs of local to international-scale groups that are making decisions to address OA concerns. Decisions concerning OA have been made most naturally and easily when information needs were clearly defined and closely aligned with science outputs and initiatives. For decisions requiring more complex information, the process slows dramatically. Decision making about OA is greatly aided (1) when a mixture of specialists participates, including scientists, resource users and managers, and policy and law makers; (2) when goals can be clearly agreed upon at the beginning of the process; (3) when mixed groups of specialists plan and create translational documents explaining the likely outcomes of policy decisions on ecosystems and natural resources; (4) when regional work on OA fits into an existing set of priorities concerning climate or water quality; and (5) when decision making can be reviewed and enhanced.
Slesnick, Irwin L.
Focuses on public education about the acquired immune deficiency syndrome (AIDS) epidemic. Discusses the problems of a second epidemic of fear and anxiety. Presents several questions for classroom discussion and analysis of the public fear of AIDS. Gives some statistics highlighting misinformation about AIDS. (CW)
Strike Planning Aid ( ESPA ) . .V-14 5.4. Tactical Environmental Ship Routing (TESR) V-24 5.5. Chaff Prediction and Planning System (CHAPPS).. V-29...chapter four TDAS from TESS: NAVSAR, acAS program for search and rescue (SARjat sea; ESPA , the Environmental Strike Planning Aid; TESR, the Tactical...STATISTICS CURRENT LOCATION AND CHARACTERISTICS SATELLITE DATA CONVERSION CONSTANTS In 5.1, we give a brief history of TESS. The TDAS NAVSAR, ESPA
Yang, Qiang; Du, Ping-an; Wang, Yong; Liang, Bin
This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs’ decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member’ decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs’ evaluations and selections. PMID:28234974
Woods, Jeffrey G.
Purpose: The purpose of this paper is to develop a conceptual model that uses dialectical inquiry (DI) to create cognitive conflict in strategic decision-makers for the purpose of improving strategic decisions. Activation of the dialectical learning process using DI requires strategic decision-makers to integrate conflicting information causing…
Goodnough, Lawrence T.; And Others
Staff communication patterns were observed during 13 open-heart surgeries to identify the transfusion decision makers. It was determined that targeting decision makers for continuing medical education would improve the quality of transfusion practice and increase the efficiency of continuing education. (SK)
Environmental Planning for Small Communities - A Guide for Local Decision-Makers presents a process for creating and implementing a community environmental plan. With a comprehensive environmental plan, local decision-makers can create an integrated approach to protecting the env...
Black, Philip G; Derse, Arthur R; Derrington, Sabrina; Lantos, John D
Most lawyers and bioethicists recommend that patients enact a durable power of attorney for health care designating somebody as their proxy decision maker should they become unable to make decisions. Most people choose family members as their agent. But what if a patient wants his or her doctor to be his or her proxy decision maker? Can the doctor be both physician and surrogate decision maker? Or should those roles necessarily be kept separate? We present a case in which those issues arose, and sought comments from Sabrina Derrington, a pediatric palliative care physician; Arthur Derse, an emergency department physician and lawyer; and Phil Black, a pulmonologist.
Pope, Thaddeus Mason; Hexum, Melinda
This "Legal Briefing" column covers recent legal developments involving patient decision aids.This topic has been the subject of recent articles in JCE. It is included in the 2010 Patient Protection and Affordable Care Act. And it has received significant attention in the biomedical literature, including a new book, a thematic issue of Health Affairs, and a recent article in the New England Journal of Medicine. Moreover, physicians and health systems across the United States are increasingly integrating decision aids into their clinical practice. Both federal and state laws play a significant role in promoting this expanded use. On the other hand, concerns about liability could stymie development and implementation. We categorize legal developments concerning patient decision aids into the following five sections: 1. Development of decision aids. 2. Effectiveness of decision aids. 3. Federal regulation of decision aids. 4. State regulation of decision aids. 5. Legal concerns regarding decision aids.
JAN 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE A Conceptual Framework for Defense Acquisition Decision...by ANSI Std Z39-18 A Conceptual Framework for Defense Acquisition Decision Makers: Giving the Schedule its Due « Image designed by Diane Fleischer... Conceptual Framework for Defense Acquisition Decision Makers: Giving the Schedule Its Due Chad Dacus and Col Stephen Hagel, USAF (Ret.) Conceptual
Besnard, Sophie; Claverie, Vincent; Blanc, Frédérique
The Emodnet Checkpoint projects aim is to assess the cost-effectiveness, reliability and utility of the existing monitoring at the sea basin level. This involves the development of monitoring system indicators and a GIS Platform to perform the assessment and make it available. Assessment or production of Check-Point information is made by developing targeted products based on the monitoring data and determining whether the products are meeting the needs of industry and public authorities. Check-point users are the research community, the 'institutional' policy makers for IMP and MSFD implementation, the 'intermediate users', i.e., users capable to understand basic raw data but that benefit from seeing the Checkpoint targeted products and the assessment of the fitness for purpose. We define assessment criteria aimed to characterize/depict the input datasets in terms of 3 territories capable to show performance and gaps of the present monitoring system, appropriateness, availability and fitness for purpose. • Appropriateness: What is made available to users? What motivate/decide them to select this observation rather than this one. • Availability: How this is made available to the user? Place to understand the readiness and service performance of the EU infrastructure • Fitness for use / fitness for purpose: Ability for non-expert user to appreciate the data exploitability (feedback on efficiency & reliability of marine data) For each territory (appropriateness, Availability and Fitness for purpose / for use), we define several indicators. For example, for Availability we define Visibility, Accessibility and Performance. And Visibility is itself defined by "Easily found" and "EU service". So these indicators can be classified according to their territory and sub-territory as seen above, but also according to the complexity to build them. Indicators are built from raw descriptors in 3 stages: Stage 1: to give a neutral and basic status directly computed from
Schmidtke, K A; Watson, D G; Vlaev, I
Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.
Kim, Song-Ju; Naruse, Makoto; Aono, Masashi; Ohtsu, Motoichi; Hara, Masahiko
Decision-making is one of the most important intellectual abilities of the human brain. Here we propose an efficient decision-making system which uses optical energy transfer between quantum dots (QDs) mediated by optical near-field interactions occurring at scales far below the wavelength of light. The simulation results indicate that our system outperforms the softmax rule, which is known as the best-fitting algorithm for human decision-making behaviour. This suggests that we can produce a nano-system which makes decisions efficiently and adaptively by exploiting the intrinsic spatiotemporal dynamics involving QDs mediated by optical near-field interactions.
Kim, Song-Ju; Naruse, Makoto; Aono, Masashi; Ohtsu, Motoichi; Hara, Masahiko
Decision-making is one of the most important intellectual abilities of the human brain. Here we propose an efficient decision-making system which uses optical energy transfer between quantum dots (QDs) mediated by optical near-field interactions occurring at scales far below the wavelength of light. The simulation results indicate that our system outperforms the softmax rule, which is known as the best-fitting algorithm for human decision-making behaviour. This suggests that we can produce a nano-system which makes decisions efficiently and adaptively by exploiting the intrinsic spatiotemporal dynamics involving QDs mediated by optical near-field interactions. PMID:23928655
Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne
The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…
Hagmayer, York; Sloman, Steven A.
Causal considerations must be relevant for those making decisions. Whether to bring an umbrella or leave it at home depends on the causal consequences of these options. However, most current decision theories do not address causal reasoning. Here, the authors propose a causal model theory of choice based on causal Bayes nets. The critical ideas…
This chapter presents an overview of current issues related to distance learning in higher education. It identifies central questions, issues, challenges, and opportunities that must be addressed by decision makers, as well as key attributes of effective leaders.
called state variables (or environ- mental variables) since they define the state of the decision environment. Decision variables must be defined in such...Vaibeison Endlogetious STRUCTURAL MODELO Varabls ~State Variables* (INTERACTION MODEL) Outcome Variables’ (Either State or Prefeence$Decision...decisions and states of the environment. This type of model requires the decision maker to aggregate mentally the effects of the interactions among his
Zhang, Xiaodong; Vesselinov, Velimir Valentinov
Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improvesmore » upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.« less
Zhang, Xiaodong; Vesselinov, Velimir Valentinov
Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improves upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.
Wewerinke, P. H.
The decision process is described in terms of classical sequential decision theory by considering the hypothesis that an abnormal condition has occurred by means of a generalized likelihood ratio test. For this, a sufficient statistic is provided by the innovation sequence which is the result of the perception an information processing submodel of the human observer. On the basis of only two model parameters, the model predicts the decision speed/accuracy trade-off and various attentional characteristics. A preliminary test of the model for single variable failure detection tasks resulted in a very good fit of the experimental data. In a formal validation program, a variety of multivariable failure detection tasks was investigated and the predictive capability of the model was demonstrated.
McNew, Kevin P.; Mapp, Harry P.; Duchon, Claude E.; Merritt, Earl S.
Numerous studies have examined the importance of weather information to farmers and ranchers across the U.S. This study is focused on the kinds of weather information received by farmers and ranchers, the sources of that information, and its use in production and marketing decisions. Our results are based on a survey of 292 producers from the principal agricultural areas of Oklahoma. Producers were classified into five categories related to their source of income from crop and livestock sales.Among temperature, precipitation, relative humility, and wind speed, temperature information was most widely received. Forecast lengths of highest interest were 24-h and 5-day forecasts. Precipitation information was used by many respondents for planting and harvesting decisions. Weather data and forecasts seem to be of greater value to diversified crop and livestock operators than specialized crop and livestock, perhaps due to more frequent timing decisions. Relative humility and wind information appear to be important especially during specific times of the growing season, for example, at harvest time and time of pesticide application. Television is the primary source of weather information for more than 60% of the producers.It appears that there may be a role for both public and private entities in transforming weather data and forecasts into recommendations to crop and livestock producers. Further research is needed to determine the potential value of weather information for alternative production, marketing and livestock decisions, different categories of producers, and different geographic regions.
Griswold, John S.; Jarvis, William F.
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…
Petrinec, Amy B.; Mazanec, Polly M.; Burant, Christopher J.; Hoffer, Alan; Daly, Barbara J.
Objective To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. Design A single-group descriptive longitudinal correlational study. Setting Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Patients Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. Interventions None. Measurements and Main Results Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing post-traumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p = 0.01) and emotion-focused (p < 0.01) coping decreased over time while avoidant coping (p = 0.20) use remained stable. Coping strategies 30 days after hospitalization (R2 = 0.50, p < 0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2 = 0.30, p = 0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of post-traumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Conclusions Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients. PMID:25785520
Bute, Jennifer J; Petronio, Sandra; Torke, Alexia M
This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients' private health information while the patient was hospitalized. This research determined that not only are surrogates guardians and thereby co-owners of the patients' private health information, they actually served in a "proxy ownership" role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients' information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed.
Bute, Jennifer J.; Petronio, Sandra; Torke, Alexia M.
This study explored the communicative experiences of surrogates who served as decision makers for patients who were unable to convey health information and choices about treatment options. Drawing on assumptions from communication privacy management theory (Petronio, 2002), 35 surrogates were interviewed to explore how they navigated the role of guardian of patients’ private health information while the patient was hospitalized. This research determined that surrogates are not only guardians and thereby co-owners of the patients’ private health information, they actually served in a “proxy ownership” role. Surrogates described obstacles to both obtaining and sharing private health information about the patient, suggesting that their rights as legitimate co-owners of the patients’ information were not fully acknowledged by the medical teams. Surrogates also described challenges in performing the proxy ownership role when they were not fully aware of the patient's wishes. Theoretical and practical implications of these challenges are discussed. PMID:25175060
Bauman, William H., III; Wheeler, Mark M.; Short, David A.
This report presents a 15-year climatological study of severe weather events and related severe weather atmospheric parameters. Data sources included local forecast rules, archived sounding data, Cloud-to-Ground Lightning Surveillance System (CGLSS) data, surface and upper air maps, and two severe weather event databases covering east-central Florida. The local forecast rules were used to set threat assessment thresholds for stability parameters that were derived from the sounding data. The severe weather events databases were used to identify days with reported severe weather and the CGLSS data was used to differentiate between lightning and non-lightning days. These data sets provided the foundation for analyzing the stability parameters and synoptic patterns that were used to develop an objective tool to aid in forecasting severe weather events. The period of record for the analysis was May - September, 1989 - 2003. The results indicate that there are certain synoptic patterns more prevalent on days with severe weather and some of the stability parameters are better predictors of severe weather days based on locally tuned threat values. The results also revealed the stability parameters that did not display any skill related to severe weather days. An interactive web-based Severe Weather Decision Aid was developed to assist the duty forecaster by providing a level of objective guidance based on the analysis of the stability parameters, CGLSS data, and synoptic-scale dynamics. The tool will be tested and evaluated during the 2005 warm season.
Changnon, Stanley A.
In-depth interviews with 27 executives in various agribusiness defined usage and needs for climate predictions. Predictions are acquired from various public and private sources but are seldom used in making major decision. Users exhibited little trust of climate predictions, relying heavily on recent weather conditions as the basis of prediction. Additions to predictions involving climatic information would better serve the needs of most of agribusiness. Improved predictive accuracies alone will not materially increase usage. A need exists to familiarize agribusiness leaders with the information currently available, and to realize benefits from this information; many agribusinesses will need to develop models and procedures that allow integration of future weather conditions (actual and predicted) with their corporate activities and economic conditions.
N'Guyen, Anouk; Hirsch, Philipp E; Adrian-Kalchhauser, Irene; Burkhardt-Holm, Patricia
Managing invasive species is a major challenge for society. In the case of newly established invaders, rapid action is key for a successful management. Here, we develop, describe and recommend a three-step transdisciplinary process (the "butterfly model") to rapidly initiate action for invasion management. In the framing of a case study, we present results from the first of these steps: assessing priorities and contributions of both scientists and decision makers. Both scientists and decision makers prioritise research on prevention. The available scientific knowledge contributions, however, are publications on impacts rather than prevention of the invasive species. The contribution of scientific knowledge does thus not reflect scientists' perception of what is essentially needed. We argue that a more objective assessment and transparent communication of not only decision makers' but also scientists' priorities is an essential basis for a successful cooperation. Our three-step model can help achieve objectivity via transdisciplinary communication.
Motloch, Chester George
The Decision-Makers' Forum on a New Paradigm for Nuclear Energy was created in response to the challenge by Sen. Pete V. Domenici to begin, "a new dialogue with serious discussion about the full range of nuclear technologies." Sponsored by the Senate Nuclear Issues Caucus, the Forum was organized and facilitated by the Idaho National Engineering and Environmental Laboratory. The participants were decision-makers and key staff from industry, government, the national laboratories, academia and professional societies. Overall, the Forum was designed to capture the ideas of a large number of decision-makers about the high priority actions recommended to help set a new national agenda for nuclear energy. The Forum recommended 10 priority actions toward this end.
Geisinger, Kurt F.; McCormick, Carina M.
Standard-setting studies utilizing procedures such as the Bookmark or Angoff methods are just one component of the complete standard-setting process. Decision makers ultimately must determine what they believe to be the most appropriate standard or cut score to use, employing the input of the standard-setting panelists as one piece of information…
The predictions of most terrestrial ecosystem models originate from deterministic simulations. Relatively few uncertainty evaluation exercises in model outputs are performed by either model developers or users. This issue has important consequences for decision makers who rely on models to develop n...
Food and Consumer Service (USDA), Washington, DC.
The School Meals Initiative for Healthy Children was launched in June 1994 to improve the health and education of children through better nutrition. This leadership guide provides information to school decision-makers on using materials and resources developed by the U.S. Department of Agriculture and describes Team Nutrition, an implementation…
Purpose: This article explores the possibilities for reciprocal dialogue between educational decision makers and Students of Color. Such dialogue--defined as interactions in which participants build on each other's words--may provide the means to develop creative ways to address manifestations of systemic racism in education. The article uses…
Morgan, Grayson B.
Decision maker perception of information quality cues from an "information system" (IS) and the process which creates such meta cueing, or data about cues, is a critical yet un-modeled component of "situation awareness" (SA). Examples of common information quality meta cueing for quality criteria include custom ring-tones for…
Christie, Christina A.
Using a set of scenarios derived from actual evaluation studies, this simulation study examines the reported influence of evaluation information on decision makers' potential actions. Each scenario described a context where one of three types of evaluation information (large-scale study data, case study data, or anecdotal accounts) is presented…
This study treats public opinion as problematic and focuses on the way it is defined, identified, and evaluated by nuclear decision makers in industry, government, and the scientific community. The data are based largely on questionnaire responses and interviews. Though public opinion is a social process amenable to empirical investigation, its identification is not self-evident. It is defined within the context of an already-existing set of often unconscious beliefs and value commitments. Like students of public opinion, decision makers focus on such characteristics of public opinion as its membership, direction, intensity, level of information, prior attitudinal predispositions, and representativeness, and on the factors that influence public opinion. They also select among the indicators of public opinion - those that seem to represent the public as against those that claim to speak for it. They identify public opinion in terms of their beliefs about what public opinion is or should be in a democracy. The antinuclear movement and the mass media are seen as important, but their equation with public opinion is challenged. Decision makers see the antinuclear movement as distinct from, though an important influence on, public opinion. Decision makers believe the public has a legitimate role in negotiating nuclear power issues, but expect the public to be informed through exposure to the relevant information and expertise.
This guide presents decision makers with a foundation for evaluating the appropriateness of conventional or innovative approaches. An introduction to pump-and-treat ground-water remediation, the guide addresses the following questions: When is pump-and-treat an appropriate remedi...
Makuch, Gary; And Others
Intended for local school district personnel, the document suggests a model for assisting decision makers in placing handicapped students in the least restrictive environment (LRE). Basic considerations of a multidisciplinary team in determining the appropriate placement for the handicapped students are listed (including the nature and degree of…
I[ -, . 1’, oo Ii AL-CR-i1992-0004 AD-A256 947lEE = IIEI ifl ll 1l I JOB AIDING/TRAINING DECISION PROCESS MODEL A R M John P. Zenyuh DTIC S Phillip C...March 1990 - April 1990 4. TITLE AND SUBTITLE S. FUNDING NUMBERS C - F33615-86-C-0545 Job Aiding/Training Decision Process Model PE - 62205F PR - 1121 6...Components to Process Model Decision and Selection Points ........... 32 13. Summary of Subject Recommendations for Aiding Approaches
This case study of climate change communications assesses the salient means of communication and the message adopted by regional political decision makers on the German Baltic coast. Realizing that cultural factors and local values (and not simply knowledge) are significant influences in explaining attitudes towards climate change, this analysis draws from the records of regional weather, from scientists with a specific focus on the region, from the political decision makers for that region, and the media message reaching the decision makers, ensuring all elements of the analysis are drawn from the same socioeconomic, geophysical, political and cultural context. This is important as the social dynamics surrounding the trust in science is of critical importance and, as such, all elements of the case study are specifically contained within a common context. If the utility of climate change knowledge is to prompt well conceived adaptation/mitigation strategies then the political decision process, or at least the perceptions shaping it, can best be understood by locating it within the world view of the decision makers involved in the production process. Using the results of two survey questionnaires, one of regional climate scientists and one of regional political decision makers, ten years of local weather records, and a summary of the message from mass media circulation, the discord in perceptions of regional climate change are quantitatively explored. The conclusions drawn from the analysis include, compared to the scientific assessment: The decision makers' perceptions of recent past differ from actual observations. The decision makers' perceptions of the future differ from scientific assessments. The decision makers tend to over estimate the magnitude of regional climate change and its impacts. The decision makers tend to over estimate the sense of immediacy for adaptation measures. The conclusions drawn suggest that in the regional political realm, it is often a
Fasbender, Ulrike; Wang, Mo
Organizational hiring practices have been charged for unfair treatment on the grounds of age. Drawing on theories of planned behavior and core self-evaluations, this research investigated the impact of negative attitudes toward older workers on hiring decisions and examined the moderating role of decision-makers' core self-evaluations. We tested our hypotheses based on a structured online questionnaire and a vignette study using a sample of 102 participants working in human resource management across different industries. As predicted, negative attitudes toward older workers were positively related to avoidance of hiring older people, which in turn was negatively related to the likelihood to select the oldest candidate. Because hiring decisions are not only about the hiring subject but also about the decision-maker, we tested the moderating role of decision-makers' core self-evaluations. Results showed that core self-evaluations buffered the relationship between negative attitudes toward older workers and avoidance of hiring older people. Theoretical implications of the findings with regard to hiring decisions about older people and practical recommendations to improve diversity management strategies and age-balanced hiring practices in organizations are discussed.
Sohl, Terry L.; Claggett, Peter R.
The last decade has seen a remarkable increase in the number of modeling tools available to examine future land-use and land-cover (LULC) change. Integrated modeling frameworks, agent-based models, cellular automata approaches, and other modeling techniques have substantially improved the representation of complex LULC systems, with each method using a different strategy to address complexity. However, despite the development of new and better modeling tools, the use of these tools is limited for actual planning, decision-making, or policy-making purposes. LULC modelers have become very adept at creating tools for modeling LULC change, but complicated models and lack of transparency limit their utility for decision-makers. The complicated nature of many LULC models also makes it impractical or even impossible to perform a rigorous analysis of modeling uncertainty. This paper provides a review of land-cover modeling approaches and the issues causes by the complicated nature of models, and provides suggestions to facilitate the increased use of LULC models by decision-makers and other stakeholders. The utility of LULC models themselves can be improved by 1) providing model code and documentation, 2) through the use of scenario frameworks to frame overall uncertainties, 3) improving methods for generalizing key LULC processes most important to stakeholders, and 4) adopting more rigorous standards for validating models and quantifying uncertainty. Communication with decision-makers and other stakeholders can be improved by increasing stakeholder participation in all stages of the modeling process, increasing the transparency of model structure and uncertainties, and developing user-friendly decision-support systems to bridge the link between LULC science and policy. By considering these options, LULC science will be better positioned to support decision-makers and increase real-world application of LULC modeling results.
Larocque, Guy R.; Bhatti, Jagtar S.; Ascough, J.C.; Liu, J.; Luckai, N.; Mailly, D.; Archambault, L.; Gordon, Andrew M.
The predictions from most forest ecosystem models originate from deterministic simulations. However, few evaluation exercises for model outputs are performed by either model developers or users. This issue has important consequences for decision makers using these models to develop natural resource management policies, as they cannot evaluate the extent to which predictions stemming from the simulation of alternative management scenarios may result in significant environmental or economic differences. Various numerical methods, such as sensitivity/uncertainty analyses, or bootstrap methods, may be used to evaluate models and the errors associated with their outputs. However, the application of each of these methods carries unique challenges which decision makers do not necessarily understand; guidance is required when interpreting the output generated from each model. This paper proposes a decision flow chart in the form of an analytical framework to help decision makers apply, in an orderly fashion, different steps involved in examining the model outputs. The analytical framework is discussed with regard to the definition of problems and objectives and includes the following topics: model selection, identification of alternatives, modelling tasks and selecting alternatives for developing policy or implementing management scenarios. Its application is illustrated using an on-going exercise in developing silvicultural guidelines for a forest management enterprise in Ontario, Canada.
Patten, San; Mitton, Craig; Donaldson, Cam
Due to resource scarcity, health organizations worldwide must decide what services to fund and, conversely, what services not to fund. One approach to priority setting, which has been widely used in Britain, Australia, New Zealand and Canada, is programme budgeting and marginal analysis (PBMA). To date, such activity has primarily been based at a micro level, within programmes of care. In order to institute and refine the PBMA framework at a macro level across major service areas within a single health authority, researchers and decision-makers in Alberta embarked on a participatory action research project together. This paper identifies key issues of importance to decision-makers in a real-world priority-setting context. Themes discussed include making comparisons across disparate patient groups, dealing with political factors, using relevant forms of evidence, recognizing innovations and involving the public. The in-depth insight gained through this qualitative analysis will enable future refinement of PBMA at a macro level in the health authority under study, and should also serve to inform priority-setting activity in regionalized contexts elsewhere. In identifying aspects of priority setting that are important to decision-makers, researchers can also be better informed with respect to real-world processes.
The Solar Technical Assistance Team (STAT) is a network of solar technology and implementation experts who provide timely, unbiased expertise to assist policymakers and regulators in making informed decisions about solar programs and policies. Government officials can submit requests directly to the STAT for technical assistance. STAT then partners with experts in solar policy, regulation, finance, technology, and other areas to deliver accurate, up-to-date information to state and local decision makers. The STAT responds to requests on a wide range of issues -- including, but not limited to, feed-in tariffs, renewable portfolio standards, rate design, program design, workforce and economic impacts of solar on jurisdictions, and project financing.
Sloane, G; Tidwell, P; Horsfield, M
If marketers wish to communicate the positive characteristics of purchasing the private hospital experience, the marketers need to be able to identify which of the participants in the purchasing process is acting in the role of decision maker. Research was undertaken of doctors in the rural setting. Potential respondents were selected from Orange to Broken Hill; from Coonabarabran to Young. Two private hospitals are known to be located within this region--one in Orange and one in Dubbo. In most cases, patients in the rural setting are having the final say as to which hospital to attend. They are filling the role of decision maker. The factors that potential patients are considering in their decision include the services provided by the hospital--specifically factors relating to accommodation, services and cost. These observations are those as interpreted by the doctors who see these patients. Based on the findings of the survey a number of recommendations have been made: (1) Any marketing communication by hospitals should target primarily patients and then doctors. (2) Further research should be undertaken to attempt to accurately determine what characteristics are considered when patients and doctors refer to hospital services. (3) Research should be undertaken to determine the identity of all parties involved in the purchasing decision process. (4) Further research should be undertaken of the general population to determine what factors relating to a hospital are considered when making the hospital purchasing decision. (5) Further in depth analysis should be conducted with the raw data.
Stamarski, Cailin S; Son Hing, Leanne S
Gender inequality in organizations is a complex phenomenon that can be seen in organizational structures, processes, and practices. For women, some of the most harmful gender inequalities are enacted within human resources (HRs) practices. This is because HR practices (i.e., policies, decision-making, and their enactment) affect the hiring, training, pay, and promotion of women. We propose a model of gender discrimination in HR that emphasizes the reciprocal nature of gender inequalities within organizations. We suggest that gender discrimination in HR-related decision-making and in the enactment of HR practices stems from gender inequalities in broader organizational structures, processes, and practices. This includes leadership, structure, strategy, culture, organizational climate, as well as HR policies. In addition, organizational decision makers' levels of sexism can affect their likelihood of making gender biased HR-related decisions and/or behaving in a sexist manner while enacting HR practices. Importantly, institutional discrimination in organizational structures, processes, and practices play a pre-eminent role because not only do they affect HR practices, they also provide a socializing context for organizational decision makers' levels of hostile and benevolent sexism. Although we portray gender inequality as a self-reinforcing system that can perpetuate discrimination, important levers for reducing discrimination are identified.
Favors, J. E.; Childs-Gleason, L. M.; Ross, K. W.; Rogers, L.; Allsbrook, K. N.; Ruiz, M. L.; Miller, T. N.; Crepps, G.
The NASA DEVELOP National Program bridges the gap between NASA Earth Science and society by building capacity in both participants and partner organizations who collaborate to conduct projects. These rapid feasibility projects highlight the capabilities of satellite and aerial Earth observations to enhance decision making on a local level. DEVELOP partners with a wide variety of organizations, including state and local governments, federal agencies, regional entities, tribal governments, international organizations and governments, NGOs and private companies. Immersion of decision and policy makers in these feasibility projects increases awareness of the capabilities of Earth observations, and contributes to the tools and resources available to support enhanced decision making. This presentation will highlight best practices, feedback from project end-users, and case studies of successful adoption of methods in the decision making process.
Khezrian, Mojtaba; Jahan, Ali; Wan Kadir, Wan Mohd Nasir; Ibrahim, Suhaimi
Web services today are among the most widely used groups for Service Oriented Architecture (SOA). Service selection is one of the most significant current discussions in SOA, which evaluates discovered services and chooses the best candidate from them. Although a majority of service selection techniques apply Quality of Service (QoS), the behaviour of QoS-based service selection leads to service selection problems in Multi-Criteria Decision Making (MCDM). In the existing works, the confidence level of decision makers is neglected and does not consider their expertise in assessing Web services. In this paper, we employ the VIKOR (VIšekriterijumskoKOmpromisnoRangiranje) method, which is absent in the literature for service selection, but is well-known in other research. We propose a QoS-based approach that deals with service selection by applying VIKOR with improvement of features. This research determines the weights of criteria based on user preference and accounts for the confidence level of decision makers. The proposed approach is illustrated by an example in order to demonstrate and validate the model. The results of this research may facilitate service consumers to attain a more efficient decision when selecting the appropriate service. PMID:24897426
The following research is intended to develop more formal mechanisms for collection, analysis, retention and dissemination of information relating to brand influence on high-technology products. Specifically, these high-technology products are associated with the engineering applications that likely would involve the loss of human life in the advent of catastrophic failure. The results of the study lead to an extension of theory involving marketing and product selection of "highly engineered" parts within the aerospace industry. The findings were separated into three distinct areas: 1) Information load will play a large role in the final design decision. If the designer is under a high level of information load during the time of a design decision, he or she likely will gravitate to the traditional design choice, regardless of the level of brand strength. 2) Even when strong brand names, like 3M, were offered as the non-traditional design choice, engineers gravitated to the traditional design choice that was presented in a mock Society for Manufacturing Engineers article. 3) Designer self-efficacy by itself will not often contribute to a decision maker's design choice. However, these data collected indicates that a combination of high designer self-efficacy moderated by high brand strength is likely to contribute significantly to a decision maker's decision. The post-hoc finding shows that many designers having high levels of self-efficacy could be developing a sense of comfort with strong brand names (like 3M) when making a design choice.
Focazio, Michael J.; Reilly, Thomas E.; Rupert, Michael G.; Helsel, Dennis R.
Throughout the United States increasing demands for safe drinking water and requirements to maintain healthy ecosystems are leading policy makers to ask complex social and scientific questions about how to assess and manage our water resources. This challenge becomes particularly difficult as policy and management objectives require scientific assessments of the potential for ground-water resources to become contaminated from anthropogenic, as well as natural sources of contamination. Assessments of the vulnerability of ground water to contamination range in scope and complexity from simple, qualitative, and relatively inexpensive approaches to rigorous, quantitative, and costly assessments. Tradeoffs must be carefully considered among the competing influences of the cost of an assessment, the scientific defensibility, and the amount of acceptable uncertainty in meeting the objectives of the water-resource decision maker.
Remillard, C. M.; Madden, M.; Favors, J.; Childs-Gleason, L.; Ross, K. W.; Rogers, L.; Ruiz, M. L.
The NASA DEVELOP National Program bridges the gap between NASA Earth Science and society by building capacity in both participants and partner organizations that collaborate to conduct projects. These rapid feasibility projects highlight the capabilities of satellite and aerial Earth observations. Immersion of decision and policy makers in these feasibility projects increases awareness of the capabilities of Earth observations and contributes to the tools and resources available to support enhanced decision making. This paper will present the DEVELOP model, best practices, and two case studies, the Colombia Ecological Forecasting project and the Miami-Dade County Ecological Forecasting project, that showcase the successful adoption of tools and methods for decision making. Through over 90 projects each year, DEVELOP is always striving for the innovative, practical, and beneficial use of NASA Earth science data.
Carter, Nancy; Lavis, John N; MacDonald-Rencz, Sandra
Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified "NPs increase access to care" and "NPs and CNSs improve patient and system outcomes" as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination.
Leclaire, Rene J; Hirsch, Gary B
The National Infrastructure Simulation and Analysis Center (NISAC) has developed a prototype learning environment simulator (LES) based on the Critical Infrastructure Protection Decision Support System (CIPDSS) infrastructure and scenario models. The LES is designed to engage decision makers at the grass-roots level (local/city/state) to deepen their understanding of an evolving crisis, enhance their intuition and allow them to test their own strategies for events before they occur. An initial version is being developed, centered on a pandemic influenza outbreak and has been successfully tested with a group of hospital administrators and first responders. LES is not a predictive tool but rather a simulated environment allowing the user to experience the complexities of a crisis before it happens. Users can contrast various approaches to the crisis, competing with alternative strategies of their own or other participants. LES is designed to assist decision makers in making informed choices by functionally representing relevant scenarios before they occur, including impacts to critical infrastructures with their interdependencies, and estimating human health & safety and economic impacts. In this paper a brief overview of the underlying models are given followed by a description of the LES, its interface and usage and an overview of the experience testing LES with a group of hospital administrators and first responders. The paper concludes with a brief discussion of the work remaining to make LES operational.
Czajkowski, K. P.
Remote sensing technology has been slow to move out of the research lab and into public use. A primary goal of the OhioView Consortium, a consortium of ten Ohio universities working together to spread remote sensing, is to take application-based research and make the results useful to the public. In particular, the group is working to remove the barriers to the use of satellite imagery including costs of imagery and software and training of policy makers. Through collaboration with the Ohio Library and Information Network (OhioLINK), OhioView is disseminating Landsat 7 imagery over Ohio with 30 percent cloud cover or less over the internet for free. In addition, OhioView has provided remote sensing software for local government agencies. As part of the OhoView Consortium, the Department of Geography and Planning at the University of Toledo has worked with policy makers on local issues that can benefit from the addition of satellite imagery. Northwest Ohio traditionally is a region of heavy industry rather than high technology. Few policy makers or environmental consultants had considered using satellite imagery in their work. We will discuss the results of this collaboration from a project we are currently conducting with local government groups to identify wetlands. Wetlands once covered over 90 percent of Northwest Ohio. Through draining, they have virtually disappeared. The goal of this project was to produce a map of existing wetlands in Northwest Ohio that could be used by government officials to make development decisions.
Miles, J A; Palmer, T S
In a role-playing study, 264 university students evaluated the fairness of procedures and outcomes used to punish a student for plagiarizing from a web site. Individuals reading the scenario gave the highest ratings of justice when the decision maker was a group of nonpeers (faculty), compared to when the decision maker was an individual or peer (student). Sex and self reported guilt of individuals reading the scenario also influenced their ratings of justice.
Schnetler, Thomas; Davis, Richard; Waddingham, John; James, Karen
The Environment Agency of England has wide ranging responsibility for environmental regulation that includes both water resources management and flood management. In order to best fulfil its role decisions need to be taken using the best available evidence in the time available. The manipulation of large amounts of hydrological data in a way that best meets the needs of decision makers is a complex challenge. Not only should any analysis be technically robust but it should also be presented in a way that communicates key messages clearly and quickly. The Environment Agency and its predecessor organisations has a long history of working with hydrological data but in recent years there has been a need to better incorporate risk and uncertainty into hydrological analysis so that subsequent decisions can take this into account. In the face of recent extreme weather events, there has been an increasing demand for forward look projections from water resource and flood risk practitioners, decision makers and contingency planners. These assessments are required to give appropriate lead in time to allow risk mitigation measures to be implemented to minimise impact upon people, the environment and infrastructure. This presentation will outline the methodologies developed by the Environment Agency to produce and publish monthly routine forward look projections using both a scenario and climate ensemble approach. It will cover how information is disseminated, providing a good example of communicating science to decision makers and to the public. Examples of practical applications of these methodologies include: • Risk based planning and forecasting of water availability for inter basin water transfers into water stressed catchments. • Assessment of water resources prospects during droughts for people and the environment • The likelihood and medium term risk of high groundwater levels impacting upon people and infrastructure. There are also a number of future challenges
Santos, R S; Malheiros, S M F; Cavalheiro, S; de Oliveira, J M Parente
Cancer is the leading cause of death in economically developed countries and the second leading cause of death in developing countries. Malignant brain neoplasms are among the most devastating and incurable forms of cancer, and their treatment may be excessively complex and costly. Public health decision makers require significant amounts of analytical information to manage public treatment programs for these patients. Data mining, a technology that is used to produce analytically useful information, has been employed successfully with medical data. However, the large-scale adoption of this technique has been limited thus far because it is difficult to use, especially for non-expert users. One way to facilitate data mining by non-expert users is to automate the process. Our aim is to present an automated data mining system that allows public health decision makers to access analytical information regarding brain tumors. The emphasis in this study is the use of ontology in an automated data mining process. The non-experts who tried the system obtained useful information about the treatment of brain tumors. These results suggest that future work should be conducted in this area.
The extensive research findings on neurotoxic risks of pesticides tend to remain in academic publications rather than being comprehensibly communicated to decision-makers and the public. Protecting health and promoting risk reduction, particularly in developing countries, requires access to current findings in a format that can inform policy, regulations, behaviour change and risk reduction. Successfully communicating research findings may require multiple strategies depending on the target audience's varying comprehension skills (e.g., numeracy literacy, visual literacy) and ability to interpret scientific data. To illustrate the complexities of risk communication, a case study of exposure to neurotoxic street pesticides amongst poor, urban South African communities attempting to control poverty related pests, is presented. What remains a challenge is how to communicate neurotoxicity research findings consistently and in a meaningful manner for a lay audience, consisting of both the general public and decision makers. A further challenge is to identify who will monitor and evaluate the ways in which these findings are communicated to ensure quality is maintained. Ultimately, researchers should carry the responsibility of knowledge translation and engaging with communication specialists when appropriate. Additionally, institutions should reward this as part of promotion and academic accolade systems, and funders should fund the translational process. Ethics review boards should also play an instrumental role in ensuring that knowledge translation is part of the ethics review requirement, while professional societies should take more responsibility for disseminating research findings to non-academics.
Established in 1863 by Congress under the Lincoln Administration, the National Academy of Sciences (NAS) is a nongovernmental organization that plays a unique role in providing scientific information to decision makers. The NAS brings together the nation’s top experts, as volunteers, to provide objective scientific analysis and advice on a wide variety of critical issues, including climate change. The Academy’s climate change-related studies range from early reports such as Carbon Dioxide and Climate: A Scientific Assessment (1979) to current activities such as America’s Climate Choices (in process). Studies have or are addressing climate forcings and feedbacks, statistics, predictability, ecological impacts, the structure of federal climate research programs, decision-making, transportation planning, and other aspects of understanding and responding to climate change. Requests for studies come primarily from Congress and federal agencies, yet the NAS is able generate a wide variety of products and reports for policy-makers, government agencies, states, and the public. With so many special interests and advocacy organizations now speaking on climate issues, the role of NAS as an objective source of information and guidance is more important than ever. This talk will highlight a range of past and ongoing Academy reports, both technical and policy-oriented, to illustrate the kinds of questions we address, the processes used to gather information and reach consensus, how we deal with multidisciplinary questions, the impacts of our studies, and the ways we are evolving to meet the needs of a changing society.
Terra. Aqua. Cloudsat. Landsat. NASA runs and partners in many missions dedicated to monitoring the Earth, and the tools used in these missions continuously return data on everything from shifts in temperature to cloud formation to pollution levels over highways. The data are of great scientific value, but they also provide information that can play a critical role in decision making during times of crisis. Real-time developments in weather, wind, ocean currents, and numerous other conditions can have a significant impact on the way disasters, both natural and human-caused, unfold. "NASA has long recognized the need to make its data from real-time sources compatible and accessible for the purposes of decision making," says Michael Goodman, who was Disasters Program manager at NASA Headquarters from 2009-2012. "There are practical applications of NASA Earth science data, and we d like to accelerate the use of those applications." One of the main obstacles standing in the way of eminently practical data is the fact that the data from different missions are collected, formatted, and stored in different ways. Combining data sets in a way that makes them useful for decision makers has proven to be a difficult task. And while the need for a collaborative platform is widely recognized, very few have successfully made it work. Dave Jones, founder and CEO of StormCenter Communications Inc., which consults with decision makers to prepare for emergencies, says that "when I talk to public authorities, they say, If I had a nickel for every time someone told me they had a common operating platform, I d be rich. But one thing we ve seen over the years is that no one has been able to give end users the ability to ingest NASA data sets and merge them with their own."
Hunt, Matthew R.; Chung, Ryoa; Durocher, Evelyne; Henrys, Jean Hugues
Background Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs. Objective The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake. Design We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response. Results Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake. Conclusions Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities. PMID:26257047
Hunt, Matthew R; Chung, Ryoa; Durocher, Evelyne; Henrys, Jean Hugues
Background Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs. Objective The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake. Design We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response. Results Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake. Conclusions Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.
creates and sustains a corporate moral code. It appears that nations with a long history, especially of fighting defensive wars, are’ more likely to...experiences and needs of the potential adopters. An idea that is not comnatible with the prevalent values and norms of a cultural and social Estem will...Decision Support Systems, ed: \\V. C. House, Petrocelli Books, New YorK/Princeton, 1983. " Corporate war rooms pluginto the computer," Business Week, August
With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.
Paxton, L. J.; Swartz, W.; Strong, S. B.; Nix, M. G.; Schaefer, R. K.; Weiss, M.
There are many challenges in using, developing, and ensuring the viability of crowd-sourced data. Establishing and maintaining relevance is one of them but each participant in the challenge has different criteria for relevance. Consider, for example, the collection of data using smart phones. Some participants just like to contribute to something they consider good for the community. How do you engender that commitment? This becomes especially problematic when an additional sensor may need to be added to the smart phone. Certainly the humanitarian-egalitarian may be willing to "buy-in" but what value does it hold for the entrepreneurial-individualist? Another challenge is that of the crowd-sourced data themselves. Most readily available apps collect only one kind of data. The frontier lies in not only aggregating the data from those devices but in fusing the data with other data types (e.g. satellite imagery, installed sensors, radars, etc.). Doing this requires resources and the establishment and negotiation of data rights, how data are valued, how data are used, and the model used for support of the process (e.g. profit-driven, communal, scientific, etc.). In this talk we will discuss a few problems that we have looked at wherein distributed sensor networks provide potential value, data fusion is a "value multiplier" of those crowd-sourced data and how we make that connection to decision makers. We have explored active decision making through our Global Assimilation of Information for Action project (see our old website http://gaia.jhuapl.edu) and the use of "serious games" to establish affinities and illuminate opportunities and issues. We assert that the field of dreams approach ("build it and they will come") is not a sufficiently robust approach; the decision-makers (or paying customers) must be involved in the process of defining the data system products and quantifying the value proposition for their clients.
Evans, Natalie; Pasman, H. Roeline; Vega Alonso, Tomás; Van den Block, Lieve; Miccinesi, Guido; Van Casteren, Viviane; Donker, Gé; Bertolissi, Stefano; Zurriaga, Oscar; Deliens, Luc; Onwuteaka-Philipsen, Bregje; EUROIMPACT, on behalf of
Background Making treatment decisions in anticipation of possible future incapacity is an important part of patient participation in end-of-life decision-making. This study estimates and compares the prevalence of GP-patient end-of-life treatment discussions and patients’ appointment of surrogate decision-makers in Italy, Spain, Belgium and the Netherlands and examines associated factors. Methods A cross-sectional, retrospective survey was conducted with representative GP networks in four countries. GPs recorded the health and care characteristics in the last three months of life of 4,396 patients who died non-suddenly. Prevalences were estimated and logistic regressions were used to examine between country differences and country-specific associated patient and care factors. Results GP-patient discussion of treatment preferences occurred for 10%, 7%, 25% and 47% of Italian, Spanish, Belgian and of Dutch patients respectively. Furthermore, 6%, 5%, 16% and 29% of Italian, Spanish, Belgian and Dutch patients had a surrogate decision-maker. Despite some country-specific differences, previous GP-patient discussion of primary diagnosis, more frequent GP contact, GP provision of palliative care, the importance of palliative care as a treatment aim and place of death were positively associated with preference discussions or surrogate appointments. A diagnosis of dementia was negatively associated with preference discussions and surrogate appointments. Conclusions The study revealed a higher prevalence of treatment preference discussions and surrogate appointments in the two northern compared to the two southern European countries. Factors associated with preference discussions and surrogate appointments suggest that delaying diagnosis discussions impedes anticipatory planning, whereas early preference discussions, particularly for dementia patients, and the provision of palliative care encourage participation. PMID:23472122
Background Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems (CCDSSs) are effective at improving ordering of tests for diagnosis, monitoring of disease, or monitoring of treatment. The outcome of interest was effect on the diagnostic test-ordering behavior of practitioners. Methods We conducted a decision-maker-researcher partnership systematic review. We searched MEDLINE, EMBASE, Ovid's EBM Reviews database, Inspec, and reference lists for eligible articles published up to January 2010. We included randomized controlled trials comparing the use of CCDSSs to usual practice or non-CCDSS controls in clinical care settings. Trials were eligible if at least one component of the CCDSS gave suggestions for ordering or performing a diagnostic procedure. We considered studies 'positive' if they showed a statistically significant improvement in at least 50% of test ordering outcomes. Results Thirty-five studies were identified, with significantly higher methodological quality in those published after the year 2000 (p = 0.002). Thirty-three trials reported evaluable data on diagnostic test ordering, and 55% (18/33) of CCDSSs improved testing behavior overall, including 83% (5/6) for diagnosis, 63% (5/8) for treatment monitoring, 35% (6/17) for disease monitoring, and 100% (3/3) for other purposes. Four of the systems explicitly attempted to reduce test ordering rates and all succeeded. Factors of particular interest to decision makers include costs, user satisfaction, and impact on workflow but were rarely investigated or reported. Conclusions Some CCDSSs can modify practitioner test-ordering behavior. To better inform development and implementation efforts, studies should describe in more detail potentially important factors such
Vavrus, S. J.; Notaro, M.
