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.
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.
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
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.
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
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.
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.
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
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…
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
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
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.
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.
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)
Pradhan, Malcolm; Liaw, Siaw Teng
This chapter gives an educational overview of: * The elements of a clinical decision; * The elements of decision making: prior probability, evidence (likelihood), posterior probability, actions, utility (value); * A framework for decision making, and support, encompassing validity, utility, importance and certainty; and * The required elements of a clinical decision support system. * The role of knowledge management in the construction and maintenance of clinical decision support.
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
Lester, M.; Liebow, E.; Holm, J.
The Department of Energy (DOE) plans to honor its commitment to government-to-government interactions by providing advance notice of DOE spent fuel and high-level waste shipments to Indian tribes whose jurisdictions are crossed by or adjacent to transportation routes. The tribes are important contributors to a regional response network, and providing tribes with advance notice of DOE shipping plans marks the start -- not the end -- of direct, government-to-government interactions with DOE. The Tribal Prenotification Analysis Support System (PASS) is being developed for the Office of Special Programs within the Department`s Office of Environmental Restoration and Waste Management. PASS will help DOE-Headquarters to coordinate field office activities and provide technical and institutional support to the DOE field offices. PASS is designed to be used by anyone with minimum computer literacy and having contemporary computer hardware and software. It uses on-screen maps to choose and display a shipment route, and to display the tribal jurisdictions. With forms that are easy to understand, it provides information about each jurisdiction and points of contact. PASS records all contacts, commitments made, and actions taken.
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.
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.
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.
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.
Hollnagel, E.; Mancini, G.; Woods, D.D.
This book deals with the basis for design of intelligent systems to support human decision-making in supervisory control, and provides a view of how human and artificial cognitive systems can interact. It covers the design and development of intelligent decision aiding systems, as well as the testing and evaluation. Topics discussed include: decision theory; cognitive engineering; systems engineering; and artificial intelligence.
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.
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.
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
comprehensive bibli- ography search was initiated . This activity continued throughout the contract period. It included a library search, and contact with...bibliography appears at the end of this report. While the bibliographical search con- tinued, a corpanion activity was initiated . This consisted of...number, support decisions which occur infrequently or are not usually anticipated. 2.3 Some Definitions of a DSS Much of the initial focus and direction
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
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.
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.
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
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.
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
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.
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
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
report are those of the author(s) and should not contrued as an official Department of the Army position, policy or decision, unless so designated by...and temporal development of phenomena and processes ; Complex multi-dimensional and heterogeneous data describing decision situations; Large or...information is an integral part of DoD operations and installation management. Spatial decision support processes and systems combine GIS and other
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.…
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
The Science Advisory Board (SAB) provided several comments on the draft Ecosystem Services Research Program's (ESRP's) Multi-Year Plan (MYP). This presentation provides a response to comments related to the decision support framework (DSF) part of Long-Term Goal 1. The comments...
By effectively closing the loop between the data, analytics, processes, and methods supporting business and clinical decision making, a healthcare organization closes the loop between its knowledge generation activities and its actions at the bedside: knowledge guiding actions, actions generating knowledge.
A decision support system (DSS) shell is being constructed that can support applications in a variety of fields, e.g., engineering, manufacturing, finance. The shell provides a hypertext-style interface for 'navigating' among DSS application models, data, and reports. The traditional notion of hypertext had to be enhanced. Hypertext normally requires manually, pre-defined links. A DSS shell, however, requires that hypertext connections to be built 'on the fly'. The role of hypertext is discussed in augmenting DSS applications and the decision making process. Also discussed is how hypertext nodes, links, and link markers tailored to an arbitrary DSS application were automatically generated.
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
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
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
Effective contaminated land management requires a number of decisions addressing a suite of technical, economic, and social concerns. These concerns include human health risks, ecological risks, economic costs, technical feasibility of proposed remedial actions, and the value society places on clean-up and re-use of formerly contaminated lands. Decision making, in the face of uncertainty and multiple and often conflicting objectives, is a vital and challenging role in environmental management that affects a significant economic activity. Although each environmental remediation problem is unique and requires a site-specific analysis, many of the key decisions are similar in structure. This has led many to attempt to develop standard approaches. As part of the standardization process, attempts have been made to codify specialist expertise into decision support tools. This activity is intended to facilitate reproducible and transparent decision making. The process of codifying procedures has also been found to be a useful activity for establishing and rationalizing management processes. This study will have two primary objectives. The first is to develop taxonomy for Decision Support Tools (DST) to provide a framework for understanding the different tools and what they are designed to address in the context of environmental remediation problems. The taxonomy will have a series of subject areas for the DST. From these subjects, a few key areas will be selected for further study and software in these areas will be identified. The second objective, will be to review the existing DST in the selected areas and develop a screening matrix for each software product.
Greenley et al. 2006) resulted in the identification of a set of overarching principles for the implementation of Joint Command Decision Support (Hales...and adjustment of resources, and longer term feasibility planning. As highlighted in the Joint Staff Front End Analysis report ( Greenley et al. 2006...Townsend (2006). The Federal Response to Hurricane Katrina Lessons Learned, Washington, D.C. February 2006. Greenley , A., Baker, K. & Cochran, L. (2006
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
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.
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
Green, Lawrence L.; Alexandrov, Natalia M.; Brown, Sherilyn A.; Cerro, Jeffrey A.; Gumbert, Clyde r.; Sorokach, Michael R.; Burg, Cecile M.
This paper is one of a set of papers, developed simultaneously and presented within a single conference session, that are intended to highlight systems analysis and design capabilities within the Systems Analysis and Concepts Directorate (SACD) of the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC). This paper focuses on the specific capabilities of uncertainty/risk analysis, quantification, propagation, decomposition, and management, robust/reliability design methods, and extensions of these capabilities into decision analysis methods within SACD. These disciplines are discussed together herein under the name of Decision Support Methods and Tools. Several examples are discussed which highlight the application of these methods within current or recent aerospace research at the NASA LaRC. Where applicable, commercially available, or government developed software tools are also discussed
Jairam, B.N.; Morris, J.D.; Emrich, M.L.; Hardee, H.K.
A primary mission of the Budget Management Division of the Air Force is fiscal analysis. This involves formulating, justifying, and tracking financial data during budget preparation and execution. An essential requirement of this process is the ready availability and easy manipulation of past and current budget data. This necessitates the decentralization of the data. A prototypical system, BAFS (Budget Analysis and Forecasting System), that provides such a capability is presented. In its current state, the system is designed to be a decision support tool. A brief report of the budget decisions and activities is presented. The system structure and its major components are discussed. An insight into the implementation strategies and the tool used is provided. The paper concludes with a discussion of future enhancements and the system's evolution into an expert system. 4 refs., 3 figs.
Applied Survival Analysis: Regression Modeling of Time to Event Data,” John Wiley & Sons, Chichester, 1999.  W. A. Knaus, F. E. Harrell Jr, J. Lynn...Review 2003, 93:1449-1475. 39. Krantz DH, Kunreuther HC: Goals and plans in decision making Judgement and decision making 2007, 2(3):137-168. 40. Rawls
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
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.
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
Stilman, Boris; Yakhnis, Vladimir
Linguistic Geometry (LG) is a revolutionary gaming approach which is ideally suited for military decision aids for Air, Ground, Naval, and Space-based operations, as well guiding robotic vehicles and traditional entertainment games. When thinking about modern or future military operations, the game metaphor comes to mind right away. Indeed, the air space together with the ground and seas may be viewed as a gigantic three-dimensional game board. Refining this picture, the LG approach is capable of providing an LG hypergame, that is, a system of multiple concurrent interconnected multi-player abstract board games (ABG) of various resolutions and time frames reflecting various kinds of hardware and effects involved in the battlespace and the solution space. By providing a hypergame representation of the battlespace, LG already provides a significant advance in situational awareness. However, the greatest advantage of the LG approach is an ability to provide commanders of campaigns and missions with decision options resulting in attainment of the commander's intent. At each game turn, an LG decision support tool assigns the best actions to each of the multitude of battlespace actors (UAVs, bombers, cruise missiles, etc.). This is done through utilization of algorithms finding winning strategies and tactics, which are the core of the LG approach.
Abstract:Managing urban water infrastructures faces the challenge of jointly dealing with assets of diverse types, useful life, cost, ages and condition. Service quality and sustainability require sound long-term planning, well aligned with tactical and operational planning and management. In summary, the objective of an integrated approach to infrastructure asset management is to assist utilities answer the following questions:•Who are we at present?•What service do we deliver?•What do we own?•Where do we want to be in the long-term?•How do we get there?The AWARE-P approach (www.aware-p.org) offers a coherent methodological framework and a valuable portfolio of software tools. It is designed to assist water supply and wastewater utility decision-makers in their analyses and planning processes. It is based on a Plan-Do-Check-Act process and is in accordance with the key principles of the International Standards Organization (ISO) 55000 standards on asset management. It is compatible with, and complementary to WERF’s SIMPLE framework. The software assists in strategic, tactical, and operational planning, through a non-intrusive, web-based, collaborative environment where objectives and metrics drive IAM planning. It is aimed at industry professionals and managers, as well as at the consultants and technical experts that support them. It is easy to use and maximizes the value of information from multiple existing data sources, both in da
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
resources—HAC through 23 AF through commander combat rescue forces.; for fighter support—TAC [Tactical Air Command] through NAF [ Numbered Air Force...making rather than the science of data aggregation, information analysis, and alternative evaluation. Numbers on the battlefield are important...Technology on the battlefield is important. But ineffective judgments and decisions made in the employment of those forces can render the numbers helpless
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
therapy, pain medication, nutritional and psychological support, thoracocentesis and/or tube thorascopy.”44 Three studies described supportive care... gestalt survival expectation is presented without loss of contradictory information. This increases the transparency and traceability of the...and/ or psychological damages to the patient. Specifically, a patient may suffer harms due to a treatment strategy (e. g. adverse effects) or
Dowler, Denetta L.; And Others
Constructed decision support system to aid referral of good candidates for rehabilitation from Social Security Administration to rehabilitation counselors. Three layers of system were gross screening based on policy guidelines, training materials, and interviews with experts; physical and mental functional capacity items derived from policy…
Campbell, Merle Wayne
Intelligent decision systems have the potential to support and greatly amplify human decision-making across a number of industries and domains. However, despite the rapid improvement in the underlying capabilities of these "intelligent" systems, increasing their acceptance as decision aids in industry has remained a formidable challenge.…
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,…
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
Yang, Qian; Zimmerman, John; Steinfeld, Aaron; Carey, Lisa; Antaki, James F.
Clinical decision support tools (DSTs) are computational systems that aid healthcare decision-making. While effective in labs, almost all these systems failed when they moved into clinical practice. Healthcare researchers speculated it is most likely due to a lack of user-centered HCI considerations in the design of these systems. This paper describes a field study investigating how clinicians make a heart pump implant decision with a focus on how to best integrate an intelligent DST into their work process. Our findings reveal a lack of perceived need for and trust of machine intelligence, as well as many barriers to computer use at the point of clinical decision-making. These findings suggest an alternative perspective to the traditional use models, in which clinicians engage with DSTs at the point of making a decision. We identify situations across patients’ healthcare trajectories when decision supports would help, and we discuss new forms it might take in these situations. PMID:27833397
Hogan, A.; Michel, J.; Localio, A.R.; Karavite, D.; Song, L.; Ramos, M.J.; Fiks, A.G.; Lorch, S.; Grundmeier, R.W.
Background and Objectives Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration. Methods We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons. Results There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05). Conclusions Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration. PMID:26767069
Bassaneze, Vinicius; Sacramento, Chester Bittencourt; Freire, Rodolfo; De Alencar, Patrícia Fernandes; Ortega, Neli Regina Siqueira; Krieger, Jose Eduardo
The a priori identification of induced pluripotent stem cells remains a challenge. Being able to quickly identify the most embryonic stem cell-similar induced pluripotent stem cells when validating results could help to reduce costs and save time. In this context, tools based on non-classic logic can be useful in creating aid-systems based on visual criteria. True colonies when viewed at 100x magnification have been found to have the following 3 characteristics: a high degree of border delineation, a more uniform texture, and the absence of a cracked texture. These visual criteria were used for fuzzy logic modeling. We investigated the possibility of predicting the presence of alkaline phosphatase activity, typical of true induced pluripotent stem cell colonies, after 25 individuals, with varying degrees of experience in working with murine iPS cells, categorized the images of 136 colonies based on visual criteria. Intriguingly, the performance evaluation by area under the ROC curve (16 individuals with satisfactory performance), Spearman correlation (all statistically significant), and Cohen's Kappa agreement analysis (all statistically significant) demonstrates that the discriminatory capacity of different evaluators are similar, even those who have never cultivated cells. Thus, we report on a new system to facilitate visual identification of murine- induced pluripotent stem cell colonies that can be useful for staff training and opens the possibility of exploring visual characteristics of induced pluripotent stem cell colonies with their functional peculiarities. The fuzzy model has been integrated as a web-based tool named "2see-iPS" which is freely accessed at http://genetica.incor.usp.br/2seeips/.
Moore, Laurence J.; Greenwood, Allen G.
The history and features of Decision Support Systems (DSS) and use of the approach by academic administrators are discussed. The objective of DSS is to involve the manager/decision maker in the decision-analysis process while simultaneously relieving that person of the burden of developing and performing detailed analysis. DSS represents a…
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.
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."
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
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
Compton, M.L.; Moser, E.C.
Sandia National Laboratories is a multiprogram national laboratory established in 1949. The Library currently uses DOBIS for its automated system, including the Periodicals Control function for periodical check-in. DOBIS performs processing and control functions adequately, but could not meet our reporting needs. Therefore the Library`s Periodicals Decision Team decided that they needed another ``system`` for collection management. A Periodicals Decision Support System was created using information downloaded from DOBIS and uploaded into dBASE IV. The Periodical Decision Support System functions as an information-processing system that has aided us in making collection management decisions for periodicals. It certainly allows us to do interactive ad-hoc analysis; although there are no modeling tools currently incorporated in the system. We hope that these modeling tools will come later. We have been gathering information and developing needed reports to achieve this goal.
Aragon, Cecilia R.
In order to safely operate their aircraft, pilots must makerapid decisions based on integrating and processing large amounts ofheterogeneous information. Visual displays are often the most efficientmethod of presenting safety-critical data to pilots in real time.However, care must be taken to ensure the pilot is provided with theappropriate amount of information to make effective decisions and notbecome cognitively overloaded. The results of two usability studies of aprototype airflow hazard visualization cockpit decision support systemare summarized. The studies demonstrate that such a system significantlyimproves the performance of helicopter pilots landing under turbulentconditions. Based on these results, design principles and implicationsfor cockpit decision support systems using visualization arepresented.
Vesselinov, V. V.; O'Malley, D.
Uncertainty quantifications and decision analyses under severe lack of information are ubiquitous in every applied field of engineering, policy, and science. A severe lack of information precludes our ability to determine unbiased probabilistic distributions for model parameters and model predictions; therefore, model and decision uncertainties due to a severe lack of information cannot be characterized probabilistically. To circumvent this problem, information gap (info-gap) theory has been developed to explicitly recognize and quantify the implications of information gaps in decision making. Here we present a decision analysis based on info-gap theory developed for a source identification problem where the locations and mass fluxes of contaminants impacting groundwater resources are unknown. The problem is characterized with a lack of information related to (1) model parameters representing contaminant migration in the aquifer, and (2) observed contamination concentration in the existing monitoring wells. These two sources of uncertainty are coupled through an inverse model where the observed concentrations are applied to estimate model parameters. The decision goal is based on contaminant predictions at points of compliance. The decision analysis is demonstrated for synthetic and real-world test cases. The applied uncertainty-quantification, decision-support techniques and computational algorithms are implemented in code MADS (Model Analyses for Decision Support; http://mads.lanl.gov). MADS is C/C++ code that provides a framework for model-based decision support. MADS performs various types of model analyses including sensitivity analysis, parameter estimation, uncertainty quantification, model calibration, selection and averaging. To perform the analyses, MADS can be coupled with any external simulators. Our efforts target development of an interactive computer-based Decision Support System (DSS) that will help domain scientist, managers, regulators, and
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
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
Barrows, R. C.; Allen, B. A.; Smith, K. C.; Arni, V. V.; Sherman, E.
We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed. PMID:8947774
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.…
Sullivan, T.M.; Moskowitz, P.D.; Gitten, M.
Decision Support Software (DSS) continues to be developed to support analysis of decisions pertaining to environmental management. Decision support systems are computer-based systems that facilitate the use of data, models, and structured decision processes in decision making. The optimal DSS should attempt to integrate, analyze, and present environmental information to remediation project managers in order to select cost-effective cleanup strategies. The optimal system should have a balance between the sophistication needed to address the wide range of complicated sites and site conditions present at DOE facilities, and ease of use (e.g., the system should not require data that is typically unknown and should have robust error checking of problem definition through input, etc.). In the first phase of this study, an extensive review of the literature, the Internet, and discussions with sponsors and developers of DSS led to identification of approximately fifty software packages that met the preceding definition.
Comparison of Identify-Friend-Foe and Blue-Force Tracking Decision Support for Combat Identification (Comparaison des Systemes d’aide a la Decision Identification ami ou Ennemi et Suivi des Forces Bleues pour l’Identification au Combat)
disposition de chaque soldat à pied. Deux expériences ont permis d’examiner l’efficacité des systèmes d’aide à la décision Identification ami ou ennemi (IAE...chaque fois qu’ils sont ciblés par une transmission donnée (infrarouge, radar, etc.). Les soldats munis du générateur et récepteur de signaux...rapidement et pourraient éventuellement être mises à la disposition de chaque soldat à pied. Deux expériences ont permis d’examiner l’efficacité des
Cawyer, Carol Stringer; Smith-Dupre, Athena
Describes supportive episodes in an HIV/AIDS support group and the role of social support for group members. Finds that members used communication as a healing agent, as a preparatory mechanism for living with AIDS, as an outlet for expressing emotions, and as a means for changing society. Identifies feedback and self-disclosure as essential…
While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the
Crofts, Gillian; Padman, Rema; Maharaja, Nisha
Ultrasound is a low cost and efficient method of detecting diseases and abnormalities in the body. Yet there is a lack of precision and reliability associated with the technology, partly due to the operator dependent nature of ultrasound scanning. When scanning is performed to an agreed protocol, ultrasound has been shown to be highly reliable. This research aims to minimize these limitations that arise during ultrasound training, scanning and reporting by developing and evaluating an image analysis and decision support system that can aid the decision making process. We hypothesize that this intervention will likely increase the role of ultrasound in diagnosis when compared with other imaging technologies, particularly in low resource settings.
CONTRACTING ORGANIZATION: Arcos , Inc. HoustonTX77018-5308 REPORT DATE: September 2013 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical... Arcos , Inc. 866 W. 41st St. Houston TX 77018-5308 The Burn Resuscitation Decision Support System (BRDSS) is a medical device designed to guide and...project: The Burn Resuscitation Decision Support System (BRDSS) Tablet project will be broken into four major phases. Throughout the project Arcos will
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
AD-AO95 892 DECISION SCIENCE CONSORTIUM INC FALLS CHURCH VA F./e 12/2 DECISION SUPPORT FOR ATTACK SUBMARINE COMMANDERS. (U) OCT 80 M S COHEN, R V...BROWN N00014-80-C-0046 UNCLASSIFIED TR-8S-11 ML DECISIN IEN$CE CUIVSURTiUM, MrC. DECISION SUPPORT FOR A TTA CK SUBMARINE COMMANDERS Marvin S . Cohen and...on reverse) DDI ,o..ŕ 1473 EDITION OF I NOV 65 IS OISOLCTZ Unclassified S /N 0102-014-6601 1 SECURITY CLASIFICATION OF TNIS PAGE (10bon DW& tateo* 01
Binder, Michael L.; Calvo, Alberto B.; Gibson, Gregory J.
This paper describes a Decision Support System for military display acquisition being developed under U.S. Display Consortium (USDC) sponsorship. The core of the system is a standard Life-Cycle Cost model. The system will use World Wide Web technology to make it widely accessible to Industry and Government Program Offices for use in the Display Acquisition Decision Process. Web-LCCA (Life-Cycle Cost Analyzer), a derivative of TASC's LCCATM, has been designed to aid in the evaluation of different Display System acquisition options. The target users of Web-LCCA are display vendors (Industry) and buyers (Government Program Offices). Web-LCCA will be USDC's standard tool for supporting cost tradeoffs and acquisition decisions among current operational displays and new flat panel display products.
Janssen, T. |; Sage, A.P.
This paper addresses the need for sound science, technology, and management assessment relative to environmental policy decision making through an approach that involves a logical structure for evidence, a framed decision-making process, and an environment that encourages group participation. Toulmin-based logic possesses these characteristics and is used as the basis for development of a group decision support system. This system can support several user groups, such as pesticide policy-making experts, who can use the support system to state arguments for or against an important policy issue, and pest management experts, who can use the system to assist in identifying and evaluating alternatives for controlling pests on agricultural commodities. The resulting decision support system assists in improving the clarity of the lines of reasoning used in specific situations; the warrants, grounds, and backings that are used to support claims and specific lines of reasoning; and the contradictions, rebuttals, and arguments surrounding each step in the reasoning process associated with evaluating a claim or counterclaim. Experts and decisions makers with differing views can better understand each other`s thought processes. The net effect is enhanced communications and understanding of the whole picture and, in many cases, consensus on decisions to be taken.
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.
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
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
Aragon, Cecilia R.
In order to safely operate their aircraft, pilots must make rapid decisions based on integrating and processing large amounts of heterogeneous information. Visual displays are often the most efficient method of presenting safety-critical data to pilots in real time. However, care must be taken to ensure the pilot is provided with the appropriate amount of information to make effective decisions and not become cognitively overloaded. The results of two usability studies of a prototype airflow hazard visualization cockpit decision support system are summarized. The studies demonstrate that such a system significantly improves the performance of helicopter pilots landing under turbulent conditions. Based on these results, design principles and implications for cockpit decision support systems using visualization are presented.
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
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
McShan, Daniel; Luo, Yi; Schipper, Matt; TenHaken, Randall
Purpose: A Bayesian Decision Network will be demonstrated to provide clinical decision support for adaptive lung response-driven treatment management based on evidence that physiologic metrics may correlate better with individual patient response than traditional (population-based) dose and volume-based metrics. Further, there is evidence that information obtained during the course of radiation therapy may further improve response predictions. Methods: Clinical factors were gathered for 58 patients including planned mean lung dose, and the bio-markers IL-8 and TGF-β1 obtained prior to treatment and two weeks into treatment along with complication outcomes for these patients. A Bayesian Decision Network was constructed using Netica 5.0.2 from Norsys linking these clinical factors to obtain a prediction of radiation induced lung disese (RILD) complication. A decision node was added to the network to provide a plan adaption recommendation based on the trade-off between the RILD prediction and complexity of replanning. A utility node provides the weighting cost between the competing factors. Results: The decision node predictions were optimized against the data for the 58 cases. With this decision network solution, one can consider the decision result for a new patient with specific findings to obtain a recommendation to adaptively modify the originally planned treatment course. Conclusions: A Bayesian approach allows handling and propagating probabilistic data in a logical and principled manner. Decision networks provide the further ability to provide utility-based trade-offs, reflecting non-medical but practical cost/benefit analysis. The network demonstrated illustrates the basic concept, but many other factors may affect these decisions and work on building better models are being designed and tested. Acknowledgement: Supported by NIH-P01-CA59827
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.
Clinical Decision Support 1 Introduction The goal of the Clinical Decision Support Track is to retrieve relevant biomedical articles given a patient record...queries: • Diagnosis: "diagnosis"[MeSH Terms] OR "diagnosis, oral"[MeSH Terms] OR "diagnostic equipment "[MeSH Terms] OR "diagnostic services"[MeSH Terms...particular biomedical domain or search strategy) that were created as part of the CISMeF project3. The Test query was manually created for 3These and
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
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
Summary Objective To summarize recent research and propose a selection of best papers published in 2014 in the field of computerized clinical decision support for the Decision Support section of the IMIA yearbook. Method A literature review was performed by searching two bibliographic databases for papers related to clinical decision support systems (CDSSs) and computerized provider order entry systems in order to select a list of candidate best papers to be then peer-reviewed by external reviewers. A consensus meeting between the two section editors and the editorial team was finally organized to conclude on the selection of best papers. Results Among the 1,254 returned papers published in 2014, the full review process selected four best papers. The first one is an experimental contribution to a better understanding of unintended uses of CDSSs. The second paper describes the effective use of previously collected data to tailor and adapt a CDSS. The third paper presents an innovative application that uses pharmacogenomic information to support personalized medicine. The fourth paper reports on the long-term effect of the routine use of a CDSS for antibiotic therapy. Conclusions As health information technologies spread more and more meaningfully, CDSSs are improving to answer users’ needs more accurately. The exploitation of previously collected data and the use of genomic data for decision support has started to materialize. However, more work is still needed to address issues related to the correct usage of such technologies, and to assess their effective impact in the long term. PMID:26293858
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
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.
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.
Demner-Fushman, Dina; Chapman, Wendy W.; McDonald, Clement J.
Computerized Clinical Decision Support (CDS) aims to aid decision making of health care providers and the public by providing easily accessible health-related information at the point and time it is needed. Natural Language Processing (NLP) is instrumental in using free-text information to drive CDS, representing clinical knowledge and CDS interventions in standardized formats, and leveraging clinical narrative. The early innovative NLP research of clinical narrative was followed by a period of stable research conducted at the major clinical centers and a shift of mainstream interest to biomedical NLP. This review primarily focuses on the recently renewed interest in development of fundamental NLP methods and advances in the NLP systems for CDS. The current solutions to challenges posed by distinct sublanguages, intended user groups, and support goals are discussed. PMID:19683066
Ballin, Mark G.; Sharma, Vivek; Vivona, Robert A.; Johnson, Edward J.; Ramiscal, Ermin
NASA is developing a flight deck decision support tool to support research into autonomous operations in a future distributed air/ground traffic management environment. This interactive real-time decision aid, referred to as the Autonomous Operations Planner (AOP), will enable the flight crew to plan autonomously in the presence of dense traffic and complex flight management constraints. In assisting the flight crew, the AOP accounts for traffic flow management and airspace constraints, schedule requirements, weather hazards, aircraft operational limits, and crew or airline flight-planning goals. This paper describes the AOP and presents an overview of functional and implementation design considerations required for its development. Required AOP functionality is described, its application in autonomous operations research is discussed, and a prototype software architecture for the AOP is presented.
A knowledge representation approach for expert systems supporting decision processes in business is proposed. A description of a knowledge representation schema using a logic programming metalanguage is described, then the role of such a schema in a management expert system is demonstrated through the problem of nursing management control in hospitals. 18 references.
Wagner, Ina-Veronika; Schneider, Werner
The paper discusses computer-based decision support in the following areas: the dental patient record system; diagnosis and treatment of diseases of the oral mucosa; treatment strategy in complex clinical situations; diagnosis and treatment of functional disturbances of the masticatory system; and patient recall. (DB)
Query Reformulation for Clinical Decision Support Search Luca Soldaini, Arman Cohan, Andrew Yates, Nazli Goharian, Ophir Frieder Information...work, we present a query reformulation approach that addresses the unique formulation of case reports, making them suitable to be used on a general... reformulation approach does not directly take into account the generic question type (diagnosis, test, treatment) provided with each approach. To ameliorate
Feather, Martin S.; Maynard-Zhang, Pedrito; Kiper, James D.
One inherent characteristic of requrements engineering is a lack of certainty during this early phase of a project. Nevertheless, decisions about requirements must be made in spite of this uncertainty. Here we describe the context in which we are exploring this, and some initial work to support elicitation of uncertain requirements, and to deal with the combination of such information from multiple stakeholders.
increasing the quality of service provided complex systems while reducing development risks, costs, and time. our work focused on decision support for...design synthesis. Mathematical models for implementing a set of automated and integrated engineering automation tools were also developed. Our work ...coordinating concurrent work by engineering teams. Our work will ensure design consistency and alleviate communication difficulties. The significance
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.
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The Multiple Objective Decision Support (MODS) tool is an automated tool used to assist decision makers and policy analysts with multiple-objective decision problems. The classes of problems that this decision support tool addresses have both multiple objectives and multiple stakeholders. Decision problems, which have multiple objectives that in general cannot be maximized simultaneously, and multiple stakeholders, who have different perspectives about the relative importance of the objectives, require analytic approaches and tools that can provide flexible support to decision makers. This tool provides capabilities for the management, analysis, and graphical display for these types of decision problems drawn from diverse problem domains. The MODS tool is a unique integration of analysis algorithms, an information database, and a graphical user interface. This collection of algorithms, the combination of an information database with the analysis into a single tool, and the graphical user interface provides a technically advanced tool to decision makers and policy analysts. There are two main issues when addressing problems of this type: what set of attributes should be used to characterize the tokens in the domain of interest, and how should the values of these attributes and their weights be determined and combined to provide a relative ordering to the tokens. This tool addresses both of these issues. This decision support tool provides a flexible way to derive and use a chosen set of attributes. For example, the tool could be used to first perform a paired comparison of a large set of attributes and from this evaluation select those attributes that have the highest weights. The flexibility of the tool allows experimentation with various attribute sets and this capability, along with domain expertise, addresses the first issue. To address the second issue, several algorithms have been implemented. For example, two algorithms that have been implemented are the
Reichert, Peter; Langhans, Simone D; Lienert, Judit; Schuwirth, Nele
Environmental decision support intends to use the best available scientific knowledge to help decision makers find and evaluate management alternatives. The goal of this process is to achieve the best fulfillment of societal objectives. This requires a careful analysis of (i) how scientific knowledge can be represented and quantified, (ii) how societal preferences can be described and elicited, and (iii) how these concepts can best be used to support communication with authorities, politicians, and the public in environmental management. The goal of this paper is to discuss key requirements for a conceptual framework to address these issues and to suggest how these can best be met. We argue that a combination of probability theory and scenario planning with multi-attribute utility theory fulfills these requirements, and discuss adaptations and extensions of these theories to improve their application for supporting environmental decision making. With respect to (i) we suggest the use of intersubjective probabilities, if required extended to imprecise probabilities, to describe the current state of scientific knowledge. To address (ii), we emphasize the importance of value functions, in addition to utilities, to support decisions under risk. We discuss the need for testing "non-standard" value aggregation techniques, the usefulness of flexibility of value functions regarding attribute data availability, the elicitation of value functions for sub-objectives from experts, and the consideration of uncertainty in value and utility elicitation. With respect to (iii), we outline a well-structured procedure for transparent environmental decision support that is based on a clear separation of scientific prediction and societal valuation. We illustrate aspects of the suggested methodology by its application to river management in general and with a small, didactical case study on spatial river rehabilitation prioritization.
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.
Forecasting and communicating the potential outcomes of decision options requires support tools that aid in evaluating alternative scenarios in a user-friendly context and that highlight variables relevant to the decision options and valuable stakeholders. Envision is a GIS-base...
Glasscoe, M. T.; Stough, T. M.; Parker, J. W.; Burl, M. C.; Donnellan, A.; Blom, R. G.; Pierce, M. E.; Wang, J.; Ma, Y.; Rundle, J. B.; Yoder, M. R.
Earthquake Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response (E-DECIDER) is a NASA-funded project developing capabilities for decision-making utilizing remote sensing data and modeling software in order to provide decision support for earthquake disaster management and response. E-DECIDER incorporates earthquake forecasting methodology and geophysical modeling tools developed through NASA's QuakeSim project in order to produce standards-compliant map data products to aid in decision-making following an earthquake. Remote sensing and geodetic data, in conjunction with modeling and forecasting tools, help provide both long-term planning information for disaster management decision makers as well as short-term information following earthquake events (i.e. identifying areas where the greatest deformation and damage has occurred and emergency services may need to be focused). E-DECIDER utilizes a service-based GIS model for its cyber-infrastructure in order to produce standards-compliant products for different user types with multiple service protocols (such as KML, WMS, WFS, and WCS). The goal is to make complex GIS processing and domain-specific analysis tools more accessible to general users through software services as well as provide system sustainability through infrastructure services. The system comprises several components, which include: a GeoServer for thematic mapping and data distribution, a geospatial database for storage and spatial analysis, web service APIs, including simple-to-use REST APIs for complex GIS functionalities, and geoprocessing tools including python scripts to produce standards-compliant data products. These are then served to the E-DECIDER decision support gateway (http://e-decider.org), the E-DECIDER mobile interface, and to the Department of Homeland Security decision support middleware UICDS (Unified Incident Command and Decision Support). The E-DECIDER decision support gateway features a web interface that
Ozbolt, Judy; Ozdas, Asli; Waitman, Lemuel R; Smith, Janis B; Brennan, Grace V; Miller, Randolph A
The application of principles and methods of cybernetics permits clinicians and managers to use feedback about care effectiveness and resource expenditure to improve quality and to control costs. Keys to the process are the specification of therapeutic goals and the creation of an organizational culture that supports the use of feedback to improve care. Daily feedback on the achievement of each patient's therapeutic goals provides tactical decision support, enabling clinicians to adjust care as needed. Monthly or quarterly feedback on aggregated goal achievement for all patients on a clinical pathway provides strategic decision support, enabling clinicians and managers to identify problems with supposed "best practices" and to test hypotheses about solutions. Work is underway at Vanderbilt University Medical Center to implement feedback loops in care and management processes and to evaluate the effects.
