Superfund Record of Decision (EPA Region 7): Cornhusker Army Ammunition Plant, Operable Unit 2, Hall County, NE, September 30, 1998

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

NONE

1999-03-01

This Record of Decision (ROD) document presents the selected remedial action for the six areas of concern (AOCs) located at the Cornhusker Army Ammunition Plant (CHAAP) in Grand Island, Nebraska designated as OU2. The remedial action is chosen in accordance with the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERLCA), as amended by the Superfund Amendments and Reauthorization Act (SARA) of 1986, and with the National Oil and Hazardous Substances Pollution Contingency Plan (NCP). The information supporting the decisions contained in the remedy is contained in the administrative record.

Complex decision making in patients with dementia in an internal medicine department.

PubMed

Kabelka, Ladislav

2017-10-01

With the increase of polymorbidity, extending life expectancy and improving treatment options for chronic diseases, the care for dementia is moving into other areas of medicine. The length and quality of life with advanced dementia is directly dependent on the quality of medical and nursing care, early detection and treatment of complications, nutritional support and palliative care plan. Significant is also the support for family carers. The key coordinators of care for patients with dementia are general practitioners (GPs), geriatricians, psychiatrists, and an increasingly important role play internists. Case reports of patients admitted to an internal medicine department. Description of clinical experiences with caring on patients with dementia. In the internal departments of regional hospitals, there is a room for adjustment of the care plan, for comprehensive assessment of the patient and for making crucial decisions regarding nutrition, treatment of chronic diseases, consideration of previously expressed wishes in the context of the patient condition, and potential prognostic indicators. This assessment must result in a comprehensive documentation and communication with patients, and in the case of advanced dementia with their family members. The general internal medicine is very often the first place where the patient has a chance to hear about indication for palliative care. Without the availability of a multidisciplinary assessment, good communication and documentation, it is unrealistic to expect that the hospital would provide comprehensive care for patients with dementia.

Superfund record of decision (EPA Region 1): Tansitor Electronics, Inc., Bennington, VT, September 29, 1995

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

NONE

1996-03-01

This Decision Document presents the selected remedial action for the Tansitor Electronics, Inc. Superfund Site in Bennington, Vermont. This ROD sets forth the selected remedy for the Tansitor Electronics, Inc. Superfund Site, which includes management of migration components to obtain a comprehensive remedy. This ROD does not include any source control component because EPA`s risk assessment concluded that the surface and subsurface soils did not present an unacceptable risk either under current conditions or under a potential future residential scenario.

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

Phillips, Laurence R.; Jordan, Danyelle N.; Bauer, Travis L.

The large number of government and industry activities supporting the Unit of Action (UA), with attendant documents, reports and briefings, can overwhelm decision-makers with an overabundance of information that hampers the ability to make quick decisions often resulting in a form of gridlock. In particular, the large and rapidly increasing amounts of data and data formats stored on UA Advanced Collaborative Environment (ACE) servers has led to the realization that it has become impractical and even impossible to perform manual analysis leading to timely decisions. UA Program Management (PM UA) has recognized the need to implement a Decision Support Systemmore » (DSS) on UA ACE. The objective of this document is to research the commercial Knowledge Discovery and Data Mining (KDDM) market and publish the results in a survey. Furthermore, a ranking mechanism based on UA ACE-specific criteria has been developed and applied to a representative set of commercially available KDDM solutions. In addition, an overview of four R&D areas identified as critical to the implementation of DSS on ACE is provided. Finally, a comprehensive database containing detailed information on surveyed KDDM tools has been developed and is available upon customer request.« less

A Patient-Centered Approach to Informed Consent: Results from a Survey and Randomized Trial.

PubMed

Krishnamurti, Tamar; Argo, Nichole

2016-08-01

Traditional informed consent documents tend to be too lengthy and technical to facilitate proper patient engagement. Patient-centered, short informed consent content could be equally informative, while minimizing patient burden and producing greater patient engagement. This study aimed to develop and evaluate patient-centered, patient-designed paper and video informed consent formats. Two studies were conducted. In study 1, 118 self-identifying asthma patients recruited from a national, online pool completed survey tasks from their personal computers. Participants in study 1 were randomly assigned to examine sections of a standard informed consent document for an asthma trial and to select information they deemed critical to their decision making. In study 2, a sample of 83 self-identifying asthma patients completed experimental tasks in a university laboratory. Participants in study 2 were randomly assigned to a full informed consent document; a shortened, patient-designed informed consent document created from study 1; or a video with content matched to the shortened paper form. Study 1 yielded a more readable, concise version of a standard informed consent document (5 v. 17 pages). This shortened, patient-designed form closely met normative criteria for good clinical practice. In study 2, participants who viewed either the shortened paper consent or video reported greater engagement than those viewing the standard paper consent, without lowered performance on any other decision-relevant variables (i.e., comprehension, judged risk/benefit, feelings of trust). The video consent format did not cause increased enrollment. Results suggest that providing concise informed consent content, systematically developed from patients' self-reported information needs, may be more effective at engaging and informing clinical trial participants than the traditional consent approach, without detriment to trial comprehension, risk assessment, or enrollment. © The Author(s) 2016.

[Technology and progress in the use of information systems in the dental office].

PubMed

Walther, K

1989-09-01

The numerous DP systems used in dental offices are designed for administrative work. Data storage and management is limited to accountancy applications, and the advantages of the flow of information are restricted to operational purposes. Data of medical use are available only to a moderate extent. It should be possible, however, to use these information systems for processing purely medical data, for the structured input of comprehensive diagnostic information, and to have these data available for specific decisions. The use of a "decision-supporting system" has been tested in the documentation of dental diagnostic findings.

Safer Liquid Natural Gas

NASA Technical Reports Server (NTRS)

1976-01-01

After the disaster of Staten Island in 1973 where 40 people were killed repairing a liquid natural gas storage tank, the New York Fire Commissioner requested NASA's help in drawing up a comprehensive plan to cover the design, construction, and operation of liquid natural gas facilities. Two programs are underway. The first transfers comprehensive risk management techniques and procedures which take the form of an instruction document that includes determining liquid-gas risks through engineering analysis and tests, controlling these risks by setting up redundant fail safe techniques, and establishing criteria calling for decisions that eliminate or accept certain risks. The second program prepares a liquid gas safety manual (the first of its kind).

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

PubMed

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

Pareto frontier analyses based decision making tool for transportation of hazardous waste.

PubMed

Das, Arup; Mazumder, T N; Gupta, A K

2012-08-15

Transportation of hazardous wastes through a region poses immense threat on the development along its road network. The risk to the population, exposed to such activities, has been documented in the past. However, a comprehensive framework for routing hazardous wastes has often been overlooked. A regional Hazardous Waste Management scheme should incorporate a comprehensive framework for hazardous waste transportation. This framework would incorporate the various stakeholders involved in decision making. Hence, a multi-objective approach is required to safeguard the interest of all the concerned stakeholders. The objective of this study is to design a methodology for routing of hazardous wastes between the generating units and the disposal facilities through a capacity constrained network. The proposed methodology uses posteriori method with multi-objective approach to find non-dominated solutions for the system consisting of multiple origins and destinations. A case study of transportation of hazardous wastes in Kolkata Metropolitan Area has also been provided to elucidate the methodology. Copyright © 2012 Elsevier B.V. All rights reserved.

Camera Ready Masters. B/M-1 Resource Assessment. B/M-2 Surveying. B/M-3 Tabulation. B/M-4 Selecting Program Goals. B/M-5 Producing CDU's. Career Planning Support System.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. Center for Vocational Education.

This package of camera ready masters is one of a set of twelve documents describing the Career Planning Support System (CPSS) and its use. (CPSS is a comprehensive guidance program management system which (1) provides techniques to improve a high school's career guidance program, (2) focuses on the skills students need to make decisions about and…

DURIP: An Ultrafast Testbed for Comprehensive Characterization of Photonics, Electronic, and Optoelectronic Properties of Inegrated Nanophotonic Structures

DTIC Science & Technology

2017-10-14

Department of the Army position, policy or decision , unless so designated by other documentation. 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS (ES...characterization equipment to an al- ready available photonic characterization setup. The following table details of the spent budget and the list of purchased ...measure the response of a high-speed optical signal processing platform. The same architecture also can be used to charac- terize high-speed

Superfund Public Information System (SPIS), January 1999

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

NONE

1999-01-01

The Superfund Public Information System (SPIS) on CD-ROM contains Superfund data for the United States Environmental Protection Agency. The Superfund data is a collection of three databases: Records of Decision (RODS); Comprehensive Environmental, Response, Compensation, and Liability Information System (CERCLIS); and Archive (NFRAP). Descriptions of these databases and CD contents are listed below. Data content: The CD contains the complete text of the official ROD documents signed and issued by EPA from fiscal years 1982--1996; 147 RODs for fiscal year 1997; and seven RODs for fiscal year 1998. The CD also contains 89 Explanation of Significant Difference (ESD) documents, asmore » well as 48 ROD Amendments. CERCLIS and Archive (NFRAP) data is through January 19, 1999. RODS is the Records Of Decision System. RODS is used to track site clean-ups under the Superfund program to justify the type of treatment chosen at each site. RODS contains information on technology justification, site history, community participation, enforcement activities, site characteristics, scope and role of response action, and remedy. Explanation of Significant Differences (ESDs) are also available on the CD. CERCLIS is the Comprehensive Environmental Response, Compensation, and Liability Information System. It is the official repository for all Superfund site and incident data. It contains comprehensive information on hazardous waste sites, site inspections, preliminary assessments, and remedial status. The system is sponsored by the EPA`s Office of Emergency and Remedial Response, Information Management Center. Archive (NFRAP) consists of hazardous waste sites that have no further remedial action planned; only basic identifying information is provided for archive sites. The sites found in the Archive database were originally in the CERCLIS database, but were removed beginning in the fall of 1995.« less

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

Kinzey, Bruce R.

The City of Detroit is undertaking a comprehensive restoration of its street lighting system that includes transitioning the existing high-pressure sodium (HPS) sources to light-emitting diode (LED). Detroit’s well-publicized financial troubles over the last several years have added many hurdles and constraints to this process. Strategies to overcome these issues have largely been successful, but have also brought some mixed results. This document provides an objective review of the circumstances surrounding the system restoration, the processes undertaken and decisions made, and the results so far.

38 CFR 26.7 - VA environmental decision making and documents.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental decision making and documents. (a) Relevant environmental documents shall accompany other decision documents as they proceed through the decision-making process. (b) The major decision points for VA actions... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false VA environmental decision...

"What is relevant in a text document?": An interpretable machine learning approach

PubMed Central

Arras, Leila; Horn, Franziska; Montavon, Grégoire; Müller, Klaus-Robert

2017-01-01

Text documents can be described by a number of abstract concepts such as semantic category, writing style, or sentiment. Machine learning (ML) models have been trained to automatically map documents to these abstract concepts, allowing to annotate very large text collections, more than could be processed by a human in a lifetime. Besides predicting the text’s category very accurately, it is also highly desirable to understand how and why the categorization process takes place. In this paper, we demonstrate that such understanding can be achieved by tracing the classification decision back to individual words using layer-wise relevance propagation (LRP), a recently developed technique for explaining predictions of complex non-linear classifiers. We train two word-based ML models, a convolutional neural network (CNN) and a bag-of-words SVM classifier, on a topic categorization task and adapt the LRP method to decompose the predictions of these models onto words. Resulting scores indicate how much individual words contribute to the overall classification decision. This enables one to distill relevant information from text documents without an explicit semantic information extraction step. We further use the word-wise relevance scores for generating novel vector-based document representations which capture semantic information. Based on these document vectors, we introduce a measure of model explanatory power and show that, although the SVM and CNN models perform similarly in terms of classification accuracy, the latter exhibits a higher level of explainability which makes it more comprehensible for humans and potentially more useful for other applications. PMID:28800619

The concept of health technology assessment. Views of applicants to funding of HTA projects.

PubMed

Lange, M; Jørgensen, T; Kristensen, F B; Stilvén, S

2000-01-01

The purpose of this study is to analyze the perception of the content of health technology assessment (HTA) among health professionals applying for a state grant of DKK 10 million. A total of 113 applications were received and analyzed. When conducting the analysis, it was assumed that the applicants' maximum five-page project description would reflect: a) the applicants' perception of what an HTA is; b) how the assessment was to be conducted; and c) what the results were going to be used for. More than 40% of all applications focused on treatment; in 51% only one or two professional groups were to be involved (thus interdisciplinarity was questionable); only 22% of the HTA cases were intended to form the basis for political/administrative decisions; in general, the HTAs were planned far less comprehensively than was relevant; 76% of the projects did not include a formal synthesis phase; 41% intended to use diffusion as the only method for publication of the HTA result. The analysis reveals several areas where DIHTA has to make an effort in order to secure that HTA in fact constitutes a comprehensive and well-documented basis for decision making. These areas concern the following topics: multidisciplinarity, the objective of HTA, comprehensiveness, the synthesis phase, and publication and utilization of the HTA result.

Sustainability Tools Inventory - Initial Gaps Analysis | Science ...

EPA Pesticide Factsheets

This report identifies a suite of tools that address a comprehensive set of community sustainability concerns. The objective is to discover whether "gaps" exist in the tool suite’s analytic capabilities. These tools address activities that significantly influence resource consumption, waste generation, and hazard generation including air pollution and greenhouse gases. In addition, the tools have been evaluated using four screening criteria: relevance to community decision making, tools in an appropriate developmental stage, tools that may be transferrable to situations useful for communities, and tools with requiring skill levels appropriate to communities. This document provides an initial gap analysis in the area of community sustainability decision support tools. It provides a reference to communities for existing decision support tools, and a set of gaps for those wishing to develop additional needed tools to help communities to achieve sustainability. It contributes to SHC 1.61.4

Superfund Record of Decision (EPA Region 3): Buckingham County Landfill Superfund Site, VA, September 1994

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

Not Available

1994-10-01

The Record of Decision (ROD) presents the final remedial action selected for the Buckingham County Landfill Superfund Site (Site), located near the town of Sprouse's Corner in Buckingham County, Virginia. The remedial action was chosen in accordance with the requirements of the Comprehensive Environmental Response Compensation and Liability Act of 1980 (CERCLA), 42 U.S.C. Section 9601 et. seg., as amended by the Superfund Amendments and Reauthorization Act of 1986 (SARA), and the National Oil and Hazardous Substances Pollution Contingency Plan (NCP), 40 C.F.R. Part 300. The decision document explains the factual and legal basis for selecting the remedial action. Themore » selected remedy includes the two following options, both of which are fully protective of human health and the environment: Monitor the ground water and cap the hazardous waste disposal area; and Implement the source control measures.« less

Logic-Based Retrieval: Technology for Content-Oriented and Analytical Querying of Patent Data

NASA Astrophysics Data System (ADS)

Klampanos, Iraklis Angelos; Wu, Hengzhi; Roelleke, Thomas; Azzam, Hany

Patent searching is a complex retrieval task. An initial document search is only the starting point of a chain of searches and decisions that need to be made by patent searchers. Keyword-based retrieval is adequate for document searching, but it is not suitable for modelling comprehensive retrieval strategies. DB-like and logical approaches are the state-of-the-art techniques to model strategies, reasoning and decision making. In this paper we present the application of logical retrieval to patent searching. The two grand challenges are expressiveness and scalability, where high degree of expressiveness usually means a loss in scalability. In this paper we report how to maintain scalability while offering the expressiveness of logical retrieval required for solving patent search tasks. We present logical retrieval background, and how to model data-source selection and results' fusion. Moreover, we demonstrate the modelling of a retrieval strategy, a technique by which patent professionals are able to express, store and exchange their strategies and rationales when searching patents or when making decisions. An overview of the architecture and technical details complement the paper, while the evaluation reports preliminary results on how query processing times can be guaranteed, and how quality is affected by trading off responsiveness.

Bayesian Inference for NASA Probabilistic Risk and Reliability Analysis

NASA Technical Reports Server (NTRS)

Dezfuli, Homayoon; Kelly, Dana; Smith, Curtis; Vedros, Kurt; Galyean, William

2009-01-01

This document, Bayesian Inference for NASA Probabilistic Risk and Reliability Analysis, is intended to provide guidelines for the collection and evaluation of risk and reliability-related data. It is aimed at scientists and engineers familiar with risk and reliability methods and provides a hands-on approach to the investigation and application of a variety of risk and reliability data assessment methods, tools, and techniques. This document provides both: A broad perspective on data analysis collection and evaluation issues. A narrow focus on the methods to implement a comprehensive information repository. The topics addressed herein cover the fundamentals of how data and information are to be used in risk and reliability analysis models and their potential role in decision making. Understanding these topics is essential to attaining a risk informed decision making environment that is being sought by NASA requirements and procedures such as 8000.4 (Agency Risk Management Procedural Requirements), NPR 8705.05 (Probabilistic Risk Assessment Procedures for NASA Programs and Projects), and the System Safety requirements of NPR 8715.3 (NASA General Safety Program Requirements).

How can the use of data within the immunisation programme be increased in order to improve data quality and ensure greater accountability in the health system? A protocol for implementation science study.

PubMed

Tilahun, Binyam; Teklu, Alemayehu; Mancuso, Arielle; Abebaw, Zeleke; Dessie, Kassahun; Zegeye, Desalegn

2018-05-03

Immunisation remains one of the most important and cost-effective interventions to reduce vaccine-preventable child morbidity, disability and mortality. Health programmes like the Expanded Program of Immunization rely on complex decision-making and strong local level evidence is important to effectively and efficiently utilise limited resources. Lack of data use for decision-making at each level of the health system remains the main challenge in most developing countries. While there is much evidence on data quality and how to improve it, there is a lack of sufficient evidence on why the use of data for decision-making at each level of the health system is low. Herein, we describe a comprehensive implementation science study that will be conducted to identify organisational, technical and individual level factors affecting local data use at each level of the Ethiopian health system. We will apply a mixed methods approach using key informant interviews and document reviews. The qualitative data will be gathered through key informant interviews using a semi-structured guide with open- and closed-ended questions with four categories of respondents, namely decision-makers, data producers, data users and community representatives at the federal, regional, zonal, woreda and community levels of the health system. The document review will be conducted on selected reports and feedback documented at different levels of the health system. Data will be collected from July 2017 to March 2018. Descriptive statistics will be analysed for the quantitative study using SPSS version 20 software and thematic content analysis will be performed for the qualitative part using NVivo software. Appropriate and timely use of health and health-related information for decision-making is an essential element in the process of transforming the health sector. The findings of the study will inform stakeholders at different levels on the institutionalisation of evidence-based practice in immunisation programmes.

Cognitive and Personality Components Underlying Spoken Idiom Comprehension in Context. An Exploratory Study.

PubMed

Cacciari, Cristina; Corrardini, Paola; Ferlazzo, Fabio

2018-01-01

In this exploratory study, we investigated whether and to what extent individual differences in cognitive and personality variables are associated with spoken idiom comprehension in context. Language unimpaired participants were enrolled in a cross-modal lexical decision study in which semantically ambiguous Italian idioms (i.e., strings with both a literal and an idiomatic interpretation as, for instance, break the ice ), predictable or unpredictable before the string offset, were embedded in idiom-biasing contexts. To explore the contributions of different cognitive and personality components, participants also completed a series of tests respectively assessing general speed, inhibitory control, short-term and working memory, cognitive flexibility, crystallized and fluid intelligence, and personality. Stepwise regression analyses revealed that online idiom comprehension was associated with the participants' working memory, inhibitory control and crystallized verbal intelligence, an association modulated by idiom type. Also personality-related variables (State Anxiety and Openness to Experience) were associated with idiom comprehension, although in marginally significant ways. These results contribute to the renewed interest on how individual variability modulates language comprehension, and for the first time document contributions of individual variability on lexicalized, high frequency multi-word expressions as idioms adding new knowledge to the existing evidence on metaphor and sarcasm.