The proliferation of output from climate model ensembles, such as CMIP3 and CMIP5, has greatly expanded access to future projections, but there is no accepted blueprint for how this data should be interpreted. Decision makers are thus faced with difficult questions when trying to utilize such information: How reliable are the multi-model mean projections? How should the changes simulated by outlier models be treated? How can raw projections of temperature and precipitation be translated into probabilities? The multi-model average is often regarded as the most accurate single estimate of future conditions, but higher-order moments representing the variance and skewness of the distribution of projections provide important information about uncertainty. We have analyzed a set of statistically downscaled climate model projections from the CMIP3 archive to conduct an assessment of extreme weather events at a level designed to be relevant for decision makers. Our analysis uses the distribution of 13 GCM projections to derive the inter-model standard deviation (and coefficient of variation, COV), skewness, and percentile ranges for simulated changes in extreme heat, cold, and precipitation during the middle and late 21st century for the A1B emissions scenario. These metrics help to establish the overall confidence level across the entire range of projections (via the inter-model COV), relative confidence in the simulated high-end versus low-end changes (via skewness), and probabilistic uncertainty bounds derived from a bootstrapping technique. Over our analysis domain centered on the United States Midwest, some primary findings include: (1) Greater confidence in projections of less extreme cold than more extreme heat and intense precipitation, (2) Greater confidence in the low-end than high-end projections of extreme heat, and (3) Higher spatial and temporal variability in the confidence of projected increases of heavy precipitation. In addition, our bootstrapping
Polito, Vincent A., Jr.
The objective of this research was to explore the possibilities of identifying knowledge style factors that could be used as central elements of a professional business analyst's (PBA) performance attributes at work for those decision makers that use advanced analytical technologies on decision making tasks. Indicators of knowledge style were…
Marre, Jean-Baptiste; Thébaud, Olivier; Pascoe, Sean; Jennings, Sarah; Boncoeur, Jean; Coglan, Louisa
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.
Sherrick, Bruce J.; Sonka, Steven T.; Lamb, Peter J.; Mazzocco, Michael A.
This paper examines the commonly used assumption that decision-makers possess accurate prior probability information about climate events that affect their well-being, and illustrates the impact of that assumption on the valuation of prediction information. A survey of large producers in the Mid-western United States is used to recover their prior beliefs about climate variables. It is found that producers systematically misrepresent the probabilities of climate events that materially affect their well-being. In particular, the most common form of the miscalibration between actual and subjective probabilities is to overstate the likelihood of adverse events and understate the likelihood of favourable events. As a result, common methods for valuing prediction information are likely to understate the true value when recipients begin with less accurate prior beliefs.
Einterz, Seth F.; Gilliam, Robin; Lin, Feng Chang; McBride, J. Marvin; Hanson, Laura C.
Objectives Decision aids are effective to improve decision-making, yet they are rarely tested in nursing homes (NHs). Study objectives were to 1) examine the feasibility of a Goals of Care (GOC) decision aid for surrogate decision-makers (SDMs)of persons with dementia; and 2) test its effect on quality of communication and decision-making. Design Pre-post intervention to test a GOC decision aid intervention for SDMs for persons with dementia in NHs. Investigators collected data from reviews of resident health records and interviews with SDMs at baseline and 3-month follow up. Setting Two NHs in North Carolina. Participants 18 residents who were over 65 years of age, had moderate to severe dementia on the Global Deterioration Scale (GDS=5,6,7), and an English-speaking surrogate decision-maker. Intervention 1) GOC Decision Aid video viewed by the SDM, and 2) a structured care plan meeting between the SDM and interdisciplinary NH team Measurements Surrogate knowledge, quality of communication with health care providers, surrogate-provider concordance on goals of care, and palliative care domains addressed in the care plan. Results 89% of the SDMs thought the decision aid was relevant to their needs. After viewing the video decision aid, SDMs increased the number of correct responses on knowledge-based questions (12.5 vs 14.2, P<.001). At 3 months they reported improved quality of communication scores (6.1 vs 6.8, P=.01) and improved concordance on primary goal of care with nursing home team (50% vs 78%, P=.003). The number of palliative care domains addressed in the care plan increased (1.8 vs 4.3, P<.001). Conclusion The decision-support intervention piloted in this study was feasible and relevant for surrogate decision-makers of persons with advanced dementia in nursing homes, and it improved quality of communication between SDM and NH providers. A larger randomized clinical trial is underway to provide further evidence of the effects of this decision aid
Galdi, Silvia; Arcuri, Luciano; Gawronski, Bertram
Common wisdom holds that choice decisions are based on conscious deliberations of the available information about choice options. On the basis of recent insights about unconscious influences on information processing, we tested whether automatic mental associations of undecided individuals bias future choices in a manner such that these choices reflect the evaluations implied by earlier automatic associations. With the use of a computer-based, speeded categorization task to assess automatic mental associations (i.e., associations that are activated unintentionally, difficult to control, and not necessarily endorsed at a conscious level) and self-report measures to assess consciously endorsed beliefs and choice preferences, automatic associations of undecided participants predicted changes in consciously reported beliefs and future choices over a period of 1 week. Conversely, for decided participants, consciously reported beliefs predicted changes in automatic associations and future choices over the same period. These results indicate that decision-makers sometimes have already made up their mind at an unconscious level, even when they consciously indicate that they are still undecided.
Geller, G.; Nativi, S.
Rapid climate and socioeconomic changes may be outrunning society's ability to understand, predict, and respond to change effectively. Decision makers want better information about what these changes will be and how various resources will be affected, while researchers want better understanding of the components and processes of ecological systems, how they interact, and how they respond to change. Although there are many excellent models in ecology and related disciplines, there is only limited coordination among them, and accessible, openly shared models or model systems that can be consulted to gain insight on important ecological questions or assist with decision-making are rare. A "consultative infrastructure" that increased access to and sharing of models and model outputs would benefit decision makers, researchers, as well as modelers. Of course, envisioning such an ambitious system is much easier than building it, but several complementary approaches exist that could contribute. The one discussed here is called the Model Web. This is a concept for an open-ended system of interoperable computer models and databases based on making models and their outputs available as services ("model as a service"). Initially, it might consist of a core of several models from which it could grow gradually as new models or databases were added. However, a model web would not be a monolithic, rigidly planned and built system--instead, like the World Wide Web, it would grow largely organically, with limited central control, within a framework of broad goals and data exchange standards. One difference from the WWW is that a model web is much harder to create, and has more pitfalls, and thus is a long term vision. However, technology, science, observations, and models have advanced enough so that parts of an ecological model web can be built and utilized now, forming a framework for gradual growth as well as a broadly accessible infrastructure. Ultimately, the value of a model
Petropoulos, Z.; Clavin, C.; Zuckerman, B.
The 2014 4-Methylcyclohexanemethanol (MCHM) spill in the Elk River of West Virginia highlighted existing gaps in emergency planning for, and response to, large-scale chemical releases in the United States. The Emergency Planning and Community Right-to-Know Act requires that facilities with hazardous substances provide Material Safety Data Sheets (MSDSs), which contain health and safety information on the hazardous substances. The MSDS produced by Eastman Chemical Company, the manufacturer of MCHM, listed "no data available" for various human toxicity subcategories, such as reproductive toxicity and carcinogenicity. As a result of incomplete toxicity data, the public and media received conflicting messages on the safety of the contaminated water from government officials, industry, and the public health community. Two days after the governor lifted the ban on water use, the health department partially retracted the ban by warning pregnant women to continue avoiding the contaminated water, which the Centers for Disease Control and Prevention deemed safe three weeks later. The response in West Virginia represents a failure in risk communication and calls to question if government officials have sufficient information to support evidence-based decisions during future incidents. Research capabilities, like the National Science Foundation RAPID funding, can provide a solution to some of the data gaps, such as information on environmental fate in the case of the MCHM spill. In order to inform policy discussions on this issue, a methodology for assessing the outcomes of RAPID and similar National Institutes of Health grants in the context of emergency response is employed to examine the efficacy of research-based capabilities in enhancing public health decision making capacity. The results of this assessment highlight potential roles rapid scientific research can fill in ensuring adequate health and safety data is readily available for decision makers during large
Xia, Lisheng; Gu, Ruolei; Zhang, Dandan; Luo, Yuejia
Impulsivity, which is linked to a wide range of psychiatric disorders, is often characterized by a preference for immediate but smaller rewards over delayed but larger rewards. However, debate exists on the relationship between anxiety and impulsivity. Here we use event-related potential (ERP) components as biomarkers in the temporal discounting task to examine the effect of anxiety on inter-temporal decision-making. Our behavioral results indicated that the high trait anxiety (HTA) group made significantly more immediate choices than the low trait anxiety (LTA) group. Compared with the LTA group, shorter response time was associated with immediate rewards in the HTA group. Furthermore, previous studies have demonstrated three ERP components that are associated with impulsivity and/or delay discounting. First, the N1 is an early sensory component involved in selective attention and attention processing for goal-directed actions. Second, the reward positivity (RewP) reflects reward-related dopaminergic activity and encodes reward values. Third, the P3 is regarded as a measure of motivational significance in the decision-making literature. Accordingly, this study found in the immediate-option-evoked ERPs that the HTA group had a larger N1 than the LTA group did. For the delayed-option-evoked ERPs, the HTA group had larger N1 and RewP for the immediate choice than the LTA group did, while the LTA group had a larger P3 for the delayed choice than the HTA group did. These results support the notion that anxiety individuals are impulsive decision-makers in the Delay Discounting Task.
Xia, Lisheng; Gu, Ruolei; Zhang, Dandan; Luo, Yuejia
Impulsivity, which is linked to a wide range of psychiatric disorders, is often characterized by a preference for immediate but smaller rewards over delayed but larger rewards. However, debate exists on the relationship between anxiety and impulsivity. Here we use event-related potential (ERP) components as biomarkers in the temporal discounting task to examine the effect of anxiety on inter-temporal decision-making. Our behavioral results indicated that the high trait anxiety (HTA) group made significantly more immediate choices than the low trait anxiety (LTA) group. Compared with the LTA group, shorter response time was associated with immediate rewards in the HTA group. Furthermore, previous studies have demonstrated three ERP components that are associated with impulsivity and/or delay discounting. First, the N1 is an early sensory component involved in selective attention and attention processing for goal-directed actions. Second, the reward positivity (RewP) reflects reward-related dopaminergic activity and encodes reward values. Third, the P3 is regarded as a measure of motivational significance in the decision-making literature. Accordingly, this study found in the immediate-option-evoked ERPs that the HTA group had a larger N1 than the LTA group did. For the delayed-option-evoked ERPs, the HTA group had larger N1 and RewP for the immediate choice than the LTA group did, while the LTA group had a larger P3 for the delayed choice than the HTA group did. These results support the notion that anxiety individuals are impulsive decision-makers in the Delay Discounting Task. PMID:28174528
Boudrias, M. A.; Estrada, M.; Anders, S.; Silva-Send, N. J.; Gershunov, A.
In San Diego County, the Climate Education Partners (CEP) includes climate scientists, science educators, behavioral scientists, environmental practitioners and community organizations that are dedicated to providing local decision makers (elected officials, business leaders, community leaders) with sound climate science learning opportunities and resources that promote informed decision making. Their work over the past three years has found that effective climate education programs are designed for specific audiences with tailored information that is relevant to them, while simultaneously building community efficacy, identity and values. An integrated approach that blends rigorous scientific facts, local climate change impact, and social science education theory is contributing towards the development of a cadre of engaged leaders and communities. To track project progress and to inform the project strategy, local Key Influentials are being interviewed to gauge their current understanding of climate change and their interest in either becoming messengers to their community or becoming the portal to their constituency. Innovation comes from productive collaboration. For this reason, CEP has been working with leading scientists (climatologists, hydrologists, meteorologists, ecologists), environmental groups, museums and zoos, media experts and government agencies (Water Authority, CalFire) to develop and refine a program of learning activities and resources geared specifically for Key Influentials. For example, a water tour has been designed to bring 25 key influential leaders in San Diego County to a dam, a pumping station and a reservoir and provide climate change facts, impacts and potential solutions to the critical issue of water supply for the San Diego Region. While learning local facts about the causes and impacts of climate change, participants also learn about what they can do (increasing efficacy), that they can be a part of a solution centered community
Belle, Ashwin; Kon, Mark A; Najarian, Kayvan
The volumes of current patient data as well as their complexity make clinical decision making more challenging than ever for physicians and other care givers. This situation calls for the use of biomedical informatics methods to process data and form recommendations and/or predictions to assist such decision makers. The design, implementation, and use of biomedical informatics systems in the form of computer-aided decision support have become essential and widely used over the last two decades. This paper provides a brief review of such systems, their application protocols and methodologies, and the future challenges and directions they suggest.
Belle, Ashwin; Kon, Mark A.; Najarian, Kayvan
The volumes of current patient data as well as their complexity make clinical decision making more challenging than ever for physicians and other care givers. This situation calls for the use of biomedical informatics methods to process data and form recommendations and/or predictions to assist such decision makers. The design, implementation, and use of biomedical informatics systems in the form of computer-aided decision support have become essential and widely used over the last two decades. This paper provides a brief review of such systems, their application protocols and methodologies, and the future challenges and directions they suggest. PMID:23431259
Stinton, David P; McGervey, Joseph; Curran, Scott
Federal agency leaders are expressing growing interest in using innovative fuel cell combined heat and power (CHP) technology at their sites, motivated by both executive branch sustainability targets and a desire to lead by example in the transition to a clean energy economy. Fuel cell CHP can deliver reliable electricity and heat with 70% to 85% efficiency. Implementing this technology can be a high efficiency, clean energy solution for agencies striving to meet ambitious sustainability requirements with limited budgets. Fuel cell CHP systems can use natural gas or renewable fuels, such as biogas. Procuring Stationary Fuel Cells for CHP: A Guide for Federal Facility Decision Makers presents an overview of the process for planning and implementing a fuel cell CHP project in a concise, step-by-step format. This guide is designed to help agency leaders turn their interest in fuel cell technology into successful installations. This guide concentrates on larger (100 kW and greater) fuel cell CHP systems and does not consider other fuel cell applications such as cars, forklifts, backup power supplies or small generators (<100 kW). Because fuel cell technologies are rapidly evolving and have high up front costs, their deployment poses unique challenges. The electrical and thermal output of the CHP system must be integrated with the building s energy systems. Innovative financing mechanisms allow agencies to make a make versus buy decision to maximize savings. This guide outlines methods that federal agencies may use to procure fuel cell CHP systems with little or no capital investment. Each agency and division, however, has its own set of procurement procedures. This guide was written as a starting point, and it defers to the reader s set of rules if differences exist. The fuel cell industry is maturing, and project developers are gaining experience in working with federal agencies. Technology improvements, cost reductions, and experienced project developers are making
On 22 October seven experts who attended a Major Risk Committee meeting were sentenced to six years in prison on charges of manslaughter for underestimating the risk before the devastating 6.3-magnitude earthquake that struck the hillside city of L'Aquila on 6 April 2009, which caused more than 300 deaths. The earthquake followed a sequence of seismic events that started at the beginning of the year, with the largest shock - a 4.2-magnitude earthquake - occurring on 30 March. A day later, the seven experts met in L'Aquila; the minutes of the meeting, which were released after the quake, contained three main conclusions: that earthquakes are not predictable in a deterministic sense; that the L'Aquila region has the highest seismic hazard in Italy; and that the occurrence of a large earthquake in the short term was unlikely. There is not doubt that this trial will represent an important turning point for seismologists, and more in general for scientists who serve as advisors for public safety purposes. Here, starting from the analysis of the accusations made by the prosecutor and a detailed scientific appraisal of what happened, we try to figure out how seismology can evolve in order to be more effective in protecting people, and (possibly) avoiding accusations like the ones who characterize the L'Aquila trial. In particular, we discuss (i) the principles of the Operational Earthquake Forecasting that were put forward by an international Commission on Earthquake Forecasting (ICEF) nominated after L'Aquila earthquake, (ii) the ICEF recommendations for Civil Protection, and (iii) the recent developments in this field in Italy. Finally, we also explore the interface between scientists and decision makers, in particular in the framework of making decisions in a low probability environment.
Lee, O. A.; Eicken, H.; Payne, J. F.
Scenarios provide a framework to develop more adaptive Arctic policies that allow decision makers to consider the best available science to address complex relationships and key uncertainties in drivers of change. These drivers may encompass biophysical factors such as climate change, socioeconomic drivers, and wild-cards that represent low likelihood but influential events such as major environmental disasters. We outline some of the lessons learned from the North Slope Science Initiative (NSSI) scenarios project that could help in the development of adaptive science-based policies. Three spatially explicit development scenarios were identified corresponding to low, medium and high resource extraction activities on the North Slope and adjacent seas. In the case of the high energy development scenario science needs were focused on new technology, oil spill response, and the effects of offshore activities on marine mammals important for subsistence. Science needs related to community culture, erosion, permafrost degradation and hunting and trapping on land were also identified for all three scenarios. The NSSI science needs will guide recommendations for future observing efforts, and data from these observing activities could subsequently improve policy guidance for emergency response, subsistence management and other issues. Scenarios at pan-Arctic scales may help improve the development of international policies for resilient northern communities and encourage the use of science to reduce uncertainties in plans for adapting to change in the Arctic.
Carter, Nancy; Dobbins, Maureen; Ireland, Sandra; Hoxby, Heather; Peachey, Gladys; DiCenso, Alba
The implementation of advanced practice nursing (APN) roles can yield improvements in patient and health system outcomes, and supportive leadership is integral in facilitating the implementation of such roles. The purpose of this study was to explore the awareness and understanding of APN roles among hospital decision-makers, and to learn about the information they require and the ways in which they prefer to receive that information. Fifteen administrators and leaders from two multi-site acute care organizations were interviewed. Their practical knowledge of APN roles was based on experience developing the roles or working with APNs in hospital programs. The most common sources of APN information were internal contacts (i.e., APNs) and documents from nursing organizations. Participants reported difficulty distinguishing between the roles of nurse practitioners (NPs) and clinical nurse specialists (CNSs), and identified knowledge regarding CNS roles as their greatest need. They required specific information regarding the "value-added" benefits offered by an APN role. Strategies to address the knowledge gaps of healthcare leaders are urgently needed in order to support the implementation of new APN roles and to sustain existing ones.
Reynolds, Cecilia; White, Robert; Brayman, Carol; Moore, Shawn
Our study investigated patterns of female participation as secondary principals that have varied across contexts and changed slowly. Researchers interviewed decision makers from a purposive sample of 10 urban and rural school districts in Ontario, Nova Scotia, Saskatchewan, and British Columbia, gathering data from structured telephone interviews,…
Fortin, Martin; Couture, Martine; Bouhali, Tarek; Leclerc, Esther; Stewart, Moira
An integrated knowledge translation strategy is a key factor in fostering the implementation of practice changes. Building on a 15-year history of projects that include close collaboration between researchers and decision-makers in the Saguenay region of Quebec (Canada), the authors identify several key elements that resulted in practice changes in primary care and improved outcomes for patients with multimorbidity.
Stroup, Jay Walter
Understanding the mind-set or perceptions of organizational leaders and decision-makers is important to ascertaining the trends and priorities in policy and governance of the organization. This study finds that a significant shift in the mind-set of government IT and information security leaders has started and will likely result in placing a…
The purpose of this research is to put forth the role of the leisure and recreation events awareness including women decision-makers effects on their fellow women. Three main themes were recognized: Past; "Process of leisure and recreation events of women in Turkey", Present; "Model of Turkey for women on leisure and…
Patriarca, Linda A.; Lamb, Margaret A.
A practicum model was designed to prepare secondary special education teachers to be collaborative decision makers and reflective practitioners. Over the course of the practicum, the nine participants were found to exhibit more reflective thinking, and collaboration with their peers seemed to assist in developing effective instructional…
Dewell, Reneé; Hanthorn, Christy; Danielson, Jared; Burzette, Rebecca; Coetzee, Johann; Griffin, D. Dee; Ramirez, Alejandro; Dewell, Grant
The purpose of the project was to evaluate the use of an interactive workshop designed to teach novel practical welfare techniques to beef cattle caretakers and decision makers. Following training, respondents reported being more likely to use or recommend use of local anesthesia for dehorning and castration and were more inclined to use meloxicam…
Development of a Nonlinear Internal Wave Tactical Decision Aid Christopher R. Jackson Global Ocean Associates 6220 Jean Louise Way Alexandria...internal waves that can be used as the basis for a future Tactical Decision Aid . OBJECTIVES The principal objective is to establish a procedure and...of a Nonlinear Internal Wave Tactical Decision Aid 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER
Senglaub, Michael E.
This efforts objective was to identify and hybridize a suite of technologies enabling the development of predictive decision aids for use principally in combat environments but also in any complex information terrain. The technologies required included formal concept analysis for knowledge representation and information operations, Peircean reasoning to support hypothesis generation, Mill's's canons to begin defining information operators that support the first two technologies and co-evolutionary game theory to provide the environment/domain to assess predictions from the reasoning engines. The intended application domain is the IED problem because of its inherent evolutionary nature. While a fully functioning integrated algorithm was not achieved the hybridization and demonstration of the technologies was accomplished and demonstration of utility provided for a number of ancillary queries.
Chu, Y. Y.; Rouse, W. B.
An experimental representation of a computer-aided multi-task flight management situation has been developed. A computer aiding program was implemented to serve as a back-up decision maker. An experiment was conducted with a balanced design of several subject runs for different workload levels. This was achieved using three levels of subsystem event arrival rates, three levels of control task involvement, and three levels of availability of computer aiding. Experimental results compared quite favorably with those from a computer simulation which employed a queueing model. It was shown that the aiding had enhanced system performance as well as subjective ratings, and that the adaptive aiding policy further reduced subsystem delay.
ZHU, C.W.; LEIBMAN, C.; TOWNSEND, R.; MCLAUGHLIN, T.; SCARMEAS, N.; ALBERT, M.; BRANDT, J.; BLACKER, D.; SANO, M.; STERN, Y.
Aim While clinical endpoints provide important information on the efficacy of treatment in controlled conditions, they often are not relevant to decision makers trying to gauge the potential economic impact or value of new treatments. Therefore, it is often necessary to translate changes in cognition, function or behavior into changes in cost or other measures, which can be problematic if not conducted in a transparent manner. The Dependence Scale (DS), which measures the level of assistance a patient requires due to AD-related deficits, may provide a useful measure of the impact of AD progression in a way that is relevant to patients, providers and payers, by linking clinical endpoints to estimates of cost effectiveness or value. The aim of this analysis was to test the association of the DS to clinical endpoints and AD-related costs. Method The relationship between DS score and other endpoints was explored using the Predictors Study, a large, multi-center cohort of patients with probable AD followed annually for four years. Enrollment required a modified Mini-Mental State Examination (mMMS) score ≥30, equivalent to a score of approximately ≥16 on the MMSE. DS summated scores (range: 0–15) were compared to measures of cognition (MMSE), function (Blessed Dementia Rating Scale, BDRS, 0–17), behavior, extrapyramidal symptoms (EPS), and psychotic symptoms (illusions, delusions or hallucinations). Also, estimates for total cost (sum of direct medical cost, direct non-medical cost, and cost of informal caregivers’ time) were compared to DS scores. Results For the 172 patients in the analysis, mean baseline scores were: DS: 5.2 (SD: 2.0), MMSE: 23.0 (SD: 3.5), BDRS: 2.9 (SD: 1.3), EPS: 10.8%, behavior: 28.9% psychotic symptoms: 21.1%. After 4 years, mean scores were: DS: 8.9 (SD: 2.9), MMSE: 17.2 (SD: 4.7), BDRS: 5.2 (SD: 1.4), EPS: 37.5%, behavior: 60.0%, psychotic symptoms: 46.7%. At baseline, DS scores were significantly correlated with MMSE (r=−0.299, p<0
Hill, M. C.; Kavetski, D.; Clark, M. P.; Ye, M.; Arabi, M.; Lu, D.; Foglia, L.; Mehl, S.
For scientists and decision-makers to understand model predictions and their limitations, models need to be as transparent and refutable as possible. This is achieved by evaluating model fit to data, estimated parameter values, sensitivities, and uncertainty. This talk illustrates methods for evaluating model accuracy, identifying important parameters and observations, quantifying uncertainty, and identifying potential new observations. We also point out some important challenges. First, advances in computing power notwithstanding, computational runtimes remain a major constraint as environmental models become more complicated in an attempt to better capture realistic complexity, heterogeneity and non-stationarity. This constraint is often particularly restrictive given the continuing push towards computationally intensive analysis methods requiring 10,000s or more model runs. In environmental fields, where models can take a week or more per forward run, such methods are burdensome and often infeasible. Second, the relationships between the various model analysis methods and metrics in current use and in research are yet to be clearly established. This makes it difficult for research managers - and even researchers themselves - to develop strategic insights from the enormous ongoing effort to model environmental systems. In our strategy for navigating these difficulties, we suggest viewing the plethora of methods and metrics based on their objectives and computational demand, and making clear links between methods pursuing the same objectives despite starkly different theoretical backgrounds. The strategy emphasizes practical solutions as embodied in the proposed integrated use of methods that range from being computationally frugal (typically local) to demanding (typically global). We identify inexpensive diagnostics to distinguish between cases where frugal methods provide adequate and efficient insights into complex, high-dimensional models and enable systematic
Reddy, K Srikanth; Sahay, Seema
This study explores decision makers' perspectives on evidence-based policy (EBP) development using the case of TB/HIV co-infection in India. Twelve in-depth interviews were conducted with purposively selected key national and international policy decision makers in India. Verbatim transcripts were processed and analysed thematically using QSR (NUD*IST 6). The decision makers were unequivocal in recognizing the TB/HIV co-infection as an important public health issue in India and stated the problem to be different than Africa. The need of having a "third programme" for co-infection was not felt. According to them, the public health management of this co-infection must be within the realm of these two programmes. The study also emphasized on decision makers' perspectives on evidence and the process of utilization of evidence for decision-making for co-infection. Study findings showed global evidence was not always accepted by the decision makers and study shows several examples of decision makers demanding local evidence for policy decisions. Decision makers did make interim policies based on global evidence but most of the time their mandate was to get local evidence. Thus, operations research/implementation science especially multi-centric studies emerge as important strategy for EBP development. Researcher-policy maker interface was a gap where role of researcher as aggressive communicator of research findings was expected.
Habib, Shahid; Nokra, Nada A.
Over the last 25 years, a tremendous progress has been made in the Earth science space-based remote sensing observations, technologies and algorithms. Such advancements have improved the predictability by providing lead-time and accuracy of forecast in weather, climate, natural hazards, and natural resources. It has further reduced or bounded the overall uncertainties by partially improving our understanding of planet Earth as an integrated system that is governed by non-linear and chaotic behavior. Many countries such US, European Community, Japan, China and others have invested billions of dollars in developing and launching space-based assets in the low earth (LEO) and geostationary (GEO) orbits. However, the wealth of this scientific knowledge that has potential of extracting monumental socio-economic benefits from such large investments have been slow in reaching the public and decision makers. For instance, there are a number of areas such as energy forecasting, aviation safety, agricultural competitiveness, disaster management, homeland security, air quality and public health, which can directly take advantage. Nevertheless, we all live in a global economy that depends on access to the best available Earth Science information for all inhabitants of this planet. This paper surveys and examines a number such applications in terms of their architecture, maturity and economic applicability as they apply to the societal needs. A detailed analysis is also presented of various challenges and issues that pertain to a number of areas such as: (1) difficulties in making a speedy transition of data and information from observations and models to relevant Decision Support Systems (DSS) or tools, (2) data and models inter-operability issues, (3) limitations of spatial, spectral and temporal resolution,(4) communication limitations as dictated by the availability of image processing and data compression techniques. Additionally, the most critical element amongst all is
Habib, Shahid; Nokra, Nada Abu
Over the last 25 years, a tremendous progress has been made in the Earth science space-based remote sensing observations, technologies and algorithms. Such advancements have improved the predictability by providing lead-time and accuracy of forecast in weather, climate, natural hazards, and natural resources. It has further reduced or bounded the overall uncertainties by partially improving our understanding of planet Earth as an integrated system that is governed by non-linear and chaotic behavior. Many countries such US, European Community, Japan, China and others have invested billions of dollars in developing and launching space-based assets in the low earth (LEO) and geostationary (GEO) orbits. However, the wealth of this scientific knowledge that has potential of extracting monumental socio-economic benefits from such large investments have been slow in reaching to public and decision makers. For instance, there are a number of areas such as energy forecasting, aviation safety, agricultural competitiveness, disaster management, security, air quality and public health can directly take advantage. Nevertheless, we all live in a global economy that depends on access to the best available Earth Science information for all inhabitants of this planet. This paper surveys and examines a number such applications in terms of their architecture, maturity and economic applicability as they apply to the societal needs. A detailed analysis is also presented of various challenges and issues that pertain to a number of areas such as: (1) difficulties in making a speedy transition of data and information from observations and models to relevant Decision Support Systems (DSS) or tools, (2) data and models inter-operability issues, (3) limitations of spatial, spectral and temporal resolution, (4) communication limitations as dictated by the availability of image processing and data compression techniques. Additionally, the most critical element amongst all is the organizational
Walton, P.; Yarker, M. B.; Mesquita, M. D. S.; Otto, F. E. L.
structures of both courses, evaluating the advantages and disadvantages of each, along with the educational approaches used. We conclude by proposing a framework for the develop of educationally robust online professional development programs that actively supports decision makers in understanding, developing and applying regional climate models.
Frosch, Dominick L.; Légaré, France; Mangione, Carol M.
Objective To assess the effects of informational brochures and video decision aids about cancer screening on patient intention to engage in shared decision making and its predictors in a racially diverse sample. Methods Participants were recruited from 13 community-based primary care practices serving racially and ethnically diverse patients in predominately economically disadvantaged neighborhoods. Participants completed theory-based measures assessing attitudes, perceived social norms, self-efficacy and intentions for working with their physician to make a cancer screening decision after reviewing a brochure or video decision aid, but before seeing the physician. A post-questionnaire assessed screening decisions and participant knowledge. Results Participants who reviewed a video decision aid had higher knowledge and were more likely to want to be the primary decision-maker. They reported lower perceived social norms, self-efficacy and intentions to work with their physicians than participants who reviewed a brochure. Participants who decided against cancer screening reported lower intentions to work with their physician in making a decision and were less likely to report having spoken with their physician about screening. Conclusion Participants who opted against cancer screening after reviewing a brochure or decision aid were less likely to discuss their decision with their physician. The tendency toward autonomous decision-making was stronger among participants who reviewed a video decision aid. PMID:18771875
Background Effective use of a patient decision aid (PtDA) can be affected by the user’s health literacy and the PtDA’s characteristics. Systematic reviews of the relevant literature can guide PtDA developers to attend to the health literacy needs of patients. The reviews reported here aimed to assess: 1. a) the effects of health literacy / numeracy on selected decision-making outcomes, and b) the effects of interventions designed to mitigate the influence of lower health literacy on decision-making outcomes, and 2. the extent to which existing PtDAs a) account for health literacy, and b) are tested in lower health literacy populations. Methods We reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews. Results Aim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies
Water management benefits from a suite of modelling tools and techniques that help simplifying and understanding the complexities involved in managing water resource systems. Early water management models were mainly concerned with optimizing a single objective, related to the design, operations or management of water resource systems (e.g. economic cost, hydroelectricity production, reliability of water deliveries). Significant improvements in methodologies, computational capacity, and data availability over the last decades have resulted in developing more complex water management models that can now incorporate multiple objectives, various uncertainties, and big data. These models provide an improved understanding of complex water resource systems and provide opportunities for making positive impacts. Nevertheless, there remains an alarming mismatch between the optimal solutions developed by these models and the decisions made by managers and stakeholders of water resource systems. Modelers continue to consider decision makers as irrational agents who fail to implement the optimal solutions developed by sophisticated and mathematically rigours water management models. On the other hand, decision makers and stakeholders accuse modelers of being idealist, lacking a perfect understanding of reality, and developing 'smart' solutions that are not practical (stable). In this talk I will have a closer look at the mismatch between the optimality and stability of solutions and argue that conventional water resources management models suffer inherently from a full-cooperation assumption. According to this assumption, water resources management decisions are based on group rationality where in practice decisions are often based on individual rationality, making the group's optimal solution unstable for individually rational decision makers. I discuss how game theory can be used as an appropriate framework for addressing the irrational "rationality assumption" of water
In addition, system evaluation studies will continue. The specific items of work for the next period include: (1) Operational testing of the color...Aid with other DDF decision aids; and (3) continuation of full scale experimental studies of the Group Decision Aid. The following specific tasks were...experimental studies are in progress at Perceptronics’ California office. The previously completed experimental hypotheses and the CACI-developed scenario
Ma, Yanfang; Xu, Jiuping
This article puts forward a cloud theory-based particle swarm optimization (CTPSO) algorithm for solving a variant of the vehicle routing problem, namely a multiple decision maker vehicle routing problem with fuzzy random time windows (MDVRPFRTW). A new mathematical model is developed for the proposed problem in which fuzzy random theory is used to describe the time windows and bi-level programming is applied to describe the relationship between the multiple decision makers. To solve the problem, a cloud theory-based particle swarm optimization (CTPSO) is proposed. More specifically, this approach makes improvements in initialization, inertia weight and particle updates to overcome the shortcomings of the basic particle swarm optimization (PSO). Parameter tests and results analysis are presented to highlight the performance of the optimization method, and comparison of the algorithm with the basic PSO and the genetic algorithm demonstrates its efficiency.
Keller, Kirby; Stanley, Kevin
McDonnell Aircraft Company (MCAIR) is involved in many large multi-discipline design and development efforts of tactical aircraft. These involve a number of design disciplines that must be coordinated to produce an integrated design and a successful product. Our interpretation of a domain specific software design (DSSD) is that of a representation or framework that is specialized to support a limited problem domain. A DSSD is an abstract software design that is shaped by the problem characteristics. This parallels the theme of object-oriented analysis and design of letting the problem model directly drive the design. The DSSD concept extends the notion of software reusability to include representations or frameworks. It supports the entire software life cycle and specifically leads to improved prototyping capability, supports system integration, and promotes reuse of software designs and supporting frameworks. The example presented in this paper is the task network architecture or design which was developed for the MCAIR Pilot's Associate program. The task network concept supported both module development and system integration within the domain of operator decision aiding. It is presented as an instance where a software design exhibited many of the attributes associated with DSSD concept.
White, D.; Trainor, S.; Walsh, J.; Gerlach, C.
The Alaska Center for Climate Assessment and Policy (ACCAP; www.uaf.edu/accap) is one of several, NOAA funded, Regional Integrated Science and Policy (RISA) programs nation-wide (http://www.climate.noaa.gov/cpo_pa/risa/). Our mission is to assess the socio-economic and biophysical impacts of climate variability in Alaska, make this information available to local and regional decision-makers, and improve the ability of Alaskans to adapt to a changing climate. We partner with the University of Alaska?s Scenario Network for Alaska Planning (SNAP; http://www.snap.uaf.edu/), state and local government, state and federal agencies, industry, and non-profit organizations to communicate accurate and up-to-date climate science and assist in formulating adaptation and mitigation plans. ACCAP and SNAP scientists are members of the Governor?s Climate Change Sub-Cabinet Adaptation and Mitigation Advisory and Technical Working Groups (http://www.climatechange.alaska.gov/), and apply their scientific expertise to provide down-scaled, state-wide maps of temperature and precipitation projections for these groups. An ACCAP scientist also serves as co-chair for the Fairbanks North Star Borough Climate Change Task Force, assisting this group as they work through the five-step model for climate change planning put forward by the International Council for Local Environmental Initiatives (http://www.investfairbanks.com/Taskforces/climate.php). ACCAP scientists work closely with federal resource managers in on a range of projects including: partnering with the U.S. Fish and Wildlife Service to analyze hydrologic changes associated with climate change and related ecological impacts and wildlife management and development issues on Alaska?s North Slope; partnering with members of the Alaska Interagency Wildland Fire Coordinating Group in statistical modeling to predict seasonal wildfire activity and coordinate fire suppression resources state-wide; and working with Alaska Native Elders and
Prahl, Andrew; Dexter, Franklin; Swol, Lyn Van; Braun, Michael T; Epstein, Richard H
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
Strömbäck, Lena; Hjerdt, Niclas; Eriksson Bram, Lena; Lewau, Per
Water management in Sweden is focused on characterization of water bodies and establishing action plans to achieve a good ecological status according to the framework directives stated by the European Union. To support this work SMHI has been commissioned to make databases of hydrography, statistics, water flows and scenario models freely available on the web. As a result of this we have created the open website vattenweb.smhi.se. The site currently provides observed and modeled data for fresh water and coastal areas as time series and statistics. In addition to this, the site also exposes data on wetlands and results from climate scenario simulations. The development of the site has been done in close cooperation with the end users at the water authorities to meet their needs and requirements. This has resulted in an easy to use website, where downloaded data easily can be imported into other tools for further use and analysis by the users. However, during the process we discovered that it was important for the users to learn more on the model setup and quality of simulated data. Therefore, during 2012, we concentrated on making the website more transparent and explain the assumptions and setup behind the simulation. Simulated data on fresh water quantity and quality are provided by the S-HYPE model, a Swedish setup of the Open Source HYPE model. The model provides daily simulations of discharge and transport of nitrogen and phosphorous for the around 40 000 subbasins defined in the Swedish Water ARchive (SVAR). To make the simulated data more transparent, the data used for model setup has been made available on the website as a possibility to download input data as well as the resulting data. In addition, we provide a reference guide where origin of data as well as the processing required for the model setup is explained. This allows decision makers to analyze the model assumptions to understand if there are differences to more detailed information on local
Walton, P.; Otto, F. E. L.
There is a recognition from academics and stakeholders that climate science has a fundamental role to play in the decision making process, but too frequently there is still uncertainty about what, when, how and why to use it. Stakeholders suggest that it is because the science is presented in an inaccessible manner, while academics suggest it is because the stakeholders do not have the scientific knowledge to understand and apply the science appropriately. What is apparent is that stakeholders need support, and that there is an onus on academia to provide it. This support is even more important with recent developments in climate science, such as extreme weather event attribution. We are already seeing the impacts of extreme weather events around the world causing lost of life and damage to property and infrastructure with current research suggesting that these events could become more frequent and more intense. If this is to be the case then a better understanding of the science will be vital in developing robust adaptation and business planning. The use of games, role playing and simulations to aid learning has long been understood in education but less so as a tool to support stakeholder understanding of climate science. Providing a 'safe' space where participants can actively engage with concepts, ideas and often emotions, can lead to deep understanding that is not possible through more passive mechanisms such as papers and web sites. This paper reports on a game that was developed through a collaboration led by the Red Cross/Red Crescent, University of Oxford and University of Reading to help stakeholders understand the role of weather event attribution in the decision making process. The game has already been played successfully at a number of high profile events including COP 19 and the African Climate Conference. It has also been used with students as part of a postgraduate environmental management course. As well as describing the design principles of the
Snyder, E. Amanda; Caprio, Anthony J.; Wessell, Kathryn; Lin, Feng Chang; Hanson, Laura C.
Objective In advanced dementia, feeding problems are nearly universal, and families face difficult decisions about feeding options. Initial interviews for a randomized trial were used to describe surrogates’ perceptions feeding options, and to determine if a decision aid on feeding options in advanced dementia would improve knowledge, reduce expectation of benefit from tube feeding, and reduce conflict over treatment choices for persons with advanced dementia. Design Semi-structured interview with pre-post study design for surrogates in the intervention group. Setting Twenty-four skilled nursing facilities across North Carolina participating in a cluster randomized trial. Participants Two hundred fifty-five surrogate decision-makers for nursing home residents with advanced dementia and feeding problems, in control (n=129) and intervention (n=126) groups. Intervention For intervention surrogates only, an audiovisual-print decision aid provided information on dementia, feeding problems in dementia, advantages and disadvantages of feeding tubes or assisted oral feeding options and the role of surrogates in making these decisions. Measurements The interview included open-ended items asking surrogates to report advantages and disadvantages of tube feeding and assisted oral feeding. Knowledge of feeding options was measured with 19 true-false items, and items measuring expectation of benefit from tube feeding. Surrogates reported which of these two feeding options they preferred for the person with dementia, and how confident they were in this choice; their level of conflict about the choice was measured using the Decisional Conflict Scale. Results Prior to the decision aid, surrogates described advantages and disadvantages of assisted oral feeding and tube feeding in practical, ethical and medical terms. After review of the decision aid, intervention surrogates had improved knowledge scores (15.5 vs. 16.8; p<0.001), decreased expectation of benefits from tube feeding
Homsy, R.V.; Sicherman, A.; Stephens, D.R.
Newly designed warheads that incorporate advanced surety concepts can reduce the risks of accidental radiological material dispersal, nuclear detonation, and unauthorized use. But these potential surety benefits entail cost and performance penalties. Present constraints on R&D budgets, time, and allowable nuclear tests also create significant uncertainties as to whether new concepts can be successfully developed and implemented. These factors complicate the decisions involved in selecting surety concepts for more extensive R&D. To help decision makers compare R&D options, we developed a decision aid called Weapon Safety Value Assessment (WESVA). This paper describes WESVA and suggests how a WESVA-like approach can be of interest in other decision-making contexts.
Bahus, Marianne K; Føerde, Reidun
This article studies whether the attitudes of Norwegian doctors regarding surrogate decision power in end-of-life care conform to legal rules, particularly as they apply to the protection of children. The article is based on a hypothetical scenario concerning a critically ill child, believed to be dying, presented to 406 doctors. The study indicates that doctors may permit parental/surrogate decision-making to a greater extent than justified by law, sometimes in contravention of the child's best interests, which should be a fundamental guideline in all decisions that concern children. This article suggests a need to improve knowledge of doctors concerning parents'/surrogates' right to participate in life-or-death decisions. We conclude that Norway needs a precedent decision from the Supreme Court that confirms the right of judicial review of end-of-life decisions, and which applies the principle of the child's best interests as a fundamental guideline in the final decision.
Jawahar, I M; Mattsson, Jonny
The authors, in two experiments, investigated the influence of the sex and attractiveness of applicants for male and female sex-typed jobs on selection decisions made by low and high self-monitors. In both experiments, attractiveness and the congruence between applicants' sex and the sex type of the job influenced selection decisions. In addition, high self-monitors were more influenced by attractiveness and sex of the applicant when hiring for sex-typed jobs than low self-monitors, but this difference in hiring pattern was not evident when the job was gender neutral. Results indicate that job applicants may encounter different employment opportunities as a function of their sex, their physical attractiveness, the sex type of the job, and the self-monitoring level of the decision maker. Implications of results are discussed and suggestions for future research are offered.
Woodhouse, Kristina Demas; Tremont, Katie; Vachani, Anil; Schapira, Marilyn M; Vapiwala, Neha; Simone, Charles B; Berman, Abigail T
Cancer treatment decisions are complex and may be challenging for patients, as multiple treatment options can often be reasonably considered. As a result, decisional support tools have been developed to assist patients in the decision-making process. A commonly used intervention to facilitate shared decision-making is a decision aid, which provides evidence-based outcomes information and guides patients towards choosing the treatment option that best aligns with their preferences and values. To ensure high quality, systematic frameworks and standards have been proposed for the development of an optimal aid for decision making. Studies have examined the impact of these tools on facilitating treatment decisions and improving decision-related outcomes. In radiation oncology, randomized controlled trials have demonstrated that decision aids have the potential to improve patient outcomes, including increased knowledge about treatment options and decreased decisional conflict with decision-making. This article provides an overview of the shared-decision making process and summarizes the development, validation, and implementation of decision aids as patient educational tools in radiation oncology. Finally, this article reviews the findings from decision aid studies in radiation oncology and offers various strategies to effectively implement shared decision-making into clinical practice.
Ryan, Gery W; Bloom, Evan W; Lowsky, David J; Linthicum, Mark T; Juday, Timothy; Rosenblatt, Lisa; Kulkarni, Sonali; Goldman, Dana P; Sayles, Jennifer N
Public health agencies face difficult decisions when allocating scarce resources to control the spread of HIV/AIDS. Decisions are often made with few local empirical data. We demonstrated the use of the robust decision making approach in Los Angeles County, an approach that is data driven and allows decision makers to compare the performance of various intervention strategies across thousands of simulated future scenarios. We found that the prevailing strategy of emphasizing behavioral risk reduction interventions was unlikely to achieve the policy goals of the national HIV/AIDS strategy. Of the alternative strategies we examined, those that invested most heavily in interventions to initiate antiretroviral treatment and support treatment adherence were the most likely to achieve policy objectives. By employing similar methods, other public health agencies can identify robust strategies and invest in interventions more likely to achieve HIV/AIDS policy goals.
Regier, Dean A; Bentley, Colene; Mitton, Craig; Bryan, Stirling; Burgess, Michael M; Chesney, Ellen; Coldman, Andy; Gibson, Jennifer; Hoch, Jeffrey; Rahman, Syed; Sabharwal, Mona; Sawka, Carol; Schuckel, Victoria; Peacock, Stuart J
Decision-makers are challenged to incorporate public input into priority-setting decisions. We conducted a pan-Canadian survey of decision-makers in cancer control to investigate the types of evidence, especially evidence supplied by the public, that are utilized in health care priority-setting. We further examined how normative attitudes and contextual factors influence the use of public engagement as evidence at the committee level. Administered between November and December 2012, 67 respondents from 117 invited individuals participated in the survey. The results indicated that public engagement was infrequently utilized compared to clinical effectiveness evidence or cost evidence. General positive agreement between normative attitudes towards the use of evidence and the frequency of evidence utilization was observed, but absence of correlative agreement was found for the types of evidence that are supplied by the general public and for cost-effectiveness inputs. Regression analyses suggested that public engagement was unevenly utilized between jurisdictions and that educational background and barriers to implementing public input may decrease the odds of using public engagement as evidence. We recommend that institutions establish a link between committee members' normative attitudes for using public engagement and its real-world utilization.
Duncan, B.; Higgason, K.; Suchanek, T.; Stachowicz, J.; Largier, J. L.; Cayan, D. R.