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.
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.
DSOM (Decision Support for Operations and Maintenance) is an expert operations and maintenance system that integrates plant operations, fuel management, and maintenance processes. The DSOM package provides operators with the information they need for cost-effective operating decisions creating savings in fuel, personnel, maintenance, and plant life extension. DSOM provides operators real-time system performance information to allow them to determine if the plant is malfunctioning or running below expectations. By catching potential problems, DSOM enables plants to operate safely at peak efficiency, while providing a higher level of reliability and safety.
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.
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.
account . The exception and annotation ability of MIDS alerted the executives to what was happening and prevented a ripple effect of overreactions...information directly to these executives, an executive support system (ESS) allows more effective analysis, control, planning, and decision making...Automated improve- ments to the management process have the potential to highly leverage the executive’s effectiveness . An ESS is a concept, a clustered IT
Arlington, VA 22203-1995 703-696-2875 firstname.lastname@example.org Report Prepared By: Thomas G. Allen Boston Fusion Corp. 1 Van de Graaff Drive...7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Boston Fusion Corp.,1 Van de Graaff Drive, Suite 107,Burlington,MA,01803 8. PERFORMING...During August, the principal activities for Boston Fusion were related to the preparation for, and attendance at, the ONR Proactive Decision Support
Wright, Adam; Phansalkar, Shobha; Bloomrosen, Meryl; Jenders, Robert A.; Bobb, Anne M.; Halamka, John D.; Kuperman, Gilad; Payne, Thomas H.; Teasdale, S.; Vaida, A. J.; Bates, D. W.
Background Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges. Purpose To identify best practices for CDS, using the domain of preventive care reminders as an example. Methods We assembled a panel of experts in CDS and held a series of facilitated online and inperson discussions. We analyzed the results of these discussions using a grounded theory method to elicit themes and best practices. Results Eight best practice themes were identified as important: deliver CDS in the most appropriate ways, develop effective governance structures, consider use of incentives, be aware of workflow, keep content current, monitor and evaluate impact, maintain high quality data, and consider sharing content. Keys themes within each of these areas were also described. Conclusion Successful implementation of CDS requires consideration of both technical and socio-technical factors. The themes identified in this study provide guidance on crucial factors that need consideration when CDS is implemented across healthcare settings. These best practice themes may be useful for developers, implementers, and users of decision support. PMID:21991299
Hardin, D. M.; Hawkins, L.; He, M.; Ebersole, S.
Since the year 2000, Eastern Louisiana, coastal Mississippi, Alabama, and the western Florida panhandle have been affected by 28 tropical storms, seven of which were hurricanes. These tropical cyclones have significantly altered normal coastal processes and characteristics in the Gulf region through sediment disturbance. Although tides, seasonality, and agricultural development influence suspended sediment and sediment deposition over periods of time, tropical storm activity has the capability of moving the largest sediment loads in the shortest periods of time for coastal areas. The SANDS project is also investigating the effects of sediment immersed oil from the Deepwater Horizon disaster in April 2010 which has the potential to resurface as a result of tropical storm activity. The importance of sediments upon water quality, coastal erosion, habitats and nutrients has made their study and monitoring vital to decision makers in the region. Currently agencies such as United States Army Corps of Engineers (USACE), NASA, and Geological Survey of Alabama (GSA) are employing a variety of in-situ and airborne based measurements to assess and monitor sediment loading and deposition. These methods provide highly accurate information but are limited in geographic range, are not continuous over a region and, in the case of airborne LIDAR are expensive and do not recur on a regular basis. Multi-temporal and multi-spectral satellite imagery that shows tropical-storm-induced suspended sediment and storm-surge sediment deposits can provide decision makers with immediate and long-term information about the impacts of tropical storms and hurricanes. It can also be valuable for those conducting research and for projects related to coastal issues such as recovery, planning, management, and mitigation. The Sediment Analysis Network for Decision Support has generated a number of decision support products derived from MODIS, Landsat and SeaWiFS instruments that potentially support
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.
The problems in drinking water management are complex and often solutions must be reached under strict time constrains. This is especially distinct in case of environmental accidents in the catchment areas of the wells that are used for drinking water supply. The beneficial tools that can help decision makers and make program of activities more efficient are decision support systems (DSS). In general they are defined as computer-based support systems that help decision makers utilize data and models to solve unstructured problems. The presented DSS was developed in the frame of INCOME project which is focused on the long-term stable and safe drinking water supply in Ljubljana. The two main water resources Ljubljana polje and Barje alluvial aquifers are characterized by a strong interconnection of surface and groundwater, high vulnerability, high velocities of groundwater flow and pollutant transport. In case of sudden pollution, reactions should be very fast to avoid serious impact to the water supply. In the area high pressures arising from urbanization, industry, traffic, agriculture and old environmental burdens. The aim of the developed DSS is to optimize the activities in cases of emergency water management and to optimize the administrative work regarding the activities that can improve groundwater quality status. The DSS is an interactive computer system that utilizes data base, hydrological modelling, and experts' and stakeholders' knowledge. It consists of three components, tackling the different abovementioned issues in water management. The first one utilizes the work on identification, cleaning up and restoration of illegal dumpsites that are a serious threat to the qualitative status of groundwater. The other two components utilize the predictive capability of the hydrological model and scenario analysis. The user interacts with the system by a graphical interface that guides the user step-by-step to the recommended remedial measures. Consequently, the
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
Sim, Ida; Berlin, Amy
Background Computer-based clinical decision support systems (CDSSs) vary greatly in design and function. A taxonomy for classifying CDSS structure and function would help efforts to describe and understand the variety of CDSSs in the literature, and to explore predictors of CDSS effectiveness and generalizability. Objective To define and test a taxonomy for characterizing the contextual, technical, and workflow features of CDSSs. Methods We retrieved and analyzed 150 English language articles published between 1975 and 2002 that described computer systems designed to assist physicians and/or patients with clinical decision making. We identified aspects of CDSS structure or function and iterated our taxonomy until additional article reviews did not result in any new descriptors or taxonomic modifications. Results Our taxonomy comprises 95 descriptors along 24 descriptive axes. These axes are in 5 categories: Context, Knowledge and Data Source, Decision Support, Information Delivery, and Workflow. The axes had an average of 3.96 coded choices each. 75% of the descriptors had an inter-rater agreement kappa of greater than 0.6. Conclusions We have defined and tested a comprehensive, multi-faceted taxonomy of CDSSs that shows promising reliability for classifying CDSSs reported in the literature. PMID:14728243
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
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
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
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.
Adumitroaie, Virgil; Hua, Hook; Lincoln, William; Block, Gary; Mrozinski, Joseph; Shelton, Kacie; Weisbin, Charles; Elfes, Alberto; Smith, Jeffrey
Strategic Assessment of Risk and Technology (START) is a user-friendly computer program that assists human managers in making decisions regarding research-and-development investment portfolios in the presence of uncertainties and of non-technological constraints that include budgetary and time limits, restrictions related to infrastructure, and programmatic and institutional priorities. START facilitates quantitative analysis of technologies, capabilities, missions, scenarios and programs, and thereby enables the selection and scheduling of value-optimal development efforts. START incorporates features that, variously, perform or support a unique combination of functions, most of which are not systematically performed or supported by prior decision- support software. These functions include the following: Optimal portfolio selection using an expected-utility-based assessment of capabilities and technologies; Temporal investment recommendations; Distinctions between enhancing and enabling capabilities; Analysis of partial funding for enhancing capabilities; and Sensitivity and uncertainty analysis. START can run on almost any computing hardware, within Linux and related operating systems that include Mac OS X versions 10.3 and later, and can run in Windows under the Cygwin environment. START can be distributed in binary code form. START calls, as external libraries, several open-source software packages. Output is in Excel (.xls) file format.
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 ...
CareScience, Inc. is a public company (NASDAQ: CARE) that originated ten years ago to commercialize risk adjustment and complication predictions developed by the Wharton School of Business and the University of Pennsylvania School of Medicine. Over the past decade, the company has grown to approximately 200 clients and 150 employees. Among the "firsts" recorded by the company, CareScience was the first to offer a clinical decision support system as an Application Service Provider (ASP), the first to offer peer-to-peer clinical data sharing among health care provider organizations and practitioners (Santa Barbara Care Data Exchange), and the first to provide a care management outsourcing arrangement.
Hamouda, M A; Anderson, W B; Huck, P M
The continuously changing drivers of the water treatment industry, embodied by rigorous environmental and health regulations and the challenge of emerging contaminants, necessitates the development of decision support systems for the selection of appropriate treatment trains. This paper explores a systematic approach to developing decision support systems, which includes the analysis of the treatment problem(s), knowledge acquisition and representation, and the identification and evaluation of criteria controlling the selection of optimal treatment systems. The objective of this article is to review approaches and methods used in decision support systems developed to aid in the selection, sequencing of unit processes and design of drinking water, domestic wastewater, and industrial wastewater treatment systems. Not surprisingly, technical considerations were found to dominate the logic of the developed systems. Most of the existing decision-support tools employ heuristic knowledge. It has been determined that there is a need to develop integrated decision support systems that are generic, usable and consider a system analysis approach.
Tams, Carl G; Euliano, Neil R
Clinical decision support systems are vital for advances in improving patient therapeutic care. We share lessons learned from creating two respiratory clinical decisions support systems for ventilating patients in a critical care setting.
Hardin, D. M.; Keiser, K.; Graves, S. J.; Conover, H.; Ebersole, S.
Since the year 2000, Eastern Louisiana, coastal Mississippi, Alabama, and the western Florida panhandle have been affected by 28 tropical storms, seven of which were hurricanes. These tropical cyclones have significantly altered normal coastal processes and characteristics in the Gulf region through sediment disturbance. Although tides, seasonality, and agricultural development influence suspended sediment and sediment deposition over periods of time, tropical storm activity has the capability of moving the largest sediment loads in the shortest periods of time for coastal areas. The importance of sediments upon water quality, coastal erosion, habitats and nutrients has made their study and monitoring vital to decision makers in the region. Currently agencies such as United States Army Corps of Engineers (USACE), NASA, and Geological Survey of Alabama (GSA) are employing a variety of in-situ and airborne based measurements to assess and monitor sediment loading and deposition. These methods provide highly accurate information but are limited in geographic range, are not continuous over a region and, in the case of airborne LIDAR are expensive and do not recur on a regular basis. Multi-temporal and multi-spectral satellite imagery that shows tropical-storm-induced suspended sediment and storm-surge sediment deposits can provide decision makers with immediate and long-term information about the impacts of tropical storms and hurricanes. It can also be valuable for those conducting research and for projects related to coastal issues such as recovery, planning, management, and mitigation. The recently awarded Sediment Analysis Network for Decision Support will generate decision support products using NASA satellite observations from MODIS, Landsat and SeaWiFS instruments to support resource management, planning, and decision making activities in the Gulf of Mexico. Specifically, SANDS will generate decision support products that address the impacts of tropical storms
The performance evaluation of innovative and alternative environmental technologies is an integral part of the US Environmental Protection Agency's (EPA) mission. Early efforts focused on evaluating technologies that supported the implementation of the Clean Air and Clean Water Acts. In 1986 the Agency began to demonstrate and evaluate the cost and performance of remediation and monitoring technologies under the Superfund Innovative Technology Evaluation (SITE) program (in response to the mandate in the Superfund Amendments and Reauthorization Act of 1986 (SARA)). In 1990, the US Technology Policy was announced. This policy placed a renewed emphasis on making the best use of technology in achieving the national goals of improved quality of life for all Americans, continued economic growth, and national security. In the spirit of the technology policy, the Agency began to direct a portion of its resources toward the promotion, recognition, acceptance, and use of US-developed innovative environmental technologies both domestically and abroad. Decision Support Software (DSS) packages integrate environmental data and simulation models into a framework for making site characterization, monitoring, and cleanup decisions. To limit the scope which will be addressed in this demonstration, three endpoints have been selected for evaluation: Visualization; Sample Optimization; and Cost/Benefit Analysis. Five topics are covered in this report: the objectives of the demonstration; the elements of the demonstration plan; an overview of the Site Characterization and Monitoring Technology Pilot; an overview of the technology verification process; and the purpose of this demonstration plan.
Birch, Patricia; Adam, S; Bansback, N; Coe, R R; Hicklin, J; Lehman, A; Li, K C; Friedman, J M
We describe the rationale, development, and usability testing for an integrated e-learning tool and decision aid for parents facing decisions about genome-wide sequencing (GWS) for their children with a suspected genetic condition. The online tool, DECIDE, is designed to provide decision-support and to promote high quality decisions about undergoing GWS with or without return of optional incidental finding results. DECIDE works by integrating educational material with decision aids. Users may tailor their learning by controlling both the amount of information and its format - text and diagrams and/or short videos. The decision aid guides users to weigh the importance of various relevant factors in their own lives and circumstances. After considering the pros and cons of GWS and return of incidental findings, DECIDE summarizes the user's responses and apparent preferred choices. In a usability study of 16 parents who had already chosen GWS after conventional genetic counselling, all participants found DECIDE to be helpful. Many would have been satisfied to use it alone to guide their GWS decisions, but most would prefer to have the option of consulting a health care professional as well to aid their decision. Further testing is necessary to establish the effectiveness of using DECIDE as an adjunct to or instead of conventional pre-test genetic counselling for clinical genome-wide sequencing.
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.
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.
VonPlinsky, Michael J.; Johnson, Pete; Crowder, Ed
The "Decision Integration and Support Environment" (DISE) is a Bayesian network (BN) based modeling and simulation of the target nomination and aircraft tasking decision process. FTI has developed two BNs to model these processes, incorporating aircraft, target, and overall mission priorities from the Air Operations Center (OAC) and the mission planners/command staff. DISE operates in event driven interactions with FTI's AOC model, being triggered from within the Time Critical Target (TCT) Operations cell. As new target detections are received by the AOC from off-board ISR Sources and processed by the Automatic Target Recognition (ATR) module in the AOC, DISE is called to determine if the target should be prosectued, and if so, which of the available aircraft should be tasked to attack it. A range of decision criteria, with priorities established off-line and input into the tool, are associated with this process, including factors such as: * Fuel Level - amount of fuel in aircraft * Type of Weapon - available weapons on board aircraft * Probability of Survival - depends on the type of TST, time criticality and other factors * Potential Collateral Damage - amount of damage incurred on TST surroundings * Time Criticality of TST - how "critical" it is to attack the target depending on its launch status * Time to Target - aircraft's distance (in minutes) from the TST * Current Mission Priority - priority of the mission to which the aircraft is currently assigned * TST Mission Priority - determined when the target is originally nominated * Possible Reassignment - represents whether it is even possible to reassign the aircraft * Aircraft Re-tasking Availability - represents any factor not taken into account by the model, including commander override.
Harvey, Craig; Lawhead, Joel; Watts, Zack
The Flood Disaster Mitigation Decision Support System (DSS) is a computerized information system that allows regional emergency-operations government officials to make decisions regarding the dispatch of resources in response to flooding. The DSS implements a real-time model of inundation utilizing recently acquired lidar elevation data as well as real-time data from flood gauges, and other instruments within and upstream of an area that is or could become flooded. The DSS information is updated as new data become available. The model generates realtime maps of flooded areas and predicts flood crests at specified locations. The inundation maps are overlaid with information on population densities, property values, hazardous materials, evacuation routes, official contact information, and other information needed for emergency response. The program maintains a database and a Web portal through which real-time data from instrumentation are gathered into the database. Also included in the database is a geographic information system, from which the program obtains the overlay data for areas of interest as needed. The portal makes some portions of the database accessible to the public. Access to other portions of the database is restricted to government officials according to various levels of authorization. The Flood Disaster Mitigation DSS has been integrated into a larger DSS named REACT (Real-time Emergency Action Coordination Tool), which also provides emergency operations managers with data for any type of impact area such as floods, fires, bomb
Wasielewska, K.; Ganzha, M.; Paprzycki, M.; Bǎdicǎ, C.; Ivanovic, M.; Lirkov, I.
The aim of our work is to design a decision support system based on ontological representation of domain(s) and semantic technologies. Specifically, we consider the case when Grid / Cloud user describes his/her requirements regarding a "resource" as a class expression from an ontology, while the instances of (the same) ontology represent available resources. The goal is to help the user to find the best option with respect to his/her requirements, while remembering that user's knowledge may be "limited." In this context, we discuss multiple approaches based on semantic data processing, which involve different "forms" of user interaction with the system. Specifically, we consider: (a) ontological matchmaking based on SPARQL queries and class expression, (b) graph-based semantic closeness of instances representing user requirements (constructed from the class expression) and available resources, and (c) multicriterial analysis based on the AHP method, which utilizes expert domain knowledge (also ontologically represented).
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...
Maloney, F.L.; Feblowitz, J.; Samal, L.; Sato, L.; Wright, A.
Summary Objective Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS). Materials and Methods Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type. Results Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity. Discussion CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments. Conclusion More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS. PMID:25298814
Celik, Basak; Girgin, Sertan; Yazici, Adnan; Unlue, Kahraman
Designing environmentally sound landfills is a challenging engineering task due to complex interactions of numerous design variables; such as landfill size, waste characteristics, and site hydrogeology. Decision support systems (DSS) can be utilized to handle these complex interactions and to aid in a performance-based landfill design by coupling system simulation models (SSM). The aim of this paper is to present a decision support system developed for a performance-based landfill design. The developed DSS is called Landfill Design Decision Support System - LFDSS. A two-step DSS framework, composed of preliminary design and detailed design phases, is set to effectively couple and run the SSMs and calculation modules. In preliminary design phase, preliminary design alternatives are proposed using general site data. In detailed design phase, proposed design alternatives are further simulated under site-specific data using SSMs for performance evaluation. LFDSS calculates the required landfill volume, performs landfill base contour design, proposes preliminary design alternatives based on general site conditions, evaluates the performance of the proposed designs, calculates the factor of safety values for slope stability analyses, and performs major cost calculations. The DSS evaluates the results of all landfill design alternatives, and determines whether the design satisfies the predefined performance criteria. The DSS ultimately enables comparisons among different landfill designs based on their performances (i.e. leachate head stability, and groundwater contamination), constructional stability and costs. The developed DSS was applied to a real site, and the results demonstrated the strengths of the developed system on designing environmentally sound and feasible landfills.
Celik, Başak; Girgin, Sertan; Yazici, Adnan; Unlü, Kahraman
Designing environmentally sound landfills is a challenging engineering task due to complex interactions of numerous design variables; such as landfill size, waste characteristics, and site hydrogeology. Decision support systems (DSS) can be utilized to handle these complex interactions and to aid in a performance-based landfill design by coupling system simulation models (SSM). The aim of this paper is to present a decision support system developed for a performance-based landfill design. The developed DSS is called Landfill Design Decision Support System - LFDSS. A two-step DSS framework, composed of preliminary design and detailed design phases, is set to effectively couple and run the SSMs and calculation modules. In preliminary design phase, preliminary design alternatives are proposed using general site data. In detailed design phase, proposed design alternatives are further simulated under site-specific data using SSMs for performance evaluation. LFDSS calculates the required landfill volume, performs landfill base contour design, proposes preliminary design alternatives based on general site conditions, evaluates the performance of the proposed designs, calculates the factor of safety values for slope stability analyses, and performs major cost calculations. The DSS evaluates the results of all landfill design alternatives, and determines whether the design satisfies the predefined performance criteria. The DSS ultimately enables comparisons among different landfill designs based on their performances (i.e. leachate head stability, and groundwater contamination), constructional stability and costs. The developed DSS was applied to a real site, and the results demonstrated the strengths of the developed system on designing environmentally sound and feasible landfills.
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.
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
Necefer, Len Edward
Decision-making surrounding pathways of future energy resource management are complexity and requires balancing tradeoffs of multiple environmental, social, economic, and technical outcomes. Technical decision aid can provide a framework for informed decision making, allowing individuals to better understand the tradeoff between resources, technology, energy services, and prices. While technical decision aid have made significant advances in evaluating these quantitative aspects of energy planning and performance, they have not been designed to incorporate human factors, such as preferences and behavior that are informed by cultural values. Incorporating cultural values into decision tools can provide not only an improved decision framework for the Navajo Nation, but also generate new insights on how these perspective can improve decision making on energy resources. Ensuring these aids are a cultural fit for each context has the potential to increase trust and promote understanding of the tradeoffs involved in energy resource management. In this dissertation I present the development of a technical tool that explicitly addresses cultural and spiritual values and experimentally assesses their influence on the preferences and decision making of Navajo citizens. Chapter 2 describes the results of a public elicitation effort to gather information about stakeholder views and concerns related to energy development in the Navajo Nation in order to develop a larger sample survey and a decision-support tool that links techno-economic energy models with sociocultural attributes. Chapter 3 details the methods of developing the energy decision aid and its underlying assumptions for alternative energy projects and their impacts. This tool also provides an alternative to economic valuation of cultural impacts based upon an ordinal index tied to environmental impacts. Chapter 4 details the the influence of various cultural, environmental, and economic outcome information provided
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
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
Smith, L. A.
Is it conceivable that models run on 2007 computer hardware could provide robust and credible probabilistic information for decision support and user guidance at the ZIP code level for sub-daily meteorological events in 2060? In 2090? Retrospectively, how informative would output from today’s models have proven in 2003? or the 1930’s? Consultancies in the United Kingdom, including the Met Office, are offering services to “future-proof” their customers from climate change. How is a US or European based user or policy maker to determine the extent to which exciting new Bayesian methods are relevant here? or when a commercial supplier is vastly overselling the insights of today’s climate science? How are policy makers and academic economists to make the closely related decisions facing them? How can we communicate deep uncertainty in the future at small length-scales without undermining the firm foundation established by climate science regarding global trends? Three distinct aspects of the communication of the uses of climate model output targeting users and policy makers, as well as other specialist adaptation scientists, are discussed. First, a brief scientific evaluation of the length and time scales at which climate model output is likely to become uninformative is provided, including a note on the applicability the latest Bayesian methodology to current state-of-the-art general circulation models output. Second, a critical evaluation of the language often employed in communication of climate model output, a language which accurately states that models are “better”, have “improved” and now “include” and “simulate” relevant meteorological processed, without clearly identifying where the current information is thought to be uninformative and misleads, both for the current climate and as a function of the state of the (each) climate simulation. And thirdly, a general approach for evaluating the relevance of quantitative climate model output
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.
... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Decision on community support statements. 944.4 Section 944.4 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK MISSION COMMUNITY SUPPORT REQUIREMENTS § 944.4 Decision on community support statements. (a) Action on community...
WaterlooClarke: TREC 2015 Clinical Decision Support Track Amira Ghenai1, Eldar Khalilov1, Pavel Valov1, and Charles L. A. Clarke1 1Department of...Abstract Clinical decision support systems help physicians with finding additional information about a partic- ular medical case. In this paper, we...develop a clinical decision support system that, based on a short medical case description, can recommend research articles to answer some common
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
Wright, Adam; Sittig, Dean F.
In this paper, we develop a four-phase model for evaluating architectures for clinical decision support that focuses on: defining a set of desirable features for a decision support architecture; building a proof-of-concept prototype; demonstrating that the architecture is useful by showing that it can be integrated with existing decision support systems and comparing its coverage to that of other architectures. We apply this framework to several well-known decision support architectures, including Arden Syntax, GLIF, SEBASTIAN and SAGE PMID:18462999
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...
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
Grossman, Arnold H.; Silverstein, Charles
Describes support groups for health care professionals who work with people with human immunodeficiency virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS) and who are experiencing burnout from excessive demands on their energy, strength, and resources. Discusses group administration, effective intervention techniques, and issues of health…
Njie, Gibril J.; Proia, Krista K.; Thota, Anilkrishna B.; Finnie, Ramona K.C.; Hopkins, David P.; Banks, Starr M.; Callahan, David B.; Pronk, Nicolaas P.; Rask, Kimberly J.; Lackland, Daniel T.; Kottke, Thomas E.
Context Clinical decision support systems (CDSSs) can help clinicians assess cardiovascular disease (CVD) risk and manage CVD risk factors by providing tailored assessments and treatment recommendations based on individual patient data. The goal of this systematic review was to examine the effectiveness of CDSSs in improving screening for CVD risk factors, practices for CVD-related preventive care services such as clinical tests and prescribed treatments, and management of CVD risk factors. Evidence acquisition An existing systematic review (search period, January 1975–January 2011) of CDSSs for any condition was initially identified. Studies of CDSSs that focused on CVD prevention in that review were combined with studies identified through an updated search (January 2011–October 2012). Data analysis was conducted in 2013. Evidence synthesis A total of 45 studies qualified for inclusion in the review. Improvements were seen for recommended screening and other preventive care services completed by clinicians, recommended clinical tests completed by clinicians, and recommended treatments prescribed by clinicians (median increases of 3.8, 4.0, and 2.0 percentage points, respectively). Results were inconsistent for changes in CVD risk factors such as systolic and diastolic blood pressure, total and low-density lipoprotein cholesterol, and hemoglobin A1C levels. Conclusions CDSSs are effective in improving clinician practices related to screening and other preventive care services, clinical tests, and treatments. However, more evidence is needed from implementation of CDSSs within the broad context of comprehensive service delivery aimed at reducing CVD risk and CVD-related morbidity and mortality. PMID:26477805
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.
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.
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
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
This scientific and management information database utilizes systems thinking to describe the linkages between decisions, human activities, and provisioning of reef ecosystem goods and services. This database provides: (1) Hierarchy of related topics - Click on topics to navigat...
Support System (GDSS) Talkwriter Human Computer Interface Voice Input Individual Decision Support System (IDSS) Voice Input/Output Man Machine Voice ... Interface Voice Processing Natural Language Voice Input Voice Recognition Natural Language Accessed Voice Recognizer Speech Entry Voice Vocabulary
Rothman, Brian; Leonard, Joan C; Vigoda, Michael M
The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data
Mistree, Farrokh; Marinopoulos, Stergios; Jackson, David M.; Shupe, Jon A.
The Decision Support Problem Technique for unified design, manufacturing and maintenance is being developed at the Systems Design Laboratory at the University of Houston. This involves the development of a domain-independent method (and the associated software) that can be used to process domain-dependent information and thereby provide support for human judgment. In a computer assisted environment, this support is provided in the form of optimal solutions to Decision Support Problems.
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
Finn, Michael P.; Usery, E. Lynn; Posch, Stephan T.; Seong, Jeong Chang
The use of commercial geographic information system software to process large raster datasets of terrain elevation, population, land cover, vegetation, soils, temperature, and rainfall requires both projection from spherical coordinates to plane coordinate systems and transformation from one plane system to another. Decision support systems deliver information resulting in knowledge that assists in policies, priorities, or processes. This paper presents an approach to handling the problems of raster dataset projection and transformation through the development of a Web-enabled decision support system to aid users of transformation processes with the selection of appropriate map projections based on data type, areal extent, location, and preservation properties.
Integrated Decision Support ( MERMAIDS ) developed for training of emergency response teams using heterogeneous resources under a unified command and control...The MERMAIDS has been designed to contain a decision-centric interface, which is not only useful for emergency information management, but has...decision models to support response planning during emergency conditions. An expert heuristic evaluation of the MERMAIDS is encouraging. The expert
Jamieson, Rhiann; Theodore, Kate; Raczka, Roman
Little is known about how women with intellectual disabilities make decisions in relation to pregnancy. Social support is important for mothers with intellectual disabilities in many areas. This study explored how the support network influenced the decision-making of women with intellectual disabilities in relation to pregnancy. The study extended…
Okamoto, Tatsuki; Takahashi, Tsuguhiro
Development of asset management decision support tools become very intensive in order to reduce maintenance cost of power equipment due to the liberalization of power business. This article reviews some aspects of present status of asset management decision support tools development for power equipment based on the papers published in international conferences, domestic conventions, and several journals.
Cummings, Mary L.
When the human element is introduced into decision support system design, entirely new layers of social and ethical issues emerge but are not always recognized as such. This paper discusses those ethical and social impact issues specific to decision support systems and highlights areas that interface designers should consider during design with an…
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
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
Thomson, R.; Robinson, A.; Greenaway, J.; Lowe, P.
Background: There is an increasing move towards clinical decision making that engages the patient, which has led to the development and use of decision aids to support better decisions. The treatment of patients in atrial fibrillation (AF) with warfarin to prevent stroke is a decision that is sensitive to patient preferences as shown by a previous decision analysis. Aim: To develop a computerised decision support tool, building upon a previous decision analysis, which would engage individual patient preferences in reaching a shared decision on whether to take warfarin to prevent stroke. Methods: The development process had two main phases: (1) the development phase which employed focus groups and repeated interviews with GPs/practice nurses and patients alongside an iterative development of a computerised tool; (2) the training and testing phase in which GPs and practice nurses underwent training in the use of the tool, including the use of simulated patients. The tool was then used in a feasibility study in a small number of patients with AF to inform the design of a subsequent randomised controlled trial. Results: The prototype tool had three components: (1) derivation of an individual patient's values for relevant health states using a standard gamble; (2) presentation/discussion of a patient's risks of stroke using the Framingham equation and the benefits/risks of warfarin from a systematic literature review; and (3) decision making component incorporating the outcome of a Markov decision analysis model. Older patients could be taken through the decision analysis based computerised tool, and patients and clinicians welcomed information on risks and benefits of treatments. The tool required time and training to use. Patients' decisions in the feasibility phase did not necessarily coincide with the output of the decision analysis model, but decision conflict appeared to be reduced and both patients and GPs were satisfied with the process. Conclusions: It is
Erskine, Michael A.
As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…
Klein, Joseph; Ronen, Herman
In the light of reports of bias, the present study investigated the hypothesis that administrative educational decisions assisted by Decision Support Systems (DSS) are characterized by different pedagogical and organizational orientation than decisions made without computer assistance. One hundred and ten high school teachers were asked to suggest…
NASA has initiated a new five year program this year, the Quiet Aircraft Technology (QAT) Program, a program which will investigate airframe and engine system noise reduction. QAT will also address community noise impact. As part of this community noise impact component, NASA will investigate air traffic management (ATM) challenges in reducing noise. In particular, controller advisory automation aids will be developed to aid the air traffic controller in addressing noise concerns as he/she manages traffic in busy terminal areas. NASA has developed controller automation tools to address capacity concerns and the QAT strategy for ATM Low Noise Operations is to build upon this tool set to create added advisories for noise mitigation. The tools developed for capacity will be briefly reviewed, followed by the QAT plans to address ATM noise concerns. A major NASA goal in global civil aviation is to triple the aviation system throughput in all-weather conditions while maintaining safety. A centerpiece of this activity is the Center/TRACON Automation System (CTAS), an evolving suite of air traffic controller decision support tools (DSTs) to enhance capacity of arrivals and departures in both the enroute center and the TRACON. Two of these DSTs, the Traffic Management Advisor (TMA) and the passive Final approach Spacing Tool (pFAST), are in daily use at the Fort Worth Center and the Dallas/Fort Worth (DFW) TRACON, respectively, where capacity gains of 5-13% have been reported in recent NASA evaluations. Under the Federal Aviation Administration's (FAA) Free Flight Phase One Program, TMA and pFAST are each being implemented at six to eight additional sites. In addition, other DSTs are being developed by NASA under the umbrella of CTAS. This means that new software will be built upon CTAS, and the paradigm of real-time simulation evaluation followed by field site development and evaluation will be the pathway for the new tools. Additional information is included in the
Armas, Iuliana; Gheorghe, Diana
Nowadays, because of the ever increasing volume of information, policymakers are faced with decision making problems. Achieving an objective and suitable decision making may become a challenge. In such situations decision support systems (DSS) have been developed. DSS can assist in the decision making process, offering support on how a decision should be made, rather than what decision should be made (Simon, 1979). This in turn potentially involves a huge number of stakeholders and criteria. Regarding seismic risk, Bucharest City is highly vulnerable (Mandrescu et al., 2007). The aim of this study is to implement a spatial decision support system in order to secure a suitable shelter in case of an earthquake occurrence in the historical centre of Bucharest City. In case of a seismic risk, a shelter is essential for sheltering people who lost their homes or whose homes are in danger of collapsing while people at risk receive first aid in the post-disaster phase. For the present study, the SMCE Module for ILWIS 3.4 was used. The methodology included structuring the problem by creating a decision tree, standardizing and weighting of the criteria. The results showed that the most suitable buildings are Tania Hotel, Hanul lui Manuc, The National Bank of Romania, The Romanian Commercial Bank and The National History Museum.