Registered nurses' decision-making regarding documentation in patients' progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy; Green, Quentine; Dyer, Kirsten; Wallis, Marianne

2012-10-01

To examine registered nurses' decision-making when documenting care in patients' progress notes. What constitutes effective nursing documentation is supported by available guidelines. However, ineffective documentation continues to be cited as a major cause of adverse events for patients. Decision-making in clinical practice is a complex process. To make an effective decision, the decision-maker must be situationally aware. The concept of situation awareness and its implications for making safe decisions has been examined extensively in air safety and more recently is being applied to health. The study was situated in a naturalistic paradigm. Purposive sampling was used to recruit 17 registered nurses who used think-aloud research methods when making decisions about documenting information in patients' progress notes. Follow-up interviews were conducted to validate interpretations. Data were analysed systematically for evidence of cues that demonstrated situation awareness as nurses made decisions about documentation. Three distinct decision-making scenarios were illuminated from the analysis: the newly admitted patient, the patient whose condition was as expected and the discharging patient. Nurses used mental models for decision-making in documenting in progress notes, and the cues nurses used to direct their assessment of patients' needs demonstrated situation awareness at different levels. Nurses demonstrate situation awareness at different levels in their decision-making processes. While situation awareness is important, it is also important to use an appropriate decision-making framework. Cognitive continuum theory is suggested as a decision-making model that could support situation awareness when nurses made decisions about documenting patient care. Because nurses are key decision-makers, it is imperative that effective decisions are made that translate into safe clinical care. Including situation awareness training, combined with employing cognitive continuum theory as a decision-making framework, provides a powerful means of guiding nurses' decision-making. © 2012 Blackwell Publishing Ltd.

Understanding the Harms and Benefits of Cancer Screening: A Model of Factors That Shape Informed Decision Making.

PubMed

Petrova, Dafina; Garcia-Retamero, Rocio; Cokely, Edward T

2015-10-01

Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making. © The Author(s) 2015.

Analysis of Stakeholder-Defined Needs in Northeast U.S. Coastal Communities to Determine Gaps in Research Informing Coastal Resilience Planning

NASA Astrophysics Data System (ADS)

Molino, G. D.; Kenney, M. A.; Sutton-Grier, A.; Penn, K.

2017-12-01

The impacts of climate change on our coastlines are increasing pressure on communities, ecosystems, infrastructure, and state-to-local economies in the northeastern United States (U.S.). As a result of current or imminent risk of acute and chronic hazards, local, state and regional entities have taken steps to identify and address vulnerabilities to climate change. Decisions to increase coastal infrastructure resilience and grey, green, and cultural infrastructure solutions requires physical, natural, and social science that is useful for decision-making and effective science translation mechanisms. Despite the desire to conduct or fund science that meets the needs of communities, there has been no comprehensive analysis to determine stakeholder-defined research needs. To address this gap, this study conducts a stakeholder needs analysis in northeast U.S. coastal communities to determine gaps in information and translation processes supporting coastal resilience planning. Documents were sourced from local, state, and regional organizations in both the public and private sectors, using the northeast region defined by the third National Climate Assessment. Modeled after Dilling et al. (2015), a deductive coding schema was developed that categorized documents using specific search terms such as "Location and condition of infrastructure" and "Proactive planning". A qualitative document analysis was then executed using NVivo to formally identify patterns and themes present in stakeholder surveys, workshop proceedings, and reports. Initial stakeholder priorities centered around incorporation of climate science into planning and decision making regarding vulnerabilities of infrastructure, enhanced emergency planning and response, and communication of key information.

Informed consent document improvement does not increase patients' comprehension in biomedical research

PubMed Central

Paris, Adeline; Brandt, Christian; Cornu, Catherine; Maison, Patrick; Thalamas, Claire; Cracowski, Jean-Luc

2010-01-01

AIMS International guidelines on ethics in biomedical research require that the informed consent of all enrolled participants is obtained. A written document describing the research, the informed consent (IC) document, must be given to all participants by the investigator. Most IC documents are long, containing much information. The aim of the present study was to determine whether the modification of the IC document by a working group or systematic improvement in its lexicosyntactic readability can improve comprehension of the written information given to patients participating in biomedical research. METHODS One hundred and fifty-nine patients were randomized to read one of the three versions of the IC document: unchanged document, document modified using systematic improvement of lexicosyntactic readability and document modified by a working group. RESULTS Neither the improvement in the lexicosyntactic readability, nor the intervention of the working group significantly improved the score of objective comprehension for the subjects included in this study: it was 66.6 (95% confidence interval 64.0, 69.2) for the control group, 68.8 (66.2, 71.4) for the group with the document improved for lexicosyntactic readability and 69.2 (66.0, 72.4) for the group who read the document improved by the working group (P= 0.38). CONCLUSIONS We failed to show that improving IC document comprehension through a lexicosyntactic approach or by a working group leads to better comprehension. PMID:20233193

The IDEA Assessment Tool: Assessing the Reporting, Diagnostic Reasoning, and Decision-Making Skills Demonstrated in Medical Students' Hospital Admission Notes.

PubMed

Baker, Elizabeth A; Ledford, Cynthia H; Fogg, Louis; Way, David P; Park, Yoon Soo

2015-01-01

Construct: Clinical skills are used in the care of patients, including reporting, diagnostic reasoning, and decision-making skills. Written comprehensive new patient admission notes (H&Ps) are a ubiquitous part of student education but are underutilized in the assessment of clinical skills. The interpretive summary, differential diagnosis, explanation of reasoning, and alternatives (IDEA) assessment tool was developed to assess students' clinical skills using written comprehensive new patient admission notes. The validity evidence for assessment of clinical skills using clinical documentation following authentic patient encounters has not been well documented. Diagnostic justification tools and postencounter notes are described in the literature (1,2) but are based on standardized patient encounters. To our knowledge, the IDEA assessment tool is the first published tool that uses medical students' H&Ps to rate students' clinical skills. The IDEA assessment tool is a 15-item instrument that asks evaluators to rate students' reporting, diagnostic reasoning, and decision-making skills based on medical students' new patient admission notes. This study presents validity evidence in support of the IDEA assessment tool using Messick's unified framework, including content (theoretical framework), response process (interrater reliability), internal structure (factor analysis and internal-consistency reliability), and relationship to other variables. Validity evidence is based on results from four studies conducted between 2010 and 2013. First, the factor analysis (2010, n = 216) yielded a three-factor solution, measuring patient story, IDEA, and completeness, with reliabilities of .79, .88, and .79, respectively. Second, an initial interrater reliability study (2010) involving two raters demonstrated fair to moderate consensus (κ = .21-.56, ρ =.42-.79). Third, a second interrater reliability study (2011) with 22 trained raters also demonstrated fair to moderate agreement (intraclass correlations [ICCs] = .29-.67). There was moderate reliability for all three skill domains, including reporting skills (ICC = .53), diagnostic reasoning skills (ICC = .64), and decision-making skills (ICC = .63). Fourth, there was a significant correlation between IDEA rating scores (2010-2013) and final Internal Medicine clerkship grades (r = .24), 95% confidence interval (CI) [.15, .33]. The IDEA assessment tool is a novel tool with validity evidence to support its use in the assessment of students' reporting, diagnostic reasoning, and decision-making skills. The moderate reliability achieved supports formative or lower stakes summative uses rather than high-stakes summative judgments.

Accessibility, usability, and usefulness of a Web-based clinical decision support tool to enhance provider-patient communication around Self-management TO Prevent (STOP) Stroke.

PubMed

Anderson, Jane A; Godwin, Kyler M; Saleem, Jason J; Russell, Scott; Robinson, Joshua J; Kimmel, Barbara

2014-12-01

This article reports redesign strategies identified to create a Web-based user-interface for the Self-management TO Prevent (STOP) Stroke Tool. Members of a Stroke Quality Improvement Network (N = 12) viewed a visualization video of a proposed prototype and provided feedback on implementation barriers/facilitators. Stroke-care providers (N = 10) tested the Web-based prototype in think-aloud sessions of simulated clinic visits. Participants' dialogues were coded into themes. Access to comprehensive information and the automated features/systematized processes were the primary accessibility and usability facilitator themes. The need for training, time to complete the tool, and computer-centric care were identified as possible usability barriers. Patient accountability, reminders for best practice, goal-focused care, and communication/counseling themes indicate that the STOP Stroke Tool supports the paradigm of patient-centered care. The STOP Stroke Tool was found to prompt clinicians on secondary stroke-prevention clinical-practice guidelines, facilitate comprehensive documentation of evidence-based care, and support clinicians in providing patient-centered care through the shared decision-making process that occurred while using the action-planning/goal-setting feature of the tool. © The Author(s) 2013.

Are the American Psychological Association's Detainee Interrogation Policies Ethical and Effective?: Key Claims, Documents, and Results.

PubMed

Pope, Kenneth S

2011-01-01

After 9-11, the United States began interrogating detainees at settings such as Abu Ghraib, Bagram, and Guantanamo. The American Psychological Association (APA) supported psychologists' involvement in interrogations, adopted formal policies, and made an array of public assurances. This article's purpose is to highlight key APA decisions, policies, procedures, documents, and public statements in urgent need of rethinking and to suggest questions that may be useful in a serious assessment, such as, "However well intended, were APA's interrogation policies ethically sound?"; "Were they valid, realistic, and able to achieve their purpose?"; "Were other approaches available that would address interrogation issues more directly, comprehensively, and actively, that were more ethically and scientifically based, and that would have had a greater likelihood of success?"; and "Should APA continue to endorse its post-9-11 detainee interrogation policies?"

Beyond diagnosis: the Core Sets for persons with schizophrenia based on the World Health Organization's International Classification of Functioning, Disability, and Health.

PubMed

Gómez-Benito, Juana; Guilera, Georgina; Barrios, Maite; Rojo, Emilio; Pino, Oscar; Gorostiaga, Arantxa; Balluerka, Nekane; Hidalgo, María Dolores; Padilla, José Luis; Benítez, Isabel; Selb, Melissa

2017-07-30

Based on the International Classification of Functioning, Disability and Health (ICF), this paper presents the results of the process to develop the Comprehensive and Brief Core Sets for schizophrenia that allow to comprehensively describe functioning in persons with schizophrenia. Twenty health professionals from diverse backgrounds participated in a formal and iterative decision-making process during an international consensus conference to develop these Core Sets. The conference was carried out based on evidence gathered from four preparatory studies (systematic literature review, qualitative study, expert survey, and empirical study). The first step of this decision-making and consensus process comprised of discussions and voting in working groups and plenary sessions to develop the comprehensive version. The categories of the Comprehensive ICF Core Set for schizophrenia served as the basis for the second step -a ranking and cutoff procedure to decide on the brief version. Of the 184 candidate categories identified in the preparatory studies, 97 categories were included in the Comprehensive Core Set for schizophrenia. A total of 25 categories were selected to constitute the Brief Core Set. The formal decision-making and consensus process integrating evidence from four preparatory studies and expert opinion led to the first version of the Core Sets for schizophrenia. Comprehensive and Brief Core Sets for schizophrenia may provide a common language among different health professionals and researchers, and a basic international standard of what to measure, report, and assess the functioning of persons with schizophrenia. Implications for rehabilitation Schizophrenia is a chronic mental disorder that has a tremendous impact on functioning and daily life of persons living with the disorder. The International Classification of Functioning, Disability and Health (ICF) offers an internationally recognized standard for describing the functioning status of these individuals. The Core Sets for schizophrenia have potential use in supporting rehabilitation practice such as for planning mental health services and other interventions or defining rehabilitation goals, and documenting patient care. The Core Sets for schizophrenia may also be used to promote interdisciplinary coordination and facilitate communication between members of a multidisciplinary rehabilitation team. Rehabilitation research is another potential area of application of the Core Sets for schizophrenia. This is valuable, since rehabilitation research provides crucial evidence for optimizing rehabilitation practice.

Cognitive and Personality Components Underlying Spoken Idiom Comprehension in Context. An Exploratory Study

PubMed Central

Cacciari, Cristina; Corrardini, Paola; Ferlazzo, Fabio

2018-01-01

In this exploratory study, we investigated whether and to what extent individual differences in cognitive and personality variables are associated with spoken idiom comprehension in context. Language unimpaired participants were enrolled in a cross-modal lexical decision study in which semantically ambiguous Italian idioms (i.e., strings with both a literal and an idiomatic interpretation as, for instance, break the ice), predictable or unpredictable before the string offset, were embedded in idiom-biasing contexts. To explore the contributions of different cognitive and personality components, participants also completed a series of tests respectively assessing general speed, inhibitory control, short-term and working memory, cognitive flexibility, crystallized and fluid intelligence, and personality. Stepwise regression analyses revealed that online idiom comprehension was associated with the participants' working memory, inhibitory control and crystallized verbal intelligence, an association modulated by idiom type. Also personality-related variables (State Anxiety and Openness to Experience) were associated with idiom comprehension, although in marginally significant ways. These results contribute to the renewed interest on how individual variability modulates language comprehension, and for the first time document contributions of individual variability on lexicalized, high frequency multi-word expressions as idioms adding new knowledge to the existing evidence on metaphor and sarcasm. PMID:29765350

12 CFR 408.5 - Ensuring environmental documents are actually considered in Agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-01-01

... considered in Agency decision-making. 408.5 Section 408.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED... Procedures § 408.5 Ensuring environmental documents are actually considered in Agency decision-making... environmental documents in agency decision-making. To implement these requirements, Eximbank officials will: (a...

50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-10-01

... actually considered in agency decision-making. 530.2 Section 530.2 Wildlife and Fisheries MARINE MAMMAL... documents are actually considered in agency decision-making. Section 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making. To...

Report on the remedial investigation of Bear Creek Valley at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 5: Appendix F -- Baseline human health risk assessment report

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

NONE

1996-09-01

This Remedial Investigation (RI) Report characterizes the nature and extent of contamination, evaluates the fate and transport of contaminants, and assesses risk to human health and the environment resulting from waste disposal and other US Department of Energy (DOE) operations in Bear Creek Valley (BCV). BCV, which is located within the DOE Oak Ridge Reservation (ORR) encompasses multiple waste units containing hazardous and radioactive wastes arising from operations at the adjacent Oak Ridge Y-12 Plant. The primary waste units discussed in this RI Report are the S-3 Site, Oil Landfarm (OLF), Boneyard/Burnyard (BYBY), Sanitary Landfill 1 (SL 1), and Bearmore » Creek Burial Grounds (BCBG). These waste units, plus the contaminated media resulting from environmental transport of the wastes from these units, are the subject of this RI. This BCV RI Report represents the first major step in the decision-making process for the BCV watershed. The RI results, in concert with the follow-on FS will form the basis for the Proposed Plan and Record of Decision for all BCV sites. This comprehensive decision document process will meet the objectives of the watershed approach for BCV. Appendix F documents potential risks and provides information necessary for making remediation decisions. A quantitative analysis of the inorganic, organic, and radiological site-related contaminants found in various media is used to characterize the potential risks to human health associated with exposure to these contaminants.« less

The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context.

PubMed

Karmali, Shazia

2012-01-01

This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.

The relationship among pressure ulcer risk factors, incidence and nursing documentation in hospital-acquired pressure ulcer patients in intensive care units.

PubMed

Li, Dan

2016-08-01

To explore the quality/comprehensiveness of nursing documentation of pressure ulcers and to investigate the relationship between the nursing documentation and the incidence of pressure ulcers in four intensive care units. Pressure ulcer prevention requires consistent assessments and documentation to decrease pressure ulcer incidence. Currently, most research is focused on devices to prevent pressure ulcers. Studies have rarely considered the relationship among pressure ulcer risk factors, incidence and nursing documentation. Thus, a study to investigate this relationship is needed to fill this information gap. A retrospective, comparative, descriptive, correlational study. A convenience sample of 196 intensive care units patients at the selected medical centre comprised the study sample. All medical records of patients admitted to intensive care units between the time periods of September 1, 2011 through September 30, 2012 were audited. Data used in the analysis included 98 pressure ulcer patients and 98 non-pressure ulcer patients. The quality and comprehensiveness of pressure ulcer documentation were measured by the modified European Pressure Ulcer Advisory Panel Pressure Ulcers Assessment Instrument and the Comprehensiveness in Nursing Documentation instrument. The correlations between quality/comprehensiveness of pressure ulcer documentation and incidence of pressure ulcers were not statistically significant. Patients with pressure ulcers had longer length of stay than patients without pressure ulcers stay. There were no statistically significant differences in quality/comprehensiveness scores of pressure ulcer documentation between dayshift and nightshift. This study revealed a lack of quality/comprehensiveness in nursing documentation of pressure ulcers. This study demonstrates that staff nurses often perform poorly on documenting pressure ulcer appearance, staging and treatment. Moreover, nursing documentation of pressure ulcers does not provide a complete picture of patients' care needs that require nursing interventions. The implication of this study involves pressure ulcer prevention and litigable risk of nursing documentation. © 2016 John Wiley & Sons Ltd.

The value of artefacts in stimulated-recall interviews.

PubMed

Burden, Sarah; Topping, Annie; O'Halloran, Catherine

2015-09-01

To assess the use of artefacts in semi-structured, stimulated-recall interviews in a study exploring mentors' decisions regarding students' competence in practice. Few empirical studies have examined how mentors reach a decision when assessing students' performance in practice. Concerns have repeatedly been voiced that students may lack essential skills at the point of registration or that mentors may have failed or been reticent to judge students' performance as unsatisfactory. Student practice assessment documents (PADs) were used in stimulated-recall (SR) interviews with mentors to explore decision making. A review of the literature identified that artefacts can play a role in triggering a more comprehensive retrospective examination of decision making, thus helping to capture the essence of a mentor's decision over time and in context. Use of an artefact to stimulate recall can elicit evidence of thought processes, which may be difficult to obtain in a normal, semi-structured interview. PADs proved to be a valuable way to generate naturalistic decision making. In addition, discussion of artefacts created by participants can promote participant-driven enquiry, thereby reducing researcher bias. Identifying an approach that captures post hoc decision making based on sustained engagement and interaction between students and their mentors was a challenge. Artefacts can be used to address the difficulties associated with retrospective introspection about a unique decision. There is the potential to increase the use of artefacts in healthcare research. SR can also help novice mentors develop their skills in making decisions regarding assessments of students.

Recommendations for Clinical Decision Support Deployment: Synthesis of a Roundtable of Medical Directors of Information Systems

PubMed Central

Jenders, Robert A.; Osheroff, Jerome A.; Sittig, Dean F.; Pifer, Eric A.; Teich, Jonathan M

2007-01-01

Background: Ample evidence exists that clinical decision support (CDS) can improve clinician performance. Nevertheless, additional evidence demonstrates that clinicians still do not perform adequately in many instances. This suggests an ongoing need for implementation of CDS, in turn prompting development of a roadmap for national action regarding CDS. Objective: Develop practical advice to aid CDS implementation in order to improve clinician performance. Method: Structured group interview during a roundtable discussion by medical directors of information systems (N = 30), with subsequent review by participants and synthesis. Results: Participant consensus was that CDS should be comprehensive and should involve techniques such as order sets and facilitated documentation as well as alerts; should be subject to ongoing feedback; and should flow from and be governed by an organization’s clinical goals. Conclusion: A structured roundtable discussion of clinicians experienced in health information technology can yield practical, consensus advice for implementation of CDS. PMID:18693858

Making Patient Risk Visible: Implementation of a Nursing Document Information System to Improve Patient Safety.