Resource managers and decision-makers in North-central California recognize a need for increased information about the impacts of climate change on the region's coast and ocean to ensure that adaptation and conservation decisions are grounded in sound science. To help meet this need, ocean climate indicators were developed in a project based at NOAA's Gulf of the Farallones National Marine Sanctuary for the North-central California coast and ocean, from Año Nuevo to Point Arena, including the Pacific coastline of the San Francisco Bay Area. These represent the first regional ocean climate indicators in the National Marine Sanctuary System. The indicators were developed in collaboration with over 50 regional research scientists and resource managers representing federal and state agencies, research universities and institutions, and non-governmental organizations. Following the indicator development process, an interdisciplinary working group incorporated the indicators into a regional indicators monitoring inventory and plan that will be used by scientists, natural resource managers, and state and municipal planners to monitor, track, and develop adaptation strategies for the impacts of climate change on the region. The working group collaborated extensively to co-identify key measurements and data sources for the indicators, and to ensure that the monitoring plan was accessible and convenient for decision-makers while still providing a valuable resource for research scientists.
Webb, Erik Karl; Tidwell, Vincent Carroll
This document outlines ways to more effectively communicate with U.S. Federal decision makers by outlining the structure, authority, and motivations of various Federal groups, how to find the trusted advisors, and how to structure communication. All three branches of Federal governments have decision makers engaged in resolving major policy issues. The Legislative Branch (Congress) negotiates the authority and the resources that can be used by the Executive Branch. The Executive Branch has some latitude in implementation and prioritizing resources. The Judicial Branch resolves disputes. The goal of all decision makers is to choose and implement the option that best fits the needs and wants of the community. However, understanding the risk of technical, political and/or financial infeasibility and possible unintended consequences is extremely difficult. Primarily, decision makers are supported in their deliberations by trusted advisors who engage in the analysis of options as well as the day-to-day tasks associated with multi-party negotiations. In the best case, the trusted advisors use many sources of information to inform the process including the opinion of experts and if possible predictive analysis from which they can evaluate the projected consequences of their decisions. The paper covers the following: (1) Understanding Executive and Legislative decision makers - What can these decision makers do? (2) Finding the target audience - Who are the internal and external trusted advisors? (3) Packaging the message - How do we parse and integrate information, and how do we use computer simulation or models in policy communication?
Reed, Alexis L.
The Fukushima Daiichi response posed a plethora of scientific questions to the U.S. Department of Energy’s (DOE) radiological emergency response community. As concerns arose for decision makers, the DOE leveraged a community of scientists well-versed in the tenants of emergency situations to provide answers to time-sensitive questions from different parts of the world. A chronology of the scientific Q and A that occurred is presented along with descriptions of the challenges that were faced and how new methods were employed throughout the course of the response.
Fisher, Z.; Bailey, R.; Willner, P.
Background: Previous research has demonstrated that people with mild intellectual disabilities (ID) have difficulty in "weighing up" information, defined as integrating disparate items of information in order to reach a decision. However, this problem could be overcome by the use of a visual aid to decision making. In an earlier study,…
Levi, M. P.; O'Grady, M. J.
The technology and economics of various wood energy systems available to the small industrial and commercial energy user are considered. This book is designed to help a plant manager, engineer, or others in a decision-making role to become more familiar with wood fuel systems and make informed decisions about switching to wood as a fuel. The following subjects are discussed: wood combustion, pelletized wood, fuel storage, fuel handling and preparation, combustion equipment, retrofitting fossil-fueled boilers, cogeneration, pollution abatement, and economic considerations of wood fuel use. (MHR)
This guide presents the Rapid Benefits Indicators (RBI) Approach, a rapid process for assessing the social benefits of ecosystem restoration. Created for those who conduct, advocate for, or support restoration, the RBI approach consists of five steps: (1) Describe the decision co...
Zhang, Xin; Anderson, Richard C.; Morris, Joshua; Miller, Brian; Nguyen-Jahiel, Kim Thi; Lin, Tzu-Jung; Zhang, Jie; Jadallah, May; Scott, Theresa; Sun, Jingjing; Latawiec, Beata; Ma, Shufeng; Grabow, Kay; Hsu, Judy Yu-Li
This research examined the influence of contrasting instructional approaches on children's decision-making competence. A total of 764 fifth graders, mostly African Americans and Hispanic Americans, from 36 classrooms in eight public schools serving children from low-income families completed a six-week unit on wolf management, using either direct…
Yenney, Sharon L.
Companies are promoting employee leadership and decision making in their worksite wellness programs for the following reasons: to make the best use of limited resources, to increase programs' chances for success by fostering employee ownership of program plans, to help integrate positive health and safety features into workplace policies and…
Wheelock, Michael D.
This dissertation uses a survey methodology to determine the factors behind the decision to adopt cloud storage. The dependent variable in the study is the intent to adopt cloud storage. Four independent variables are utilized including need, security, cost-effectiveness and reliability. The survey includes a pilot test, field test and statistical…
Elshami, Ahmed M.
In an era when patrons want access to CD-ROM resources but few libraries can afford to buy multiple copies, CD-ROM local area networks (LANs) are emerging as a cost-effective way to provide shared access. To help librarians make informed decisions, this manual offers information on: (1) the basics of LANs, a "local area network primer";…
Kirlik, Alex; Markert, Wendy J.; Kossack, Merrick
Currently, two main approaches exist for improving the human-machine interface component of a system in order to improve overall system performance, display enhancement and intelligent decision aiding. Each of these two approaches has its own set of advantages and disadvantages, as well as introduce its own set of additional performance problems. These characteristics should help identify which types of problem situations and domains are better aided by which type of strategy. The characteristic issues are described of these two decision aiding strategies. Then differences in expert and novice decision making are described in order to help determine whether a particular strategy may be better for a particular type of user. Finally, research is outlined to compare and contrast the two technologies, as well as to examine the interaction effects introduced by the different skill levels and the different methods for training operators.
By applying Sensible Agent (SA) multi-agent system (MAS) technology to the biosurveillance domain, we can reduce the burden on the TDH ...epidemiologist by distributing and coordinating decision-making, as well as help the TDH manage the uncertainty of incoming data and understand how that...demonstrated for biosurveillance in support of the Texas Department of Health ( TDH ). In the current configuration, all data acquired from hospitals
Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.
Background/Objectives When hospitalized older adults have impaired cognition, family members or other surrogates must communicate with clinicians to provide information and make medical decisions for the patient. The present study describes communication experiences of surrogates who recently made a major medical decision for a hospitalized older adult. Design Semi-structured interviews about a recent hospitalization. Setting Two hospitals both affiliated with 1 large medical school: an urban, public hospital; and a university-affiliated tertiary referral hospital. Participants Surrogates were eligible if they had recently made a major medical decision for a hospitalized patient aged 65 or older and were available for an interview within 1 month (2-5 months if the patient died). Measurements Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. Results We interviewed 35 surrogates. They were 80% female, 44% white and 56% African American. Three primary themes emerged. We found the Nature of Surrogate/Clinician Relationships was best characterized as a relationship with a “team” of clinicians rather than individual clinicians due to frequent staff changes and multiple clinicians. Surrogates reported their Communication Needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described Trust and Mistrust, which were formed largely through surrogates’ communication experiences. Conclusion In the hospital, surrogates form relationships with a “team” of clinicians rather than with individuals. Yet effective communication and expressions of emotional support frequently occur and are highly valued by surrogates. Future interventions should focus on meeting surrogates’ needs for frequent communication, high levels of information and emotional support. PMID:22881864
Alaboudi, Abdulellah; Atkins, Anthony; Sharp, Bernadette; Balkhair, Ahmed; Alzahrani, Mohammed; Sunbul, Tamara
Despite emerging evidence about the benefits of telemedicine, there are still many barriers and challenges to its adoption. Its adoption is often cited as a failed project because 75% of them are abandoned or 'failed outright' and this percentage increases to 90% in developing countries. The literature has clarified that there is neither one-size-fit-all framework nor best-practice solution for all ICT innovations or for all countries. Barriers and challenges in adopting and implementing one ICT innovation in a given country/organisation may not be similar - not for the same ICT innovation in another country/organisation nor for another ICT innovation in the same country/organisation. To the best of our knowledge, no comprehensive scientific study has investigated these challenges and barriers in all Healthcare Facilities (HCFs) across the Kingdom of Saudi Arabia (KSA). This research, which is undertaken based on the Saudi Telemedicine Network roadmap and in collaboration with the Saudi Ministry of Health (MOH), is aimed at identifying the principle predictive challenges and barriers in the context of the KSA, and understanding the perspective of the decision makers of each HCF type, sector, and location. Three theories are used to underpin this research: the Unified Theory of Acceptance and Use of Technology (UTAUT), the Technology-Organisation-Environment (TOE) theoretical framework, and the Evaluating Telemedicine Systems Success Model (ETSSM). This study applies a three-sequential-phase approach by using three mixed methods (i.e., literature review, interviews, and questionnaires) in order to utilise the source triangulation and the data comparison analysis technique. The findings of this study show that the top three influential barriers to adopt and implement telemedicine by the HCF decision makers are: (i) the availability of adequate sustainable financial support to implement, operate, and maintain the telemedicine system, (ii) ensuring conformity of
The Transportation Energy Futures (TEF) project examines underexplored greenhouse gas-abatement and oil-savings opportunities by consolidating transportation energy knowledge, conducting advanced analysis, and exploring additional opportunities for sound strategic action. Led by NREL, in collaboration with Argonne National Laboratory, the project's primary goal is to provide analysis to accompany DOE-EERE's long-term transportation energy planning by addressing high-priority questions, informing domestic decisions about transportation energy strategies, priorities, and investments. Research and analysis were conducted with an eye toward short-term actions that support long-term energy goals The project looks beyond technology to examine each key question in the context of the marketplace, consumer behavior, industry capabilities, and infrastructure. This updated fact sheet includes a new section on initial project findings.
Meris, Ronald G; Barbera, Joseph A
In a large-scale outdoor, airborne, hazardous materials (HAZMAT) incident, such as ruptured chlorine rail cars during a train derailment, the local Incident Commanders and HAZMAT emergency responders must obtain accurate information quickly to assess the situation and act promptly and appropriately. HAZMAT responders must have a clear understanding of key information and how to integrate it into timely and effective decisions for action planning. This study examined the use of HAZMAT plume modeling as a decision support tool during incident action planning in this type of extreme HAZMAT incident. The concept of situation awareness as presented by Endsley's dynamic situation awareness model contains three levels: perception, comprehension, and projection. It was used to examine the actions of incident managers related to adequate data acquisition, current situational understanding, and accurate situation projection. Scientists and engineers have created software to simulate and predict HAZMAT plume behavior, the projected hazard impact areas, and the associated health effects. Incorporating the use of HAZMAT plume projection modeling into an incident action plan may be a complex process. The present analysis used a mixed qualitative and quantitative methodological approach and examined the use and limitations of a "HAZMAT Plume Modeling Cycle" process that can be integrated into the incident action planning cycle. HAZMAT response experts were interviewed using a computer-based simulation. One of the research conclusions indicated the "HAZMAT Plume Modeling Cycle" is a critical function so that an individual/team can be tasked with continually updating the hazard plume model with evolving data, promoting more accurate situation awareness.
Background Cochrane reviews are one of the best known and most trusted sources of evidence-based information in health care. While steps have been taken to make Cochrane intervention reviews accessible to a diverse readership, little is known about the accessibility of the newcomer to the Cochrane library: diagnostic test accuracy reviews (DTARs). The current qualitative study explored how healthcare decision makers, who varied in their knowledge and experience with test accuracy research and systematic reviews, read and made sense of DTARs. Methods A purposive sample of clinicians, researchers and policy makers (n = 21) took part in a series of think-aloud interviews, using as interview material the first three DTARs published in the Cochrane library. Thematic qualitative analysis of the transcripts was carried out to identify patterns in participants’ ‘reading’ and interpretation of the reviews and the difficulties they encountered. Results Participants unfamiliar with the design and methodology of DTARs found the reviews largely inaccessible and experienced a range of difficulties stemming mainly from the mismatch between background knowledge and level of explanation provided in the text. Experience with systematic reviews of interventions did not guarantee better understanding and, in some cases, led to confusion and misinterpretation. These difficulties were further exacerbated by poor layout and presentation, which affected even those with relatively good knowledge of DTARs and had a negative impact not only on their understanding of the reviews but also on their motivation to engage with the text. Comparison between the readings of the three reviews showed that more accessible presentation, such as presenting the results as natural frequencies, significantly increased participants’ understanding. Conclusions The study demonstrates that authors and editors should pay more attention to the presentation as well as the content of Cochrane DTARs
Mohammed, Rakib; Poss, Jeff; Egan, Mary; Rappolt, Susan; Berg, Katherine
Objectif : Explorer les mécanismes actuels de prise de décision en matière de répartition des services de physiothérapie et d'ergothérapie dans les soins à domicile pour les clients aux besoins complexes nécessitant des soins à domicile à long terme en Ontario. Méthode : Une étude exploratoire à l'aide d'entrevues auprès d'intervenants clés et de vignettes a été réalisée auprès des décideurs en matière de soins à domicile (gestionnaires de cas et personnel de direction) dans quatre régions de soins à domicile de l'Ontario. Les données des entrevues ont été analysées à l'aide d'une méthode dite de « l'analyse des structures ». Résultats : La prise de décision pour la répartition des services de thérapie comporte quatre étapes: admission, évaluation, acheminement vers le fournisseur de services et réévaluation. Certaines disparités dans les processus de gestion ont toutefois été observées à chacune des étapes. La principale variation se situait dans le processus visant à établir la quantité de services de thérapie dans les diverses régions, en raison principalement des contraintes financières touchant les programmes de soins à domicile. La méthode de financement du gouvernement et les modes de partage de l'information ont aussi des effets considérables sur la répartition des soins à domicile. Conclusion : Les contraintes financières des soins à domicile constituent le principal facteur contextuel affectant la répartition des services de thérapie dans les divers secteurs de soins à domicile. Compte tenu de l'inflation dans les coûts des soins de santé, de nouveaux modèles de financement et de prestation des services devront être créés afin de s'assurer que la bonne personne reçoit les bons soins avant que son état ne se détériore et qu'il ne nécessite des soins à long terme encore plus coûteux.
Chewning, Betty; Mosena, Pat; Wilson, Dale; Erdman, Harold; Potthoff, Sandra; Murphy, Anita; Kuhnen, Kathleen Kennedy
Discusses a computer-based contraceptive decision aid used with adolescent female family planning clinic patients (N=949). Results show improved short-term knowledge of and confidence in oral contraceptive (OC) efficacy. Higher OC knowledge after one year and fewer pregnancies were seen in one group. Findings suggest the usefulness of informatics…
Tactical Decision Aid, Simulations using PAGES Visual Basic Programming 64 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION OF 19...27 APPENDIX A. COMPOSITE OUTPUT DISPLAYS ..................................................................... 29 APPENDIX B. VISUAL BASIC SOURCE...41 APPENDIX D. VISUAL BASIC SOURCE CODE FOR SIMULATION ......................................... 43 APPENDIX E
Chan, Siu Y.
Discussion of information overload focuses on a study of masters degree students at a Hong Kong university that investigated the effectiveness of graphs as decision aids to reduce adverse effects of information overload on decision quality. Results of a simulation of a business prediction task with a sample of business managers are presented.…
Prados, A. I.; Blevins, B.; Hook, E.
NASA ARSET http://arset.gsfc.nasa.gov has been providing applied remote sensing training since 2008. The goals of the program are to develop the technical and analytical skills necessary to utilize NASA resources for decision-support. The program has reached over 3500 participants, with 1600 stakeholders from 100 countries in 2015 alone. The target audience for the program are professionals engaged in environmental management in the public and private sectors, such as air quality forecasters, public utilities, water managers and non-governmental organizations engaged in conservation. Many program participants have little or no expertise in NASA remote sensing, and it's frequently their very first exposure to NASA's vast resources. One the key challenges for the program has been the evolution and refinement of its approach to communicating NASA data access, research, and ultimately its value to stakeholders. We discuss ARSET's best practices for sharing NASA science, which include 1) training ARSET staff and other NASA scientists on methods for science communication, 2) communicating the proper amount of scientific information at a level that is commensurate with the technical skills of program participants, 3) communicating the benefit of NASA resources to stakeholders, and 4) getting to know the audience and tailoring the message so that science information is conveyed within the context of agencies' unique environmental challenges.
Maule, A. J.; Maule, Simon
Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions. PMID:26779052
Paxton, L. J.; Schaefer, R. K.; Nix, M.; Fountain, G. H.; Weiss, M.; Swartz, W. H.; Parker, C. L.; MacDonald, L.; Ihde, A. G.; Simpkins, S.; GAIA Team
In this paper we describe the application of a proven methodology for modeling the complex social and economic interactions embodied in real-world decision making to water scarcity and water resources. We have developed a generalizable, extensible facility we call "GAIA" - Global Assimilation of Information for Action - and applied it to different problem sets. We describe the use of the "Green Country Model" and other gaming/simulation tools to address the impacts of climate and climate disruption issues at the intersection of science, economics, policy, and society. There is a long history in the Defense community of using what are known as strategic simulations or "wargames" to model the complex interactions between the environment, people, resources, infrastructure and the economy in a competitive environment. We describe in this paper, work that we have done on understanding how this heritage can be repurposed to help us explore how the complex interplay between climate disruption and our socio/political and economic structures will affect our future. Our focus here is on a fundamental and growing issue - water and water availability. We consider water and the role of "virtual water" in the system. Various "actors" are included in the simulations. While these simulations cannot definitively predict what will happen, they do illuminate non-linear feedbacks between, for example, treaty agreement, the environment, the economy, and the government. These simulations can be focused on the global, regional, or local environment. We note that these simulations are not "zero sum" games - there need not be a winner and a loser. They are, however, competitive influence games: they represent the tools that a nation, state, faction or group has at its disposal to influence policy (diplomacy), finances, industry (economy), infrastructure, information, etc to achieve their particular goals. As in the real world the problem is competitive - not everyone shares the same
Rapid climate and socioeconomic changes may be outrunning society's ability to understand, predict, and respond to change effectively. Decision makers such as natural resource managers want better information about what these changes will be and how the resources they are managing will be affected. Researchers want better understanding of the components and processes of ecological systems, how they interact, and how they respond to change. Nearly all these activities require computer models to make ecological forecasts that can address "what if" questions. However, despite many excellent models in ecology and related disciplines, there is no coordinated model system—that is, a model infrastructure--that researchers or decision makers can consult to gain insight on important ecological questions or help them make decisions. While this is partly due to the complexity of the science, to lack of critical observations, and other issues, limited access to and sharing of models and model outputs is a factor as well. An infrastructure that increased access to and sharing of models and model outputs would benefit researchers, decision makers of all kinds, and modelers. One path to such a "consultative infrastructure" for ecological forecasting is called the Model Web, a concept for an open-ended system of interoperable computer models and databases communicating using a Service Oriented Architectures (SOA). Initially, it could consist of a core of several models, perhaps made interoperable retroactively, and then it could grow gradually as new models or databases were added. Because some models provide basic information of use to many other models, such as simple physical parameters, these "keystone" models are of particular importance in a model web. In the long run, a model web would not be rigidly planned and built--instead, like the World Wide Web, it would grow largely organically, with limited central control, within a framework of broad goals and data exchange
DOD’s 2013-2018 Workforce Plan 22 functional communities 32 mission-critical occupations (series) Medical Psychology Series (0180) Social Work...Updates. Listen to our Podcasts . Visit GAO on the web at www.gao.gov. Contact: Website: http://www.gao.gov/fraudnet/fraudnet.htm E-mail: fraudnet
Background In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective. Aim The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM. Methods The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM. Results The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant. Conclusions The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious
Chung, Ryoa; Rochon, Christiane; Hunt, Matthew
Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants’ conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst’s (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster. PMID:27617037
Durocher, Evelyne; Chung, Ryoa; Rochon, Christiane; Hunt, Matthew
Vulnerability is a central concept in humanitarian aid. Discussions of vulnerability in disaster response literature and guidelines for humanitarian aid range from considerations of a universal human vulnerability, to more nuanced examinations of how particular characteristics render individuals more or less at risk. Despite its frequent use, there is a lack of clarity about how vulnerability is conceptualized and how it informs operational priorities in humanitarian assistance. Guided by interpretive description methodology, we draw on the feminist taxonomy of vulnerability presented by Mackenzie, Rogers and Dodds (2014) to examine perspectives of 24 expatriate and Haitian decision-makers and health professionals interviewed between May 2012 and March 2013. The analysis explores concepts of vulnerability and equity in relation to the humanitarian response following the 2010 earthquake in Haiti. Participants' conceptualizations of vulnerability included consideration for inherent vulnerabilities related to individual characteristics (e.g. being a woman or disabled) and situational vulnerabilities related to particular circumstances such as having less access to health care resources or basic necessities. Participants recognized that vulnerabilities could be exacerbated by socio-political structures but felt ill-equipped to address these. The use of the taxonomy and a set of questions inspired by Hurst's (2008) approach to identifying and reducing vulnerability can guide the analysis of varied sources of vulnerability and open discussions about how and by whom vulnerabilities should be addressed in humanitarian responses. More research is required to inform how humanitarian responders could balance addressing acute vulnerability with consideration of systemic and pre-existing circumstances that underlie much of the vulnerability experienced following an acute disaster.
Holden, Gary; Rosenberg, Gary; Barker, Kathleen
The assessment of scholarship assumes a central role in the evaluation of individual faculty, educational programs and academic fields. Because the production and assessment of scholarship is so central to the faculty role, it is incumbent upon decision makers to strive to make assessments of scholarship fair and equitable. This paper will focus on an approach to the assessment of the quantity and impact of the most important subset of an individual's scholarship-peer-reviewed journal articles. The primary goal of this paper is to stimulate discussion regarding scholarship assessment in hiring, reappointment, tenure and promotion decisions.
Siminoff, L A; Sandberg, D E
Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach.
Approved for public release; distribution unlimited PSDA predicts the impact of hypothermia and dehydration on survival time during exposure for a wide...thus will have a minimal impact on the heat loss from the body to the environment. survival, model, hypothermia , dehydration, immersion...Decision Aid (PSDA v1.0). PSDA predicts the impact of hypothermia and dehydration on survival time during exposure for a wide range of conditions in
was conducted in April 1988 to validate the Phase I Ship Response Tactical Decision Aid. The ship, USS CONYNGHAM ( DDG -17), was equipped with the SPS...the relative direction of the seas and ship. Comparisons between measured and predicted ship motions made aboard USS CONYN- GHAM are presented in Figs...environment. 1 I I I I 18! I I ACKNOWLEDGEMENTS The kind cooperation of the USS CONYNGHAM, under the capable leadership of Commander David Rose, allowed
Arrigo, J. S.
There are several new and ongoing efforts around communicating climate and global change and variability by developing Climate Indicators (e.g. the US Global Change Research Project's Pilot Indicators Program, the US EPA's Climate Change Indicators, and the Ocean Observations Panel for Climate State of the Ocean indicators). Indicators provide information tailored to identified stakeholders and facilitate monitoring status, trends, extremes and variability of important climate features or processes. NOAA's Climate Monitoring program is in the middle of a three-year initiative toward supporting research toward the development of Ocean Climate Indicators for research, prediction, and decision makers. These indices combine ocean observations, climate data and products from platforms like (but not limited to) the drifting buoy, Argo, satellite, and buoy arrays that provide fundamental observations that contribute towards climate understanding, predictions, and projections. The program is supporting eight distinct projects that focus on primarily regional indices that target varied stakeholders and outreach strategies - from public awareness and education to targeted model performance improvement. This presentation will discuss the diverse set of projects, initial results, and discuss possibilities for and examples of using the indicators and processes for developing them for broader science outreach and education, with an eye toward the aim of organizing the ocean climate and observing community around developing a comprehensive ocean monitoring and indicators system.
Corson, Alan; And Others
Presented are key issues to be addressed by state, regional, and local governments and agencies in creating effective hazardous waste management programs. Eight chapters broadly frame the topics which state-level decision makers should consider. These chapters include: (1) definition of hazardous waste; (2) problem definition and recognition; (3)…
Wiley & Sons, Inc. 153. Arterburn, D.E., et al., Randomized trial of a video-based patient decision aid for bariatric surgery . Obesity (Silver Spring... surgery than those who did not, while those who felt strongly about preserving their sexual function were less likely to have surgery 25 [104...knowledge and treatment decision making for breast cancer surgery : a randomized trial. Jama, 2004. 139 292(4): p. 435-41. 118. Street, R.L., Jr., et al
Reynolds, J. H.; Murphy, K.
The coastal zones of Western Alaska are expected to experience a nexus of climate-driven changes in landform processes resulting from the impacts of sea ice loss; sea level change; permafrost thaw; and changes in frequency, intensity, and direction of coastal storms, etc. These climate-driven changes will cascade through the near-shore and coastal physical systems, ecological systems, and human communities, and thus present major sources of uncertainty for a wide variety of the region's decision makers. To effectively and efficiently address some of the information needs of these decision makers, the Western Alaska Landscape Conservation Cooperative created a two-year program of applied science focused on 'Changes in Coastal Storms and their Impacts'. We summarize program components that successfully advanced applied science to address these decision maker information needs. All the components share a common feature of promoting linkages: (i) among resource decision makers, stakeholders and scientists, to identify and address key areas of uncertainty associated with coastal storms and thus align the science activities with decision maker needs for a variety of climate vulnerability assessments; (ii) among researchers, to mutually advance their science efforts; and (iii) among organizations, to efficiently address shared science needs. Resulting applied science benefits include (i) integrative projects using very fine resolution surge modeling to assess impacts of saltwater inundation on migratory waterfowl breeding populations and habitat; (ii) coordinating the selection of historic storms for reanalysis by two surge modeling efforts of differing resolution and domain, thus allowing for cross-model comparisons of performance over their shared spatial domain and future regional-scale application of the higher resolution model; and (iii) collaborative, cross-agency efforts to establish a water level network that meets multiple purposes (from model calibration to
Burges Watson, Duika; Thomson, Richard G; Murtagh, Madeleine J
Background Patient decision aids are increasingly regarded as important components of clinical practice that enable shared decision making (SDM) and evidence based patient choice. Despite broad acceptance of their value, there remains little evidence of their successful implementation in primary care settings. Methods Health care practitioners from five general practice surgeries in northern England participated in focus group sessions around the themes of patient decision aids, patient and practitioner preferences and SDM. Participants included general practitioners (n = 19), practice nurses (n = 5) and auxiliary staff (n = 3). Transcripts were analysed using a framework approach. Results We report a) practitioners' discussion of the current impetus towards sharing decisions and their perspectives on barriers to SDM, and b) the implementation of patient decision aids in practice and impediments such as lack of an evidence base and time available in consultations. Conclusion We demonstrate two orientations to sharing decisions: practitioner-centred and patient-centred with the former predominating. We argue that it is necessary to rethink the changes required in practice for the implementation of SDM. PMID:18190683
Chiu, Yao-Chu; Lin, Ching-Hung; Huang, Jong-Tsun; Lin, Shuyeu; Lee, Po-Lei; Hsieh, Jen-Chuen
Background The Somatic Marker Hypothesis suggests that normal subjects are "foreseeable" and ventromedial prefrontal patients are "myopic" in making decisions, as the behavior shown in the Iowa Gambling Task. The present study questions previous findings because of the existing confounding between long-term outcome (expected value, EV) and gain-loss frequency variables in the Iowa Gambling Task (IGT). A newly and symmetrically designed gamble, namely the Soochow Gambling Task (SGT), with a high-contrast EV between bad (A, B) and good (C, D) decks, is conducted to clarify the issue about IGT confounding. Based on the prediction of EV (a basic assumption of IGT), participants should prefer to choose good decks C and D rather than bad decks A and B in SGT. In contrast, according to the prediction of gain-loss frequency, subjects should prefer the decks A and B because they possessed relatively the high-frequency gain. Methods The present experiment was performed by 48 participants (24 males and 24 females). Most subjects are college students recruited from different schools. Each subject played the computer version SGT first and completed a questionnaire for identifying their final preference. The IGT experimental procedure was mostly followed to assure a similar condition of decision uncertainty. Results The SGT experiment demonstrated that the prediction of gain-loss frequency is confirmed. Most subjects preferred to choose the bad decks A and B than good decks C and D. The learning curve and questionnaire data indicate that subjects can not "hunch" the EV throughout the game. Further analysis of the effect of previous choice demonstrated that immediate gain increases the probability to stay at the same deck. Conclusion SGT provides a balanced structure to clarify the confounding inside IGT and demonstrates that gain-loss frequency rather than EV guides decision makers in these high-ambiguity gambles. Additionally, the choice behavior is mostly following the "gain
Taylor, Kathryn L.; Williams, Randi M.; Davis, Kimberly; Luta, George; Penek, Sofiya; Barry, Samantha; Kelly, Scott; Tomko, Catherine; Schwartz, Marc; Krist, Alexander H.; Woolf, Steven H.; Fishman, Mary B.; Cole, Carmella; Miller, Edward
IMPORTANCE The conflicting recommendations for prostate cancer (PCa) screening and the mixed messages communicated to the public about screening effectiveness make it critical to assist men in making informed decisions. OBJECTIVE To assess the effectiveness of 2 decision aids in helping men make informed PCa screening decisions. DESIGN, SETTING, AND PARTICIPANTS A racially diverse group of male outpatients aged 45 to 70 years from 3 sites were interviewed by telephone at baseline, 1 month, and 13 months, from 2007 through 2011. We conducted intention-to-treat univariate analyses and multivariable linear and logistic regression analyses, adjusting for baseline outcome measures. INTERVENTION Random assignment to print-based decision aid (n = 628), web-based interactive decision aid (n = 625), or usual care (UC) (n = 626). MAIN OUTCOMES AND MEASURES Prostate cancer knowledge, decisional conflict, decisional satisfaction, and whether participants underwent PCa screening. RESULTS Of 4794 eligible men approached, 1893 were randomized. At each follow-up assessment, univariate and multivariable analyses indicated that both decision aids resulted in significantly improved PCa knowledge and reduced decisional conflict compared with UC (all P <.001). At 1 month, the standardized mean difference (Cohen’s d) in knowledge for the web group vs UC was 0.74, and in the print group vs UC, 0.73. Decisional conflict was significantly lower for web vs UC (d = 0.33) and print vs UC (d = 0.36). At 13 months, these differences were smaller but remained significant. At 1 month, high satisfaction was reported by significantly more print (60.4%) than web participants (52.2%; P = .009) and significantly more web (P = .001) and print (P = .03) than UC participants (45.5%). At 13 months, differences in the proportion reporting high satisfaction among print (55.7%) compared with UC (49.8%; P = .06) and web participants (50.4%; P = .10) were not significant. Screening rates at 13 months did not
Hegedus, A. M.; Darmenova, K.; Grant, F.; Kiley, H.; Higgins, G. J.; Apling, D.
According to the World Heath Organization (WHO) climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations. Worldwide, the occurrence of some diseases and other threats to human health depend predominantly on local climate patterns. Rising average temperatures, in combination with changing rainfall patterns and humidity levels, alter the lifecycle and regional distribution of certain disease-carrying vectors, such as mosquitoes, ticks and rodents. In addition, higher surface temperatures will bring heat waves and heat stress to urban regions worldwide and will likely increase heat-related health risks. A growing body of scientific evidence also suggests an increase in extreme weather events such as floods, droughts and hurricanes that can be destructive to human health and well-being. Therefore, climate adaptation and health decision aids are urgently needed by city planners and health officials to determine high risk areas, evaluate vulnerable populations and develop public health infrastructure and surveillance systems. To address current deficiencies in local planning and decision making with respect to regional climate change and its effect on human health, our research is focused on performing a dynamical downscaling with the Weather Research and Forecasting (WRF) model to develop decision aids that translate the regional climate data into actionable information for users. WRF model is initialized with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model simulations forced with the Special Report on Emissions (SRES) A1B emissions scenario. Our methodology involves development of climatological indices of extreme weather, quantifying the risk of occurrence of water/rodent/vector-borne diseases as well as developing various heat stress related decision aids. Our results indicate that the downscale simulations provide the necessary
Necefer, Len Edward
through the developed decision aid on beliefs and preferences related to the type and scale of energy development, trust of decision makers, and larger concern for environmental protection. Finally, chapter 5 presents concluding thoughts future research and on how technical-social decision tools can provide a means ensuring effective decision making on the Navajo Nation and other American Indian communities.
Hannaford, Jamie; Barker, Lucy; Svensson, Cecilia; Tanguy, Maliko; Laize, Cedric; Bachmair, Sophie; Tijdeman, Erik; Stahl, Kerstin; Collins, Kevin
of M&EW and future aspirations. Different stakeholders clearly have different goals for M&EW, but there are a number of common themes, including a desire to better understand the links between the outputs of large-scale M&EW systems (rainfall, river flow, etc), localised triggers used by decision-makers during drought episodes, and actual impacts of drought. Secondly, we present analyses designed to test the utility of a wide range of drought indicators for their use in UK applications. We demonstrate the suitability of standardised indicators (like the SPI) for use in the UK, addressing the suitability of statistical distributions and using these indicators for drought severity quantification and for understanding propagation from meteorological to hydrological drought; all of which are currently poorly understood aspects that are vital for future monitoring. We then address the extent to which these indicators can be used to predict drought impacts, focusing on several sectors (water supply, agriculture and ecosystems). These analyses test which indicators perform best at predicting drought impacts, and seek to identify indicator thresholds that trigger impact occurrence. Unsurprisingly, we found that no single indicator best predicts impacts, and results are domain, sector and season specific. However, we reveal important linkages between indicators and impacts that could enhance the design and delivery of monitoring and forecasting information and its uptake by decision-makers concerned with drought.
Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic
1959. b Schlaifer, R. Anais 2f decisions under uncertainitv. New York: McGraw-Hill, 1969. Schopenhauer , A. The art of controversy. In J. B. Saunders...Ed.), 7_11a s qf L u Schopenhauer , New York: Wiley Book Co., no date. Schrenk, L. P. Objective difficulty and input history in sequential decision
Harris, Regina; Shaffer, Steven; Stokes, James; Goldstein, David
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.
Domenach, Florent; Tayari, Ali
There have been various attempts, solutions, and approaches towards constructing an appropriate consensus tree based on a given set of phylogenetic trees. However, for practitioners, it is not always clear, for a given data set, which of these would create the most relevant consensus tree. In this paper, we introduce an open-source software called DASACT (Decision Aiding Software for Axiomatic Consensus Theory) created to assist practitioners on choosing the most appropriate consensus function. It is based on an exhaustive evaluation of axiomatic properties and consensus functions, which define the knowledge space as a concept lattice. Using a selection of axiomatic properties provided by the user, it is able to aid the user in choosing the most suitable function. DASACT is freely available at http://www.cs.unic.ac.cy/florent/software.htm.
Introduction Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. Methods We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes. Results Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. Conclusions The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision
Maher, T.M.; Boykin, W.; Heysse, D.R.
In several deep, overpressured wells in Oklahoma and Louisiana, Apache Corp. has used photoelectric measurements provided by wireline density tools to aid in completion decisions. The information helped identify permeable zones in several tight formations; these zones were subsequently perforated, hydraulically fractured and successfully produced. Because formation conditions and small borehole sizes precluded running traditional micrologs as permeability indicators, the photoelectric information proved to be particularly valuable on these wells. The operating principles of the tool, supplied by Halliburton Energy Services, are presented here. And example applications in Caddo County, Oklahoma, and Jackson Parish, Louisiana, deep wells are presented.
Lowe, Dawn; Quillin, Bob; Matteson, Nadine; Wilkinson, Bill; Miksell, Steve
The Fault Tolerance Expert System for Tracking and Data Relay Satellite System (TDRSS) Applications (FIESTA) is a fault detection and fault diagnosis expert system being developed as a decision aid to support operations in the Network Control Center (NCC) for NASA's Space Network. The operational objectives which influenced FIESTA development are presented and an overview of the architecture used to achieve these goals are provided. The approach to the knowledge engineering effort and the methodology employed are also presented and illustrated with examples drawn from the FIESTA domain.
Madni, A.; Freedy, A.
A tactical decision aid (TDA) for the F-14 aircrew, i.e., the naval flight officer and pilot, in conducting a multitarget attack during the performance of a Combat Air Patrol (CAP) role is presented. The TDA employs hierarchical multiattribute utility models for characterizing mission objectives in operationally measurable terms, rule based AI-models for tactical posture selection, and fast time simulation for maneuver consequence prediction. The TDA makes aspect maneuver recommendations, selects and displays the optimum mission posture, evaluates attackable and potentially attackable subsets, and recommends the 'best' attackable subset along with the required course perturbation.
Friend, John; Chun, Maria BJ
Background: As the health care field moves toward patient-centered care (PCC), increasing emphasis has been placed on the benefits of patient decision aids for promoting shared decision making (SDM). This study provides a baseline measure of knowledge, attitudes, and practices (KAP) among Hawai‘i's physicians with respect to patient decision aids (DAs). Physicians throughout the State of Hawai‘i were invited to complete a survey assessing their knowledge, attitudes, and practices with respect to the clinical use of DAs. One hundred and seventy four valid surveys were analyzed. Reported awareness and use of DAs were low, but recognition of the benefits of SDM and openness to the use of DAs were very high. The leading perceived barriers to the implementation of DAs were lack of awareness, lack of resources, and limited physician time to learn about DA technology. However, a significant majority of the respondents reported that DAs could empower patients by improving knowledge (88%), increasing satisfaction with the consultation process (81%), and increasing compliance (74%). Among physicians currently employing DAs, use of brochures or options matrix sheets was the most common aid tool. However, leading recommended DA formats were paper-based brochures for clinic use (75%) and interactive online website programs for outside clinic use (73.5%). Given growing emphasis on the PCC model and the recognized desire of many patients to participate in the medical decision making process, positive responses toward SDM and the use of DAs by Hawai‘i physicians are promising. PMID:24251086
Nicholas Zdenkowski; Butow, Phyllis; Tesson, Stephanie; Boyle, Frances
Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid. A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format. Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/- reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy. Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.
Violette, Philippe D; Agoritsas, Thomas; Alexander, Paul; Riikonen, Jarno; Santti, Henrikki; Agarwal, Arnav; Bhatnagar, Neera; Dahm, Philipp; Montori, Victor; Guyatt, Gordon H; Tikkinen, Kari A O
Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.
A comprehensive evaluation of the market for solar heating and cooling products for new and retrofit markets is reported. The emphasis is on the analysis of solar knowledge among HVAC decision makers and a comprehensive evaluation of their solar attitudes and behavior. The data from each of the following sectors are described and analyzed: residential consumers, organizational and manufacturing buildings, HVAC engineers and architects, builders/developers, and commercial/institutional segments. (MHR)
Iverson, Ellen; Celious, Aaron; Shehane, Erica; Oerke, Mandy; Warren, Victoria; Eastman, Alexander; Kennedy, Carie R; Freeman, Bradley D
Critical illness clinical trials that entail genomic data collection pose unique challenges. In this qualitative study, we found that surrogate decision makers (SDMs) for critically ill individuals, such as those who would be approached for study participation, appeared to have a limited grasp of genomic principles. We argue that low levels of genomic literacy should neither preclude nor be in conflict with the conduct of ethically rigorous clinical trials.
Anagnostakis, Ioannis; Idris, Husni R.; Clark, John-Paul; Feron, Eric; Hansman, R. John; Odoni, Amedeo R.; Hall, William D.
Terminal area Air Traffic Management handles both arriving and departing traffic. To date, research work on terminal area operations has focused primarily on the arrival flow and typically departures are taken into account only in an approximate manner. However, arrivals and departures are highly coupled processes especially in the terminal airspace, with complex interactions and sharing of the same airport resources between arrivals and departures taking place in practically every important terminal area. Therefore, the addition of automation aids for departures, possibly in co-operation with existing arrival flow automation systems, could have a profound contribution in enhancing the overall efficiency of airport operations. This paper presents the conceptual system architecture for such an automation aid, the Departure Planner (DP). This architecture can be used as a core in the development of decision-aiding systems to assist air traffic controllers in improving the performance of departure operations and optimize runway time allocation among different operations at major congested airports. The design of such systems is expected to increase the overall efficiency of terminal area operations and yield benefits for all stakeholders involved in Air Traffic Management (ATM) operations, users as well as service providers.
Terwel, Bart W.; Harinck, Fieke; Ellemers, Naomi; Daamen, Dancker D. L.
The implementation of carbon dioxide capture and storage technology (CCS) is considered an important climate change mitigation strategy, but the viability of this technology will depend on public acceptance of CCS policy decisions. The results of three experiments with students as participants show that whether or not interest groups receive an…
Topuz, E; Talinli, I; Aydin, E
Environmental management, for which environmental and human health risk assessment is the first stage, is a requirement for industries both before construction and during operation in order to sustain improved quality of life in the ecosystem. Therefore, the aim of this study is to propose an approach that integrates environmental and human health risk assessment for industries using hazardous materials in order to support environmental decision makers with quantitative and directive results. Analytic hierarchy process and fuzzy logic are used as tools to handle problems caused by complexity of environment and uncertain data. When the proposed approach is implemented to a scenario, it was concluded that it is possible to define risk sources with their risk classes and related membership degrees in that classes which enable the decision maker to decide which risk source has priority. In addition, they can easily point out and rank the factors contributing those risk sources owing to priority weights of them. As a result, environmental decision makers can use this approach while they are developing management alternatives for unfounded and on-going industrial plants using hazardous materials.
Pfender, W F; Gent, D H; Mahaffee, W F; Coop, L B; Fox, A D
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.
Carriço, N; Covas, D I C; Almeida, M Céu; Leitão, J P; Alegre, H
The aim of this paper is to compare sorting and ranking methods for prioritization of rehabilitation interventions of sewers, taking into account risk, performance and cost. For that purpose multiple criteria decision-aid (MCDA) methods such as ELECTRE TRI for sorting and ELECTRE III for ranking are applied in a real case-study and the results obtained are compared. The case study is a small sanitary sewer system from a Portuguese utility located in the metropolitan area of Lisbon. The problem to investigate is the prioritization of the sewer candidates for rehabilitation. The decision maker (a panel group of specialists) has chosen five assessment measures: water level and maximum flow velocity (hydraulic performance indices), sewer importance and failure repair cost (collapse-related consequences of failure) and the risk of collapse. The results show that the outcomes from ELECTRE III are easier to understand than those from ELECTRE TRI method. Two different sets of weights were used, and the sorting and ranking results from both methods were found to be sensitive to them. ELECTRE TRI method is not straightforward as it involves technical parameters that are difficult to define, such as reference profiles and cut levels.
Background The original version of the International Patient Decision Aid Standards (IPDAS) recommended that patient decision aids (PtDAs) should be carefully developed, user-tested and open to scrutiny, with a well-documented and systematically applied development process. We carried out a review to check the relevance and scope of this quality dimension and, if necessary, to update it. Methods Our review drew on three sources: a) published papers describing PtDAs evaluated in randomised controlled trials and included in the most recent Cochrane Collaboration review; b) linked papers cited in the trial reports that described how the PtDAs had been developed; and c) papers and web reports outlining the development process used by organisations experienced in developing multiple PtDAs. We then developed an extended model of the development process indicating the various steps on which documentation is required, as well as a checklist to assess the frequency with which each of the elements was publicly reported. Results Key features common to all patient decision aid (PtDA) development processes include: scoping and design; development of a prototype; ‘alpha’ testing with patients and clinicians in an iterative process; ‘beta’ testing in ‘real life’ conditions (field tests); and production of a final version for use and/or further evaluation. Only about half of the published reports on the development of PtDAs that we reviewed appear to have been field tested with patients, and even fewer had been reviewed or tested by clinicians not involved in the development process. Very few described a distribution strategy, and surprisingly few (17%) described a method for reviewing and synthesizing the clinical evidence. We describe a model development process that includes all the original elements of the original IPDAS criterion, expanded to include consideration of format and distribution plans as well as prototype development. Conclusions The case for including
Svensson, Per G.; Hancock, Meg G.; Hums, Mary A.
Sport for Development and Peace (SDP) policy-makers and practitioners continue to offer ambitious claims regarding the potential role of sport-based programs for promoting social change. Yet, it is important to put sport under a critical lens in order to develop a more balanced and realistic understanding of the role of sport in society. Whether…
ARL-TN-0688 ● AUG 2015 US Army Research Laboratory Adapting My Weather Impacts Decision Aid (MyWIDA) to Additional Web...Laboratory Adapting My Weather Impacts Decision Aid (MyWIDA) to Additional Web Application Server Technologies by Jacob C Randall and Jeffrey O...COVERED (From - To) May–Aug 2015 4. TITLE AND SUBTITLE Adapting My Weather Impacts Decision Aid (MyWIDA) to Additional Web Application Server
Glass, Nancy; Eden, Karen B.; Bloom, Tina; Perrin, Nancy
A computerized safety decision aid was developed and tested with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups (n = 90). The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user. Women reported that the decision aid was useful and provided much-needed privacy for making safety decisions. The majority (69%) reported severe to extreme danger in their relationship as scored by Danger Assessment (DA); only 60% reported having made a safety plan. After using the safety decision aid, the women felt more supported in their decision (p = .012) and had less total decisional conflict (p = .014). The study demonstrated that a computerized safety decision aid improved the safety planning process, as demonstrated by reduced decisional conflict after only one use in a sample of abused women. PMID:20040709
Integrated sustainability assessment is part of a new paradigm for urban water decision making. Multi-criteria decision aid (MCDA) is an integrative framework used in urban water sustainability assessment, which has a particular focus on utilising stakeholder participation. Here ...