Approved for public release; distribution unlimited. • DMOC-, N3- and N6-specific CCIRs • GCCS-M • C2RPC / MTC2 SOA • ENMS and other network health...Process RFI Request for Information SMDP Semi-Markov decision process SOA Service-Oriented Architecture SOP Standard Operating Procedure TTP Tactics, Techniques, and Procedures
One of the most effective ways to pursue environmental progress is through the use of consistent metrics within a decision making framework. The US Environmental Protection Agency’s Sustainable Technology Division has developed TRACI, the Tool for the Reduction and Assessment of...
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
Lindsey, Tony; Shetye, Sandeep; Shaw, Tianna (Editor)
The Exploration Clinical Decision Support (ECDS) System project is intended to enhance the Exploration Medical Capability (ExMC) Element for extended duration, deep-space mission planning in HRP. A major development guideline is the Risk of "Adverse Health Outcomes & Decrements in Performance due to Limitations of In-flight Medical Conditions". ECDS attempts to mitigate that Risk by providing crew-specific health information, actionable insight, crew guidance and advice based on computational algorithmic analysis. The availability of inflight health diagnostic computational methods has been identified as an essential capability for human exploration missions. Inflight electronic health data sources are often heterogeneous, and thus may be isolated or not examined as an aggregate whole. The ECDS System objective provides both a data architecture that collects and manages disparate health data, and an active knowledge system that analyzes health evidence to deliver case-specific advice. A single, cohesive space-ready decision support capability that considers all exploration clinical measurements is not commercially available at present. Hence, this Task is a newly coordinated development effort by which ECDS and its supporting data infrastructure will demonstrate the feasibility of intelligent data mining and predictive modeling as a biomedical diagnostic support mechanism on manned exploration missions. The initial step towards ground and flight demonstrations has been the research and development of both image and clinical text-based computer-aided patient diagnosis. Human anatomical images displaying abnormal/pathological features have been annotated using controlled terminology templates, marked-up, and then stored in compliance with the AIM standard. These images have been filtered and disease characterized based on machine learning of semantic and quantitative feature vectors. The next phase will evaluate disease treatment response via quantitative linear
Laszig, P; Clement, U; Gramatikov, L
An explorative meta-analytic study analysed all published empirical studies on social support of HIV/AIDS patients (n = 57 studies with 347 data sets). Empirical and conceptual questions are addressed. The focus of the empirical questions is to identify meta-analytically confirmed correlates of social support. The conceptual question aims at differentiating the large-scale construct "social support". Results indicate that social support 1. is independent of objective physical parameters, 2. is positively correlated with approach coping and negatively with avoidance coping, 3. shows a substantial negative correlation with indicators of psychological distress, 4. is positively correlated with condom use. The conceptual analysis shows that 5. there is no consensus on how to operationalise the construct of "social support".
Manic, G; Printemps, C; Zug, M; Lemoine, C
Managing sewerage systems is a highly complex task due to the dynamic nature of the facilities. Their performance strongly depends on the know-how applied by the operators. In order to define optimal operational settings, two decision support tools based on mathematical models have been developed. Moreover, easy-to-use interfaces have been created as well, aiding operators who presumably do not have the necessary skills to use modelling software. The two developed programs simulate the behaviour of both wastewater treatment plants (WWTP) and sewer network systems, respectively. They have essentially the same structure, including raw data management and statistical analysis, a simulation layer using the application programming interface of the applied software and a layer responsible for the representation of the obtained results. Four user modes are provided in the two software including the simulation of historical data using the applied and novel operational settings, as well as modes concerning prediction of possible operation periods and updates. Concerning the WWTP software, it was successfully installed in Nantes (France) in June 2004. Moreover, the one managing sewer networks has been deployed in Saint-Malo (France) in January 2005. This paper presents the structure of the developed software and the first results obtained during the commissioning phase.
Krause, Andreas; Hartl, Dominik; Theis, Fabian; Stangl, Manfred; Gerauer, Klaus E; Mehlhorn, Alexander T
In high-critical medical fields instant information delivery is essential. Task-flow analyses within the transplantation unit of the Technische Universität München revealed that valuable time could be saved in pre-transplantation management being able to retrieve data of organ receivers ubiquitously. Inspired by this clinical scenario, a mobile application was designed and implemented providing surgeons with decision-relevant information on potential organ receivers. It assists them in considering the prospects of forthcoming organ transplantations and facilitates decision making and documentation with regard to high security demands. The described system services three organ receiver lists and is used by the surgeons in every transplantation procedure. After a 6-month period of clinical usage, the system has been evaluated in terms of handling, clinical benefit and total time savings. Intuitive, ubiquitous access to decision-relevant patient data and authenticated documentation were the major improvements with average total time savings of 50 min in comparison to the old system.
McConville, Jennifer R; Künzle, Rahel; Messmer, Ulrike; Udert, Kai M; Larsen, Tove A
This paper offers a methodology for structuring the design space for innovative process engineering technology development. The methodology is exemplified in the evaluation of a wide variety of treatment technologies for source-separated domestic wastewater within the scope of the Reinvent the Toilet Challenge. It offers a methodology for narrowing down the decision-making field based on a strict interpretation of treatment objectives for undiluted urine and dry feces and macroenvironmental factors (STEEPLED analysis) which influence decision criteria. Such an evaluation identifies promising paths for technology development such as focusing on space-saving processes or the need for more innovation in low-cost, energy-efficient urine treatment methods. Critical macroenvironmental factors, such as housing density, transportation infrastructure, and climate conditions were found to affect technology decisions regarding reactor volume, weight of outputs, energy consumption, atmospheric emissions, investment cost, and net revenue. The analysis also identified a number of qualitative factors that should be carefully weighed when pursuing technology development; such as availability of O&M resources, health and safety goals, and other ethical issues. Use of this methodology allows for coevolution of innovative technology within context constraints; however, for full-scale technology choices in the field, only very mature technologies can be evaluated.
Land resource sustainability for urban development characterizes the problem of decision-making with multiplicity and uncertainty. A decision support system prototype aids in the assessment of incremental land development plan proposals put forth within the long-term community priority of a sustainable growth. Facilitating this assessment is the analytic hierarchy process (AHP), a multi-criteria evaluation and decision support system. The decision support system incorporates multiple sustainability criteria, weighted strategically responsive to local public policy priorities and community-specific situations and values, while gauging and directing desirable future courses of development. Furthermore, the decision support system uses a GIS, which facilitates an assessment of urban form with multiple indicators of sustainability as spatial criteria thematically. The resultant land-use sustainability scores indicate, on the ratio-scale of AHP, whether or not a desirable urban form is likely in the long run, and if so, to what degree. The two alternative modes of synthesis in AHP-ideal and distributive-provide assessments of a land development plan incrementally (short-term) and city-wide pattern comprehensively (long-term), respectively. Thus, the spatial decision support system facilitates proactive and collective public policy determination of land resource for future sustainable urban development.
Richter, Linda M.; Sherr, Lorraine; Adato, Michèle; Belsey, Mark; Chandan, Upjeet; Desmond, Chris; Drimie, Scott; Haour-Knipe, Mary; Hosegood, Victoria; Kimou, Jose; Madhavan, Sangeetha; Mathambo, Vuyiswa; Wakhweya, Angela
This paper provides an overview of the arguments for the central role of families, defined very broadly, and we emphasise the importance of efforts to strengthen families to support children affected by HIV and AIDS. We draw on work conducted in the Joint Learning Initiative on Children and AIDS's Learning Group 1: Strengthening Families, as well as published data and empirical literature to provide the rationale for family strengthening. We close with the following recommendations for strengthening families to ameliorate the effects of HIV and AIDS on children. Firstly, a developmental approach to poverty is an essential feature of responses to protect children affected by HIV and AIDS, necessary to safeguard their human capital. For this reason, access to essential services, such as health and education, as well as basic income security, must be at the heart of national strategic approaches. Secondly, we need to ensure that support garnered for children is directed to families. Unless we adopt a family oriented approach, we will not be in a position to interrupt the cycle of infection, provide treatment to all who need it and enable affected individuals to be cared for by those who love and feel responsible for them. Thirdly, income transfers, in a variety of forms, are desperately needed and positively indicated by available research. Basic economic security will relieve the worst distress experienced by families and enable them to continue to invest in the health care and education of their children. Lastly, interventions are needed to support distressed families and prevent knock-on negative outcomes through programmes such as home visiting, and protection and enhancement of children's potential through early child development efforts. PMID:22380973
Hair, D. Charles; Pickslay, Kent
NCCOSC RDT&E Division (NRaD) is conducting research into ways of improving decision support systems (DSS) that are used in tactical Navy decision making situations. The research has focused on the incorporation of findings about naturalistic decision-making processes into the design of the DSS. As part of that research, two computer tools were developed that model the two primary naturalistic decision-making strategies used by Navy experts in tactical settings. Current work is exploring how best to incorporate the information produced by those tools into an existing simulation of current Navy decision support systems. This work has implications for any applications involving the need to make decisions under time constraints, based on incomplete or ambiguous data.
Doctors must frequently make decisions during medical treatment, whether in an acute care facility, such as an Intensive Care Unit (ICU), or in an operating room. These decisions rely on a various information sources, such as the patient's medical history, preoperative images, and general medical knowledge. Decision support systems can assist by facilitating access to this information when and where it is needed. This paper presents some research eorts that address the integration of information with clinical practice. The example systems include a clinical decision support system (CDSS) for pediatric traumatic brain injury, an augmented reality head- mounted display for neurosurgery, and an augmented reality telerobotic system for minimally-invasive surgery. While these are dierent systems and applications, they share the common theme of providing information to support clinical decisions and actions, whether the actions are performed with the surgeon's own hands or with robotic assistance.
Nagle, Cate; Lewis, Sharon; Meiser, Bettina; Metcalfe, Sylvia; Carlin, John B; Bell, Robin; Gunn, Jane; Halliday, Jane
significant contribution to improving women's experience of prenatal testing and will have application to a variety of maternity care settings. The evaluation of a tailored decision aid will also have implications for pregnancy care providers by identifying whether or not such a resource will support their role in providing prenatal testing information. PMID:16611368
The mission of ORD's Ecosystem Services Research Program (ESRP) is to provide the information and methods needed by decision-makers to assess the benefits of ecosystem goods and services to human well-being for inclusion in management alternatives. The Decision Support Framework...
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…
Standridge, Shannon; Faist, Robert; Pestian, John; Glauser, Tracy; Ittenbach, Richard
We developed a content validated computerized epilepsy treatment clinical decision support system to assist clinicians with selecting the best antiepilepsy treatments. Before disseminating our computerized epilepsy treatment clinical decision support system, further rigorous validation testing was necessary. As reliability is a precondition of validity, we verified proof of reliability first. We evaluated the consistency of the epilepsy treatment clinical decision support system in three areas including the preferred antiepilepsy drug choice, the top three recommended choices, and the rank order of the three choices. We demonstrated 100% reliability on 15,000 executions involving a three-step process on five different common pediatric epilepsy syndromes. Evidence for the reliability of the epilepsy treatment clinical decision support system was essential for the long-term viability of the system, and served as a crucial component for the next phase of system validation.
To assist stormwater management professionals in planning for best management practices (BMPs) implementation, the U.S. Environmental Protection Agency (USEPA) is developing a decision support system for placement of BMPs at strategic locations in urban watersheds. This tool wil...
Kamaleswaran, Rishikesan; McGregor, Carolyn
This paper presents in detail the component of the Complex Business Process for Stream Processing framework that is responsible for integrating complex business processes to enable knowledge-driven Clinical Decision Support System (CDSS) recommendations. CDSSs aid the clinician in supporting the care of patients by providing accurate data analysis and evidence-based recommendations. However, the incorporation of a dynamic knowledge-management system that supports the definition and enactment of complex business processes and real-time data streams has not been researched. In this paper we discuss the process web service as an innovative method of providing contextual information to a real-time data stream processing CDSS.
Pestian, John; Spencer, Malik; Matykiewicz, Pawel; Zhang, Kejian; Vinks, Alexander A.; Glauser, Tracy
This article describes the process of developing an advanced pharmacogenetics clinical decision support at one of the United States’ leading pediatric academic medical centers. This system, called CHRISTINE, combines clinical and genetic data to identify the optimal drug therapy when treating patients with epilepsy or Attention Deficit Hyperactivity Disorder. In the discussion a description of clinical decision support systems is provided, along with an overview of neurocognitive computing and how it is applied in this setting. PMID:19898682
Pestian, John; Spencer, Malik; Matykiewicz, Pawel; Zhang, Kejian; Vinks, Alexander A; Glauser, Tracy
This article describes the process of developing an advanced pharmacogenetics clinical decision support at one of the United States' leading pediatric academic medical centers. This system, called CHRISTINE, combines clinical and genetic data to identify the optimal drug therapy when treating patients with epilepsy or Attention Deficit Hyperactivity Disorder. In the discussion a description of clinical decision support systems is provided, along with an overview of neurocognitive computing and how it is applied in this setting.
Woosley, R L; Whyte, J; Mohamadi, A; Romero, K
For decades, medical practice has increasingly relied on prescription medicines to treat, cure, or prevent illness but their net benefit is reduced by prescribing errors that result in adverse drug reactions (ADRs) and tens of thousands of deaths each year. Optimal prescribing requires effective management of massive amounts of data. Clinical decision support systems (CDSS) can help manage information and support optimal therapeutic decisions before errors are made by operating as the prescribers' "autopilot."
quality of the decision depends on the depth of the program manager’s analysis . Recently, management has attempted to use the support of others to make...knowledge of system analysis and management techniques. 4. Program Managers will have access to the developed deci- sion support system. Definitions...the depth of the Progr a Managers analysis . A decision is more apt to be correct if the depth of analysis is increased (21:a-8). The depth of analysis
Purpose: This paper aims to support academic advising, which plays a crucial role in student success and retention. The paper focuses on one of the most challenging tasks involved in academic advising: individual course scheduling. This task includes not only careful planning for different courses over several semesters according to students'…
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
A bidding decision, despite its being important for the contractor, often needs to be made quickly and within a limited timeframe. To facilitate the contractor's reasoning by limiting randomness that may lead to mistakes decision support models are frequently applied. This paper presents possible applications of an Artificial Neural Network (ANN) to support bidding decisions. The proposed model involving networks with radial basis functions (RBF) was to perform a classification task. On the basis of a set of input data, the network was to suggest either participation in the bid or resignation from it. The results, 93% of correctly classified cases, confirmed the usability of RBF network in solving the problem.
Ozbolt, Judy G.
Developing decision support systems for nursing has been limited by difficulties in defining and representing nursing's knowledge base and by a lack of knowledge of how nurses make decisions. Recent theoretical and empirical work offers solutions to those problems. The challenge now is to represent nursing knowledge in a way that is comprehensible to both nurse and computer and to design decision support modalities that are accurate, efficient, and appropriate for nurses with different levels of expertise. This paper reviews the issues and critically evaluates Prolog as a tool for meeting the challenge.
Tsaloglidou, A; Rammos, K; Kiriklidis, K; Zourladani, A; Matziari, C
This study provides an insight into the process of ethical decision-making regarding the initiation or withdrawal of artificial nutritional support of seriously ill patients and explores the nursing involvement in it. Fifteen health carers were recruited from a clinical nutrition unit in the UK and qualitative research methods were used to gather data. The findings of the study indicate that nursing contribution to decision-making appeared to be in the 'back room' as the nurses feel that the decisions about difficult ethical dilemmas are 'out of their hands' because of lack of knowledge, experience and confidence. The medical staff and the clinical nurse specialist appear to be primarily responsible for making important decisions. It is clear from the study that to become more effective in the process, nurses need to enhance their knowledge in nutritional support and to develop their practical skills in ethical decision-making through experience and research.
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.
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.
Sojda, Richard S.; Chen, Serena H.; El Sawah, Sondoss; Guillaume, Joseph H.A.; Jakeman, A.J.; Lautenbach, Sven; McIntosh, Brian S.; Rizzoli, A.E.; Seppelt, Ralf; Struss, Peter; Voinov, Alexey; Volk, Martin
Two of the basic tenets of decision support system efforts are to help identify and structure the decisions to be supported, and to then provide analysis in how those decisions might be best made. One example from wetland management would be that wildlife biologists must decide when to draw down water levels to optimise aquatic invertebrates as food for breeding ducks. Once such a decision is identified, a system or tool to help them make that decision in the face of current and projected climate conditions could be developed. We examined a random sample of 100 papers published from 2001-2011 in Environmental Modelling and Software that used the phrase “decision support system” or “decision support tool”, and which are characteristic of different sectors. In our review, 41% of the systems and tools related to the water resources sector, 34% were related to agriculture, and 22% to the conservation of fish, wildlife, and protected area management. Only 60% of the papers were deemed to be reporting on DSS. This was based on the papers reviewed not having directly identified a specific decision to be supported. We also report on the techniques that were used to identify the decisions, such as formal survey, focus group, expert opinion, or sole judgment of the author(s). The primary underlying modelling system, e.g., expert system, agent based model, Bayesian belief network, geographical information system (GIS), and the like was categorised next. Finally, since decision support typically should target some aspect of unstructured decisions, we subjectively determined to what degree this was the case. In only 23% of the papers reviewed, did the system appear to tackle unstructured decisions. This knowledge should be useful in helping workers in the field develop more effective systems and tools, especially by being exposed to the approaches in different, but related, disciplines. We propose that a standard blueprint for reporting on DSS be developed for
Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.
Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441
Kawamoto, Kensaku; Del Fiol, Guilherme; Orton, Charles; Lobach, David F
System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating the widespread implementation of CDS systems, little has been described regarding the benefits and challenges of their use. In this manuscript, the authors address this need by describing potential benefits and challenges of using a system-agnostic CDS service. This analysis is based on the authors’ formal assessments of, and practical experiences with, various approaches to developing, implementing, and maintaining CDS capabilities. In particular, the analysis draws on the authors’ experience developing and leveraging a system-agnostic CDS Web service known as SEBASTIAN. A primary potential benefit of using a system-agnostic CDS service is the relative ease and flexibility with which the service can be leveraged to implement CDS capabilities across applications and care settings. Other important potential benefits include facilitation of centralized knowledge management and knowledge sharing; the potential to support multiple underlying knowledge representations and knowledge resources through a common service interface; improved simplicity and componentization; easier testing and validation; and the enabling of distributed CDS system development. Conversely, important potential challenges include the increased effort required to develop knowledge resources capable of being used in many contexts and the critical need to standardize the service interface. Despite these challenges, our experiences to date indicate that the benefits of using a system-agnostic CDS service generally outweigh the challenges of using this approach to implementing and maintaining CDS systems. PMID:21603281
Kawamoto, Kensaku; Del Fiol, Guilherme; Orton, Charles; Lobach, David F
System-agnostic clinical decision support (CDS) services provide patient evaluation capabilities that are independent of specific CDS systems and system implementation contexts. While such system-agnostic CDS services hold great potential for facilitating the widespread implementation of CDS systems, little has been described regarding the benefits and challenges of their use. In this manuscript, the authors address this need by describing potential benefits and challenges of using a system-agnostic CDS service. This analysis is based on the authors' formal assessments of, and practical experiences with, various approaches to developing, implementing, and maintaining CDS capabilities. In particular, the analysis draws on the authors' experience developing and leveraging a system-agnostic CDS Web service known as SEBASTIAN. A primary potential benefit of using a system-agnostic CDS service is the relative ease and flexibility with which the service can be leveraged to implement CDS capabilities across applications and care settings. Other important potential benefits include facilitation of centralized knowledge management and knowledge sharing; the potential to support multiple underlying knowledge representations and knowledge resources through a common service interface; improved simplicity and componentization; easier testing and validation; and the enabling of distributed CDS system development. Conversely, important potential challenges include the increased effort required to develop knowledge resources capable of being used in many contexts and the critical need to standardize the service interface. Despite these challenges, our experiences to date indicate that the benefits of using a system-agnostic CDS service generally outweigh the challenges of using this approach to implementing and maintaining CDS systems.
Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L
OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058
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.
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.
Swain, N. R.; Latu, K.; Christiensen, S.; Jones, N.; Nelson, J.
Advances in computation resources and greater availability of water resources data represent an untapped resource for addressing hydrologic uncertainties in water resources decision-making. The current practice of water authorities relies on empirical, lumped hydrologic models to estimate watershed response. These models are not capable of taking advantage of many of the spatial datasets that are now available. Physically-based, distributed hydrologic models are capable of using these data resources and providing better predictions through stochastic analysis. However, there exists a digital divide that discourages many science-minded decision makers from using distributed models. This divide can be spanned using a combination of existing web technologies. The purpose of this presentation is to present a cloud-based environment that will offer hydrologic modeling tools or 'apps' for decision support and the web technologies that have been selected to aid in its implementation. Compared to the more commonly used lumped-parameter models, distributed models, while being more intuitive, are still data intensive, computationally expensive, and difficult to modify for scenario exploration. However, web technologies such as web GIS, web services, and cloud computing have made the data more accessible, provided an inexpensive means of high-performance computing, and created an environment for developing user-friendly apps for distributed modeling. Since many water authorities are primarily interested in the scenario exploration exercises with hydrologic models, we are creating a toolkit that facilitates the development of a series of apps for manipulating existing distributed models. There are a number of hurdles that cloud-based hydrologic modeling developers face. One of these is how to work with the geospatial data inherent with this class of models in a web environment. Supporting geospatial data in a website is beyond the capabilities of standard web frameworks and it
Decision support intended to improve ecosystem sustainability requires that we link stakeholder priorities directly to quantitative tools and measures of desired outcomes. Actions taken at the community level can have large impacts on production and delivery of ecosystem service...
Singer, Alexander; Salman, Mo; Thulke, Hans-Hermann
Animal health is of societal importance as it affects human welfare, and anthropogenic interests shape decision making to assure animal health. Scientific advice to support decision making is manifold. Modelling, as one piece of the scientific toolbox, is appreciated for its ability to describe and structure data, to give insight in complex processes and to predict future outcome. In this paper we study the application of scientific modelling to support practical animal health decisions. We reviewed the 35 animal health related scientific opinions adopted by the Animal Health and Animal Welfare Panel of the European Food Safety Authority (EFSA). Thirteen of these documents were based on the application of models. The review took two viewpoints, the decision maker's need and the modeller's approach. In the reviewed material three types of modelling questions were addressed by four specific model types. The correspondence between tasks and models underpinned the importance of the modelling question in triggering the modelling approach. End point quantifications were the dominating request from decision makers, implying that prediction of risk is a major need. However, due to knowledge gaps corresponding modelling studies often shed away from providing exact numbers. Instead, comparative scenario analyses were performed, furthering the understanding of the decision problem and effects of alternative management options. In conclusion, the most adequate scientific support for decision making - including available modelling capacity - might be expected if the required advice is clearly stated.
Clark, Phillip M.
Describes some of the available software and hardware tools that can be used to develop a decision support system implemented on microcomputers. Activities that should be supported by software are discussed, including data entry, data coding, finding and combining data, and data compatibility. Hardware considerations include speed, storage…
Greenes, Robert A.
Information technology approaches to delivering diagnostic clinical decision support (CDS) are the subject of the papers to follow in the proceedings. These will address the history of CDS and present day approaches (Miller), evaluation of diagnostic CDS methods (Friedman), and the role of clinical documentation in supporting diagnostic decision…
Lizotte, Daniel J.; Laber, Eric B.
We present new methodology based on Multi-Objective Markov Decision Processes for developing sequential decision support systems from data. Our approach uses sequential decision-making data to provide support that is useful to many different decision-makers, each with different, potentially time-varying preference. To accomplish this, we develop an extension of fitted-Q iteration for multiple objectives that computes policies for all scalarization functions, i.e. preference functions, simultaneously from continuous-state, finite-horizon data. We identify and address several conceptual and computational challenges along the way, and we introduce a new solution concept that is appropriate when different actions have similar expected outcomes. Finally, we demonstrate an application of our method using data from the Clinical Antipsychotic Trials of Intervention Effectiveness and show that our approach offers decision-makers increased choice by a larger class of optimal policies. PMID:28018133
Abrefa-Gyan, Tina; Wu, Liyun; Lewis, Marilyn W
HIV/AIDS, a chronic burden in Ghana, poses social and health outcome concerns to those infected. Examining the Medical Outcome Study Social Support Survey (MOS-SSS) instrument among 300 Ghanaians from a cross-sectional design, Principal Component Analysis yielded four factors (positive interaction, trust building, information giving, and essential support), which accounted for 85.73% of the total variance in the MOS-SSS. A logistic regression analysis showed that essential support was the strongest predictor of the length of time an individual stayed in the support group, whereas positive interaction indicated negative association. The study's implications for policy, research, and practice were discussed.
Vasilecas, Olegas; Smaizys, Aidas; Brazinskas, Ramunas
Intelligent information systems are acting by structured rules and do not deal with possible impact on the business environment or future consequences. That is the main reason why automated decisions based on such rules cannot take responsibility and requires involvement or approval of dedicated business people. This limits decision automation possibilities in information systems. However, business rules describe business policy and represent business logics. This can be used in intelligent information systems, together with risk assessment model to simulate real business environment and evaluate possible impact of automated decisions, to support intelligent decision automation. The chapter proposes risk and business rule model integration to provide full intelligent decision automation model used for business rule enforcement and implementation into intelligent software systems of information systems.
Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.
Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736
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).
review; data mining; text mining; bibliometrics ; scientometrics; resource allocation; project selection; operations research; management science. REPORT...review; data mining; text mining; bibliometrics ; scientometrics; resource allocation; project selection; operations research; management science. 16...support techniques include roadmaps, metrics, peer review, data and text mining, information retrieval, bibliometrics , and retrospective studies. The
Crowell, Karen; Vardell, Emily
ClinicalAccess is a new clinical decision support tool that uses a question-and-answer format to mirror clinical decision-making strategies. The unique format of ClinicalAccess delivers concise, authoritative answers to more than 120,000 clinical questions. This column presents a review of the product, a sample search, and a comparison with other point-of-care search engines.
Zhou, Jianlan; Sun, Koumei
It is important to make decisions on how to attract foreign direct investment (FDI) to China and know how the inequality of FDI introduction by locational different provinces. Following background descriptions on China's FDI economic environments and FDI-related policies, this paper demonstrates the uses of geographical information system (GIS) and multi-criterion decision-making (MCDM) framework in solving a spatial multi-objective problem of evaluating and ranking China's provinces for FDI introduction. It implements a foreign direct investment decision support system, which reveals the main determinants of FDI in China and gives some results of regional geographical analysis over spatial data.
Marotta, Stephen; Metzger, Max; Gorman, Joe; Sliva, Amy
The Dual Node Decision Wheels (DNDW) architecture is a new approach to information fusion and decision support systems. By combining cognitive systems engineering organizational analysis tools, such as decision trees, with the Dual Node Network (DNN) technical architecture for information fusion, the DNDW can align relevant data and information products with an organization's decision-making processes. In this paper, we present the Compositional Inference and Machine Learning Environment (CIMLE), a prototype framework based on the principles of the DNDW architecture. CIMLE provides a flexible environment so heterogeneous data sources, messaging frameworks, and analytic processes can interoperate to provide the specific information required for situation understanding and decision making. It was designed to support the creation of modular, distributed solutions over large monolithic systems. With CIMLE, users can repurpose individual analytics to address evolving decision-making requirements or to adapt to new mission contexts; CIMLE's modular design simplifies integration with new host operating environments. CIMLE's configurable system design enables model developers to build analytical systems that closely align with organizational structures and processes and support the organization's information needs.
Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.
The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731
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…
Lynnes, C.; Miller, J.; Ramapriyan, H.; Isaac, D.; Harberts, R.
NASA's growth in remote sensing data volumes has kept pace with Moore's Law, i.e., doubling every 18 months, with future growth likely from new instruments. Also, advances in instrumental design (e.g., hyperspectral scanners) and science algorithms are enabling more near-real-time applications of the data. The confluence of low-latency requirements with high data volumes and numbers of files poses major challenges for archive data management. In order to make the right data available at the right time, an archive will need to apply knowledge of the data content in its data management decisions. This decision support domain includes aspects such as automatic quality assessment, feature detection to support caching decisions, and content-based metadata to support efficient data selection. In this study, we evaluate a variety of machine learning algorithms for use in several decision support roles in intelligent data management. Machine learning algorithms such as neural networks and clustering have been used for decision support in business and policy domains. These techniques have found some use in remote sensing, e.g., for cloud and land cover classification. Yet most research on remote sensing data rests on science-based algorithms, such as those based on radiative transfer equations. Machine learning for scientific applications faces challenges such as discretization constraints, non-physical basis, and the difficulty of assembling training sets. However, these difficulties may be less significant in the decision support role. For instance, it is often enough to know whether a data attribute exceeds a certain threshold when selecting it for an application, without knowing the exact value. The training data problem can be surmounted by using products output by the science-based algorithms. On the other hand, an advantage of machine learning algorithms for decision support is their speed once they have been trained. Data management decisions must be made while the
Bravo, Paulina; Cabieses, Báltica; Bustamante, Claudia; Campos, Solange; Stacey, Dawn
WHAT ABOUT POLICY REGARDING SDM? Since 1999, there has been a small but growing interest by academics, the government, and society as a whole in strengthening patients' and professionals' involvement in shared decision making (SDM). Two governmental policy documents that indicate support for SDM are (1) Health Reform in 2003 and (2) Sanitary Objectives 2011-2020, which includes a brief section on client participation and SDM. WHAT ABOUT TOOLS - DECISION SUPPORT FOR PATIENTS? Research by Chilean academics has highlighted the patients' desire to participate in health decisions and effective approaches for enhancing health professionals' skills in interprofessional SDM; however, little has been done to support this need and the work is centralised in only one academic institution. Decision support tools and coaching interventions are limited to patients considering decisions about managing type 2 diabetes. WHAT ABOUT PROFESSIONAL INTEREST AND IMPLEMENTATION? Although there is increasing attention to studying patients' participation and involvement on their healthcare, little has been studied in relation to professionals' interest in SDM. As well, there are significant challenges for implementation of a country-wide SDM policy. WHAT DOES THE FUTURE LOOK LIKE? The future looks promising given the new health policies, local Chilean research projects, and international initiatives. Collaboration between health professionals, academics, and government policy makers, with public involvement needs to be strengthened in order to promote concrete strategies to implement SDM in Chile.
Rodriquez, Luis F.
Decision support systems have been implemented in many applications including strategic planning for battlefield scenarios, corporate decision making for business planning, production planning and control systems, and recommendation generators like those on Amazon.com(Registered TradeMark). Such tools are reviewed for developing a similar tool for NASA's ALS Program. DSS are considered concurrently with the development of the OPIS system, a database designed for chronicling of research and development in ALS. By utilizing the OPIS database, it is anticipated that decision support can be provided to increase the quality of decisions by ALS managers and researchers.
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
Lawton, Clare; Cook, Sharon; May, Andrew; Clemo, Keith; Brown, Susan
The paper discusses a series of driving trials that were conducted to investigate postural stability of disabled drivers and to assess the effectiveness of a representative sample of support aids. Twenty-three disabled drivers with varying levels of physical disability and seven non disabled drivers participated in the study. The test car was equipped with transducers to measure vehicle velocity and acceleration (longitudinal and lateral), steering wheel movement and torque, and the bracing forces exerted by the driver on the steering wheel. Video cameras were installed to record postural support strategies and displacement of the driver and to record deviation of the car from the specified path. Subjective data regarding driver attitudes and acceptance were also collected through the administration of questionnaires. Findings from the study showed that support aids significantly improved driving performance and reduced physical exertion to maintain an upright driving position for disabled drivers. However, ergonomics design aspects regarding the ease of use and acceptance of the support aids by the end users were identified as obstacles to their sustained use in everyday driving.
Adumitroaie, V.; Weisbin, C. R.