PubMed

Wang, Panfeng; Zhang, Hongjun; Li, Baohua; Lin, Keke

2016-01-01

The aims of this study were to develop a nursing information system (NIS), enhance the visibility of patient risk, and identify challenges and facilitators to adoption of the NIS risk assessment system for nurse leaders. This article describes the function of a nursing risk assessment information system, and the results of a survey on the risk assessment system. The results suggested that quality of information processing in nursing significantly improved patient safety. Nurses surveyed demonstrated a high degree of satisfaction, with saving time and improving safety. The nursing document information system described was introduced to improve patient safety and decrease risk. The application of the system has greatly enhanced the efficiency of nursing work, and guides the nurses to make an accurate, comprehensive and objective assessment of patient information, contributing significantly to further improvement in care standards and care decisions.

40 CFR 300.700 - Activities by other persons.

Code of Federal Regulations, 2010 CFR

2010-07-01

... action is conducted in accordance with the preauthorization decision document, and costs are reasonable... preauthorization decision document. (8) For a claim to be awarded under section 111 of CERCLA, EPA must certify that the costs were necessary and consistent with the preauthorization decision document. (e) Section...

Is treatment of feline hypertrophic cardiomyopathy based in science or faith? A survey of cardiologists and a literature search.

PubMed

Rishniw, Mark; Pion, Paul D

2011-07-01

Feline hypertrophic cardiomyopathy (HCM) is the most common cardiac disease of cats. Treatment of HCM is usually directed at controlling signs of congestive heart failure (CHF), preventing occurrence or recurrence of systemic thromboembolism or delaying/preventing/reversing progression of subclinical disease. Despite the laudable goals of therapy, however, little objective evidence supporting therapeutic decisions has been published. We, therefore, hypothesized that cardiologists base their treatment strategies on information other than published clinically relevant science. To gain insight into therapeutic decisions that cardiologists and clinicians with an interest in cardiology (n=99) make for cats with HCM, and on what information they base these decisions, we presented participants with, and asked them to select therapy for, 12 hypothetical scenarios of HCM (± CHF). Responses and justifications for treatment choices were compiled and compared with the results of a comprehensive literature search for published information about treatment of feline HCM. Evaluation of the therapeutic strategies chosen for these hypothetical cases of HCM suggests that cardiologists or clinicians with a strong interest in cardiology often prescribe treatments knowing that little documented evidence supports their decisions. Copyright © 2011 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.

Medical Decision-Making Among Elderly People in Long Term Care.

ERIC Educational Resources Information Center

Tymchuk, Alexander J.; And Others

1988-01-01

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

77 FR 22316 - Notification of a Public Teleconference of the Science Advisory Board Ecological Processes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-13

...) document, ``Integrating Ecological Assessment and Decision-Making at EPA, 2011 RAF Ecological Assessment... document, ``Integrating Ecological Assessment and Decision- Making at EPA, 2011 RAF Ecological Assessment... review comments on the EPA RAF draft document ``Integrating Ecological Assessment and Decision-Making at...

Risk Management Structured for Today's Environment

NASA Technical Reports Server (NTRS)

Greenfield, Michael A.

1998-01-01

In NPG (NASA Procedures and Guidelines) 7120.5A, we define risk management as "an organized, systematic decision-making process that efficiently identifies, analyzes, plans, tracks, controls, and communicates and documents risk in order to increase the likelihood of achieving program/project goals." Effective risk management depends upon a thorough understanding of the concept of risk, the principles of risk management and the formation of a disciplined risk management process. In human spaceflight programs, NASA has always maintained a rigorous and highly structured risk management effort. When lives are at stake, NASA's missions must be 100% safe; the risk management approach used in human spaceflight has always been comprehensive.

Plain Language in Environmental Policy Documents: An Assessment of Reader Comprehension and Perceptions

ERIC Educational Resources Information Center

Jones, Natasha; McDavid, Justin; Derthick, Katie; Dowell, Randy; Spyridakis, Jan

2012-01-01

Several government agencies are seeking quality improvement in environmental policy documents by asking for the implementation of Plain Language (PL) guidelines. Our mixed-methods research examines whether the application of certain PL guidelines affects the comprehension and perceptions of readers of environmental policy documents. Results show…

A classification of errors in lay comprehension of medical documents.

PubMed

Keselman, Alla; Smith, Catherine Arnott

2012-12-01

Emphasis on participatory medicine requires that patients and consumers participate in tasks traditionally reserved for healthcare providers. This includes reading and comprehending medical documents, often but not necessarily in the context of interacting with Personal Health Records (PHRs). Research suggests that while giving patients access to medical documents has many benefits (e.g., improved patient-provider communication), lay people often have difficulty understanding medical information. Informatics can address the problem by developing tools that support comprehension; this requires in-depth understanding of the nature and causes of errors that lay people make when comprehending clinical documents. The objective of this study was to develop a classification scheme of comprehension errors, based on lay individuals' retellings of two documents containing clinical text: a description of a clinical trial and a typical office visit note. While not comprehensive, the scheme can serve as a foundation of further development of a taxonomy of patients' comprehension errors. Eighty participants, all healthy volunteers, read and retold two medical documents. A data-driven content analysis procedure was used to extract and classify retelling errors. The resulting hierarchical classification scheme contains nine categories and 23 subcategories. The most common error made by the participants involved incorrectly recalling brand names of medications. Other common errors included misunderstanding clinical concepts, misreporting the objective of a clinical research study and physician's findings during a patient's visit, and confusing and misspelling clinical terms. A combination of informatics support and health education is likely to improve the accuracy of lay comprehension of medical documents. Published by Elsevier Inc.

Satisfying the needs of Japanese cancer patients: a comparative study of detailed and standard informed consent documents.

PubMed

Sato, Keiko; Watanabe, Toru; Katsumata, Noriyuki; Sato, Tosiya; Ohashi, Yasuo

2014-02-01

Simplified informed consent forms have been successful in improving patient satisfaction and decreasing patient anxiety. However, unsolved problems remain about whether these documents improve comprehension and satisfaction of patients with standard literacy skills. s To investigate whether a detailed consent form explaining the key elements of informed consent, in comparison to a standard consent form, would increase the comprehension and satisfaction of adult cancer patients. Patients who were eligible for the National Surgical Adjuvant Study of Breast Cancer (protocol 01(N-SAS/BC-01)) were randomly selected to receive one of the following four versions: detailed document with graphics, detailed document without graphics, standard document with graphics, and standard document without graphics. The forms were written in plain language from the patients' point of view. A total of 85 patients were administered questionnaires via interview to assess levels of comprehension, satisfaction, and anxiety. Patients demonstrated a strong understanding of information regarding treatment and research. Patient comprehension did not differ significantly between the detailed document arms and the standard document arms. Patient satisfaction level increased according to the amount of information presented in the consent form; most patients preferred the detailed document with graphics. Anxiety and accrual rates in the parent study were not affected by informed consent procedures. Findings were limited to adults who had standard literacy skills and may not be generalizable to a population with lower literacy. Informed consent can be a significant experience for a population with standard literacy skills, as long as the document is easily comprehensible. Such information should be provided in a format that corresponds with patient needs, education levels, and preferences.

No Further Action Decision Document for Site 8 at Alpena Combat Readiness Training Center, Alpena, Michigan.

DTIC Science & Technology

1998-04-01

INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 8 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland fr r=.~r i^:r^f>^’ m% Approved for public...Document 4. TITLE AND SUBTITLE No Further Action Decision Document for Site 8 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 7. PERFORMING

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

Phenotypic and Genetic Associations between Reading Comprehension, Decoding Skills, and ADHD Dimensions: Evidence from Two Population-Based Studies

ERIC Educational Resources Information Center

Plourde, Vickie; Boivin, Michel; Forget-Dubois, Nadine; Brendgen, Mara; Vitaro, Frank; Marino, Cecilia; Tremblay, Richard T.; Dionne, Ginette

2015-01-01

Background: The phenotypic and genetic associations between decoding skills and ADHD dimensions have been documented but less is known about the association with reading comprehension. The aim of the study is to document the phenotypic and genetic associations between reading comprehension and ADHD dimensions of inattention and…

Situation awareness and documentation of changes that affect patient outcomes in progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy

2014-05-01

To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. © 2013 John Wiley & Sons Ltd.

75 FR 48179 - Comprehensive List of Guidance Documents at the Food and Drug Administration

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

...The Food and Drug Administration (FDA) is publishing a comprehensive list of all guidance documents currently in use at the agency. This list is being published under FDA's Good Guidance Practices (GGPs). It is intended to inform the public of the existence and availability of all of our current guidance documents. It also provides information on guidance documents that have been added or withdrawn in the past 5 years.

Incorporating ethics into your comprehensive organizational plan.

PubMed

Oetjen, Dawn; Rotarius, Timothy

2005-01-01

Today's health care executives find their organizations facing internal and external environments that are behaving in chaotic and unpredictable ways. From inadequate staffing and an increase in clinical errors to outdated risk management procedures and increased competition for scare reimbursements, these health care managers find themselves making decisions without being fully informed of the ethical ramifications of these decisions. A 6-part Comprehensive Organizational Plan is presented that helps the health care decision maker better understand the key success factors for the organization. The Comprehensive Organizational Plan is an overall plan that is intended to protect and serve your organization. The 6 plans in the Comprehensive Organizational Plan cover the following areas: competition, facilities, finances, human resources, information management, and marketing. The comprehensive organizational plan includes an overlay of the ethical considerations for each part of the plan.

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

Treesearch

Morgan Pence; Tom Zimmerman

2011-01-01

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

Framework for ecological monitoring on lands of Alaska National Wildlife Refuges and their partners

USGS Publications Warehouse

Woodward, Andrea; Beever, Erik A.

2010-01-01

National Wildlife Refuges in Alaska and throughout the U.S. have begun developing a spatially comprehensive monitoring program to inform management decisions, and to provide data to broader research projects. In an era of unprecedented rates of climate change, monitoring is essential to detecting, understanding, communicating and mitigating climate-change effects on refuge and other resources under the protection of U.S. Fish and Wildlife Service, and requires monitoring results to address spatial scales broader than individual refuges. This document provides guidance for building a monitoring program for refuges in Alaska that meets refuge-specific management needs while also allowing synthesis and summary of ecological conditions at the ecoregional and statewide spatial scales.

Establishing end-of-life boards for palliative care of patients with advanced diseases.

PubMed

Masel, Eva K; Unseld, Matthias; Adamidis, Feroniki; Roider-Schur, Sophie; Watzke, Herbert H

2018-04-01

Interdisciplinary tumor board decisions improve the quality of oncological therapies, while no such boards exist for end-of-life (EOL) decisions. The aim of this study was to assess the willingness of hemato-oncological and palliative care professionals to develop and participate in EOL boards. An aim of an EOL board would be to establish an interdisciplinary and comprehensive care for the remaining lifetime of patients suffering from advanced incurable diseases. Staff from the interdisciplinary teams of all hemato-oncological and palliative care wards in Vienna were invited to anonymously participate in an online survey. 309 professionals responded. 91% respondents reported a need to establish an EOL board, 63% expressed their willingness to actively participate in an EOL board, and 25% were indecisive. Regarding patient presence, 50% voted for an EOL board in the presence of the patients, and 36% voted for an EOL board in the absence of the patients. 95% had the opinion that an EOL board could improve patient care in the last phase of life. 64% stated that the development of an EOL board would be worthwhile, while 28% did not see enough resources available at their institutions. Regarding the desired type of documentation, 61% voted for a centrally available EOL decision, and 31% supported an in-house-based documentation. 94% voted for the availability of an information folder about EOL care. The willingness of professionals to establish an EOL board was very high. Further steps should be taken to implement such boards to improve EOL care.

Appropriate evidence sources for populating decision analytic models within health technology assessment (HTA): a systematic review of HTA manuals and health economic guidelines.

PubMed

Zechmeister-Koss, Ingrid; Schnell-Inderst, Petra; Zauner, Günther

2014-04-01

An increasing number of evidence sources are relevant for populating decision analytic models. What is needed is detailed methodological advice on which type of data is to be used for what type of model parameter. We aim to identify standards in health technology assessment manuals and economic (modeling) guidelines on appropriate evidence sources and on the role different types of data play within a model. Documents were identified via a call among members of the International Network of Agencies for Health Technology Assessment and by hand search. We included documents from Europe, the United States, Canada, Australia, and New Zealand as well as transnational guidelines written in English or German. We systematically summarized in a narrative manner information on appropriate evidence sources for model parameters, their advantages and limitations, data identification methods, and data quality issues. A large variety of evidence sources for populating models are mentioned in the 28 documents included. They comprise research- and non-research-based sources. Valid and less appropriate sources are identified for informing different types of model parameters, such as clinical effect size, natural history of disease, resource use, unit costs, and health state utility values. Guidelines do not provide structured and detailed advice on this issue. The article does not include information from guidelines in languages other than English or German, and the information is not tailored to specific modeling techniques. The usability of guidelines and manuals for modeling could be improved by addressing the issue of evidence sources in a more structured and comprehensive format.

Promoting social responsibility amongst health care users: medical tourists' perspectives on an information sheet regarding ethical concerns in medical tourism.

PubMed

Adams, Krystyna; Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory

2013-12-06

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants' desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry.

Internal NASA Study: NASAs Protoflight Research Initiative

NASA Technical Reports Server (NTRS)

Coan, Mary R.; Hirshorn, Steven R.; Moreland, Robert

2015-01-01

The NASA Protoflight Research Initiative is an internal NASA study conducted within the Office of the Chief Engineer to better understand the use of Protoflight within NASA. Extensive literature reviews and interviews with key NASA members with experience in both robotic and human spaceflight missions has resulted in three main conclusions and two observations. The first conclusion is that NASA's Protoflight method is not considered to be "prescriptive." The current policies and guidance allows each Program/Project to tailor the Protoflight approach to better meet their needs, goals and objectives. Second, Risk Management plays a key role in implementation of the Protoflight approach. Any deviations from full qualification will be based on the level of acceptable risk with guidance found in NPR 8705.4. Finally, over the past decade (2004 - 2014) only 6% of NASA's Protoflight missions and 6% of NASA's Full qualification missions experienced a publicly disclosed mission failure. In other words, the data indicates that the Protoflight approach, in and of it itself, does not increase the mission risk of in-flight failure. The first observation is that it would be beneficial to document the decision making process on the implementation and use of Protoflight. The second observation is that If a Project/Program chooses to use the Protoflight approach with relevant heritage, it is extremely important that the Program/Project Manager ensures that the current project's requirements falls within the heritage design, component, instrument and/or subsystem's requirements for both the planned and operational use, and that the documentation of the relevant heritage is comprehensive, sufficient and the decision well documented. To further benefit/inform this study, a recommendation to perform a deep dive into 30 missions with accessible data on their testing/verification methodology and decision process to research the differences between Protoflight and Full Qualification missions' Design Requirements and Verification & Validation (V&V) (without any impact or special request directly to the project).

Promoting social responsibility amongst health care users: medical tourists’ perspectives on an information sheet regarding ethical concerns in medical tourism

PubMed Central

2013-01-01

Background Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. Results According to feedback provided in interviews with former Canadian medical tourists, the majority of participants responded positively to the information sheet and indicated that this document prompted them to engage in further consideration of these issues. Participants indicated some frustration after reading the information sheet regarding a lack of know-how in terms of learning more about the concerns discussed in the document and changing their decision-making. This frustration was due to participants’ desperation for medical care, a topic which participants frequently discussed regarding ethical concerns related to health care provision. Conclusions The overall perceptions of former medical tourists indicate that an information sheet may promote further consideration of ethical concerns of medical tourism. However, given that these interviews were performed with former medical tourists, it remains unknown whether such a document might impact upon the decision-making of prospective medical tourists. Furthermore, participants indicated a need for an additional tool such as a website for continued discussion about these concerns. As such, along with dissemination of the information sheet, future research implications should include the development of a website for ongoing discussion that could contribute to a raised awareness of these concerns and potentially increase social responsibility in the medical tourism industry. PMID:24314027

Development of a robust space power system decision model

NASA Astrophysics Data System (ADS)

Chew, Gilbert; Pelaccio, Dennis G.; Jacobs, Mark; Stancati, Michael; Cataldo, Robert

2001-02-01

NASA continues to evaluate power systems to support human exploration of the Moon and Mars. The system(s) would address all power needs of surface bases and on-board power for space transfer vehicles. Prior studies have examined both solar and nuclear-based alternatives with respect to individual issues such as sizing or cost. What has not been addressed is a comprehensive look at the risks and benefits of the options that could serve as the analytical framework to support a system choice that best serves the needs of the exploration program. This paper describes the SAIC developed Space Power System Decision Model, which uses a formal Two-step Analytical Hierarchy Process (TAHP) methodology that is used in the decision-making process to clearly distinguish candidate power systems in terms of benefits, safety, and risk. TAHP is a decision making process based on the Analytical Hierarchy Process, which employs a hierarchic approach of structuring decision factors by weights, and relatively ranks system design options on a consistent basis. This decision process also includes a level of data gathering and organization that produces a consistent, well-documented assessment, from which the capability of each power system option to meet top-level goals can be prioritized. The model defined on this effort focuses on the comparative assessment candidate power system options for Mars surface application(s). This paper describes the principles of this approach, the assessment criteria and weighting procedures, and the tools to capture and assess the expert knowledge associated with space power system evaluation. .

Underground Test Area Activity Preemptive Review Guidance Nevada National Security Site, Nevada, Revision 0

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

Farnham, Irene; Rehfeldt, Kenneth

Preemptive reviews (PERs) of Underground Test Area (UGTA) Activity corrective action unit (CAU) studies are an important and long-maintained quality improvement process. The CAU-specific PER committees provide internal technical review of ongoing work throughout the CAU lifecycle. The reviews, identified in the UGTA Quality Assurance Plan (QAP) (Sections 1.3.5.1 and 3.2), assure work is comprehensive, accurate, in keeping with the state of the art, and consistent with CAU goals. PER committees review various products, including data, documents, software/codes, analyses, and models. PER committees may also review technical briefings including Federal Facility Agreement and Consent Order (FFACO)-required presentations to the Nevadamore » Division of Environmental Protection (NDEP) and presentations supporting key technical decisions (e.g., investigation plans and approaches). PER committees provide technical recommendations to support regulatory decisions that are the responsibility of the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Field Office (NNSA/NFO) and NDEP.« less

Coastal processes study at Ocean Beach, San Francisco, CA: summary of data collection 2004-2006

USGS Publications Warehouse

Barnard, Patrick L.; Eshleman, Jodi; Erikson, Li H.; Hanes, Daniel M.

2007-01-01

Ocean Beach in San Francisco, California, contains a persistent erosional section in the shadow of the San Francisco ebb tidal delta and south of Sloat Boulevard that threatens valuable public infrastructure as well as the safe recreational use of the beach. Coastal managers have been discussing potential mediation measures for over a decade, with little scientific research available to aid in decision making. The United States Geological Survey (USGS) initiated the Ocean Beach Coastal Processes Study in April 2004 to provide the scientific knowledge necessary for coastal managers to make informed management decisions. This study integrates a wide range of field data collection and numerical modeling techniques to document nearshore sediment transport processes at the mouth of San Francisco Bay, with emphasis on how these processes relate to erosion at Ocean Beach. The Ocean Beach Coastal Processes Study is the first comprehensive study of coastal processes at the mouth of San Francisco Bay.