MORADI, Ghobad; MOHRAZ, Minoo; GOUYA, Mohammad Mehdi; DEJMAN, Masoumeh; SEYEDALINAGHI, SeyedAhmad; KHOSHRAVESH, Sahar; MALEKAFZALI ARDAKANI, Hossein
Abstract Background HIV/AIDS has been concentrated among injecting drug users in the country. This study aimed to investigate and identify health and treatment needs of people living with HIV/AIDS in Iran. Methods This qualitative study was conducted in 2012 in Iran. The study groups consisted of experts, practitioners, and consultants working with People Living with HIV/AIDS and their families. Data was collected through Focus Group Discussions and deep interviews. Data were analyzed using content analysis method. Results The findings of this study included the needs of people living with HIV/AIDS, which were classified in three main categories. The first category was prevention and counseling services with several sub-groups such as education and public and available consultation, distribution of condoms to vulnerable groups, increasing counseling centers in urban areas, providing appropriate psychological and supportive counseling, and family planning services. The second category included diagnostic and treatment services and had several sub-groups such as full retroviral treatment, Tuberculosis treatment and continuing care, providing care and treatment for patients with hepatitis, and providing dental services. The third category included rehabilitation services and had some sub-categories such as home care, social and psychological support, nutritional support, and empowering positive clubs. Conclusions This study puts emphasis on making plans based on the priorities to meet the needs of people living with HIV/AIDS in Iran. PMID:26060705
Nave, Rosella; Isaia, Roberto; Sandri, Laura; Cristiani, Chiara
In the communication chain between scientists and decision makers (end users), scientific outputs, as maps, are a fundamental source of information on hazards zoning and the related at risk areas definition. Anyway the relationship between volcanic phenomena, their probability and potential impact can be complex and the geospatial information not easily decoded or understood by not experts even if decision makers. Focusing on volcanic hazard the goal of MED SUV WP6 Task 3 is to improve the communication efficacy of scientific outputs, to contribute in filling the gap between scientists and decision-makers. Campi Flegrei caldera, in Neapolitan area has been chosen as the pilot research area where to apply an evaluation/validation procedure to provide a robust evaluation of the volcanic maps and its validation resulting from end users response. The selected sample involved are decision makers and officials from Campanian Region Civil Protection and municipalities included in Campi Flegrei RED ZONE, the area exposed to risk from to pyroclastic currents hazard. Semi-structured interviews, with a sample of decision makers and civil protection officials have been conducted to acquire both quantitative and qualitative data. The tested maps have been: the official Campi Flegrei Caldera RED ZONE map, three maps produced by overlapping the Red Zone limit on Orthophoto, DTM and Contour map, as well as other maps included a probabilistic one, showing volcanological data used to border the Red Zone. The outcomes' analysis have assessed level of respondents' understanding of content as displayed, and their needs in representing the complex information embedded in volcanic hazard. The final output has been the development of a leaflet as "guidelines" that can support decision makers and officials in understanding volcanic hazard and risk maps, and also in using them as a communication tool in information program for the population at risk. The same evaluation /validation process
Suter, Esther; Armitage, Gail D
Purpose The study is an examination of how a knowledge synthesis, conducted to fill an information gap identified by decision makers and planners responsible for integrating health systems in a western Canadian health authority, is being used within that organization. Methods Purposive sampling and snowball technique were used to identify 13 participants who were interviewed about how they are using the knowledge synthesis for health services planning and decision-making. Results The knowledge synthesis is used by those involved in the strategic direction of the provincial healthcare organization and those tasked with the operationalization of integration at the provincial or local level. Both groups most frequently use the 10 key principles for integration, followed by the sections on integration processes, strategies and models. The key principles facilitate discussion on priority areas to be considered and provide a reference point for a desired future state. Perceived information gaps relate to a lack of detail on ‘how to’ strategies, tools and processes that would lead to successful integration. Discussion and conclusion The current project demonstrates that decision makers and planners will effectively use a knowledge synthesis if it is timely, relevant and accessible. The information can be applied at strategic and operations levels. Attention needs to be paid to include more information on implementation strategies and processes. Including knowledge users in identifying research questions will increase information uptake. PMID:21637708
Glass, Nancy; Eden, Karen B.; Bloom, Tina; Perrin, Nancy
A computerized safety decision aid was developed and tested with Spanish or English-speaking abused women in shelters or domestic violence (DV) support groups (n = 90). The decision aid provides feedback about risk for lethal violence, options for safety, assistance with setting priorities for safety, and a safety plan personalized to the user.…
George, Tracy P.; DeCristofaro, Claire; Dumas, Bonnie P.; Murphy, Pamela F.
Unintended pregnancies are an important public health issue. Long-acting reversible contraceptive methods (LARCs) are reliable, safe, highly effective methods for most women; however they are underutilized in the United States. Shared decision aids were added to usual care in five public health family planning clinics in the Southeastern United States, staffed by advance practice nurses and registered nurses. All five sites showed an increase in the use of LARCs during the time period that shared decision aids were used (results statistically significant to p < 0.001). It is important for women to make informed choices about contraception, and shared decision aids can be utilized to support this decision making. This resource has been adopted for statewide use in all public health clinics, and implications for practice suggest that the use of shared decision aids is an effective method to support informed patient decision making and acceptance of LARC methods of contraception. PMID:27417757
The role of decision-makers is to take the outputs from hydrological and hydraulic analyses and, in some extent, use them as inputs to make decisions that are related to planning, design and operation of water systems. However, the use of these technical analyses is frequently limited, since there are other non-hydrological issues that must be considered, that may end up in very different solutions than those envisaged by the purely technical ones. A possibility to account for the nature of the human decisions under uncertainty is by exploring the use of concepts from decision theory and behavioural economics, such as Value of Information and Prospect Theory and embed them into the methodologies we use in the hydrology practice. Three examples are presented to illustrate these multidisciplinary interactions. The first one, for monitoring network design, uses Value of Information within a methodology to locate water level stations in a complex canal of networks in the Netherlands. The second example, for operation, shows how the Value of Information concept can be used to formulate alternative methods to evaluate flood risk according to the set of options available for decision-making during a flood event. The third example, for planning, uses Prospect Theory concepts to understand how the "losses hurt more than gains feel good" effect can determine the final decision of urbanise or not a flood-prone area. It is demonstrated that decision theory and behavioural economic principles are promising to evaluate the complex decision-making process in water-related issues.
Rudolph, Frederick M.; Homoki, David A.; Sexton, George A.
It was determined that artificial intelligence technology can provide pilots with the help they need in making the complex decisions concerning en route changes in a flight plan. A diverter system should have the capability to take all of the available information and produce a recommendation to the pilot. Phase three illustrated that using Joshua to develop rules for an expert system and a Statice database provided additional flexibility by permitting the development of dynamic weighting of diversion relevant parameters. This increases the fidelity of the AI functions cited as useful in aiding the pilot to perform situational assessment, navigation rerouting, flight planning/replanning, and maneuver execution. Additionally, a prototype pilot-vehicle interface (PVI) was designed providing for the integration of both text and graphical based information. Advanced technologies were applied to PVI design, resulting in a hierarchical menu based architecture to increase the efficiency of information transfer while reducing expected workload. Additional efficiency was gained by integrating spatial and text displays into an integrated user interface.
Background Patient preference is one of the main components of clinical decision making, therefore leading to the development of patient decision aids. The goal of this study was to describe physicians’ and patients’ viewpoints on the barriers and limitations of using patient decision aids in Iran, their proposed solutions, and, the benefits of using these tools. Methods This qualitative study was conducted in 2011 in Iran by holding in-depth interviews with 14 physicians and 8 arthritis patient. Interviewees were selected through purposeful and maximum variation sampling. As an example, a patient decision aid on the treatment of knee arthritis was developed upon literature reviews and gathering expert opinion, and was presented at the time of interview. Thematic analysis was conducted to analyze the data by using the OpenCode software. Results The results were summarized into three categories and ten codes. The extracted categories were the perceived benefits of using the tools, as well as the patient-related and physician-related barriers in using decision aids. The following barriers in using patient decision aids were identified in this study: lack of patients and physicians’ trainings in shared decision making, lack of specialist per capita, low treatment tariffs and lack of an exact evaluation system for patient participation in decision making. Conclusions No doubt these barriers demand the health authorities’ special attention. Hence, despite patients and physicians’ inclination toward using patient decision aids, these problems have hindered the practical usage of these tools in Iran - as a developing country. PMID:24066792
Background An increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures. Methods A mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid. Results Twelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use. Conclusions This decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool. PMID:24642051
Horwitz, Joshua; Grilley, Anna; Kennedy, Orla
In a policy arena characterized by polarized debate, such as the consideration of legal interventions to prevent gun violence, research evidence is an important tool to inform decision-making processes. However, unless the evidence is communicated to stakeholders who can influence policy decisions, the research will often remain an academic exercise with little practical impact. The Educational Fund to Stop Violence's process of "unfreezing" individual perceptions and conventional interpretations of the relationship between mental illness and gun violence, forming a consensus, and translating this knowledge to stakeholders through state discussion forums is one way to inform policy change. The recent passage of gun violence prevention legislation in California provides an example of successfully closing the knowledge translation gap between research and decision-making processes.
In summary, how do we assess these decision-makers, with their wide variations in composition, emerging today from medical technology and advances unknown and unforeseen by earlier practitioners? At the threshold, we should not dismiss lightly the traditional role of the doctor as the autocrat. There is much to be said in his or her favor: 1. The basic decision, after all, is a medical one--diagnosis and prognosis--with the concurrence perhaps of a consultant or a specialist. That decision was and is a major premise. Miss it and one misses the mark. 2. What is so novel, what is so startling about a fateful life-death issue in the medical profession? It is quotidian. In the Armageddon between human life and human demise, doctors have been making those solemn decisions in other areas of medicine from time immemorial. Often--not always--the patient is silently saying to the doctor, "My life is in your hands." 3. And within what context does he act? Usually--not always--he knows the patient. He knows the family. He knows the surrounding circumstances. But there still lurks that gnawing, underlying flaw. The decision-making is not diffused. The doctor stands alone. Small "groups" or "committees," retaining medical guidance, share responsibilities, make more palatable to themselves those agonizing decisions, and contribute to their acceptability by society. Here, then, is the harvest to be reaped by diffusion. What is so striking is that the decision-making process anent life-support systems still calls for a superior breed of men and women.(ABSTRACT TRUNCATED AT 250 WORDS)
Saposnik, Gustavo; Goyal, Mayank; Majoie, Charles; Dippel, Diederik; Roos, Yvo; Demchuk, Andrew; Menon, Bijoy; Mitchell, Peter; Campbell, Bruce; Dávalos, Antoni; Jovin, Tudor; Hill, Michael D
Background Acute stroke care represents a challenge for decision makers. Recent randomized trials showed the benefits of endovascular therapy. Our goal was to provide a visual aid tool to guide clinicians in the decision process of endovascular intervention in patients with acute ischemic stroke. Methods We created visual plots (Cates' plots; www.nntonline.net ) representing benefits of standard of care vs. endovascular thrombectomy from the pooled analysis of five RCTs using stent retrievers. These plots represent the following clinically relevant outcomes (1) functionally independent state (modified Rankin scale (mRS) 0 to 2 at 90 days) (2) excellent recovery (mRS 0-1) at 90 days, (3) NIHSS 0-2 (4) early neurological recovery, and (5) revascularization at 24 h. Subgroups visually represented include time to treatment and baseline stroke severity strata. Results Overall, 1287 patients (634 assigned to endovascular thrombectomy, 653 assigned to control were included to create the visual plots. Cates' visual plots revealed that for every 100 patients with acute ischemic stroke and large vessel occlusion, 27 would achieve independence at 90 days (mRS 0-2) in the control group compared to 49 (95% CI 43-56) in the intervention group. Similarly, 21 patients would achieve early neurological recovery at 24 h compared to 54 (95% CI 45-63) out of 100 for the intervention group. Conclusion Cates' plots may assist clinicians and patients to visualize and compare potential outcomes after an acute ischemic stroke. Our results suggest that for every 100 treated individuals with an acute ischemic stroke and a large vessel occlusion, endovascular thrombectomy would provide 22 additional patients reaching independency at three months and 33 more patients achieving ENR compared to controls.
Boudrias, M. A.; Estrada, M.; Gershunov, A.; Silva-Send, N. J.; Young, E.
Decision makers and community leaders are key audiences to engage in our efforts to improve climate literacy. Climate Education Partners has been working with business leaders, elected officials, tribal leaders, and other Key Influentials in the San Diego Region to enhance the channels of communication outside traditional settings. Over the past year we have interviewed over 90 Key Influential San Diego leaders asking them about their knowledge of climate change and their personal and professional efforts to adapt to and/or mitigate the impacts of climate change. We also engaged them directly in the creation of an innovative educational resource called "San Diego, 2050 is Calling. How will we answer?" Results of the interviews indicate that 90% of these leaders are concerned about climate change, more than 50% are already doing something about the impacts, and the majority of them want more information, greater dialogue and examples of actions taken by other community leaders. We found that repeated engagement of leaders at the San Diego County Water Authority went from basic collaboration in our water tours, to greater participation of their top leaders in a water tour for top decision makers from the City of San Diego, finally culminating with full support of and participation in the 2050 report. The 2050 report represents an integrated approach blending local climate change science, social science education theory and presentation of a suite of solution-driven opportunities for local leaders. The report includes science infographics that illustrate rigorous scientific facts, statements from expert scientists and direct quotes from decision makers, and examples of successful climate change adaptation actions from companies, government groups and others. The video and photography sessions for the 2050 report led to many unexpected discussion among leaders with differing opinions on climate change, greater enthusiasm to participate in outreach activities with other
Bender, Filmore E., Ed.; Cunnings, Lucy M., Ed.
The nine in this publication are based on the assumption that communities must develop a framework for analyzing economic growth if they are to make responsible decisions relative to rate and form of economic growth. Divided into two parts, this document presents: (1) papers relative to general perspectives on economic growth and development, and…
Background Health care planning for pandemic influenza is a challenging task which requires predictive models by which the impact of different response strategies can be evaluated. However, current preparedness plans and simulations exercises, as well as freely available simulation models previously made for policy makers, do not explicitly address the availability of health care resources or determine the impact of shortages on public health. Nevertheless, the feasibility of health systems to implement response measures or interventions described in plans and trained in exercises depends on the available resource capacity. As part of the AsiaFluCap project, we developed a comprehensive and flexible resource modelling tool to support public health officials in understanding and preparing for surges in resource demand during future pandemics. Results The AsiaFluCap Simulator is a combination of a resource model containing 28 health care resources and an epidemiological model. The tool was built in MS Excel© and contains a user-friendly interface which allows users to select mild or severe pandemic scenarios, change resource parameters and run simulations for one or multiple regions. Besides epidemiological estimations, the simulator provides indications on resource gaps or surpluses, and the impact of shortages on public health for each selected region. It allows for a comparative analysis of the effects of resource availability and consequences of different strategies of resource use, which can provide guidance on resource prioritising and/or mobilisation. Simulation results are displayed in various tables and graphs, and can also be easily exported to GIS software to create maps for geographical analysis of the distribution of resources. Conclusions The AsiaFluCap Simulator is freely available software (http://www.cdprg.org) which can be used by policy makers, policy advisors, donors and other stakeholders involved in preparedness for providing evidence based and
Rapport, Frances; Iredale, Rachel; Jones, Wendy; Sivell, Stephanie; Edwards, Adrian; Gray, Jonathon; Elwyn, Glyn
Abstract Background There is increasing need for accessible information about familial breast cancer for those facing complex decisions around genetic testing, screening and treatment. Information currently includes leaflets and computerized decision aids, offering interactive interfaces to clarify complex choices. Objective Exploration of users’ views and reactions to three decision aids for genetic testing for breast cancer using focus groups. Setting A regional cancer genetics service in the UK. Participants Women over 18 years of age who had been referred to Cancer Genetics Service for Wales (CGSW) and had received a risk assessment for familial breast cancer. Methods Qualitative study involving one pilot and six extended focus groups with 39 women at high, moderate and population risk. Two CD‐ROMs and one paper‐based aid evaluated for: clarity of presentation, ease of handling, emotive response, increased knowledge and greater informed choice. Results Women reported variable preferences for different types of decision aids and mixed emotions, indicating the sensitivity of raising issues in decision support tools, lack of consensus over the most appropriate aid and no systematic differences between risk groups. Women remarked that aids increased their knowledge, particularly about breast cancer genes and risk and wanted a decision aid designed within the context of the NHS, in both paper‐based and CD‐ROM formats from an authoritative source. Mixed views about presentation styles suggest decision aids would be most effective with a user‐selected range of formats. Conclusions Decision aid development should be informed by users and should meet the needs of those concerned about their risk of breast cancer in the UK. Without such aids, patients will continue to search for information from a variety of sources of varying quality. PMID:16911137
Strini, Robert A.; Strini, Keith
Military air operations in the European theater require U.S. and NATO participants to send various mission experts to 10 Combined Air Operations Centers (CAOCs). Little or no training occurs prior to their arrival for tours of duty ranging between 90 days to 3 years. When training does occur, there is little assessment of its effectiveness in raising CAOC mission readiness. A comprehensive training management system has been developed that utilizes traditional and web based distance-learning methods for providing instruction and task practice as well as distributed simulation to provide mission rehearsal training opportunities on demand for the C2 warrior. This system incorporates new technologies, such as voice interaction and virtual tutors, and a Learning Management System (LMS) that tracks trainee progress from academic learning through procedural practice and mission training exercises. Supervisors can monitor their subordinate's progress through synchronous or asynchronous methods. Embedded within this system are virtual tutors, which provide automated performance measurement as well as tutoring. The training system offers a true time management savings for current instructors and training providers that today must perform On the Job Training (OJT) duties before, during and after each event. Many units do not have the resources to support OJT and are forced to maintain an overlap of several days to minimally maintain unit readiness. One CAOC Commander affected by this paradigm has advocated supporting a beta version of this system to test its ability to offer training on-demand and track the progress of its personnel and unit readiness. If successful, aircrew simulation devices can be connected through either Distributed Interactive Simulation or High Level Architecture methods to provide a DMT-C2 air operations training environment in Europe. This paper presents an approach to establishing a training, testing and decision aid capability and means to assess
Brehaut, Jamie C; Lott, Alison; Fergusson, Dean A; Shojania, Kaveh G; Kimmelman, Jonathan; Saginur, Raphael
Background Evidence shows that the standard process for obtaining informed consent in clinical trials can be inadequate, with study participants frequently not understanding even basic information fundamental to giving informed consent. Patient decision aids are effective decision support tools originally designed to help patients make difficult treatment or screening decisions. We propose that incorporating decision aids into the informed consent process will improve the extent to which participants make decisions that are informed and consistent with their preferences. A mixed methods study will test this proposal. Methods Phase one of this project will involve assessment of a stratified random sample of 50 consent documents from recently completed investigator-initiated clinical trials, according to existing standards for supporting good decision making. Phase two will involve interviews of a purposive sample of 50 trial participants (10 participants from each of five different clinical areas) about their experience of the informed consent process, and how it could be improved. In phase three, we will convert consent forms for two completed clinical trials into decision aids and pilot test these new tools using a user-centered design approach, an iterative development process commonly employed in computer usability literature. In phase four, we will conduct a pilot observational study comparing the new tools to standard consent forms, with potential recruits to two hypothetical clinical trials. Outcomes will include knowledge of key aspects of the decision, knowledge of the probabilities of different outcomes, decisional conflict, the hypothetical participation decision, and qualitative impressions of the experience. Discussion This work will provide initial evidence about whether a patient decision aid can improve the informed consent process. The larger goal of this work is to examine whether study recruitment can be improved from (barely) informed consent
Volk, Robert J; Llewellyn-Thomas, Hilary; Stacey, Dawn; Elwyn, Glyn
In 2003, the International Patient Decision Aid Standards (IPDAS) Collaboration was established to enhance the quality and effectiveness of patient decision aids by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation. Over this 10 year period, the Collaboration has established: a) the background document on 12 core dimensions to inform the original modified Delphi process to establish the IPDAS checklist (74 items); b) the valid and reliable IPDAS instrument (47 items); and c) the IPDAS qualifying (6 items), certifying (6 items + 4 items for screening), and quality criteria (28 items). The objective of this paper is to describe the evolution of the IPDAS Collaboration and discuss the standardized process used to update the background documents on the theoretical rationales, evidence and emerging issues underlying the 12 core dimensions for assessing the quality of patient decision aids.
Childs, L. M.; Rogers, L.; Favors, J.; Ruiz, M.
Through the years, NASA has played a distinct/important/vital role in advancing Earth System Science to meet the challenges of environmental management and policy decision making. Within NASA's Earth Science Division's Applied Sciences' Program, the DEVELOP National Program seeks to extend NASA Earth Science for societal benefit. DEVELOP is a capacity building program providing young professionals and students the opportunity to utilize NASA Earth observations and model output to demonstrate practical applications of those resources to society. Under the guidance of science advisors, DEVELOP teams work in alignment with local, regional, national and international partner organizations to identify the widest array of practical uses for NASA data to enhance related management decisions. The program's structure facilitates a two-fold approach to capacity building by fostering an environment of scientific and professional development opportunities for young professionals and students, while also providing end-user organizations enhanced management and decision making tools for issues impacting their communities. With the competitive nature and growing societal role of science and technology in today's global workplace, DEVELOP is building capacity in the next generation of scientists and leaders by fostering a learning and growing environment where young professionals possess an increased understanding of teamwork, personal development, and scientific/professional development and NASA's Earth Observation System. DEVELOP young professionals are partnered with end user organizations to conduct 10 week feasibility studies that demonstrate the use of NASA Earth science data for enhanced decision making. As a result of the partnership, end user organizations are introduced to NASA Earth Science technologies and capabilities, new methods to augment current practices, hands-on training with practical applications of remote sensing and NASA Earth science, improved remote
Hankins, Catherine; Macklin, Ruth; Warren, Mitchell
Introduction The extraordinary feat of proving the effectiveness of oral pre-exposure prophylaxis (PrEP) in clinical trials in different populations in a variety of settings may prove to have been easier than ensuring it is used well. Decision-makers must make difficult choices to realize the promise of antiretroviral prophylaxis for their countries. This paper outlines key economic, regulatory and distributive justice issues that must be addressed for effective and acceptable PrEP implementation. Discussion In considering the role that PrEP can play in combination prevention programmes, decision-makers must determine who can benefit most from PrEP, how PrEP can be provided safely and efficiently, and what kind of health system support will ensure successful implementation. To do this, they need contextualized information on disease burden by population, analyses of how PrEP services might best be delivered, and projections of the human resource and infrastructure requirements for each potential delivery model. There are cost considerations, varying cost-effectiveness results and regulatory challenges. The principles of ethics can inform thorny discussions about who should be prioritized for oral PrEP and how best to introduce it fairly. We describe the cost-effectiveness of PrEP in different populations at higher risk of HIV exposure, its price in low- and middle-income countries, and the current regulatory situation. We explore the principles of ethics that can inform resource allocation decision-making about PrEP anchored in distributive justice, at a time when universal access to antiretroviral treatment remains to be assured. We then highlight the role of advocacy in moving the PrEP agenda forward. Conclusions The time is ripe now for decisions about whether, how and for whom PrEP should be introduced into a country's HIV response. It has the potential to contribute significantly to high impact HIV prevention if it is tailored to those who can most benefit
Background Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. Method An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. Results The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. Conclusion A substantial and
and Canadian indices differ. The U.S. uses the Heat Index (HI) based on Steadman’s model. Canada uses Humidex (HD). Our comparison used the USARIEM Heat Strain Decision Aid (HSDA) to evaluate both indices.
Krömker, Dörthe; Meguerditchian, Ari N; Tamblyn, Robyn
Background Patient information and education, such as decision aids, are gradually moving toward online, computer-based environments. Considerable research has been conducted to guide content and presentation of decision aids. However, given the relatively new shift to computer-based support, little attention has been given to how multimedia and interactivity can improve upon paper-based decision aids. Objective The first objective of this review was to summarize published literature into a proposed classification of features that have been integrated into computer-based decision aids. Building on this classification, the second objective was to assess whether integration of specific features was associated with higher-quality decision making. Methods Relevant studies were located by searching MEDLINE, Embase, CINAHL, and CENTRAL databases. The review identified studies that evaluated computer-based decision aids for adults faced with preference-sensitive medical decisions and reported quality of decision-making outcomes. A thematic synthesis was conducted to develop the classification of features. Subsequently, meta-analyses were conducted based on standardized mean differences (SMD) from randomized controlled trials (RCTs) that reported knowledge or decisional conflict. Further subgroup analyses compared pooled SMDs for decision aids that incorporated a specific feature to other computer-based decision aids that did not incorporate the feature, to assess whether specific features improved quality of decision making. Results Of 3541 unique publications, 58 studies met the target criteria and were included in the thematic synthesis. The synthesis identified six features: content control, tailoring, patient narratives, explicit values clarification, feedback, and social support. A subset of 26 RCTs from the thematic synthesis was used to conduct the meta-analyses. As expected, computer-based decision aids performed better than usual care or alternative aids; however
This perspective article builds upon the theory of local thinking in interpretation and prediction of consumer behavior in a contemporary world of information overload. It is shown that even informed and socially and environmentally responsible consumers (consumers 3.0) exhibit selective recall, limited attention, and bounded search in the perception and interpretation of price and quality of purchases. Their decisions fall into local cognitive frames, which specifically focus attention only on a narrow structure and content of the choice. The cognitive frames can be established by recent or regular purchases, but also extreme or primary purchase experiences. The article includes a short conceptual review of car, food, clothing, insurance, drugs, paintings, and other product purchases showing that the local cognitive frames often lead to bad bargains across various sectors. The article presents several suggestions for future research. PMID:27375527
Moja, Lorenzo; Kwag, Koren Hyogene
The structure and aim of continuing medical education (CME) is shifting from the passive transmission of knowledge to a competency-based model focused on professional development. Self-directed learning is emerging as the foremost educational method for advancing competency-based CME. In a field marked by the constant expansion of knowledge, self-directed learning allows physicians to tailor their learning strategy to meet the information needs of practice. Point of care information services are innovative tools that provide health professionals with digested evidence at the front line to guide decision making. By mobilising self-directing learning to meet the information needs of clinicians at the bedside, point of care information services represent a promising platform for competency-based CME. Several points, however, must be considered to enhance the accessibility and development of these tools to improve competency-based CME and the quality of care. PMID:25655251
Viel, Christian; Beaulant, Anne-Lise; Soubeyroux, Jean-Michel; Céron, Jean-Pierre
The FP7 project EUPORIAS was a great opportunity for the climate community to co-design with stakeholders some original and innovative climate services at seasonal time scales. In this framework, Météo-France proposed a prototype that aimed to provide to water resource managers some tailored information to better anticipate the coming season. It is based on a forecasting system, built on a refined hydrological suite, forced by a coupled seasonal forecast model. It particularly delivers probabilistic river flow prediction on river basins all over the French territory. This paper presents the work we have done with "EPTB Seine Grands Lacs" (EPTB SGL), an institutional stakeholder in charge of the management of 4 great reservoirs on the upper Seine Basin. First, we present the co-design phase, which means the translation of classical climate outputs into several indices, relevant to influence the stakeholder's decision making process (DMP). And second, we detail the evaluation of the impact of the forecast on the DMP. This evaluation is based on an experiment realised in collaboration with the stakeholder. Concretely EPTB SGL has replayed some past decisions, in three different contexts: without any forecast, with a forecast A and with a forecast B. One of forecast A and B really contained seasonal forecast, the other only contained random forecasts taken from past climate. This placebo experiment, realised in a blind test, allowed us to calculate promising skill scores of the DMP based on seasonal forecast in comparison to a classical approach based on climatology, and to EPTG SGL current practice.
O'Neill, M.; Sampson, N.; McCormick, S.; Rood, R. B.; Buxton, M.; Ebi, K. L.; Gronlund, C. J.; Zhang, K.; Catalano, L.; White-Newsome, J. L.; Conlon, K. C.; Parker, E. A.
To better understand how to prevent illness and deaths during hot weather, particularly among at-risk populations, we conducted a study in Detroit, Michigan; Phoenix, Arizona; New York, New York, and Philadelphia, Pennsylvania. Our aims were to characterize and better understand how heatwave and health early warning systems (HHWS) and related prevention and sustainability programs can be more widely and effectively implemented. Specifically, we here report on the scientific evidence, expert judgments and the process used in deciding to trigger a HHWS and activate public health and social services interventions. We conducted interviews with public officials who decide if and when heat advisories/warnings are issued. After transcribing the interviews, we used a qualitative analysis software, QSR NVivo 9.0, to assign codes to portions of text from each transcript and allow analysis of information with common themes across the data. For example, several sentences in a transcript discussing a heat index might be coded as 'definition of heat wave'. A common theme across cities was that deciding what type of weather is dangerous to health is not straightforward. The time in season that heat occurs; the duration of the heat; the level of humidity and other meteorological factors; the extent to which temperatures drop at night, allowing people to cool off; and prevailing weather conditions all play a role. A single 'safe' threshold is unrealistic because people's individual sensitivity, housing, surrounding environments, behaviors, and access to air conditioning can differ greatly. However, choices must be made as to the trigger for the HHWS. Although quantitative analysis with health data (mortality, hospital admissions) can inform the design of the triggers, historical analysis has limitations, and decisions to issue heat warnings are sometimes related to planned activities, such as parades or fairs, that may expose large numbers of people to heat. The HHWS approach
Légaré, France; Hébert, Jessica; Goh, Larissa; Lewis, Krystina B; Leiva Portocarrero, Maria Ester; Robitaille, Hubert; Stacey, Dawn
Objectives Choosing Wisely is a remarkable physician-led campaign to reduce unnecessary or harmful health services. Some of the literature identifies Choosing Wisely as a shared decision-making approach. We evaluated the patient materials developed by Choosing Wisely Canada to determine whether they meet the criteria for shared decision-making tools known as patient decision aids. Design Descriptive analysis of all Choosing Wisely Canada patient materials. Data source In May 2015, we selected all Choosing Wisely Canada patient materials from its official website. Main outcomes and measures Four team members independently extracted characteristics of the English materials using the International Patient Decision Aid Standards (IPDAS) modified 16-item minimum criteria for qualifying and certifying patient decision aids. The research team discussed discrepancies between data extractors and reached a consensus. Descriptive analysis was conducted. Results Of the 24 patient materials assessed, 12 were about treatments, 11 were about screening and 1 was about prevention. The median score for patient materials using IPDAS criteria was 10/16 (range: 8–11) for screening topics and 6/12 (range: 6–9) for prevention and treatment topics. Commonly missed criteria were stating the decision (21/24 did not), providing balanced information on option benefits/harms (24/24 did not), citing evidence (24/24 did not) and updating policy (24/24 did not). Out of 24 patient materials, only 2 met the 6 IPDAS criteria to qualify as patient decision aids, and neither of these 2 met the 6 certifying criteria. Conclusions Patient materials developed by Choosing Wisely Canada do not meet the IPDAS minimal qualifying or certifying criteria for patient decision aids. Modifications to the Choosing Wisely Canada patient materials would help to ensure that they qualify as patient decision aids and thus as more effective shared decision-making tools. PMID:27566638
Schiebener, Johannes; García-Arias, María; García-Villamisar, Domingo; Cabanyes-Truffino, Javier; Brand, Matthias
Previous studies have shown that children and adolescents often tend toward risky decisions despite explicit knowledge about the potential negative consequences. This phenomenon has been suggested to be associated with the immaturity of brain areas involved in cognitive control functions. Particularly, "frontal lobe functions," such as executive functions and reasoning, mature until young adulthood and are thought to be involved in age-related changes in decision making under explicit risk conditions. We investigated 112 participants, aged 8-19 years, with a frequently used task assessing decisions under risk, the Game of Dice Task (GDT). Additionally, we administered the Modified Card Sorting Test assessing executive functioning (categorization, cognitive flexibility, and strategy maintenance) as well as the Ravens Progressive Matrices assessing reasoning. The results showed that risk taking in the GDT decreased with increasing age and this effect was not moderated by reasoning but by executive functions: Particularly, young persons with weak executive functioning showed very risky decision making. Thus, the individual maturation of executive functions, associated with areas in the prefrontal cortex, seems to be an important factor in young peoples' behavior in risky decision-making situations.
Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real
Crowder, L. B.
Scientists are most comfortable talking to other scientists. But if we hope our science will be used to drive good policy decisions at the state or federal level, we have to be willing to leave the comfortable cloisters of science and venture out into a world where people speak different languages and have different perspectives. Early in my career, I had the good fortune to be involved in two research programs that were focused on basic science, but also proved to be relevant to management and policy. The first project involved modeling the bioenergetics of growth in salmonid fishes. The second modeled the population dynamics of a threatened marine species, loggerhead sea turtle. Somewhat to my surprise, both papers led to major policy changes and the models were actively employed by managers within a year of two of publication. The question for me then became whether this could be done deliberately. Since then I have had the opportunity to communicate with a wide variety of people from congressmen, to school children, to the public, and among professionals across disciplinary boundaries. Communication skills are critical for scientists to become influential in the policy arena. We have to listen to all people involved in the policymaking process AND we have to be able to communicate effectively with them. This requires a deep understanding of the science and a willingness to work hard on communicating the science clearly, concisely, and compellingly. Scientists can work to develop their own skills, but professional training helps. This can come via shortcourses, mentorships, or full university courses. At Duke Marine Lab, we initiated graduate course in Professional Writing that focuses upon writing for different audiences, including commercial fishermen, retirees, teenagers, scientists in different fields, politicians, and managers. This course has been widely endorsed by our graduates as one of the most important courses they attended; interviews and job offers
Poli, Riccardo; Valeriani, Davide; Cinel, Caterina
We look at the possibility of integrating the percepts from multiple non-communicating observers as a means of achieving better joint perception and better group decisions. Our approach involves the combination of a brain-computer interface with human behavioural responses. To test ideas in controlled conditions, we asked observers to perform a simple matching task involving the rapid sequential presentation of pairs of visual patterns and the subsequent decision as whether the two patterns in a pair were the same or different. We recorded the response times of observers as well as a neural feature which predicts incorrect decisions and, thus, indirectly indicates the confidence of the decisions made by the observers. We then built a composite neuro-behavioural feature which optimally combines the two measures. For group decisions, we uses a majority rule and three rules which weigh the decisions of each observer based on response times and our neural and neuro-behavioural features. Results indicate that the integration of behavioural responses and neural features can significantly improve accuracy when compared with the majority rule. An analysis of event-related potentials indicates that substantial differences are present in the proximity of the response for correct and incorrect trials, further corroborating the idea of using hybrids of brain-computer interfaces and traditional strategies for improving decision making. PMID:25072739
affairs, communication and information systems operation, explosive ordinance disposal, military intelligence, psychological operations, and any other...Connect with GAO on Facebook, Flickr, Twitter, and YouTube. Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts . Visit GAO on the
the MITRE Air Force site coordinator education report, the environmental education research being done by the School of Aerospace Medicine, and the...Each iteration is a result 56 of discussions with Lt Col Maricle and Maj Duncan- and a review of the environmental education research completed by the
Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and
Muehlschlegel, Susanne; Shutter, Lori; Col, Nananda; Goldberg, Robert
Improved resuscitation methods and advances in critical care have significantly increased the survival of patients presenting with devastating brain injuries compared to prior decades. After the patient's stabilization phase, families and patients are faced with "goals-of-care" decisions about continuation of aggressive intensive care unit care or comfort care only (CMO). Highly varying rates of CMO between centers raise the question of "self-fulfilling prophecies." Disease severity, the physician's communication and the family's understanding of projected outcomes, their uncertainties, complication risks with continued care, physician bias, and the patient's and surrogate's wishes and values all influence a CMO decision. Disease-specific decision support interventions, decision aids (DAs), may remedy these issues in the neurocritical care unit, potentially leading to better-informed and less-biased goals-of-care decisions in neurocritically ill patients, while increasing decision knowledge, confidence, and realistic expectations and decreasing decisional conflict and regret. Shared decision-making (SDM) is a collaborative process that enhances patients' and proxies' understanding about prognosis, encourages them to actively weigh the risks and benefits of a treatment, and considers the patient's preferences and values to make better decisions. DAs are SDM tools, which have been successfully implemented for many other conditions to assist difficult decision-making. In this article, we summarize the purposes of SDM, the derivation of DAs, and their potential application in neurocritical care.
Durstine, Richard M.
This paper is the second step in the preparation of forecasts of occupational and industrial information which will meet the needs of the Information System for Vocational Decisions (ISVD). The author discusses the computation routines which need to be developed, tested and operationalized toward the goal of combining occupational and industrial…
The purpose of this project, Development of an Analytic Approach to Determine How Environmental Protection Agency’s Integrated Risk Information System (IRIS) Is Used By Non EPA Decision Makers, is to describe how IRIS is used by a small number of representative groups of u...
EPA announced the availability of the final contractor report entitled, Development of an Analytic Approach to Determine How Environmental Protection Agency’s Integrated Risk Information System (IRIS) Is Used By Non EPA Decision Makers. This contractor report analyzed how ...
Hamilton, T. W.; Pandit, H. G.; Lombardi, A. V.; Adams, J. B.; Oosthuizen, C. R.; Clavé, A.; Dodd, C. A. F.; Berend, K. R.; Murray, D. W.
Aims An evidence-based radiographic Decision Aid for meniscal-bearing unicompartmental knee arthroplasty (UKA) has been developed and this study investigates its performance at an independent centre. Patients and Methods Pre-operative radiographs, including stress views, from a consecutive cohort of 550 knees undergoing arthroplasty (UKA or total knee arthroplasty; TKA) by a single-surgeon were assessed. Suitability for UKA was determined using the Decision Aid, with the assessor blinded to treatment received, and compared with actual treatment received, which was determined by an experienced UKA surgeon based on history, examination, radiographic assessment including stress radiographs, and intra-operative assessment in line with the recommended indications as described in the literature. Results The sensitivity and specificity of the Decision Aid was 92% and 88%, respectively. Excluding knees where a clear pre-operative plan was made to perform TKA, i.e. patient request, the sensitivity was 93% and specificity 96%. The false-positive rate was low (2.4%) with all affected patients readily identifiable during joint inspection at surgery. In patients meeting Decision Aid criteria and receiving UKA, the five-year survival was 99% (95% confidence intervals (CI) 97 to 100). The false negatives (3.5%), who received UKA but did not meet the criteria, had significantly worse functional outcomes (flexion p < 0.001, American Knee Society Score - Functional p < 0.001, University of California Los Angeles score p = 0.04), and lower implant survival of 93.1% (95% CI 77.6 to 100). Conclusion The radiographic Decision Aid safely and reliably identifies appropriate patients for meniscal-bearing UKA and achieves good results in this population. The widespread use of the Decision Aid should improve the results of UKA. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):3–10. PMID:27694509
Brunner, Norbert; Starkl, Markus
Assessing sustainability in compliance with the EU water framework directive is affected by numerous conflicting interests. As they can no longer be resolved by means of intuitive reasoning, some authors propose the integration of the major fragmented indicators into one common indicator of the overall sustainability by means of a codified multi-criteria decision support methodology (DSM). Practitioners in urban water management, however, usually object to the use of a codified DSM, as in the legal context (negotiations between the stakeholders, tendering procedure) it might jeopardize the feasibility of the decision making process (DMP). Here we show that a feasible implementation of a DSM into the DMP is possible. To this end, we design a cooperative approach, which by means of an axiomatic evaluation helps to select an appropriate DSM. We illustrate it by a hypothetical dialogue between the relevant authority and the developer. It will expose the inherent limitations of the DSM, which are due to their underlying mathematical features.
planning and in execution, and in determining the best means for error correction. • Agile Development of Knowledge . The underlying knowledge can...experimentation plan focuses on providing decision-support to three of those individuals: S3 (maneuver), S2 (intel), and FSO (fires) Top 20% Laboratory...I n meline " Refresh FSO 12-03-201111:59:48 - ongoing Active Activity Based P ... • lnstanceld: Demonstration Concept Current Commonality Slider
Wilson, Robyn S
Despite advances in the quality of participatory decision making for conservation, many current efforts still suffer from an inability to bridge the gap between science and policy. Judgment and decision-making research suggests this gap may result from a person's reliance on affect-based shortcuts in complex decision contexts. I examined the results from 3 experiments that demonstrate how affect (i.e., the instantaneous reaction one has to a stimulus) influences individual judgments in these contexts and identified techniques from the decision-aiding literature that help encourage a balance between affect-based emotion and cognition in complex decision processes. In the first study, subjects displayed a lack of focus on their stated conservation objectives and made decisions that reflected their initial affective impressions. Value-focused approaches may help individuals incorporate all the decision-relevant objectives by making the technical and value-based objectives more salient. In the second study, subjects displayed a lack of focus on statistical risk and again made affect-based decisions. Trade-off techniques may help individuals incorporate relevant technical data, even when it conflicts with their initial affective impressions or other value-based objectives. In the third study, subjects displayed a lack of trust in decision-making authorities when the decision involved a negatively affect-rich outcome (i.e., a loss). Identifying shared salient values and increasing procedural fairness may help build social trust in both decision-making authorities and the decision process.
Barnett, Erin R; Boucher, Elizabeth A; Daviss, William B; Elwyn, Glyn
There is a lack of research to guide collaborative treatment decision-making for children who have complex behavioral problems, despite the extensive use of mental health services in this population. We developed and pilot-tested a one-page Option Grid™ patient decision aid to facilitate shared decision-making for these situations. An editorial team of parents, child psychiatrists, researchers, and other stakeholders developed the scope and structure of the decision aid. Researchers included information about a carefully chosen number of psychosocial and pharmacological treatment options, using descriptions based on the best available evidence. Using semi-structured qualitative interviews (n = 18), we conducted user testing with four parents and four clinical prescribers and field testing with four parents, four clinical prescribers, and two clinic administrators. The researchers coded and synthesized the interview responses using mixed inductive and deductive methods. Parents, clinicians, and administrators felt the Option Grid had significant value, although they reported that additional training and other support would be required in order to successfully implement the Option Grid and achieve shared decision-making in clinical practice.
Selecting a risk-based tool to aid in decision making is as much of a challenge as properly using the tool once it has been selected. Failure to consider customer and stakeholder requirements and the technical bases and differences in risk-based decision making tools will produce confounding and/or politically unacceptable results when the tool is used. Selecting a risk-based decisionmaking tool must therefore be undertaken with the same, if not greater, rigor than the use of the tool once it is selected. This paper presents a process for selecting a risk-based tool appropriate to a set of prioritization or resource allocation tasks, discusses the results of applying the process to four risk-based decision-making tools, and identifies the ``musts`` for successful selection and implementation of a risk-based tool to aid in decision making.
Kegelmeyer, W.P. Jr.; Groshong, B.; Allmen, M.; Woods, K.
Breast cancer is a serious problem, which in the United States causes 43,000 deaths a year, eventually striking 1 in 9 women. Early detection is the only effective countermeasure, and mass mammography screening is the only reliable means for early detection. Mass screening has many shortcomings which could be addressed by a computer-aided mammographic screening system. Accordingly, we have applied the pattern recognition methods developed in earlier investigations of speculated lesions in mammograms to the detection of microcalcifications and circumscribed masses, generating new, more rigorous and uniform methods for the detection of both those signs. We have also improved the pattern recognition methods themselves, through the development of a new approach to combinations of multiple classifiers.
Butler, Mary; Ratner, Edward; McCreedy, Ellen; Shippee, Nathan; Kane, Robert L
Advance care planning honors patients' goals and preferences for future care by creating a plan for when illness or injury impedes the ability to think or communicate about health decisions. Fewer than 50% of severely or terminally ill patients have an advance directive in their medical record, and physicians are accurate only about 65% of the time when predicting patient preferences for intensive care. Decision aids can support the advance care planning process by providing a structured approach to informing patients about care options and prompting them to document and communicate their preferences. This review, commissioned as a technical brief by the Agency for Healthcare Research and Quality Effective Health Care Program, provides a broad overview of current use of and research related to decision aids for adult advance care planning. Using interviews of key informants and a search of the gray and published literature from January 1990 to May 2014, the authors found that many decision aids are widely available but are not assessed in the empirical literature. The 16 published studies testing decision aids as interventions for adult advance care planning found that most are proprietary or not publicly available. Some are constructed for the general population, whereas others address disease-specific conditions that have more predictable end-of-life scenarios and, therefore, more discrete choices. New decision aids should be designed that are responsive to diverse philosophical perspectives and flexible enough to change as patients gain experience with their personal illness courses. Future efforts should include further research, training of advance care planning facilitators, dissemination and access, and tapping potential opportunities in social media or other technologies.
This paper explores the notion of evidence-informed policy making and the factors that have hindered its development in the UK to date. It then explores Flyvbjerg's notion of "phronetic" expertise and hypothesises that the learning that accrues from engaging with multiple cases could also lead to policy-makers developing competency in…
de Laat, Sonya; Schwartz, Lisa
Introduction Prospective informed consent is required for most research involving human participants; however, this is impracticable under some circumstances. The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS) outlines the requirements for research involving human participants in Canada. The need for an exception to consent (deferred consent) is recognised and endorsed in the TCPS for research in individual medical emergencies; however, little is known about substitute decision-maker (SDM) experiences. A paediatric resuscitation trial (SQUEEZE) (NCT01973907) using an exception to consent process began enrolling at McMaster Children's Hospital in January 2014. This qualitative research study aims to generate new knowledge on SDM experiences with the exception to consent process as implemented in a randomised controlled trial. Methods and analysis The SDMs of children enrolled into the SQUEEZE pilot trial will be the sampling frame from which ethics study participants will be derived. Design: Qualitative research study involving individual interviews and grounded theory methodology. Participants: SDMs for children enrolled into the SQUEEZE pilot trial. Sample size: Up to 25 SDMs. Qualitative methodology: SDMs will be invited to participate in the qualitative ethics study. Interviews with consenting SDMs will be conducted in person or by telephone, taped and professionally transcribed. Participants will be encouraged to elaborate on their experience of being asked to consent after the fact and how this process occurred. Analysis: Data gathering and analysis will be undertaken simultaneously. The investigators will collaborate in developing the coding scheme, and data will be coded using NVivo. Emerging themes will be identified. Ethics and dissemination This research represents a rare opportunity to interview parents/guardians of critically ill children enrolled into a resuscitation trial without their knowledge or prior consent
Brantley, S. L.