In a restricted science budget environment and increasingly numerous required technology developments, the technology investment decisions within NASA are objectively more and more difficult to make such that the end results are satisfying the technical objectives and all the organizational constraints. Under these conditions it is rationally desirable to build an investment portfolio, which has the highest possible technology infusion rate. Arguably the path to infusion is subject to many influencing factors, but here only the challenges associated with the very initial stages are addressed: defining the needs and the subsequent investment decision-support process. It is conceivable that decision consistency and possibly its quality suffer when the decision-making process has limited or no traceability. This paper presents a structured decision-support framework aiming to provide traceable, auditable, infusion- driven recommendations towards a selection process in which these recommendations are used as reference points in further discussions among stakeholders. In this framework addressing well-defined requirements, different measures of success can be defined based on traceability to specific selection criteria. As a direct result, even by using simplified decision models the likelihood of infusion can be probed and consequently improved.
Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform.
Gamification means the use of various elements of game design in nongame contexts including workplace collaboration, marketing, education, military, and medical services. Gamification is effective for both improving workplace productivity and motivating employees. However, introduction of gamification is not easy because the planning and implementation processes of gamification are very complicated and it needs interdisciplinary knowledge such as information systems, organization behavior, and human psychology. Providing a systematic decision making method for gamification process is the purpose of this paper. This paper suggests the decision criteria for selection of gamification platform to support a systematic decision making process for managements. The criteria are derived from previous works on gamification, introduction of information systems, and analytic hierarchy process. The weights of decision criteria are calculated through a survey by the professionals on game, information systems, and business administration. The analytic hierarchy process is used to derive the weights. The decision criteria and weights provided in this paper could support the managements to make a systematic decision for selection of gamification platform. PMID:24892075
Lynch, Abigail J.; Taylor, William W.; McCright, Aaron M.
Decision support tools can aid decision making by systematically incorporating information, accounting for uncertainties, and facilitating evaluation between alternatives. Without user buy-in, however, decision support tools can fail to influence decision-making processes. We surveyed fishery researchers, managers, and fishers affiliated with the Lake Whitefish Coregonus clupeaformis fishery in the 1836 Treaty Waters of Lakes Huron, Michigan, and Superior to assess opinions of current and future management needs to identify barriers to, and opportunities for, developing a decision support tool based on Lake Whitefish recruitment projections with climate change. Approximately 64% of 39 respondents were satisfied with current management, and nearly 85% agreed that science was well integrated into management programs. Though decision support tools can facilitate science integration into management, respondents suggest that they face significant implementation barriers, including lack of political will to change management and perceived uncertainty in decision support outputs. Recommendations from this survey can inform development of decision support tools for fishery management in the Great Lakes and other regions.
McQuay, William K.
The past decade has produced significant changes in the conduct of military operations: increased humanitarian missions, asymmetric warfare, the reliance on coalitions and allies, stringent rules of engagement, concern about casualties, and the need for sustained air operations. Future mission commanders will need to assimilate a tremendous amount of information, make quick-response decisions, and quantify the effects of those decisions in the face of uncertainty. Integral to this process is creating situational assessment-understanding the mission space, simulation to analyze alternative futures, current capabilities, planning assessments, course-of-action assessments, and a common operational picture-keeping everyone on the same sheet of paper. Decision support tools in a distributed collaborative environment offer the capability of decomposing these complex multitask processes and distributing them over a dynamic set of execution assets. Decision support technologies can semi-automate activities, such as planning an operation, that have a reasonably well-defined process and provide machine-level interfaces to refine the myriad of information that is not currently fused. The marriage of information and simulation technologies provides the mission commander with a collaborative virtual environment for planning and decision support.
Khan, Shiraj; Ganguly, Auroop R; Gupta, Amar
The process of Data Mining converts information to knowledge by utilizing tools from the disciplines of computational statistics, database technologies, machine learning, signal processing, nonlinear dynamics, process modeling, simulation, and allied disciplines. Data Mining allows business problems to be analyzed from diverse perspectives, including dimensionality reduction, correlation and co-occurrence, clustering and classification, regression and forecasting, anomaly detection, and change analysis. The predictive insights generated from Data Mining can be further utilized through real-time analysis and decision sciences, as well as through human-driven analysis based on management by exceptions or by objectives, to generate actionable knowledge. The tools that enable the transformation of raw data to actionable predictive insights are collectively referred as Decision Support tools. This chapter presents a new formalization of the decision process, leading to a new Decision Superiority model, partially motivated by the Joint Directors of Laboratories (JDL) Data Fusion Model. In addition, it examines the growing importance of Data Fusion concepts.
Overby, Casey Lynnette; Erwin, Angelika Ludtke; Abul-Husn, Noura S; Ellis, Stephen B; Scott, Stuart A; Obeng, Aniwaa Owusu; Kannry, Joseph L; Hripcsak, George; Bottinger, Erwin P; Gottesman, Omri
This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII). The survey also includes items to measure physicians' characteristics (awareness, experience, and perceived usefulness), attitudes about personal genome testing (PGT) services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS). The majority were residency program trainees (~88%). Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions.
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.
Mattila, Jussi; Koikkalainen, Juha; Virkki, Arho; van Gils, Mark; Lötjönen, Jyrki
Medical research and clinical practice are currently being redefined by the constantly increasing amounts of multiscale patient data. New methods are needed to translate them into knowledge that is applicable in healthcare. Multiscale modeling has emerged as a way to describe systems that are the source of experimental data. Usually, a multiscale model is built by combining distinct models of several scales, integrating, e.g., genetic, molecular, structural, and neuropsychological models into a composite representation. We present a novel generic clinical decision support system, which models a patient's disease state statistically from heterogeneous multiscale data. Its goal is to aid in diagnostic work by analyzing all available patient data and highlighting the relevant information to the clinician. The system is evaluated by applying it to several medical datasets and demonstrated by implementing a novel clinical decision support tool for early prediction of Alzheimer's disease.
There are six strategic objectives for promoting adoption of clinical decision support: Use a standardized format for representing clinical data and CDS interventions. Ensure appropriate access to clinical data and CDS interventions. Provide support and incentives for providers to use CDS. Disseminate information about best practices for system design, CDS delivery, and CDS implementation. Continue national demonstrations and evaluation of CDS use. Leverage data interchange between EHRs.
Hirsch, Gary B.; Homer, Jack; Chenoweth, Brooke N.; Backus, George A.; Strip, David R.
As Sandia National Laboratories serves its mission to provide support for the security-related interests of the United States, it is faced with considering the behavioral responses that drive problems, mitigate interventions, or lead to unintended consequences. The effort described here expands earlier works in using healthcare simulation to develop behavior-aware decision support systems. This report focuses on using qualitative choice techniques and enhancing two analysis models developed in a sister project.
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.
Rural inhabitants of arid lands lack sufficient water to fulfill their agricultural and household needs. They do not have readily available technical information to support decisions regarding the course of action they should follow to handle the agro-climatic risk. In this paper, a computer model (...
Filatovas, Ernestas; Kurasova, Olga
In this paper, multiple criteria optimization has been investigated. A new decision support system (DSS) has been developed for interactive solving of multiple criteria optimization problems (MOPs). The weighted-sum (WS) approach is implemented to solve the MOPs. The MOPs are solved by selecting different weight coefficient values for the criteria…
Bergey, Paul; King, Mark
This paper reports on the cross-disciplinary research that resulted in a decision-support tool, Team Machine (TM), which was designed to create maximally diverse student teams. TM was used at a large United States university between 2004 and 2012, and resulted in significant improvement in the performance of student teams, superior overall balance…
To assist stormwater management professionals in planning for best management practices (BMPs) implementation, the U.S. Environmental Protection Agency (USEPA) initiated a research in 2003 to develop a decision support system for placement of BMPs at strategic locations in urban ...
Rems, M; Bohanec, M; Urh, B; Kramar, Z
Decision support system for nosocomial infection therapy Ptah can reduce antibiotic misuse with data about bacteria resistance and antibiotic ineffectiveness. Resistance vectors in time series show epidemiological problems with resistant bacterias, named house-bacteria. Most important implementation factors are integrated hospital information system and doctors, nurses and managers interested in problems of nosocomial infection.
Upper Saddle River, NJ, USA. 23 Mataxiotis, K. (2004). Decision support through knowledge management: The role of t artificial intelligence ...paper was the ability of the United States military to achieve dominance through information superiority. The use of intelligent sensors and... Intelligence Agency, National Security Agency, Defense Intelligence Agency, and individual Service intelligence agencies). In fact, these edge entities would
We developed a set of tools to provide decision support for community-based salmon recovery planning in Salish Sea watersheds. Here we describe how these tools are being integrated and applied in collaboration with Puget Sound tribes and community stakeholders to address restora...
Tyagi, Rajesh; Tseng, Fan T.
This paper presents the development of a prototype Knowledge-based Decision Support System, currently under development, for scheduling payloads/experiments on space station missions. The DSS is being built on Symbolics, a Lisp machine, using KEE, a commercial knowledge engineering tool.
Lenert, Leslie; Dunlea, Robert; Del Fio, Guilherme; KellyHall, Leslie
Shared Decision Making (SDM) is an approach to medical care based on collaboration between provider and patient with both sharing in medical decisions. When patients’ values and preferences are incorporated in decision-making, then care is more appropriate, ethically sound, and often lower in cost. However, SDM is difficult to implement in routine practice because of the time required for SDM methods, the lack of integration of SDM approaches into electronic health records systems (EHRs), and absence of explanatory mechanisms for providers on the results of patients’ use of decision aids. This paper discusses potential solutions including the concept of a “Personalize Button” for EHRs. Leveraging a four-phased clinical model for SDM, this article describes how computer decision support (CDS) technologies integrated into EHRs can help insure that healthcare is delivered in a way that is respectful of those preferences. The architecture described herein, called CDS for SDM, is built upon recognized standards that are currently integrated into certification requirements for EHRs as part of Meaningful Use regulations. While additional work is needed on modeling of preferences and on techniques for rapid communication models of preferences to clinicians, unless EHRs are re-designed to support SDM around and during clinical encounters, they are likely to continue to be an unintended barrier to SDM. With appropriate development, EHRs could be a powerful tool to promote SDM by reminding providers of situations for SDM and monitoring on going care to insure treatments are consistent with patients’ preferences. PMID:25224366
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.
Background Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. Methods As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Results Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the ‘actionable message(s)’ from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing
Rashidi, Maria; Lemass, Brett; Gibson, Peter
The maintenance of bridges as a key element in transportation infrastructure has become a major concern for asset managers and society due to increasing traffic volumes, deterioration of existing bridges and well-publicised bridge failures. A pivotal responsibility for asset managers in charge of bridge remediation is to identify the risks and assess the consequences of remediation programs to ensure that the decisions are transparent and lead to the lowest predicted losses in recognized constraint areas. The ranking of bridge remediation treatments can be quantitatively assessed using a weighted constraint approach to structure the otherwise ill-structured phases of problem definition, conceptualization and embodiment . This Decision Support System helps asset managers in making the best decision with regards to financial limitations and other dominant constraints imposed upon the problem at hand. The risk management framework in this paper deals with the development of a quantitative intelligent decision support system for bridge maintenance which has the ability to provide a source for consistent decisions through selecting appropriate remediation treatments based upon cost, service life, product durability/sustainability, client preferences, legal and environmental constraints. Model verification and validation through industry case studies is ongoing.
Brodin, N. Patrik; Maraldo, Maja V.; Aznar, Marianne C.; Vogelius, Ivan R.; Petersen, Peter M.; Bentzen, Søren M.; Specht, Lena
Purpose: To present a novel tool that allows quantitative estimation and visualization of the risk of various relevant normal tissue endpoints to aid in treatment plan comparison and clinical decision making in radiation therapy (RT) planning for Hodgkin lymphoma (HL). Methods and Materials: A decision-support tool for risk-based, individualized treatment plan comparison is presented. The tool displays dose–response relationships, derived from published clinical data, for a number of relevant side effects and thereby provides direct visualization of the trade-off between these endpoints. The Quantitative Analyses of Normal Tissue Effects in the Clinic reports were applied, complemented with newer data where available. A “relevance score” was assigned to each data source, reflecting how relevant the input data are to current RT for HL. Results: The tool is applied to visualize the local steepness of dose–response curves to drive the reoptimization of a volumetric modulated arc therapy treatment plan for an HL patient with head-and-neck involvement. We also use this decision-support tool to visualize and quantitatively evaluate the trade-off between a 3-dimensional conformal RT plan and a volumetric modulated arc therapy plan for a patient with mediastinal HL. Conclusion: This multiple-endpoint decision-support tool provides quantitative risk estimates to supplement the clinical judgment of the radiation oncologist when comparing different RT options.
Feldman, D.L.; Dobson, J.E.
This report examines the adequacy of current command and control systems designed to make timely decisions that would enable sufficient warning and protective response to an accident at the Edgewood area of Aberdeen Proving Ground (APG), Maryland, and at Pine Bluff Arsenal (PBA), Arkansas. Institutional procedures designed to facilitate rapid accident assessment, characterization, warning, notification, and response after the onset of an emergency and computer-assisted decision-making aids designed to provide salient information to on- and-off-post emergency responders are examined. The character of emergency decision making at APG and PBA, as well as potential needs for improvements to decision-making practices, procedures, and automated decision-support systems (ADSSs), are described and recommendations are offered to guide equipment acquisition and improve on- and off-post command and control relationships. We recommend that (1) a continued effort be made to integrate on- and off-post command control, and decision-making procedures to permit rapid decision making; (2) the pathways for alert and notification among on- and off-post officials be improved and that responsibilities and chain of command among off-post agencies be clarified; (3) greater attention be given to organizational and social context factors that affect the adequacy of response and the likelihood that decision-making systems will work as intended; and (4) faster improvements be made to on-post ADSSs being developed at APG and PBA, which hold considerable promise for depicting vast amounts of information. Phased development and procurement of computer-assisted decision-making tools should be undertaken to balance immediate needs against available resources and to ensure flexibility, equity among sites, and compatibility among on- and off-post systems. 112 refs., 6 tabs.
A group of women formed the Women and AIDS Support Network (WASN) in Zimbabwe in June 1989 to improve women;s self-esteem and confidence and to bring about changes in attitudes and reactions toward AIDS-related problems. Both HIV-positive and HIV-negative women are WASN members. Women have limited control over sexual relationships. Women who know their partners are having intercourse with other women have few options, e.g., they may depend on their partners. A family council settles marital disagreements, but husbands do not always cooperate. Increased peer pressure could change societal acceptance of male infidelity to positive attitudes toward friendship and partnership in marriage. Therefore, WASN explores sexual relationships, especially control and power in them. These discussions should lead to affirmation of positive behavior. For example, men can promote condom use and monogamy to their male peers. They can also talk to their partners and their sons about HIV. Rural women should not blame urban women for their partner's HIV status. WASN also targets schoolgirls. Most early and some current messages of AIDS campaigns reinforces the dichotomy of good and bad women, supported by an earlier link between urban women and sexually transmitted diseases. Yet, they ignored men's role in HIV transmission. WASN speaks out against such negative images, e.g., dramas that depict the HIV-infected woman as evil and the innocent as good while the man worries about which woman infected him instead of feeling awful about infecting other women. WASN also addressee AIDS-related discrimination on the job and stigmatization issues. It now is conducting 2 research projects: information needs of urban and rural women and capacities of family support systems to assist HIV-positive women.
Kawamoto, Kensaku; Lobach, David F.
To facilitate the provision of clinical decision support (CDS), the Unified Medical Language System (UMLS) was leveraged to implement a terminology Web service. Supported functions include inter-vocabulary translation and the identification of concepts subsumed by a parent concept. Currently, the service is being used to aid the specification of clinical concepts within CDS knowledge modules. Insights gained from this process are discussed, including the limitations of using the UMLS to fulfill CDS terminology needs. PMID:17238598
Veroff, David; Marr, Amy; Wennberg, David E
Shared decision making is an approach to care that seeks to fully inform patients about the risks and benefits of available treatments and engage them as participants in decisions about the treatments. Although recent federal and state policies pursue the expanded use of shared decision making as a way to improve care quality and patient experience, payers and providers want evidence that this emerging model of care is cost-effective. We examined data obtained from a year-long randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support. The enhanced-support group had 12.5 percent fewer hospital admissions than the usual-support group, and 9.9 percent fewer preference-sensitive surgeries, including 20.9 percent fewer preference-sensitive heart surgeries. These findings indicate that support for shared decision making can generate savings. They also suggest that a "remote" model of support-combining telephonic coaching with decision aids, for example-may constitute a relatively low-cost and effective intervention that could reach broader populations without the need for the direct involvement of regular medical care team members.
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.
Marco-Ruiz, Luis; Bellika, Johan Gustav
The interoperability of Clinical Decision Support (CDS) systems with other health information systems has become one of the main limitations to their broad adoption. Semantic interoperability must be granted in order to share CDS modules across different health information systems. Currently, numerous standards for different purposes are available to enable the interoperability of CDS systems. We performed a literature review to identify and provide an overview of the available standards that enable CDS interoperability in the areas of clinical information, decision logic, terminology, and web service interfaces.
Gomoi, Valentin-Sergiu; Dragu, Daniel; Stoicu-Tivadar, Vasile
Development of clinical decision support systems (CDS) is a process which highly depends on the local databases, this resulting in low interoperability. To increase the interoperability of CDS a standard representation of clinical information is needed. The paper suggests a CDS architecture which integrates several HL7 standards and the new vMR (virtual Medical Record). The clinical information for the CDS systems (the vMR) is represented with Topic Maps technology. Beside the implementation of the vMR, the architecture integrates: a Data Manager, an interface, a decision making system (based on Egadss), a retrieving data module. Conclusions are issued.
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.
Lippmann, John; Livingston, Patricia; Craike, Melinda J.
Aims: Flexible-learning first aid courses are increasingly common due to reduced classroom contact time. This study compared retention of first aid knowledge and basic life support (BLS) skills three months after a two-day, classroom-based first aid course (STD) to one utilizing on-line theory learning at home followed by one day of classroom…
Dolan, James G.; Veazie, Peter J.
Background Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision making. The use of tabular balance sheets to support clinical decision making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive a deeper understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. Method The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision making. Two separate surveys were conducted: one for the control group and one for the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and asked to choose between three hypothetical drug treatments that varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief washout period, members of the control group made a second treatment choice after reviewing the balance sheet again while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices participants rated their degree of confidence in their choice on a 1–10 scale. Results Members of the dashboard intervention group were more likely to change their choice of preferred drug, (10.2% vs. 7.5%, p=0.054) and had a larger increase in decision confidence than the control group: 0.67 vs. 0.075, p<0.03. There were no statistically significant between group differences in decisional conflict or decision aid acceptability. Conclusion These findings suggest that clinical
Hoskinson, Reed Louis; Hess, John Richard; Fink, Raymond Keith
The Decision Support System for Agriculture (DSS4Ag) is an expert system being developed by the Site-Specific Technologies for Agriculture (SST4Ag) precision farming research project at the INEEL. DSS4Ag uses state-of-the-art artificial intelligence and computer science technologies to make spatially variable, site-specific, economically optimum decisions on fertilizer use. The DSS4Ag has an open architecture that allows for external input and addition of new requirements and integrates its results with existing agricultural systems’ infrastructures. The DSS4Ag reflects a paradigm shift in the information revolution in agriculture that is precision farming. We depict this information revolution in agriculture as an historic trend in the agricultural decision-making process.
R. L. Hoskinson; J. R. Hess; R. K. Fink
The Decision Support System for Agriculture (DSS4Ag) is an expert system being developed by the Site-Specific Technologies for Agriculture (SST4Ag) precision farming research project at the INEEL. DSS4Ag uses state-of-the-art artificial intelligence and computer science technologies to make spatially variable, site-specific, economically optimum decisions on fertilizer use. The DSS4Ag has an open architecture that allows for external input and addition of new requirements and integrates its results with existing agricultural systems' infrastructures. The DSS4Ag reflects a paradigm shift in the information revolution in agriculture that is precision farming. We depict this information revolution in agriculture as an historic trend in the agricultural decision-making process.
Chernovita, H. P.; Manongga, D.; Iriani, A.
One of company activities to retain their business is marketing the products which include in acquisition management to get new customers. Insurance contract analysis using ID3 to produce decision tree and rules to be decision support for the insurance company. The decision tree shows 13 rules that lead to contract termination claim. This could be a guide for the insurance company in acquisition management to prevent contract binding with these contract condition because it has a big chance for the customer to terminate their insurance contract before its expired date. As the result, there are several strong points that could be the determinant of contract termination such as: 1) customer age whether too young or too old, 2) long insurance period (above 10 years), 3) big insurance amount, 4) big amount of premium charges, and 5) payment method.
Rohweder, Jason J.; Zigler, Steven J.; Fox, Timothy J.; Hulse, Steven N.
This user's manual describes the Middle Mississippi River Decision Support System (MMRDSS) and gives detailed examples on its use. The MMRDSS provides a framework to assist decision makers regarding natural resource issues in the Middle Mississippi River floodplain. The MMRDSS is designed to provide users with a spatially explicit tool for tasks, such as inventorying existing knowledge, developing models to investigate the potential effects of management decisions, generating hypotheses to advance scientific understanding, and developing scientifically defensible studies and monitoring. The MMRDSS also includes advanced tools to assist users in evaluating differences in complexity, connectivity, and structure of aquatic habitats among river reaches. The Environmental Systems Research Institute ArcView 3.x platform was used to create and package the data and tools of the MMRDSS.
Tso, Geoffrey J.; Tu, Samson W.; Oshiro, Connie; Martins, Susana; Ashcraft, Michael; Yuen, Kaeli W.; Wang, Dan; Robinson, Amy; Heidenreich, Paul A.; Goldstein, Mary K.
As utilization of clinical decision support (CDS) increases, it is important to continue the development and refinement of methods to accurately translate the intention of clinical practice guidelines (CPG) into a computable form. In this study, we validate and extend the 13 steps that Shiffman et al.5 identified for translating CPG knowledge for use in CDS. During an implementation project of ATHENA-CDS, we encoded complex CPG recommendations for five common chronic conditions for integration into an existing clinical dashboard. Major decisions made during the implementation process were recorded and categorized according to the 13 steps. During the implementation period, we categorized 119 decisions and identified 8 new categories required to complete the project. We provide details on an updated model that outlines all of the steps used to translate CPG knowledge into a CDS integrated with existing health information technology. PMID:28269916
The evaluation and prioritization of Engineering Support Requests (ESR's) is a particularly difficult task at the Kennedy Space Center (KSC) -- Shuttle Project Engineering Office. This difficulty is due to the complexities inherent in the evaluation process and the lack of structured information. The evaluation process must consider a multitude of relevant pieces of information concerning Safety, Supportability, O&M Cost Savings, Process Enhancement, Reliability, and Implementation. Various analytical and normative models developed over the past have helped decision makers at KSC utilize large volumes of information in the evaluation of ESR's. The purpose of this project is to build on the existing methodologies and develop a multiple criteria decision support system that captures the decision maker's beliefs through a series of sequential, rational, and analytical processes. The model utilizes the Analytic Hierarchy Process (AHP), subjective probabilities, the entropy concept, and Maximize Agreement Heuristic (MAH) to enhance the decision maker's intuition in evaluating a set of ESR's.
Bhayat, Imtiaz; Manuguerra, Maurizio; Baldock, Clive
In this paper, a model and tool is proposed to assist universities and other mission-based organisations to ascertain systematically the optimal portfolio of projects, in any year, meeting the organisations risk tolerances and available funds. The model and tool presented build on previous work on university operations and decision support systems…
Harrison, Roberta L; Lyerla, Frank
The Health Information Technology and Clinical Health Act (one component of the American Recovery and Reinvestment Act) is responsible for providing incentive payments to hospitals and eligible providers in an effort to support the adoption of electronic health records. Future penalties are planned for electronic health record noncompliance. In order to receive incentives and avoid penalties, hospitals and eligible providers must demonstrate "meaningful use" of their electronic health records. One of the meaningful-use objectives established by the Centers for Medicare & Medicaid Services involves the use of a clinical decision support rule that addresses a hospital-defined, high-priority condition. This article describes the Plan-Do-Study-Act process for creating and implementing a nursing clinical decision support system designed to improve guideline adherence for hypoglycemia management. This project identifies hypoglycemia management as the high-priority area. However, other facilities with different high-priority conditions may find the process presented in this article useful for implementing additional clinical decision support rules geared toward improving outcomes and meeting federal mandates.
paper), one opinion shared is that the rational, economic, deliberate listing/evaluation of all options is NOT representative of how many decision are made. A framework gaining interest lately describes two systems predominantly at work: intuition and reasoning (Kahneman, 2003). Intuition is fast, automatic, and parallel contrasted with the more effortful, deliberative, and sequential reasoning. One of the issues of contention is that considerable research is stacked supporting both sides claiming that intuition is: • A hallmark of expertise responsible for rapid, optimal decisions in the face of adversity • A vulnerability where biases serve as decision traps leading to wrong choices Using seminal studies from a range of domains and tasking, potential solutions for SSA decision support will be offered. Important issues such as managing uncertainty, framing inquiries, and information architecture, and contextual cues will be discussed. The purpose is to provide awareness of the human limitations and capabilities in complex decision making so engineers and designers can consider such factors in their development of SSA tools.
Faraday, Sally; Harris, Richard
Technical aids and information technology are the subjects of this document, one of 9 modules in an 11-unit resource pack designed to help trainers and postsecondary and continuing education staff meet the needs of special needs students in Great Britain. Having completed the module, staff should be able to: (1) identify technical aids; (2)…
Sarter, N B; Schroeder, B
Operators in high-risk domains such as aviation often need to make decisions under time pressure and uncertainty. One way to support them in this task is through the introduction of decision support systems (DSSs). The present study examined the effectiveness of two different DSS implementations: status and command displays. Twenty-seven pilots (9 pilots each in a baseline, status, and command group) flew 20 simulated approaches involving icing encounters. Accuracy of the decision aid (a smart icing system), familiarity with the icing condition, timing of icing onset, and autopilot usage were varied within subjects. Accurate information from either decision aid led to improved handling of the icing encounter. However, when inaccurate information was presented, performance dropped below that of the baseline condition. The cost of inaccurate information was particularly high for command displays and in the case of unfamiliar icing conditions. Our findings suggest that unless perfect reliability of a decision aid can be assumed, status displays may be preferable to command displays in high-risk domains (e.g., space flight, medicine, and process control), as the former yield more robust performance benefits and appear less vulnerable to automation biases.
Huang, Jung; Tien, Yu-Chuan; Lin, Hsuan-Te; Liu, Tzu-Ming; Tung, Ching-Pin
Climate change creates more challenges for water resources management. Due to the lack of sufficient precipitation in Taiwan in fall of 2014, many cities and counties suffered from water shortage during early 2015. Many companies in Hsinchu Science Park were significantly influenced and realized that they need a decision support tool to help them managing water resources. Therefore, a customized computer program was developed, which is capable of predicting the future status of public water supply system and water storage of factories when the water rationing is announced by the government. This program presented in this study for drought decision support (DDSS) is a customized model for a semiconductor company in the Hsinchu Science Park. The DDSS is programmed in Java which is a platform-independent language. System requirements are any PC with the operating system above Windows XP and an installed Java SE Runtime Environment 7. The DDSS serves two main functions. First function is to predict the future storage of Baoshan Reservoir and Second Baoshan Reservoir, so to determine the time point of water use restriction in Hsinchu Science Park. Second function is to use the results to help the company to make decisions to trigger their response plans. The DDSS can conduct real-time scenario simulations calculating the possible storage of water tank for each factory with pre-implementation and post-implementation of those response plans. In addition, DDSS can create reports in Excel to help decision makers to compare results between different scenarios.
Davidson, Gavin; Kelly, Berni; Macdonald, Geraldine; Rizzo, Maria; Lombard, Louise; Abogunrin, Oluwaseye; Clift-Matthews, Victoria; Martin, Alison
Supported decision making (SDM) refers to the process of supporting people, whose decision making ability may be impaired, to make decisions and so promote autonomy and prevent the need for substitute decision making. There have been developments in SDM but mainly in the areas of intellectual disabilities and end-of-life care rather than in mental health. The main aim of this review was to provide an overview of the available evidence relevant to SDM and so facilitate discussion of how this aspect of law, policy and practice may be further developed in mental health services. The method used for this review was a Rapid Evidence Assessment which involved: developing appropriate search strategies; searching relevant databases and grey literature; then assessing, including and reviewing relevant studies. Included studies were grouped into four main themes: studies reporting stakeholders' views on SDM; studies identifying barriers to the implementation of SDM; studies highlighting ways to improve implementation; and studies on the impact of SDM. The available evidence on implementation and impact, identified by this review, is limited but there are important rights-based, effectiveness and pragmatic arguments for further developing and researching SDM for people with mental health problems.
Wagholikar, Kavishwar; Mangrulkar, Sanjeev; Deshpande, Ashok; Sundararajan, Vijayraghavan
The potential of computer based tools to assist physicians in medical decision making, was envisaged five decades ago. Apart from factors like usability, integration with work-flow and natural language processing, lack of decision accuracy of the tools has hindered their utility. Hence, research to develop accurate algorithms for medical decision support tools, is required. Pioneering research in last two decades, has demonstrated the utility of fuzzy set theory for medical domain. Recently, Wagholikar and Deshpande proposed a fuzzy relation based method (FR) for medical diagnosis. In their case studies for heart and infectious diseases, the FR method was found to be better than naive bayes (NB). However, the datasets in their studies were small and included only categorical symptoms. Hence, more evaluative studies are required for drawing general conclusions. In the present paper, we compare the classification performance of FR with NB, for a variety of medical datasets. Our results indicate that the FR method is useful for classification problems in the medical domain, and that FR is marginally better than NB. However, the performance of FR is significantly better for datasets having high proportion of unknown attribute values. Such datasets occur in problems involving linguistic information, where FR can be particularly useful. Our empirical study will benefit medical researchers in the choice of algorithms for decision support tools.
Ruland, Cornelia M.
Objective: While preference elicitation techniques have been effective in helping patients make decisions consistent with their preferences, little is known about whether information about patient preferences affects clinicians in clinical decision making and improves patient outcomes. The purpose of this study was to evaluate a decision support system for eliciting elderly patients' preferences for self-care capability and providing this information to nurses in clinical practice—specifically, its effect on nurses' care priorities and the patient outcomes of preference achievement and patient satisfaction. Design: Three-group quasi-experimental design with one experimental and two control groups (N = 151). In the experimental group computer-processed information about individual patient's preferences was placed in patients' charts to be used for care planning. Results: Information about patient preferences changed nurses' care priorities to be more consistent with patient preferences and improved patients' preference achievement and physical functioning. Further, higher consistency between patient preferences and nurses' care priorities was associated with higher preference achievement, and higher preference achievement with greater patient satisfaction. Conclusion: This study demonstrated that decision support for eliciting patient preferences and including them in nursing care planning is an effective and feasible strategy for improving nursing care and patient outcomes. PMID:10428003
Khedher, Laila; Illán, Ignacio A; Górriz, Juan M; Ramírez, Javier; Brahim, Abdelbasset; Meyer-Baese, Anke
Computer-aided diagnosis (CAD) systems constitute a powerful tool for early diagnosis of Alzheimer's disease (AD), but limitations on interpretability and performance exist. In this work, a fully automatic CAD system based on supervised learning methods is proposed to be applied on segmented brain magnetic resonance imaging (MRI) from Alzheimer's disease neuroimaging initiative (ADNI) participants for automatic classification. The proposed CAD system possesses two relevant characteristics: optimal performance and visual support for decision making. The CAD is built in two stages: a first feature extraction based on independent component analysis (ICA) on class mean images and, secondly, a support vector machine (SVM) training and classification. The obtained features for classification offer a full graphical representation of the images, giving an understandable logic in the CAD output, that can increase confidence in the CAD support. The proposed method yields classification results up to 89% of accuracy (with 92% of sensitivity and 86% of specificity) for normal controls (NC) and AD patients, 79% of accuracy (with 82% of sensitivity and 76% of specificity) for NC and mild cognitive impairment (MCI), and 85% of accuracy (with 85% of sensitivity and 86% of specificity) for MCI and AD patients.
Douali, Nassim; De Roo, Jos; Jaulent, Marie-Christine
Personalized medicine may be considered an extension of traditional approaches to understanding and treating diseases, but with greater precision. A profile of a patient's genetic variation can guide the selection of drugs or treatment protocols that minimize harmful side effects or ensure a more successful outcome. In this paper we describe a decision support system designed to assist physicians for personalized care, and methodology for integration in the clinical workflow. A reasoning method for interacting heterogeneous knowledge and data is a necessity in the context of personalized medicine. Development of clinical decision support based semantic web for personalized patient care is to achieve its potential and improve the quality, safety and efficiency of healthcare.