Maintenance action readiness assessment plan for White Oak Creek and Melton Branch Weir Stilling Pool cleanout at Oak Ridge National Laboratory

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

NONE

1995-08-01

This Readiness Assessment Plan has been prepared to document operational readiness for the following maintenance action: (1) removal of sediment from the White Oak Creek and Melton Branch Weir Stilling Pools and (2) disposal of the radiologically contaminated sediment in another location upstream of the weirs in an area previously contaminated by stream overflow from Melton Branch in Waste Area Grouping 2 (WAG) at Oak Ridge National Laboratory. This project is being performed as a maintenance action rather than an action under the Comprehensive Environmental Response, Compensation, and Liability Act because the risk to human health and environment is wellmore » below the US Environmental Protection Agency`s level of concern. The decision to proceed as a maintenance action was documented by an interim action proposed plan, which is included in the administrative record. The administrative record is available for review at the US Department of Energy Information Resource Center, 105 Broadway Avenue, Oak Ridge, Tennessee 37830.« less

Measure Guideline: Passive Vents

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

Berger, David; Neri, Robin

2016-02-05

This document addresses the use of passive vents as a source of outdoor air in multifamily buildings. The challenges associated with implementing passive vents and the factors affecting performance are outlined. A comprehensive design methodology and quantified performance metrics are provided. Two hypothetical design examples are provided to illustrate the process. This document is intended to be useful to designers, decision-makers, and contractors implementing passive ventilation strategies. It is also intended to be a resource for those responsible for setting high-performance building program requirements, especially pertaining to ventilation and outdoor air. To ensure good indoor air quality, a dedicated sourcemore » of outdoor air is an integral part of high-performance buildings. Presently, there is a lack of guidance pertaining to the design and installation of passive vents, resulting in poor system performance. This report details the criteria necessary for designing, constructing, and testing passive vent systems to enable them to provide consistent and reliable levels of ventilation air from outdoors.« less

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

PubMed

Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

2016-02-01

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

The use of typed lambda calculus for comprehension and construction of simulation models in the domain of ecology

NASA Technical Reports Server (NTRS)

Uschold, Michael

1992-01-01

We are concerned with two important issues in simulation modelling: model comprehension and model construction. Model comprehension is limited because many important choices taken during the modelling process are not documented. This makes it difficult for models to be modified or used by others. A key factor hindering model construction is the vast modelling search space which must be navigated. This is exacerbated by the fact that many modellers are unfamiliar with the terms and concepts catered to by current tools. The root of both problems is the lack of facilities for representing or reasoning about domain concepts in current simulation technology. The basis for our achievements in both of these areas is the development of a language with two distinct levels; one for representing domain information, and the other for representing the simulation model. Of equal importance, is the fact that we make formal connections between these two levels. The domain we are concerned with is ecological modelling. This language, called Elklogic, is based on the typed lambda calculus. Important features include a rich type structure, the use of various higher order functions, and semantics. This enables complex expressions to be constructed from relatively few primitives. The meaning of each expression can be determined in terms of the domain, the simulation model, or the relationship between the two. We describe a novel representation for sets and substructure, and a variety of other general concepts that are especially useful in the ecological domain. We use the type structure in a novel way: for controlling the modelling search space, rather than a proof search space. We facilitate model comprehension by representing modelling decisions that are embodied in the simulation model. We represent the simulation model separately from, but in terms of a domain mode. The explicit links between the two models constitute the modelling decisions. The semantics of Elklogic enables English text to be generated to explain the simulation model in domain terms.

Counting seizures: The primary outcome measure in epileptology from the patients' perspective.

PubMed

Blachut, Barbara; Hoppe, Christian; Surges, Rainer; Stahl, Jutta; Elger, Christian E; Helmstaedter, Christoph

2015-07-01

Patient-reported seizure counts represent a key outcome measure for individual treatments and clinical studies in epileptology. Video-EEG based research, however, demonstrated lack of validity due to underreporting. Here we examined the practice of keeping seizure diaries and the patients' attitudes toward seizure counting. Anticipating a low return rate, a comprehensive survey was mailed to 1100 adult outpatients. Besides methods and reasons to document or not to document seizures, the questionnaire addressed clinical, personality and sociodemographic characteristics as well as the subjective experience of seizures. Questionnaires from 170 patients (15%) could be included in our analysis. Patients estimated to be aware of 5.3 out of 10 daytime seizures (nocturnal seizures: 2.6) while they supposed that relatives/colleagues noticed 7.1 (nocturnal: 4.6). Almost two-thirds of the patients reported to keep a seizure diary with a self-estimated documentation rate of 8.7 out of 10 noticed daytime seizures (nocturnal: 7.7). Documenters and non-documenters showed only marginal group differences with regard to clinical, personality and sociodemographic characteristics. Importantly, patients were more committed to keep a seizure diary when they judged it to be relevant for clinical treatment decisions. Patients appear to know that they underreport seizures. According to their view, seizure unawareness as induced by seizures themselves seems to be a more important factor than omitting documentation of noticed seizures. Thus, the potential to improve the validity of seizure diaries of electronic devices which facilitate documenting noticed seizures appears limited. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Assisting Public Organizations in Their Outsourcing Endeavors: A Decision Support Mode

NASA Technical Reports Server (NTRS)

Kremic, TIbor; Tukel, Oya

2006-01-01

There has been a tremendous growth in outsourcing practices in recent years. The public organizations in the United States have outsourced some functions and are now being compelled to outsource additional ones. While there are numerous studies that document and analyze outsourcing practices, there is limited research to guide public or governmental organizations in determining what functions to outsource. This study fills this gap by developing a decision support model for a typical public organization in determining what to outsource and how. A set of outsourcing decision factors is identified that can be used as parameters in the three integer programming formulations developed. These formulations are used as solution engines in the model. The first formulation identifies which functions are the best candidates for outsourcing given the organization's priorities. The other formulations place the functions into recommended contracts and re-assign displaced employees. Data from NASA Glenn Research Center in Ohio is used to test and analyze the model. Analysis indicates that cost and skills-related factors are the most sensitive parameters for the data tested. The model and the formulations are a relatively comprehensive package and may help guide outsourcing decisionmakers and policymakers in public organizations.

Installation restoration program. Decision document for soil and groundwater at the storage area at the USMC Subleased Area, Site 3. 144th Fighter Wing, California Air National Guard, Fresno Air Terminal, California

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

NONE

1996-01-01

Decision Document for IRP Site No. 3 - Storage Area at the USMC Sublease Area, California Air National Guard, 144th Fighter Wing, Fresno Air Terminal, Fresno, California. This report documents the data, conclusion, and recommendation to support a No Further Remedial Action Planned decision at Site 3 under the IRP.

[Electronic data records in primary health care and aspects of their development in Bosnia and Herzegovina].

PubMed

Novo, Ahmed; Masić, Izet; Toromanović, Selim; Karić, Mediha; Zunić, Lejla

2004-01-01

In Medical Informatics medical documentation and evidention are most probably the key areas. Also, in primary health care it is very important and part of daily activity of medical staff. Bosnia and Herzegovina is trying to be close to developed countries and to modernize and computerize current systems of documentation and to cross over from manual and semi manual methods to computerized medical data analysis. The most of European countries have developed standards and classification systems in primary health care for collecting, examination, analysis and interpretation of medical data assessed. One of possibilities as well as dilemma, which data carrier should be used for storage and manipulation of patient data in primary health care, is use of electronic medical record. Most of the South East European countries use chip or smart card and some of countries in neighborhood (Italy) choose laser card as patient data carrier. Both technologies have the advantages and disadvantages what was comprehensively colaborated by the authors in this paper, with intention to help experts who make decisions in this segment to create and to correctly influence on improvement of quality, correctness and accuracy of medical documentation in primary health care.

Review of Developments in Electronic, Clinical Data Collection, and Documentation Systems over the Last Decade - Are We Ready for Big Data in Routine Health Care?

PubMed

Kessel, Kerstin A; Combs, Stephanie E

2016-01-01

Recently, information availability has become more elaborate and widespread, and treatment decisions are based on a multitude of factors, including imaging, molecular or pathological markers, surgical results, and patient's preference. In this context, the term "Big Data" evolved also in health care. The "hype" is heavily discussed in literature. In interdisciplinary medical specialties, such as radiation oncology, not only heterogeneous and voluminous amount of data must be evaluated but also spread in different styles across various information systems. Exactly this problem is also referred to in many ongoing discussions about Big Data - the "three V's": volume, velocity, and variety. We reviewed 895 articles extracted from the NCBI databases about current developments in electronic clinical data management systems and their further analysis or postprocessing procedures. Few articles show first ideas and ways to immediately make use of collected data, particularly imaging data. Many developments can be noticed in the field of clinical trial or analysis documentation, mobile devices for documentation, and genomics research. Using Big Data to advance medical research is definitely on the rise. Health care is perhaps the most comprehensive, important, and economically viable field of application.

Shared Decision-Making for Nursing Practice: An Integrative Review.

PubMed

Truglio-Londrigan, Marie; Slyer, Jason T

2018-01-01

Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions.

Rate of electronic health record adoption in South Korea: A nation-wide survey.

PubMed

Kim, Young-Gun; Jung, Kyoungwon; Park, Young-Taek; Shin, Dahye; Cho, Soo Yeon; Yoon, Dukyong; Park, Rae Woong

2017-05-01

The adoption rate of electronic health record (EHR) systems in South Korea has continuously increased. However, in contrast to the situation in the United States (US), where there has been a national effort to improve and standardize EHR interoperability, no consensus has been established in South Korea. The goal of this study was to determine the current status of EHR adoption in South Korean hospitals compared to that in the US. All general and tertiary teaching hospitals in South Korea were surveyed regarding their EHR status in 2015 with the same questionnaire as used previously. The survey form estimated the level of adoption of EHR systems according to 24 core functions in four categories (clinical documentation, result view, computerized provider order entry, and decision supports). The adoption level was classified into comprehensive and basic EHR systems according to their functionalities. EHRs and computerized physician order entry systems were used in 58.1% and 86.0% of South Korean hospitals, respectively. Decision support systems and problem list documentation were the functions most frequently missing from comprehensive and basic EHR systems. The main barriers cited to adoption of EHR systems were the cost of purchasing (48%) and the ongoing cost of maintenance (11%). The EHR adoption rate in Korean hospitals (37.2%) was higher than that in US hospitals in 2010 (15.1%), but this trend was reversed in 2015 (58.1% vs. 75.2%). The evidence suggests that these trends were influenced by the level of financial and political support provided to US hospitals after the HITECH Act was passed in 2009. The EHR adoption rate in Korea has increased, albeit more slowly than in the US. It is logical to suggest that increased funding and support tied to the HITECH Act in the US partly explains the difference in the adoption rates of EHRs in both countries. Copyright © 2017 Elsevier B.V. All rights reserved.

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... integrated into the decision-making process. Because of the diversity of FEMA, it is not feasible to describe..., for integration of environmental considerations into the decision-making process. The Regional... document for the purpose of justifying the decision. Rather it is a concise document that sets forth the...

The potential for advanced computerized aids for comprehensible writing of technical documents

NASA Astrophysics Data System (ADS)

Kieras, D. E.

1985-01-01

It is widely agreed that technical documents for equipment are poorly written and hard to comprehend. This has been a long-standing problem because the information-processing demands of editing and revision are so high that many comprehensibility problems go undetected. However, many of these problems can be detected by computerized systems that scan a document and point out where the writing can be improved. Existing systems of this type are based on conventional writing customs, rather than on the research literature on comprehension, and give poor advice or miss important problems. They also do not process the input document to any depth. An approach to advanced writing aids is described; such a system would base its criticisms on what is known about the cognition psychology of comprehension, and would make use of techniques from artificial intelligence for processing the language. Some examples of the relevant research results are presented, and a demonstration system of this type is briefly described.

Glossary

MedlinePlus

... healthcare A document that designates the person you trust to make medical decisions on your behalf if ... healthcare: a document that designates the person you trust to make medical decisions on your behalf if ...

Management of the geriatric trauma patient at risk of death: therapy withdrawal decision making.

PubMed

Trunkey, D D; Cahn, R M; Lenfesty, B; Mullins, R

2000-01-01

The management of geriatric injured patients admitted to a trauma center includes the selective decision to provide comfort care only, including withdrawal of therapy, and a choice to not use full application of standard therapies. The decision makers in this process include multiple individuals in addition to the patient. Retrospective review of documentation by 2 blinded reviewers of the cohort of patients over a recent 5-year period (1993-1997). Trauma service of a level I trauma center. A convenience sample of patients aged 65 years and older who died, and whose medical record was available for review. Patients were categorized as having withdrawal of therapy, and documentation in the medical record of who made the assessment decisions and recommendations, and to what extent the processes of care were documented. Among 87 geriatric trauma patients who died, 47 had documentation interpreted as indicating a decision was made to withdraw therapy. In only a few circumstances was the patient capable of actively participating in these decisions. The other individuals involved in recommendations for withdrawal of therapy were, in order of prevalence, the treating trauma surgeon, family members (as proxy reporting the patient's preferences), or a second physician. Documentation regarding the end-of-life decisions was often fragmentary, and in some cases ambiguous. Copies of legal advance directives were rarely available in the medical record, and ethics committee participation was used only once. Withdrawal of therapy is a common event in the terminal care of geriatric injured patients. The process for reaching a decision regarding withdrawal of therapy is complex because in most circumstances patients' injuries preclude their full participation. Standards for documentation of essential information, including patients' preferences and decision-making ability, should be developed to improve the process and assist with recording these complicated decisions that often occur over several days of discussion.

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

41 CFR 51-7.3 - Ensuring environmental documents are actually considered in agency determinations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... contains requirements to ensure adequate consideration of environmental documents in agency decision-making... environmental documents as a part of their decision-making: (1) Action: Request. (2) Start of NEPA process: Upon... Property Management Other Provisions Relating to Public Contracts COMMITTEE FOR PURCHASE FROM PEOPLE WHO...

76 FR 49526 - Environmental Impact Statement; Saint Louis County, MN

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... environmental impacts of alternatives, including (1) No-build, (2) Purchasing title and possession of the.... The Scoping Document/Draft Scoping Decision Document is anticipated to be published in late 2011. A... Decision Document will be published after the public comment period has closed. A Draft EIS will be...

Data-based Decision-making: Teachers' Comprehension of Curriculum-based Measurement Progress-monitoring Graphs

ERIC Educational Resources Information Center

van den Bosch, Roxette M.; Espin, Christine A.; Chung, Siuman; Saab, Nadira

2017-01-01

Teachers have difficulty using data from Curriculum-based Measurement (CBM) progress graphs of students with learning difficulties for instructional decision-making. As a first step in unraveling those difficulties, we studied teachers' comprehension of CBM graphs. Using think-aloud methodology, we examined 23 teachers' ability to…

Shared Decision-Making for Nursing Practice: An Integrative Review

PubMed Central

Truglio-Londrigan, Marie; Slyer, Jason T.

2018-01-01

Background: Shared decision-making has received national and international interest by providers, educators, researchers, and policy makers. The literature on shared decision-making is extensive, dealing with the individual components of shared decision-making rather than a comprehensive process. This view of shared decision-making leaves healthcare providers to wonder how to integrate shared decision-making into practice. Objective: To understand shared decision-making as a comprehensive process from the perspective of the patient and provider in all healthcare settings. Methods: An integrative review was conducted applying a systematic approach involving a literature search, data evaluation, and data analysis. The search included articles from PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO from 1970 through 2016. Articles included quantitative experimental and non-experimental designs, qualitative, and theoretical articles about shared decision-making between all healthcare providers and patients in all healthcare settings. Results: Fifty-two papers were included in this integrative review. Three categories emerged from the synthesis: (a) communication/ relationship building; (b) working towards a shared decision; and (c) action for shared decision-making. Each major theme contained sub-themes represented in the proposed visual representation for shared decision-making. Conclusion: A comprehensive understanding of shared decision-making between the nurse and the patient was identified. A visual representation offers a guide that depicts shared decision-making as a process taking place during a healthcare encounter with implications for the continuation of shared decisions over time offering patients an opportunity to return to the nurse for reconsiderations of past shared decisions. PMID:29456779

Missouri Comprehensive Outdoor Recreation Plan: Executive Summary.

ERIC Educational Resources Information Center

Missouri State Inter-Agency for Outdoor Recreation, Jefferson.

The document is a summary of the Missouri State Comprehensive Outdoor Recreation Plan, which was designed to provide guidelines for allocation of resources for needed recreation facilities. The plan identifies the present and future needs for outdoor recreation and recommends ways of meeting these needs. This 1967 document provides a brief history…

78 FR 64970 - New Deadlines for Public Comment on Draft Environmental Documents

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-30

... interested parties to contact Service personnel and Web sites for information about these draft documents. As..., fdsys/pkg/FR-2013- CO; Comprehensive Conservation 08-07/pdf/2013- Plan and Environmental Impact 19052.pdf. Statement; Two Ponds National Wildlife Refuge, Arvada, CO; Comprehensive Conservation Plan and...

RECOVER: An Automated Cloud-Based Decision Support System for Post-fire Rehabilitation Planning

NASA Technical Reports Server (NTRS)

Schnase, John L.; Carroll, Mark; Weber, K. T.; Brown, Molly E.; Gill, Roger L.; Wooten, Margaret; May J.; Serr, K.; Smith, E.; Goldsby, R.;

RECOVER: An Automated, Cloud-Based Decision Support System for Post-Fire Rehabilitation Planning

NASA Astrophysics Data System (ADS)

Schnase, J. L.; Carroll, M. L.; Weber, K. T.; Brown, M. E.; Gill, R. L.; Wooten, M.; May, J.; Serr, K.; Smith, E.; Goldsby, R.; Newtoff, K.; Bradford, K.; Doyle, C.; Volker, E.; Weber, S.

2014-11-01

RECOVER is a site-specific decision support system that automatically brings together in a single analysis environment the information necessary for post-fire rehabilitation decision-making. After a major wildfire, law requires that the federal land management agencies certify a comprehensive plan for public safety, burned area stabilization, resource protection, and site recovery. These burned area emergency response (BAER) plans are a crucial part of our national response to wildfire disasters and depend heavily on data acquired from a variety of sources. Final plans are due within 21 days of control of a major wildfire and become the guiding document for managing the activities and budgets for all subsequent remediation efforts. There are few instances in the federal government where plans of such wide-ranging scope and importance are assembled on such short notice and translated into action more quickly. RECOVER has been designed in close collaboration with our agency partners and directly addresses their high-priority decision-making requirements. In response to a fire detection event, RECOVER uses the rapid resource allocation capabilities of cloud computing to automatically collect Earth observational data, derived decision products, and historic biophysical data so that when the fire is contained, BAER teams will have a complete and ready-to-use RECOVER dataset and GIS analysis environment customized for the target wildfire. Initial studies suggest that RECOVER can transform this information-intensive process by reducing from days to a matter of minutes the time required to assemble and deliver crucial wildfire-related data.

30 CFR 746.13 - Decision document and recommendation on mining plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Decision document and recommendation on mining plan. 746.13 Section 746.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR FEDERAL LANDS PROGRAM REVIEW AND APPROVAL OF MINING PLANS § 746.13 Decision...

A computerized clinical decision support system as a means of implementing depression guidelines.

PubMed

Trivedi, Madhukar H; Kern, Janet K; Grannemann, Bruce D; Altshuler, Kenneth Z; Sunderajan, Prabha

2004-08-01

The authors describe the history and current use of computerized systems for implementing treatment guidelines in general medicine as well as the development, testing, and early use of a computerized decision support system for depression treatment among "real-world" clinical settings in Texas. In 1999 health care experts from Europe and the United States met to confront the well-documented challenges of implementing treatment guidelines and to identify strategies for improvement. They suggested the integration of guidelines into computer systems that is incorporated into clinical workflow. Several studies have demonstrated improvements in physicians' adherence to guidelines when such guidelines are provided in a computerized format. Although computerized decision support systems are being used in many areas of medicine and have demonstrated improved patient outcomes, their use in psychiatric illness is limited. The authors designed and developed a computerized decision support system for the treatment of major depressive disorder by using evidence-based guidelines, transferring the knowledge gained from the Texas Medication Algorithm Project (TMAP). This computerized decision support system (CompTMAP) provides support in diagnosis, treatment, follow-up, and preventive care and can be incorporated into the clinical setting. CompTMAP has gone through extensive testing to ensure accuracy and reliability. Physician surveys have indicated a positive response to CompTMAP, although the sample was insufficient for statistical testing. CompTMAP is part of a new era of comprehensive computerized decision support systems that take advantage of advances in automation and provide more complete clinical support to physicians in clinical practice.