Citizens living in areas of shale-gas development such as the Marcellus gas play in Pennsylvania and surrounding states are cognizant of the possibility that drilling and production of natural gas -- including hydraulic fracturing -- may have environmental impacts on their water. The Critical Zone is defined as the zone from vegetation canopy to the lower limits of groundwater. This definition is nebulous in terms of the lower limit, and yet, defining the bottom of the Critical Zone is important if citizens are to embrace shale-gas development. This is because, although no peer-reviewed study has been presented that documents a case where hydraulic fracturing or formation fluids have migrated upwards from fracturing depths to drinking water resources, a few cases of such leakage have been alleged. On the other hand, many cases of methane migration into aquifers have been documented to occur and some have been attributed to shale-gas development. The Critical Zone science community has a role to play in understanding such contamination problems, how they unfold, and how they should be ameliorated. For example, one big effort of the Critical Zone science community is to promote sharing of data describing the environment. This data effort has been extended to provide data for citizens to understand water quality by a team known as the Shale Network. As scientists learn to publish data online, these efforts must also be made accessible to non-scientists. As citizens access the data, the demand for data will grow and all branches of government will eventually respond by providing more accessible data that will help the public and policy-makers make decisions.
Liedlgruber, Michael; Uhl, Andreas
Today, medical endoscopy is a widely used procedure to inspect the inner cavities of the human body. The advent of endoscopic imaging techniques-allowing the acquisition of images or videos-created the possibility for the development of the whole new branch of computer-aided decision support systems. Such systems aim at helping physicians to identify possibly malignant abnormalities more accurately. At the beginning of this paper, we give a brief introduction to the history of endoscopy, followed by introducing the main types of endoscopes which emerged so far (flexible endoscope, wireless capsule endoscope, and confocal laser endomicroscope). We then give a brief introduction to computer-aided decision support systems specifically targeted at endoscopy in the gastrointestinal tract. Then we present general facts and figures concerning computer-aided decision support systems and summarize work specifically targeted at computer-aided decision support in the gastrointestinal tract. This summary is followed by a discussion of some common issues concerning the approaches reviewed and suggestions of possible ways to resolve them.
Elwyn, Glyn; Dannenberg, Michelle; Blaine, Arianna; Poddar, Urbashi; Durand, Marie-Anne
Objective Our aim in this study was to examine the competing interest policies and procedures of organisations who develop and maintain patient decision aids. Design Descriptive and thematic analysis of data collected from a cross-sectional survey of patient decision aid developer's competing interest policies and disclosure forms. Results We contacted 25 organisations likely to meet the inclusion criteria. 12 eligible organisations provided data. 11 organisations did not reply and 2 declined to participate. Most patient decision aid developers recognise the need to consider the issue of competing interests. Assessment processes vary widely and, for the most part, are insufficiently robust to minimise the risk of competing interests. Only half of the 12 organisations had competing interest policies. Some considered disclosure to be sufficient, while others imposed differing levels of exclusion. Conclusions Patient decision aid developers do not have a consistent approach to managing competing interests. Some have developed policies and procedures, while others pay no attention to the issue. As is the case for clinical practice guidelines, increasing attention will need to be given to how the competing interests of contributors of evidence-based publications may influence materials, especially if they are designed for patient use. PMID:27612542
On 26 June 2003, the England and Wales Court of Appeal (Civil Division) granted an application for leave to appeal a decision of the Immigration Appeal Tribunal, which had overturned an adjudicator's decision to allow an HIV-positive citizen of Uganda to immigrate to the United Kingdom (UK).
Hunink, M G
To have real-time impact on medical decision making, decision analysts need a wide variety of tools to aid logical thinking and communication. Decision models provide a formal framework to integrate evidence and values, but they are commonly perceived as complex and difficult to understand by those unfamiliar with the methods, especially in the context of clinical decision making. The theory of constraints, introduced by Eliyahu Goldratt in the business world, provides a set of tools for logical thinking and communication that could potentially be useful in medical decision making. The author used the concept of a conflict resolution diagram to analyze the decision to perform carotid endarterectomy prior to coronary artery bypass grafting in a patient with both symptomatic coronary and asymptomatic carotid artery disease. The method enabled clinicians to visualize and analyze the issues, identify and discuss the underlying assumptions, search for the best available evidence, and use the evidence to make a well-founded decision. The method also facilitated communication among those involved in the care of the patient. Techniques from fields other than decision analysis can potentially expand the repertoire of tools available to support medical decision making and to facilitate communication in decision consults.
Liu, Chengfang; Zhang, Linxiu; Luo, Renfu; Wang, Xiaobing; Rozelle, Scott; Sharbono, Brian; Adams, Jennifer; Shi, Yaojiang; Yue, Ai; Li, Hongbin; Glauben, Thomas
Many educational systems have struggled with the question about how best to give out financial aid. In particular, if students do not know the amount of financial aid that they can receive before they make a decision about where to go to college and what major to study, it may distort their decision. This study utilizes an experiment (implemented…
Alden, Dana L; Friend, John; Schapira, Marilyn; Stiggelbout, Anne
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
Hausken, Kjell; Ncube, Mthuli
A four-period game is developed between a policy maker, the international community, and the population. This research supplements, through implementing strategic interaction, earlier research analyzing "one player at a time". The first two players distribute funds between preventing and treating diseases. The population reacts by degree of risky behavior which may cause no disease, disease contraction, recovery, sickness/death. More funds to prevention implies less disease contraction but higher death rate given disease contraction. The cost effectiveness of treatment relative to prevention, country specific conditions, and how the international community converts funds compared with the policy maker in a country, are illustrated. We determine which factors impact funding, e.g. large probabilities of disease contraction, and death given contraction, and if the recovery utility and utility of remaining sick or dying are far below the no disease utility. We also delineate how the policy maker and international community may free ride on each other's contributions. The model is tested against empirical data for 43 African countries. The results show consistency between the theoretical model and empirical estimates. The paper argues for the need to create commitment mechanisms to ensure that free riding by both countries and the international community is avoided.
making processes under which virtually all decisions can be categorized. Optimizing. To optimize is to make the best possible decision under the... community ; 45 AFIT students may not be a representative sample. A subjective case may be made, however, that these subjects were relatively typical...career paths of the population studied, compared with that which apparently exists in the acquisition community . Discussion of Variables Major Constructs
Elgin, Peter D.; Thomas, Rickey P.
The National Airspace System s capacity will experience considerable growth in the next few decades. Weather adversely affects safe air travel. The FAA and NASA are working to develop new technologies that display weather information to support situation awareness and optimize pilot decision-making in avoiding hazardous weather. Understanding situation awareness and naturalistic decision-making is an important step in achieving this goal. Information representation and situation time stress greatly influence attentional resource allocation and working memory capacity, potentially obstructing accurate situation awareness assessments. Three naturalistic decision-making theories were integrated to provide an understanding of the levels of decision making incorporated in three operational situations and two conditions. The task characteristics associated with each phase of flight govern the level of situation awareness attained and the decision making processes utilized. Weather product s attributes and situation task characteristics combine to classify weather products according to the decision-making processes best supported. In addition, a graphical interface is described that affords intuitive selection of the appropriate weather product relative to the pilot s current flight situation.
The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment.
Venkat, Arvind; Becker, Julianna
While the ethics and critical care literature is replete with discussion of medical futility and the ethics of end-of-life care decisions in the intensive care unit, little attention is paid to the effect of statutory limitations on the authority of substitute decision makers during the course of treatment of patients in the critical care setting. In many jurisdictions, a clear distinction is made between the authority of a health care power of attorney, who is legally designated by a competent adult to make decisions regarding withholding or withdrawing life-sustaining treatment, and of next-of-kin, who are limited in this regard. However, next-of-kin are often relied upon to consent to necessary procedures to advance a patient's medical care. When conflicts arise between critical care physicians and family members regarding projected patient outcome and functional status, these statutory limitations on decision-making authority by next of kin can cause paralysis in the medical care of severely ill patients, leading to practical and ethical impasses. In this article, we will provide case examples of how statutory limitations on substitute decision making authority for next of kin can impede the care of patients. We will also review the varying jurisdictional limitations on the authority of substitute decision makers and explore their implications for patient care in the critical care setting. Finally, we will review possible ethical and legal solutions to resolve these impasses.
Shukla, S.; Husak, G. J.; Funk, C. C.; Verdin, J. P.
The USAID's Famine Early Warning Systems Network (FEWS NET) provides seasonal assessments of crop conditions over the Greater Horn of Africa (GHA) and other food insecure regions. These assessments and current livelihood, nutrition, market conditions and conflicts are used to generate food security scenarios that help national, regional and local decision makers target their resources and mitigate socio-economic losses. Among the various tools that FEWS NET uses is the FAO's Water Requirement Satisfaction Index (WRSI). The WRSI is a simple yet powerful crop assessment model that incorporates current moisture conditions (at the time of the issuance of forecast), precipitation scenarios, potential evapotranspiration and crop parameters to categorize crop conditions into different classes ranging from "failure" to "very good". The WRSI tool has been shown to have a good agreement with local crop yields in the GHA region. At present, the precipitation scenarios used to drive the WRSI are based on either a climatological forecast (that assigns equal chances of occurrence to all possible scenarios and has no skill over the forecast period) or a sea-surface temperature anomaly based scenario (which at best have skill at the seasonal scale). In both cases, the scenarios fail to capture the skill that can be attained by initial atmospheric conditions (i.e., medium-range weather forecasts). During the middle of a cropping season, when a week or two of poor rains can have a devastating effect, two weeks worth of skillful precipitation forecasts could improve the skill of the crop scenarios. With this working hypothesis, we examine the value of incorporating medium-range weather forecasts in improving the skill of crop scenarios in the GHA region. We use the NCEP's Global Ensemble Forecast system (GEFS) weather forecasts and examine the skill of crop scenarios generated using the GEFS weather forecasts with respect to the scenarios based solely on the climatological forecast
The aviation community is faced with reducing the fatal aircraft accident rate by 80 percent within 10 years. This must be achieved even with ever increasing, traffic and a changing National Airspace System. This is not just an altruistic goal, but a real necessity, if our growing level of commerce is to continue. Honeywell Technology Center's topical study, "Weather Avoidance Using Route Optimization as a Decision Aid", addresses these pressing needs. The goal of this program is to use route optimization and user interface technologies to develop a prototype decision aid for dispatchers and pilots. This decision aid will suggest possible diversions through single or multiple weather hazards and present weather information with a human-centered design. At the conclusion of the program, we will have a laptop prototype decision aid that will be used to demonstrate concepts to industry for integration into commercialized products for dispatchers and/or pilots. With weather a factor in 30% of aircraft accidents, our program will prevent accidents by strategically avoiding weather hazards in flight. By supplying more relevant weather information in a human-centered format along with the tools to generate flight plans around weather, aircraft exposure to weather hazards can be reduced. Our program directly addresses the NASA's five year investment areas of Strategic Weather Information and Weather Operations (simulation/hazard characterization and crew/dispatch/ATChazard monitoring, display, and decision support) (NASA Aeronautics Safety Investment Strategy: Weather Investment Recommendations, April 15, 1997). This program is comprised of two phases, Phase I concluded December 31, 1998. This first phase defined weather data requirements, lateral routing algorithms, an conceptual displays for a user-centered design. Phase II runs from January 1999 through September 1999. The second phase integrates vertical routing into the lateral optimizer and combines the user
-allowing ensemble also showed greater skill in forecasting heavy precipitation amounts in the vicinity of where they were observed during the most active convective period, particularly near urbanized areas. A total of 9 Front Range EMs were interviewed to research how they understood hazardous weather information, and how their perception of forecast uncertainty would influence their decision making following a heavy rain event. Many of the EMs use situational awareness and past experiences with major weather events to guide their emergency planning. They also highly valued their relationship with the National Weather Service to improve their understanding of weather forecasts and ask questions about the uncertainties. Most of the EMs perceived forecast uncertainty in terms of probability and with the understanding that forecasting the weather is an imprecise science. The greater the likelihood of occurrence (implied by a higher probability of precipitation) showed greater confidence in the forecast that an event was likely to happen. Five probabilistic forecast products were generated from the convection-allowing ensemble output to generate a hypothetical warm season heavy rain event scenario. Responses varied between the EMs in which products they found most practical or least useful. Most EMs believed that there was a high probability for flooding, as illustrated by the degree of forecasted precipitation intensity. Most confirmed perceiving uncertainty in the different forecast representations, sharing the idea that there is an inherent uncertainty that follows modeled forecasts. The long-term goal of this research is to develop and add reliable probabilistic forecast products to the "toolbox" of decision-makers to help them better assess hazardous weather information and improve warning notifications and response.
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...
Background Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient’s values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. Methods/Design We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Discussion Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. Trial registration
Wang, Wei; Zhuge, Qunbi; Morsy-Osman, Mohamed; Gao, Yuliang; Xu, Xian; Chagnon, Mathieu; Qiu, Meng; Hoang, Minh Thang; Zhang, Fangyuan; Li, Rui; Plant, David V
We propose a decision-aided algorithm to compensate the sampling frequency offset (SFO) between the transmitter and receiver for reduced-guard-interval (RGI) coherent optical (CO) OFDM systems. In this paper, we first derive the cyclic prefix (CP) requirement for preventing OFDM symbols from SFO induced inter-symbol interference (ISI). Then we propose a new decision-aided SFO compensation (DA-SFOC) algorithm, which shows a high SFO tolerance and reduces the CP requirement. The performance of DA-SFOC is numerically investigated for various situations. Finally, the proposed algorithm is verified in a single channel 28 Gbaud polarization division multiplexing (PDM) RGI CO-OFDM experiment with QPSK, 8 QAM and 16 QAM modulation formats, respectively. Both numerical and experimental results show that the proposed DA-SFOC method is highly robust against the standard SFO in optical fiber transmission.
Elrick, John R.
The Night Vision Goggle (NVG) Tactical Decision Aid (TDA) was developed to support Army operations in situations requiring accurate predictions of light levels. Minimum thresholds of illumination are used by the Army to plan and execute missions during periods of darkness or near darkness. The NVG TDA is part of a suite of decision aids that will become part of the fielded Integrated Meteorological System (IMETS). The IMETS is a system designed to be operated by Air Force Staff Weather Officers supporting Army tactical operations in peacetime and in times of conflict. The verification and validation (V & V) effort discussed in this report is part of the Battlefield Environment Directorate configuration management plan to field physically correct and user-friendly software to Army units over the entire conflict spectrum. The V & V described is thorough and shows that the NVG TDA is physically correct and applicable for accreditation before use.
APPROACH The Maritime Energy Portfolio Management Approach provides a means for determining the best course of action where several initiatives...Decision Aid also provides a means for determining the best course of action where several ECMs compete for scarce funds. Efficient, user friendly...Investment (ROI) and Break Even Point ( BEP ). These metrics are essential for determining whether an initiative would be worth pursuing. Balanced
Link, R; Kallel, S
Soft-decision-feedback MAP decoders are developed for joint source/channel decoding (JSCD) which uses the residual redundancy in two-dimensional sources. The source redundancy is described by a second order Markov model which is made available to the receiver for row-by-row decoding, wherein the output for one row is used to aid the decoding of the next row. Performance can be improved by generalizing so as to increase the vertical depth of the decoder. This is called sheet decoding, and entails generalizing trellis decoding of one-dimensional data to trellis decoding of two-dimensional data (2-D). The proposed soft-decision-feedback sheet decoder is based on the Bahl algorithm, and it is compared to a hard-decision-feedback sheet decoder which is based on the Viterbi algorithm. The method is applied to 3-bit DPCM picture transmission over a binary symmetric channel, and it is found that the soft-decision-feedback decoder with vertical depth V performs approximately as well as the hard-decision-feedback decoder with vertical depth V+1. Because the computational requirement of the decoders depends exponentially on the vertical depth, the soft-decision-feedbark decoder offers significant reduction in complexity. For standard monochrome Lena, at a channel bit error rate of 0.05, the V=1 and V=2 soft-decision-feedback decoder JSCD gains in RSNR are 5.0 and 6.3 dB, respectively.
Gayer, Christopher C; Crowley, Matthew J; Lawrence, William F; Gierisch, Jennifer M; Gaglio, Bridget; Williams, John W; Myers, Evan R; Kendrick, Amy; Slutsky, Jean; Sanders, Gillian D
Decision aids (DAs) help patients make informed healthcare decisions in a manner consistent with their values and preferences. Despite their promise, DAs developed with public research dollars are not being implemented and adopted in real-world patient care settings at a rate consistent with which they are being developed. To appraise the sum of the parts of the portfolio and create a strategic imperative surrounding future funding, the Patient-Centered Outcomes Research Institute (PCORI) tasked the Duke Evidence Synthesis Group with evaluating its DA portfolio. This paper describes PCORI's portfolio of DAs according to the Duke Evidence Synthesis Group's analysis in the context of PCORI's mission and the field of decision science. The results revealed a diversity within PCORI's portfolio of funded DA projects. Findings support the movement toward more rigorous DA development, assessment and maintenance. PCORI's funding priorities related to DAs are clarified and comparative questions of interest are posed.
Jackson, Cath; Cheater, Francine M.; Peacock, Rose; Leask, Julie; Trevena, Lyndal
Objective: The objective of this feasibility study was to evaluate the acceptability and potential effectiveness of a web-based MMR decision aid in supporting informed decision-making for the MMR vaccine. Design: This was a prospective before-and-after evaluation. Setting: Thirty parents of children eligible for MMR vaccination were recruited from…
Ubbink, Dirk T; Knops, Anouk M; Molenaar, Sjaak; Goossens, Astrid
Objective To design, develop, and evaluate an evidence-based decision aid (DA) for patients with an asymptomatic abdominal aortic aneurysm (AAA) to inform them about the pros and cons of their treatment options (ie, surgery or watchful observation) and to help them make a shared decision. Methods A multidisciplinary team defined criteria for the desired DA as to design, medical content and functionality, particularly for elderly users. Development was according to the international standard (IPDAS). Fifteen patients with an AAA, who were either treated or not yet treated, evaluated the tool. Results A DA was developed to offer information about the disease, the risks and benefits of surgical treatment and watchful observation, and the individual possibilities and threats based on the patient’s aneurysm diameter and risk profile. The DA was improved and judged favorably by physicians and patients. Conclusion This evidence-based DA for AAA patients, developed according to IPDAS criteria, is likely to be a simple, user-friendly tool to offer patients evidence-based information about the pros and cons of treatment options for AAA, to improve patients’ understanding of the disease and treatment options, and may support decision making based on individual values. PMID:19920978
Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli
Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.
Karagiannis, Thomas; Liakos, Aris; Branda, Megan E; Athanasiadou, Eleni; Mainou, Maria; Boura, Panagiota; Goulis, Dimitrios G; LeBlanc, Annie; Montori, Victor M
Objective To assess the efficacy of the Diabetes Medication Choice Decision Aid among patients with type 2 diabetes in Greece. Design Open-label cluster randomised controlled trial. Setting Primary and secondary care practices across Greece. Participants 5 sites allocated to the decision aid (n=101 patients) and 4 sites to control (n=103 patients). Intervention Clinicians and patients in the intervention arm used a decision aid, based on outcomes that both consider important when choosing among antihyperglycaemic medications. Patients in the control arm received usual care. Outcome measures The primary outcome was patient's level of decisional comfort after the initial clinical encounter. Secondary outcomes included patient's knowledge about type 2 diabetes and medications, and patient's and clinician's satisfaction. Adherence to prescribed antihyperglycaemic medication and change in glycated haemoglobin were assessed at 24 weeks. Results Patients in both arms had similar scores in overall decisional comfort (mean difference between the usual care and decision aid arms −6.9, 95% CI −21.5 to 7.7) and its subscales. Patients' knowledge was high in both arms (mean difference 2.3%, 95% CI −15.7% to 20.4%). Patients and clinicians in both groups were equally satisfied with the decision-making. No significant difference in medication adherence and glycaemic control was found across arms. Clinicians found the decision aid useful and reported that its integration in their daily routine was easy. Conclusions The decision aid was implemented and positively received in the clinical setting in Greece, in line with the patient-centred approach endorsed by current guidelines. However, this trial yielded imprecise results in terms of patient outcomes. Further research is needed to investigate the interaction between the patient and the clinician in order to clarify the association between the use of decision aids and implementation of shared decision-making. Trial
Brown, Paula E.
Findings of three tests given to 267 undergraduates (Wonderlic Personnel Test, Group Embedded Figures Test, and a case problem in 4 formats) were that neither graphic aids alone nor cognitive style alone significantly affected decision making; and when graphic aids and cognitive style are considered in conjunction, cognitive style is responsible…
Hunt, D. L.; Haynes, R. B.; Morgan, D.
BACKGROUND: Implementation rates of interventions known to be beneficial for people with diabetes mellitus are often suboptimal. Computer-aided decision support systems (CDSSs) can improve these rates. The complexity of establishing a fully integrated electronic medical record that provides decision support, however, often prevents their use. OBJECTIVE: To develop a CDSS for diabetes care that can be easily introduced into primary care settings and diabetes clinics. THE SYSTEM: The CDSS uses fax-machine-based optical character recognition software for acquiring patient information. Simple, 1-page paper forms, completed by patients or health practitioners, are faxed to a central location. The information is interpreted and recorded in a database. This initiates a routine that matches the information against a knowledge base so that patient-specific recommendations can be generated. These are formatted and faxed back within 4-5 minutes. IMPLEMENTATION: The system is being introduced into 2 diabetes clinics. We are collecting information on frequency of use of the system, as well as satisfaction with the information provided. CONCLUSION: Computer-aided decision support can be provided in any setting with a fax machine, without the need for integrated electronic medical records or computerized data-collection devices. PMID:11825194
Dorneich, Michael C.; Olofinboba, Olu; Pratt, Steve; Osborne, Dannielle; Feyereisen, Thea; Latorella, Kara
This document describes the results and analysis of the formal evaluation plan for the Honeywell software tool developed under the NASA AWIN (Aviation Weather Information) 'Weather Avoidance using Route Optimization as a Decision Aid' project. The software tool aims to provide airline dispatchers with a decision aid for selecting optimal routes that avoid weather and other hazards. This evaluation compares and contrasts route selection performance with the AWIN tool to that of subjects using a more traditional dispatcher environment. The evaluation assesses gains in safety, in fuel efficiency of planned routes, and in time efficiency in the pre-flight dispatch process through the use of the AWIN decision aid. In addition, we are interested in how this AWIN tool affects constructs that can be related to performance. The construct of Situation Awareness (SA), workload, trust in an information system, and operator acceptance are assessed using established scales, where these exist, as well as through the evaluation of questionnaire responses and subject comments. The intention of the experiment is to set up a simulated operations area for the dispatchers to work in. They will be given scenarios in which they are presented with stored company routes for a particular city-pair and aircraft type. A diverse set of external weather information sources is represented by a stand-alone display (MOCK), containing the actual historical weather data typically used by dispatchers. There is also the possibility of presenting selected weather data on the route visualization tool. The company routes have not been modified to avoid the weather except in the case of one additional route generated by the Honeywell prototype flight planning system. The dispatcher will be required to choose the most appropriate and efficient flight plan route in the displayed weather conditions. The route may be modified manually or may be chosen from those automatically displayed.
Sofolahan, Y. A.; Airhihenbuwa, C. O.
Using the PEN-3 model, the purpose of this qualitative study was to understand the factors responsible for the childbearing decisions of women living with HIV/AIDS (WLHA) in Lagos, Nigeria. Sixty WLHA who sought care at a teaching hospital in Lagos were recruited to participate in in-depth interviews. The average age of the participants was 30 years, and 48 participants were receiving antiretroviral therapy. Healthcare and spiritual practices, healthcare provider-patient communication about childbearing, and husband/partner support emerged as factors that contribute to the childbearing decisions of WLHA. The findings reveal the importance of discussing sexual reproductive health and childbearing issues with WLHA in the healthcare context prior to pregnancy. PMID:23320152
Raposo, João; Rodrigues, Ana; Silva, Carlos; Dentinho, Tomaz
This article presents a new multi-criteria decision aid methodology, dynamic-PROMETHEE, here used to design electric vehicle charging networks. In applying this methodology to a Portuguese city, results suggest that it is effective in designing electric vehicle charging networks, generating time and policy based scenarios, considering offer and demand and the city's urban structure. Dynamic-PROMETHE adds to the already known PROMETHEE's characteristics other useful features, such as decision memory over time, versatility and adaptability. The case study, used here to present the dynamic-PROMETHEE, served as inspiration and base to create this new methodology. It can be used to model different problems and scenarios that may present similar requirement characteristics.
Kagan, Jonathan M; Gupta, Nitin; Varghese, Suresh; Virkar, Hemant
The National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS (DAIDS) Enterprise Information System (DAIDS-ES) is a web-based system that supports NIAID in the scientific, strategic, and tactical management of its global clinical research programs for HIV/AIDS vaccines, prevention, and therapeutics. Different from most commercial clinical trials information systems, which are typically protocol-driven, the DAIDS-ES was built to exchange information with those types of systems and integrate it in ways that help scientific program directors lead the research effort and keep pace with the complex and ever-changing global HIV/AIDS pandemic. Whereas commercially available clinical trials support systems are not usually disease-focused, DAIDS-ES was specifically designed to capture and incorporate unique scientific, demographic, and logistical aspects of HIV/AIDS treatment, prevention, and vaccine research in order to provide a rich source of information to guide informed decision-making. Sharing data across its internal components and with external systems, using defined vocabularies, open standards and flexible interfaces, the DAIDS-ES enables NIAID, its global collaborators and stakeholders, access to timely, quality information about NIAID-supported clinical trials which is utilized to: (1) analyze the research portfolio, assess capacity, identify opportunities, and avoid redundancies; (2) help support study safety, quality, ethics, and regulatory compliance; (3) conduct evidence-based policy analysis and business process re-engineering for improved efficiency. This report summarizes how the DAIDS-ES was conceptualized, how it differs from typical clinical trial support systems, the rationale for key design choices, and examples of how it is being used to advance the efficiency and effectiveness of NIAID's HIV/AIDS clinical research programs.
Toledo-Chávarri, A; Rué, M; Codern-Bové, N; Carles-Lavila, M; Perestelo-Pérez, L; Pérez-Lacasta, M J; Feijoo-Cid, M
This qualitative study evaluates a decision aid that includes the benefits and harms of breast cancer screening and analyses women's perception of the information received and healthcare professionals' perceptions of the convenience of providing it. Seven focus groups of women aged 40-69 years (n = 39) and two groups of healthcare professionals (n = 23) were conducted in Catalonia and the Canary Islands. The focus groups consisted of guided discussions regarding decision-making about breast cancer screening, and acceptability and feasibility of the decision aid. A content analysis was performed. Women positively value receiving information regarding the benefits and harms of breast cancer screening. Several women had difficulties understanding some concepts, especially those regarding overdiagnosis. Women preferred to share the decisions on screening with healthcare professionals. The professionals noted the lack of inclusion of some harms and benefits in the decision aid, and proposed improving the clarity of the statistical information. The information on overdiagnosis generates confusion among women and controversy among professionals. Faced with the new information presented by the decision aid, the majority of women prefer shared decision-making; however, its feasibility might be limited by a lack of knowledge and attitudes of rejection from healthcare professionals.
Ko, Linda K.; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael
As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse and most vulnerable populations. Latinos also have the lowest colorectal (CRC) screening rates of any ethnic group in the U.S. To address such disparities, health communication interventionists are often faced with the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. We describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish language version of an evidenced-based (English language) multimedia CRC screening decision aid. Our multi-step process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. We integrated these findings in the creation of the new adapted intervention. We describe how we used this process to identify and integrate socio-cultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish language decision aid. PMID:24328496
Background Coaching and guidance are structured approaches that can be used within or alongside patient decision aids (PtDAs) to facilitate the process of decision making. Coaching is provided by an individual, and guidance is embedded within the decision support materials. The purpose of this paper is to: a) present updated definitions of the concepts “coaching” and “guidance”; b) present an updated summary of current theoretical and empirical insights into the roles played by coaching/guidance in the context of PtDAs; and c) highlight emerging issues and research opportunities in this aspect of PtDA design. Methods We identified literature published since 2003 on shared decision making theoretical frameworks inclusive of coaching or guidance. We also conducted a sub-analysis of randomized controlled trials included in the 2011 Cochrane Collaboration Review of PtDAs with search results updated to December 2010. The sub-analysis was conducted on the characteristics of coaching and/or guidance included in any trial of PtDAs and trials that allowed the impact of coaching and/or guidance with PtDA to be compared to another intervention or usual care. Results Theoretical evidence continues to justify the use of coaching and/or guidance to better support patients in the process of thinking about a decision and in communicating their values/preferences with others. In 98 randomized controlled trials of PtDAs, 11 trials (11.2%) included coaching and 63 trials (64.3%) provided guidance. Compared to usual care, coaching provided alongside a PtDA improved knowledge and decreased mean costs. The impact on some other outcomes (e.g., participation in decision making, satisfaction, option chosen) was more variable, with some trials showing positive effects and other trials reporting no differences. For values-choice agreement, decisional conflict, adherence, and anxiety there were no differences between groups. None of these outcomes were worse when patients were exposed
... page: //medlineplus.gov/ency/article/000594.htm HIV/AIDS To use the sharing features on this page, ... immunodeficiency virus (HIV) is the virus that causes AIDS. When a person becomes infected with HIV, the ...
Xiao, Wei; Wu, Qing; Yang, Qun; Zhou, Liang; Jiang, Yuan; Zhang, Jiaxi; Miao, Danmin; Peng, Jiaxi
Background People encounter various moral issues that involve making decisions for others by giving advice. Objective This study investigated the characteristics of providing suggestions for oneself versus providing suggestions for others in ethical decision-making and the differences between them based on Construal Level Theory (CLT). Methods A total of 768 undergraduate students from three universities in China were randomly assigned to eight groups on the basis of a grid of two Construal Levels (self or others) by two different numbers of people saved (5 people or 15 people) by two problem situations (trolley problem vs. footbridge problem). The investigation examined participants’ decisions to opt to take action or refrain from action that would have the consequence of saving more people. Results The main effects of Construal Level (F1, 752 = 6.46, p = .011), saving number (F1, 752 = 35.81, p < .001), and problem situation type (F1, 752 = 330.55, p < .001) were all significant. The interaction of the problem situation and saving number (F1, 752 = 1.01, p = .31), and social distance and saving number (F1, 752 = 0.85, p = .36), and interaction of the three independent factors (F1, 752 = 0.47, p = .49) were not significant. However, the interaction of social distance and problem situation (F1, 752 = 9.46, p = .002) was significant. Results indicated the participants utilized a component of utilitarian reasoning in the decision-making, and their behaviors appeared more utilitarian at low Construal Levels (CLs) compared to high. Conclusion CLs, saving numbers, and problem situation significantly affected moral decision-making and exhibited significant interaction. Making decisions for oneself (low-construal) rather than giving advice to others (high-construal) was one important factor that determined whether the people were utilitarian or not. Utilitarian considerations are more relevant in impersonal dilemmas. PMID:25689521
Schuurman, Nadine; Randall, Ellen; Berube, Myriam
There is mounting pressure on healthcare planners to manage and contain costs. In rural regions, there is a particular need to rationalize health service allocation to ensure the best possible coverage for a dispersed population. Rural health administrators need to be able to quantify the population affected by their allocation decisions and, therefore, need the capacity to incorporate spatial analyses into their decision-making process. Spatial decision support systems (SDSS) can provide this capability. In this article, we combine geographical information systems (GIS) with a web-based graphical user interface (webGUI) in a SDSS tool that enables rural decision-makers charged with service allocation, to estimate population catchments around specific health services in rural and remote areas. Using this tool, health-care planners can model multiple scenarios to determine the optimal location for health services, as well as the number of people served in each instance.
Smith, Sian K; Kearney, Paul; Trevena, Lyndal; Barratt, Alexandra; Nutbeam, Don; McCaffery, Kirsten J
Abstract Background Offering informed choice in screening is increasingly advocated, but little is known about how evidence‐based information about the benefits and harms of screening influences understanding and participation in screening. Objective We aimed to explore how a bowel cancer screening decision aid influenced decision making and screening behaviour among adults with lower education and literacy. Methods Twenty‐one men and women aged 55–64 years with lower education levels were interviewed about using a decision aid to make their screening decision. Participants were purposively selected to include those who had and had not made an informed choice. Results Understanding the purpose of the decision aid was an important factor in whether participants made an informed choice about screening. Participants varied in how they understood and integrated quantitative risk information about the benefits and harms of screening into their decision making; some read it carefully and used it to justify their screening decision, whereas others dismissed it because they were sceptical of it or lacked confidence in their own numeracy ability. Participants’ prior knowledge and beliefs about screening influenced how they made sense of the information. Discussion and conclusions Participants valued information that offered them a choice in a non‐directive way, but were concerned that it would deter people from screening. Healthcare providers need to be aware that people respond to screening information in diverse ways involving a range of literacy skills and cognitive processes. PMID:22512746
Helping the decision maker effectively promote various experts’ views into various optimal solutions to China’s institutional problem of health care provider selection through the organization of a pilot health care provider research system
Background The main aim of China’s Health Care System Reform was to help the decision maker find the optimal solution to China’s institutional problem of health care provider selection. A pilot health care provider research system was recently organized in China’s health care system, and it could efficiently collect the data for determining the optimal solution to China’s institutional problem of health care provider selection from various experts, then the purpose of this study was to apply the optimal implementation methodology to help the decision maker effectively promote various experts’ views into various optimal solutions to this problem under the support of this pilot system. Methods After the general framework of China’s institutional problem of health care provider selection was established, this study collaborated with the National Bureau of Statistics of China to commission a large-scale 2009 to 2010 national expert survey (n = 3,914) through the organization of a pilot health care provider research system for the first time in China, and the analytic network process (ANP) implementation methodology was adopted to analyze the dataset from this survey. Results The market-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the doctors’ point of view; the traditional government’s regulation-oriented health care provider approach was the optimal solution to China’s institutional problem of health care provider selection from the pharmacists’ point of view, the hospital administrators’ point of view, and the point of view of health officials in health administration departments; the public private partnership (PPP) approach was the optimal solution to China’s institutional problem of health care provider selection from the nurses’ point of view, the point of view of officials in medical insurance agencies, and the health care researchers’ point
Weitkamp, Gerd; Van den Berg, Agnes E; Bregt, Arnold K; Van Lammeren, Ron J A
In the last decade policy makers have increasingly recognized the need to include people's perceptions in methods for describing landscape quality. At the same time, a third wave of Geographic Information Systems (GIS) has become available that make it technically possible to model landscape quality in a realistic manner. However, as there is often a mismatch between science and policy, it remains unclear to what extent perception-based models developed by scientists can be useful to policy makers. The aim of the present study was to evaluate the usefulness to policy making of a GIS-based procedure for describing perceived landscape openness. To this end, a workshop was organized which was attended by eight Dutch policy makers who acted as representatives of their province (region). The Group Decision Room (GDR) technique was used to elicit the policy makers' evaluations of the procedure in an anonymous and reliable manner. The procedure was presented to the policy makers using cases from their own province, which they assessed using a mixture of qualitative and quantitative methods. The results show that policy makers rated the procedure as being highly relevant to policy making, scientifically credible, usable by policy makers and feasible to implement in the policy making process. They especially appreciated the flexibility and transparency of the procedure. The policy makers concluded that the procedure would be of most value for monitoring landscape changes and for analysing impacts on landscape openness in land use scenario studies. However, they requested guidelines for proper implementation of the various options in the procedure. In general, the current study shows that explicit and transparent evaluation of the usefulness of GIS-based tools can aid integration at the science-policy interface and help to ensure that both scientists and policy makers are informed of interrelated options and requirements.
Lee, Ji Eun; Shin, Dong Wook; Suh, Beomseok; Chun, Sohyun; Nam, You-Seon; Cho, Belong
Introduction In Asian countries, reluctance to seek pharmacological intervention is a major barrier for smoking cessation. Culturally appropriate decision aids are expected to help people in the decision making for the use of smoking cessation medication. Objective The aim of this study was to develop a culturally tailored decision aid for smoking cessation and evaluate its effect on the use of smoking cessation medication. Patients and methods A 7-minute video on smoking cessation information and options was developed. Physicians were randomized into intervention and control groups. The decision aid was provided to patients in the intervention group, and they watched it, while those in the control group were provided usual medical care for smoking cessation. The primary outcome was the proportion of smokers who were prescribed smoking cessation medication within 1 month after consultation. The secondary outcomes were abstinence rate and use of smoking cessation medication within 6 months. A logistic regression analysis was used to assess the effect of the decision aid on the outcomes. Results In total, 414 current smokers (intervention group: 195; control group: 219) were enrolled. The mean age of the participants was 48.2 years, and 381 subjects (92%) were males. In total, 11.8% of the participants in the intervention group and 10.5% in the control group were prescribed smoking cessation medications within 1 month. The odds ratio was 1.02 (95% CI: 0.40–2.63) after adjustment for baseline characteristics. Within 6 months, 17.4% of the participants in the intervention group and 15% in the control group were prescribed medication (adjusted odds ratio 1.12, 95% CI: 0.59–2.13). Conclusion The culturally tailored smoking cessation decision aid developed in this study did not show a significant impact on the decision to use smoking cessation medication. Further research to develop more effective and more interactive interventions is expected. PMID:27703338
Sarif, Siti Mahfuzah; Ibrahim, Norfiza; Shiratuddin, Norshuhada
This paper provides a structured review of a design model of a computerized personal decision aid that is intended for youth, named as YouthPDA Design Model. The proposed design model was examined by experts in related areas to ensure the appropriateness of the proposed components and elements, relevancy of the terminologies used, logic of the flow, usability, and practicality of the design model towards development of YouthPDA application. Seven experts from related areas were involved in the evaluation. Discussions on the findings obtained from the expert review are included in this paper. Finally, a revised design model of YouthPDA is proposed as main guidance to develop YouthPDA application.
Patrick, Nicholas J. M.; Sheridan, Thomas B.
different airspace design and air traffic management policies. A decision aid is proposed which would combine the pilot's notion of optimility with the GA-based optimization, provide the pilot with a number of alternative pareto-optimal trajectories, and allow him to consider un-modelled attributes and constraints in choosing among them. A solution to the problem of displaying alternatives in a multi-attribute decision space is also presented.
Patrick, Nicholas J. M.; Sheridan, Thomas B.
different airspace design and air traffic management policies. A decision aid is proposed which would combine the pilot's notion of optimality with the GA-based optimization, provide the pilot with a number of alternative pareto-optimal trajectories, and allow him to consider unmodelled attributes and constraints in choosing among them. A solution to the problem of displaying alternatives in a multi-attribute decision space is also presented.
Stilman, Boris; Yakhnis, Vladimir; Umanskiy, Oleg; Boyd, Ron
In the increasingly NetCentric battlespace of the 21st century, Stilman Advanced Strategies Linguistic Geometry software has the potential to revolutionize the way that the Navy fights in two key areas: as a Tactical Decision Aid and for creating a relevant Common Operating Picture. Incorporating STILMAN's software into a prototype Tactical Action Officers (TAO) workstation as a Tactical Decision Aid (TDA) will allow warfighters to manage their assets more intelligently and effectively. This prototype workstation will be developed using human-centered design principles and will be an open, component-based architecture for combat control systems for future small surface combatants. It will integrate both uninhabited vehicles and onboard sensors and weapon systems across a squadron of small surface combatants. In addition, the hypergame representation of complex operations provides a paradigm for the presentation of a common operating picture to operators and personnel throughout the command hierarchy. In the hypergame technology there are game levels that span the range from the tactical to the global strategy level, with each level informing the others. This same principle will be applied to presenting the relevant common operating picture to operators. Each operator will receive a common operating picture that is appropriate for their level in the command hierarchy. The area covered by this operating picture and the level of detail contained within it will be dependent upon the specific tasks the operator is performing (supervisory vice tactical control) and the level of the operator (or command personnel) within the command hierarchy. Each level will inform the others to keep the picture concurrent and up-to-date.
Kaner, Eileen; Heaven, Ben; Rapley, Tim; Murtagh, Madeleine; Graham, Ruth; Thomson, Richard; May, Carl
Background Much of the research on decision-making in health care has focused on consultation outcomes. Less is known about the process by which clinicians and patients come to a treatment decision. This study aimed to quantitatively describe the behaviour shown by doctors and patients during primary care consultations when three types of decision aids were used to promote treatment decision-making in a randomised controlled trial. Methods A video-based study set in an efficacy trial which compared the use of paper-based guidelines (control) with two forms of computer-based decision aids (implicit and explicit versions of DARTS II). Treatment decision concerned warfarin anti-coagulation to reduce the risk of stroke in older patients with atrial fibrillation. Twenty nine consultations were video-recorded. A ten-minute 'slice' of the consultation was sampled for detailed content analysis using existing interaction analysis protocols for verbal behaviour and ethological techniques for non-verbal behaviour. Results Median consultation times (quartiles) differed significantly depending on the technology used. Paper-based guidelines took 21 (19–26) minutes to work through compared to 31 (16–41) minutes for the implicit tool; and 44 (39–55) minutes for the explicit tool. In the ten minutes immediately preceding the decision point, GPs dominated the conversation, accounting for 64% (58–66%) of all utterances and this trend was similar across all three arms of the trial. Information-giving was the most frequent activity for both GPs and patients, although GPs did this at twice the rate compared to patients and at higher rates in consultations involving computerised decision aids. GPs' language was highly technically focused and just 7% of their conversation was socio-emotional in content; this was half the socio-emotional content shown by patients (15%). However, frequent head nodding and a close mirroring in the direction of eye-gaze suggested that both parties
Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors
Shaffer, Victoria A; Zikmund-Fisher, Brian J
The use of patient stories in decision aids is a highly controversial practice. However, the resulting debates and research have yielded little consensus about the impact of patient stories due to vague operational definitions of narratives. In this article, we argue that narratives are not homogeneous in either content or effect and hence should not be considered a single construct in research. The purpose of this article is to provide a taxonomy that guides both the development of decision aids and future research on this topic. We define three dimensions of narratives that are likely to moderate their impact on decision making: 1) the purpose of the narrative, 2) the content of the message, and 3) the evaluative valence, or overall tone, of the message. In addition, we describe predicted effects of different types of narratives on decision making and discuss their potential interactions. Our taxonomy provides a framework that will allow for the precise documentation of different narrative types, the use of appropriate outcome measures, and a systematic evaluation of narratives in all types of decision aids. Failures to recognize the complex structure of narratives will result both in research that does little to inform our understanding of the impact of patient stories and in the use of narratives in patient education materials that have unintended consequences on both decision processes and behavior.
Background Decision aids are evidence-based tools designed to inform people of the potential benefit and harm of treatment options, clarify their preferences and provide a shared decision-making structure for discussion at a clinic visit. For patients with rheumatoid arthritis (RA) who are considering methotrexate, we have developed a web-based patient decision aid called the ANSWER (Animated, Self-serve, Web-based Research Tool). This study aimed to: 1) assess the usability of the ANSWER prototype; 2) identify strengths and limitations of the ANSWER from the patient’s perspective. Methods The ANSWER prototype consisted of: 1) six animated patient stories and narrated information on the evidence of methotrexate for RA; 2) interactive questionnaires to clarify patients’ treatment preferences. Eligible participants for the usability test were patients with RA who had been prescribed methotrexate. They were asked to verbalize their thoughts (i.e., think aloud) while using the ANSWER, and to complete the System Usability Scale (SUS) to assess overall usability (range = 0-100; higher = more user friendly). Participants were audiotaped and observed, and field notes were taken. The testing continued until no new modifiable issues were found. We used descriptive statistics to summarize participant characteristics and the SUS scores. Content analysis was used to identified usability issues and navigation problems. Results 15 patients participated in the usability testing. The majority were aged 50 or over and were university/college graduates (n = 8, 53.4%). On average they took 56 minutes (SD = 34.8) to complete the tool. The mean SUS score was 81.2 (SD = 13.5). Content analysis of audiotapes and field notes revealed four categories of modifiable usability issues: 1) information delivery (i.e., clarity of the information and presentation style); 2) navigation control (i.e., difficulties in recognizing and using the navigation control buttons); 3
Gwede, Clement K.; Davis, Stacy N.; Wilson, Shaenelle; Patel, Mitul; Vadaparampil, Susan T.; Meade, Cathy D.; Rivers, Brian M.; Yu, Daohai; Torres-Roca, Javier; Heysek, Randy; Spiess, Philippe E.; Pow-Sang, Julio; Jacobsen, Paul
Purpose First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity. Design A cross-sectional, qualitative Setting Study setting was a cancer center in southwest Florida. Participants The study comprised 44 participants (24 PC patients and 20 unaffected FDRs). Method Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods. Results Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM. Conclusion Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway. PMID:24968183
Sheridan, Thomas B.; Roseborough, James B.; Das, Hari; Chin, Kan-Ping; Inoue, Seiichi
Four separate projects recently completed or in progress at the MIT Man-Machine Systems Laboratory are summarized. They are: a decision aid for retrieving a tumbling satellite in space; kinematic control and graphic display of redundant teleoperators; real time terrain/object generation: a quad-tree approach; and two dimensional control for three dimensional obstacle avoidance.
Rodriguez, Daniela Cristina
In Mexico, as in many other countries, HIV/AIDS strategies are developed at the federal level and implemented at the state level. Local programs are expected to use data, in particular surveillance data, to drive their decisions on programmatic activities and prioritize populations with which the program will engage. Since the early 1980s Mexico…
Jibaja-Weiss, Maria L; Volk, Robert J
Decision aids have been developed by using various delivery methods, including interactive computer programs. Such programs, however, still rely heavily on written information, health and digital literacy, and reading ease. We describe an approach to overcome these potential barriers for low-literate, underserved populations by making design considerations for poor readers and naïve computer users and by using concepts from entertainment education to engage the user and to contextualize the content for the user. The system design goals are to make the program both didactic and entertaining and the navigation and graphical user interface as simple as possible. One entertainment education strategy, the soap opera, is linked seamlessly to interactive learning modules to enhance the content of the soap opera episodes. The edutainment decision aid model (EDAM) guides developers through the design process. Although designing patient decision aids that are educational, entertaining, and targeted toward poor readers and those with limited computer skills is a complex task, it is a promising strategy for aiding this population. Entertainment education may be a highly effective approach to promoting informed decision making for patients with low health literacy.