Query Modification through External Sources to Support Clinical Decisions Raymond Wan1, Jannifer Hiu-Kwan Man2, and Ting-Fung Chan1 1School of Life...query modifications that use either external data sources or a domain expert. While each method gave slightly different results, we discovered that...biomedical literature offers many possible paths of investigation, our study focused on modifications to the query using external data sources. We submitted 5
NY 14260 USA email@example.com T. Kesavadas, Ph.D 315 Bell Hall University at Buffalo Buffalo, NY 14260 USA kesh @eng.buffalo.edu...Decision- Making Support Dr. James Llinas Dr. “ Kesh ” Kesavadas Center for Multisource Information Fusion (CMIF) State University of New York at...Buffalo Buffalo, New York, USA firstname.lastname@example.org kesh @eng.buffalo.edu 7-2 Visualization, Info. Fusion and Logical Constructs Info Fusion Traditional
Keshavjee, K; Holbrook, AM; Lau, E; Esporlas-Jewer, I; Troyan, S
The COMPETE III Vascular Disease Tracker (C3VT) is a personalized, Web-based, clinical decision support tool that provides patients and physicians access to a patient’s 16 individual vascular risk markers, specific advice for each marker and links to best practices in vascular disease management. It utilizes the chronic care model1 so that physicians can better manage patients with chronic diseases. Over 1100 patients have been enrolled into the COMPETE III study to date.
Fienen, M. N.; Masterson, J.; Plant, N. G.; Gutierrez, B. T.; Thieler, E. R.
Bayesian decision networks (BDN) have long been used to provide decision support in systems that require explicit consideration of uncertainty; applications range from ecology to medical diagnostics and terrorism threat assessments. Until recently, however, few studies have applied BDNs to the study of groundwater systems. BDNs are particularly useful for representing real-world system variability by synthesizing a range of hydrogeologic situations within a single simulation. Because BDN output is cast in terms of probability—an output desired by decision makers—they explicitly incorporate the uncertainty of a system. BDNs can thus serve as a more efficient alternative to other uncertainty characterization methods such as computationally demanding Monte Carlo analyses and others methods restricted to linear model analyses. We present a unique application of a BDN to a groundwater modeling analysis of the hydrologic response of Assateague Island, Maryland to sea-level rise. Using both input and output variables of the modeled groundwater response to different sea-level (SLR) rise scenarios, the BDN predicts the probability of changes in the depth to fresh water, which exerts an important influence on physical and biological island evolution. Input variables included barrier-island width, maximum island elevation, and aquifer recharge. The variability of these inputs and their corresponding outputs are sampled along cross sections in a single model run to form an ensemble of input/output pairs. The BDN outputs, which are the posterior distributions of water table conditions for the sea-level rise scenarios, are evaluated through error analysis and cross-validation to assess both fit to training data and predictive power. The key benefit for using BDNs in groundwater modeling analyses is that they provide a method for distilling complex model results into predictions with associated uncertainty, which is useful to decision makers. Future efforts incorporate
As populations become increasingly concentrated in large cities, the world is experiencing an inevitably growing trend towards the urbanisation of disasters. Scientists have contributed significant advances in understanding the geophysical causes of natural hazards and have developed sophisticated tools to predict their effects; while, much less attention has been devoted to tools that increase situational awareness, facilitate leadership, provide effective communication channels and data flow and enhance the cognitive abilities of decision makers and first responders. In this paper, we envisioned the capabilities of a next generation disaster decision support system and hence proposed a state-of-the-art system architecture design to facilitate the decision making process in natural catastrophes such as flood and bushfire by utilising a combination of technologies for multi-channel data aggregation, disaster modelling, visualisation and optimisation. Moreover, we put our thoughts into action by implementing an Intelligent Disaster Decision Support System (IDDSS). The developed system can easily plug in to external disaster models and aggregate large amount of heterogeneous data from government agencies, sensor networks, and crowd sourcing platforms in real-time to enhance the situational awareness of decision makers and offer them a comprehensive understanding of disaster impacts from diverse perspectives such as environment, infrastructure and economy, etc. Sponsored by the Australian Government and the Victorian Department of Justice (Australia), the system was built upon a series of open-source frameworks (see attached figure) with four key components: data management layer, model application layer, processing service layer and presentation layer. It has the potential to be adopted by a range of agencies across Australian jurisdictions to assist stakeholders in accessing, sharing and utilising available information in their management of disaster events.
Presents findings from interviews conducted with 18 African American women living with HIV/AIDS. Presents their perceptions of ways in which their families function as a source of support and as a source of stress in their dealings with HIV/AIDS issues. Provides information on supportive aspects provided by family in emotional, concrete, and…
Wood, Lesley; Ntaote, Grace Makeletso; Theron, Linda
HIV and AIDS threaten to erode the wellbeing of teachers who are faced with an increasing number of children rendered vulnerable by the pandemic. This article explores the usefulness of a supportive group intervention, Resilient Educators (REds), in supporting Lesotho teachers to respond to the HIV and AIDS-related challenges. A time-series pre-…
unlimited Overall objective is to create and test (using specific applications) a theory and model-based technology for enabling and advancing a...decision-makers build, maintain, and represent situational context. Integrate multiple existing theories and conceptual models of context that address...Develop NIMSS Theory & Formalism In this task, we will develop the NIM context model and develop a Decision Support model based on the underlying context
Sacchi, L.; Lanzola, G.; Viani, N.
Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857
El-Gafy, Inas; El-Ganzori, Akram
The mismatch between the supply and demand, inequitable distribution and the over irrigation of water consuming crops are the main constraints that are faced in the implementation of the integrated water resources management in Egypt. With water scarcity, the problem under consideration is that the current cropping pattern is not economically efficient in the utilization of the available water resource. Moreover, in consequence of the importance of the agricultural sector to the national economies, it is necessary to be aware of the economic performance of water use in the crops production. The scope of this study is to develop economic value of irrigation water maps of Egypt. The objective of the study is carried out by acquiring a Decision Support System for economic value of irrigation water of Egypt. This Decision Support System is applied for developing economic value maps for the irrigation water that is used for cultivating 45 crops under cereal, fiber, legumes, and vegetables, herbalist, and forages categories at each governorate of Egypt in year 2008 and 2009. The crops that achieve the highest and lowest economic value of irrigation water at each governorate of Egypt were identified. The reasons of the variations in the economic value of irrigation water at the governorates of Egypt were determined. The developed Decision Support System could be used yearly as a tool for demonstrating a picture about the economic value of irrigation water for the decision makers in the areas of water resources and agriculture. The developed economic value of irrigation water maps can be used in proposing a cropping pattern that maximizes the economic value of irrigation water in each governorate of Egypt.
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…
Shropshire, David Earl; Jacobson, Jacob Jordan; Berrett, Sharon; Cobb, D. A.; Worhach, P.
The Demonstration of Decision Support Tools for Sustainable Development project integrated the Bechtel/Nexant Industrial Materials Exchange Planner and the Idaho National Engineering and Environmental Laboratory System Dynamic models, demonstrating their capabilities on alternative fuel applications in the Greater Yellowstone-Teton Park system. The combined model, called the Dynamic Industrial Material Exchange, was used on selected test cases in the Greater Yellow Teton Parks region to evaluate economic, environmental, and social implications of alternative fuel applications, and identifying primary and secondary industries. The test cases included looking at compressed natural gas applications in Teton National Park and Jackson, Wyoming, and studying ethanol use in Yellowstone National Park and gateway cities in Montana. With further development, the system could be used to assist decision-makers (local government, planners, vehicle purchasers, and fuel suppliers) in selecting alternative fuels, vehicles, and developing AF infrastructures. The system could become a regional AF market assessment tool that could help decision-makers understand the behavior of the AF market and conditions in which the market would grow. Based on this high level market assessment, investors and decision-makers would become more knowledgeable of the AF market opportunity before developing detailed plans and preparing financial analysis.
White, Douglas C
How can investments that would potentially improve a manufacturing plant's decision process be economically justified? What is the value of "better information," "more flexibility," or "improved integration" and the technologies that provide these effects? Technology investments such as improved process modelling, new real time historians and other databases, "smart" instrumentation, better data analysis and visualization software, and/or improved user interfaces often include these benefits as part of their valuation. How are these "soft" benefits to be converted to a quantitative economic return? Quantification is important if rational management decisions are to be made about the correct amount of money to invest in the technologies, and which technologies to choose among the many available ones. Modelling the plant operational decision cycle-detect, analyse, forecast, choose and implement--provides a basis for this economic quantification. In this paper a new economic model is proposed for estimation of the value of decision support investments based on their effect upon the uncertainty in forecasting plant financial performance. This model leads to quantitative benefit estimates that have a realistic financial basis. An example is presented demonstrating the application of the method.
Fienen, Michael N.; Masterson, John P.; Plant, Nathaniel G.; Gutierrez, Benjamin T.; Thieler, E. Robert
Resource managers need to make decisions to plan for future environmental conditions, particularly sea level rise, in the face of substantial uncertainty. Many interacting processes factor in to the decisions they face. Advances in process models and the quantification of uncertainty have made models a valuable tool for this purpose. Long-simulation runtimes and, often, numerical instability make linking process models impractical in many cases. A method for emulating the important connections between model input and forecasts, while propagating uncertainty, has the potential to provide a bridge between complicated numerical process models and the efficiency and stability needed for decision making. We explore this using a Bayesian network (BN) to emulate a groundwater flow model. We expand on previous approaches to validating a BN by calculating forecasting skill using cross validation of a groundwater model of Assateague Island in Virginia and Maryland, USA. This BN emulation was shown to capture the important groundwater-flow characteristics and uncertainty of the groundwater system because of its connection to island morphology and sea level. Forecast power metrics associated with the validation of multiple alternative BN designs guided the selection of an optimal level of BN complexity. Assateague island is an ideal test case for exploring a forecasting tool based on current conditions because the unique hydrogeomorphological variability of the island includes a range of settings indicative of past, current, and future conditions. The resulting BN is a valuable tool for exploring the response of groundwater conditions to sea level rise in decision support.
Adolf, Jurine A.; Holden, Kritina L.
Decision Support Systems (DSSs) have been available to medical diagnosticians for some time, yet their acceptance and use have not increased with advances in technology and availability of DSS tools. Medical DSSs will be necessary on future long duration space missions, because access to medical resources and personnel will be limited. Human-Computer Interaction (HCI) experts at NASA's Human Factors and Ergonomics Laboratory (HFEL) have been working toward understanding how humans use DSSs, with the goal of being able to identify and solve the problems associated with these systems. Work to date consists of identification of HCI research areas, development of a decision making model, and completion of two experiments dealing with 'anchoring'. Anchoring is a phenomenon in which the decision maker latches on to a starting point and does not make sufficient adjustments when new data are presented. HFEL personnel have replicated a well-known anchoring experiment and have investigated the effects of user level of knowledge. Future work includes further experimentation on level of knowledge, confidence in the source of information and sequential decision making.
VonPlinsky, Michael J.; Crowder, Ed
The Decision Integration and Support Environment (DISE) is a Bayesian network (BN) based modeling and simulation of the target nomination and aircraft tasking decision processes. DISE operates in event driven interactions with FTI's AOC model, being triggered from within the Time Critical Target (TCT) Operations cell. As new target detections are received by the AOC from off-board ISR sources and processed by the Automatic Target Recognition (ATR) module in the AOC, DISE is called to determine if the target should be prosecuted, and if so, which of the available aircraft should be tasked to attack it. A range of decision criteria, with priorities established off-line and input into the tool, are associated with this process. DISE, when running in its constructive mode, automatically selects the best-suited aircraft and assigns the new target. In virtual mode, with a human operator, DISE presents the user with a suitability ranked list of the available aircraft for assignment. Recent DISE enhancements are applying this concept to the prioritization and scheduling of ISR support requests from Users to support both latent and dynamic tasking and scheduling of both space-based and airborne ISR assets.
Song, M.; Li, W.; Zhou, X.
In the era of big data, polar sciences have already faced an urgent demand of utilizing intelligent approaches to support precise and effective spatiotemporal decision-making. Service-oriented cyberinfrastructure has advantages of seamlessly integrating distributed computing resources, and aggregating a variety of geospatial data derived from Earth observation network. This paper focuses on building a smart service-oriented cyberinfrastructure to support intelligent question answering related to polar datasets. The innovation of this polar cyberinfrastructure includes: (1) a problem-solving environment that parses geospatial question in natural language, builds geoprocessing rules, composites atomic processing services and executes the entire workflow; (2) a self-adaptive spatiotemporal filter that is capable of refining query constraints through semantic analysis; (3) a dynamic visualization strategy to support results animation and statistics in multiple spatial reference systems; and (4) a user-friendly online portal to support collaborative decision-making. By means of this polar cyberinfrastructure, we intend to facilitate integration of distributed and heterogeneous Arctic datasets and comprehensive analysis of multiple environmental elements (e.g. snow, ice, permafrost) to provide a better understanding of the environmental variation in circumpolar regions.
A review of the state of oil spill response planning and an interpretation of the administrative, procedural and political climate surrounding response in general and in the Venezuelan case in particular reveals critical areas where things go wrong, affecting speed and appropriateness of response. Generic issues faced by any region preparing contingency plans are identified and techniques for resolving them and the appropriate institutional setting are suggested. The first reported design of an integrated interactive graphic microcomputer based decision Support System for operational oil spill response is presented. The integrated DSS with its status display and log entries provides a formal mechanism for recording activities, and their justifications at the time of occurrence so that activities and their consequences can be reviewed to improve procedures and priorities. There is an identifiable dearth of realistic training exercises meant to hone decision making skills under the pressures of an ongoing major spill event. The design of an operational oil spill response training system based directly on the framework of an interactive, graphics oriented Decision Support System for operational response to oil spills is presented. This training framework not only develops skills needed by new spill response coordinators in devising and carrying out action plans, it also identified flaws or gaps in managerial or institutional arrangements before the response system is tested by an actual spill. The underlying concepts of both the DSS and the training exercise are general and can be readily applied to any region concerned with organizing oil spill response.
Schnabel, William; Brumbelow, Kelly
The objective of this project was to enhance the water resource decision-making process with respect to oil and gas exploration/production activities on Alaska’s North Slope. To this end, a web-based software tool was developed to allow stakeholders to assemble, evaluate, and communicate relevant information between and amongst themselves. The software, termed North Slope Decision Support System (NSDSS), is a visually-referenced database that provides a platform for running complex natural system, planning, and optimization models. The NSDSS design was based upon community input garnered during a series of stakeholder workshops, and the end product software is freely available to all stakeholders via the project website. The tool now resides on servers hosted by the UAF Water and Environmental Research Center, and will remain accessible and free-of-charge for all interested stakeholders. The development of the tool fostered new advances in the area of data evaluation and decision support technologies, and the finished product is envisioned to enhance water resource planning activities on Alaska’s North Slope.
Sanfilippo, Antonio P.; Cowell, Andrew J.; Malone, Elizabeth L.; Riensche, Roderick M.; Thomas, James J.; Unwin, Stephen D.; Whitney, Paul D.; Wong, Pak C.
A main challenge we face in fostering sustainable growth is to anticipate outcomes through predictive and proactive across domains as diverse as energy, security, the environment, health and finance in order to maximize opportunities, influence outcomes and counter adversities. The goal of this paper is to present new methods for anticipatory analytical thinking which address this challenge through the development of a multi-perspective approach to predictive modeling as a core to a creative decision making process. This approach is uniquely multidisciplinary in that it strives to create decision advantage through the integration of human and physical models, and leverages knowledge management and visual analytics to support creative thinking by facilitating the achievement of interoperable knowledge inputs and enhancing the user’s cognitive access. We describe a prototype system which implements this approach and exemplify its functionality with reference to a use case in which predictive modeling is paired with analytic gaming to support collaborative decision-making in the domain of agricultural land management.
Goldberg, Howard S; Paterno, Marilyn D; Rocha, Beatriz H; Schaeffer, Molly; Wright, Adam; Erickson, Jessica L; Middleton, Blackford
Objective To create a clinical decision support (CDS) system that is shareable across healthcare delivery systems and settings over large geographic regions. Materials and methods The enterprise clinical rules service (ECRS) realizes nine design principles through a series of enterprise java beans and leverages off-the-shelf rules management systems in order to provide consistent, maintainable, and scalable decision support in a variety of settings. Results The ECRS is deployed at Partners HealthCare System (PHS) and is in use for a series of trials by members of the CDS consortium, including internally developed systems at PHS, the Regenstrief Institute, and vendor-based systems deployed at locations in Oregon and New Jersey. Performance measures indicate that the ECRS provides sub-second response time when measured apart from services required to retrieve data and assemble the continuity of care document used as input. Discussion We consider related work, design decisions, comparisons with emerging national standards, and discuss uses and limitations of the ECRS. Conclusions ECRS design, implementation, and use in CDS consortium trials indicate that it provides the flexibility and modularity needed for broad use and performs adequately. Future work will investigate additional CDS patterns, alternative methods of data passing, and further optimizations in ECRS performance. PMID:23828174
Tidwell, Vincent Carroll; Malczynski, Leonard A.; Kobos, Peter Holmes; Castillo, Cesar; Hart, William Eugene; Klise, Geoffrey T.
Currently, electrical power generation uses about 140 billion gallons of water per day accounting for over 39% of all freshwater withdrawals thus competing with irrigated agriculture as the leading user of water. Coupled to this water use is the required pumping, conveyance, treatment, storage and distribution of the water which requires on average 3% of all electric power generated. While water and energy use are tightly coupled, planning and management of these fundamental resources are rarely treated in an integrated fashion. Toward this need, a decision support framework has been developed that targets the shared needs of energy and water producers, resource managers, regulators, and decision makers at the federal, state and local levels. The framework integrates analysis and optimization capabilities to identify trade-offs, and 'best' alternatives among a broad list of energy/water options and objectives. The decision support framework is formulated in a modular architecture, facilitating tailored analyses over different geographical regions and scales (e.g., national, state, county, watershed, NERC region). An interactive interface allows direct control of the model and access to real-time results displayed as charts, graphs and maps. Ultimately, this open and interactive modeling framework provides a tool for evaluating competing policy and technical options relevant to the energy-water nexus.
In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations
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
This chapter examines data quality management (DQM) and information governance (IG) of electronic decision support (EDS) systems so that they are safe and fit for use by clinicians and patients and their carers. This is consistent with the ISO definition of data quality as being fit for purpose. The scope of DQM & IG should range from data creation and collection in clinical settings, through cleaning and, where obtained from multiple sources, linkage, storage, use by the EDS logic engine and algorithms, knowledge base and guidance provided, to curation and presentation. It must also include protocols and mechanisms to monitor the safety of EDS, which will feedback into DQM & IG activities. Ultimately, DQM & IG must be integrated across the data cycle to ensure that the EDS systems provide guidance that leads to safe and effective clinical decisions and care.
Sordo, M; Fox, J; Blum, C; Taylor, P; Lee, R; Alberdi, E
This paper addresses two important problems in medical image interpretation:(1) integration of numeric and symbolic information, (2) access to external sources of medical knowledge. We have developed a prototype in which image processing algorithms are combined with symbolic representations for reasoning, decision making and task management in an integrated, platform-independent system for the differential diagnosis of abnormalities in mammograms. The prototype is based on PROforma, a generic technology for building decision support systems based on clinical guidelines. The PROforma language defines a set of tasks, one of which, the enquiry, is used as means of interaction with the outside world. However, the current enquiry model has proved to be too limited for our purposes. In this paper we outline a more general model, which can be used as an interface between symbolic functions and image or other signal data.
Fan, Aihua; Tang, Yu
In this paper, we present the design of a clinical decision support system (CDSS) for monitoring comorbid conditions. Specifically, we address the architecture of a CDSS by characterizing it from three layers and discuss the algorithms in each layer. Also we address the applications of CDSSs in a few real scenarios and analyze the accuracy of a CDSS in consideration of the potential conflicts when using multiple clinical practice guidelines concurrently. Finally, we compare the system performance in our design with that in the other design schemes. Our study shows that our proposed design can achieve a clinical decision in a shorter time than the other designs, while ensuring a high level of system accuracy. PMID:28373881
Rüping, Stefan; Anguita, Alberto; Bucur, Anca; Cirstea, Traian Cristian; Jacobs, Björn; Torge, Antje
Clinical decision support (CDS) systems promise to improve the quality of clinical care by helping physicians to make better, more informed decisions efficiently. However, the design and testing of CDS systems for practical medical use is cumbersome. It has been recognized that this may easily lead to a problematic mismatch between the developers' idea of the system and requirements from clinical practice. In this paper, we will present an approach to reduce the complexity of constructing a CDS system. The approach is based on an ontological annotation of data resources, which improves standardization and the semantic processing of data. This, in turn, allows to use data mining tools to automatically create hypotheses for CDS models, which reduces the manual workload in the creation of a new model. The approach is implemented in the context of EU research project p-medicine. A proof of concept implementation on data from an existing Leukemia study is presented.
Kamarudin, Anis Aklima; Othman, Zulaiha Ali; Sarim, Hafiz Mohd
This paper discuss about the role of Decision Support Tool in Travelling Salesman Problem (TSP) for helping the researchers who doing research in same area will get the better result from the proposed algorithm. A study has been conducted and Rapid Application Development (RAD) model has been use as a methodology which includes requirement planning, user design, construction and cutover. Water Flow Algorithm (WFA) with initialization technique improvement is used as the proposed algorithm in this study for evaluating effectiveness against TSP cases. For DST evaluation will go through usability testing conducted on system use, quality of information, quality of interface and overall satisfaction. Evaluation is needed for determine whether this tool can assists user in making a decision to solve TSP problems with the proposed algorithm or not. Some statistical result shown the ability of this tool in term of helping researchers to conduct the experiments on the WFA with improvements TSP initialization.
Utama, D. N.; Zaki, F. A.; Munjeri, I. J.; Putri, N. U.
Several ways and efforts have been already conducted to formally solve the road traffic congestion. However, the objective strategy type of road traffic engineering could not be proven truly. Try and error is one inefficient way in road traffic engineering to degrade the level of congestion. The combination between fuzzy-logic and water flow algorithm methods (called FWFA) was used as a main method to construct the decision support system (DSS) for selecting the objective strategy in road traffic engineering. The proposed DSS can suggest the most optimal strategy decision in road traffic engineering. Here, a main traffic road of Juanda in area Ciputat, Tangerang Selatan, province Banten, Indonesia; was selected as a research object in this study. The constructed DSS for road traffic engineering was structurally delivered in this paper.
Celi, Leo Anthony; Zimolzak, Andrew J; Stone, David J
The research world is undergoing a transformation into one in which data, on massive levels, is freely shared. In the clinical world, the capture of data on a consistent basis has only recently begun. We propose an operational vision for a digitally based care system that incorporates data-based clinical decision making. The system would aggregate individual patient electronic medical data in the course of care; query a universal, de-identified clinical database using modified search engine technology in real time; identify prior cases of sufficient similarity as to be instructive to the case at hand; and populate the individual patient's electronic medical record with pertinent decision support material such as suggested interventions and prognosis, based on prior outcomes. Every individual's course, including subsequent outcomes, would then further populate the population database to create a feedback loop to benefit the care of future patients.
Background In many countries, the responsibility for planning and delivery of health services is devolved to the subnational level. Health programs, however, often fall short of efficient use of data to inform decisions. As a result, programs are not as effective as they can be at meeting the health needs of the populations they serve. In Kenya, a decision-support tool, the District Health Profile (DHP) tool was developed to integrate data from health programs, primarily HIV, at the district level and to enable district health management teams to review and monitor program progress for specific health issues to make informed service delivery decisions. Methods Thirteen in-depth interviews were conducted with ten tool users and three non-users in six districts to qualitatively assess the process of implementing the tool and its effect on data-informed decision making at the district level. The factors that affected use or non-use of the tool were also investigated. Respondents were selected via convenience sample from among those that had been trained to use the DHP tool except for one user who was self-taught to use the tool. Selection criteria also included respondents from urban districts with significant resources as well as respondents from more remote, under-resourced districts. Results Findings from the in-depth interviews suggest that among those who used it, the DHP tool had a positive effect on data analysis, review, interpretation, and sharing at the district level. The automated function of the tool allowed for faster data sharing and immediate observation of trends that facilitated data-informed decision making. All respondents stated that the DHP tool assisted them to better target existing services in need of improvement and to plan future services, thus positively influencing program improvement. Conclusions This paper stresses the central role that a targeted decision-support tool can play in making data aggregation, analysis, and presentation
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
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.
Gustafson, D. H.; Hawkins, R. P.; Boberg, E. W.; Bricker, E.; Pingree, S.; Chan, C. L.
CHESS (the Comprehensive Health Enhancement Support System) is an interactive, computer-based system to support people facing AIDS/HIV Infection and other health-related crises or concerns. CHESS provides information, referral to service providers, support in making tough decisions and networking to experts and others facing the same concerns. CHESS is designed to improve access to health and human services for people who would otherwise face psychological, social, economic or geographic barriers to receiving services. CHESS has been evaluated in a random-assignment study with over 200 men and women living with AIDS and HIV infection. When CHESS was placed in subjects' homes for 3-6 months, use of CHESS was extremely heavy, with the average subject using CHESS 138 times for 39 hours. Compared with a control group which did not receive CHESS, subjects who used CHESS reported significantly higher quality of life in several dimensions, including social support and cognitive functioning. Users also reported significant reductions in some types of health care costs, especially inpatient services (hospitalizations). All segments of the study population used and benefited from CHESS, including women, minorities and those subjects with lower levels of education. Thus, CHESS appears to be an effective means of delivering education and support to the diverse populations which are affected by AIDS and HIV infection. PMID:7949999
Nair, U. S.; Keiser, K.; Wu, Y.; Kaulfus, A.; Srinivasan, K.; Anderson, E. R.; McEniry, M.
An Event-Driven Data delivery (ED3) framework has been created that provides reusable services and configurations to support better data preparedness for decision support of disasters and other events by rapidly providing pre-planned access to data, special processing, modeling and other capabilities, all executed in response to criteria-based events. ED3 facilitates decision makers to plan in advance of disasters and other types of events for the data necessary for decisions and response activities. A layer of services provided in the ED3 framework allows systems to support user definition of subscriptions for data plans that will be triggered when events matching specified criteria occur. Pre-planning for data in response to events lessens the burden on decision makers in the aftermath of an event and allows planners to think through the desired processing for specialized data products. Additionally the ED3 framework provides support for listening for event alerts and support for multiple workflow managers that provide data and processing functionality in response to events. Landslides are often costly and, at times, deadly disaster events. Whereas intense and/or sustained rainfall is often the primary trigger for landslides, soil type and slope are also important factors in determining the location and timing of slope failure. Accounting for the substantial spatial variability of these factors is one of the major difficulties when predicting the timing and location of slope failures. A wireless sensor network (WSN), developed by NASA SERVIR and USRA, with peer-to-peer communication capability and low power consumption, is ideal for high spatial in situ monitoring in remote locations. In collaboration with the University of Huntsville at Alabama, WSN equipped with accelerometer, rainfall and soil moisture sensors is being integrated into an end-to-end landslide warning system. The WSN is being tested to ascertain communication capabilities and the density of
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
Tafazzoli, A G; Altmann, U; Bürkle, T; Hölzer, S; Dudeck, J
In this paper we present (a) a shell for integrated knowledge-based functions that is destined to support decision processes of the users of the Giessener Tumordokumentationssystem (GTDS) and (b) some results we obtained during a 6-month observation period at one of the customers of the GTDS. A special characteristic of the provided decision support is the high degree of integration in the underlying information system GTDS, i.e. the functions are triggered by events in the patient database, existing patient data is reused as input for the reasoning process and generated alerts are presented instantly to the end-user. The first routine field of application was supporting registrars to adhere to integrity constraints as defined by the International Agency of Research on Cancer (IARC) during the documentation process. This information is important for the registrars since the checks of the IARC are an accepted standard for data quality in cancer registries. The expected benefit of this application area is less effort in achieving adherence to the specification of the IARC by preventing the costly rectification at a later time. During the last 5 months of the observation period 164 alerts were displayed. About 65% of the assessed alerts were considered to be correct. Especially, the analysis of the incorrect alerts revealed some shortcomings in the knowledge behind some of the integrity constraints of the IARC. The general feedback from the end-users indicate positive user satisfaction. Currently, the shell is in use in six hospital cancer registries.
Adler, Richard M.
Knowledge-based technologies have been applied successfully to automate planning and scheduling in many problem domains. Automation of decision support can be increased further by integrating task-specific applications with supporting database systems, and by coordinating interactions between such tools to facilitate collaborative activities. Unfortunately, the technical obstacles that must be overcome to achieve this vision of transparent, cooperative problem-solving are daunting. Intelligent decision support tools are typically developed for standalone use, rely on incompatible, task-specific representational models and application programming interfaces (API's), and run on heterogeneous computing platforms. Getting such applications to interact freely calls for platform independent capabilities for distributed communication, as well as tools for mapping information across disparate representations. Symbiotics is developing a layered set of software tools (called NetWorks! for integrating and coordinating heterogeneous distributed applications. he top layer of tools consists of an extensible set of generic, programmable coordination services. Developers access these services via high-level API's to implement the desired interactions between distributed applications.
Mirza, Muzna; Saini, Devashish; Brown, Todd B; Orthner, Helmuth F; Mazza, Giovanni; Battles, Marcie M
The knowledge base (KB) for E-CAD (Enhanced Computer-Aided Dispatch), a triage decision support system for Emergency Medical Dispatch (EMD) of medical resources in trauma cases, is being evaluated. We aim to achieve expert consensus for validation and refinement of the E-CAD KB using the modified Delphi technique. Evidence-based, expert-validated and refined KB will provide improved EMD practice guidelines and may facilitate acceptance of the E-CAD by state-wide professionals.
Li, Li; Wu, Sheng; Wu, Zunyou; Sun, Stephanie; Cui, Haixia; Jia, Manhong
This study examines how family support affects people living with HIV/AIDS (PLHA) in China. In-depth, semi-structured interviews (n=30) were conducted with people living with HIV/AIDS who were infected through different routes (e.g., intravenous drug use, sex) and of different age groups. Findings showed that all of the participants were in great need of help and the primary source of support came from their families. Family support included financial assistance, support in the disclosure process, daily routine activities, medical assistance, or psychological support. This study illustrates that the support provided by family makes multiple levels of positive impact on people living with HIV/AIDS, suggesting the importance of including families in HIV/AIDS interventions. PMID:16741672
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.
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
Reher, Cornelia; Metzner, Franka
Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.
Sojda, Richard S.
The number of trumpeter swans (Cygnus buccinator) breeding in the Tri-State area where Montana, Idaho, and Wyoming come together has declined to just a few hundred pairs. However, these birds are part of the Rocky Mountain Population which additionally has over 3,500 birds breeding in Alberta, British Columbia, Northwest Territories, and Yukon Territory. To a large degree, these birds seem to have abandoned traditional migratory pathways in the flyway. Waterfowl managers have been interested in decision support tools that would help them explore simulated management scenarios in their quest towards reaching population recovery and the reestablishment of traditional migratory pathways. I have developed a decision support system to assist biologists with such management, especially related to wetland ecology. Decision support systems use a combination of models, analytical techniques, and information retrieval to help develop and evaluate appropriate alternatives. Swan management is a domain that is ecologically complex, and this complexity is compounded by spatial and temporal issues. As such, swan management is an inherently distributed problem. Therefore, the ecological context for modeling swan movements in response to management actions was built as a multiagent system of interacting intelligent agents that implements a queuing model representing swan migration. These agents accessed ecological knowledge about swans, their habitats, and flyway management principles from three independent expert systems. The agents were autonomous, had some sensory capability, and could respond to changing conditions. A key problem when developing ecological decision support systems is empirically determining that the recommendations provided are valid. Because Rocky Mountain trumpeter swans have been surveyed for a long period of time, I was able to compare simulated distributions provided by the system with actual field observations across 20 areas for the period 1988
Frevert, D.; Lins, H.; ,
Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.
Arzt, Noam H.