Interactive decision support in hepatic surgery

PubMed Central

Dugas, Martin; Schauer, Rolf; Volk, Andreas; Rau, Horst

2002-01-01

Background Hepatic surgery is characterized by complicated operations with a significant peri- and postoperative risk for the patient. We developed a web-based, high-granular research database for comprehensive documentation of all relevant variables to evaluate new surgical techniques. Methods To integrate this research system into the clinical setting, we designed an interactive decision support component. The objective is to provide relevant information for the surgeon and the patient to assess preoperatively the risk of a specific surgical procedure. Based on five established predictors of patient outcomes, the risk assessment tool searches for similar cases in the database and aggregates the information to estimate the risk for an individual patient. Results The physician can verify the analysis and exclude manually non-matching cases according to his expertise. The analysis is visualized by means of a Kaplan-Meier plot. To evaluate the decision support component we analyzed data on 165 patients diagnosed with hepatocellular carcinoma (period 1996–2000). The similarity search provides a two-peak distribution indicating there are groups of similar patients and singular cases which are quite different to the average. The results of the risk estimation are consistent with the observed survival data, but must be interpreted with caution because of the limited number of matching reference cases. Conclusion Critical issues for the decision support system are clinical integration, a transparent and reliable knowledge base and user feedback. PMID:12003639

Evidence-based patient information about treatment of multiple sclerosis--a phase one study on comprehension and emotional responses.

PubMed

Kasper, Jürgen; Köpke, Sascha; Mühlhauser, Ingrid; Heesen, Christoph

2006-07-01

This study analysis the comprehension and emotional responses of people suffering from multiple sclerosis when provided with an evidence-based information module. It is a core module of a comprehensive decision aid about immunotherapy. The core module is designed to enable patients to process scientific uncertainty without adverse effects. It considers existing standards for risk communication and presentation of data. Using a mailing approach we investigated 169 patients with differing courses of disease in a before-after design. Items addressed the competence in processing relative and absolute risk information and patients' emotional response to the tool, comprising grade of familiarity with the information, understanding, relevance, emotional arousal, and certainty. Overall, numeracy improved (p < 0.001), although 99 of 169 patients did not complete the numeracy task correctly. Understanding depended on the relevance related to the course of disease. A moderate level of uncertainty was induced. No adverse emotional responses could be shown, neither in those who did comprehend the information, nor in those who did not develop numeracy skills. In conclusion, the tool supports people suffering from multiple sclerosis to process evidence-based medical information and scientific uncertainty without burdening them emotionally. This study is an example for the documentation of an important step in the development process of a complex intervention.

43 CFR 46.315 - How to format an environmental assessment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... planning, decision-making, and appropriate public participation. (b) An environmental assessment may be accompanied by any other planning or decision-making document. The portion of the document that analyzes the...

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

PubMed

Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

2017-01-01

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

Non-medical influences on medical decision-making.

PubMed

McKinlay, J B; Potter, D A; Feldman, H A

1996-03-01

The influence of non-medical factors on physicians' decision-making has been documented in many observational studies, but rarely in an experimental setting capable of demonstrating cause and effect. We conducted a controlled factorial experiment to assess the influence of non-medical factors on the diagnostic and treatment decisions made by practitioners of internal medicine in two common medical situations. One hundred and ninety-two white male internists individually viewed professionally produced video scenarios in which the actor-patient, presenting with either chest pain or dyspnea, possessed various balanced combinations of sex, race, age, socioeconomic status, and health insurance coverage. Physician subjects were randomly drawn from lists of internists in private practice, hospital-based practice, and HMO's, at two levels of experience. The most frequent diagnoses for both chest pain and dyspnea were psychogenic origin and cardiac problems. Smoking cessation was the most frequent treatment recommendation for both conditions. Younger patients (all other factors being the same) were significantly more likely to receive the psychogenic diagnosis. Older patients were more likely to receive the cardiac diagnosis for chest pain, particularly if they were insured. HMO-based physicians were more likely to recommend a follow-up visit for chest pain. Several interactions of patient and physician factors were significant in addition to the main effects. The variability in decision-making evidenced by physicians in this experiment was not entirely accounted for by strictly rational Bayesian inference (the common prescriptive model for medical decision-making), in-as-much as non-medical factors significantly affected the decisions that they made. There is a need to supplement idealized medical schemata with considerations of social behavior in any comprehensive theory of medical decision-making.

75 FR 18205 - Notice of Peer Review Meeting for the External Peer Review Drafts of Two Documents on Using...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... Role of Risk Analysis in Decision-Making AGENCY: Environmental Protection Agency (EPA). ACTION: Notice... documents entitled, ``Using Probabilistic Methods to Enhance the Role of Risk Analysis in Decision- Making... Probabilistic Methods to Enhance the Role of Risk Analysis in Decision-Making, with Case Study Examples'' and...

Power, Authority and Decision Making in Teacher Education. Yearbook 1971.

ERIC Educational Resources Information Center

American Association of Colleges for Teacher Education, Washington, DC.

This document is a collection of reports of the American Association of Colleges for Teacher Education (AACTE) for 1971. The title of the document reflects much of the association's concern for that year and is close to the theme of the association's 1971 annual meeting, "Power and Decision Making in Teacher Education." The document is divided…

An experimental paradigm for team decision processes

NASA Technical Reports Server (NTRS)

Serfaty, D.; Kleinman, D. L.

1986-01-01

The study of distributed information processing and decision making is presently hampered by two factors: (1) The inherent complexity of the mathematical formulation of decentralized problems has prevented the development of models that could be used to predict performance in a distributed environment; and (2) The lack of comprehensive scientific empirical data on human team decision making has hindered the development of significant descriptive models. As a part of a comprehensive effort to find a new framework for multihuman decision making problems, a novel experimental research paradigm was developed involving human terms in decision making tasks. Attempts to construct parts of an integrated model with ideas from queueing networks, team theory, distributed estimation and decentralized resource management are described.

Beyond the Story Map: Inferential Comprehension via Character Perspective

ERIC Educational Resources Information Center

McTigue, Erin; Douglass, April; Wright, Katherine L.; Hodges, Tracey S.; Franks, Amanda D.

2015-01-01

Inferential comprehension requires both emotional intelligence and cognitive skills, however instructional comprehension strategies typically underemphasize the emotional contribution. This article documents an intervention used by diverse third grade students which centers on teaching story comprehension through character perspective-taking…

'Practical' resources to support patient and family engagement in healthcare decisions: a scoping review.

PubMed

Kovacs Burns, Katharina; Bellows, Mandy; Eigenseher, Carol; Gallivan, Jennifer

2014-04-15

Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify 'patient/family engagement' tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders. Search terms related to 'patient engagement', tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing 'patient engagement' with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents. Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of 'tools', 'education' and 'infrastructure'. The synthesis and findings in the literature include 15 different terms and definitions for 'patient engagement', 17 different engagement models, numerous barriers and benefits, and 34 toolkits for various patient engagement and evaluation initiatives. Patient engagement is very complex. This scoping review for patient/family engagement tools and guides is a good start for a resource inventory and can guide the content development of a patient engagement resource kit to be used by patients/families, healthcare providers and administrators.

‘Practical’ resources to support patient and family engagement in healthcare decisions: a scoping review

PubMed Central

2014-01-01

Background Extensive literature exists on public involvement or engagement, but what actual tools or guides exist that are practical, tested and easy to use specifically for initiating and implementing patient and family engagement, is uncertain. No comprehensive review and synthesis of general international published or grey literature on this specific topic was found. A systematic scoping review of published and grey literature is, therefore, appropriate for searching through the vast general engagement literature to identify ‘patient/family engagement’ tools and guides applicable in health organization decision-making, such as within Alberta Health Services in Alberta, Canada. This latter organization requested this search and review to inform the contents of a patient engagement resource kit for patients, providers and leaders. Methods Search terms related to ‘patient engagement’, tools, guides, education and infrastructure or resources, were applied to published literature databases and grey literature search engines. Grey literature also included United States, Australia and Europe where most known public engagement practices exist, and Canada as the location for this study. Inclusion and exclusion criteria were set, and include: English documents referencing ‘patient engagement’ with specific criteria, and published between 1995 and 2011. For document analysis and synthesis, document analysis worksheets were used by three reviewers for the selected 224 published and 193 grey literature documents. Inter-rater reliability was ensured for the final reviews and syntheses of 76 published and 193 grey documents. Results Seven key themes emerged from the literature synthesis analysis, and were identified for patient, provider and/or leader groups. Articles/items within each theme were clustered under main topic areas of ‘tools’, ‘education’ and ‘infrastructure’. The synthesis and findings in the literature include 15 different terms and definitions for ‘patient engagement’, 17 different engagement models, numerous barriers and benefits, and 34 toolkits for various patient engagement and evaluation initiatives. Conclusions Patient engagement is very complex. This scoping review for patient/family engagement tools and guides is a good start for a resource inventory and can guide the content development of a patient engagement resource kit to be used by patients/families, healthcare providers and administrators. PMID:24735787

Research on comprehensive decision-making of PV power station connecting system

NASA Astrophysics Data System (ADS)

Zhou, Erxiong; Xin, Chaoshan; Ma, Botao; Cheng, Kai

2018-04-01

In allusion to the incomplete indexes system and not making decision on the subjectivity and objectivity of PV power station connecting system, based on the combination of improved Analytic Hierarchy Process (AHP), Criteria Importance Through Intercriteria Correlation (CRITIC) as well as grey correlation degree analysis (GCDA) is comprehensively proposed to select the appropriate system connecting scheme of PV power station. Firstly, indexes of PV power station connecting system are divided the recursion order hierarchy and calculated subjective weight by the improved AHP. Then, CRITIC is adopted to determine the objective weight of each index through the comparison intensity and conflict between indexes. The last the improved GCDA is applied to screen the optimal scheme, so as to, from the subjective and objective angle, select the connecting system. Comprehensive decision of Xinjiang PV power station is conducted and reasonable analysis results are attained. The research results might provide scientific basis for investment decision.

Death Penalty Decisions: Instruction Comprehension, Attitudes, and Decision Mediators.

PubMed

Patry, Marc W; Penrod, Steven D

2013-01-01

A primary goal of this research was to empirically evaluate a set of assumptions, advanced in the Supreme Court's ruling in Buchanan v. Angelone (1998), about jury comprehension of death penalty instructions. Further, this research examined the use of evidence in capital punishment decision making by exploring underlying mediating factors upon which death penalty decisions may be based. Manipulated variables included the type of instructions and several variations of evidence. Study 1 was a paper and pencil study of 245 undergraduate mock jurors. The experimental design was an incomplete 4×2×2×2×2 factorial model resulting in 56 possible conditions. Manipulations included four different types of instructions, presence of a list of case-specific mitigators to accompany the instructions, and three variations in the case facts: age of the defendant, bad prior record, and defendant history of emotional abuse. Study 2 was a fully-crossed 2×2×2×2×2 experiment with four deliberating mock juries per cell. Manipulations included jury instructions (original or revised), presence of a list of case-specific mitigators, defendant history of emotional abuse, bad prior record, and heinousness of the crime. The sample of 735 jury-eligible participants included 130 individuals who identified themselves as students. Participants watched one of 32 stimulus videotapes based on a replication of a capital sentencing hearing. The present findings support previous research showing low comprehension of capital penalty instructions. Further, we found that higher instruction comprehension was associated with higher likelihood of issuing life sentence decisions. The importance of instruction comprehension is emphasized in a social cognitive model of jury decision making at the sentencing phase of capital cases.

Death Penalty Decisions: Instruction Comprehension, Attitudes, and Decision Mediators

PubMed Central

Patry, Marc W.; Penrod, Steven D.

2013-01-01

A primary goal of this research was to empirically evaluate a set of assumptions, advanced in the Supreme Court’s ruling in Buchanan v. Angelone (1998), about jury comprehension of death penalty instructions. Further, this research examined the use of evidence in capital punishment decision making by exploring underlying mediating factors upon which death penalty decisions may be based. Manipulated variables included the type of instructions and several variations of evidence. Study 1 was a paper and pencil study of 245 undergraduate mock jurors. The experimental design was an incomplete 4×2×2×2×2 factorial model resulting in 56 possible conditions. Manipulations included four different types of instructions, presence of a list of case-specific mitigators to accompany the instructions, and three variations in the case facts: age of the defendant, bad prior record, and defendant history of emotional abuse. Study 2 was a fully-crossed 2×2×2×2×2 experiment with four deliberating mock juries per cell. Manipulations included jury instructions (original or revised), presence of a list of case-specific mitigators, defendant history of emotional abuse, bad prior record, and heinousness of the crime. The sample of 735 jury-eligible participants included 130 individuals who identified themselves as students. Participants watched one of 32 stimulus videotapes based on a replication of a capital sentencing hearing. The present findings support previous research showing low comprehension of capital penalty instructions. Further, we found that higher instruction comprehension was associated with higher likelihood of issuing life sentence decisions. The importance of instruction comprehension is emphasized in a social cognitive model of jury decision making at the sentencing phase of capital cases. PMID:24072981

Automatic design of decision-tree induction algorithms tailored to flexible-receptor docking data.

PubMed

Barros, Rodrigo C; Winck, Ana T; Machado, Karina S; Basgalupp, Márcio P; de Carvalho, André C P L F; Ruiz, Duncan D; de Souza, Osmar Norberto

2012-11-21

This paper addresses the prediction of the free energy of binding of a drug candidate with enzyme InhA associated with Mycobacterium tuberculosis. This problem is found within rational drug design, where interactions between drug candidates and target proteins are verified through molecular docking simulations. In this application, it is important not only to correctly predict the free energy of binding, but also to provide a comprehensible model that could be validated by a domain specialist. Decision-tree induction algorithms have been successfully used in drug-design related applications, specially considering that decision trees are simple to understand, interpret, and validate. There are several decision-tree induction algorithms available for general-use, but each one has a bias that makes it more suitable for a particular data distribution. In this article, we propose and investigate the automatic design of decision-tree induction algorithms tailored to particular drug-enzyme binding data sets. We investigate the performance of our new method for evaluating binding conformations of different drug candidates to InhA, and we analyze our findings with respect to decision tree accuracy, comprehensibility, and biological relevance. The empirical analysis indicates that our method is capable of automatically generating decision-tree induction algorithms that significantly outperform the traditional C4.5 algorithm with respect to both accuracy and comprehensibility. In addition, we provide the biological interpretation of the rules generated by our approach, reinforcing the importance of comprehensible predictive models in this particular bioinformatics application. We conclude that automatically designing a decision-tree algorithm tailored to molecular docking data is a promising alternative for the prediction of the free energy from the binding of a drug candidate with a flexible-receptor.

Automatic design of decision-tree induction algorithms tailored to flexible-receptor docking data

PubMed Central

2012-01-01

Background This paper addresses the prediction of the free energy of binding of a drug candidate with enzyme InhA associated with Mycobacterium tuberculosis. This problem is found within rational drug design, where interactions between drug candidates and target proteins are verified through molecular docking simulations. In this application, it is important not only to correctly predict the free energy of binding, but also to provide a comprehensible model that could be validated by a domain specialist. Decision-tree induction algorithms have been successfully used in drug-design related applications, specially considering that decision trees are simple to understand, interpret, and validate. There are several decision-tree induction algorithms available for general-use, but each one has a bias that makes it more suitable for a particular data distribution. In this article, we propose and investigate the automatic design of decision-tree induction algorithms tailored to particular drug-enzyme binding data sets. We investigate the performance of our new method for evaluating binding conformations of different drug candidates to InhA, and we analyze our findings with respect to decision tree accuracy, comprehensibility, and biological relevance. Results The empirical analysis indicates that our method is capable of automatically generating decision-tree induction algorithms that significantly outperform the traditional C4.5 algorithm with respect to both accuracy and comprehensibility. In addition, we provide the biological interpretation of the rules generated by our approach, reinforcing the importance of comprehensible predictive models in this particular bioinformatics application. Conclusions We conclude that automatically designing a decision-tree algorithm tailored to molecular docking data is a promising alternative for the prediction of the free energy from the binding of a drug candidate with a flexible-receptor. PMID:23171000

Choice and Decision Processes and Careers. Information Series No. 7.

ERIC Educational Resources Information Center

Tiedeman, David V.; Miller-Tiedeman, Anna

The state of the art review depicts comprehension of choice and decision making as knowable and demonstrates that something is already known about both processes and how to facilitate their comprehension. The assumption is made that deciding to choose, choosing to decide, deciding in order to choose, and choosing in order to decide must be…

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

Phytotechnology Technical and Regulatory Guidance Document

DTIC Science & Technology

2001-04-01

contaminated media is rather new. Throughout the development process of this document, we referred to the science as “ phytoremediation .” Recently...the media containing contaminants, we now refer to “phytotechnologies” as the overarching terminology, while using “ phytoremediation ” more...publication of the ITRC document, Phytoremediation Decision Tree. The decision tree was designed to allow potential users to take basic information

Documenting Living Monuments in Indonesia: Methodology for Sustainable Utility

NASA Astrophysics Data System (ADS)

Suryaningsih, F.; Purwestri, N.

2013-07-01

The systematic documentation of cultural heritage in Indonesia has been developed after the establishment of Bataviaasch Genootschap van Kunsten en Wetenschappen (1778) and De Oudheidkundige Dienst (1913) by the Netherlands Indies government. After Indonesian independent, the tasks of cultural heritage documentation take over by The Ministry of Culture (now become The Ministry of Education of Culture) with focus on the ancient and classical heritage, so called dead monument. The needed of comprehensive documentation data regarding cultural heritage become significant issues since the government and private sector pay attention to the preservation of heritage building in the urban site, so called living monument. The archives of original drawing plan many times do not fit with the existing condition, while the conservation plan demands a document such as built drawing plan to work on. The technology, methodology and system to provide such comprehensive document of heritage building and site become important, to produce good conservation plan and heritage building regular maintenance. It means the products will have a sustainable and various utility values. Since 1994, Documentation Centre for Architecture - Indonesia (PDA), has established to meet the needs of a comprehensive data of heritage building (living monuments), to utilized as basic document for conservation planning. Not only provide document of the digital drawing such site plan, plan, elevation, section and details of architecture elements, but also document of historic research, material analysis and completed with diagnosis and mapping of building damages. This manuscript is about PDA field experience, working in this subject issue

Exploring model based engineering for large telescopes: getting started with descriptive models

NASA Astrophysics Data System (ADS)

Karban, R.; Zamparelli, M.; Bauvir, B.; Koehler, B.; Noethe, L.; Balestra, A.

2008-07-01

Large telescopes pose a continuous challenge to systems engineering due to their complexity in terms of requirements, operational modes, long duty lifetime, interfaces and number of components. A multitude of decisions must be taken throughout the life cycle of a new system, and a prime means of coping with complexity and uncertainty is using models as one decision aid. The potential of descriptive models based on the OMG Systems Modeling Language (OMG SysMLTM) is examined in different areas: building a comprehensive model serves as the basis for subsequent activities of soliciting and review for requirements, analysis and design alike. Furthermore a model is an effective communication instrument against misinterpretation pitfalls which are typical of cross disciplinary activities when using natural language only or free-format diagrams. Modeling the essential characteristics of the system, like interfaces, system structure and its behavior, are important system level issues which are addressed. Also shown is how to use a model as an analysis tool to describe the relationships among disturbances, opto-mechanical effects and control decisions and to refine the control use cases. Considerations on the scalability of the model structure and organization, its impact on the development process, the relation to document-centric structures, style and usage guidelines and the required tool chain are presented.