STEMRUST_G, a simulation model for epidemics of stem rust in perennial ryegrass grown to maturity as a seed crop, was validated for use as an heuristic tool and as a decision aid for disease management with fungicides. Model validation was by comparison of model output with observed disease severit...
Ickenroth, Martine H. P.; Grispen, J. E. J.; de Vries, N. K.; Dinant, G. J.; Ronda, G.; van der Weijden, T.
Currently, there are many diagnostic self-tests on body materials available to consumers. The aim of this study was to assess the effect of an online decision aid on diagnostic self-testing for cholesterol and diabetes on knowledge among consumers with an intention to take these tests. A randomized controlled trial was designed. A total of 1259…
Hirsch, Oliver; Szabo, Elisabeth; Keller, Heidemarie; Kramer, Lena; Krones, Tanja; Donner-Banzhoff, Norbert
Computerised log files are important for analysing user behaviour in health informatics to gain insight into processes that lead to suboptimal user patterns. This is important for software training programmes or for changes to improve usability. Technical user behaviour regarding decision aids has not so far been thoroughly investigated with log files. The aim of our study was to examine more detailed user interactions of primary-care physicians and their patients with arriba-lib, our multimodular electronic library of decision aids used during consultations, on the basis of log data. We analysed 184 consultation log files from 28 primary-care physicians. The average consultation time of our modules was about 8 min. Two-thirds of the consultation time were spent in the history information part of the programme. In this part, mainly bar charts were used to display risk information. Our electronic library of decision aids does not generate specific user behaviour based on physician characteristics such as age, gender, years in practice, or prior experience with decision aids. This supports the widespread use of our e-library in the primary-care sector and probably beyond.
Patrick, Nicholas J. M.
Our scientific goal is to understand the process of human decision-making. Specifically, a model of human decision-making in piloting modern commercial aircraft which prescribes optimal behavior, and against which we can measure human sub-optimality is sought. This model should help us understand such diverse aspects of piloting as strategic decision-making, and the implicit decisions involved in attention allocation. Our engineering goal is to provide design specifications for (1) better computer-based decision-aids, and (2) better training programs for the human pilot (or human decision-maker, DM).
Eden, Karen B.; Perrin, Nancy A.; Hanson, Ginger C.; Messing, Jill T.; Bloom, Tina L.; Campbell, Jacquelyn C.; Gielen, Andrea C.; Clough, Amber S.; Barnes-Hoyt, Jamie S.; Glass, Nancy E.
Background An Internet safety decision aid was developed to help abused women understand their risk for repeat and near-lethal intimate partner violence, clarify priorities related to safety, and develop an action plan customized to these priorities. Purpose The overall purpose of this study was to test the effectiveness of a safety decision aid compared with usual safety planning (control) delivered through a secure website, using a multi-state randomized controlled trial design. The paper evaluated the effectiveness of the safety decision aid in reducing decisional conflict after a single use by abused women. Design Randomized controlled trial referred to as IRIS, Internet Resource for Intervention and Safety Participants Abused women who spoke English (N = 708) were enrolled in a four-state, randomized controlled trial. Intervention and Control The intervention was an interactive safety decision aid with personalized safety plan; the control condition was usual safety planning resources. Both were delivered to participants through the secure study website. Main Outcome Measures This paper compared women’s decisional conflict about safety: total decisional conflict and the four subscales of this measure (feeling: uninformed, uncertain, unclear about safety priorities; and sensing lack of support) between intervention/control conditions. Data were collected 3/2011–5/2013 and analyzed 1/2014–3/2014. Results Immediately following the first use of the interactive safety decision aid, intervention women had significantly lower total decisional conflict than control women, controlling for baseline value of decisional conflict (p=0.002, effect size=.12). After controlling for baseline values, the safety decision aid group had significantly greater reduction in feeling uncertain (p=0.006, effect size=.07), and in feeling unsupported (p=0.008, effect size=.07) about safety than the usual safety planning group. Conclusions Abused women randomized to the safety
Rauner, M S; Brandeau, M L
Decisions about HIV prevention and treatment programs are based on factors such as program costs and health benefits, social and ethical issues, and political considerations. AIDS policy models--that is, models that evaluate the monetary and non-monetary consequences of decisions about HIV/AIDS interventions--can play a role in helping policy makers make better decisions. This paper provides an overview of the key issues related to developing useful AIDS policy models. We highlight issues of importance for researchers in the field of AIDS policy modeling as well as for policy makers. These include geographic area, setting, target groups, interventions, affordability and effectiveness of interventions, type and time horizon of policy model, and type of economic analysis. This paper is not intended to be an exhaustive review of the AIDS policy modeling literature, although many papers from the literature are discussed as examples; rather, we aim to convey the composition, achievements, and challenges of AIDS policy modeling.
Plant disease management decision aids typically require inputs of weather elements such as air temperature. Whereas many disease models are created based on weather elements at the crop canopy, and with relatively fine time resolution, the decision aids commonly are implemented with hourly weather...
Educators are increasingly responsible for teaching students about the deadly AIDS virus. This article discusses curricular approaches for certain age groups, summarizes progress in various communities, and provides blunt facts for decision-makers, an AIDS resource list with addresses, and an urgent plea from the Center for Disease Control. (MLH)
Langleyâs new Personal Fabrication Laboratory now has a MakerBot. In this video, the 3D printer is making a space shuttle out of glow-in-the-dark plastic material. In real-time, the process took...
Education Commission of the States, Denver, CO.
This paper provides an overview of SuccessMaker, a computer-based reading program that uses literature-based activities to focus on comprehension, vocabulary, phonics, and writing. Intended for use with students in prekindergarten through grade 8, the curriculum challenges students to apply knowledge from literature, content-area reading and…
... SECURITY Coast Guard Record of Decision (ROD) on the U.S. Coast Guard Long Range Aids to Navigation (Loran... ``USCG Long Range Aids to Navigation (Loran-C) Program'' Web site at http://loranpeis.uscg.e2m-inc.com....1D., and ``Aids to Navigation Authorized,'' which appears at 14 U.S.C. 81. Dated: January 4,...
Lueckmann, Sara Lena; Behmann, Mareike; Bisson, Susanne; Schneider, Nils
Background Statements on potential measures to improve palliative care in Germany predominantly reflect the points of view of experts from specialized palliative care organizations. By contrast, relatively little is known about the views of representatives of organizations and institutions that do not explicitly specialize in palliative care, but are involved to a relevant extent in the decision-making and policy-making processes. Therefore, for the first time in Germany, we carried out a representative study of the attitudes of a broad range of different stakeholders acting at the national or state level of the health care system. Methods 442 organizations and institutions were included and grouped as follows: patient organizations, nursing organizations, medical associations, specialized palliative care organizations, political institutions, health insurance funds and others. Using a standardized questionnaire, the participants were asked to rate their agreement with the World Health Organization's definition of palliative care (five-point scale: 1 = completely agree, 5 = completely disagree) and to evaluate 18 pre-selected improvement measures with regard to their general meaningfulness and the feasibility of their introduction into the German health care system (two-point scale: 1 = good, 2 = poor). Results The response rate was 67%. Overall, the acceptance of the aims of palliative care in the WHO definition was strong. However, the level of agreement among health insurance funds' representatives was significantly less than that among representatives of the palliative care organizations. All the improvement measures selected for evaluation were rated significantly higher in respect of their meaningfulness than of their feasibility in Germany. In detail, the meaningfulness of 16 measures was evaluated positively (70–100% participants chose the answer "good"); for six of these measures feasibility was evaluated negatively (0–30% "good"), while for the
Roggenstein, E. B.
The National Oceanic and Atmospheric Administration (NOAA) National Ocean Service (NOS) Physical Oceanographic Real-Time System (PORTS®) provides real-time water level, currents and meteorological data for aid to navigation in twenty-three major ports and harbors. In response to PORTS® users' requests for visibility data, NOS began testing several varieties of visibility sensors for operations in a marine environment. Extensive testing resulted in the selection of the Vaisala FS11 visibility sensor. The FS11 sensor uses forward scattering technology to measure the amount of scattering in a small volume of air between the transmitter and receiver, resulting in an extrapolated visibility at a set height out to 75 km. Two sensors have been successfully operating in the Mobile Bay PORTS® at Middle Bay Port and Pinto Island since installation in 2010. The sensors are positioned at a height of 3 m above the ground, 24 km apart along the western shore of the bay in areas susceptible to fog formation. Real-time data from these sensors are disseminated on NOAA's Center for Operational Oceanographic Products and Services (COOPS) PORTS® website every 6 minutes (min) and for distances up to 10 km (5.4 nm) from the instrument. This has proven to aid port pilots' decision making for safe movement of vessels in the harbor. Additionally, the Pinto Island sensor is located directly adjacent to the shipping channel - an area with high levels of atmospheric particulates of high carbon content. These particulates do not appear to have negatively affected sensor performance. This success has prompted interest in visibility sensors from other harbors with PORTS®. The ports of San Francisco, Narragansett Bay, Chesapeake Bay, Jacksonville FL, and Gulfport MS are planning or exploring the addition of visibility sensors to their PORTS® to aid in navigation. Additionally, the NOAA/COOPS Ocean System Test Evaluation Program (OSTEP) has continued with additional field testing of the FS11
Thompson, Jocelyn S.; Matlock, Daniel D.; McIlvennan, Colleen K.; Jenkins, Amy R.; Allen, Larry A.
STRUCTURED ABSTRACT Objective We aimed to create decision aids (DAs) for patients considering destination therapy left ventricular assist device (DT LVAD). Background DT LVAD is a major decision for patients with end-stage heart failure. Patients facing decisions with complex tradeoffs may benefit from high-quality decision support resources. Methods Following the International Patient Decision Aid Standards (IPDAS) guidelines and based on a needs assessment with stakeholders, we developed drafts of paper and video DAs. With input from patients, caregivers, and clinicians through alpha testing, we iteratively modified the DAs to ensure acceptability. Results We conducted semi-structured interviews with 24 patients, 20 caregivers, and 24 clinicians to assess readability, bias, and usability of the DAs. Stakeholder feedback allowed us to integrate aspects critical to decision-making around highly invasive therapies for life-threatening diseases, including addressing emotion and fear of death, using gain frames for all options that focus on living, highlighting palliative and hospice care, integrating the caregiver role, and utilizing a range of balanced testimonials. After 19 iterative versions of the paper DA and four versions of the video DA, final materials were made available for wider use. Conclusion We developed the first IPDAS-level DAs for DT LVAD. Given the extreme nature of this medical decision, we augmented traditional DA characteristics with non-traditional DA features to address a spectrum of cognitive, automatic, and emotional aspects of end-of-life decision-making. Not only are the DAs important tools for those confronting end-stage heart failure, but the lessons learned will likely inform decision support for other invasive therapies. UNSTRUCTURED ABSTRACT Destination therapy left ventricular assist device (DT LVAD) is a major decision for patients with end-stage heart failure. We aimed to create decision aids (DAs) to support patients and their
Uhler, Lauren M; Pérez Figueroa, Rafael E; Dickson, Mark; McCullagh, Lauren; Kushniruk, Andre; Monkman, Helen; Witteman, Holly O
Background Advance care planning may help patients receive treatments that better align with their goals for care. We developed a Web-based decision aid called InformedTogether to facilitate shared advance care planning between chronic obstructive pulmonary disease (COPD) patients and their doctors. Objective Our objective was to assess the usability of the InformedTogether decision aid, including whether users could interact with the decision aid to engage in tasks required for shared decision making, whether users found the decision aid acceptable, and implications for redesign. Methods We conducted an observational study with 15 patients and 8 doctors at two ethnically and socioeconomically diverse outpatient clinics. Data included quantitative and qualitative observations of patients and doctors using the decision aid on tablet or laptop computers and data from semistructured interviews. Patients were shown the decision aid by a researcher acting as the doctor. Pulmonary doctors were observed using the decision aid independently and asked to think aloud (ie, verbalize their thoughts). A thematic analysis was implemented to explore key issues related to decision aid usability. Results Although patients and doctors found InformedTogether acceptable and would recommend that doctors use the decision aid with COPD patients, many patients had difficulty understanding the icon arrays that were used to communicate estimated prognoses and could not articulate the definitions of the two treatment choices—Full Code and Do Not Resuscitate (DNR). Minor usability problems regarding content, links, layout, and consistency were also identified and corresponding recommendations were outlined. In particular, participants suggested including more information about potential changes in quality of life resulting from the alternative advance directives. Some doctor participants thought the decision aid was too long and some thought it may cause nervousness among patients due to
Nagle, Cate; Lewis, Sharon; Meiser, Bettina; Metcalfe, Sylvia; Carlin, John B; Bell, Robin; Gunn, Jane; Halliday, Jane
Background By providing information on the relative merits and potential harms of the options available and a framework to clarify preferences, decision aids can improve knowledge and realistic expectations and decrease decisional conflict in individuals facing decisions between alternative forms of action. Decision-making about prenatal testing for fetal abnormalities is often confusing and difficult for women and the effectiveness of decision aids in this field has not been established. This study aims to test whether a decision aid for prenatal testing of fetal abnormalities, when compared to a pamphlet, improves women's informed decision-making and decreases decisional conflict. Methods/design A cluster designed randomised controlled trial is being conducted in Victoria, Australia. Fifty General Practitioners (GPs) have been randomised to one of two arms: providing women with either a decision aid or a pamphlet. The two primary outcomes will be measured by comparing the difference in percentages of women identified as making an informed choice and the difference in mean decisional conflict scores between the two groups. Data will be collected from women using questionnaires at 14 weeks and 24 weeks gestation. The sample size of 159 women in both arms of the trial has been calculated to detect a difference of 18% (50 to 68%) in informed choice between the two groups. The required numbers have been adjusted to accommodate the cluster design, miscarriage and participant lost – to – follow up. Baseline characteristics of women will be summarised for both arms of the trial. Similarly, characteristics of GPs will be compared between arms. Differences in the primary outcomes will be analysed using 'intention-to-treat' principles. Appropriate regression techniques will adjust for the effects of clustering and include covariates to adjust for the stratifying variable and major potential confounding factors. Discussion The findings from this trial will make a
Hegenbart, Sebastian; Uhl, Andreas; Vécsei, Andreas
Celiac disease (CD) is a complex autoimmune disorder in genetically predisposed individuals of all age groups triggered by the ingestion of food containing gluten. A reliable diagnosis is of high interest in view of embarking on a strict gluten-free diet, which is the CD treatment modality of first choice. The gold standard for diagnosis of CD is currently based on a histological confirmation of serology, using biopsies performed during upper endoscopy. Computer aided decision support is an emerging option in medicine and endoscopy in particular. Such systems could potentially save costs and manpower while simultaneously increasing the safety of the procedure. Research focused on computer-assisted systems in the context of automated diagnosis of CD has started in 2008. Since then, over 40 publications on the topic have appeared. In this context, data from classical flexible endoscopy as well as wireless capsule endoscopy (WCE) and confocal laser endomicrosopy (CLE) has been used. In this survey paper, we try to give a comprehensive overview of the research focused on computer-assisted diagnosis of CD. PMID:25770906
Al-Ayat, R.A.; Lamont, A.; Sicherman, A.
This report describes a prototype decision aid which has been developed to assist the Institutional Research and Development (IR&D) Committee in selecting proposals for funding. This tool was requested to help address the following concerns about the IR&D proposal selection process: Some good proposals might be overlooked simply because no one on the Committee advocates them forcefully. The process takes a lot of time. The final portfolio of proposals selected may not maximize the long-run benefits to the Laboratory. These concerns stem from the observation that there is no formal framework for making distinctions between proposals, or weighing and comparing those distinctions. It was felt that the process could be improved by a framework that: Provides explicit descriptors that Committee members can use to evaluate and compare different features of proposals. Encourages the Committee to use a uniform, systematic scheme for evaluating the proposals. Helps the Committee focus more quickly on the issues that are truly relevant for distinguishing between proposals.
Volk, Michael L; Roney, Meghan; Fagerlin, Angela
Prior studies have shown that patients are reluctant to accept donor-specific risks, and transplant professionals lack an effective and time-efficient means of obtaining informed consent. We designed and pilot-tested a Web-based patient decision aid (DA) on organ quality. The DA was administered to 53 liver transplant candidates (median Model for End-Stage Liver Disease score = 14, range = 7-26), and they took a mean of 15 minutes to complete it. Questions about knowledge and attitudes were asked before and after the DA. Subjects' knowledge improved, with 53% and 60% correctly answering questions about hepatitis B virus and human immunodeficiency virus transmission before the DA and 94% and 100%, respectively, correctly answering them afterward (P < 0.001). The accuracy of mortality prediction also improved from a mean 3-month mortality estimate of 22% before the DA to 12% afterward (P < 0.001). After the DA, subjects felt that it was more likely that they might be offered a less-than-perfect liver (P = 0.001), and they were more likely to consider accepting such a liver (P < 0.001). In conclusion, implementing a Web-based patient DA is feasible and improves knowledge among liver transplant candidates. The use of this tool may decrease candidates' reluctance to accept extended criteria organs.
Nugent, Richard O.; Tucker, Richard W.
MITRE has been developing a Knowledge-Based Battle Management Testbed for evaluating the viability of integrating independently-developed knowledge-based decision aids in the Air Force tactical domain. The primary goal for the testbed architecture is to permit a new system to be added to a testbed with little change to the system's software. Each system that connects to the testbed network declares that it can provide a number of services to other systems. When a system wants to use another system's service, it does not address the server system by name, but instead transmits a request to the testbed network asking for a particular service to be performed. A key component of the testbed architecture is a common database which uses a relational database management system (RDBMS). The RDBMS provides a database update notification service to requesting systems. Normally, each system is expected to monitor data relations of interest to it. Alternatively, a system may broadcast an announcement message to inform other systems that an event of potential interest has occurred. Current research is aimed at dealing with issues resulting from integration efforts, such as dealing with potential mismatches of each system's assumptions about the common database, decentralizing network control, and coordinating multiple agents.
Butow, Phyllis; Hutchings, Elizabeth; Douglas, Charles; Coll, Joseph R; Boyle, Frances M
Background Neoadjuvant systemic therapy is offered to selected women with large and/or highly proliferative operable breast cancers. This option adds further complexity to an already complex breast cancer treatment decision tree. Patient decision aids are an established method of increasing patient involvement and knowledge while decreasing decisional conflict. There is currently no decision aid available for women considering neoadjuvant systemic therapy. Objective We aimed to develop a decision aid for women diagnosed with operable breast cancer and considered suitable for neoadjuvant systemic therapy, and the protocol for a multicenter pre-post study evaluating the acceptability and feasibility of the decision aid. Methods The decision aid was developed through literature review, expert advisory panel, adherence to the International Patient Decision Aid Standards, and iterative review. The protocol for evaluation of the decision aid consists of the following: eligible women will undertake a series of questionnaires prior to and after using the decision aid. The primary endpoint is decision aid acceptability to patients and investigators and the feasibility of use. Secondary endpoints include change in decisional conflict, participant knowledge, and information involvement preference. Feasibility is defined as the proportion of eligible participants who use the decision aid to help inform their treatment decision. Results This study has recruited 29 out of a planned 50 participants at four Australian sites. A 12-month recruitment period is expected with a further 12-months follow-up. Conclusions The decision aid has the potential to allow patients with operable breast cancer, who have been offered neoadjuvant systemic therapy, decreased decisional conflict, and greater involvement in the decision. If this study finds that an online decision aid is feasible and acceptable, it will be made widely available for routine clinical practice. Trial Registration
Knight, Gwenan M; Dharan, Nila J; Fox, Gregory J; Stennis, Natalie; Zwerling, Alice; Khurana, Renuka; Dowdy, David W
The dominant approach to decision-making in public health policy for infectious diseases relies heavily on expert opinion, which often applies empirical evidence to policy questions in a manner that is neither systematic nor transparent. Although systematic reviews are frequently commissioned to inform specific components of policy (such as efficacy), the same process is rarely applied to the full decision-making process. Mathematical models provide a mechanism through which empirical evidence can be methodically and transparently integrated to address such questions. However, such models are often considered difficult to interpret. In addition, models provide estimates that need to be iteratively re-evaluated as new data or considerations arise. Using the case study of a novel diagnostic for tuberculosis, a framework for improved collaboration between public health decision-makers and mathematical modellers that could lead to more transparent and evidence-driven policy decisions for infectious diseases in the future is proposed. The framework proposes that policymakers should establish long-term collaborations with modellers to address key questions, and that modellers should strive to provide clear explanations of the uncertainty of model structure and outputs. Doing so will improve the applicability of models and clarify their limitations when used to inform real-world public health policy decisions.
Frederiksen, Christian; Kehoe, E. James; Wood, Robert
This study tested the effects of two instructional aids in a complex, dynamic environment, specifically, a business simulation. Participants studied (1) a "causal map," which depicted key variables in an interconnected network, (2) a textual outline of the same relationships, or (3) no-aid. With the relevant aid still available, the participants…
Jimenez, Manuel E; DuRivage, Nathalie E; Bezpalko, Orysia; Suh, Andrew; Wade, Roy; Blum, Nathan J; Fiks, Alexander G
Many young children identified with developmental concerns in pediatric settings do not receive early intervention (EI). We assessed the impact of a video decision aid and text message reminder on knowledge and attitudes regarding developmental delay and EI as well as referral completion. We conducted a pilot randomized controlled trial in an urban setting and enrolled 64 parent-child dyads referred to EI. Compared with controls, participants who received the intervention demonstrated increased knowledge regarding developmental delay and EI as well as more favorable attitudes in certain topics. Although we did not find a significant difference between arms in EI intake and evaluation, we found a pattern suggestive of increased intake and evaluation among participants with low health literacy in the intervention arm. Additional study is needed to identify strategies that improve the EI referral process for families and to understand the potential targeted role for decision aids and text messages.
Pfender, W F; Coop, L B; Seguin, S G; Mellbye, M E; Gingrich, G A; Silberstein, T B
STEMRUST_G, a simulation model for epidemics of stem rust in perennial ryegrass grown to maturity as a seed crop, was validated for use as a heuristic tool and as a decision aid for disease management with fungicides. Multistage validation had been used in model creation by incorporating previously validated submodels for infection, latent period duration, sporulation, fungicide effects, and plant growth. Validation of the complete model was by comparison of model output with observed disease severities in 35 epidemics at nine location-years in the Pacific Northwest of the United States. We judge the model acceptable for its purposes, based on several tests. Graphs of modeled disease progress were generally congruent with plotted disease severity observations. There was negligible average bias in the 570 modeled-versus-observed comparisons across all data, although there was large variance in size of the deviances. Modeled severities were accurate in >80% of the comparisons, where accuracy is defined as the modeled value being within twice the 95% confidence interval of the observed value, within ±1 day of the observation date. An interactive website was created to produce disease estimates by running STEMRUST_G with user-supplied disease scouting information and automated daily weather data inputs from field sites. The model and decision aid supplement disease managers' information by estimating the level of latent (invisible) and expressed disease since the last scouting observation, given season-long weather conditions up to the present, and it estimates effects of fungicides on epidemic development. In additional large-plot experiments conducted in grower fields, the decision aid produced disease management outcomes (management cost and seed yield) as good as or better than the growers' standard practice. In future, STEMRUST_G could be modified to create similar models and decision aids for stem rust of wheat and barley, after additional experiments to
Lurie, Jon D.; Spratt, Kevin F.; Blood, Emily A.; Tosteson, Tor D.; Tosteson, Anna N. A.; Weinstein, James N.
Study Design Secondary analysis within a large clinical trial Objective To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process. Summary of Background Data A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known. Methods Subjects enrolling in the Spine Patient Outcomes Research Trial (SPORT) with intervertebral disc herniation (IDH), spinal stenosis (SPS), or degenerative spondylolisthesis (DS) at thirteen multidisciplinary spine centers across the US were given an evidence-based videotape decision aid viewed prior to enrollment as part of informed consent. Results Of the 2505 patients, 86% (n=2151) watched the video and 14% (n=354) did not. Watchers shifted their preference more often than non-watchers(37.9% vs. 20.8%, p < 0.0001) and more often demonstrated a strengthened preference (26.2% vs. 11.1%, p < 0.0001). Among the 806 patients whose preference shifted after watching the video, 55% shifted toward surgery (p=0.003). Among the 617 who started with no preference, after the video 27% preferred non-operative care, 22% preferred surgery, and 51% remained uncertain. Conclusion After watching the evidence-based patient decision aid (video) used in SPORT, patients with specific lumbar spine disorders formed and/or strengthened their treatment preferences in a balanced way that did not appear biased toward or away from surgery. PMID:21358485
Griffith, Jennifer M; Lewis, Carmen L; Brenner, Alison RT; Pignone, Michael P
Background Decision aids can improve decision making processes, but the amount and type of information that they should attempt to communicate is controversial. We sought to compare, in a pilot randomized trial, two colorectal cancer (CRC) screening decision aids that differed in the number of screening options presented. Methods Adults ages 48–75 not currently up to date with screening were recruited from the community and randomized to view one of two versions of our previously tested CRC screening decision aid. The first version included five screening options: fecal occult blood test (FOBT), sigmoidoscopy, a combination of FOBT and sigmoidoscopy, colonoscopy, and barium enema. The second discussed only the two most frequently selected screening options, FOBT and colonoscopy. Main outcomes were differences in screening interest and test preferences between groups after decision aid viewing. Patient test preference was elicited first without any associated out-of-pocket costs (OPC), and then with the following costs: FOBT-$10, sigmoidoscopy-$50, barium enema-$50, and colonoscopy-$200. Results 62 adults participated: 25 viewed the 5-option decision aid, and 37 viewed the 2-option version. Mean age was 54 (range 48–72), 58% were women, 71% were White, 24% African-American; 58% had completed at least a 4-year college degree. Comparing participants that viewed the 5-option version with participants who viewed the 2-option version, there were no differences in screening interest after viewing (1.8 vs. 1.9, t-test p = 0.76). Those viewing the 2-option version were somewhat more likely to choose colonoscopy than those viewing the 5-option version when no out of pocket costs were assumed (68% vs. 46%, p = 0.11), but not when such costs were imposed (41% vs. 42%, p = 1.00). Conclusion The number of screening options available does not appear to have a large effect on interest in colorectal cancer screening. The effect of offering differing numbers of options may
Burley, Jarred L.; Fiorino, Steven T.; Randall, Robb M.; Bartell, Richard J.; Cusumano, Salvatore J.
This study demonstrates the development of a high energy laser tactical decision aid (HELTDA) by the AFIT/CDE for mission planning High Energy Laser (HEL) weapon system engagements as well as centralized, decentralized, or hybrid predictive avoidance (CPA/DPA/HPA) assessments. Analyses of example HEL mission engagements are described as well as how mission planners are expected to employ the software. Example HEL engagement simulations are based on geographic location and recent/current atmospheric weather conditions. The atmospheric effects are defined through the AFIT/CDE Laser Environmental Effects Definition and Reference (LEEDR) model or the High Energy Laser End-to-End Operational Simulation (HELEEOS) model upon which the HELTDA is based. These models enable the creation of vertical profiles of temperature, pressure, water vapor content, optical turbulence, and atmospheric particulates and hydrometeors as they relate to line-by-line layer extinction coefficient magnitude at wavelengths from the UV to the RF. Seasonal and boundary layer variations (summer/winter) and time of day variations for a range of relative humidity percentile conditions are considered to determine optimum efficiency in a specific environment. Each atmospheric particulate/hydrometeor is evaluated based on its wavelength-dependent forward and off-axis scattering characteristics and absorption effects on the propagating environment to and beyond the target. In addition to realistic vertical profiles of molecular and aerosol absorption and scattering, correlated optical turbulence profiles in probabilistic (percentile) format are included. Numerical weather model forecasts are incorporated in the model to develop comprehensive understanding of HEL weapon system performance.
Campbell, Michael S.; Holt, Carson; Moore, Barry; Yandell, Mark
This unit describes how to use the genome annotation and curation tools MAKER and MAKER-P to annotate protein coding and non-coding RNA genes in newly assembled genomes, update/combine legacy annotations in light of new evidence, add quality metrics to annotations from other pipelines, and map existing annotations to a new assembly. MAKER and MAKER-P can rapidly annotate genomes of any size, and scale to match available computational resources. PMID:25501943
Massey, R.; Miller, S.; Heward, A.
The need to engage with Europe's policy makers is more crucial now than ever. MEPs' understanding of the contribution and importance of planetary science to European research, industry, culture, education and job-creation may have major implications for both the direction of research and future funding for Europe's planetary science community. The mid-term review of the European Commission's Seventh Framework Programme is currently in progress and these discussions will feed into the drafting of Framework Eight. With space-going nations around the world redefining priorities, Europe may have an opportunity to take a lead in planetology on a global scale. This should be taken into account when considering planetology within the frameworks of the European Space Policy. This panel discussion, hosted by Dr Robert Massey, Deputy Executive of the Royal Astronomical Session, will look at engaging with policy makers from the point of view of those working in the European Parliament, European Commission, industry, as well as the planetary community.
Thomson, Richard G; Eccles, Martin P; Steen, I Nick; Greenaway, Jane; Stobbart, Lynne; Murtagh, Madeleine J; May, Carl R
Objective To determine the efficacy of a computerised decision aid in patients with atrial fibrillation making decisions on whether to take warfarin or aspirin therapy. Design Two‐armed open exploratory randomised controlled trial. Setting Two research clinics deriving participants from general practices in Northeast England. Participants 109 patients with atrial fibrillation aged over 60. Interventions Computerised decision aid applied in shared decision‐making clinic compared to evidence‐based paper guidelines applied as direct advice. Main outcome measures Primary outcome measure was the decision conflict scale. Secondary outcome measures included anxiety, knowledge, decision‐making preference, treatment decision, use of primary and secondary care services and health outcomes. Results Decision conflict was lower in the computerised decision aid group immediately after the clinic; mean difference −0.18 (95% CI −0.34 to −0.01). Participants in this group not already on warfarin were much less likely to start warfarin than those in the guidelines arm (4/16, 25% compared to the guidelines group 15/16, 93.8%, RR 0.27, 95% CI 0.11 to 0.63). Conclusions Decision conflict was lower immediately following the use of a computerised decision aid in a shared decision‐making consultation than immediately following direct doctor‐led advice based on paper guidelines. Furthermore, participants in the computerised decision aid group were significantly much less likely to start warfarin than those in the guidelines arm. The results show that such an approach has a positive impact on decision conflict comparable to other studies of decision aids, but also reduces the uptake of a clinically effective treatment that may have important implications for health outcomes. PMID:17545350
Schuttler, Jessica Oeth
Decision-making is a universal process that occurs constantly in life. Parent participation in educational decision-making is recognized as important by special education law, by special education and school psychology literature (Christenson & Sheridan, 2001; IDEIA, 2004;). Partnership in decision-making is especially important for parents of…
Having a framework and tools to help sort through complicated environmental issues in an objective way would be useful to communities and risk managers, and all the stakeholders affected by these issues. This is one need that DASEES (Decision Analysis for a Sustainable En...
Owens, Justin; Zikmund-Fisher, Brian J
Background Previous research has examined the impact of patient narratives on treatment choices, but to our knowledge, no study has examined the effect of narratives on information search. Further, no research has considered the relative impact of their format (text vs video) on health care decisions in a single study. Objective Our goal was to examine the impact of video and text-based narratives on information search in a Web-based patient decision aid for early stage breast cancer. Methods Fifty-six women were asked to imagine that they had been diagnosed with early stage breast cancer and needed to choose between two surgical treatments (lumpectomy with radiation or mastectomy). Participants were randomly assigned to view one of four versions of a Web decision aid. Two versions of the decision aid included videos of interviews with patients and physicians or videos of interviews with physicians only. To distinguish between the effect of narratives and the effect of videos, we created two text versions of the Web decision aid by replacing the patient and physician interviews with text transcripts of the videos. Participants could freely browse the Web decision aid until they developed a treatment preference. We recorded participants’ eye movements using the Tobii 1750 eye-tracking system equipped with Tobii Studio software. A priori, we defined 24 areas of interest (AOIs) in the Web decision aid. These AOIs were either separate pages of the Web decision aid or sections within a single page covering different content. Results We used multilevel modeling to examine the effect of narrative presence, narrative format, and their interaction on information search. There was a significant main effect of condition, P=.02; participants viewing decision aids with patient narratives spent more time searching for information than participants viewing the decision aids without narratives. The main effect of format was not significant, P=.10. However, there was a
Pereira, A C; Verdonschot, E H; Huysmans, M C
The decision to place sealants is a difficult one, and it has been suggested that in a low risk population it may be efficient to wait until caries is detected in the fissure. An invasive sealant technique with fissure preparation may then be indicated. The diagnostic method used in the indication of such a procedure should accurately detect both dentine caries and sound fissures: high sensitivity for dentine caries (at D3 threshold) with high specificity for enamel caries (at D1 threshold). The aims of this study were to assess the diagnostic performance of selected diagnostic methods at normal cut-offs for traditional dentine caries detection and at reduced cut-offs in relation to the desired performance mentioned above, and to assess whether fissure opening allows for accurate visual detection of dentinal caries. Data were obtained from 230 occlusal sites of 101 extracted human molar teeth. Diagnostic methods used on the entire sample were: visual inspection, electrical conductance measurements and laser fluorescence measurements. The sample was then divided into two groups. Group 1 was subjected to visual inspection after application of a dye. Group 2 was subjected to visual inspection after fissure opening only, and after subsequent dye application. Validation was performed by histological investigation. The results with cut-offs normally used in dentine caries detection were roughly in accordance with the literature, except for laser fluorescence. The sensitivity of visual inspection for dentinal caries (D3) was 17% before and 70% after fissure opening. Using reduced cut-offs, a 100% sensitivity (D3) was achieved with 2 methods, but this also resulted in 63 or 87% false positive diagnoses of sound surfaces. Visual inspection and electrical methods both showed a moderate to high sensitivity (D3) with a higher than 50% specificity (D1). It was concluded that visual inspection and electrical methods at reduced cut-offs may aid the indication of invasive sealant
TITLE: Proposal for Development of EBM-CDSS (Evidence-based Clinical Decision Support System) to Aid Prognostication in Terminally Ill Patients...SUBTITLE Proposal for development of EBM-CDSS (Evidence-based Clinical Decision Support System) to aid prognostication in terminally ill patients 5a...to improve prognostication of the life expectancy of terminally ill patients to improve referral of patients to hospice. In addition, the EBM-CDSS
Translating comparative effectiveness of depression medications into practice by comparing the depression medication choice decision aid to usual care: study protocol for a randomized controlled trial
Background Comparative effectiveness research (CER) documents important differences in antidepressants in terms of efficacy, safety, cost, and burden to the patient. Decision aids can adapt this evidence to help patients participate in making informed choices. In turn, antidepressant therapy will more likely reflect patients’ values and context, leading to improved adherence and mood outcomes. Methods/Design The objective of this study is to develop the Depression Medication Choice decision aid for use during primary care encounters, and to test its efficacy by conducting a clustered practical randomized trial comparing the decision aid to usual depression care in primary care practices. We will use a novel practice-based, patient-centered approach based on participatory action research that involves a multidisciplinary team of designers, investigators, clinicians, patient representatives, and other stakeholders for the development of the decision aid. We will then conduct a clustered practical randomized trial enrolling clinicians and their patients (n = 300) with moderate to severe depression from rural, suburban and inner city primary care practices (n = 10). The intervention will consist of the use of the depression medication choice decision aid during the clinical encounter. This trial will generate preliminary evidence of the relative impact of the decision aid on patient involvement in decision making, decision making quality, patient knowledge, and 6-month measures of medication adherence and mental health compared to usual depression care. Discussion Upon completion of the proposed research, we will have developed and evaluated the efficacy of the decision aid depression medication choice as a novel translational tool for CER in depression treatment, engaged patients with depression in their care, and refined the process by which we conduct practice-based trials with limited research footprint. Trial registration Clinical Trials.gov: NCT01502891 PMID
The study explored the effects of the overall similarity between donor and recipient of resistance and the recipient’s level of self - esteem on his... esteem -low self esteem recipients were the three experimental factors. The effect of these experimental variables on the recipients self -perceptions...reactions to being helped. A 2 x 2 x 2 factorial between subjects design was employed in which aid-no aid, similar donor-dissimilar donor and high self
Patzer, Rachel E.; Basu, Mohua; Mohan, Sumit; Smith, Kayla D.; Wolf, Michael; Ladner, Daniela; Friedewald, John J.; Chiles, Mariana; Russell, Allison; McPherson, Laura; Gander, Jennifer; Pastan, Stephen
Kidney transplantation is the preferred treatment for patients with end-stage renal disease, as it substantially increases a patient's survival and is cost saving compared to a lifetime of dialysis. However, transplantation is not universally chosen by patients with renal failure, and limited knowledge about the survival benefit of transplantation vs. dialysis may play a role. We created a mobile application clinical decision aid called iChoose Kidney to improve access to individualized prognosis information comparing dialysis and transplantation outcomes. We describe the iChoose Kidney study, a randomized controlled trial designed to test the clinical efficacy of a mobile health decision aid among end-stage renal disease patients referred for kidney transplantation at three large, diverse transplant centers across the U.S. Approximately 450 patients will be randomized to receive either: (1) standard of care or “usual” transplantation education, or (2) standard of care plus iChoose Kidney. The primary outcome is change in knowledge about the survival benefit of kidney transplantation vs. dialysis from baseline to immediate follow-up; secondary outcomes include change in treatment preferences, improved decisional conflict, and increased access to kidney transplantation. Analyses are also planned to examine effectiveness across subgroups of race, socioeconomic status, health literacy and health numeracy. Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation. PMID:27610423
Hazen, Robert M.
Since time immemorial, we have treasured diamonds for their exquisite beauty and unrivaled hardness. Yet, most of the earth's diamonds lie deep underground and totally unaccessible to us--if only we knew how to fabricate them! In The Diamond Makers Robert Hazen vividly recounts the very human desire to exceed nature and create a synthetic diamond. Spanning centuries of ground-breaking science, instances of bitter rivalry, cases of outright fraud and self-delusion, Hazen blends drama and science to reveal the extraordinary technological advances and devastating failures of the diamond industry. Along the way, readers will be introduced to the brilliant, often eccentric and controversial, pioneers of high-pressure research who have harnessed crushing pressures and scorching temperatures to transform almost any carbon-rich material, from road tar to peanut butter, into the most prized of all gems. Robert M. Hazen is the author of fifteen books, including the bestseller, Science Matters: Achieving Scientific Literacy, which he wrote with James Trefil. Dr. Hazen has won numerous awards for his research and scientific writing.
Anders, Mary C.; Christopher, F. Scott
The purpose of our study was to identify factors underlying rape survivors' post-assault prosecution decisions by testing a decision model that included the complex relations between the multiple social ecological systems within which rape survivors are embedded. We coded 440 police rape cases for characteristics of the assault and characteristics…
Checker, A. K.; Raj, R. Appavu
Flight vehicles carrying sensitive payloads and large amount of propellants pose danger to life and property around launch pad area. There are inherent limitations in conventional decision support system and at times the man in the loop is under severe strain while analyzing the real time data of flight vehicle for range safety decision support system. It is essential to use newer technological input for designing flight termination system for handling high speed, high maneuvering and multi-platform based flight vehicles. This calls for extensive trajectory simulation under various flight conditions and failure modes, collection of actual test data of sub systems and post flight data along with geographical, metrological and tracking instrument data to be collected and organized in a data warehouse for data mining. The information obtained in real time using large data base will aid range safety decision making in a complex scenario of flight testing in a test range. This paper highlights briefly the existing system and its constraints and attempt to evolve an innovative system combining knowledge base and real time data from multiple sensors and fusing the data from similar and dissimilar sensors using state-vector fusion technique for more reliable and quick range safety decision making.
air squadron. Roege formulated the problem as an assignment problem. The objective was to assign pilots to duties at a specified cost subject to crew...rest conitraints. Roege solved the problem using integer programming. Roege used the requirements in TACM 51-50 to form an objective function. The costs ...Measures: Measure of the impact the DSS has on decisions. Examples of productivity measures include the time required to reach a decision, the cost of making
Miles, A; Chronakis, I; Fox, J; Mayer, A
Objectives To develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA. Design Mixed methods. Setting Single outpatient oncology department in central London. Participants Consecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14–56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy. Primary outcomes Patient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA. Results PrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone. Conclusions Patients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy. PMID:28341685
Computer-based assessment of problem solving. Computers in Human Behavior , 15, 269–282. Booher, H.R. (1978). Job performance aids: Research and...Perspectives on computer-based performance assessment of problem solving. Computers in Human Behavior , 15, 255–268. Orasanu, J., and Connolly, T. (1993). The
Ko, Linda K; Reuland, Daniel; Jolles, Monica; Clay, Rebecca; Pignone, Michael
As the United States becomes more linguistically and culturally diverse, there is a need for effective health communication interventions that target diverse, vulnerable populations, including Latinos. To address such disparities, health communication interventionists often face the challenge to adapt existing interventions from English into Spanish in a way that retains essential elements of the original intervention while also addressing the linguistic needs and cultural perspectives of the target population. The authors describe the conceptual framework, context, rationale, methods, and findings of a formative research process used in creating a Spanish-language version of an evidence-based (English language) multimedia colorectal cancer screening decision aid. The multistep process included identification of essential elements of the existing intervention, literature review, assessment of the regional context and engagement of key stakeholders, and solicitation of direct input from target population. The authors integrated these findings in the creation of the new adapted intervention. They describe how they used this process to identify and integrate sociocultural themes such as personalism (personalismo), familism (familismo), fear (miedo), embarrassment (verguenza), power distance (respeto), machismo, and trust (confianza) into the Spanish-language decision aid.
Brown, Molly E.; Escobar, Vanessa M.; Lovell, Heather
This chapter will describe the challenges that earth scientists face in developing science data products relevant to decision maker and policy needs, and will describe strategies that can improve the two-way communication between the scientist and the policy maker. Climate change policy and decision making happens at a variety of scales - from local government implementing solar homes policies to international negotiations through the United Nations Framework Convention on Climate Change. Scientists can work to provide data at these different scales, but if they are not aware of the needs of decision makers or understand what challenges the policy maker is facing, they are likely to be less successful in influencing policy makers as they wished. This is because the science questions they are addressing may be compelling, but not relevant to the challenges that are at the forefront of policy concerns. In this chapter we examine case studies of science-policy partnerships, and the strategies each partnership uses to engage the scientist at a variety of scales. We examine three case studies: the global Carbon Monitoring System pilot project developed by NASA, a forest biomass mapping effort for Silvacarbon project, and a forest canopy cover project being conducted for forest management in Maryland. In each of these case studies, relationships between scientists and policy makers were critical for ensuring the focus of the science as well as the success of the decision-making.
Bates, Seth P.
Students are introduced to methods and concepts for systematic selection and evaluation of materials which are to be used to manufacture specific products in industry. For this laboratory exercise, students are asked to work in groups to identify and describe a product, then to proceed through the process to select a list of three candidates to make the item from. The exercise draws on knowledge of mechanical, physical, and chemical properties, common materials test techniques, and resource management skills in finding and assessing property data. A very important part of the exercise is the students' introduction to decision making algorithms, and learning how to apply them to a complex decision making process.
contingency plans have not been in- corporated in an option, but significant information is likely to become available during its execution. 188.8.131.52...Technology Corporation , 16 September 1983. Riemenschneider, R.A., Rockmore, A.J., and Wikman, T.A.A. Route planning aid: System specification (PAR Report...83-135). New Hartford, NY: PAR Technology Corporation , 31 October 1983. Savage, L.J. The foundations of statistics. NY: Wiley, 1954. Schum, D
Hongoh, Valerie; Michel, Pascal; Gosselin, Pierre; Samoura, Karim; Ravel, André; Campagna, Céline; Cissé, Hassane Djibrilla; Waaub, Jean-Philippe
The effects of climate change on infectious diseases are an important global health concern and necessitate decisions for allocation of resources. Economic tools have been used previously; however, how prioritization results might differ when done using broader considerations identified by local stakeholders has yet to be assessed. A multicriteria decision analysis (MCDA) approach was used to assess multi-stakeholder expressed concerns around disease prioritization via focus groups held in Quebec and Burkina Faso. Stakeholders weighted criteria and comparisons were made across study sites. A pilot disease prioritization was done to examine effects on disease rankings. A majority of identified criteria were common to both sites. The effect of context specific criteria and weights resulted in similar yet distinct prioritizations of diseases. The presence of consistent criteria between sites suggests that common concerns exist for prioritization; however, context-specific adjustments reveal much regarding resource availability, capacity and concerns that should be considered as this impacts disease ranking. Participatory decision aid approaches facilitate rich knowledge exchange and problem structuring. Furthermore, given multiple actors in low- and middle-income countries settings, multi-actor collaborations across non-governmental organizations, local government and community are important. Formal mechanisms such as MCDA provide means to foster consensus, shared awareness and collaboration. PMID:27077875
CATALOG NUMBERTechnical Report 475%; , ADAPTIVE DECISION &IDING IN OMPUTER-ASSISTED *JECHNICAL REPOT INSTRUCTION: ADAPTIVE COMPUTERIZED TRAINING )16...alternative. For example, in auto maintenance, the mechanic is trained to adjust the dis- tributor with a "feeler" guage or a dwell tachometer . He
Stringer, W. C.; And Others
Describes the development of a computer simulation model of forage-beef production systems, which is intended to incorporate soil, forage, and animal decisions into an enterprise scenario. Produces a summary of forage production and livestock needs. Cites positive assessment of the program's value by participants in inservice training workshops.…
Lajubutu, Oyebanjo A.