This article focuses on the requirements and current developments in clinical decision support technologies for immunizations (CDSi) in both the public health and clinical communities, with an emphasis on shareable solutions. The requirements of the Electronic Health Record Incentive Programs have raised some unique challenges for the clinical community, including vocabulary mapping, update of changing guidelines, single immunization schedule, and scalability. This article discusses new, collaborative approaches whose long-term goal is to make CDSi more sustainable for both the public and private sectors. PMID:27789956
Ito, M; Ramos, M P; Chern, M S; Espósito, S R; Carmagnani, M I; Cunha, I C; Piveta, V M; Nespoulos, E; Iwasa, A T; Anção, M S
The present work proposes a Decision Support System for nursing procedures: SAPIEN-Tx. The discussion includes the acquisition, modeling , and implementation of nursing expertise professionals in Renal Transplant. It was developed to obtain better quality healthcare services, as well as an effective contribution to the nursing professional in the global assistance of their clientele. We used the KADS methodology to develop the system knowledge base. This methodology permitted us to perform the knowledge modeling with quality and organization. In opposition to the old method, errors were detected before the implementation, avoiding possible modification on the whole project structure.
Samsa, M.; Van Kuiken, J.; Jusko, M.; Decision and Information Sciences
The Critical Infrastructure Protection Decision Support System Decision Model (CIPDSS-DM) is a useful tool for comparing the effectiveness of alternative risk-mitigation strategies on the basis of CIPDSS consequence scenarios. The model is designed to assist analysts and policy makers in evaluating and selecting the most effective risk-mitigation strategies, as affected by the importance assigned to various impact measures and the likelihood of an incident. A typical CIPDSS-DM decision map plots the relative preference of alternative risk-mitigation options versus the annual probability of an undesired incident occurring once during the protective life of the investment, assumed to be 20 years. The model also enables other types of comparisons, including a decision map that isolates a selected impact variable and displays the relative preference for the options of interest--parameterized on the basis of the contribution of the isolated variable to total impact, as well as the likelihood of the incident. Satisfaction/regret analysis further assists the analyst or policy maker in evaluating the confidence with which one option can be selected over another.
van Essen, J Theresia; Hurink, Johann L; Hartholt, Woutske; van den Akker, Bernd J
Due to surgery duration variability and arrivals of emergency surgeries, the planned Operating Room (OR) schedule is disrupted throughout the day which may lead to a change in the start time of the elective surgeries. These changes may result in undesirable situations for patients, wards or other involved departments, and therefore, the OR schedule has to be adjusted. In this paper, we develop a decision support system (DSS) which assists the OR manager in this decision by providing the three best adjusted OR schedules. The system considers the preferences of all involved stakeholders and only evaluates the OR schedules that satisfy the imposed resource constraints. The decision rules used for this system are based on a thorough analysis of the OR rescheduling problem. We model this problem as an Integer Linear Program (ILP) which objective is to minimize the deviation from the preferences of the considered stakeholders. By applying this ILP to instances from practice, we determined that the given preferences mainly lead to (i) shifting a surgery and (ii) scheduling a break between two surgeries. By using these changes in the DSS, the performed simulation study shows that less surgeries are canceled and patients and wards are more satisfied, but also that the perceived workload of several departments increases to compensate this. The system can also be used to judge the acceptability of a proposed initial OR schedule.
Scimeca, Jason M.; Katzman, Perri L.; Badre, David
Adaptive memory requires context-dependent control over how information is retrieved, evaluated and used to guide action, yet the signals that drive adjustments to memory decisions remain unknown. Here we show that prediction errors (PEs) coded by the striatum support control over memory decisions. Human participants completed a recognition memory test that incorporated biased feedback to influence participants' recognition criterion. Using model-based fMRI, we find that PEs—the deviation between the outcome and expected value of a memory decision—correlate with striatal activity and predict individuals' final criterion. Importantly, the striatal PEs are scaled relative to memory strength rather than the expected trial outcome. Follow-up experiments show that the learned recognition criterion transfers to free recall, and targeting biased feedback to experimentally manipulate the magnitude of PEs influences criterion consistent with PEs scaled relative to memory strength. This provides convergent evidence that declarative memory decisions can be regulated via striatally mediated reinforcement learning signals. PMID:27713407
Vyazilov, Evgeny; Chunyaev, Nikita
In spite of using highly automated systems of measurement, collecting, storing, handling, prediction and delivery of information on the marine environment, including natural hazards, the amount of damage from natural phenomena increases. Because information on the marine environment delivered to the industrial facilities not effectively used. To such information pays little attention by individual decision-makers and not always perform preventive measures necessary for reduce and prevent damage. Automation of information support will improve the efficiency management of the marine activities. In Russia develops "The Unified system of the information about World ocean" (ESIMO, http://esimo.ru/), that integrates observation, analysis, prognostic and climate data. Necessary to create tools to automatic selection natural disasters through all integrated data; notification decision-makers about arising natural hazards - software agent; provision of information in a compact form for the decision-makers; assessment of possible damage and costs to the preventive measures; providing information on the impacts of environment on economic facilities and recommendations for decision-making; the use of maps, diagrams, tables for reporting. Tools for automatic selection designed for identification of natural phenomena based on the resources ESIMO and corresponding critical values of the indicators environment. The result of this module will be constantly updated database of critical situations of environment for each object or technological process. To operational notify and provide current information about natural hazards proposes using a software agent that is installed on the computer decision-makers, which is activated in case critical situations and provides a minimum of information. In the event of natural disaster software agent should be able to inform decision-makers about this, providing information on the current situation, and the possibility for more and detailed
Background Clean birth practices can prevent sepsis, one of the leading causes of both maternal and newborn mortality. Evidence suggests that clean birth kits (CBKs), as part of package that includes education, are associated with a reduction in newborn mortality, omphalitis, and puerperal sepsis. However, questions remain about how best to approach the introduction of CBKs in country. We set out to develop a practical decision support tool for programme managers of public health systems who are considering the potential role of CBKs in their strategy for care at birth. Methods Development and testing of the decision support tool was a three-stage process involving an international expert group and country level testing. Stage 1, the development of the tool was undertaken by the Birth Kit Working Group and involved a review of the evidence, a consensus meeting, drafting of the proposed tool and expert review. In Stage 2 the tool was tested with users through interviews (9) and a focus group, with federal and provincial level decision makers in Pakistan. In Stage 3 the findings from the country level testing were reviewed by the expert group. Results The decision support tool comprised three separate algorithms to guide the policy maker or programme manager through the specific steps required in making the country level decision about whether to use CBKs. The algorithms were supported by a series of questions (that could be administered by interview, focus group or questionnaire) to help the decision maker identify the information needed. The country level testing revealed that the decision support tool was easy to follow and helpful in making decisions about the potential role of CBKs. Minor modifications were made and the final algorithms are presented. Conclusion Testing of the tool with users in Pakistan suggests that the tool facilitates discussion and aids decision making. However, testing in other countries is needed to determine whether these results can be
Ma, Kevin; Jacobs, Colin; Fernandez, James; Amezcua, Lilyana; Liu, Brent
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. The chronic nature of MS necessitates multiple MRI studies to track disease progression. Currently, MRI assessment of multiple sclerosis requires manual lesion measurement and yields an estimate of lesion volume and change that is highly variable and user-dependent. In the setting of a longitudinal study, disease trends and changes become difficult to extrapolate from the lesions. In addition, it is difficult to establish a correlation between these imaged lesions and clinical factors such as treatment course. To address these clinical needs, an MS specific e-Folder for decision support in the evaluation and assessment of MS has been developed. An e-Folder is a disease-centric electronic medical record in contrast to a patient-centric electronic health record. Along with an MS lesion computer aided detection (CAD) package for lesion load, location, and volume, clinical parameters such as patient demographics, disease history, clinical course, and treatment history are incorporated to make the e-Folder comprehensive. With the integration of MRI studies together with related clinical data and informatics tools designed for monitoring multiple sclerosis, it provides a platform to improve the detection of treatment response in patients with MS. The design and deployment of MS e-Folder aims to standardize MS lesion data and disease progression to aid in decision making and MS-related research.
Freimuth, Robert R.; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G.
We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS. PMID:25954360
Freimuth, Robert R; Wix, Kelly; Zhu, Qian; Siska, Mark; Chute, Christopher G
We evaluated the potential use of RxNorm to provide standardized representations of generic drug name and route of administration to facilitate management of drug lists for clinical decision support (CDS) rules. We found a clear representation of generic drug name but not route of administration. We identified several issues related to data quality, including erroneous or missing defined relationships, and the use of different concept hierarchies to represent the same drug. More importantly, we found extensive semantic precoordination of orthogonal concepts related to route and dose form, which would complicate the use of RxNorm for drug-based CDS. This study demonstrated that while RxNorm is a valuable resource for the standardization of medications used in clinical practice, additional work is required to enhance the terminology so that it can support expanded use cases, such as managing drug lists for CDS.
Lobach, David F; Kawamoto, Kensaku; Anstrom, Kevin J; Russell, Michael L; Woods, Peter; Smith, Dwight
Clinical decision support is recognized as one potential remedy for the growing crisis in healthcare quality in the United States and other industrialized nations. While decision support systems have been shown to improve care quality and reduce errors, these systems are not widely available. This lack of availability arises in part because most decision support systems are not portable or scalable. The Health Level 7 international standard development organization recently adopted a draft standard known as the Decision Support Service standard to facilitate the implementation of clinical decision support systems using software services. In this paper, we report the first implementation of a clinical decision support system using this new standard. This system provides point-of-care chronic disease management for diabetes and other conditions and is deployed throughout a large regional health system. We also report process measures and usability data concerning the system. Use of the Decision Support Service standard provides a portable and scalable approach to clinical decision support that could facilitate the more extensive use of decision support systems.
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.
Wright, Adam; Sittig, Dean F.
A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics. PMID:18693950
Kumar, S.; Cantrell, S.; Higgins, G. J.; Marshall, J.; VanWijngaarden, F.
Environmental changes are happening now that has caused concern in many parts of the world; particularly vulnerable are the countries and communities with limited resources and with natural environments that are more susceptible to climate change impacts. Global leaders are concerned about the observed phenomena and events such as Amazon deforestation, shifting monsoon patterns affecting agriculture in the mountain slopes of Peru, floods in Pakistan, water shortages in Middle East, droughts impacting water supplies and wildlife migration in Africa, and sea level rise impacts on low lying coastal communities in Bangladesh. These environmental changes are likely to get exacerbated as the temperatures rise, the weather and climate patterns change, and sea level rise continues. Large populations and billions of dollars of infrastructure could be affected. At Northrop Grumman, we have developed an integrated decision support framework for providing necessary information to stakeholders and planners to adapt to the impacts of climate variability and change at the regional and local levels. This integrated approach takes into account assimilation and exploitation of large and disparate weather and climate data sets, regional downscaling (dynamic and statistical), uncertainty quantification and reduction, and a synthesis of scientific data with demographic and economic data to generate actionable information for the stakeholders and decision makers. Utilizing a flexible service oriented architecture and state-of-the-art visualization techniques, this information can be delivered via tailored GIS portals to meet diverse set of user needs and expectations. This integrated approach can be applied to regional and local risk assessments, predictions and decadal projections, and proactive adaptation planning for vulnerable communities. In this paper we will describe this comprehensive decision support approach with selected applications and case studies to illustrate how this
Ahmadi, Bouda Vosough; Moran, Dominic; Barnes, Andrew P; Baret, Philippe V
Sustainable intensification (SI) is a multifaceted concept incorporating the ambition to increase or maintain the current level of agricultural yields while reduce negative ecological and environmental impacts. Decision-support systems (DSS) that use integrated analytical methods are often used to support decision making processes in agriculture. However, DSS often consist of set of values, objectives, and assumptions that may be inconsistent or in conflict with merits and objectives of SI. These potential conflicts will have consequences for adoption and up-take of agricultural research, technologies and related policies and regulations such as genetic technology in pursuit of SI. This perspective paper aimed at comparing a number of frequently used socio-economic DSS with respect to their capacity in incorporating various dimensions of SI, and discussing their application to analyzing farm animal genetic resources (FAnGR) policies. The case of FAnGR policies was chosen because of its great potential in delivering merits of SI. It was concluded that flexible DSS, with great integration capacity with various natural and social sciences, are needed to provide guidance on feasibility, practicality, and policy implementation for SI.
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
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
Inada, Masanori; Sato, Mayumi; Yoneyama, Akiko
This paper discusses a knowledge management system for clinical laboratories. In the clinical laboratory of Toranomon Hospital, we receive about 20 questions relevant to laboratory tests per day from medical doctors or co-medical staff. These questions mostly involve the essence to appropriately accomplish laboratory tests. We have to answer them carefully and suitably because an incorrect answer may cause a medical accident. Up to now, no method has been in place to achieve a rapid response and standardized answers. For this reason, the laboratory staff have responded to various questions based on their individual knowledge. We began to develop a knowledge management system to promote the knowledge of staff working for the laboratory. This system is a type of knowledge base for assisting the work, such as inquiry management, laboratory consultation, process management, and clinical support. It consists of several functions: guiding laboratory test information, managing inquiries from medical staff, reporting results of patient consultation, distributing laboratory staffs notes, and recording guidelines for laboratory medicine. The laboratory test information guide has 2,000 records of medical test information registered in the database with flexible retrieval. The inquiry management tool provides a methos to record all questions, answer easily, and retrieve cases. It helps staff to respond appropriately in a short period of time. The consulting report system treats patients' claims regarding medical tests. The laboratory staffs notes enter a file management system so they can be accessed to aid in clinical support. Knowledge sharing using this function can achieve the transition from individual to organizational learning. Storing guidelines for laboratory medicine will support EBM. Finally, it is expected that this system will support intellectual activity concerning laboratory work and contribute to the practice of knowledge management for clinical work support.
Ross, Kenton W.; McKellip, Rodney; Moore, Roxzana F.; Fendley, Debbie
This section of the evaluation report summarizes the verification and validation (V&V) of recently implemented, NASA-supported enhancements to the decision support tools of the Production Estimates and Crop Assessment Division (PECAD). The implemented enhancements include operationally tailored Moderate Resolution Imaging Spectroradiometer (MODIS) products and products of the Global Reservoir and Lake Monitor (GRLM). The MODIS products are currently made available through two separate decision support tools: the MODIS Image Gallery and the U.S. Department of Agriculture (USDA) Foreign Agricultural Service (FAS) MODIS Normalized Difference Vegetation Index (NDVI) Database. Both the Global Reservoir and Lake Monitor and MODIS Image Gallery provide near-real-time products through PECAD's CropExplorer. This discussion addresses two areas: 1. Assessments of the standard NASA products on which these enhancements are based. 2. Characterizations of the performance of the new operational products.
... 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 ...
Alpert, J. C.
model output offering access to probability and calibrating information for real time decision making. The aggregation content server reports over ensemble component and forecast time in addition to the other data dimensions of vertical layer and position for each variable. The unpacking, organization and reading of many binary packed files is accomplished most efficiently on the server while weather element event probability calculations, the thresholds for more accurate decision support, or display remain for the client. Our goal is to reduce uncertainty for variables of interest, e.g, agricultural importance. The weather service operational GFS model ensemble and short range ensemble forecasts can make skillful probability forecasts to alert users if and when their selected weather events will occur. A description of how this framework operates and how it can be implemented using existing NOMADS content services and applications is described.
American School Health Association, Kent, OH.
This booklet describes a multi-disciplinary approach to student support services related to the Human Immunodeficiency Virus (HIV) epidemic. The guidelines can be used by student support services personnel to evaluate the quality of services they are providing, by school administrators to design a comprehensive student support services delivery…
Biscarini, C.; di Francesco, S.; Manciola, P.
The focus of the present document is on specific decision-making aspects of flood risk analysis. A flood is the result of runoff from rainfall in quantities too great to be confined in the low-water channels of streams. Little can be done to prevent a major flood, but we may be able to minimize damage within the flood plain of the river. This broad definition encompasses many possible mitigation measures. Floodplain management considers the integrated view of all engineering, nonstructural, and administrative measures for managing (minimizing) losses due to flooding on a comprehensive scale. The structural measures are the flood-control facilities designed according to flood characteristics and they include reservoirs, diversions, levees or dikes, and channel modifications. Flood-control measures that modify the damage susceptibility of floodplains are usually referred to as nonstructural measures and may require minor engineering works. On the other hand, those measures designed to modify the damage potential of permanent facilities are called non-structural and allow reducing potential damage during a flood event. Technical information is required to support the tasks of problem definition, plan formulation, and plan evaluation. The specific information needed and the related level of detail are dependent on the nature of the problem, the potential solutions, and the sensitivity of the findings to the basic information. Actions performed to set up and lay out the study are preliminary to the detailed analysis. They include: defining the study scope and detail, the field data collection, a review of previous studies and reports, and the assembly of needed maps and surveys. Risk analysis can be viewed as having many components: risk assessment, risk communication and risk management. Risk assessment comprises an analysis of the technical aspects of the problem, risk communication deals with conveying the information and risk management involves the decision process
Frost, C. R.; Enomoto, F. Y.; D'Ortenzio, M. V.; Nguyen, Q. B.
NASA developed the Collaborative Decision Environment (CDE), the ground-based component of its Intelligent Mission Management (IMM) technology for science missions employing long endurance unmanned aerial vehicles (UAVs). The CDE was used to support science mission planning and decision-making for a NASA- and U.S. Forest Service-sponsored mission to monitor wildfires in the western United States using a multi- spectral imager flown onboard the General Atomics Altair UAV in summer of 2006. The CDE is a ground-based system that provides the mission/science team with situational awareness, collaboration, and decision tools. The CDE is used for pre-flight planning, mission monitoring, and visualization of acquired data. It integrates external data products used for planning and executing a mission, such as weather, large wildfire locations, satellite-derived fire detection data, temporarily restricted airspace, and satellite imagery. While a prototype CDE was developed as a Java-based client/server application in 2004-2005, the team investigated the use of Google Earth to take advantage of its 3-D visualization capabilities, friendly user interface, and enhanced graphics performance. External data is acquired via the Internet by leveraging established and emerging Open Geospatial Consortium (OGC) standards and is re-formatted into the Keyhole Markup Language (KML) specification used by Google Earth. Aircraft flight position and sensor data products are relayed from the instrument ground station to CDE servers where they are made available to users. An instant messaging chat server is used to facilitate real-time communication between remote users. This paper will present an overview of the CDE system architecture, and discuss how science user input was crucial to shaping and developing the system. Examples from the UAV mission will be used to illustrate the presentation. Plans for future development work to improve mission operations, such as integration with
Sordo, Margarita; Rocha, Beatriz H; Morales, Alfredo A; Maviglia, Saverio M; Oglio, Elisa Dell'Oglio; Fairbanks, Amanda; Aroy, Teal; Dubois, David; Bouyer-Ferullo, Sharon; Rocha, Roberto A
Traditionally, rule interactions are handled at implementation time through rule task properties that control the order in which rules are executed. By doing so, knowledge about the behavior and interactions of decision rules is not captured at modeling time. We argue that this is important knowledge that should be integrated in the modeling phase. In this project, we build upon current work on a conceptual schema to represent clinical knowledge for decision support in the form of if
Fraser, Hannah; Rumpff, Libby; Yen, Jian D L; Robinson, Doug; Wintle, Brendan A
Many objectives motivate ecological restoration including improving vegetation condition, increasing the range and abundance of threatened species, and improving aggregate measures of biodiversity such as richness and diversity. While ecological models have been used to examine the outcomes of ecological restoration, there are few attempts to develop models to account for multiple, potentially competing objectives. We develop the first predictive model that integrates a vegetation-focused state-and-transition model with species distribution models for birds. We demonstrate how this integrated model can be used to identify effective restoration options for vegetation and bird species under a constrained budget. For example, using a typical agricultural land management scenario from south-eastern Australia, we demonstrate how the optimal management actions for promoting the occurrence of the Brown Treecreeper, an iconic threatened species, may be suboptimal for meeting vegetation condition objectives. This highlights that any 'preferred' management decision depends on the value assigned to the different objectives. An exploration of sensitivity to value weightings highlighted that 'no management' or 'weed control' were most likely to be the best management options to meet multiple objectives in the scenario we explored. We thus illustrate an approach to using the model outputs to explore trade-offs between bird and vegetation objectives. Our approach to exploring management outcomes and trade-offs using integrated modelling and structured decision support approaches has wide application for conservation management problems in which trade-offs exist between competing objectives. This article is protected by copyright. All rights reserved.
Shieh, Yao-Yang; Roberson, Glenn H.
A physician's decision support system consists of three components: (1) a comprehensive patient record and medical knowledge database, (2) information infrastructure for data storage, transfer, and (3) an analytical inference engine, accompanied by business operation database. Medical knowledge database provides the guideline for the selection of powerful clinical features or tests to be observed so that an accurate diagnosis as well as effective treatment can be quickly reached. With a tremendous amount of information stored in multiple data centers, it takes an effective information infrastructure to provide streamlined flow of information to the physician in a timely fashion. A real-time analytical inference engine mimics the physician's reasoning process. However due to incomplete, imperfect data and medical knowledge, a realistic output from this engine will be a list of options with associated confidence level, expected risk, so that the physician can make a well-informed final decision. Physicians are challenged to pursue the objective of ensuring an acceptable quality of care in an economically restrained environment. Therefore, business operation data have to be factored into the calculation of overall loss. Follow-up of diagnosis and treatment provides retrospective assessment of the accuracy and effectiveness of the existing inference engine.
The virtual test bed for launch and range operations developed at NASA Ames Research Center consists of various independent expert systems advising on weather effects, toxic gas dispersions and human health risk assessment during space-flight operations. An individual dedicated server supports each expert system and the master system gather information from the dedicated servers to support the launch decision-making process. Since the test bed is based on the web system, reducing network traffic and optimizing the knowledge base is critical to its success of real-time or near real-time operations. Jess, a fast rule engine and powerful scripting environment developed at Sandia National Laboratory has been adopted to build the expert systems providing robustness and scalability. Jess also supports XML representation of knowledge base with forward and backward chaining inference mechanism. Facts added - to working memory during run-time operations facilitates analyses of multiple scenarios. Knowledge base can be distributed with one inference engine performing the inference process. This paper discusses details of the knowledge base and inference engine using Jess for a launch and range virtual test bed.
Paulson, Patrick R.; Coles, Garill A.; Shoemaker, Steven V.
Modernization of nuclear power operations control systems, in particular the move to digital control systems, creates an opportunity to modernize existing legacy infrastructure and extend plant life. We describe here decision support tools that allow the assessment of different facets of risk and support the optimization of available resources to reduce risk as plants are upgraded and maintained. This methodology could become an integrated part of the design review process and a part of the operations management systems. The methodology can be applied to the design of new reactors such as small nuclear reactors (SMR), and be helpful in assessing the risks of different configurations of the reactors. Our tool provides a low cost evaluation of alternative configurations and provides an expanded safety analysis by considering scenarios while early in the implementation cycle where cost impacts can be minimized. The effects of failures can be modeled and thoroughly vetted to understand their potential impact on risk. The process and tools presented here allow for an integrated assessment of risk by supporting traditional defense in depth approaches while taking into consideration the insertion of new digital instrument and control systems.
Wanderer, Jonathan P; Ehrenfeld, Jesse M
Clinical decision support (CDS) systems are being used to optimize the increasingly complex care that our health care system delivers. These systems have become increasingly important in the delivery of perioperative care for patients undergoing cardiac, thoracic, and vascular procedures. The adoption of perioperative information management systems (PIMS) has allowed these technologies to enter the operating room and support the clinical work flow of anesthesiologists and operational processes. Constructing effective CDS systems necessitates an understanding of operative work flow and technical considerations as well as achieving integration with existing information systems. In this review, we describe published examples of CDS for PIMS, including support for cardiopulmonary bypass separation physiological alarms, β-blocker guideline adherence, enhanced revenue capture for arterial line placement, and detection of hemodynamic monitoring gaps. Although these and other areas are amenable to CDS systems, the challenges of latency and data reliability represent fundamental limitations on the potential application of these tools to specific types of clinical issues. Ultimately, we expect that CDS will remain an important tool in our efforts to optimize the quality of care delivered.
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
SULLIVAN,T.; BARDOS,R.P.; MAROT,C.; MARIOTTI,R.
Effective contaminated land management requires a number of decisions addressing a suite of technical, economic and social concerns. This paper offers a common framework and terminology for describing decision support approaches, along with an overview of recent applications of decision support tools in Europe and the USA. A common problem with work on decision support approaches is a lack of a common framework and terminology to describe the process. These have been proposed in this paper.
Fernandes, Ana S.; Alves, Pedro; Jarman, Ian H.; Etchells, Terence A.; Fonseca, José M.; Lisboa, Paulo J. G.
This paper proposes a Web clinical decision support system for clinical oncologists and for breast cancer patients making prognostic assessments, using the particular characteristics of the individual patient. This system comprises three different prognostic modelling methodologies: the clinically widely used Nottingham prognostic index (NPI); the Cox regression modelling and a partial logistic artificial neural network with automatic relevance determination (PLANN-ARD). All three models yield a different prognostic index that can be analysed together in order to obtain a more accurate prognostic assessment of the patient. Missing data is incorporated in the mentioned models, a common issue in medical data that was overcome using multiple imputation techniques. Risk group assignments are also provided through a methodology based on regression trees, where Boolean rules can be obtained expressed with patient characteristics.
Ash, Joan S.; Sittig, Dean F.; McMullen, Carmit K.; McCormack, James L.; Wright, Adam; Bunce, Arwen; Wasserman, Joseph; Mohan, Vishnu; Cohen, Deborah J.; Shapiro, Michael; Middleton, Blackford
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors’ perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a “three way conversation” among content vendors, EHR vendors, and user organizations. PMID:22195058
Broverman, C A; Clyman, J I; Schlesinger, J M; Want, E
We report on a joint development effort between ALLTEL Information Services Health Care Division and IBM Worldwide Healthcare Industry to demonstrate concurrent clinical decision support using Arden Syntax at order-entry time. The goal of the partnership is to build a high performance CDS toolkit that may be easily customized for multiple health care enterprises. Our work uses and promotes open technologies and health care standards while building a generalizable interface to a legacy patient-care system and clinical database. This paper identifies four areas of design challenges and solutions unique to a concurrent order-entry environment: the clinical information model, the currency of the patient virtual chart, the granularity of event triggers and rule evaluation context, and performance.
Scott, C. A.
The National Weather Service Alaska Region's (AR) Regional Operation Center (ROC) provided weather and ice decision support services for the Bureau of Ocean and Energy Management (BOEM) oversight of Royal Dutch Shell's exploratory drilling operations in the Chukchi Sea during the summer and early fall of 2015. The AR ROC, coordinated input from WFO's Anchorage and Fairbanks, the NCEP/Ocean Prediction Center and Climate Prediction Center, and NOAA's National Ice Center. Briefings began in early Spring 2015, focused on melt-out and freeze up dates in the vicinity of the "Burger" drill site. Initially packages were prepared and briefed twice weekly. The frequency increased as the drilling season progressed, and included marine and aviation weather forecasts, current and forecast sea ice conditions as it impacts vessels and aircraft transiting to and from the drilling sites in the Chukchi Sea. Spot forecasts are also available for specific missions as needed.
Seeberg, Trine M; Vardoy, Astrid-Sofie B; Austad, Hanne O; Wiggen, Oystein; Stenersen, Henning S; Liverud, Anders E; Storholmen, Tore Christian B; Faerevik, Hilde
The cold and harsh climate in the High North represents a threat to safety and work performance. The aim of this study was to show that sensors integrated in clothing can provide information that can improve decision support for workers in cold climate without disturbing the user. Here, a wireless demonstrator consisting of a working jacket with integrated temperature, humidity and activity sensors has been developed. Preliminary results indicate that the demonstrator can provide easy accessible information about the thermal conditions at the site of the worker and local cooling effects of extremities. The demonstrator has the ability to distinguish between activity and rest, and enables implementation of more sophisticated sensor fusion algorithms to assess work load and pre-defined activities. This information can be used in an enhanced safety perspective as an improved tool to advice outdoor work control for workers in cold climate.
Huang, Zhenyu [Richland, WA; Wong, Pak Chung [Richland, WA; Ma, Jian [Richland, WA; Mackey, Patrick S [Richland, WA; Chen, Yousu [Richland, WA; Schneider, Kevin P [Seattle, WA
Methods and systems for automated decision support in analyzing operation data from a complex network. Embodiments of the present invention utilize these algorithms and techniques not only to characterize the past and present condition of a complex network, but also to predict future conditions to help operators anticipate deteriorating and/or problem situations. In particular, embodiments of the present invention characterize network conditions from operation data using a state estimator. Contingency scenarios can then be generated based on those network conditions. For at least a portion of all of the contingency scenarios, risk indices are determined that describe the potential impact of each of those scenarios. Contingency scenarios with risk indices are presented visually as graphical representations in the context of a visual representation of the complex network. Analysis of the historical risk indices based on the graphical representations can then provide trends that allow for prediction of future network conditions.
Ash, Joan S; Sittig, Dean F; McMullen, Carmit K; McCormack, James L; Wright, Adam; Bunce, Arwen; Wasserman, Joseph; Mohan, Vishnu; Cohen, Deborah J; Shapiro, Michael; Middleton, Blackford
In prior work, using a Rapid Assessment Process (RAP), we have investigated clinical decision support (CDS) in ambulatory clinics and hospitals. We realized that individuals in these settings provide only one perspective related to the CDS landscape, which also includes content vendors and electronic health record (EHR) vendors. To discover content vendors' perspectives and their perceived challenges, we modified RAP for industrial settings. We describe how we employed RAP, and show its utility by describing two illustrative themes. We found that while the content vendors believe they provide unique much-needed services, the amount of labor involved in content development is underestimated by others. We also found that the content vendors believe their products are resources to be used by practitioners, so they are somewhat protected from liability issues. To promote adequate understanding about these issues, we recommend a "three way conversation" among content vendors, EHR vendors, and user organizations.
Amland, Robert C; Hahn-Cover, Kristin E
Sepsis is an inflammatory response triggered by infection, with a high in-hospital mortality rate. Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes. One challenge clinicians face is identifying the inflammatory syndrome against the background of the patient's infectious illness and comorbidities. An approach to this problem is implementation of computerized early warning tools for sepsis. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Data encompassed 6200 adult hospitalizations from 2012 through 2013. Of 13% patients screened-in, 51% were already suspected to have an infection when the system activated. This study focused on a patient cohort screened-in before infection was suspected; median time from arrival to CDS activation was 3.5 hours, and system activation to diagnostic collect was another 8.6 hours.
Madhukar, Monica; Agaian, Sos; Chronopoulos, Anthony T.
In this paper, we build up a new decision support tool to improve treatment intensity choice in childhood ALL. The developed system includes different methods to accurately measure furthermore cell properties in microscope blood film images. The blood images are exposed to series of pre-processing steps which include color correlation, and contrast enhancement. By performing K-means clustering on the resultant images, the nuclei of the cells under consideration are obtained. Shape features and texture features are then extracted for classification. The system is further tested on the classification of spectra measured from the cell nuclei in blood samples in order to distinguish normal cells from those affected by Acute Lymphoblastic Leukemia. The results show that the proposed system robustly segments and classifies acute lymphoblastic leukemia based on complete microscopic blood images.
Botsis, Taxiarchis; Jankosky, Christopher; Arya, Deepa; Kreimeyer, Kory; Foster, Matthew; Pandey, Abhishek; Wang, Wei; Zhang, Guangfan; Forshee, Richard; Goud, Ravi; Menschik, David; Walderhaug, Mark; Woo, Emily Jane; Scott, John
We have developed a Decision Support Environment (DSE) for medical experts at the US Food and Drug Administration (FDA). The DSE contains two integrated systems: The Event-based Text-mining of Health Electronic Records (ETHER) and the Pattern-based and Advanced Network Analyzer for Clinical Evaluation and Assessment (PANACEA). These systems assist medical experts in reviewing reports submitted to the Vaccine Adverse Event Reporting System (VAERS) and the FDA Adverse Event Reporting System (FAERS). In this manuscript, we describe the DSE architecture and key functionalities, and examine its potential contributions to the signal management process by focusing on four use cases: the identification of missing cases from a case series, the identification of duplicate case reports, retrieving cases for a case series analysis, and community detection for signal identification and characterization.
Today’s software business development projects often lay claim to low-risk value to the customers in order to be financed. Emerging agile processes offer shorter investment periods, faster time-to-market and better customer satisfaction. To date, however, in agile environments there is no sound methodological schedule support contrary to the traditional plan-based approaches. To address this situation, we present an agile iteration scheduling method whose usefulness is evaluated with post-mortem simulation. It demonstrates that the method can significantly improve load balancing of resources (cca. 5×), produce higher quality and lower-risk feasible schedule, and provide more informed and established decisions by optimized schedule production. Finally, the paper analyzes benefits and issues from the use of this method.