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

ERIC Educational Resources Information Center

Landmesser, John Andrew

2014-01-01

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

Measuring nursing essential contributions to quality patient care outcomes.

PubMed

Wolgast, Kelly A; Taylor, Katherine; Garcia, Dawn; Watkins, Miko

2011-01-01

Workload Management System for Nursing (WMSN) is a core Army Medical Department business system that has provided near real-time, comprehensive nursing workload and manpower data for decision making at all levels for over 25 years. The Army Manpower Requirements and Documentation Agency populates data from WMSN into the Manpower Staffing Standards System (Inpatient module within Automated Staffing Assessment Model). The current system, Workload Management System for Nursing Internet (WMSNi), is an interim solution that requires additional functionalities for modernization and integration at the enterprise level. The expanding missions and approved requirements for WMSNi support strategic initiatives on the Army Medical Command balanced scorecard and require continued sustainment for multiple personnel and manpower business processes for both inpatient and outpatient nursing care. This system is currently being leveraged by the TRICARE Management Activity as an interim multiservice solution, and is being used at 24 Army medical treatment facilities. The evidenced-based information provided to Army decision makers through the methods used in the WMSNi will be essential across the Army Medical Command throughout the system's life cycle.

Building America Case Study: Design Guidance for Passive Vents in New Construction Multifamily Buildings, New York, New York

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

2016-02-01

This document addresses the use of passive vents as a source of outdoor air in multifamily buildings. The challenges associated with implementing passive vents and the factors affecting performance are outlined. A comprehensive design methodology and quantified performance metrics are provided. Two hypothetical design examples are provided to illustrate the process. This document is intended to be useful to designers, decision-makers, and contractors implementing passive ventilation strategies. It is also intended to be a resource for those responsible for setting high-performance building program requirements, especially pertaining to ventilation and outdoor air. To ensure good indoor air quality, a dedicated sourcemore » of outdoor air is an integral part of high-performance buildings. Presently, there is a lack of guidance pertaining to the design and installation of passive vents, resulting in poor system performance. This report details the criteria necessary for designing, constructing, and testing passive vent systems to enable them to provide consistent and reliable levels of ventilation air from outdoors.« less

Postconstruction report of the United Nuclear Corporation Disposal Site at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Environmental Restoration Program

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

Oakley, L.B.; Siberell, J.K.; Voskuil, T.L.

1993-06-01

Remedial actions conducted under the auspices of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) were completed at the Y-12 United Nuclear Corporation (UNC) Disposal Site in August 1992. The purpose of this Postconstruction Report is to summarize numerous technical reports and provide CERCLA documentation for completion of the remedial actions. Other CERCLA reports, such as the Feasibility Study for the UNC Disposal Site, provide documentation leading up to the remedial action decision. The remedial action chosen, placement of a modified RCRA cap, was completed successfully, and performance standards were either met or exceeded. This remedial action provided solutionsmore » to two environmentally contaminated areas and achieved the goal of minimizing the potential for contamination of the shallow groundwater downgradient of the site, thereby providing protection of human health and the environment. Surveillance and maintenance of the cap will be accomplished to ensure cap integrity, and groundwater monitoring downgradient of the site will continue to confirm the acceptability of the remedial action chosen.« less

Health technology funding decision-making processes around the world: the same, yet different.

PubMed

Stafinski, Tania; Menon, Devidas; Philippon, Donald J; McCabe, Christopher

2011-06-01

All healthcare systems routinely make resource allocation decisions that trade off potential health gains to different patient populations. However, when such trade-offs relate to the introduction of new, promising health technologies, perceived 'winners' and 'losers' are more apparent. In recent years, public scrutiny over such decisions has intensified, raising the need to better understand how they are currently made and how they might be improved. The objective of this paper is to critically review and compare current processes for making health technology funding decisions at the regional, state/provincial and national level in 20 countries. A comprehensive search for published, peer-reviewed and grey literature describing actual national, state/provincial and regional/institutional technology decision-making processes was conducted. Information was extracted by two independent reviewers and tabulated to facilitate qualitative comparative analyses. To identify strengths and weaknesses of processes identified, websites of corresponding organizations were searched for commissioned reviews/evaluations, which were subsequently analysed using standard qualitative methods. A total of 21 national, four provincial/state and six regional/institutional-level processes were found. Although information on each one varied, they could be grouped into four sequential categories: (i) identification of the decision problem; (ii) information inputs; (iii) elements of the decision-making process; and (iv) public accountability and decision implementation. While information requirements of all processes appeared substantial and decision-making factors comprehensive, the way in which they were utilized was often unclear, as were approaches used to incorporate social values or equity arguments into decisions. A comprehensive inventory of approaches to implementing the four main components of all technology funding decision-making processes was compiled, from which areas for future work or research aimed at improving the acceptability of decisions were identified. They include the explication of decision criteria and social values underpinning processes.

SciReader enables reading of medical content with instantaneous definitions.

PubMed

Gradie, Patrick R; Litster, Megan; Thomas, Rinu; Vyas, Jay; Schiller, Martin R

2011-01-25

A major problem patients encounter when reading about health related issues is document interpretation, which limits reading comprehension and therefore negatively impacts health care. Currently, searching for medical definitions from an external source is time consuming, distracting, and negatively impacts reading comprehension and memory of the material. SciReader was built as a Java application with a Flex-based front-end client. The dictionary used by SciReader was built by consolidating data from several sources and generating new definitions with a standardized syntax. The application was evaluated by measuring the percentage of words defined in different documents. A survey was used to test the perceived effect of SciReader on reading time and comprehension. We present SciReader, a web-application that simplifies document interpretation by allowing users to instantaneously view medical, English, and scientific definitions as they read any document. This tool reveals the definitions of any selected word in a small frame at the top of the application. SciReader relies on a dictionary of ~750,000 unique Biomedical and English word definitions. Evaluation of the application shows that it maps ~98% of words in several different types of documents and that most users tested in a survey indicate that the application decreases reading time and increases comprehension. SciReader is a web application useful for reading medical and scientific documents. The program makes jargon-laden content more accessible to patients, educators, health care professionals, and the general public.

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

ERIC Educational Resources Information Center

Erskine, Michael A.

2013-01-01

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…

Evaluating the impact of an educational intervention on documentation of decision-making capacity in an emergency medical services system.

PubMed

Riley, Jennifer; Burgess, Rob; Schwartz, Brian

2004-07-01

To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.

Drinking-water-criteria document for phthalic acid esters (PAES). Final report

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

Not Available

1991-08-01

The document provides the health effects basis to be considered in establishing the MCLG. To achieve the objective, data on pharmacokinetics human exposure, acute and chronic toxicity to animals and humans, epidemiology and mechanisms of toxicity are evaluated for phthalic acid esters. Specific emphasis is placed on literature data providing dose-response information. Thus, while the literature search and evaluation performed in support of the document has been comprehensive, only the reports considered most pertinent in the derivation of the MCLG are cited in the document. The comprehensive literature data base in support of the document includes information published up tomore » 1986; however, more recent data may have been added during the review process.« less

Lexical decision as an endophenotype for reading comprehension: An exploration of an association

PubMed Central

NAPLES, ADAM; KATZ, LEN; GRIGORENKO, ELENA L.

2012-01-01

Based on numerous suggestions in the literature, we evaluated lexical decision (LD) as a putative endophenotype for reading comprehension by investigating heritability estimates and segregation analyses parameter estimates for both of these phenotypes. Specifically, in a segregation analysis of a large sample of families, we established that there is little to no overlap between genes contributing to LD and reading comprehension and that the genetic mechanism behind LD derived from this analysis appears to be more complex than that for reading comprehension. We conclude that in our sample, LD is not a good candidate as an endophenotype for reading comprehension, despite previous suggestions from the literature. Based on this conclusion, we discuss the role and benefit of the endophenotype approach in studies of complex human cognitive functions. PMID:23062302

Analyzing Decision Logs to Understand Decision Making in Serious Crime Investigations.

PubMed

Dando, Coral J; Ormerod, Thomas C

2017-12-01

Objective To study decision making by detectives when investigating serious crime through the examination of decision logs to explore hypothesis generation and evidence selection. Background Decision logs are used to record and justify decisions made during serious crime investigations. The complexity of investigative decision making is well documented, as are the errors associated with miscarriages of justice and inquests. The use of decision logs has not been the subject of an empirical investigation, yet they offer an important window into the nature of investigative decision making in dynamic, time-critical environments. Method A sample of decision logs from British police forces was analyzed qualitatively and quantitatively to explore hypothesis generation and evidence selection by police detectives. Results Analyses revealed diversity in documentation of decisions that did not correlate with case type and identified significant limitations of the decision log approach to supporting investigative decision making. Differences emerged between experienced and less experienced officers' decision log records in exploration of alternative hypotheses, generation of hypotheses, and sources of evidential inquiry opened over phase of investigation. Conclusion The practical use of decision logs is highly constrained by their format and context of use. Despite this, decision log records suggest that experienced detectives display strategic decision making to avoid confirmation and satisficing, which affect less experienced detectives. Application Potential applications of this research include both training in case documentation and the development of new decision log media that encourage detectives, irrespective of experience, to generate multiple hypotheses and optimize the timely selection of evidence to test them.

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

Tiradani, Tiradani,Anthony; Altunay, Mine; Dagenhart, David

The Decision Engine is a critical component of the HEP Cloud Facility. It provides the functionality of resource scheduling for disparate resource providers, including those which may have a cost or a restricted allocation of cycles. Along with the architecture, design, and requirements for the Decision Engine, this document will provide the rationale and explanations for various design decisions. In some cases, requirements and interfaces for a limited subset of external services will be included in this document. This document is intended to be a high level design. The design represented in this document is not complete and does notmore » break everything down in detail. The class structures and pseudo-code exist for example purposes to illustrate desired behaviors, and as such, should not be taken literally. The protocols and behaviors are the important items to take from this document. This project is still in prototyping mode so flaws and inconsistencies may exist and should be noted and treated as failures.« less

Improving Reading Comprehension by Predicting, Monitoring Comprehension, Remediation, and Personal Response Strategies.

ERIC Educational Resources Information Center

Jacobucci, Leanne; Richert, Judy; Ronan, Susan; Tanis, Ariana

This report describes a program for improving inconsistent reading comprehension. The targeted population consisted of first, third, and fifth grade classrooms in a diverse middle class community located in Illinois. The problems of low academic achievement were documented through teacher observation, reading comprehension test scores, and low…

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How is the decision made to issue or deny..., PURCHASE, BARTER, EXPORTATION, AND IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) CONVENTION ON... Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

No Further Remedial Action Planned Decision Document for Site 3.

DTIC Science & Technology

1998-04-01

INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 3 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland &nc QUALITY IMSmm«^ 19980519 204 XA REPORT...Document for Site 3 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Montgomery

A systematic review and summarization of the recommendations and research surrounding Curriculum-Based Measurement of oral reading fluency (CBM-R) decision rules.

PubMed

Ardoin, Scott P; Christ, Theodore J; Morena, Laura S; Cormier, Damien C; Klingbeil, David A

2013-02-01

Research and policy have established that data are necessary to guide decisions within education. Many of these decisions are made within problem solving and response to intervention frameworks for service delivery. Curriculum-Based Measurement in Reading (CBM-R) is a widely used data collection procedure within those models of service delivery. Although the evidence for CBM-R as a screening and benchmarking procedure has been summarized multiple times in the literature, there is no comprehensive review of the evidence for its application to monitor and evaluate individual student progress. The purpose of this study was to identify and summarize the psychometric and empirical evidence for CBM-R as it is used to monitor and evaluate student progress. There was an emphasis on the recommended number of data points collected during progress monitoring and interpretive guidelines. The review identified 171 journal articles, chapters, and instructional manuals using online search engines and research databases. Recommendations and evidence from 102 documents that met the study criteria were evaluated and summarized. Results indicate that most decision-making practices are based on expert opinion and that there is very limited psychometric or empirical support for such practices. There is a lack of published evidence to support program evaluation and progress monitoring with CBM-R. More research is required to inform data collection procedures and interpretive guidelines. Copyright © 2012 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Principles of haemophilia care: The Asia-Pacific perspective.

PubMed

Dunkley, S; Lam, J C M; John, M J; Wong, R S M; Tran, H; Yang, R; Nair, S C; Shima, M; Street, A; Srivastava, A

2018-02-21

Optimal haemophilia care is best established and implemented through a well-coordinated plan guided by clearly defined principles and priorities. A document which enunciates those details is therefore important. A successful example of this approach is the definition of principles of haemophilia care (PHC) outlined by the European Association for Haemophilia and Associated Disorders (EAHAD) and also the World Federation of Hemophilia. A similar document applicable to the Asia-Pacific region must take into account not only the highly varied healthcare systems but also the tremendous socio-economic and cultural diversities which impact provision of such care. The Asia-Pacific Haemophilia Working Group (APHWG), representing the countries in this region, has prepared this perspective of the PHC. While endorsing the overall framework outlined by EAHAD, this APHWG document emphasizes regional priorities on education and training of healthcare personnel in the diagnosis and management of hereditary bleeding disorders. Central coordinating agencies with wide stakeholder input, networks of haemophilia treatment centres and national registries as well as robust processes for procurement and distribution of safe and effective clotting factor concentrates (CFCs), implementation of prophylaxis programmes and management of patients with inhibitors should also be developed. The implementation of these strategies should lead to establishment of good comprehensive care programmes. This document should also be an advocacy tool to lobby for improved care for people with haemophilia (PWH) in the region. We urge national healthcare policy makers to consider these principles and initiate strong and decisive action to reach these goals. © 2018 John Wiley & Sons Ltd.

49 CFR 219.901 - Retention of alcohol testing records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... test results; and (2) A copy of the annual report summarizing the results of its alcohol misuse... connection with decisions to administer reasonable suspicion alcohol tests. (iv) Documents generated in connection with decisions on post-accident testing. (v) Documents verifying the existence of a medical...

15 CFR 764.5 - Voluntary self-disclosure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retained by the person making the disclosure until OEE requests them, or until a final decision on the disclosed information has been made. After a final decision, the documents should be maintained in... account and supporting documentation. If the person making the disclosure believes otherwise, a request...

Global Health Governance and the Commercial Sector: A Documentary Analysis of Tobacco Company Strategies to Influence the WHO Framework Convention on Tobacco Control

PubMed Central

Weishaar, Heide; Collin, Jeff; Smith, Katherine; Grüning, Thilo; Mandal, Sema; Gilmore, Anna

2012-01-01

Background In successfully negotiating the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) has led a significant innovation in global health governance, helping to transform international tobacco control. This article provides the first comprehensive review of the diverse campaign initiated by transnational tobacco corporations (TTCs) to try to undermine the proposed convention. Methods and Findings The article is primarily based on an analysis of internal tobacco industry documents made public through litigation, triangulated with data from official documentation relating to the FCTC process and websites of relevant organisations. It is also informed by a comprehensive review of previous studies concerning tobacco industry efforts to influence the FCTC. The findings demonstrate that the industry's strategic response to the proposed WHO convention was two-fold. First, arguments and frames were developed to challenge the FCTC, including: claiming there would be damaging economic consequences; depicting tobacco control as an agenda promoted by high-income countries; alleging the treaty conflicted with trade agreements, “good governance,” and national sovereignty; questioning WHO's mandate; claiming the FCTC would set a precedent for issues beyond tobacco; and presenting corporate social responsibility (CSR) as an alternative. Second, multiple tactics were employed to promote and increase the impact of these arguments, including: directly targeting FCTC delegations and relevant political actors, enlisting diverse allies (e.g., mass media outlets and scientists), and using stakeholder consultation to delay decisions and secure industry participation. Conclusions TTCs' efforts to undermine the FCTC were comprehensive, demonstrating the global application of tactics that TTCs have previously been found to have employed nationally and further included arguments against the FCTC as a key initiative in global health governance. Awareness of these strategies can help guard against industry efforts to disrupt the implementation of the FCTC and support the development of future, comparable initiatives in global health. Please see later in the article for the Editors' Summary PMID:22745607

Global health governance and the commercial sector: a documentary analysis of tobacco company strategies to influence the WHO framework convention on tobacco control.

PubMed

Weishaar, Heide; Collin, Jeff; Smith, Katherine; Grüning, Thilo; Mandal, Sema; Gilmore, Anna

2012-01-01

In successfully negotiating the Framework Convention on Tobacco Control (FCTC), the World Health Organization (WHO) has led a significant innovation in global health governance, helping to transform international tobacco control. This article provides the first comprehensive review of the diverse campaign initiated by transnational tobacco corporations (TTCs) to try to undermine the proposed convention. The article is primarily based on an analysis of internal tobacco industry documents made public through litigation, triangulated with data from official documentation relating to the FCTC process and websites of relevant organisations. It is also informed by a comprehensive review of previous studies concerning tobacco industry efforts to influence the FCTC. The findings demonstrate that the industry's strategic response to the proposed WHO convention was two-fold. First, arguments and frames were developed to challenge the FCTC, including: claiming there would be damaging economic consequences; depicting tobacco control as an agenda promoted by high-income countries; alleging the treaty conflicted with trade agreements, "good governance," and national sovereignty; questioning WHO's mandate; claiming the FCTC would set a precedent for issues beyond tobacco; and presenting corporate social responsibility (CSR) as an alternative. Second, multiple tactics were employed to promote and increase the impact of these arguments, including: directly targeting FCTC delegations and relevant political actors, enlisting diverse allies (e.g., mass media outlets and scientists), and using stakeholder consultation to delay decisions and secure industry participation. TTCs' efforts to undermine the FCTC were comprehensive, demonstrating the global application of tactics that TTCs have previously been found to have employed nationally and further included arguments against the FCTC as a key initiative in global health governance. Awareness of these strategies can help guard against industry efforts to disrupt the implementation of the FCTC and support the development of future, comparable initiatives in global health.

An Investigation of the Relationship between Reading Comprehension and Morphological Awareness Skills

ERIC Educational Resources Information Center

Loudermill, Chenell Smith

2014-01-01

The purpose of this study was to investigate the relationship between reading comprehension and morphological awareness skills. Researchers have documented a wide range of skills that influence reading comprehension ability at different times to different degrees. One of the skills identified as having an influence on reading comprehension ability…

A Problem Based Learning Project Analyzing Rubrics Used to Evaluate Elementary STEM Immersion Programs

NASA Astrophysics Data System (ADS)

Pearson, Roxanne N.

In 2010, the President's Council of Advisors on Science and Technology recommended that eight hundred new STEM focused elementary and middle schools be established. Unfortunately, districts may be slow to implement STEM at the elementary level because they do not understand how to do so effectively (Zimny, 2017). School administrators need a framework for decision-making and supervisory feedback related to the process of managing these programs (Zimny, 2017). To support administrators in implementing elementary STEM immersion programs, this project explored three questions: What criteria are common among existing STEM immersion program rubrics? What criteria should be included in a comprehensive rubric for managing elementary STEM immersion programs at the district level? What do district documents show about how elementary STEM immersion programs develop, implement, and evaluate those programs? The team developed a comprehensive STEM program review instrument including criteria for effective elementary STEM curriculum and the professional development and administrative support necessary to implement such curriculum. These criteria were organized into three stages, including the planning and development of elementary STEM immersion programs, the implementation of these programs, and the evaluation of these programs after they had been implemented for a significant period of time. The team synthesized best practice indicators relevant to elementary STEM programs from existing K-12 guides, then validated those indicators against current best practice research and feedback from STEM education experts. District documents from seven elementary STEM immersion programs in Missouri and Colorado were examined using the team's rubric. Scores were higher in the areas of program planning, content alignment, and ongoing refinement of curriculum, and lower in the areas of professional development for professional skills and STEM-specific pedagogy, two-way communication with stakeholders, and data collection for program refinement. Scores were lowest for those schools with inadequate documentation of their program management processes. The team recommended districts institute a more rigorous documentation process for managing innovative programs such as STEM immersion. Communication plans should include procedures for two-way communication with all stakeholders. Data collection and refinement efforts should increase, as should professional development opportunities related to professional skills and STEM-specific pedagogy; this should include administrators.