This paper shows how three critical enrollment indicators drawn from a relationship database were used to guide planning and management decisions. The paper discusses the guidelines for the development of the model, attributes needed, variables to be calculated, and other issues that may improve the effectiveness and efficiency of daily enrollment…
Hopf-Weichel, Rosemarie; And Others
This report describes results of the first year of a three-year program to develop and evaluate a new Adaptive Computerized Training System (ACTS) for electronics maintenance training. (ACTS incorporates an adaptive computer program that learns the student's diagnostic and decision value structure, compares it to that of an expert, and adapts the…
this area are still relatively scant in general (Brehmer, 1987; Flin et al 1997; Kerstholt, 1996; Mynatt et al 1977; Roelofsma, 1995; Zsambok & Klein...in a dynamic decision environment. Management Science, 31, 680-702. Mynatt , C.R., Doherty, M.E. and Tweney, R.T. (1977). Confirmation Bias in a
This comparison of two approaches to the development of computerized supports for decision making--expert systems and multivariate models--focuses on computerized systems that assist professionals with tasks related to diagnosis or classification in human services. Validation of both expert systems and statistical models is emphasized. (39…
Air Force Research Laboratory Human Effectiveness Directorate Warfighter Interface Division Cognitive Systems Branch...REPORT Warfighter Interface Division NUMBER(S) Cognitive Systems Branch Wright-Patterson AFB OH 45433-7604 AFRL-HE-WP-TR-2007-0042 12...training to support a commanders’ predictive battle-space awareness ability. The program provided an understanding of the decisions and other cognitive
Hansen, Helle Ploug; Draborg, Eva; Pedersen, Claus Duedal; Lamont, Ronald F; Jørgensen, Jan Stener
Background In Denmark, all pregnant women are offered screening in early pregnancy to estimate the risk of having a fetus with Down syndrome. Pregnant women participating in the screening program should be provided with information and support to allow them to make an informed choice. There is increasing interest in the use of Web-based technology to provide information and digital solutions for the delivery of health care. Objective The aim of this study was to develop an eHealth tool that contained accurate and relevant information to allow pregnant women to make an informed choice about whether to accept or reject participation in screening for Down syndrome. Methods The development of the eHealth tool involved the cooperation of researchers, technology experts, clinicians, and users. The underlying theoretical framework was based on participatory design, the International Patient Decision Aid Standards (IPDAS) Collaboration guide to develop a patient decision aid, and the roadmap for developing eHealth technologies from the Center for eHealth Research and Disease Management (CeHRes). The methods employed were a systematic literature search, focus group interviews with 3 care providers and 14 pregnant women, and 2 weeks of field observations. A qualitative descriptive approach was used in this study. Results Relevant themes from pregnant women and care providers with respect to information about Down syndrome screening were identified. Based on formalized processes for developing patient decision aids and eHealth technologies, an interactive website containing information about Down syndrome, methods of screening, and consequences of the test was developed. The intervention was based on user requests and needs, and reflected the current hospital practice and national guidelines. Conclusions This paper describes the development and content of an interactive website to support pregnant women in making informed choices about Down syndrome screening. To develop the
Juan, Anne S; Wakefield, Claire E; Kasparian, Nadine A; Kirk, Judy; Tyler, Janet; Tucker, Kathy
Despite the fact that both men and women can carry a breast/ovarian cancer-related mutation, the main emphasis in genetic counseling for breast/ovarian cancer-related risk remains on females. This study aimed to develop and pilot a decision aid specifically designed for men with a strong family history of breast and/or ovarian cancer who are considering genetic testing. The decision aid was developed by a multidisciplinary team of experts and a consumer representative. It was then reviewed by 27 men who had previously undergone genetic testing to identify a mutation in a BRCA1 or BRCA2 gene. All men who reviewed the decision aid indicated that they would recommend the booklet to other men in the same situation, and 96% of the sample (n = 26) reported being "very satisfied" or "satisfied" with the information contained in the decision aid. The decision aid was perceived by all participants as "very relevant" or "quite relevant" for men considering genetic testing. Ninety-three percent of men felt that it was easy to weigh the pros and cons of genetic testing with the help of the decision aid. The perceived impact on participants' emotions and understanding of the genetic testing process was also assessed. Several factors may hinder men from effectively weighing up the potential benefits and risks of genetic testing. A greater understanding of these issues may help health professionals to encourage men with a strong family history of breast and/or ovarian cancer to learn about cancer risk and the appropriate management strategies for themselves and their female relatives.
APPROACH The Maritime Energy Portfolio Management Approach provides a means for determining the best course of action where several initiatives...course of action where several ECMs compete for scarce funds. Efficient, user friendly use of the Maritime Energy Portfolio Interface and Decision...ship application. Outputs from the Business Case Analysis (BCA) include: Return on Investment (ROI) and Break Even Point ( BEP ). These metrics are
Duan, Suolin; Yu, Zhuqing
Safety is one of the crucial issues for robot-aided neurorehabilitation exercise. When it comes to the passive rehabilitation training for stroke patients, the existing control strategies are usually just based on position control to carry out the training, and the patient is out of the controller. However, to some extent, the patient should be taken as a “cooperator” of the training activity, and the movement speed and range of the training movement should be dynamically regulated according to the internal or external state of the subject, just as what the therapist does in clinical therapy. This research presents a novel motion control strategy for patient-centered robot-aided passive neurorehabilitation exercise from the point of the safety. The safety-motion decision-making mechanism is developed to online observe and assess the physical state of training impaired-limb and motion performances and regulate the training parameters (motion speed and training rage), ensuring the safety of the supplied rehabilitation exercise. Meanwhile, position-based impedance control is employed to realize the trajectory tracking motion with interactive compliance. Functional experiments and clinical experiments are investigated with a healthy adult and four recruited stroke patients, respectively. The two types of experimental results demonstrate that the suggested control strategy not only serves with safety-motion training but also presents rehabilitation efficacy. PMID:28194413
Stratton, D. A.; Stengel, Robert F.
Modern control theory and artificial intelligence technology are applied to the Wind Shear Safety Advisor, a conceptual airborne advisory system to help flight crews avoid or survive encounter with hazardous low-altitude wind shear. Numerical and symbolic processes of the system fuse diverse, time-varying data from ground-based and airborne measurements. Simulated wind-shear-encounter scenarios illustrate the need to consider a variety of factors for optimal decision reliability. The wind-shear-encounter simulations show the Wind Shear Safety Advisor's potential for effectively integrating the available information, highlighting the benefits of the computational techniques employed.
Coe, Austin M; Ueng, William; Vargas, Jennifer M; David, Raven; Vanegas, Alejandro; Infante, Katherine; Trivedi, Meghna; Yi, Haeseung; Dimond, Jill; Crew, Katherine D; Kukafka, Rita
Chemoprevention with antiestrogens could decrease the incidence of invasive breast cancer but uptake has been low among high-risk women in the United States. We have designed a web-based patient-facing decision aid, called RealRisks, to inform high-risk women about the risks and benefits of chemoprevention and facilitate shared decision-making with their primary care provider. We conducted two rounds of usability testing to determine how subjects engaged with and understood the information in RealRisks. A total of 7 English-speaking and 4 Spanish-speaking subjects completed testing. Using surveys, think-aloud protocols, and subject recordings, we identified several themes relating to the usability of RealRisks, specifically in the content, ease of use, and navigability of the application. By conducting studies in two languages with a diverse multi-ethnic population, we were able to implement interface changes to make RealRisks accessible to users with varying health literacy and acculturation.
Coe, Austin M.; Ueng, William; Vargas, Jennifer M.; David, Raven; Vanegas, Alejandro; Infante, Katherine; Trivedi, Meghna; Yi, Haeseung; Dimond, Jill; Crew, Katherine D.; Kukafka, Rita
Chemoprevention with antiestrogens could decrease the incidence of invasive breast cancer but uptake has been low among high-risk women in the United States. We have designed a web-based patient-facing decision aid, called RealRisks, to inform high-risk women about the risks and benefits of chemoprevention and facilitate shared decision-making with their primary care provider. We conducted two rounds of usability testing to determine how subjects engaged with and understood the information in RealRisks. A total of 7 English-speaking and 4 Spanish-speaking subjects completed testing. Using surveys, think-aloud protocols, and subject recordings, we identified several themes relating to the usability of RealRisks, specifically in the content, ease of use, and navigability of the application. By conducting studies in two languages with a diverse multi-ethnic population, we were able to implement interface changes to make RealRisks accessible to users with varying health literacy and acculturation. PMID:28269836
Wong, Jennifer; D'Alimonte, Laura; Angus, Jan; Paszat, Larry; Metcalfe, Kelly; Whelan, Tim; Llewellyn-Thomas, Hilary; Warner, Eiran; Franssen, Edmee; Szumacher, Ewa
Purpose: To develop a patient decision aid (PtDA) for older women with Stage I, pathologically node negative, estrogen receptor-positive progesterone receptor-positive breast cancer who are considering adjuvant radiotherapy after lumpectomy and to examine its impact on patients' decision making. Methods and Materials: A PtDA was developed and evaluated in three steps according to the Ottawa Decision Support Framework: (1) needs assessment (n = 16); (2) Pilot I to examine PtDA acceptability (n = 12); and (3) Pilot II, a pretest posttest (n = 38) with older women with estrogen receptor-positive progesterone receptor-positive breast cancer after lumpectomy who were receiving adjuvant radiation therapy. Measures included patients' satisfaction with the PtDA, self-reported decisional conflict, level of distress, treatment-related knowledge, and choice predisposition. Results: The PtDA is a booklet that details each adjuvant treatment option's benefits, risks, and side effects tailored to the patient's clinical profile; includes a values clarification exercise; and includes steps to guide patients towards their decision. On the basis of qualitative comments and satisfaction ratings, all women thought that the PtDA was helpful and informative. In comparison with their baseline scores, patients had a statistically significant (p < 0.05) reduction in decisional conflict (adjusted mean difference [AMD], -7.18; 95% confidence interval [CI], -13.50 to 12.59); increased clarity of the benefits and risks (AMD, -10.86; CI, -20.33 to 21.49); and improved general treatment knowledge (AMD, 8.99; CI, 2.88-10.28) after using the PtDA. General trends were also reported in the patients' choice predisposition scores that suggested potential differences in treatment decision after PtDA use. Conclusions: This study provides evidence that this PtDA may be a helpful educational tool for this group of women. The quality of care for older breast cancer patients may be enhanced by the use of a
Moura, P; Barraud, S; Baptista, M B; Malard, F
Nowadays, stormwater infiltration systems are frequently used because of their ability to reduce flows and volumes in downstream sewers, decrease overflows in surface waters and make it possible to recharge groundwater. Moreover, they come in various forms with different uses. Despite these advantages the long term sustainability of these systems is questionable and their real performances have to be assessed taking into account various and sometimes conflicting aspects. To address this problem a decision support system is proposed. It is based on a multicriteria method built to help managers to evaluate the performance of an existing infiltration system at different stages of its lifespan and identify whether it performs correctly or not, according to environmental, socio-economic, technical and sanitary aspects. The paper presents successively: the performance indicators and the way they were built, the multicriteria method to identify if the system works properly and a case study.
Merényi, Erzsébet; Tasdemir, Kadim; Farrand, William H.
Effective scientific exploration of remote targets such as solar system objects increasingly calls for autonomous data analysis and decision making on-board. Today, robots in space missions are programmed to traverse from one location to another without regard to what they might be passing by. By not processing data as they travel, they can miss important discoveries, or will need to travel back if scientists on Earth find the data warrant backtracking. This is a suboptimal use of resources even on relatively close targets such as the Moon or Mars. The farther mankind ventures into space, the longer the delay in communication, due to which interesting findings from data sent back to Earth are made too late to command a (roving, floating, or orbiting) robot to further examine a given location. However, autonomous commanding of robots in scientific exploration can only be as reliable as the scientific information extracted from the data that is collected and provided for decision making. In this paper, we focus on the discovery scenario, where information extraction is accomplished with unsupervised clustering. For high-dimensional data with complicated structure, detailed segmentation that identifies all significant groups and discovers the small, surprising anomalies in the data, is a challenging task at which conventional algorithms often fail. We approach the problem with precision manifold learning using self-organizing neural maps with non-standard features developed in the course of our research. We demonstrate the effectiveness and robustness of this approach on multi-spectral imagery from the Mars Exploration Rovers Pancam, and on synthetic hyperspectral imagery.
Garcia-Retamero, Rocio; Cokely, Edward T
Background Effective risk communication is essential for informed decision making. Unfortunately, many people struggle to understand typical risk communications because they lack essential decision-making skills. Objective The aim of this study was to review the literature on the effect of numeracy on risk literacy, decision making, and health outcomes, and to evaluate the benefits of visual aids in risk communication. Method We present a conceptual framework describing the influence of numeracy on risk literacy, decision making, and health outcomes, followed by a systematic review of the benefits of visual aids in risk communication for people with different levels of numeracy and graph literacy. The systematic review covers scientific research published between January 1995 and April 2016, drawn from the following databases: Web of Science, PubMed, PsycINFO, ERIC, Medline, and Google Scholar. Inclusion criteria were investigation of the effect of numeracy and/or graph literacy, and investigation of the effect of visual aids or comparison of their effect with that of numerical information. Thirty-six publications met the criteria, providing data on 27,885 diverse participants from 60 countries. Results Transparent visual aids robustly improved risk understanding in diverse individuals by encouraging thorough deliberation, enhancing cognitive self-assessment, and reducing conceptual biases in memory. Improvements in risk understanding consistently produced beneficial changes in attitudes, behavioral intentions, trust, and healthy behaviors. Visual aids were found to be particularly beneficial for vulnerable and less skilled individuals. Conclusion Well-designed visual aids tend to be highly effective tools for improving informed decision making among diverse decision makers. We identify five categories of practical, evidence-based guidelines for heuristic evaluation and design of effective visual aids.
Wood, E. F.; Sheffield, J.; Fisher, C. K.; Chaney, N.; Wanders, N.
forecast skill and the effective delivery of the information to decision makers.
Begley, Charles; Shegog, Ross; Harding, Angelique; Goldsmith, Corey; Hope, Omotola; Newmark, Michael
The purpose of this paper is to report on the development and feasibility of the longitudinal version of MINDSET, a clinical tool to assist patients and health-care providers in epilepsy self-management. A previous study described the feasibility of using MINDSET to identify and prioritize self-management issues during a clinic visit. This paper describes the development of the longitudinal version of MINDSET and feasibility test over multiple visits with a printed action plan for goal setting and the capacity for monitoring changes in self-management. Feasibility was assessed based on 1) postvisit patient and provider interviews addressing ease of use and usefulness, patient/provider communication, and shared decision-making and 2) the capacity of the tool to monitor epilepsy characteristics and self-management over time. Results indicate MINDSET feasibility for 1) identifying and facilitating discussion of self-management issues during clinic visits, 2) providing a printable list of prioritized issues and tailored self-management goals, and 3) tracking changes in epilepsy characteristics and self-management over time.
Vitorino de Souza Melaré, Angelina; Montenegro González, Sahudy; Faceli, Katti; Casadei, Vitor
Population growth associated with population migration to urban areas and industrial development have led to a consumption relation that results in environmental, social, and economic problems. With respect to the environment, a critical concern is the lack of control and the inadequate management of the solid waste generated in urban centers. Among the challenges are proper waste-collection management, treatment, and disposal, with an emphasis on sustainable management. This paper presents a systematic review on scientific publications concerning decision support systems applied to Solid Waste Management (SWM) using ICTs and OR in the period of 2010-2013. A statistical analysis of the eighty-seven most relevant publications is presented, encompassing the ICTs and OR methods adopted in SWM, the processes of solid-waste management where they were adopted, and which countries are investigating solutions for the management of solid waste. A detailed discussion on how the ICTs and OR methods have been combined in the solutions was also presented. The analysis and discussion provided aims to help researchers and managers to gather insights on technologies/methods suitable the SWM challenges they have at hand, and on gaps that can be explored regarding technologies/methods that could be useful as well as the processes in SWM that currently do not benefit from using ICTs and OR methods.
Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S.; Aguirre, Alejandra N.; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D.; Kukafka, Rita
The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%–94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention. PMID:26958276
Yi, Haeseung; Xiao, Tong; Thomas, Parijatham S; Aguirre, Alejandra N; Smalletz, Cindy; Dimond, Jill; Finkelstein, Joseph; Infante, Katherine; Trivedi, Meghna; David, Raven; Vargas, Jennifer; Crew, Katherine D; Kukafka, Rita
The purpose of this study was to identify barriers and facilitators to patient-provider communication when discussing breast cancer risk to aid in the development of decision support tools. Four patient focus groups (N=34) and eight provider focus groups (N=10) took place in Northern Manhattan. A qualitative analysis was conducted using Atlas.ti software. The coding yielded 62.3%-94.5% agreement. The results showed that 1) barriers are time constraints, lack of knowledge, low health literacy, and language barriers, and 2) facilitators are information needs, desire for personalization, and autonomy when communicating risk in patient-provider encounters. These results will inform the development of a patient-centered decision aid (RealRisks) and a provider-facing breast cancer risk navigation (BNAV) tool, which are designed to facilitate patient-provider risk communication and shared decision-making about breast cancer prevention strategies, such as chemoprevention.
Chambers, David W
A decision is a commitment of resources under conditions of risk in expectation of the best future outcome. The smart decision is always the strategy with the best overall expected value-the best combination of facts and values. Some of the special circumstances involved in decision making are discussed, including decisions where there are multiple goals, those where more than one person is involved in making the decision, using trigger points, framing decisions correctly, commitments to lost causes, and expert decision makers. A complex example of deciding about removal of asymptomatic third molars, with and without an EBD search, is discussed.
Geduld, Harry M., Ed.
This collection includes essays by and interviews with more than 30 film-makers, both classic and contemporary, on the subjects of their major interests and procedures in making films. The directors are: Louis Lumiere, Cecil Hepworth, Edwin S. Porter, Mack Sennett, David W. Griffith, Robert Flaherty, Charles Chaplin, Eric von Stroheim, Dziga…
Banegas, Matthew P.; McClure, Jennifer B.; Barlow, William E.; Ubel, Peter A.; Smith, Dylan M.; Zikmund-Fisher, Brian J.; Greene, Sarah M.; Fagerlin, Angela
Objective To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women’s decisions about prophylactic tamoxifen and raloxifene use. Methods Postmenopausal women, age 46–74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms: intervention (n = 690), Time 1 control (n = 160), or 3-month control (n = 162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women’s decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively. Results Intervention participants had significantly lower decisional conflict levels at post-test (p < 0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p < 0.001) compared to control participants. Conclusion GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk. Practice implications Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients’ decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values. PMID:23395006
Bass, Sarah Bauerle; Gordon, Thomas F; Ruzek, Sheryl Burt; Wolak, Caitlin; Ruggieri, Dominique; Mora, Gabriella; Rovito, Michael J; Britto, Johnson; Parameswaran, Lalitha; Abedin, Zainab; Ward, Stephanie; Paranjape, Anuradha; Lin, Karen; Meyer, Brian; Pitts, Khaliah
African Americans have higher colorectal cancer (CRC) mortality than White Americans and yet have lower rates of CRC screening. Increased screening aids in early detection and higher survival rates. Coupled with low literacy rates, the burden of CRC morbidity and mortality is exacerbated in this population, making it important to develop culturally and literacy appropriate aids to help low-literacy African Americans make informed decisions about CRC screening. This article outlines the development of a low-literacy computer touch-screen colonoscopy decision aid using an innovative marketing method called perceptual mapping and message vector modeling. This method was used to mathematically model key messages for the decision aid, which were then used to modify an existing CRC screening tutorial with different messages. The final tutorial was delivered through computer touch-screen technology to increase access and ease of use for participants. Testing showed users were not only more comfortable with the touch-screen technology but were also significantly more willing to have a colonoscopy compared with a "usual care group." Results confirm the importance of including participants in planning and that the use of these innovative mapping and message design methods can lead to significant CRC screening attitude change.
Zhang, Yong; Wang, Yulong
We propose a general model to entirely describe XPM effects induced by 16QAM channels in hybrid QPSK/16QAM wavelength division multiplexed (WDM) systems. A power spectral density (PSD) formula is presented to predict the statistical properties of XPM effects at the end of dispersion management (DM) fiber links. We derive the analytical expression of phase error variance for optimizing block length of QPSK channel coherent receiver with decision-aided (DA) maximum-likelihood (ML) phase estimation (PE). With our theoretical analysis, the optimum block length can be employed to improve the performance of coherent receiver. Bit error rate (BER) performance in QPSK channel is evaluated and compared through both theoretical derivation and Monte Carlo simulation. The results show that by using the DA-ML with optimum block length, bit signal-to-noise ratio (SNR) improvement over DA-ML with fixed block length of 10, 20 and 40 at BER of 10-3 is 0.18 dB, 0.46 dB and 0.65 dB, respectively, when in-line residual dispersion is 0 ps/nm.
Zhang, Yong; Wang, Yulong
Although decision-aided (DA) maximum likelihood (ML) phase estimation (PE) algorithm has been investigated intensively, block length effect impacts system performance and leads to the increasing of hardware complexity. In this paper, a flexible DA-ML algorithm is proposed in hybrid QPSK/OOK coherent optical wavelength division multiplexed (WDM) systems. We present a general cross phase modulation (XPM) model based on Volterra series transfer function (VSTF) method to describe XPM effects induced by OOK channels at the end of dispersion management (DM) fiber links. Based on our model, the weighted factors obtained from maximum likelihood method are introduced to eliminate the block length effect. We derive the analytical expression of phase error variance for the performance prediction of coherent receiver with the flexible DA-ML algorithm. Bit error ratio (BER) performance is evaluated and compared through both theoretical derivation and Monte Carlo (MC) simulation. The results show that our flexible DA-ML algorithm has significant improvement in performance compared with the conventional DA-ML algorithm as block length is a fixed value. Compared with the conventional DA-ML with optimum block length, our flexible DA-ML can obtain better system performance. It means our flexible DA-ML algorithm is more effective for mitigating phase noise than conventional DA-ML algorithm.
Enenkel, M.; Dorigo, W.; See, L. M.; Vinck, P.; Pham, P.
Droughts statistically exceed all other natural disasters in spatio-temporal extent, number of people affected or financial loss. Triggered by crop failure, food insecurity is a major manifestation of agricultural drought and water scarcity. However, other socio-economic precursors, such as chronically low levels of disaster preparedness, hampered access to food security or a lack of social safety nets are equally important factors. Consequently, this study is focused on two complementary developments - a new satellite-derived agricultural drought index and a mobile phone application. The Combined Drought Index (CDI) is enhanced by replacing field measurements of temperature and rainfall modelled/assimilated data. The vegetation component is replaced by a smoothed NDVI dataset. A soil moisture component is introduced to close the gap between rainfall deficiencies and the first visible impacts of atmospheric anomalies on vegetation. The mobile phone application enables the validation of drought index outputs and gives aid organizations an opportunity to increase the speed of socio-economic vulnerability assessments. Supported by Doctors without Borders (MSF) this approach aims at decreasing uncertainties in decision-making via a more holistic risk framework.
Barrett, Tyler W.; Storrow, Alan B.; Jenkins, Cathy A.; Abraham, Robert L.; Liu, Dandan; Miller, Karen F.; Moser, Kelly M.; Russ, Stephan; Roden, Dan M.; Harrell, Frank E.; Darbar, Dawood
There is wide variation in the management of emergency department (ED) patients with atrial fibrillation (AF). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated, tertiary-care, ED. Patients were enrolled from June 9, 2010 to February 28, 2013 and followed for 30 days. We enrolled a convenience sample of ED patients presenting with symptomatic AF. Candidate predictors were based on ED data available in the first two hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We utilized an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (<1%) patients, respectively. The decision aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement); medical history (heart failure, home sotalol use, prior percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms); ED data (2 hour heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid’s c-statistic in predicting any 30-day adverse event was 0.7 (95% CI, 0.65, 0.76). In conclusion, among ED patients with AF, AFFORD provides the first evidence based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. PMID:25633190
Li, Ye; Gao, Jie; Enkavi, A Zeynep; Zaval, Lisa; Weber, Elke U; Johnson, Eric J
Age-related deterioration in cognitive ability may compromise the ability of older adults to make major financial decisions. We explore whether knowledge and expertise accumulated from past decisions can offset cognitive decline to maintain decision quality over the life span. Using a unique dataset that combines measures of cognitive ability (fluid intelligence) and of general and domain-specific knowledge (crystallized intelligence), credit report data, and other measures of decision quality, we show that domain-specific knowledge and expertise provide an alternative route for sound financial decisions. That is, cognitive aging does not spell doom for financial decision-making in domains where the decision maker has developed expertise. These results have important implications for public policy and for the design of effective interventions and decision aids.
Li, Ye; Gao, Jie; Enkavi, A. Zeynep; Zaval, Lisa; Weber, Elke U.; Johnson, Eric J.
Age-related deterioration in cognitive ability may compromise the ability of older adults to make major financial decisions. We explore whether knowledge and expertise accumulated from past decisions can offset cognitive decline to maintain decision quality over the life span. Using a unique dataset that combines measures of cognitive ability (fluid intelligence) and of general and domain-specific knowledge (crystallized intelligence), credit report data, and other measures of decision quality, we show that domain-specific knowledge and expertise provide an alternative route for sound financial decisions. That is, cognitive aging does not spell doom for financial decision-making in domains where the decision maker has developed expertise. These results have important implications for public policy and for the design of effective interventions and decision aids. PMID:25535381
Health programs are shaped by the decisions made in budget processes, so how budget-makers view health programs is an important part of making health policy. Budgeting in any country involves its own policy community, with key players including budgeting professionals and political authorities. This article reviews the typical pressures on and attitudes of these actors when they address health policy choices. The worldview of budget professionals includes attitudes that are congenial to particular policy perspectives, such as the desire to select packages of programs that maximize population health. The pressures on political authorities, however, are very different: most importantly, public demand for health care services is stronger than for virtually any other government activity. The norms and procedures of budgeting also tend to discourage adoption of some of the more enthusiastically promoted health policy reforms. Therefore talk about rationalizing systems is not matched by action; and action is better explained by the need to minimize blame. The budget-maker's perspective provides insight about key controversies in healthcare policy such as decentralization, competition, health service systems as opposed to health insurance systems, and dedicated vs. general revenue finance. It also explains the frequency of various "gaming" behaviors.
Mosier, Kathleen L.; Skitka, Linda J.; Burdick, Mark R.; Heers, Susan T.; Rosekind, Mark R. (Technical Monitor)
Automated decision aids and decision support systems have become essential tools in many high-tech environments. In aviation, for example, flight management systems computers not only fly the aircraft, but also calculate fuel efficient paths, detect and diagnose system malfunctions and abnormalities, and recommend or carry out decisions. Air Traffic Controllers will soon be utilizing decision support tools to help them predict and detect potential conflicts and to generate clearances. Other fields as disparate as nuclear power plants and medical diagnostics are similarly becoming more and more automated. Ideally, the combination of human decision maker and automated decision aid should result in a high-performing team, maximizing the advantages of additional cognitive and observational power in the decision-making process. In reality, however, the presence of these aids often short-circuits the way that even very experienced decision makers have traditionally handled tasks and made decisions, and introduces opportunities for new decision heuristics and biases. Results of recent research investigating the use of automated aids have indicated the presence of automation bias, that is, errors made when decision makers rely on automated cues as a heuristic replacement for vigilant information seeking and processing. Automation commission errors, i.e., errors made when decision makers inappropriately follow an automated directive, or automation omission errors, i.e., errors made when humans fail to take action or notice a problem because an automated aid fails to inform them, can result from this tendency. Evidence of the tendency to make automation-related omission and commission errors has been found in pilot self reports, in studies using pilots in flight simulations, and in non-flight decision making contexts with student samples. Considerable research has found that increasing social accountability can successfully ameliorate a broad array of cognitive biases and
Disney, W Terry; Peters, Mark A
Simulation modeling can be used in aiding decision-makers in deciding when to invest in additional research and when the risky animal disease-import decision should go forward. Simulation modeling to evaluate value-of-information (VOI) techniques provides a robust, objective and transparent framework for assisting decision-makers in making risky animal and animal product decisions. In this analysis, the hypothetical risk from poultry disease in chicken-meat imports was modeled. Economic criteria were used to quantify alternative confidence-increasing decisions regarding potential import testing and additional research requirements. In our hypothetical example, additional information about poultry disease in the exporting country (either by requiring additional export-flock surveillance that results in no sign of disease, or by conducting additional research into lack of disease transmittal through chicken-meat ingestion) captured >75% of the value-of-information attainable regarding the chicken-meat-import decision.
Légaré, France; Moisan, Jocelyne; Boulet, Louis-Philippe
Background Not providing adequate patient education interventions to asthma patients remains a major care gap. To help asthma patients and caregivers discuss inhaled controller medication use, our team has previously developed a decision aid (DA). We sought to assess whether adding this DA to education interventions improved knowledge, decisional conflict, and asthma control among adults with asthma. Methods A parallel clinical trial (NCT02516449). We recruited adults with asthma, aged 18 to 65 years, prescribed inhaled controller medication to optimize asthma control. Educators randomly allocated participants either to the education + DA or to the education group. At baseline and two-month follow-up, we measured asthma knowledge (primary outcome) with a validated self-administered questionnaire (score –37 to +37). Secondary outcomes included decisional conflict and asthma control. Blinded assessors collected data. Between the two time points, the within- and between-group changes were estimated by generalized linear mixed models. Results Fifty-one participants (response rate: 53%; age: 44 ± 13 years; women: n = 32) were randomized either to the education + DA group (n = 26) or to the education group (n = 25), and included in statistical analyses. Between baseline and follow-up, mean [95% CI] knowledge scores increased from 21.5 [19.9–23.2] to 25.1 [23.1–27.0] in the education + DA group (P = 0.0002) and from 24.0 [22.3–25.7] to 26.0 [24.0–28.0] in the education group (P = 0.0298). In both of the groups, decisional conflict and asthma control improved. There were no differences between groups. Conclusions Education improved knowledge, decisional conflict, and asthma control whether the DA was added or not. PMID:28107540
Jibaja‐Weiss, Maria L.; Volk, Robert J.; Friedman, Lois C.; Granchi, Thomas S.; Neff, Nancy E.; Spann, Stephen J.; Robinson, Emily K.; Aoki, Noriaki; Robert Beck, J.
Abstract Objective To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. Design Pre‐post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. Sample Fifty‐one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. Intervention A computerized decision aid that combines entertainment‐education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. Outcomes Patients’ use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). Results Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. Conclusions A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients. PMID:16911136
Ebadian, M.A.; Boudreaux, J.F.; Chinta, S.; Zanakis, S.H.
The principal objective for designing Decision Analysis System for Decontamination (DASD) is to support DOE-EM's endeavor to employ the most efficient and effective technologies for treating radiologically contaminated surfaces while minimizing personnel and environmental risks. DASD will provide a tool for environmental decision makers to improve the quality, consistency, and efficacy of their technology selection decisions. The system will facilitate methodical comparisons between innovative and baseline decontamination technologies and aid in identifying the most suitable technologies for performing surface decontamination at DOE environmental restoration sites.
Barton, Jennifer L.; Trupin, Laura; Schillinger, Dean; Evans-Young, Gina; Imboden, John; Montori, Victor M.; Yelin, Edward
Objective Despite innovations in treatment of rheumatoid arthritis (RA), adherence is poor and disparities persist. Shared decision making (SDM) promotes patient engagement and enhances adherence, however few tools support SDM in RA. Our objective was to pilot a low literacy medication guide and decision aid to facilitate patient-clinician conversations about RA medications. Methods RA patients were consecutively enrolled into one of three arms: (1) control, patients received existing medication guide prior to clinic visit; (2) adapted guide prior to visit; (3) adapted guide prior plus decision aid during visit. Outcomes were collected immediately post-visit, at 1-week, 3- and 6-month interviews. Eligible adults had to have failed at least one DMARD and fulfill one of the following: age >65, immigrant, non-English speaker, < high school education, limited health literacy, racial/ethnic minority. Primary outcomes were knowledge of RA medications, decisional conflict, and acceptability of interventions. Results Majority of 166 patients were immigrants (66%), non-English speakers (54%), and had limited health literacy (71%). Adequate RA knowledge post visit in arm 3 was higher (78%) than arm 1 (53%, adjusted OR 2.7, 95% CI 1.2–6.1). Among patients with a medication change, there was lower (better) mean decisional conflict in arms 2 and 3 (p=0.03). No significant differences in acceptability. Conclusion A low literacy medication guide and decision aid was acceptable, improved knowledge, and reduced decisional conflict among vulnerable RA patients. Enhancing knowledge and patient engagement with decision support tools may lead to medication choices better aligned with patient values and preferences in RA. PMID:26605752
Deason, V.A.; Ward, M.B.
A compact and portable diffraction grating maker is comprised of a laser beam, optical and fiber optics devices coupling the beam to one or more evanescent beam splitters, and collimating lenses or mirrors directing the split beam at an appropriate photosensitive material. The collimating optics, the output ends of the fiber optic coupler and the photosensitive plate holder are all mounted on an articulated framework so that the angle of intersection of the beams can be altered at will without disturbing the spatial filter, collimation or beam quality, and assuring that the beams will always intersect at the position of the plate. 4 figures.
Deason, Vance A.; Ward, Michael B.
A compact and portable diffraction grating maker comprised of a laser beam, optical and fiber optics devices coupling the beam to one or more evanescent beam splitters, and collimating lenses or mirrors directing the split beam at an appropriate photosensitive material. The collimating optics, the output ends of the fiber optic coupler and the photosensitive plate holder are all mounted on an articulated framework so that the angle of intersection of the beams can be altered at will without disturbing the spatial filter, collimation or beam quality, and assuring that the beams will always intersect at the position of the plate.
Ruzek, Sheryl B; Bass, Sarah Bauerle; Greener, Judith; Wolak, Caitlin; Gordon, Thomas F
The goal of this study was to assess the effectiveness of a touch screen decision aid to increase acceptance of colonoscopy screening among African American patients with low literacy, developed and tailored using perceptual mapping methods grounded in Illness Self-Regulation and Information-Communication Theories. The pilot randomized controlled trial investigated the effects of a theory-based intervention on patients' acceptance of screening, including their perceptions of educational value, feelings about colonoscopy, likelihood to undergo screening, and decisional conflict about colonoscopy screening. Sixty-one African American patients with low literacy, aged 50-70 years, with no history of colonoscopy, were randomly assigned to receive a computerized touch screen decision aid (CDA; n = 33) or a literacy appropriate print tool (PT; n = 28) immediately before a primary care appointment in an urban, university-affiliated general internal medicine clinic. Patients rated the CDA significantly higher than the PT on all indicators of acceptance, including the helpfulness of the information for making a screening decision, and reported positive feelings about colonoscopy, greater likelihood to be screened, and lower decisional conflict. Results showed that a touch screen decision tool is acceptable to African American patients with low iteracy and, by increasing intent to screen, may increase rates of colonoscopy screening.
Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.
Thelen, Jean-Claude; Havemann, Stephan; Wong, Gerald
The Havemann-Taylor Fast Radiative Transfer Code (HT-FRTC) is a core component of the Met Office NEON Tactical Decision Aid (TDA). Within NEON, the HT-FRTC has for a number of years been used to predict the infrared apparent thermal contrasts between different surface types as observed by an airborne sensor. To achieve this, the HT-FRTC is supplied with the inherent temperatures and spectral properties of these surfaces (i.e. ground target(s) and backgrounds). A key strength of the HT-FRTC is its ability to take into account the detailed properties of the atmosphere, which in the context of NEON tend to be provided by a Numerical Weather Prediction (NWP) forecast model. While water vapour and ozone are generally the most important gases, additional trace gases are now being incorporated into the HT-FRTC. The HT-FRTC also includes an exact treatment of atmospheric scattering based on spherical harmonics. This allows for the treatment of several different aerosol species and of liquid and ice clouds. Recent developments can even account for rain and falling snow. The HT-FRTC works in Principal Component (PC) space and is trained on a wide variety of atmospheric and surface conditions, which significantly reduces the computational requirements regarding memory and processing time. One clear-sky simulation takes approximately one millisecond at the time of writing. Recent developments allow the training of HT-FRTC to be both completely generalised and sensor independent. This is significant as the user of the code can add new sensors and new surfaces/targets by supplying extra files which contain their (possibly classified) spectral properties. The HT-FRTC has been extended to cover the spectral range of Photopic and NVG sensors. One aim here is to give guidance on the expected, directionally resolved sky brightness, especially at night, again taking the actual or forecast atmospheric conditions into account. Recent developments include light level predictions during
Vuillet, Marc; Peyras, Laurent; Serre, Damien; Diab, Youssef
France and more generally the World have to face frequent episodes of devastating floods. The human and material damages are multiplied during the failure of a protection structure. In France the length of dykes is estimated to 7500 kilometers, protecting around 15 000 to 18 000 km² and an estimated population between 1.6 to 2 millions. Regrettably, these structures are most of the time old, unidentified, badly maintained, showing signs of weaknesses on numerous occasions. The management of these dikes raises then considerable problems to the decision-makers who are in charge of guaranteeing a maximal safety to the populations at a rational and acceptable management cost. The ambition of the project "Performance and capacity in the service of river dykes of protection against the floods" is to propose to Administrator scientific methods and technical tools for the management of river dykes. These tools will be capable of estimating the capacity in the service of dykes, and to define and organize into a hierarchy the actions of inspection, maintenance and repair. Scientific objectives: • To suggest a methodology of evaluation of the performance of river dykes • To identify and to understand the causes of variability (spatial and temporal) • To analyze the relation between the quality of the data and the quality of the profile of performance • To propose a methodology of auscultation and confortation of the information The research work consists in adapting functional analysis based on safety engineering method, in order to precise the role of each rivers dyke's component in regard to the mechanisms of degradation they suffer. It will allow us to identify failure indicators and decision criteria for evaluating the performance of dykes. The criteria will be the basis to develop a multicriteria decision aid tool allowing to determine the hierarchical organization and the selection of the sections of a park of dykes of protection against the floods, according
Hummel, J Marjan; Bridges, John F P; IJzerman, Maarten J
The analytic hierarchy process (AHP) has been increasingly applied as a technique for multi-criteria decision analysis in healthcare. The AHP can aid decision makers in selecting the most valuable technology for patients, while taking into account multiple, and even conflicting, decision criteria. This tutorial illustrates the procedural steps of the AHP in supporting group decision making about new healthcare technology, including (1) identifying the decision goal, decision criteria, and alternative healthcare technologies to compare, (2) structuring the decision criteria, (3) judging the value of the alternative technologies on each decision criterion, (4) judging the importance of the decision criteria, (5) calculating group judgments, (6) analyzing the inconsistency in judgments, (7) calculating the overall value of the technologies, and (8) conducting sensitivity analyses. The AHP is illustrated via a hypothetical example, adapted from an empirical AHP analysis on the benefits and risks of tissue regeneration to repair small cartilage lesions in the knee.
Lee, Yew Kong; Lee, Ping Yein; Ng, Chirk Jenn; Teo, Chin Hai; Abu Bakar, Ahmad Ihsan; Abdullah, Khatijah Lim; Khoo, Ee Ming; Hanafi, Nik Sherina; Low, Wah Yun; Chiew, Thiam Kian
This study aimed to evaluate the usability (ease of use) and utility (impact on user's decision-making process) of a web-based patient decision aid (PDA) among older-age users. A pragmatic, qualitative research design was used. We recruited patients with type 2 diabetes who were at the point of making a decision about starting insulin from a tertiary teaching hospital in Malaysia in 2014. Computer screen recording software was used to record the website browsing session and in-depth interviews were conducted while playing back the website recording. The interviews were analyzed using the framework approach to identify usability and utility issues. Three cycles of iteration were conducted until no more major issues emerged. Thirteen patients participated: median age 65 years old, 10 men, and nine had secondary education/diploma, four were graduates/had postgraduate degree. Four usability issues were identified (navigation between pages and sections, a layout with open display, simple language, and equipment preferences). For utility, participants commented that the website influenced their decision about insulin in three ways: it had provided information about insulin, it helped them deliberate choices using the option-attribute matrix, and it allowed them to involve others in their decision making by sharing the PDA summary printout.
In December 1984, the Department of Energy (DOE) published draft environmental assessments (EAs) to support the proposed nomination of five sites and the recommendation of three sites for characterization for the first radioactive-waste repository. A chapter common to all the draft EAs (Chapter 7) presented rankings of the five sites against the postclosure and the preclosure technical siting guidelines. To determine which three sites appeared most favorable for recommendation for characterization, three simple quantitative methods were used to aggregate the rankings assigned to each site for the various technical guidelines. In response to numerous comments on the methods, the DOE has undertaken a formal application of one of them (hereafter referred to as the decision-aiding methodology) for the purpose of obtaining a more rigorous evaluation of the nominated sites. The application of the revised methodology is described in this report. The method of analysis is known as multiattribute utility analysis; it is a tool for providing insights as to which sites are preferable and why. The decision-aiding methodology accounts for all the fundamental considerations specified by the siting guidelines and uses as source information the data and evaluations reported or referenced in the EAs. It explicitly addresses the uncertainties and value judgments that are part of all siting problems. Furthermore, all scientific and value judgments are made explicit for the reviewer. An independent review of the application of the decision-aiding methodology has been conducted by the Board on Radioactive Waste Management of the National Academy of Sciences; the comments of the Board are included as an appendix to this report.
Programmable Calculators and Minicomputers in Agriculture. A Symposium Exploring Computerized Decision-Making Aids and Their Extension to the Farm Level. Proceedings of a Symposium (Hot Springs, Arkansas, February 6-7, 1980)
Bentley, Ernest, Ed.
Ten papers presented at a symposium discuss the array of computerized decision-making aids currently available to farmers and ways to speed up the rate of adoption of computers by agriculturalists. Topics presented include the development of software for agricultural decision-making; the role of programmable calculators and minicomputers in…
Mitchell, Christine M.
The Georgia Tech-Multisatellite Operations Control Center (GT-MSOCC), a real-time interactive simulation of the operator interface to a NASA ground control system for unmanned earth-orbiting satellites, is described. The GT-MSOCC program for investigating a range of modeling, decision aiding, and workstation design issues related to the human-computer interaction is discussed. A GT-MSOCC operator function model is described in which operator actions, both cognitive and manual, are represented as the lowest level discrete control network nodes, and operator action nodes are linked to information needs or system reconfiguration commands.
Yi, Haeseung; Xiao, Tong; Thomas, Parijatham; Aguirre, Alejandra; Smalletz, Cindy; David, Raven; Crew, Katherine
Background Breast cancer risk assessment including genetic testing can be used to classify people into different risk groups with screening and preventive interventions tailored to the needs of each group, yet the implementation of risk-stratified breast cancer prevention in primary care settings is complex. Objective To address barriers to breast cancer risk assessment, risk communication, and prevention strategies in primary care settings, we developed a Web-based decision aid, RealRisks, that aims to improve preference-based decision-making for breast cancer prevention, particularly in low-numerate women. Methods RealRisks incorporates experience-based dynamic interfaces to communicate risk aimed at reducing inaccurate risk perceptions, with modules on breast cancer risk, genetic testing, and chemoprevention that are tailored. To begin, participants learn about risk by interacting with two games of experience-based risk interfaces, demonstrating average 5-year and lifetime breast cancer risk. We conducted four focus groups in English-speaking women (age ≥18 years), a questionnaire completed before and after interacting with the decision aid, and a semistructured group discussion. We employed a mixed-methods approach to assess accuracy of perceived breast cancer risk and acceptability of RealRisks. The qualitative analysis of the semistructured discussions assessed understanding of risk, risk models, and risk appropriate prevention strategies. Results Among 34 participants, mean age was 53.4 years, 62% (21/34) were Hispanic, and 41% (14/34) demonstrated low numeracy. According to the Gail breast cancer risk assessment tool (BCRAT), the mean 5-year and lifetime breast cancer risk were 1.11% (SD 0.77) and 7.46% (SD 2.87), respectively. After interacting with RealRisks, the difference in perceived and estimated breast cancer risk according to BCRAT improved for 5-year risk (P=.008). In the qualitative analysis, we identified potential barriers to adopting risk
Establishing the decision context for a management problem is the critical first step for effective decision analysis. Understanding the decision context allow stakeholders and decision-makers to integrate the societal, environmental, and economic considerations that must be con...
Martin, Eileen M; DeHaan, Samantha; Vassileva, Jasmin; Gonzalez, Raul; Weller, Joshua; Bechara, Antoine
HIV+ substance-dependent individuals (SDIs) make significantly poorer decisions than HIV- SDIs, but the neurocognitive mechanisms underlying this impairment have not been identified. We administered the Iowa Gambling Task (IGT), a measure of decision making under uncertain risk, and the Cups Task, a measure of decision making under specified risk, to a group of 56 HIV+ and 23 HIV- men who have sex with men (MSMs) with a history of substance dependence enrolled in the Multicenter AIDS Cohort Study. The IGT provides no explicit information regarding the contingencies for each possible choice, and the probability of each outcome remains ambiguous at least for the early trials; in contrast, the Cups Task provides explicit information about the probability of each outcome. The HIV+ group made significantly poorer decisions on the IGT than the HIV- group. Cups Task performance did not differ significantly between HIV- and HIV+ groups. Exploratory analyses of the IGT data suggested that HIV+ subjects tended to perform more poorly during the early learning phase when uncertainty about specific outcomes was greatest. Additionally, performance on the final two trial blocks was significantly correlated with Stroop Interference scores, suggesting that IGT performance is driven increasingly by executive control during the later portion of the task. Potential cognitive mechanisms to be explored in later studies are discussed, including impairment in implicit learning processing.