Abidin, Mohammad Zukuwwan Zainol; Nawawi, Mohd Kamal Mohd; Kasim, Maznah Mat
This paper proposes a suitable research procedure that can be referred to while conducting a Decision Support System (DSS) study, especially when the development activity of system artifacts becomes one of the research objectives. The design of the research procedure was based on the completion of a football DSS development that can help in determining the position of a player and the best team formation to be used during a game. After studying the relevant literature, we found that it is necessary to combine the conventional rainfall System Development Life Cycle (SDLC) approach with Case Study approach to help in structuring the research task and phases, which can contribute to the fulfillment of the research aim and objectives.
Filos, Dimitris; Triantafyllidis, Andreas; Chouvarda, Ioanna; Buys, Roselien; Cornelissen, Véronique; Budts, Werner; Walsh, Deirdre; Woods, Catherine; Moran, Kieran; Maglaveras, Nicos
Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach.
Timofeyeva, M. M.; Higgins, W.; Strager, C.; Horsfall, F. M.
NOAA is an active participant of the Global Framework for Climate Services (GFCS) contributing data, information, analytical capabilities, forecasts, and decision support services to the Climate Services Partnership (CSP). These contributions emerge from NOAA's own climate services, which have evolved to respond to the urgent and growing need for reliable, trusted, transparent, and timely climate information across all sectors of the U.S. economy. Climate services not only enhance development opportunities in many regions, but also reduce vulnerability to climate change around the world. The NOAA contribution lies within the NOAA Climate Goal mission, which is focusing its efforts on four key climate priority areas: water, extremes, coastal inundation, and marine ecosystems. In order to make progress in these areas, NOAA is exploiting its fundamental capabilities, including foundational research to advance understanding of the Earth system, observations to preserve and build the climate data record and monitor changes in climate conditions, climate models to predict and project future climate across space and time scales, and the development and delivery of decision support services focused on risk management. NOAA's National Weather Services (NWS) is moving toward provision of Decision Support Services (DSS) as a part of the Roadmap on the way to achieving a Weather Ready National (WRN) strategy. Both short-term and long-term weather, water, and climate information are critical for DSS and emergency services and have been integrated into NWS in the form of pilot projects run by National and Regional Operations Centers (NOC and ROCs respectively) as well as several local offices. Local offices with pilot projects have been focusing their efforts on provision of timely and actionable guidance for specific tasks such as DSS in support of Coastal Environments and Integrated Environmental Studies. Climate information in DSS extends the concept of climate services to
Stein, A; Hoosbeek, M R; Sterk, G
This paper summarizes statistical procedures which are useful for precision farming at different scales. Three topics are addressed: spatial comparison of scenarios for land use, analysis of data in the space-time domain, and sampling in space and time. The first study compares six scenarios for nitrate leaching to ground water. Disjunctive cokriging reduces the computing time by 80% without loss of accuracy. The second study analyses wind erosion during four storms in a field in Niger measured with 21 devices. We investigated the use of temporal replicates to overcome the lack of spatial data. The third study analyses the effects of sampling in space and time for soil nutrient data in a Southwest African field. We concluded that statistical procedures are indispensable for decision support to smart farming.
Aleskerov, Fuad; Say, Arzu Iseri; Toker, Aysegül; Akin, H Levent; Altay, Gülay
This paper describes a Decision Support System for Disaster Management (DSS-DM) to aid operational and strategic planning and policy-making for disaster mitigation and preparedness in a less-developed infrastructural context. Such contexts require a more flexible and robust system for fast prediction of damage and losses. The proposed system is specifically designed for earthquake scenarios, estimating the extent of human losses and injuries, as well as the need for temporary shelters. The DSS-DM uses a scenario approach to calculate the aforementioned parameters at the district and sub-district level at different earthquake intensities. The following system modules have been created: clusters (buildings) with respect to use; buildings with respect to construction typology; and estimations of damage to clusters, human losses and injuries, and the need for shelters. The paper not only examines the components of the DSS-DM, but also looks at its application in Besiktas municipality in the city of Istanbul, Turkey.
Xia, Meimei; Xu, Zeshui; Wang, Zhong
The experts may have difficulty in expressing all their preferences over alternatives or criteria, and produce the incomplete linguistic preference relation. Consistency plays an important role in estimating unknown values from an incomplete linguistic preference relation. Many methods have been developed to obtain a complete linguistic preference relation based on additive consistency, but some unreasonable values may be produced in the estimation process. To overcome this issue, we propose a new characterisation about multiplicative consistency of the linguistic preference relation, present an algorithm to estimate missing values from an incomplete linguistic preference relation, and establish a decision support system for aiding the experts to complete their linguistic preference relations in a more consistent way. Some examples are also given to illustrate the proposed methods.
Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F
Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.
Liu, Hai-Ying; Bartonova, Alena; Neofytou, Panagiotis; Yang, Aileen; Kobernus, Michael J; Negrenti, Emanuele; Housiadas, Christos
The HENVINET Health and Environment Network aimed to enhance the use of scientific knowledge in environmental health for policy making. One of the goals was to identify and evaluate Decision Support Tools (DST) in current use. Special attention was paid to four "priority" health issues: asthma and allergies, cancer, neurodevelopment disorders, and endocrine disruptors.We identified a variety of tools that are used for decision making at various levels and by various stakeholders. We developed a common framework for information acquisition about DSTs, translated this to a database structure and collected the information in an online Metadata Base (MDB).The primary product is an open access web-based MDB currently filled with 67 DSTs, accessible through the HENVINET networking portal http://www.henvinet.eu and http://henvinet.nilu.no. Quality assurance and control of the entries and evaluation of requirements to use the DSTs were also a focus of the work. The HENVINET DST MDB is an open product that enables the public to get basic information about the DSTs, and to search the DSTs using pre-designed attributes or free text. Registered users are able to 1) review and comment on existing DSTs; 2) evaluate each DST's functionalities, and 3) add new DSTs, or change the entry for their own DSTs. Assessment of the available 67 DSTs showed: 1) more than 25% of the DSTs address only one pollution source; 2) 25% of the DSTs address only one environmental stressor; 3) almost 50% of the DSTs are only applied to one disease; 4) 41% of the DSTs can only be applied to one decision making area; 5) 60% of the DSTs' results are used only by national authority and/or municipality/urban level administration; 6) almost half of the DSTs are used only by environmental professionals and researchers. This indicates that there is a need to develop DSTs covering an increasing number of pollution sources, environmental stressors and health end points, and considering links to other 'Driving
Kukafka, Rita; Millery, Mari; Chan, Connie; LaRock, William; Bakken, Suzanne
Psychosocial counselors have a vital and challenging role in supporting persons living with HIV/AIDS (PLWH/A) to better manage their disease. However, gaps in training, education, and skills limit the effectiveness of counselors' efforts. We propose that the use of a decision-support tool for counselors at the point of care can support them in their work as well as help alleviate many training and practice gaps. Decision-support tools aimed at reducing knowledge and practice gaps are used extensively to assist clinical providers at the point of care; however, there is a need for decision-support tools designed specifically for HIV/AIDS counselors. To identify requirements for such a tool, we conducted a needs assessment through interviews of 19 HIV/AIDS clinic counselors who provide 20 or more hours per week of psychosocial support to PLWH/A. The assessment explored their education and training backgrounds, the extent to which evidence-based practices are implemented, and how a decision-support tool can support counselor work practices. Qualitative analysis was organized around seven main categories: counselor characteristics, patient characteristics, barriers, definitions of key concepts, use of guidelines, client assessments, and resources. The resulting coding schemes revealed knowledge and practice gaps among the interviewees, as well as barriers and challenges of counseling. Education and training background of the counseling staff varied widely. When asked to define five key concepts related to HIV counseling, 26-47% of respondents were unable to articulate an adequate definition. Less than half of the interviewees recalled sources of guidelines used in their work and specific models of care introduced during trainings. Interviews identified environmental barriers, language and literacy, patient education, and patient communication as the most prominent challenges to counseling work. The results from this study inform the need for and development of a
Pulwarty, R. S.
As has been long noted, a comprehensive, coordinated observing system is the backbone of any Earth information system. Demands are increasingly placed on earth observation and prediction systems and attendant services to address the needs of economically and environmentally vulnerable sectors and investments, including energy, water, human health, transportation, agriculture, fisheries, tourism, biodiversity, and national security. Climate services include building capacity to interpret information and recognize standards and limitations of data in the promotion of social and economic development in a changing climate. This includes improving the understanding of climate in the context of a variety of temporal and spatial scales (including the influence of decadal scale forcings and land surface feedbacks on seasonal forecast reliability). Climate data and information are central for developing decision options that are sensitive to climate-related uncertainties and the design of flexible adaptation pathways. Ideally monitoring should be action oriented to support climate risk assessment and adaptation including informing robust decision making to multiple risks over the long term. Based on the experience of global observations programs and empirical research we outline- Challenges in developing effective monitoring and climate information systems to support adaptation. The types of observations of critical importance needed for sector planning to enhance food, water and energy security, and to improve early warning for disaster risk reduction Observations needed for ecosystem-based adaptation including the identification of thresholds, maintenance of biological diversity and land degradation The benefits and limits of linking regional model output to local observations including analogs and verification for adaptation planning To support these goals a robust systems of integrated observations are needed to characterize the uncertainty surrounding emergent risks
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
Marshall, M. T.
Population driven water scarcity, aggravated by climate-driven evaporative demand in dry regions of the world, has the potential of transforming ecological and social systems to the point of armed conflict. Water shortages will be most severe in agricultural areas, as the priority shifts to urban and industrial use. In order to design, evaluate, and monitor appropriate mitigation strategies, predictive models must be developed that quantify exposure to water shortage. Remote sensing data has been used for more than three decades now to parametrize these models, because field measurements are costly and difficult in remote regions of the world. In the past decade, decision-makers for the first time can make accurate and near real-time evaluations of field conditions with the advent of hyper- spatial and spectral and coarse resolution continuous remote sensing data. Here, we summarize two projects representing diverse applications of remote sensing to improve agricultural water decision support. The first project employs MODIS (coarse resolution continuous data) to drive an evapotranspiration index, which is combined with the Standardized Precipitation Index driven by meteorological satellite data to improve famine early warning in Africa. The combined index is evaluated using district-level crop yield data from Kenya and Malawi and national-level crop yield data from the United Nations Food and Agriculture Organization. The second project utilizes hyper- spatial (GeoEye 1, Quickbird, IKONOS, and RapidEye) and spectral (Hyperion/ALI), as well as multi-spectral (Landsat ETM+, SPOT, and MODIS) data to develop biomass estimates for key crops (alfalfa, corn, cotton, and rice) in the Central Valley of California. Crop biomass is an important indicator of crop water productivity. The remote sensing data is combined using various data fusion techniques and evaluated with field data collected in the summer of 2012. We conclude with a brief discussion on implementation of
Gaitanaru, Dragos; Leonard, Anghel; Radu Gogu, Constantin; Le Guen, Yvi; Scradeanu, Daniel; Pagnejer, Mihaela
Environmental decision support systems (DSS) paradigm evolves and changes as more knowledge and technology become available to the environmental community. Geographic Information Systems (GIS) can be used to extract, assess and disseminate some types of information, which are otherwise difficult to access by traditional methods. In the same time, with the help of the Internet and accompanying tools, creating and publishing online interactive maps has become easier and rich with options. The Decision Support System (MDSS) developed for the MUSTANG (A MUltiple Space and Time scale Approach for the quaNtification of deep saline formations for CO2 storaGe) project is a user friendly web based application that uses the GIS capabilities. MDSS can be exploited by the experts for CO2 injection and storage in deep saline aquifers. The main objective of the MDSS is to help the experts to take decisions based large structured types of data and information. In order to achieve this objective the MDSS has a geospatial objected-orientated database structure for a wide variety of data and information. The entire application is based on several principles leading to a series of capabilities and specific characteristics: (i) Open-Source - the entire platform (MDSS) is based on open-source technologies - (1) database engine, (2) application server, (3) geospatial server, (4) user interfaces, (5) add-ons, etc. (ii) Multiple database connections - MDSS is capable to connect to different databases that are located on different server machines. (iii)Desktop user experience - MDSS architecture and design follows the structure of a desktop software. (iv)Communication - the server side and the desktop are bound together by series functions that allows the user to upload, use, modify and download data within the application. The architecture of the system involves one database and a modular application composed by: (1) a visualization module, (2) an analysis module, (3) a guidelines module
This article reviews the literature on the relationships between gay men with AIDS and their families of origin to determine why the family is not a principal source of social support. Several reasons explain the absence of the family from the support network, including the family's lack of acceptance of homosexuality and the relationship with a male partner; the stigma associated with AIDS; the inability of family members to communicate openly about homosexuality and AIDS; the lack of competence among family members in dealing with HIV issues; and overprotective, infantilizing behavior by parents. A sibling, most often a sister, is the family member to whom the gay man with AIDS feels closest and from whom he is most likely to seek support. Implications for practice and research are discussed.
Hawamdeh, Ziad M; Alshraideh, Mohammad A; Al-Ajlouni, Jihad M; Salah, Imad K; Holm, Margo B; Otom, Ali H
To design a medical decision support system (MDSS) that would accurately predict the rehabilitation protocols prescribed by the physicians for patients with knee osteoarthritis (OA) using only their demographic and clinical characteristics. The demographic and clinical variables for 170 patients receiving one of three treatment protocols for knee OA were entered into the MDSS. Demographic variables in the model were age and sex. Clinical variables entered into the model were height, weight, BMI, affected side, severity of knee OA, and severity of pain. All patients in the study received one of three treatment protocols for patients with knee OA: (a) hot packs, followed by electrotherapy and exercise, (b) ice packs, followed by ultrasound and exercise and (c) exercise alone. The resilient back propagation artificial neural network algorithm was used, with a ten-fold cross-validation. It was estimated that the MDSS is able to accurately predict the treatment prescribed by the physician for 87% of the patients. We developed an artificial neural network-based decision support system that can viably aid physicians in determining which treatment protocol would best match the anthropometric and clinical characteristics of patients with knee OA.
Allen, Will; Cruz, Jennyffer; Warburton, Bruce
Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.
Alexander, Gregory L
Clinical decision support systems are computer technologies that model and provide support for human decision-making processes. Decision support mechanisms facilitate and enhance a clinician's ability to make decisions at the point of care. Decisions are facilitated through technology by using automated mechanisms that provide alerts or messages to clinicians about a potential patient problem. A clinician's level of trust in these technologies to support decision making is affected by how knowledge is represented in these tools, their ability to make reasonable decisions, and how they are designed. Furthermore, ethical tensions occur if these systems do not promote standards, if clinicians do not understand how to use these systems, and when professional relationships are affected. Issues of trust and ethical concerns will be examined in this article, using a research study of midwestern nursing homes that implemented a clinical decision support system.
Coppini, Giovanni; Lyubartsev, Vladyslav; Pinardi, Nadia; Montanari, Giuseppe; Rinaldi, Attilio; Serra, Stefano; Santoleri, Rosalia
Blower, J. D.; Bretherton, D.; Haines, K.; Liu, C.; Rawlings, C.; Santokhee, A.; Smith, I.
A key advantage of Virtual Globes ("geobrowsers") such as Google Earth is that they can display many different geospatial data types at a huge range of spatial scales. In this demonstration and poster display we shall show how marine data from disparate sources can be brought together in a geobrowser in order to support both scientific research and operational search and rescue activities. We have developed the Godiva2 interactive website for browsing and exploring marine data, mainly output from supercomputer analyses and predictions of ocean circulation. The user chooses a number of parameters (e.g. sea temperature at 100m depth on 1st July 2006) and can load an image of the resulting data in Google Earth. Through the use of an automatically-refreshing NetworkLink the user can explore the whole globe at a very large range of spatial scales: the displayed data will automatically be refreshed to show data at increasingly fine resolution as the user zooms in. This is a valuable research tool for exploring these terabyte- scale datasets. Many coastguard organizations around the world use SARIS, a software application produced by BMT Cordah Ltd., to predict the drift pattern of objects in the sea in order to support search and rescue operations. Different drifting objects have different trajectories depending on factors such as their buoyancy and windage and so a computer model, supported by meteorological and oceanographic data, is needed to help rescuers locate their targets. We shall demonstrate how Google Earth is used to display output from the SARIS model (including the search target location and associated error polygon) alongside meteorological data (wind vectors) and oceanographic data (sea temperature, surface currents) from Godiva2 in order to support decision-making. We shall also discuss the limitations of using Google Earth in this context: these include the difficulties of working with time- dependent data and the need to access data securely. essc
McKellipo, Rodney; Ross, Kenton W.
The NASA Applied Sciences Directorate (ASD), part of the Earth-Sun System Division of NASA's Science Mission Directorate, has partnered with the U.S. Department of Agriculture (USDA) to enhance decision support in the area of agricultural efficiency-an application of national importance. The ASD integrated the results of NASA Earth science research into USDA decision support tools employed by the USDA Foreign Agricultural Service (FAS) Production Estimates and Crop Assessment Division (PECAD), which supports national decision making by gathering, analyzing, and disseminating global crop intelligence. Verification and validation of the following enhancements are summarized: 1) Near-real-time Moderate Resolution Imaging Spectroradiometer (MODIS) products through PECAD's MODIS Image Gallery; 2) MODIS Normalized Difference Vegetation Index (NDVI) time series data through the USDA-FAS MODIS NDVI Database; and 3) Jason-1 and TOPEX/Poseidon lake level estimates through PECAD's Global Reservoir and Lake Monitor. Where possible, each enhanced product was characterized for accuracy, timeliness, and coverage, and the characterized performance was compared to PECAD operational requirements. The MODIS Image Gallery and the GRLM are more mature and have achieved a semi-operational status, whereas the USDA-FAS MODIS NDVI Database is still evolving and should be considered
Tordoff, June; Dovey, Susan; Reith, David; Lloyd, Hywel; Tilyard, Murray; Smith, Alesha
Background Polypharmacy and inappropriate continuation of medicines can lead to a significant risk of adverse drug events and drug interactions with patient harm and escalating health care costs as a result. Thorough review of patients’ medications focusing on the need for each drug can reduce the potential for harm. Limitations in performing effective medicine reviews in practice include consultation time constraints and funding for pharmacy services. We will aim to overcome these problems by designing an automatic electronic decision support tool (the medicines optimization/review and evaluation (MORE) module) that is embedded in general practice electronic records systems. The tool will focus on medicines optimization and reducing polypharmacy to aid prescribers in reviewing medicines and improve patient outcomes. Objective The objectives of this study are: (1) to develop an electronic decision support tool to assist prescribers in performing clinical medication reviews with a particular focus on patients experiencing multimorbidity and polypharmacy, and (2) evaluate and assess the use of the electronic decision support tool, providing pilot data on its usefulness in supporting prescribers during consultations with patients. Methods The first three study phases involve development of clinical rules outlining clinical interventions and the creation and validation of the MORE decision support tool. Phase four is a community-based, single-blind, prospective, 6-month controlled trial involving two interventions and two control general practices, matched for practice demographics. We will be measuring the number of times prescribers engage with the tool, total number of interventions suggested by the tool, and total number of times prescribers change medicines in response to recommendations. There will also be prospective follow-up of patients in the intervention group to examine whether changes to medications are upheld, and to determine the number of
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.
This paper describes the system architecture and implementation technology of the decision support system for sports competitions, discusses the design of decision-making modules, management modules and security of the system, and proposes the development idea of building a web-based decision support system for sports competitions.
Baba, A. Fevzi; Kuscu, Dincer; Han, Kerem
The complex nature and uncertain information in social problems required the emergence of fuzzy decision support systems in social areas. In this paper, we developed user-friendly Fuzzy Group Decision Support Systems (FGDSS) software. The software can be used for multi-purpose decision making processes. It helps the users determine the main and…
Alvarado, Lori; Gates, Ann Q.; Gray, Bob; Reyes, Raul
Tilting the Balance: Climate Variability and Water Resource Management in the Southwest, a regional conference hosted by the Pan American Center for Environmental Studies, will be held at The University of Texas at El Paso on March 2-4, 1998. The conference is supported through the US Global Change Research Program (USGCRP) established by the President in 1989, and codified by Congress in the Global Change Research Act of 1990. The NASA Mission to Planet Earth program is one of the workshops sponsors. The purpose of the regional workshops is to improve understanding of the consequences of global change. This workshop will be focused on issues along the border and the Rio Grande River and thus will bring together stakeholders from Mexico, California, Texas, New Mexico, Arizona and Colorado representing federal, state, and local governments; universities and laboratories; industry, agricultural and natural resource managers; and non-governmental organizations. This paper discusses the efforts of the NASA PACES center create a GIS-based decision-support system that can be used to facilitate discussion of the complex issues of resource management within the targeted international region.
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
This document describes a proposed decision model that, if developed to its fullest, can provide a wide range of analysis options and insights to pretreatment/sludge washing alternatives. A recent decision has been made to terminate this work
Raskob, W; Heling, R; Zheleznyak, M
This paper discusses the role of hydrological modelling in decision support systems for nuclear emergencies. In particular, most recent developments such as, the radionuclide transport models integrated in to the decision support system RODOS will be explored. Recent progress in the implementation of physically-based distributed hydrological models for operational forecasting in national and supranational centres, may support a closer cooperation between national hydrological services and therefore, strengthen the use of hydrological and radiological models implemented in decision support systems.
Wu, Shu-Chieh; Luna, Rocio; Johnson, Walter W.
Weather related disruptions account for seventy percent of the delays in the National Airspace System (NAS). A key component in the weather plan of the Next Generation of Air Transportation System (NextGen) is to assimilate observed weather information and probabilistic forecasts into the decision process of flight crews and air traffic controllers. In this research we explore supporting flight crew weather decision making through the development of a flight deck predicted weather display system that utilizes weather predictions generated by ground-based radar. This system integrates and presents this weather information, together with in-flight trajectory modification tools, within a cockpit display of traffic information (CDTI) prototype. that the CDTI features 2D and perspective 3D visualization models of weather. The weather forecast products that we implemented were the Corridor Integrated Weather System (CIWS) and the Convective Weather Avoidance Model (CWAM), both developed by MIT Lincoln Lab. We evaluated the use of CIWS and CWAM for flight deck weather avoidance in two part-task experiments. Experiment 1 compared pilots' en route weather avoidance performance in four weather information conditions that differed in the type and amount of predicted forecast (CIWS current weather only, CIWS current and historical weather, CIWS current and forecast weather, CIWS current and forecast weather and CWAM predictions). Experiment 2 compared the use of perspective 3D and 21/2D presentations of weather for flight deck weather avoidance. Results showed that pilots could take advantage of longer range predicted weather forecasts in performing en route weather avoidance but more research will be needed to determine what combinations of information are optimal and how best to present them.
Svoboda, M. D.; Hayes, M. J.
The National Drought Mitigation Center (NDMC) (http://drought.unl.edu) has been working with the National Integrated Drought Information System (NIDIS) (http://drought.gov) and other partners with a goal of developing tools, products, services and outreach with a goal of contributing to a U.S. drought early warning system (DEWS) as well as contributing to efforts underway toward building a virtual and collaborative global drought early warning system (GDEWS). The NDMC's mission is to work to reduce societal vulnerability to drought by helping decision makers at all levels to: develop and implement DEWS, understand and prevent drought impacts and increase long-term resilience to drought through proactive risk management planning. The NDMC is a national center founded in 1995 and located at the University of Nebraska-Lincoln. The NDMC conducts basic and applied research, services and decision support applications, along with the maintaining of a number of operational drought-related tools, products and outreach activities, including the U.S. Drought Monitor (USDM), Drought Impact Reporter (DIR), Vegetation Drought Response Index (VegDRI) along with the newly developed and enhanced National Drought Atlas, Drought Ready Communities Guide to Community Drought Preparedness and our Managing Drought Risk on the Ranch planning section on our newly revamped web site at http://drought.unl.edu. This presentation will describe in more detail the various drought resources, tools, research efforts, services and collaborations already being provided by the NDMC and its partners toward developing a collaborative DEWS in the U.S. and around the world.
Schreck, M. B.; Nelson, J. A., Jr.; Heim, R.
The National Weather Service's Alaska Sea Ice Program is designed to service customers and partners operating and planning operations within Alaska waters. The Alaska Sea Ice Program offers daily sea ice and sea surface temperature analysis products. The program also delivers a five day sea ice forecast 3 times each week, provides a 3 month sea ice outlook at the end of each month, and has staff available to respond to sea ice related information inquiries. These analysis and forecast products are utilized by many entities around the state of Alaska and nationally for safety of navigation and community strategic planning. The list of current customers stem from academia and research institutions, to local state and federal agencies, to resupply barges, to coastal subsistence hunters, to gold dredgers, to fisheries, to the general public. Due to a longer sea ice free season over recent years, activity in the waters around Alaska has increased. This has led to a rise in decision support services from the Alaska Sea Ice Program. The ASIP is in constant contact with the National Ice Center as well as the United States Coast Guard (USCG) for safety of navigation. In the past, the ASIP provided briefings to the USCG when in support of search and rescue efforts. Currently, not only does that support remain, but our team is also briefing on sea ice outlooks into the next few months. As traffic in the Arctic increases, the ASIP will be called upon to provide more and more services on varying time scales to meet customer needs. This talk will address the many facets of the current Alaska Sea Ice Program as well as delve into what we see as the future of the ASIP.
Irving, G; Bor, R; Catalan, J
To date, there has been little research to examine how much psychological distress is caused to people providing care and support to a lover or partner with AIDS. This study aimed to determine the level of psychological distress experienced by a sample of gay men providing care and support to a lover or partner with AIDS. It was conducted as a cross-sectional questionnaire survey. A control group was not enlisted, thus the study was descriptive in nature. The experimental hypothesis proposed that providing care and support would result in a high level of psychological distress. Thirty-eight gay men, some of whom themselves were infected with HIV, who were the primary carer of a lover or partner with an AIDS diagnosis were assessed using a self-report questionnaire. The 28-item General Health Questionnaire was used as a measure of global psychological distress. In addition, Martin's (1988) Traumatic Stress Response Scale was used as a measure of psychological distress arising specifically from AIDS. The sample reported high levels of global and AIDS-specific psychological distress. The levels of distress reported were of such a degree to indicate that the majority of the sample were probably suffering from significant psychiatric problems. The results strongly suggest that providing care and support to a lover or partner with AIDS may have an adverse affect on the carer's own psychological health: however, because of the design of the study it is impossible to state this conclusively.
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.
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.
Wright, Adam; Sittig, Dean F.
Background A large body of evidence over many years suggests that clinical decision support systems can be helpful in improving both clinical outcomes and adherence to evidence-based guidelines. However, to this day, clinical decision support systems are not widely used outside of a small number of sites. One reason why decision support systems are not widely used is the relative difficulty of integrating such systems into clinical workflows and computer systems. Purpose To review and synthesize the history of clinical decision support systems, and to propose a model of various architectures for integrating clinical decision support systems with clinical systems. Methods The authors conducted an extensive review of the clinical decision support literature since 1959, sequenced the systems and developed a model. Results The model developed consists of four phases: standalone decision support systems, decision support integrated into clinical systems, standards for sharing clinical decision support content and service models for decision support. These four phases have not heretofore been identified, but they track remarkably well with the chronological history of clinical decision support, and show evolving and increasingly sophisticated attempts to ease integrating decision support systems into clinical workflows and other clinical systems. Conclusions Each of the four evolutionary approaches to decision support architecture has unique advantages and disadvantages. A key lesson was that there were common limitations that almost all the approaches faced, and no single approach has been able to entirely surmount: 1) fixed knowledge representation systems inherently circumscribe the type of knowledge that can be represented in them, 2) there are serious terminological issues, 3) patient data may be spread across several sources with no single source having a complete view of the patient, and 4) major difficulties exist in transferring successful interventions from one
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
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
Jacob, Joseph; Turmon, Michael; Stough, Timothy; Siegel, Herbert; Walter, patrick; Kurt, Cindy
The visualization front-end of a Decision Support System (DSS) also includes an analysis engine linked to vehicle telemetry, and a database of learned models for known behaviors. Because the display is graphical rather than text-based, the summarization it provides has a greater information density on one screen for evaluation by a flight controller.This tool provides a system-level visualization of the state of a vehicle, and drill-down capability for more details and interfaces to separate analysis algorithms and sensor data streams. The system-level view is a 3D rendering of the vehicle, with sensors represented as icons, tied to appropriate positions within the vehicle body and colored to indicate sensor state (e.g., normal, warning, anomalous state, etc.). The sensor data is received via an Information Sharing Protocol (ISP) client that connects to an external server for real-time telemetry. Users can interactively pan, zoom, and rotate this 3D view, as well as select sensors for a detail plot of the associated time series data. Subsets of the plotted data can be selected and sent to an external analysis engine to either search for a similar time series in an historical database, or to detect anomalous events. The system overview and plotting capabilities are completely general in that they can be applied to any vehicle instrumented with a collection of sensors. This visualization component can interface with the ISP for data streams used by NASA s Mission Control Center at Johnson Space Center. In addition, it can connect to, and display results from, separate analysis engine components that identify anomalies or that search for past instances of similar behavior. This software supports NASA's Software, Intelligent Systems, and Modeling element in the Exploration Systems Research and Technology Program by augmenting the capability of human flight controllers to make correct decisions, thus increasing safety and reliability. It was designed specifically as a
Meshkat, Leila; Hogle, Charles; Ruszkowski, James
The Mission Operations Directorate (MOD) at the Johnson Space Center (JSC) has put in place a Model Based Systems Engineering (MBSE) technological framework for the development and execution of the Flight Production Process (FPP). This framework has provided much added value and return on investment to date. This paper describes a vision for a model based Decision Support System (DSS) for the development and execution of the FPP and its design and development process. The envisioned system extends the existing MBSE methodology and technological framework which is currently in use. The MBSE technological framework currently in place enables the systematic collection and integration of data required for building an FPP model for a diverse set of missions. This framework includes the technology, people and processes required for rapid development of architectural artifacts. It is used to build a feasible FPP model for the first flight of spacecraft and for recurrent flights throughout the life of the program. This model greatly enhances our ability to effectively engage with a new customer. It provides a preliminary work breakdown structure, data flow information and a master schedule based on its existing knowledge base. These artifacts are then refined and iterated upon with the customer for the development of a robust end-to-end, high-level integrated master schedule and its associated dependencies. The vision is to enhance this framework to enable its application for uncertainty management, decision support and optimization of the design and execution of the FPP by the program. Furthermore, this enhanced framework will enable the agile response and redesign of the FPP based on observed system behavior. The discrepancy of the anticipated system behavior and the observed behavior may be due to the processing of tasks internally, or due to external factors such as changes in program requirements or conditions associated with other organizations that are outside of
The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.
The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.
Stewart, Greig M.; Gregory, Barry C.
Support groups are established psychosocial treatment modalities where clients address particular problems or diagnoses. Discusses a long-term (five year) AIDS support group and examines the following issues: (1) marginality; (2) making choices; (3) coping with emotions; (4) premature confrontation of life issues; (5) chronic illness versus…
Jefferson, David K.
Viewgraphs and discussion on data management standards in computer-aided acquisition and logistic support (CALS) are presented. CALS is intended to reduce cost, increase quality, and improve timeliness of weapon system acquisition and support by greatly improving the flow of technical information. The phase 2 standards, industrial environment, are discussed. The information resource dictionary system (IRDS) is described.
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…
Zuniga, Areli A.
Modern radiation therapy techniques allow for improved target conformity and normal tissue sparing. These highly conformal treatment plans have allowed dose escalation techniques increasing the probability of tumor control. At the same time this conformation has introduced inhomogeneous dose distributions, making delivered dose characterizations more difficult. The concept of equivalent uniform dose (EUD) characterizes a heterogeneous dose distribution within irradiated structures as a single value and has been used in biologically based treatment planning (BBTP); however, there are no substantial validation studies on clinical outcome data supporting EUD's use and therefore has not been widely adopted as decision-making support. These highly conformal treatment plans have also introduced the need for safety margins around the target volume. These margins are designed to minimize geometrical misses, and to compensate for dosimetric and treatment delivery uncertainties. The margin's purpose is to reduce the chance of tumor recurrence. This dissertation introduces a new EUD formulation designed especially for tumor volumes, called generalized Tumor Dose (gTD). It also investigates, as a second objective, margins extensions for potential improvements in local control while maintaining or minimizing toxicity. The suitability of gTD to rank LC was assessed by means of retrospective studies in a head and neck (HN) squamous cell carcinoma (SCC) and non-small cell lung cancer (NSCLC) cohorts. The formulation was optimized based on two datasets (one of each type) and then, model validation was assessed on independent cohorts. The second objective of this dissertation was investigated by ranking the probability of LC of the primary disease adding different margin sizes. In order to do so, an already published EUD formula was used retrospectively in a HN and a NSCLC datasets. Finally, recommendations for the viability to implement this new formulation into a routine treatment
Johnson, Alistair E. W.; Ghassemi, Mohammad M.; Nemati, Shamim; Niehaus, Katherine E.; Clifton, David A.; Clifford, Gari D.
Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms. With increasing excitement surrounding “secondary use of medical records” and “Big Data” analytics, it is important to understand the limitations of current databases and what needs to change in order to enter an era of “precision medicine.” This review article covers many of the issues involved in the collection and preprocessing of critical care data. The three challenges in critical care are considered: compartmentalization, corruption, and complexity. A range of applications addressing these issues are covered, including the modernization of static acuity scoring; on-line patient tracking; personalized prediction and risk assessment; artifact detection; state estimation; and incorporation of multimodal data sources such as genomic and free text data. PMID:27765959
Zakaria, F; Garcia, H A; Hooijmans, C M; Brdjanovic, D
Proper provision of sanitation in emergencies is considered a life-saving intervention. Without access to sanitation, refugees at emergency camps are at a high risk of contracting diseases. Even the most knowledgeable relief agencies have experienced difficulties providing sanitation alternatives in such challenging scenarios. This study developed a computer-based decision support system (DSS) to plan a sanitation response in emergencies. The sanitation alternatives suggested by the DSS are based on a sanitation chain concept that considers different steps in the faecal sludge management, from the toilet or latrine to the safe disposal of faecal matters. The DSS first screens individual sanitation technologies using the user's given input. Remaining sanitation options are then built into a feasible sanitation chain. Subsequently, each technology in the chain is evaluated on a scoring system. Different sanitation chains can later be ranked based on the total evaluation scores. The DSS addresses several deficiencies encountered in the provision of sanitation in emergencies including: the application of standard practices and intuition, the omission of site specific conditions, the limited knowledge exhibited by emergency planners, and the provision of sanitation focused exclusively on the collection step (i.e., just the provision of toilets).
Shih, Chung Yan
Critical infrastructures, such as telecommunications, energy, banking and finance, transportation, water systems and emergency services are the foundations of modern society. There is a heavy dependence on critical infrastructures at multiple levels within the supply chain of any good or service. Any disruptions in the supply chain may cause profound cascading effect to other critical infrastructures. A 1997 report by the President's Commission on Critical Infrastructure Protection states that a serious interruption in freight rail service would bring the coal mining industry to a halt within approximately two weeks and the availability of electric power could be reduced in a matter of one to two months. Therefore, this research aimed at representing and assessing the interdependencies between coal supply, transportation and energy production. A proposed geospatial decision support framework was established and applied to analyze interdependency related disruption impact. By utilizing the data warehousing approach, geospatial and non-geospatial data were retrieved, integrated and analyzed based on the transportation model and geospatial disruption analysis developed in the research. The results showed that by utilizing this framework, disruption impacts can be estimated at various levels (e.g., power plant, county, state, etc.) for preventative or emergency response efforts. The information derived from the framework can be used for data mining analysis (e.g., assessing transportation mode usages; finding alternative coal suppliers, etc.).
Aquifer recharge (AR) is a technical method being utilized to enhance groundwater resources through man-made replenishment means, such as infiltration basins and injections wells. Aquifer storage and recovery (ASR) furthers the AR techniques by withdrawal of stored groundwater at a later time for beneficial use. It is a viable adaptation technique for water availability problems. Variants of the water storage practices include recharge through urban green infrastructure and the subsurface injection of reclaimed water, i.e., wastewater, which has been treated to remove solids and impurities. In addition to a general overview of ASR variations, this report focuses on the principles and technical basis for an ASR decision support system (DSS), with the necessary technical references provided. The DSS consists of three levels of tools and methods for ASR system planning and assessment, design, and evaluation. Level 1 of the system is focused on ASR feasibility, for which four types of data and technical information are organized around: 1) ASR regulations and permitting needs, 2) Water demand projections, 3) Climate change and water availability, and 4) ASR sites and technical information. These technical resources are integrated to quantify water availability gaps and the feasibility of using ASR to meet the volume and timing of the water resource shortages. A systemic analysis of water resources was conducted for sustainable water supplies in Las Vegas, Nevada f
Gray, Alasdair J G; Sadler, Jason; Kit, Oles; Kyzirakos, Kostis; Karpathiotakis, Manos; Calbimonte, Jean-Paul; Page, Kevin; García-Castro, Raúl; Frazer, Alex; Galpin, Ixent; Fernandes, Alvaro A A; Paton, Norman W; Corcho, Oscar; Koubarakis, Manolis; De Roure, David; Martinez, Kirk; Gómez-Pérez, Asunción
Sensing devices are increasingly being deployed to monitor the physical world around us. One class of application for which sensor data is pertinent is environmental decision support systems, e.g., flood emergency response. For these applications, the sensor readings need to be put in context by integrating them with other sources of data about the surrounding environment. Traditional systems for predicting and detecting floods rely on methods that need significant human resources. In this paper we describe a semantic sensor web architecture for integrating multiple heterogeneous datasets, including live and historic sensor data, databases, and map layers. The architecture provides mechanisms for discovering datasets, defining integrated views over them, continuously receiving data in real-time, and visualising on screen and interacting with the data. Our approach makes extensive use of web service standards for querying and accessing data, and semantic technologies to discover and integrate datasets. We demonstrate the use of our semantic sensor web architecture in the context of a flood response planning web application that uses data from sensor networks monitoring the sea-state around the coast of England.
Cao, Yu; Yan, Jing
Watershed management decision support system (DSS) is an intellectual system developed for the optimal allocation of water resources by watershed managers, and the simulation results of the system can directly affect the scientificity and practicability of watershed management. This paper summarized the related researches from the aspects of water quantity simulation and deployment systems, water quality monitoring and evaluation systems, and integrated watershed management systems. The main features and problems in existing DSS were analyzed, and the model structure and development status of the representative systems such as AQUA-Tool, Elbe-DSS, and HD were introduced. It was suggested that the accuracy and stability of simulated results, the succinctness of working process, and the high degree of user visualization would be the focuses in developing the DSS in the future, and the optimization of program-selecting models and 3D visualization tools, the research and development of inter-basin integrated management DSS, and the improvement of stakeholder participation would be the development trend for the future watershed management DSS.
Blanquer, Ignacio; Hernández, Vicente; Segrelles, Damià; Robles, Montserrat; García, Juan Miguel; Robledo, Javier Vicente
This paper presents an architecture defined for searching and executing Clinical Decision Support Systems (CDSS) in a LCG2/GT2 Grid environment, using web-based protocols. A CDSS is a system that provides a classification of the patient illness according to the knowledge extracted from clinical practice and using the patient's information in a structured format. The CDSS classification engines can be installed in any site and can be used by different medical users from a Virtual Organization (VO). All users in a VO can consult and execute different classification engines that have been installed in the Grid independently of the platform, architecture or site where the engines are installed or the users are located. The present paper present a solution to requirements such as short-job execution, reducing the response delay on LCG2 environments and providing grid-enabled authenticated access through web portals. Resource discovering and job submission is performed through web services, which are also described in the article.
van der Bolt, Frank; Seid, Abdulkarim
To analyze options for increasing food supply in the Nile basin the Nile Agricultural Model (AM) was developed. The AM includes state-of-the-art descriptions of biophysical, hydrological and economic processes and realizes a coherent and consistent integration of hydrology, agronomy and economics. The AM covers both the agro-ecological domain (water, crop productivity) and the economic domain (food supply, demand, and trade) and allows to evaluate the macro-economic and hydrological impacts of scenarios for agricultural development. Starting with the hydrological information from the NileBasin-DSS the AM calculates the available water for agriculture, the crop production and irrigation requirements with the FAO-model AquaCrop. With the global commodity trade model MAGNET scenarios for land development and conversion are evaluated. The AM predicts consequences for trade, food security and development based on soil and water availability, crop allocation, food demand and food policy. The model will be used as a decision support tool to contribute to more productive and sustainable agriculture in individual Nile countries and the whole region.
Gray, Alasdair J. G.; Sadler, Jason; Kit, Oles; Kyzirakos, Kostis; Karpathiotakis, Manos; Calbimonte, Jean-Paul; Page, Kevin; García-Castro, Raúl; Frazer, Alex; Galpin, Ixent; Fernandes, Alvaro A. A.; Paton, Norman W.; Corcho, Oscar; Koubarakis, Manolis; De Roure, David; Martinez, Kirk; Gómez-Pérez, Asunción
Sensing devices are increasingly being deployed to monitor the physical world around us. One class of application for which sensor data is pertinent is environmental decision support systems, e.g., flood emergency response. For these applications, the sensor readings need to be put in context by integrating them with other sources of data about the surrounding environment. Traditional systems for predicting and detecting floods rely on methods that need significant human resources. In this paper we describe a semantic sensor web architecture for integrating multiple heterogeneous datasets, including live and historic sensor data, databases, and map layers. The architecture provides mechanisms for discovering datasets, defining integrated views over them, continuously receiving data in real-time, and visualising on screen and interacting with the data. Our approach makes extensive use of web service standards for querying and accessing data, and semantic technologies to discover and integrate datasets. We demonstrate the use of our semantic sensor web architecture in the context of a flood response planning web application that uses data from sensor networks monitoring the sea-state around the coast of England. PMID:22164110
Amland, Robert C.; Hahn-Cover, Kristin E.
Sepsis is an inflammatory response triggered by infection, with a high in-hospital mortality rate. Early recognition and treatment can reverse the inflammatory response, with evidence of improved patient outcomes. One challenge clinicians face is identifying the inflammatory syndrome against the background of the patient’s infectious illness and comorbidities. An approach to this problem is implementation of computerized early warning tools for sepsis. This multicenter retrospective study sought to determine clinimetric performance of a cloud-based computerized sepsis clinical decision support system (CDS), understand the epidemiology of sepsis, and identify opportunities for quality improvement. Data encompassed 6200 adult hospitalizations from 2012 through 2013. Of 13% patients screened-in, 51% were already suspected to have an infection when the system activated. This study focused on a patient cohort screened-in before infection was suspected; median time from arrival to CDS activation was 3.5 hours, and system activation to diagnostic collect was another 8.6 hours. PMID:25385815
Liedgren, Pernilla; Elvhage, Gudrun; Ehrenberg, Anna; Kullberg, Christian
Decision support systems are known to be helpful for professionals in many medical professions. In social work, decision support systems have had modest use, accompanied by strong criticism from the profession but often by praise from political management. In this study the aim of the authors was to collect and report on the published evidence on decision support systems in social work. The conclusion of the authors is that a decision support system gives support to social workers in conducting a thorough investigation, but at the same time gives them the freedom to make autonomous decisions that might be the most helpful for and used by social workers. Their results also indicate that decision support systems focusing on atypical rather than typical cases are perceived as the most useful among experienced staff.
Ben Othman, Sarah; Hammadi, Slim; Quilliot, Alain; Martinot, Alain; Renard, Jean-Marie
Health organization management is facing a high amount of complexity due to the inherent dynamics of the processes and the distributed organization of hospitals. It is therefore necessary for health care institutions to focus on this issue in order to deal with patients' requirements and satisfy their needs. The main objective of this study is to develop and implement a Decision Support System which can help physicians to better manage their organization, to anticipate the overcrowding feature, and to establish avoidance proposals for it. This work is a part of HOST project (Hospital: Optimization, Simulation, and Crowding Avoidance) of the French National Research Agency (ANR). It aims to optimize the functioning of the Pediatric Emergency Department characterized by stochastic arrivals of patients which leads to its overcrowding and services overload. Our study is a set of tools to smooth out patient flows, enhance care quality and minimize long waiting times and costs due to resources allocation. So we defined a decision aided tool based on Multi-agent Systems where actors negotiate and cooperate under some constraints in a dynamic environment. These entities which can be either physical agents representing real actors in the health care institution or software agents allowing the implementation of optimizing tools, cooperate to satisfy the demands of patients while respecting emergency degrees. This paper is concerned with agents' negotiation. It proposes a new approach for multi-skill tasks scheduling based on interactions between agents.
Bittermann, Vincent; Deker, Guy; Sassus, Pierre; Mielnik, Jean-Christophe; Jud, Jean-Marie
Decision-aid systems, likely to appear in future aircraft generations, could play a central role in the cockpit thanks to the broad spectrum of functionalities and decision support facilities they will offer to the crew. As part of such systems, the exploratory FINDER mock-up is a knowledge based system (KBS) designed to help crew members continually optimize their flight plan by suggesting solutions considering exhaustive information related to flight context, either on pilot request or upon external information occurrence. The successful evaluation by Air France pilots of that first mock-up dedicated to diversion procedure on pilot request has led to the current development of an enhanced system with nominal enroute operations and real-time capabilities. Nominal enroute operations concern the optimization with respect to an evolutive constraining of favoring environment (due to weather, traffic or regulated areas, and ETOPS constraints). This study paves the way for a future flight assistant system concept which is already under investigation and may take place in SEXTANT Avionique's future development steps.
Stanley, R Joe; De, Soumya; Demner-Fushman, Dina; Antani, Sameer; Thoma, George R
The illustrations in biomedical publications often provide useful information in aiding clinicians' decisions when full text searching is performed to find evidence in support of a clinical decision. In this research, image analysis and classification techniques are explored to automatically extract information for differentiating specific modalities to characterize illustrations in biomedical publications, which may assist in the evidence finding process. Global, histogram-based, and texture image illustration features were compared to basis function luminance histogram correlation features for modality-based discrimination over a set of 742 manually annotated images by modality (radiological, photo, etc.) selected from the 2004-2005 issues of the British Journal of Oral and Maxillofacial Surgery. Using a mean shifting supervised clustering technique, automatic modality-based discrimination results as high as 95.57% were obtained using the basis function features. These results compared favorably to other feature categories examined. The experimental results show that image-based features, particularly correlation-based features, can provide useful modality discrimination information.
Grant, F.; Kumar, S.
Climate change and vector-borne diseases constitute a massive threat to human development. It will not be enough to cut emissions of greenhouse gases-the tide of the future has already been established. Climate change and vector-borne diseases are already undermining the world's efforts to reduce extreme poverty. It is in the best interests of the world leaders to think in terms of concerted global actions, but adaptation and mitigation must be accomplished within the context of local community conditions, resources, and needs. Failure to act will continue to consign developed countries to completely avoidable health risks and significant expense. Failure to act will also reduce poorest of the world's population-some 2.6 billion people-to a future of diminished opportunity. Northrop Grumman has taken significant steps forward to develop the tools needed to assess climate change impacts on public health, collect relevant data for decision making, model projections at regional and local levels; and, deliver information and knowledge to local and regional stakeholders. Supporting these tools is an advanced enterprise architecture consisting of high performance computing, GIS visualization, and standards-based architecture. 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. For the present climate WRF was forced with the Max Planck Institute European Center/Hamburg Model version 5 (ECHAM5) General Circulation Model 20th century simulation. For the 21th century climate, we used an ECHAM5 simulation with the Special Report on Emissions (SRES) A1B emissions scenario. WRF was run in nested mode at spatial resolution of 108 km, 36 km and 12 km and 28 vertical levels
NETWORK OPERATIONS WITH COLLABORATIVE DECISION SUPPORT AND AUGMENTED REALITY TECHNOLOGIES by John J. Fay March 2004 Thesis Advisor: Alex...Network Operations with Collaborative Decision Support and Augmented Reality Technologies 6. AUTHOR(S) John J Fay 5. FUNDING NUMBERS 7. PERFORMING...management for distributed sea-based forces using existing technologies. Combining a collaborative tool, Decision Support System (DSS), and Augmented Reality (AR
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...
Sim, Ida; Gorman, Paul; Greenes, Robert A.; Haynes, R. Brian; Kaplan, Bonnie; Lehmann, Harold; Tang, Paul C.
Background: The use of clinical decision support systems to facilitate the practice of evidence-based medicine promises to substantially improve health care quality. Objective: To describe, on the basis of the proceedings of the Evidence and Decision Support track at the 2000 AMIA Spring Symposium, the research and policy challenges for capturing research and practice-based evidence in machine-interpretable repositories, and to present recommendations for accelerating the development and adoption of clinical decision support systems for evidence-based medicine. Results: The recommendations fall into five broad areas—capture literature-based and practice-based evidence in machine-interpretable knowledge bases; develop maintainable technical and methodological foundations for computer-based decision support; evaluate the clinical effects and costs of clinical decision support systems and the ways clinical decision support systems affect and are affected by professional and organizational practices; identify and disseminate best practices for work flow–sensitive implementations of clinical decision support systems; and establish public policies that provide incentives for implementing clinical decision support systems to improve health care quality. Conclusions: Although the promise of clinical decision support system–facilitated evidence-based medicine is strong, substantial work remains to be done to realize the potential benefits. PMID:11687560
Wright, Adam; Sittig, Dean F
In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:
Makropoulos, C K; Morley, M; Memon, F A; Butler, D; Savic, D; Ashley, R A
The paper discusses issues of decision support within the context of sustainable development and more specifically sustainable water cycle management to provide a context and a rationale for the decision support approach adopted within an on-going U.K. EPSRC-funded project, WaND. The paper proposes a set-up for a flexible, upgradeable, efficient and modular decision support framework and associated tools. Furthermore, the paper presents early prototypes of three decision support tools developed within the proposed framework including initial results for one of them.
Yadav, Kabir; Chamberlain, James M.; Lewis, Vicki R.; Abts, Natalie; Chawla, Shawn; Hernandez, Angie; Johnson, Justin; Tuveson, Genevieve; Burd, Randall S.
Background Use of electronic clinical decision support (eCDS) has been recommended to improve implementation of clinical decision rules. Many eCDS tools, however, are designed and implemented without taking into account the context in which clinical work is performed. Implementation of the pediatric traumatic brain injury (TBI) clinical decision rule at one Level I pediatric emergency department includes an electronic questionnaire triggered when ordering a head computed tomography using computerized physician order entry (CPOE). Providers use this CPOE tool in less than 20% of trauma resuscitation cases. A human factors engineering approach could identify the implementation barriers that are limiting the use of this tool. Objectives The objective was to design a pediatric TBI eCDS tool for trauma resuscitation using a human factors approach. The hypothesis was that clinical experts will rate a usability-enhanced eCDS tool better than the existing CPOE tool for user interface design and suitability for clinical use. Methods This mixed-methods study followed usability evaluation principles. Pediatric emergency physicians were surveyed to identify barriers to using the existing eCDS tool. Using standard trauma resuscitation protocols, a hierarchical task analysis of pediatric TBI evaluation was developed. Five clinical experts, all board-certified pediatric emergency medicine faculty members, then iteratively modified the hierarchical task analysis until reaching consensus. The software team developed a prototype eCDS display using the hierarchical task analysis. Three human factors engineers provided feedback on the prototype through a heuristic evaluation, and the software team refined the eCDS tool using a rapid prototyping process. The eCDS tool then underwent iterative usability evaluations by the five clinical experts using video review of 50 trauma resuscitation cases. A final eCDS tool was created based on their feedback, with content analysis of the
Spetzler and C. A. von Holstein . "Probability encoding in [3871 R. D. Tweney, M. E. Doherty. W. 1. Warner, D. B. Pliske. C.. . . decision analysis...different frames of the decision The significance of this observation is that a situation as indicated in Figure 10, which is cow - knowledge of information
The Virtual Beach Managers Tool (VB) is decision-making software developed to help local beach managers make decisions as to when beaches should be closed due to predicted high levels of water borne pathogens. The tool is being developed under the umbrella of EPA's Advanced Monit...
... 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,...
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
Kuo, Kuan-Liang; Fuh, Chiou-Shann
Health examinations can obtain relatively complete health information and thus are important for the personal and public health management. For clinicians, one of the most important works in the health examinations is to interpret the health examination results. Continuously interpreting numerous health examination results of healthcare receivers is tedious and error-prone. This paper proposes a clinical decision support system to assist solving above problems. In order to customize the clinical decision support system intuitively and flexibly, this paper also proposes the rule syntax to implement computer-interpretable logic for health examinations. It is our purpose in this paper to describe the methodology of the proposed clinical decision support system. The evaluation was performed by the implementation and execution of decision rules on health examination results and a survey on clinical decision support system users. It reveals the efficiency and user satisfaction of proposed clinical decision support system. Positive impact of clinical data interpretation is also noted.
Maughan, T.; Das, J.; McCann, M. P.; Rajan, K.
Thom Maughan, Jnaneshwar Das, Mike McCann, Danelle Cline, Mike Godin, Fred Bahr, Kevin Gomes, Tom O'Reilly, Frederic Py, Monique Messie, John Ryan, Francisco Chavez, Jim Bellingham, Maria Fox, Kanna Rajan Monterey Bay Aquarium Research Institute Moss Lading, California, United States Many of the coastal ocean processes we wish to observe in order to characterize marine ecosystems have large spatial extant (tens of square km) and are dynamic moving kilometers in a day with biological processes spanning anywhere from minutes to days. Some like harmful algal blooms generate toxins which can significantly impact human health and coastal economies. In order to obtain a viable understanding of the biogeochemical processes which define their dynamics and ecology, it is necessary to persistently observe, track and sample within and near the dynamic fields using augmented methods of observation such as autonomous platforms like AUVs, gliders and surface craft. Field experiments to plan, execute and manage such multitude of assets are challenging. To alleviate this problem the autonomous systems group with its collaborators at MBARI and USC designed, built and fielded a prototype Oceanographic Decision Support System (ODSS) that provides situational awareness and a single portal to visualize and plan deployments for the large scale October 2010 CANON field program as well as a series of 2 week field programs in 2011. The field programs were conducted in Monterey Bay, a known 'red tide' incubator, and varied from as many as twenty autonomous platforms, four ships and 2 manned airplanes to coordinated AUV operations, drifters and a single ship. The ODSS web-based portal was used to assimilate information from a collection of sources at sea, including AUVs, moorings, radar data as well as remote sensing products generated by partner organizations to provide a synthesis of views useful to predict the movement of a chlorophyll patch in the confines of the northern Monterey Bay
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.
Graham, Timothy A D; Bullard, Michael J; Kushniruk, Andre W; Holroyd, Brian R; Rowe, Brian H
Clinicians in Emergency Medicine (EM) are increasingly exposed to guidelines and treatment recommendations. To help access and recall these recommendations, electronic Clinical Decision Support Systems (CDSS) have been developed. This study examined the use and sensibility of two CDSS designed for emergency physicians. CDDS for community acquired pneumonia (CAP) and neutropenic fever (NF) were developed by multidisciplinary teams and have been accessed via an intranet-based homepage (eCPG) for several years. Sensibility is a term coined by Feinstein that describes common sense aspects of a survey instrument. It was modified by emergency researchers to include four main headings: (1) Appropriateness; (2) Objectivity; (3) Content; and (4) Discriminative Power. Sensibility surveys were developed using an iterative approach for both the CAP and NF CDSS and distributed to all 25 emergency physicians at one Canadian site. The overall response rate was 88%. Respondents were 88% male and 83% were less than 40; all were attending EM physicians with specialty designations. A number reported never having used the CAP (21%) or NF (33%) CDSS; 54% (CAP) and 21% (NF) of respondents had used the respective CDSS less than 10 times. Overall, both CDSS were rated highly by users with a mean response of 4.95 (SD 0.56) for CAP and 5.62 (SD 0.62) for NF on a seven-point Likert scale. The majority or respondents (CAP 59%, NF 80%) felt that the NF CDSS was more likely than the CAP CDSS to decrease the chances of making a medical error in medication dose, antibiotic choice or patient disposition (4.61 vs. 5.81, p=0.008). Despite being in place for several years, CDSS for CAP and NF are not used by all EM clinicians. Users were generally satisfied with the CDSS and felt that the NF was more likely than the CAP CDSS to decrease medical errors. Additional research is required to determine the barriers to CDSS use.
Leman, Sugani; Lehto, Mark R
Customers using printers occasionally experience problems such as fuzzy images, bands, or streaks. The customer may call or otherwise contact the manufacturer, who attempts to diagnose the problem based on the customer's description of the problem. This study evaluated Bayesian inference as a tool for identifying or diagnosing 16 different types of print defects from such descriptions. The Bayesian model was trained using 1701 narrative descriptions of print defects obtained from 60 subjects with varying technical backgrounds. The Bayesian model was then implemented as an interactive decision support system, which was used by eight 'agents' to diagnose print defects reported by 16 'customers' in a simulated call centre. The 'agents' and 'customers' in the simulated call centre were all students at Purdue University. Each customer made eight telephone calls, resulting in a total of 128 telephone calls in which the customer reported defects to the agents. The results showed that the Bayesian model closely fitted the data in the training set of narratives. Overall, the model correctly predicted the actual defect category with its top prediction 70% of the time. The actual defect was in the top five predictions 94% of the time. The model in the simulated call centre performed nearly as well for the test subjects. The top prediction was correct 50% of the time, and the defect was one of the top five predictions 80% of the time. Agent accuracy in diagnosing the problem improved when using the tool. These results demonstrated that the Bayesian system learned enough from the existing narratives to accurately classify print defect categories.
Bonazountas, Marc; Kallidromitou, Despina; Kassomenos, Pavlos; Passas, Nikos
Southern Europe is exposed to anthropogenic and natural forest fires. These result in loss of lives, goods and infrastructure, but also deteriorate the natural environment and degrade ecosystems. The early detection and combating of such catastrophes requires the use of a decision support system (DSS) for emergency management. The current literature reports on a series of efforts aimed to deliver DSSs for the management of the forest fires by utilising technologies like remote sensing and geographical information systems (GIS), yet no integrated system exists. This manuscript presents the results of scientific research aiming to the development of a DSS for managing forest fires. The system provides a series of software tools for the assessment of the propagation and combating of forest fires based on Arc/Info, ArcView, Arc Spatial Analyst, Arc Avenue, and Visual C++ technologies. The system integrates GIS technologies under the same data environment and utilises a common user interface to produce an integrated computer system based on semi-automatic satellite image processing (fuel maps), socio-economic risk modelling and probabilistic models that would serve as a useful tool for forest fire prevention, planning and management. Its performance has been demonstrated via real time up-to-date accurate information on the position and evolution of the fire. The system can assist emergency assessment, management and combating of the incident. A site demonstration and validation has been accomplished for the island of Evoia, Greece, an area particularly vulnerable to forest fires due to its ecological characteristics and prevailing wind patterns.
traditional concept of decision making as a basically rational process ( Simon 1960). In an effort to reconceptualize decision making, this paper...originates in organization science ( Simon 1960). Decision Support Systems are computer technologies used to support complex decision making in...technical tools supporting the traditional concept of decision making as a basically rational process ( Simon 1960). The techno-centric character of DSS
Cole, Rod; Green, Steve; Jardin, Matt; Schwartz, Barry; Benjamin, Stan
The performance of Air Traffic Management and flight deck decision support tools depends in large part on the accuracy of the supporting 4D trajectory predictions. This is particularly relevant to conflict prediction and active advisories for the resolution of conflicts and the conformance with of traffic-flow management flow-rate constraints (e.g., arrival metering / required time of arrival). Flight test results have indicated that wind prediction errors may represent the largest source of trajectory prediction error. The tests also discovered relatively large errors (e.g., greater than 20 knots), existing in pockets of space and time critical to ATM DST performance (one or more sectors, greater than 20 minutes), are inadequately represented by the classic RMS aggregate prediction-accuracy studies of the past. To facilitate the identification and reduction of DST-critical wind-prediction errors, NASA has lead a collaborative research and development activity with MIT Lincoln Laboratories and the Forecast Systems Lab of the National Oceanographic and Atmospheric Administration (NOAA). This activity, begun in 1996, has focussed on the development of key metrics for ATM DST performance, assessment of wind-prediction skill for state of the art systems, and development/validation of system enhancements to improve skill. A 13 month study was conducted for the Denver Center airspace in 1997. Two complementary wind-prediction systems were analyzed and compared to the forecast performance of the then standard 60 km Rapid Update Cycle - version 1 (RUC-1). One system, developed by NOAA, was the prototype 40-km RUC-2 that became operational at NCEP in 1999. RUC-2 introduced a faster cycle (1 hr vs. 3 hr) and improved mesoscale physics. The second system, Augmented Winds (AW), is a prototype en route wind application developed by MITLL based on the Integrated Terminal Wind System (ITWS). AW is run at a local facility (Center) level, and updates RUC predictions based on an
This research focuses on the development of a decision support model to identify the preferred strategy for managing municipal solid waste using the...principles of decision analysis theory. The model provides an effective decision making tool to evaluate and compare different municipal solid waste management
Tseng, Chiu-Che; Gmytrasiewicz, Piotr J.
The challenge of the investment domain is that a large amount of diverse information can be potentially relevant to an investment decision, and that, frequently, the decisions have to be made in a timely manner. This presents the potential for better decision support, but poses the challenge of building a decision support agent that gathers information from different sources and incorporates it for timely decision support. These problems motivate us to investigate ways in which the investors can be equipped with a flexible real-time decision support system to be practical in time-critical situations. The flexible real-time decision support system considers a tradeoff between decision quality and computation cost. For this purpose, we propose a system that uses the object oriented Bayesian knowledge base (OOBKB) design to create a decision model at the most suitable level of detail to guide the information gathering activities, and to produce an investment recommendation within a reasonable length of time. The decision models our system uses are implemented as influence diagrams. We validate our system with experiments in a simplified investment domain. The experiments show that our system produces a quality recommendation under different urgency situations. The contribution of our system is that it provides the flexible decision recommendation for an investor under time constraints in a complex environment.
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
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
Spatial Analysis and Decision Assistance (SADA) is freeware that implements terrestrial ecological risk assessment and yields a selective remediation design using its integral geographical information system, based on ecological and risk assessment inputs. Selective remediation ...
Low-income students face a number of obstacles that go beyond the cost of tuition and fees. For instance, their schooling often requires expenses that aren't covered by financial aid, such as books and commuting costs. What's more, education is often competing for their time with other responsibilities, such as the need to work or take care of…
Gomoi, Valentin; Vida, Mihaela; Stoicu-Tivadar, Lăcrămioara; Stoicu-Tivadar, Vasile
The paper presents a method connecting medical databases to a medical decision system, and describes a service created to extract the necessary information that is transferred based on standards. The medical decision can be improved based on many inputs from different medical locations. The developed solution is described for a concrete case concerning the management for chronic pelvic pain, based on the information retrieved from diverse healthcare databases.
2005) reviewed and analyzed the National Aeronautics and Space Administration ( NASA ) project management policies and compared them to the GAO’s best...practices on knowledge-based decision making. The study was primarily focused on the Goddard Space Flight Center, the Jet Propulsion Lab, Johnson ...Space Center, and Marshall Space Flight Center. During its investigation, the GAO found NASA deficient in key criteria and decision reviews to fully
Feather, Martin S.; Kiper, James D.; Menzies, Tim
Key decisions are made in the early stages of planning and management of software developments. The information basis for these decisions is often a mix of analogy with past developments, and the best judgments of domain experts. Visualization of this information can support to such decision making by clarifying the status of the information and yielding insights into the ramifications of that information vis-a-vis decision alternatives.
Mullinx, Cassandra; Phillips, Scott; Shenk, Kelly; Hearn, Paul; Devereux, Olivia
The Chesapeake Bay Program (CBP) is attempting to more strategically implement management actions to improve the health of the Nation’s largest estuary. In 2007 the U.S. Geological Survey (USGS) and U.S. Environmental Protection Agency (USEPA) CBP office began a joint effort to develop a suite of Internetaccessible decision-support tools and to help meet the needs of CBP partners to improve water quality and habitat conditions in the Chesapeake Bay and its watersheds. An adaptive management framework is being used to provide a structured decision process for information and individual tools needed to implement and assess practices to improve the condition of the Chesapeake Bay ecosystem. The Chesapeake Online Adaptive Support Toolkit (COAST) is a collection of web-based analytical tools and information, organized in an adaptive management framework, intended to aid decisionmakers in protecting and restoring the integrity of the Bay ecosystem. The initial version of COAST is focused on water quality issues. During early and mid- 2008, initial ideas for COAST were shared and discussed with various CBP partners and other potential user groups. At these meetings, test cases were selected to help improve understanding of the types of information and analytical functionality that would be most useful for specific partners’ needs. These discussions added considerable knowledge about the nature of decisionmaking for Federal, State, local and nongovernmental partners. Version 1.0 of COAST, released in early winter of 2008, will be further reviewed to determine improvements needed to address implementation and assessment of water quality practices. Future versions of COAST may address other aspects of ecosystem restoration, including restoration of habitat and living resources and maintaining watershed health.