Turning whine into wine: the fiscal impact of comprehensive documentation and billing for nonoperative pediatric surgical services.

PubMed

Gollin, Gerald; Moores, Donald

2006-06-01

Some pediatric surgeons rarely document nonoperative services, believing that the reimbursement provided for such care is negligible. We evaluated the impact of comprehensive documentation and billing for nonoperative, pediatric surgical care. All bills submitted for inpatient, nonoperative care for 1 year were reviewed. Total receipts for documented admissions, consultations, critical care, and daily care were determined. The Evaluation and Management code billed for each service was recorded, and the total and average payments attributable to each Evaluation and Management code were calculated. Fifty-six percent of services were covered by Medicaid and 26% by a commercial insurer. There were 607 billed admission history and physical exams for which reimbursement totaled 43,493 dollars. Critical care services were provided to 49 patients and yielded 8964 dollars in payments. Six hundred thirty-nine inpatient consultations were performed with a reimbursement of 42,830 dollars. Daily care services were billed 1044 times and produced 71,579 dollars in payments. Overall reimbursement for documented, nonoperative services was 166,866 dollars. This represented 16.2% of total, noncontracted income for the practice. Despite a payer mix heavily weighted toward Medicaid, comprehensive documentation and billing for nonoperative services increased total, noncontracted reimbursement by almost 20% over what it would have been had only operative services been billed. The yield from properly documented, nonoperative care can be substantial.

"Below the Line": The tobacco industry and youth smoking.

PubMed

Coombs, Jaimee; Bond, Laura; Van, Victoria; Daube, Mike

2011-01-01

This paper provides a comprehensive account of how the tobacco industry, over time, has promoted its products to young people. A comprehensive search of tobacco industry documents relating to youth smoking was conducted using documents available on the World Wide Web through the Master Settlement Agreement. The documents provide evidence that the industry invested great time and resources in developing strategies to attract young people through Youth Smoking Prevention strategies (including education strategies) and marketing to youth. The results include information from published literature and direct excerpts from the tobacco industry documents. The tobacco industry documents confirm that the tobacco industry has promoted and supported strategies that are ineffective in reducing smoking by youth, and opposed strategies that have proven to be effective. It is clear from the documents reviewed that the industry values the youth market and through a number of measures continues to promote its products to young people.

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

[Required Framework for the Collection of Real-life Data: An Example from University Eye Hospital Munich].

PubMed

Kortüm, Karsten; Kern, Christoph; Meyer, Gerhard; Priglinger, Siegfried; Hirneiß, Christoph

2017-12-01

Background The importance of evaluating real-life data is constantly increasing. Currently available computer systems better allow for analyses of data, as more and more data is available in a digital form. Before a project for real-life data analyses is started, technical considerations and staff, legal, and data protection procedures need to be addressed. In this manuscript, experiences made at the University Eye Hospital in Munich will be shared. Materials and Methods Legal requirements, as found in laws and guidelines governing documentation and data privacy, are highlighted. Technical requirements for information technology infrastructure and software are defined. A survey conducted by the German Ophthalmological Society, among German eye hospitals investigating the current state of digitalization, was conducted. Also, staff requirements are outlined. Results A database comprising results of 330,801 patients was set up. It includes all diagnoses, procedures, clinical findings and results from diagnostic devices. This database was approved by the local data protection officer. In less than half of German eye hospitals (n = 21) that participated in the survey (n = 54), a complete electronic documentation is done. Fourteen institutions are completely paper-based, and the remainder of the hospitals used a mixed system. Conclusion In this work, we examined the framework that is required to develop a comprehensive database containing real-life data from clinics. In future, these databases will become increasingly important as more and more innovation are made in decision support systems. The base for this is comprehensive and well-curated databases. Georg Thieme Verlag KG Stuttgart · New York.

A review of legal framework applicable for the management of healthcare waste and current management practices in Ethiopia.

PubMed

Haylamicheal, Israel Deneke; Desalegne, Solomon Akalu

2012-06-01

The management of healthcare waste (HCW) requires special attention due to the risk posed by the presence of hazardous waste. The first step towards this is the issuance of national legislation complemented by policy documents, regulations and technical guidelines. In Ethiopia there is no specific legislation for healthcare waste management (HCWM). However, there are various legislations which may provide a legal framework for the management of HCW. This review assesses the various legislations that are relevant to HCWM. It also looks into the institutional arrangements put in place and waste management practices that prevail in the country. It was found that, although the existing legislations have provisions that may provide a legal framework for the management of HCW in Ethiopia, they are not comprehensive and lack specificity in terms of defining hazardous HCW and its categories; in indicating legal obligations of healthcare facilities (HCFs) in handling, transporting, treating and disposing HCW, and record keeping and reporting. There is overlapping of mandates and lackof co-ordination among various government institutions that are responsible for HCWM. The HCWM practices also do not conform to the principles of waste management in general and HCWM in particular. Thus, to better manage HCW in Ethiopia, a specific and comprehensive legislation and policy document on HCWM with clear designation of responsibilities to various stakeholders should be issued immediately. Moreover, training and awareness raising activities on proper HCWM should be undertaken targeting medical staffs, HCF administrators, waste handlers, policy and decision makers and the general public.

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support

PubMed Central

2014-01-01

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). Conclusions CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

PubMed

North, Frederick; Richards, Debra D; Bremseth, Kimberly A; Lee, Mary R; Cox, Debra L; Varkey, Prathibha; Stroebel, Robert J

2014-03-20

Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care.

Development a minimum data set of the information management system for burns.

PubMed

Ahmadi, Maryam; Alipour, Jahanpour; Mohammadi, Ali; Khorami, Farid

2015-08-01

Burns are the most common and destructive injuries in across of the world and especially in developing countries. Nevertheless, a standard tool for collecting the data of burn injury has not been developed yet. The purpose of this study was to develop a minimum data set (MDS) of the information management system for burns in Iran. This descriptive and cross-sectional study was performed in 2014. Data were collected from hospitals affiliated with Hormozgan and Iran University of Medical Sciences and medical documents centers, emergency centers and legal medicine centers located in Bandar Abbas city, in addition to internet access and library. Investigated documents were burn injury records in 2013, and documents that retrieved from the internet, and printed materials. Records were selected randomly based on T20-T29 categories from ICD-10. Data were collected using a checklist. In order to make a consensus about the data elements the decision Delphi technique was applied using a questionnaire. The content validity and reliability of questionnaire were assessed by expert's opinions and test-retest method, respectively. An MDS of burns was developed. This MDS divided into two categories: administrative and clinical with six and 17 section and 161 and 311 data elements respectively. This study showed that comprehensive and uniform data elements about burns do not exist in Iran. Therefore a MDS was developed for burns in Iran. Development of an MDS will result in standardization and effective management of the data through providing uniform and comprehensive data elements for burns. Thus, comparability of the extracted information from different analyses and researches will be possible in various levels. In addition, establishment of policies and prevention and control of burns will be possible, which results in the improvement of the quality of care and containment of costs. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

The role of emotion in decision-making: a cognitive neuroeconomic approach towards understanding sexual risk behavior.

PubMed

Gutnik, Lily A; Hakimzada, A Forogh; Yoskowitz, Nicole A; Patel, Vimla L

2006-12-01

Models of decision-making usually focus on cognitive, situational, and socio-cultural variables in accounting for human performance. However, the emotional component is rarely addressed within these models. This paper reviews evidence for the emotional aspect of decision-making and its role within a new framework of investigation, called neuroeconomics. The new approach aims to build a comprehensive theory of decision-making, through the unification of theories and methods from economics, psychology, and neuroscience. In this paper, we review these integrative research methods and their applications to issues of public health, with illustrative examples from our research on young adults' safe sex practices. This approach promises to be valuable as a comprehensively descriptive and possibly, better predictive model for construction and customization of decision support tools for health professionals and consumers.

Superfund record of decision (EPA Region 9): Riverbank Army Ammunition Plant Site, Riverbank, CA, March 1994

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

Not Available

1994-07-01

This decision document presents the selected remedial actions for the Riverbank Army Ammunition Plant (RBAAP) in Riverbank, California. This sitewide ROD contains two response actions that address the media of concern at RBAAP. This ROD also documents the decision that no further action is warranted at the Evaporation/Percolation (E/P) ponds. The two response actions for this ROD are a groundwater response action and a landfill response action.

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

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

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

Superfund Site Information

EPA Pesticide Factsheets

This asset includes a number of individual data sets related to site-specific information for Superfund, which is governed under the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) of 1980, which was amended by the Superfund Amendments and Reauthorization Act (SARA) in 1986. The Superfund Enterprise Management System (SEMS) contains basic site description, location, schedule of activities, enforcement and settlement data, contaminants and selected remedy and much more, as well as the records that clearly document site decisions. This asset also includes sampling data and lab results (CLPSS, EDDs), redevelopment and technical assistance case studies, site reuse and land revitalization information, EPAOSC.net information, Superfund Technical Assistance Grants information, site management information records (RODs, Remediation plans, cleanup directives), contract management information, and more.Superfund site management information can also be found in agency wide systems such as EAS and COMPASS.

Assessment, prevention and management of skin tears.

PubMed

Benbow, Maureen

2017-04-28

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

TECHNICAL GUIDANCE DOCUMENT: QUALITY ASSURANCE AND QUALITY CONTROL FOR WASTE CONTAINMENT FACILITIES

EPA Science Inventory

This Technical Guidance Document provides comprehensive guidance on procedures for quality assurance and quality control for waste containment facilities. he document includes a discussion of principles and concepts, compacted soil liners, soil drainage systems, geosynthetic drai...

TECHNICAL GUIDANCE DOCUMENT: QUALITY ASSURANCE AND QUALITY CONTROL FOR WASTE CONTAINMENT FACILITIES

EPA Science Inventory

This Technical Guidance Document provides comprehensive guidance on procedures for quality assurance and quality control for waste containment facilities. The document includes a discussion of principles and concepts, compacted soil liners, soil drainage systems, geosynthetic dr...

Reducing NPR 7120.5D to Practice: Preparing for a Life-Cycle Review

NASA Technical Reports Server (NTRS)

Taylor, Randall L.

2008-01-01

In March 2007, NASA issued revised rules for space flight project management, NPR 7120.5D, 'NASA Space Flight Program and Project Management Requirements.' Central to the new rules was the construct of Key Decision Points, maturity gates that the project team must pass in order to continue development. In order that the KDP decision be fully informed, the NPR required, as entrance criteria for the gate, the generation and delivery of specified planning, technical, and cost/schedule documents (gate products) and a life-cycle review, the Preliminary Design Review. Building on JPL experience on the Prometheus and Juno projects, the team successfully organized for and conducted these reviews on an aggressive schedule. Key actions were taken to proactively interact with the SRB, produce high-quality gate products with stakeholder review, generate review presentation materials, and handle a myriad of supporting logistical functions. A review preparation team was established, including a Review Captain and leads for documentation, information systems, and logistics, and their roles, responsibilities and task assignments were identified. Aids were produced, including a detailed review preparation schedule and a comprehensive gate products production table. Institutional support was leveraged early and often. Implementation strategy reflected the needs of a nationally-distributed team, as well as applicable export control and IT security requirements. This paper gives a brief overview of the GRAIL mission and its project management challenges, provides a detailed description of project PMSR and PDR preparation and execution activities, including positive and negative lessons learned, and identifies recommendations for future NASA (and non-NASA) project teams.

Comprehensive CT Evaluation in Acute Ischemic Stroke: Impact on Diagnosis and Treatment Decisions

PubMed Central

Löve, Askell; Siemund, Roger; Andsberg, Gunnar; Cronqvist, Mats; Holtås, Stig; Björkman-Burtscher, Isabella

2011-01-01

Background. With modern CT imaging a comprehensive overview of cerebral macro- and microcirculation can be obtained within minutes in acute ischemic stroke. This opens for patient stratification and individualized treatment. Methods. Four patients with acute ischemic stroke of different aetiologies and/or treatments were chosen for illustration of the comprehensive CT protocol and its value in subsequent treatment decisions. The patients were clinically evaluated according to the NIHSS-scale, examined with the comprehensive CT protocol including both CT angiography and CT perfusion, and followed up by MRI. Results. The comprehensive CT examination protocol increased the examination time but did not delay treatment initiation. In some cases CT angiography revealed the cause of stroke while CT perfusion located and graded the perfusion defect with reasonable accuracy, confirmed by follow-up MR-diffusion. In the presented cases findings of the comprehensive CT examination influenced the treatment strategy. Conclusions. The comprehensive CT examination is a fast and safe method allowing accurate diagnosis and making way for individualized treatment in acute ischemic stroke. PMID:21603175

Report on the remedial investigation of Bear Creek Valley at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 3: Appendix D -- Nature and extent of contamination report

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

NONE

1996-09-01

This Remedial Investigation (RI) Report characterizes the nature and extent of contamination, evaluates the fate and transport of contaminants, and assesses risk to human health and the environment resulting from waste disposal and other US Department of Energy (DOE) operations in Bear Creek Valley (BCV). BCV, which is located within the DOE Oak Ridge Reservation (ORR) encompasses multiple waste units containing hazardous and radioactive wastes arising from operations at the adjacent Oak Ridge Y-12 Plant. The primary waste units discussed in this RI Report are the S-3 Site, Oil Landfarm (OLF), Boneyard/Burnyard (BYBY), Sanitary Landfill 1 (SL 1), and Bearmore » Creek Burial Grounds (BCBG). These waste units, plus the contaminated media resulting from environmental transport of the wastes from these units, are the subject of this RI. This BCV RI Report represents the first major step in the decision-making process for the BCV watershed. The RI results, in concert with the follow-on FS will form the basis for the Proposed Plan and Record of Decision for all BCV sites. This comprehensive decision document process will meet the objectives of the watershed approach for BCV. Appendix D describes the nature and extent of contamination in environmental media and wastes.« less

Understanding human resource management practices in Botswana's public health sector.

PubMed

Seitio-Kgokgwe, Onalenna Stannie; Gauld, Robin; Hill, Philip C; Barnett, Pauline

2016-11-21

Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a large study that used a mixed methods approach to assess performance of Botswana's Ministry of Health (MOH). It uses data collected through document analysis and in-depth interviews of 54 key informants comprising policy makers, senior staff of the MOH and its stakeholder organizations. Findings Public health sector HRM in Botswana has experienced inadequate planning, poor deployment and underutilization of staff. Lack of comprehensive retention strategies and poor working conditions contributed to the failure to attract and retain skilled personnel. Relationships with both formal and informal environments affected HRM performance. Research limitations/implications While document review was a major source of data for this paper, the weaknesses in the human resource information system limited availability of data. Practical implications This paper presents an argument for the need for consideration of formal and informal environments in developing effective HRM strategies. Originality/value This research provides a rare system-wide approach to health HRM in a Sub-Saharan African country. It contributes to the literature and evidence needed to guide HRM policy decisions and practices.

The Effect of Structured Decision-Making Techniques and Gender on Student Reaction and Quality of Written Documents.

ERIC Educational Resources Information Center

Neal, Joan; Echternacht, Lonnie

1995-01-01

Experimental groups used four decision-making techniques--reverse brainstorming (RS), dialectical inquiry (DI), devil's advocacy (DA), and consensus--in evaluating writing assignments. Control group produced a better quality document. Student reaction to negative features of RS, DI, and DA were not significant. (SK)

Report: Administrative Leave Decisions for EPA Employee Disciplinary Actions Should Be Better Documented, and Parameters on Use of Such Leave Should Be Established

EPA Pesticide Factsheets

Report #16-P-0036, November 9, 2015. EPA’s use of extended administrative leave can result in unnecessary and excessive payroll costs, and lack of documentation and justification can lead others to second guess the agency’s decisions.

Corrective Action Decision Document for Corrective Action Unit 340: Pesticide Release sites, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document has been prepared for Corrective Action Unit 340, the NTS Pesticide Release Sites, in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 340 is located at the Nevada Test Site, Nevada, and is comprised of the following Corrective Action Sites: 23-21-01, Area 23 Quonset Hut 800 Pesticide Release Ditch; 23-18-03, Area 23 Skid Huts Pesticide Storage; and 15-18-02, Area 15 Quonset Hut 15-11 Pesticide Storage. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended correctivemore » action alternative for each Corrective Action Site. The scope of this Corrective Action Decision Document consists of the following tasks: Develop corrective action objectives; Identify corrective action alternative screening criteria; Develop corrective action alternatives; Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria; and Recommend and justify a preferred corrective action alternative for each Corrective Action Site.« less

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System

PubMed Central

Wolfe, Christopher R.; Reyna, Valerie F.; Widmer, Colin L.; Cedillos-Whynott, Elizabeth M.; Brust-Renck, Priscila G; Weil, Audrey M.; Hu, Xiangen

2016-01-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one’s own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension. PMID:28008216

Understanding Genetic Breast Cancer Risk: Processing Loci of the BRCA Gist Intelligent Tutoring System.

PubMed

Wolfe, Christopher R; Reyna, Valerie F; Widmer, Colin L; Cedillos-Whynott, Elizabeth M; Brust-Renck, Priscila G; Weil, Audrey M; Hu, Xiangen

2016-07-01

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one's own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist , a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

Model performance evaluation (validation and calibration) in model-based studies of therapeutic interventions for cardiovascular diseases : a review and suggested reporting framework.

PubMed

Haji Ali Afzali, Hossein; Gray, Jodi; Karnon, Jonathan

2013-04-01

Decision analytic models play an increasingly important role in the economic evaluation of health technologies. Given uncertainties around the assumptions used to develop such models, several guidelines have been published to identify and assess 'best practice' in the model development process, including general modelling approach (e.g., time horizon), model structure, input data and model performance evaluation. This paper focuses on model performance evaluation. In the absence of a sufficient level of detail around model performance evaluation, concerns regarding the accuracy of model outputs, and hence the credibility of such models, are frequently raised. Following presentation of its components, a review of the application and reporting of model performance evaluation is presented. Taking cardiovascular disease as an illustrative example, the review investigates the use of face validity, internal validity, external validity, and cross model validity. As a part of the performance evaluation process, model calibration is also discussed and its use in applied studies investigated. The review found that the application and reporting of model performance evaluation across 81 studies of treatment for cardiovascular disease was variable. Cross-model validation was reported in 55 % of the reviewed studies, though the level of detail provided varied considerably. We found that very few studies documented other types of validity, and only 6 % of the reviewed articles reported a calibration process. Considering the above findings, we propose a comprehensive model performance evaluation framework (checklist), informed by a review of best-practice guidelines. This framework provides a basis for more accurate and consistent documentation of model performance evaluation. This will improve the peer review process and the comparability of modelling studies. Recognising the fundamental role of decision analytic models in informing public funding decisions, the proposed framework should usefully inform guidelines for preparing submissions to reimbursement bodies.

Earth Observations and the Role of UAVs: A Capabilities Assessment

NASA Technical Reports Server (NTRS)

Cox, Timothy H.