Martin, Eileen M.; DeHaan, Samantha; Vassileva, Jasmin; Gonzalez, Raul; Weller, Joshua; Bechara, Antoine
HIV+ substance dependent individuals (SDIs) make significantly poorer decisions compared with HIV− SDIs, but the neurocognitive mechanisms underlying this impairment have not been identified. We administered the Iowa Gambling Task, a measure of decision making under uncertain risk, and the Cups Task, a measure of decision making under specified risk, to a group of 56 HIV+ and 23 HIV− men who have sex with men (MSMs) with a history of substance dependence enrolled in the Multicenter AIDS Cohort Study. The IGT provides no explicit information regarding the contingencies for each possible choice, and the probability of each outcome remains ambiguous at least for the early trials; in contrast, the Cups Task provides explicit information about the probability of each outcome. The HIV+ group made significantly poorer decisions on the IGT compared with the HIV− group. Cups Task performance did not differ significantly between HIV− and HIV+ groups. Exploratory analyses of the IGT data suggested that HIV+ subjects tended to perform more poorly during the early learning phase when uncertainty about specific outcomes was greatest. Additionally, performance on the final two trial blocks was significantly correlated with Stroop Interference scores, suggesting IGT performance is driven increasingly by executive control during the later portion of the task. Potential cognitive mechanisms to be explored in later studies are discussed, including impairment in implicit learning processing PMID:23701366
Sutherland, William J.; Freckleton, Robert P.
One of the aims of ecology is to aid policy makers and practitioners through the development of testable predictions of relevance to society. Here, we argue that this capacity can be improved in three ways. Firstly, by thinking more clearly about the priority issues using a range of methods including horizon scanning, identifying policy gaps, identifying priority questions and using evidence-based conservation to identify knowledge gaps. Secondly, by linking ecological models with models of other systems, such as economic and social models. Thirdly, by considering alternative approaches to generate and model data that use, for example, discrete or categorical states to model ecological systems. We particularly highlight that models are essential for making predictions. However, a key to the limitation in their use is the degree to which ecologists are able to communicate results to policy makers in a clear, useful and timely fashion. PMID:22144394
Kapp, Julie M; Hensel, Brian; Schnoring, Kyle T
Findings from scientific research largely remain inside the scientific community. Research scientists are being encouraged to use social media, and especially Twitter, for dissemination of evidence. The potential for Twitter to narrow the gap on evidence translated into policy presents new opportunities. We explored the innovative question of the feasibility of Twitter as a tool for the scientific community to disseminate to and engage with health policy makers for research impact. We created a list of federal "health policy makers." In December 2014, we identified members using several data sources, then collected and summarized their Twitter usage data. Nearly all health policy makers had Twitter accounts. Their communication volume varied broadly. Policy makers are more likely to push information via Twitter than engage with constituents, although usage varied broadly. Twitter has the potential to aid the scientific community in dissemination of health-related research to health policy makers, after understanding how to effectively (and selectively) use Twitter.
Orasanu, Judith; Statler, Irving C. (Technical Monitor)
The importance of crew decision making to aviation safety has been well established through NTSB accident analyses: Crew judgment and decision making have been cited as causes or contributing factors in over half of all accidents in commercial air transport, general aviation, and military aviation. Yet the bulk of research on decision making has not proven helpful in improving the quality of decisions in the cockpit. One reason is that traditional analytic decision models are inappropriate to the dynamic complex nature of cockpit decision making and do not accurately describe what expert human decision makers do when they make decisions. A new model of dynamic naturalistic decision making is offered that may prove more useful for training or aiding cockpit decision making. Based on analyses of crew performance in full-mission simulation and National Transportation Safety Board accident reports, features that define effective decision strategies in abnormal or emergency situations have been identified. These include accurate situation assessment (including time and risk assessment), appreciation of the complexity of the problem, sensitivity to constraints on the decision, timeliness of the response, and use of adequate information. More effective crews also manage their workload to provide themselves with time and resources to make good decisions. In brief, good decisions are appropriate to the demands of the situation and reflect the crew's metacognitive skill. Effective crew decision making and overall performance are mediated by crew communication. Communication contributes to performance because it assures that all crew members have essential information, but it also regulates and coordinates crew actions and is the medium of collective thinking in response to a problem. This presentation will examine the relation between communication that serves to build performance. Implications of these findings for crew training will be discussed.
What Works Clearinghouse, 2009
The SuccessMaker[R] program is a set of computer-based courses used to supplement regular classroom reading instruction in grades K-8. Using adaptive lessons tailored to a student's reading level, SuccessMaker[R] aims to improve understanding in areas such as phonological awareness, phonics, fluency, vocabulary, comprehension, and concepts of…
Rockwell, T. H.; Giffin, W. C.; Romer, D. J.
Rockwell and Giffin (1982) and Giffin and Rockwell (1983) have discussed the use of computer aided testing (CAT) in the study of pilot response to critical in-flight events. The present investigation represents an extension of these earlier studies. In testing pilot responses to critical in-flight events, use is made of a Plato-touch CRT system operating on a menu based format. In connection with the typical diagnostic problem, the pilot was presented with symptoms within a flight scenario. In one problem, the pilot has four minutes for obtaining the information which is needed to make a diagnosis of the problem. In the reported research, the attempt has been made to combine both diagnosis and diversion scenario into a single computer aided test. Tests with nine subjects were conducted. The obtained results and their significance are discussed.
Huang, Yueng-Hsiang; Leamon, Tom B; Courtney, Theodore K; Chen, Peter Y; DeArmond, Sarah
This study, through a random national survey, explored how senior financial executives or managers (those who determined high-level budget, resource allocation, and corporate priorities) of medium-to-large companies perceive important workplace safety issues. The three top-rated safety priorities in resource allocation reported by the participants (overexertion, repetitive motion, and bodily reaction) were consistent with the top three perceived causes of workers' compensation losses. The greatest single safety concerns reported were overexertion, repetitive motion, highway accidents, falling on the same level and bodily reaction. A majority of participants believed that the indirect costs associated with workplace injury were higher than the direct costs. Our participants believed that money spent improving workplace safety would have significant returns. The perceived top benefits of an effective workplace safety program were increased productivity, reduced cost, retention, and increased satisfaction among employees. The perceived most important safety modification was safety training. The top reasons senior financial executives gave for believing their safety programs were better than those at other companies were that their companies paid more attention to and emphasized safety, they had better classes and training focused on safety, and they had teams/individuals focused specifically on safety.
Hilton, Annette; Nichols, Kim; Kanasa, Harry
Globally, science curricula have been described as outdated, and students perceive school science as lacking in relevance. Declines in senior secondary and tertiary student participation in science indicate an urgent need for change if we are to sustain future scientific research and development, and perhaps more importantly, to equip students…
Morelli, T. L.
Despite increasing knowledge of how climate will continue to change, there remain substantial challenges in determining what actions to take to curb the anticipated loss of biodiversity. Scientists sometimes struggle to speak across disciplines, and managers are often treated as a repository of information rather than a partner in the scientific process. However, through integrative study and collaboration, resource managers can collaborate with physical and biological scientists to translate the latest science into strategies that conserve species in spite of climate change uncertainty. We highlight case studies of how scientists and managers are working together to manage forest ecosystems, songbirds, and cold-adapted fish species in the face of climate change. This work is a collaboration of postdoctoral researchers and graduate students funded through the Department of Interior Northeast Climate Science Center.
What's the main factor coloring employee satisfaction? Many organizations' leaders think the answer is salary, yet in reality, employee benefits packages are one of the biggest incentives an employer can offer. Educational institutions have done well in providing benefits to employees. However, with an unpredictable economic climate and a complex…
Walker, Kevin B.
Knowledge acquisition under uncertainty is examined. Theories proposed in deKorvin's paper 'Extracting Fuzzy Rules Under Uncertainty and Measuring Definability Using Rough Sets' are discussed as they relate to rule calculation algorithms. A data structure for holding an arbitrary number of data fields is described. Limitations of Pascal for loops in the generation of combinations are also discussed. Finally, recursive algorithms for generating all possible combination of attributes and for calculating the intersection of an arbitrary number of fuzzy sets are presented.
really existed or was a creation of Argentine writer Jorge Luis Borges , it is a striking example of the human possibilities of even such a potentially...1 Jorge Luis Borges , quoted by Michel Foucault in The Order of Things, and cited by David Augsburger in Conflict
virtue. 5- , Lead me from darkneu to light. - Lead me from death to eternal Life. ( Vedic Payer) p. I, MULTIMODEL DESIGN OF LARGE SCALE SYSTEMS WITH...guidance during the course of *: this research . He would also like to thank Professors W. R. Perkins, P. V. Kokotovic, T. Basar, and T. N. Trick for...thesis concludes with Chapter 7 where we summarize the results obtained, outline the main contributions, and indicate directions for future research . 7- I
There are a number of established, scientifically supported metrics of sustainability. Many of the metrics are data intensive and require extensive effort to collect data and compute. Moreover, individual metrics may not capture all aspects of a system that are relevant to sust...
Using Pirsig's "Zen and the Art of Motorcycle Maintenance" as a basis, the author offers an alternative to deficit model programing (catch-up classes for "deficient" students) and posits an approach to problem solving that depends on dialog and interaction. (WD)
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients' value.
The clinical decision analysis (CDA) has used to overcome complexity and uncertainty in medical problems. The CDA is a tool allowing decision-makers to apply evidence-based medicine to make objective clinical decisions when faced with complex situations. The usefulness and limitation including six steps in conducting CDA were reviewed. The application of CDA results should be done under shared decision with patients’ value. PMID:25358466
Perceived Barriers and Facilitators of Using a Web-Based Interactive Decision Aid for Colorectal Cancer Screening in Community Practice Settings: Findings From Focus Groups With Primary Care Clinicians and Medical Office Staff
Background Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. Objective To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. Methods Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. Results All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients’ lack of Internet access or low computer literacy, and potential impediments to the clinics’ daily workflow. Expanding patients’ use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients’ screening preferences. Participants described that a system to link the
This manual discusses the benefits of public involvement to agency decision makers, including expanding shared baseline knowledge, generating support for the decision, and developing ongoing relationships that will help in implementing decisions.
Owens, Otis L.; Friedman, Daniela B.; Brandt, Heather M.; Bernhardt, Jay M.; Hébert, James R.
African-American (AA) men are significantly more likely to die of prostate cancer (PrCA) than other racial groups, and there is a critical need to identify strategies for providing information about PrCA screening and the importance of informed decision making (IDM). To assess whether a computer-based IDM intervention for PrCA screening would be appropriate for AA men, this formative evaluation study examined their (1) PrCA risk and screening knowledge, (2) decision-making processes for PrCA screening, (3) usage of, attitudes toward, and access to interactive communication technologies (ICTs), and (4) perceptions regarding a future novel computer-based PrCA education intervention. A purposive convenience sample of 39 AA men aged 37–66 years in the Southeastern United States were recruited through faith-based organizations to participate in one of six 90-minute focus groups and complete a 45-item descriptive survey. Participants were generally knowledgeable about PrCA; however, few engaged in IDM with their doctor and few were informed about the associated risks and uncertainties of PrCA screening. Most participants used ICTs on a daily basis for various purposes including health information seeking. Most participants were open to a novel computer-based intervention if the system was easy to use and its animated avatars were culturally appropriate. Because study participants had low exposure to IDM for PrCA, but frequently used ICTs, IDM interventions using ICTs (e.g, computers) hold promise for AA men and should be explored for feasibility and effectiveness. These interventions should aim to increase PrCA screening knowledge and stress the importance of participating in IDM with their doctor. PMID:25563381
Shen, Ying; Colloc, Joël; Jacquet-Andrieu, Armelle; Lei, Kai
This research aims to depict the methodological steps and tools about the combined operation of case-based reasoning (CBR) and multi-agent system (MAS) to expose the ontological application in the field of clinical decision support. The multi-agent architecture works for the consideration of the whole cycle of clinical decision-making adaptable to many medical aspects such as the diagnosis, prognosis, treatment, therapeutic monitoring of gastric cancer. In the multi-agent architecture, the ontological agent type employs the domain knowledge to ease the extraction of similar clinical cases and provide treatment suggestions to patients and physicians. Ontological agent is used for the extension of domain hierarchy and the interpretation of input requests. Case-based reasoning memorizes and restores experience data for solving similar problems, with the help of matching approach and defined interfaces of ontologies. A typical case is developed to illustrate the implementation of the knowledge acquisition and restitution of medical experts.
Bailey, Donald B; Lewis, Megan A; Harris, Shelly L; Grant, Tracey; Bann, Carla; Bishop, Ellen; Roche, Myra; Guarda, Sonia; Barnum, Leah; Powell, Cynthia; Therrell, Bradford L
The major objectives of this project were to develop and evaluate a brochure to help parents make an informed decision about participation in a fragile X newborn screening study. We used an iterative development process that drew on principles of Informed Decision Making (IDM), stakeholder input, design expertise, and expert evaluation. A simulation study with 118 women examined response to the brochure. An independent review rated the brochure high on informational content, guidance, and values. Mothers took an average of 6.5 min to read it and scored an average of 91.1 % correct on a knowledge test. Most women rated the brochure as high quality and trustworthy. When asked to make a hypothetical decision about study participation, 61.9 % would agree to screening. Structural equation modeling showed that agreement to screening and decisional confidence were associated with perceived quality and trust in the brochure. Minority and white mothers did not differ in perceptions of quality or trust. We demonstrate the application of IDM in developing a study brochure. The brochure was highly rated by experts and consumers, met high standards for IDM, and achieved stated goals in a simulation study. The IDM provides a model for consent in research disclosing complicated genetic information of uncertain value.
Background The decision aids for diabetes (DAD) trial explored the feasibility of testing the effectiveness of decision aids (DAs) about coronary prevention and diabetes medications in community-based primary care practices, including rural clinics that care for patients with type 2 diabetes. Methods As originally designed, we invited clinicians in eight practices to participate in the trial, reviewed the patient panel of clinicians who accepted our invitation for potentially eligible patients, and contacted these patients by phone, enrolling those who accepted our invitation. As enrollment failed to meet targets, we recruited four new practices. After discussing the study with the clinicians and receiving their support, we reviewed all clinic panels for potentially eligible patients. Clinicians were approached to confirm participation and patient eligibility, and patients were approached before their visit to provide written informed consent. This in-clinic approach required study coordinators to travel and stay longer at the clinics as well as to screen more patient records for eligibility. The in-clinic approach was associated with better recruitment rates, lower patient retention and outcome completion rates, and a better intervention effect. Results We drew four lessons: 1) difficulties identifying potentially eligible patients threaten the viability of practical trials of DAs; 2) to improve the recruitment yield, recruit clinicians and patients for the study at the clinic, just before their visit; 3) approaches that improve recruitment may be associated with reduced retention and survey response; and 4) procedures that involve working closely with the practice may improve recruitment and may also affect the quality of the implementation of the interventions. Conclusion Success in practice-based trials in usual primary care including rural clinics may require the smallest possible research footprint on the practice while implementing a streamlined protocol
Chiang, Kai-Wei; Liao, Jhen-Kai; Tsai, Guang-Je; Chang, Hsiu-Wen
Hardware sensors embedded in a smartphone allow the device to become an excellent mobile navigator. A smartphone is ideal for this task because its great international popularity has led to increased phone power and since most of the necessary infrastructure is already in place. However, using a smartphone for indoor pedestrian navigation can be problematic due to the low accuracy of sensors, imprecise predictability of pedestrian motion, and inaccessibility of the Global Navigation Satellite System (GNSS) in some indoor environments. Pedestrian Dead Reckoning (PDR) is one of the most common technologies used for pedestrian navigation, but in its present form, various errors tend to accumulate. This study introduces a fuzzy decision tree (FDT) aided by map information to improve the accuracy and stability of PDR with less dependency on infrastructure. First, the map is quickly surveyed by the Indoor Mobile Mapping System (IMMS). Next, Bluetooth beacons are implemented to enable the initializing of any position. Finally, map-aided FDT can estimate navigation solutions in real time. The experiments were conducted in different fields using a variety of smartphones and users in order to verify stability. The contrast PDR system demonstrates low stability for each case without pre-calibration and post-processing, but the proposed low-complexity FDT algorithm shows good stability and accuracy under the same conditions. PMID:26729114
Chiang, Kai-Wei; Liao, Jhen-Kai; Tsai, Guang-Je; Chang, Hsiu-Wen
Hardware sensors embedded in a smartphone allow the device to become an excellent mobile navigator. A smartphone is ideal for this task because its great international popularity has led to increased phone power and since most of the necessary infrastructure is already in place. However, using a smartphone for indoor pedestrian navigation can be problematic due to the low accuracy of sensors, imprecise predictability of pedestrian motion, and inaccessibility of the Global Navigation Satellite System (GNSS) in some indoor environments. Pedestrian Dead Reckoning (PDR) is one of the most common technologies used for pedestrian navigation, but in its present form, various errors tend to accumulate. This study introduces a fuzzy decision tree (FDT) aided by map information to improve the accuracy and stability of PDR with less dependency on infrastructure. First, the map is quickly surveyed by the Indoor Mobile Mapping System (IMMS). Next, Bluetooth beacons are implemented to enable the initializing of any position. Finally, map-aided FDT can estimate navigation solutions in real time. The experiments were conducted in different fields using a variety of smartphones and users in order to verify stability. The contrast PDR system demonstrates low stability for each case without pre-calibration and post-processing, but the proposed low-complexity FDT algorithm shows good stability and accuracy under the same conditions.
Decision Support Methodologies for Acquisition of Military Equipment (Methodologies d’aide a la decision pour l’acquisition d’ equipements militaires). Meeting Proceedings of Systems Analysis and Studies Panel (SAS) Specialists Meeting held in Brussels, Belgium on 22 and 23 October 2009.
PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION...military needs of the Alliance, to maintain a technological lead, and to provide advice to NATO and national decision makers. The RTO performs its...Cycle Costing, support for the development of operational requirements, and assessment of performance . However it should be noticed that important
Zilly, W; Richter, E
The clearance of a drug predominantly metabolized in the liver may serve as an estimate of quantitative liver function. In 260 consecutive patients presenting with a history of liver disease and abnormal laboratory findings but without a current definite diagnosis we have measured the clearance of hexobarbital and investigated if low values in patients are able to support the decision for an invasive diagnostic procedure such as needle biopsy or laparoscopy. 250 mg of hexobarbital was given orally to the patients between 8 and 10 hrs p.m. 12 hrs later blood samples were taken. Hexobarbital was determined by gas chromatography with N-selective detection, and a single point clearance was calculated. We recommended liver biopsy or laparoscopy to all patients with a hexobarbital clearance below 2.7 ml/min/kg body weight (normal 2.66-5.34 ml/min/kg). 73 out of 260 patients showed a reduced hexobarbital clearance. In 44 patients blind liver biopsy (n = 14) or laparoscopy (n = 30) was performed, 29 patients refused an invasive diagnostic procedure. 17 out of 26 patients with the tentative diagnosis chronic hepatitis had already an incomplete or complete liver cirrhosis. In 11 out of 18 patients with the tentative diagnosis alcohol toxic liver injury we found a progressive portal fibrosis or complete liver cirrhosis. Reduced drug clearance reflecting quantitative liver function can be an indicator of advanced liver disease, thus adding substantially to the decision for further invasive diagnostic procedures.
Hertogh, C M P M
Recent evaluation of the practice of euthanasia and related medical decisions at the end of life in the Netherlands has shown a slight decrease in the frequency of physician-assisted death since the enactment of the Euthanasia Law in 2002. This paper focuses on the absence of euthanasia cases concerning patients with dementia and a written advance euthanasia directive, despite the fact that the only real innovation of the Euthanasia Law consisted precisely in allowing physicians to act upon such directives. The author discusses two principal reasons for this absence. One relates to the uncertainty about whether patients with advanced dementia truly experience the suffering they formerly feared. There is reason to assume that they don't, as a consequence of psychological adaptation and progressive unawareness (anosognosia). The second, more fundamental reason touches upon the ethical relevance of shared understanding and reciprocity. The author argues that, next to autonomy and mercifulness, "reciprocity" is a condition sine qua non for euthanasia. The absence thereof in advanced dementia renders euthanasia morally inconceivable, even if there are signs of suffering and notwithstanding the presence of an advance euthanasia directive. This does not mean, however, that advance euthanasia directives of patients with dementia are worthless. They might very well have a role in the earlier stages of certain subtypes of the disease. To illustrate this point the author presents a case in which the advance directive helped to create a window of opportunity for reciprocity and shared decision-making.
Janet, J.; Natesan, T. R.; Santhosh, Ramamurthy; Ibramsha, Mohideen
An intelligent decision support tool to the Radiologist in telemedicine is described. Medical prescriptions are given based on the images of cyst that has been transmitted over computer networks to the remote medical center. The digital image, acquired by sonography, is converted into an intensity image. This image is then subjected to image preprocessing which involves correction methods to eliminate specific artifacts. The image is resized into a 256 x 256 matrix by using bilinear interpolation method. The background area is detected using distinct block operation. The area of the cyst is calculated by removing the background area from the original image. Boundary enhancement and morphological operations are done to remove unrelated pixels. This gives us the cyst volume. This segmented image of the cyst is sent to the remote medical center for analysis by Knowledge based artificial Intelligent Decision Support System (KIDSS). The type of cyst is detected and reported to the control mechanism of KIDSS. Then the inference engine compares this with the knowledge base and gives appropriate medical prescriptions or treatment recommendations by applying reasoning mechanisms at the remote medical center.
Mulder, Maxim J H L; Venema, Esmee; Roozenbeek, Bob; Broderick, Joseph P; Yeatts, Sharon D; Khatri, Pooja; Berkhemer, Olvert A; Roos, Yvo B W E M; Majoie, Charles B L M; van Oostenbrugge, Robert J; van Zwam, Wim H; van der Lugt, Aad; Steyerberg, Ewout W; Dippel, Diederik W J; Lingsma, Hester F
Introduction Overall, intra-arterial treatment (IAT) proved to be beneficial in patients with acute ischaemic stroke due to a proximal occlusion in the anterior circulation. However, heterogeneity in treatment benefit may be relevant for personalised clinical decision-making. Our aim is to improve selection of patients for IAT by predicting individual treatment benefit or harm. Methods and analysis We will use data collected in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) trial to analyse the effect of baseline characteristics on outcome and treatment effect. A multivariable proportional odds model with interaction terms will be developed to predict the outcome for each individual patient, both with and without IAT. Model performance will be expressed as discrimination and calibration, after bootstrap resampling and shrinkage of regression coefficients, to correct for optimism. External validation will be conducted on data of patients in the Interventional Management of Stroke III trial (IMS III). Primary outcome will be the modified Rankin Scale (mRS) at 90 days after stroke. Ethics and dissemination The proposed study will provide an internationally applicable clinical decision aid for IAT. Findings will be disseminated widely through peer-reviewed publications, conference presentations and in an online web application tool. Formal ethical approval was not required as primary data were already collected. Trial registration numbers ISRCTN10888758; Post-results and NCT00359424; Post-resultsc. PMID:28336740
BAILEY, STEPHEN K.
THE AUTHOR EXAMINES THE VARIOUS WAYS IN WHICH THE UNIVERSITY CAN AND SHOULD INFLUENCE URBAN DECISION MAKING. THE CENTRAL UNIVERSITY ROLE IS SENSITIZING THE DECISION MAKERS AND THE CITIZENS TO HUMAN MISERY, SUCH AS BIGOTRY, SQUALOR, DISEASE, UGLINESS, POVERTY, AND IGNORANCE. LONG-RANGE ROLES ARE PINPOINTING THE PROBLEMS URBAN DECISION MAKERS SHOULD…
Hixson, Laurie L.; Houts, Michael G.; Clement, Steven D.
The extent to which, if any, full power ground nuclear testing of space reactors should be performed has been a point of discussion within the industry for decades. Do the benefits outweigh the risks? Are there equivalent alternatives? Can a test facility be constructed (or modified) in a reasonable amount of time? Is the test article an accurate representation of the flight system? Are the costs too restrictive? The obvious benefits of full power ground nuclear testing; obtaining systems integrated reliability data on a full-scale, complete end-to-end system; come at some programmatic risk. Safety related information is not obtained from a full-power ground nuclear test. This paper will discuss and assess these and other technical considerations essential in the decision to conduct full power ground nuclear-or alternative-tests.
Rizik, Peter D.
The development of a case identification decision support tool in a Public Health setting is presented in this research. The analytic problem is described as the classification problem (Duda and Hart, 1974). Using logistic regression with a variable selection option enables iterative improvements in classification criteria through dimensionality reduction and subspace modification. The performance of the classifier on new samples is simulated by a subset jackknife technique which trains the model on one portion of the sample and tests on the other portion. Repeating this several times gives estimates of case detection and suggests underlying patterns of predictive variable sets through key variable selections and parameter estimate stability. From these estimates, positive and negative predictive values and referral rates can be estimated for proper evaluation of the tool.
very much by the actual decision makers, for a number of reasons: (i) some of them are too artificial , using models and language that are too abstract...individually scaled. o The tool insists that the decision maker performs artificial tradeoffs between cri- teria, while the decision maker wants to...which the decision maker considers artificial , rather in the language he or she would naturally use in comparing alter- natives and reaching a decision
St John, C.
Scientific information about climate change and other human impacts on the environment are increasingly available and sought after (often in the form of probabilistic forecasts or technical information related to engineering solutions). However, it is increasingly apparent that there are barriers to the use of this information by decision makers - either from its lack of application altogether, its usability for people without scientific backgrounds, or its ability to inform sound decisions and widespread behavior change. While the argument has been made that an information deficit is to blame, we argue that there is also a motivation deficit contributing to a lack of understanding of information about climate change impacts and solutions. Utilizing insight from over thirty years of research in social and cognitive psychology, in addition to other social sciences, the Center for Research on Environmental Decisions (CRED) seeks to understand how people make environmental decisions under conditions of uncertainty, and how these decisions can be improved. This presentation will focus specifically on recent research that has come forth since the 2009 publication of CRED's popular guide 'The Psychology of Climate Change Communication: A Guide for Scientists, Journalists, Educators, Political Aides, and the Interested Public.' Utilizing case studies from real world examples, this talk will explore how decision making can be improved through a better understanding of how people perceive and process uncertainty and risk. It will explore techniques such as choice architecture and 'nudging' behavior change, how social goals and group participation affect decision making, and how framing of environmental information influences mitigative behavior.
Augustine, Kurt E.; Camp, Jon J.; Holmes, David R.; Huddleston, Paul M.; Lu, Lichun; Yaszemski, Michael J.; Robb, Richard A.
Failure of the spine's structural integrity from metastatic disease can lead to both pain and neurologic deficit. Fractures that require treatment occur in over 30% of bony metastases. Our objective is to use computed tomography (CT) in conjunction with analytic techniques that have been previously developed to predict fracture risk in cancer patients with metastatic disease to the spine. Current clinical practice for cancer patients with spine metastasis often requires an empirical decision regarding spinal reconstructive surgery. Early image-based software systems used for CT analysis are time consuming and poorly suited for clinical application. The Biomedical Image Resource (BIR) at Mayo Clinic, Rochester has developed an image analysis computer program that calculates from CT scans, the residual load-bearing capacity in a vertebra with metastatic cancer. The Spine Cancer Assessment (SCA) program is built on a platform designed for clinical practice, with a workflow format that allows for rapid selection of patient CT exams, followed by guided image analysis tasks, resulting in a fracture risk report. The analysis features allow the surgeon to quickly isolate a single vertebra and obtain an immediate pre-surgical multiple parallel section composite beam fracture risk analysis based on algorithms developed at Mayo Clinic. The analysis software is undergoing clinical validation studies. We expect this approach will facilitate patient management and utilization of reliable guidelines for selecting among various treatment option based on fracture risk.
Marble, Julie Lynne; Medema, Heather Dawne; Hill, Susan Gardiner
Eight participants were asked to view a computer-based multimedia presentation on an environmental phenomenon. Participants were asked to play a role as a senior aide to a national legislator. In this role, they were told that the legislator had asked them to review a multimedia presentation regarding the hypoxic zone phenomenon in the Gulf of Mexico. Their task in assuming the role of a senior aide was to decide how important a problem this issue was to the United States as a whole, and the proportion of the legislator’s research budget that should be devoted to study of the problem. The presentation was divided into 7 segments, each containing some new information not contained in the previous segments. After viewing each segment, participants were asked to indicate how close they were to making a decision and how certain they were that their current opinion would be their final decision. After indicating their current state of decision-making, participants were interviewed regarding the factors affecting their decision-making. Of interest was the process by which participants moved toward a decision. This experiment revealed a number of possible directions for future research. There appeared to be two approaches to decision-making: Some decision-makers moved steadily toward a decision, and occasionally reversed decisions after viewing information, while others abruptly reached a decision after a certain time period spent reviewing the information. Although the difference in estimates of distance to decisions did not differ statistically for these two groups, that difference was reflected in the participants’ estimates of confidence that their current opinion would be their final decision. The interviews revealed that the primary difference between these two groups was in their trade-offs between willingness to spend time in information search and the acquisition of new information. Participants who were less confident about their final decision, tended to be
Carpenter, Stephanie M.; Yates, J. Frank; Preston, Stephanie D.; Chen, Lydia
Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional “coherence shifting,” the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed. PMID:26986752
Carpenter, Stephanie M; Yates, J Frank; Preston, Stephanie D; Chen, Lydia
Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed.
Zhu, Mei; Chiarella, Carl; He, Xue-Zhong; Wang, Duo
The market maker plays an important role in price formation, but his/her behavior and stabilizing impact on the market are relatively unclear, in particular in speculative markets. This paper develops a financial market model that examines the impact on market stability of the market maker, who acts as both a liquidity provider and an active investor in a market consisting of two types of boundedly rational speculative investors-the fundamentalists and trend followers. We show that the market maker does not necessarily stabilize the market when he/she actively manages the inventory to maximize profits, and that rather the market maker’s impact depends on the behavior of the speculators. Numerical simulations show that the model is able to generate outcomes for asset returns and market inventories that are consistent with empirical findings.
Wylie, C E; Shaw, D J; Verheyen, K L P; Newton, J R
The objective of this cross-sectional study was to compare the prevalence of selected clinical signs in laminitis cases and non-laminitic but lame controls to evaluate their capability to discriminate laminitis from other causes of lameness. Participating veterinary practitioners completed a checklist of laminitis-associated clinical signs identified by literature review. Cases were defined as horses/ponies with veterinary-diagnosed, clinically apparent laminitis; controls were horses/ponies with any lameness other than laminitis. Associations were tested by logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals, with veterinary practice as an a priori fixed effect. Multivariable analysis using graphical classification tree-based statistical models linked laminitis prevalence with specific combinations of clinical signs. Data were collected for 588 cases and 201 controls. Five clinical signs had a difference in prevalence of greater than +50 per cent: 'reluctance to walk' (OR 4.4), 'short, stilted gait at walk' (OR 9.4), 'difficulty turning' (OR 16.9), 'shifting weight' (OR 17.7) and 'increased digital pulse' (OR 13.2) (all P<0.001). 'Bilateral forelimb lameness' was the best discriminator; 92 per cent of animals with this clinical sign had laminitis (OR 40.5, P<0.001). If, in addition, horses/ponies had an 'increased digital pulse', 99 per cent were identified as laminitis. 'Presence of a flat/convex sole' also significantly enhanced clinical diagnosis discrimination (OR 15.5, P<0.001). This is the first epidemiological laminitis study to use decision-tree analysis, providing the first evidence base for evaluating clinical signs to differentially diagnose laminitis from other causes of lameness. Improved evaluation of the clinical signs displayed by laminitic animals examined by first-opinion practitioners will lead to equine welfare improvements.
Edwards, W; Fasolo, B
This review is about decision technology-the rules and tools that help us make wiser decisions. First, we review the three rules that are at the heart of most traditional decision technology-multi-attribute utility, Bayes' theorem, and subjective expected utility maximization. Since the inception of decision research, these rules have prescribed how we should infer values and probabilities and how we should combine them to make better decisions. We suggest how to make best use of all three rules in a comprehensive 19-step model. The remainder of the review explores recently developed tools of decision technology. It examines the characteristics and problems of decision-facilitating sites on the World Wide Web. Such sites now provide anyone who can use a personal computer with access to very sophisticated decision-aiding tools structured mainly to facilitate consumer decision making. It seems likely that the Web will be the mode by means of which decision tools will be distributed to lay users. But methods for doing such apparently simple things as winnowing 3000 options down to a more reasonable number, like 10, contain traps for unwary decision technologists. The review briefly examines Bayes nets and influence diagrams-judgment and decision-making tools that are available as computer programs. It very briefly summarizes the state of the art of eliciting probabilities from experts. It concludes that decision tools will be as important in the 21st century as spreadsheets were in the 20th.
Peterson, Curtis W; Rose, Donny; Mink, Jonah; Levitz, David
In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by "smart" diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.
Peterson, Curtis W.; Rose, Donny; Mink, Jonah; Levitz, David
In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by “smart” diagnostic medical devices holds promise for broader use in screening programs in low-resource settings. PMID:27196932
Lack of access to relevant scientific data has limited decision makers from incorporating scientific information into their management and policy schemes. Yet, there is increasing interest among decision makers and scientists to integrate coastal and marine science into the polic...
Instone, Susan; Mueller, Mary-Rose
The number of HIV-positive Latinas of child-bearing age living on the US-Mexico border is a growing concern. Little is known about how religious beliefs influence the reproductive health decisions of these women in light of disease demands and cultural and religious norms that support high fertility rates and childbearing. Such decisions may be further complicated by the stigma of HIV/AIDS and structural issues related to immigration status and trans-border lives. This paper analyzes extant literature and supports the need for further research so that policy makers and heath and social service providers can develop meaningful and comprehensive reproductive-health related interventions.
Yan, Bo; Slagle, Mike
As schools turn to data-driven decision making to improve student achievement, research is playing an increasingly important role in local policy making. Researchers have worked to help policy makers better "understand" research with a focus on research design and method. How to better "use" research, however, has received little attention. This…
The second iteration of the Systems Prioritization Method: A systems prioritization and decision-aiding tool for the Waste Isolation Pilot Plant: Volume 3, Analysis for final programmatic recommendations
Prindle, N.H.; Boak, D.M.; Weiner, R.F.
Systems Prioritization Method (SPM) is a decision-aiding tool developed by Sandia National Laboratories for the US DOE Carlsbad Area Office (DOE/CAO). This tool provides an analytical basis for programmatic decision making for the Waste Isolation Pilot Plant (WIPP). SPM integrates decision-analysis techniques, performance,a nd risk-assessment tools, and advanced information technology. Potential outcomes of proposed activities and combination of activities are used to calculate a probability of demonstrating compliance (PDC) with selected regulations. The results are presented in a decision matrix showing cost, duration, and maximum PDC for all activities in a given cost and duration category. This is the third and final volume in the series which presents the analysis for final programmatic recommendations.
Hornak, Anne M.; Garza Mitchell, Regina L.
Objective: The objective of this article is to delve more deeply into the thought processes of the key decision makers at community colleges and understand how they make decisions. Specifically, this article focuses on the role of the community college president's personal values in decision making. Method: We conducted interviews with 13…
Baxter, V. D.
Four test unit ice maker heat pumps (IMHPs) were tested under the annual cycle energy system (ACES) program. Performance results on the effects of harvesting scheme, plate loading, and cycling operation were compared. The ice packing density of IMHPs was also studied and compared with that of ice manufactured by commerical ice makers and brine chiller ACES. Three harvesting schemes were tested: hot gas, stored refrigerant, and dual fluid, off cycle. The hot gas scheme tended to penalize excessively the heating output of the system. Stored refrigerant schemes eliminated that problem but caused compressor failures due to flood-back and oil dilution. The dual fluid schemes exhibited no such problems and demonstrated an ability to harvest during compressor off cycles. Therefore, it was concluded that dual fluid, off cycle schemes are the best for use with IMPHs. Plate loading tests in which compressor speed and evaporator size are varied clearly showed that evaporator plate loading should be as low as possible.
Aliaga-Rossel, R.; Bayley, J.
A cryogenic fiber maker that continuously extrudes fibers is presented. The design of the fiber maker is based on the use of two cooling stages maintained at different temperatures. The fiber maker consists of two copper reservoirs that are connected in series and are kept at different temperatures. The first reservoir is used to liquefy the gas coming in from an external gas line. The second reservoir is colder than the first; here, the liquid that comes from the first reservoir is frozen and later extruded using the pressure of the external line gas supply. A two-stage closed-cycle refrigerator (a Gifford-McMahon cooler), which uses helium as a working fluid, is used as a cooling system. The frozen gas is extruded through a stainless-steel capillary nozzle with internal diameters between 50 and 250 μm and a length of 2 mm. The temperature of the two reservoirs is set independently, which permits the extrusion rate of the fibers to be controlled and to produce the fibers continuously. Using this system, hydrogen, deuterium, nitrogen, and argon fibers of various diameters were extruded.
Many environmental decision makers and practitioners worldwide assume that the quality of data pertaining to a contaminated site is primarily determined by the nature of thhe analytical chemistry methods used to collect information. This assumption, which diminishes the importan...
Bjornstad, David J.; Wolfe, Amy K.
Framing remediation decision making as negotiation: (1) social choice, not technology choice; (2) prompts decision makers to identify interested and affected parties, anticipate objections, effectively address and ameliorate objections, and avoid unacceptable decisions.
König, Niklas; Singh, Navrag B.; Baumann, Christian R.; Taylor, William R.
A disturbed, inconsistent walking pattern is a common feature of patients with Parkinson's disease (PwPD). Such extreme variability in both temporal and spatial parameters of gait has been associated with unstable walking and an elevated prevalence of falls. However, despite their ability to discretise healthy from pathological function, normative variability values for key gait parameters are still missing. Furthermore, an understanding of each parameter's response to pathology, as well as the inter-parameter relationships, has received little attention. The aim of this systematic literature review and meta-analysis was therefore to define threshold levels for pathological gait variability as well as to investigate whether all gait parameters are equally perturbed in PwPD. Based on a broader systematic literature search that included 13′195 titles, 34 studies addressed Parkinson's disease, presenting 800 PwPD and 854 healthy subjects. Eight gait parameters were compared, of which six showed increased levels of variability during walking in PwPD. The most commonly reported parameter, coefficient of variation of stride time, revealed an upper threshold of 2.4% to discriminate the two groups. Variability of step width, however, was consistently lower in PwPD compared to healthy subjects, and therefore suggests an explicit sensory motor system control mechanism to prioritize balance during walking. The results provide a clear functional threshold for monitoring treatment efficacy in patients with Parkinson's disease. More importantly, however, quantification of specific functional deficits could well provide a basis for locating the source and extent of the neurological damage, and therefore aid clinical decision-making for individualizing therapies. PMID:27445759
Yu, Changyuan; Zhang, Shaoliang; Kam, Pooi Yuen; Chen, Jian
The bit-error rate (BER) expressions of 16- phase-shift keying (PSK) and 16- quadrature amplitude modulation (QAM) are analytically obtained in the presence of a phase error. By averaging over the statistics of the phase error, the performance penalty can be analytically examined as a function of the phase error variance. The phase error variances leading to a 1-dB signal-to-noise ratio per bit penalty at BER=10(-4) have been found to be 8.7 x 10(-2) rad(2), 1.2 x 10(-2) rad(2), 2.4 x 10(-3) rad(2), 6.0 x 10(-4) rad(2) and 2.3 x 10(-3) rad(2) for binary, quadrature, 8-, and 16-PSK and 16QAM, respectively. With the knowledge of the allowable phase error variance, the corresponding laser linewidth tolerance can be predicted. We extend the phase error variance analysis of decision-aided maximum likelihood carrier phase estimation in M-ary PSK to 16QAM, and successfully predict the laser linewidth tolerance in different modulation formats, which agrees well with the Monte Carlo simulations. Finally, approximate BER expressions for different modulation formats are introduced to allow a quick estimation of the BER performance as a function of the phase error variance. Further, the BER approximations give a lower bound on the laser linewidth requirements in M-ary PSK and 16QAM. It is shown that as far as laser linewidth tolerance is concerned, 16QAM outperforms 16PSK which has the same spectral efficiency (SE), and has nearly the same performance as 8PSK which has lower SE. Thus, 16-QAM is a promising modulation format for high SE coherent optical communications.
document are those of the author . They are not intended and should not be thought to represent official ideas, attitudes, or policies of any agency of the...United States Government. The author has not had special access to official information or ideas and has employed only open-source material available...the Air Command and Staff *College." - All reproduced copies must contain the name(s) of the report’s author (s). - If format modification is necessary
Bauman, William H., III; Wheeler, Mark
The Applied Meteorology Unit developed a forecast tool that provides an assessment of the likelihood of local convective severe weather for the day in order to enhance protection of personnel and material assets of the 45th Space Wing Cape Canaveral Air Force Station (CCAFS), and Kennedy Space Center (KSC).
Delanoë, Agathe; Lépine, Johanie; Turcotte, Stéphane; Leiva Portocarrero, Maria Esther; Robitaille, Hubert; Giguère, Anik MC; Wilson, Brenda J; Witteman, Holly O; Lévesque, Isabelle; Guillaumie, Laurence
Background Deciding about undergoing prenatal screening is difficult, as it entails risks, potential loss and regrets, and challenges to personal values. Shared decision making and decision aids (DAs) can help pregnant women give informed and values-based consent or refusal to prenatal screening, but little is known about factors influencing the use of DAs. Objective The objective of this study was to identify the influence of psychosocial factors on pregnant women’s intention to use a DA for prenatal screening for Down syndrome (DS). We also added health literacy variables to explore their influence on pregnant women’s intention. Methods We conducted a survey of pregnant women in the province of Quebec (Canada) using a Web panel. Eligibility criteria included age >18 years, >16 weeks pregnant, low-risk pregnancy, and having decided about prenatal screening for the current pregnancy. We collected data based on an extended version of the Theory of Planned Behavior assessing 7 psychosocial constructs (intention, attitude, anticipated regret, subjective norm, descriptive norm, moral norm, and perceived control), 3 related sets of beliefs (behavioral, normative, and control beliefs), 4 health literacy variables, and sociodemographics. Eligible women watched a video depicting the behavior of interest before completing a Web-based questionnaire. We performed descriptive, bivariate, and ordinal logistic regression analyses. Results Of the 383 eligible pregnant women who agreed to participate, 350 pregnant women completed the Web-based questionnaire and 346 were retained for analysis (completion rate 350/383, 91.4%; mean age 30.1, SD 4.3, years). In order of importance, factors influencing intention to use a DA for prenatal screening for DS were attitude (odds ratio, OR, 9.16, 95% CI 4.02-20.85), moral norm (OR 7.97, 95% CI 4.49-14.14), descriptive norm (OR 2.83, 95% CI 1.63-4.92), and anticipated regret (OR 2.43, 95% CI 1.71-3.46). Specific attitudinal beliefs
Maready, William F.
This report discusses the expanding role of Federal judges as educational policymakers. The report discusses court decisions related to interpretations by the Federal Courts of the U.S. Constitution. The report notes that court decisions have covered the following topics: dress codes, flying of the flag, freedom of speech, unwed mothers,…
Decision makers using environmental decision support tools are often confronted with information that predicts a multitude of different human health effects due to environmental stressors. If these health effects need to be contrasted with costs or compared with alternative scena...
The second iteration of the Systems Prioritization Method: A systems prioritization and decision-aiding tool for the Waste Isolation Pilot Plant: Volume 2, Summary of technical input and model implementation
Prindle, N.H.; Mendenhall, F.T.; Trauth, K.; Boak, D.M.; Beyeler, W.; Hora, S.; Rudeen, D.
The Systems Prioritization Method (SPM) is a decision-aiding tool developed by Sandia National Laboratories (SNL). SPM provides an analytical basis for supporting programmatic decisions for the Waste Isolation Pilot Plant (WIPP) to meet selected portions of the applicable US EPA long-term performance regulations. The first iteration of SPM (SPM-1), the prototype for SPM< was completed in 1994. It served as a benchmark and a test bed for developing the tools needed for the second iteration of SPM (SPM-2). SPM-2, completed in 1995, is intended for programmatic decision making. This is Volume II of the three-volume final report of the second iteration of the SPM. It describes the technical input and model implementation for SPM-2, and presents the SPM-2 technical baseline and the activities, activity outcomes, outcome probabilities, and the input parameters for SPM-2 analysis.
regarding continuation of life-sustaining vs. palliative care . Finally, using regret DCA, the optimal decision for the specific patient is suggested...is to develop an Evidence-based Clinical Decision Support (CDSS-EBM) system and make it available at the point of care to improve prognostication of...Analysis and Regret theory to compare multiple decision strategies based on the decision maker’s personal attitudes towards each strategy
too artificial , using models and language that are too abstract, and are difficult for top-level decision makers to understand; (ii) some of the models... artificial tradeoffs between cri- teria, while the decision maker wants to compare alte,-native in terms of their profiles over a number of relevant...Moreover, when such information is pro- vided, it is often expressed in language which the decision maker considers artificial , rather in the language he
... Health Info » Hearing, Ear Infections, and Deafness Hearing Aids On this page: What is a hearing aid? ... the ear through a speaker. How can hearing aids help? Hearing aids are primarily useful in improving ...
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... 46 Shipping 4 2014-10-01 2014-10-01 false Contact makers. 113.25-11 Section 113.25-11 Shipping... SYSTEMS AND EQUIPMENT General Emergency Alarm Systems § 113.25-11 Contact makers. Each contact maker must— (a) Have normally open contacts and be constructed in accordance with Type 4 or 4X of NEMA 250 or...
... 46 Shipping 4 2011-10-01 2011-10-01 false Contact makers. 113.25-11 Section 113.25-11 Shipping... SYSTEMS AND EQUIPMENT General Emergency Alarm Systems § 113.25-11 Contact makers. Each contact maker must— (a) Have normally open contacts and be constructed in accordance with Type 4 or 4X of NEMA 250 or...
... 46 Shipping 4 2013-10-01 2013-10-01 false Contact makers. 113.25-11 Section 113.25-11 Shipping... SYSTEMS AND EQUIPMENT General Emergency Alarm Systems § 113.25-11 Contact makers. Each contact maker must— (a) Have normally open contacts and be constructed in accordance with Type 4 or 4X of NEMA 250 or...