2006-01-01

This three-volume document, based on the draft document located on the website given on page 6, presents the findings of a NASA-led capabilities assessment of Uninhabited Aerial Vehicles (UAVs) for civil (defined as non-DoD) use in Earth observations. Volume 1 is the report that presents the overall assessment and summarizes the data. The second volume contains the appendices and references to address the technologies and capabilities required for viable UAV missions. The third volume is the living portion of this effort and contains the outputs from each of the Technology Working Groups (TWGs) along with the reviews conducted by the Universities Space Research Association (USRA). The focus of this report, intended to complement the Office of the Secretary of Defense UAV Roadmap, is four-fold: 1) To determine and document desired future Earth observation missions for all UAVs based on user-defined needs; 2) To determine and document the technologies necessary to support those missions; 3) To discuss the present state of the art platform capabilities and required technologies, including identifying those in progress, those planned, and those for which no current plans exist; 4) Provide the foundations for development of a comprehensive civil UAV roadmap. It is expected that the content of this report will be updated periodically and used to assess the feasibility of future missions. In addition, this report will provide the foundation to help influence funding decisions to develop those technologies that are considered enabling or necessary but are not contained within approved funding plans. This document is written such that each section will be supported by an Appendix that will give the reader a more detailed discussion of that section's topical materials.

Premarital Childbearing Decision Making.

ERIC Educational Resources Information Center

Oakley, Deborah

1985-01-01

Investigated premarital decision-making among community college students. Results concluded that premarital decisions about the number of children to have is associated with certain characteristics of the rational-comprehensive thinker, but is also associated with non-normative childbearing expectations, whether they are above or below the popular…

ENVIRONMENTAL PLANNING FOR SMALL COMMUNITIES: A GUIDE FOR LOCAL DECISION-MAKERS

EPA Science Inventory

Environmental Planning for Small Communities - A Guide for Local Decision-Makers presents a process for creating and implementing a community environmental plan. With a comprehensive environmental plan, local decision-makers can create an integrated approach to protecting the env...

Improving Reading Comprehension through Higher-Order Thinking Skills

ERIC Educational Resources Information Center

McKown, Brigitte A.; Barnett, Cynthia L.

2007-01-01

This action research project report documents the action research project that was conducted to improve reading comprehension with second grade and third grade students. The teacher researchers intended to improve reading comprehension by using higher-order thinking skills such as predicting, making connections, visualizing, inferring,…

24 CFR 5.502 - Requirements concerning documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Requirements concerning documents... § 5.502 Requirements concerning documents. For any notice or document (decision, declaration, consent... regulations for requirements concerning communications with persons with disabilities.) ...

Providing Greater Protection for Environmental Audits: A Proposal for a Self-Evaluative Privilege

DTIC Science & Technology

1993-04-01

make the government more accountable to the people. It also intended to encourage governmental responsibility. FOIA provides, in part, that any person ...document is exempt.84 Pre- decisional documents lose their exempt status if the documents are incorporated by reference in the agency’s final decision .85 E...the employee making the communication, of whatever rank he may be, is in a position to control or even to take a substantial part in a decision about

Comprehensive decision tree models in bioinformatics.

PubMed

Stiglic, Gregor; Kocbek, Simon; Pernek, Igor; Kokol, Peter

2012-01-01

Classification is an important and widely used machine learning technique in bioinformatics. Researchers and other end-users of machine learning software often prefer to work with comprehensible models where knowledge extraction and explanation of reasoning behind the classification model are possible. This paper presents an extension to an existing machine learning environment and a study on visual tuning of decision tree classifiers. The motivation for this research comes from the need to build effective and easily interpretable decision tree models by so called one-button data mining approach where no parameter tuning is needed. To avoid bias in classification, no classification performance measure is used during the tuning of the model that is constrained exclusively by the dimensions of the produced decision tree. The proposed visual tuning of decision trees was evaluated on 40 datasets containing classical machine learning problems and 31 datasets from the field of bioinformatics. Although we did not expected significant differences in classification performance, the results demonstrate a significant increase of accuracy in less complex visually tuned decision trees. In contrast to classical machine learning benchmarking datasets, we observe higher accuracy gains in bioinformatics datasets. Additionally, a user study was carried out to confirm the assumption that the tree tuning times are significantly lower for the proposed method in comparison to manual tuning of the decision tree. The empirical results demonstrate that by building simple models constrained by predefined visual boundaries, one not only achieves good comprehensibility, but also very good classification performance that does not differ from usually more complex models built using default settings of the classical decision tree algorithm. In addition, our study demonstrates the suitability of visually tuned decision trees for datasets with binary class attributes and a high number of possibly redundant attributes that are very common in bioinformatics.

Comprehensive Decision Tree Models in Bioinformatics

PubMed Central

Stiglic, Gregor; Kocbek, Simon; Pernek, Igor; Kokol, Peter

2012-01-01

Purpose Classification is an important and widely used machine learning technique in bioinformatics. Researchers and other end-users of machine learning software often prefer to work with comprehensible models where knowledge extraction and explanation of reasoning behind the classification model are possible. Methods This paper presents an extension to an existing machine learning environment and a study on visual tuning of decision tree classifiers. The motivation for this research comes from the need to build effective and easily interpretable decision tree models by so called one-button data mining approach where no parameter tuning is needed. To avoid bias in classification, no classification performance measure is used during the tuning of the model that is constrained exclusively by the dimensions of the produced decision tree. Results The proposed visual tuning of decision trees was evaluated on 40 datasets containing classical machine learning problems and 31 datasets from the field of bioinformatics. Although we did not expected significant differences in classification performance, the results demonstrate a significant increase of accuracy in less complex visually tuned decision trees. In contrast to classical machine learning benchmarking datasets, we observe higher accuracy gains in bioinformatics datasets. Additionally, a user study was carried out to confirm the assumption that the tree tuning times are significantly lower for the proposed method in comparison to manual tuning of the decision tree. Conclusions The empirical results demonstrate that by building simple models constrained by predefined visual boundaries, one not only achieves good comprehensibility, but also very good classification performance that does not differ from usually more complex models built using default settings of the classical decision tree algorithm. In addition, our study demonstrates the suitability of visually tuned decision trees for datasets with binary class attributes and a high number of possibly redundant attributes that are very common in bioinformatics. PMID:22479449

Other ways of knowing: considerations for information communication in decision aid design1

PubMed Central

Basile, Melissa J.; Kozikowski, Andrzej; Akerman, Meredith; Liberman, Tara; McGinn, Thomas; Diefenbach, Michael A.

2016-01-01

Background Patients with advanced stage chronic obstructive pulmonary disease (COPD) may suffer severe respiratory exacerbations and need to decide between accepting life sustaining treatments versus foregoing these treatments (choosing comfort care only). We designed the InformedTogether decision aid to inform this decision, and describe results of a pilot study to assess usability focusing on participants’ trust in the content of the decision aid, acceptability, recommendations for improvement; and emotional reactions to this emotionally-laden decision. Methods Study participants (N=26) comprised of clinicians, patients, and surrogates viewed the decision aid, completed usability tasks, and participated in interviews and focus groups assessing comprehension, trust, perception of bias, and perceived acceptability of InformedTogether implementation. Mixed methods were used to analyze results. Results Almost all participants understood the gist (general meaning) of InformedTogether. However, many lower literacy participants had difficulty answering the more detailed questions related to comprehension, especially when interpreting icon arrays, and many were not aware that they had misunderstood the information. Qualitative analysis showed a range of emotional reactions to the information. Participants with low verbatim comprehension frequently referenced lived experiences when answering knowledge questions, which we termed “alternative knowledge”. Conclusion We found a range of emotional reactions to the information, and frequent use of alternative knowledge frameworks for deriving meaning from the data. These observations led to insights into the impact of lived experiences on the uptake of biomedical information presented in decision aids. Communicating prognostic information could potentially be improved by eliciting alternative knowledge as a starting ground to build communication, in particular for low literacy patients. Decision aids designed to facilitate shared decision making should elicit this knowledge and help clinicians tailor information accordingly. PMID:28061041

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target for Decision Support?

PubMed Central

Kerber, Kevin A.; Morgenstern, Lewis B.; Meurer, William J.; McLaughlin, Thomas; Hall, Pamela A.; Forman, Jane; Fendrick, A. Mark; Newman-Toker, David E.

2011-01-01

Objectives Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important target in decision support efforts. Methods Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population-based cohort study. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made. Results Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 185 out of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis. Conclusions Nystagmus assessments are frequently documented in acute dizziness presentations, but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations. PMID:21676060

Auditory perception modulated by word reading.

PubMed

Cao, Liyu; Klepp, Anne; Schnitzler, Alfons; Gross, Joachim; Biermann-Ruben, Katja

2016-10-01

Theories of embodied cognition positing that sensorimotor areas are indispensable during language comprehension are supported by neuroimaging and behavioural studies. Among others, the auditory system has been suggested to be important for understanding sound-related words (visually presented) and the motor system for action-related words. In this behavioural study, using a sound detection task embedded in a lexical decision task, we show that in participants with high lexical decision performance sound verbs improve auditory perception. The amount of modulation was correlated with lexical decision performance. Our study provides convergent behavioural evidence of auditory cortex involvement in word processing, supporting the view of embodied language comprehension concerning the auditory domain.

A Framework for Comprehensive Health Terminology Systems in the United States

PubMed Central

Chute, Christopher G.; Cohn, Simon P.; Campbell, James R.

1998-01-01

Health care in the United States has become an information-intensive industry, yet electronic health records represent patient data inconsistently for lack of clinical data standards. Classifications that have achieved common acceptance, such as the ICD-9-CM or ICD, aggregate heterogeneous patients into broad categories, which preclude their practical use in decision support, development of refined guidelines, or detailed comparison of patient outcomes or benchmarks. This document proposes a framework for the integration and maturation of clinical terminologies that would have practical applications in patient care, process management, outcome analysis, and decision support. Arising from the two working groups within the standards community—the ANSI (American National Standards Institute) Healthcare Informatics Standards Board Working Group and the Computer-based Patient Records Institute Working Group on Codes and Structures—it outlines policies regarding 1) functional characteristics of practical terminologies, 2) terminology models that can broaden their applications and contribute to their sustainability, 3) maintenance attributes that will enable terminologies to keep pace with rapidly changing health care knowledge and process, and 4) administrative issues that would facilitate their accessibility, adoption, and application to improve the quality and efficiency of American health care. PMID:9824798

Personal data assistants: using new technology to enhance nursing practice.

PubMed

Lewis, Judith A; Sommers, Catherine O

2003-01-01

This article explains how the new technology of personal data assistants can be used to enhance and augment comprehensive nursing care. Nurses are constantly challenged in their need for current, reliable, and accurate information at the point of patient care. Professional books and journals, by the very nature of their print format, have been prepared long before they can be actually used in practice. More current information is available from the World Wide Web, but it is often impractical for a nurse to access a computer during a patient encounter. Personal data assistants [PDAs] allow clinicians to access and document absolutely current information at the moment the patient is being seen. There are many general applications for PDAs that nurses might use such as keeping electronic calendars, address books, and reminder lists. In addition, however, there are even more actual healthcare applications, including patient tracking systems, access to pharmacologic databases, and a variety of clinical decision-making support tools. This article describes the wide variety of PDAs, along with the factors a nurse should consider in the decision of whether to purchase a PDA, and which type of device is best suited for which application.

HEALTH TECHNOLOGY ASSESSMENT OF MEDICAL DEVICES IN EUROPE: PROCESSES, PRACTICES, AND METHODS.

PubMed

Fuchs, Sabine; Olberg, Britta; Panteli, Dimitra; Busse, Reinhard

2016-01-01

To review and compare current Health Technology Assessment (HTA) activities for medical devices (MDs) across European HTA institutions. A comprehensive approach was adopted to identify institutions involved in HTA in European countries. We systematically searched institutional Web sites and other online sources by using a structured tool to extract information on the role and link to decision making, structure, scope, process, methodological approach, and available HTA reports for each included institution. Information was obtained from eighty-four institutions, forty-seven of which were analyzed. Fifty-four methodological documents from twenty-three agencies in eighteen countries were identified. Only five agencies had separate documents for the assessment of MDs. A few agencies made separate provisions for the assessment of MDs in their general methods. The amount of publicly available HTA reports on MDs varied by device category and agency remit. Despite growing consensus on their importance and international initiatives, such as the EUnetHTA Core Model®, specific tools for the assessment of MDs are rarely developed and implemented at the national level. Separate additional signposts incorporated in existing general methods guides may be sufficient for the evaluation of MDs.

Decision aid prototype development for parents considering adenotonsillectomy for their children with sleep disordered breathing.

PubMed

Maguire, Erin; Hong, Paul; Ritchie, Krista; Meier, Jeremy; Archibald, Karen; Chorney, Jill

2016-11-04

To describe the process involved in developing a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. A paper-based decision aid prototype was developed using the framework proposed by the International Patient Decision Aids Standards Collaborative. The decision aid focused on two main treatment options: watchful waiting and adenotonsillectomy. Usability was assessed with parents of pediatric patients and providers with qualitative content analysis of semi-structured interviews, which included open-ended user feedback. A steering committee composed of key stakeholders was assembled. A needs assessment was then performed, which confirmed the need for a decision support tool. A decision aid prototype was developed and modified based on semi-structured qualitative interviews and a scoping literature review. The prototype provided information on the condition, risk and benefits of treatments, and values clarification. The prototype underwent three cycles of accessibility, feasibility, and comprehensibility testing, incorporating feedback from all stakeholders to develop the final decision aid prototype. A standardized, iterative methodology was used to develop a decision aid prototype for parents considering adenotonsillectomy for their children with sleep disordered breathing. The decision aid prototype appeared feasible, acceptable and comprehensible, and may serve as an effective means of improving shared decision-making.

36 CFR 220.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental impact statement (EIS) or environmental assessment (EA). Decision notice. A concise written record... ENVIRONMENTAL POLICY ACT (NEPA) COMPLIANCE § 220.3 Definitions. The following definitions supplement, by adding... about natural resource systems is sometimes uncertain. Decision document. A record of decision, decision...

Facsimile Transmission of Microforms.

DTIC Science & Technology

1983-12-30

display terminals, high speed printers, conventional facsimile receivers, and/or graphics COM recorders. Microforms designed for storage, retrieval...author and Whould not be construed as an official Department of the Army position, policy, or decision, unless so designated by other documentation...beconstrued as an official Department of the Army position, policy, or decision, unless so designated by other documentation. ,, -- UNCLASSIFIED SECURITY

An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting.

PubMed

Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

2017-02-01

Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a 'breastfeeding culture'. Research on the programme has revealed multiple barriers since implementation. To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia. A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a 'documents as commentary' approach to gain insight into individual and collective social practices not otherwise observable. Four major themes were identified: "a breastfeeding culture"; "resource implications"; "ambivalent support for breastfeeding and the BFHI" and "business versus advocacy". "A breastfeeding culture" included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation. Key stakeholders' decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Wichita Mountains Wildlife Refuge - Comprehensive Alternative Transportation Plan

DOT National Transportation Integrated Search

2014-05-01

The Comprehensive Alternative Transportation Plan for Wichita Mountains Wildlife Refuge in southwestern Oklahoma analyzes a range of transportation and resource management challenges and documents a holistic set of alternative transportation strategi...

The Application of Recognition-Primed Decision Theory to Decisions Made in an Outdoor Education Context

ERIC Educational Resources Information Center

Boyes, Mike; Potter, Tom

2015-01-01

This research examined the decisions that highly experienced outdoor leaders made on backpacking expeditions conducted by a tertiary institution in the Southern Alps of New Zealand. The purpose of the research was to document decision problems and explore them as Recognition-Primed Decisions (RPD) within naturalistic decision making (NDM)…

How restudy decisions affect overall comprehension for seventh-grade students.

PubMed

Thiede, Keith W; Redford, Joshua S; Wiley, Jennifer; Griffin, Thomas D

2017-12-01

Self-regulated learning requires accurate monitoring and effective regulation of study. Little is known about how effectively younger readers regulate their study. We examined how decisions about which text to restudy affect overall comprehension for seventh-grade students. In addition to a Participant's Choice condition where students were allowed to pick texts for restudy on their own, we compared learning gains in two other conditions in which texts were selected for them. The Test-Based Restudy condition determined text selection using initial test performance - presenting the text with the lowest initial test performance for restudy, thereby circumventing potential problems associated with inaccurate monitoring and ineffective regulation. The Judgement-Based Restudy condition determined text selection using metacognitive judgements of comprehension - presenting the text with the lowest judgement of comprehension, thereby circumventing potential problems associated with ineffective regulation. Four hundred and eighty seventh-grade students participated. Students were randomly assigned to conditions in an experimental design. Gains in comprehension following restudy were larger for the Test-Based Restudy condition than for the Judgement-Based Restudy condition or the Participant's Choice condition. No differences in comprehension were seen between the Judgement-Based Restudy and Participant's Choice conditions. These results suggest seventh graders can systematically use their monitoring to make decisions about what to restudy. However, the results highlight how inaccurate monitoring is one reason why younger students fail to benefit from self-regulated study opportunities. © 2017 The British Psychological Society.

36 CFR 1010.13 - Trust decision-making procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... environmental document (i.e., the EA, finding of no significant impact, EIS, or notice of intent), in addition... environmental factors. (b) The Trust shall consider in its decision-making process only decision alternatives...

Older Adults' Comprehension of Transformational and Deactivation Negation

ERIC Educational Resources Information Center

Margolin, Sara J.

2015-01-01

The present research aimed to examine young and older adults' comprehension of negated text to determine the locus of older adults' difficulty in understanding this text construction. Participants were asked to read short passages at their own pace, complete a lexical decision task, and answer a comprehension question about what they had read.…

Easy to Understand but Difficult to Decide: Information Comprehensibility and Controversiality Affect Laypeople's Science-Based Decisions

ERIC Educational Resources Information Center

Scharrer, Lisa; Britt, M. Anne; Stadtler, Marc; Bromme, Rainer

2013-01-01

Well-educated laypeople tend to rely on their own ability to evaluate scientific claims when they obtain information from texts with high comprehensibility. The present study investigated whether controversial content reduces this facilitating effect of high text comprehensibility on readers' self-reliance and whether the influence of…

Recovered vs. not-recovered from post-stroke aphasia: The contributions from the dominant and non-dominant hemispheres

PubMed Central

Szaflarski, Jerzy P.; Allendorfer, Jane B.; Banks, Christi; Vannest, Jennifer; Holland, Scott K.

2013-01-01

Purpose Several adult studies have documented the importance of the peri-stroke areas to aphasia recovery. But, studies examining the differences in patterns of cortical participation in language comprehension in patients who have (LMCA-R) or have not recovered (LMCA-NR) from left middle cerebral artery infarction have not been performed up to date. Methods In this study, we compare cortical correlates of language comprehension using fMRI and semantic decision/tone decision task in 9 LMCA-R and 18 LMCA-NR patients matched at the time of stroke for age and handedness. We examine the cortical correlates of language performance by correlating intra- and extra-scanner measures of linguistic performance with fMRI activation and stroke volumes. Results Our analyses show that LMCA-R at least 1 year after stroke show a return to typical fMRI language activation patterns and that there is a compensatory reorganization of language function in LMCA-NR patients with shifts to the right hemispheric brain regions. Further, with increasing strength of the left-hemispheric fMRI signal shift there are associated improvements in performance as tested with standardized linguistic measures. A negative correlation between the size of the stroke and performance on some of the linguistic tests is also observed. Conclusions This right-hemispheric shift as a mechanism of post-stroke recovery in adults appears to be an ineffective mode of language function recovery with increasing right-hemispheric shift associated with lower language performance. Thus, normalization of the post-stroke language activation patterns is needed for better language performance while shifts of the activation patterns to the non-dominant (right) hemisphere and/or large stroke size are associated with decreased linguistic abilities after stroke. PMID:23482065

Conceptual Coherence, Comprehension, and Vocabulary Acquisition: A Knowledge Effect?

ERIC Educational Resources Information Center

Cervetti, Gina N.; Wright, Tanya S.; Hwang, HyeJin

2016-01-01

Previous research has documented the role of readers' existing topic knowledge in supporting students' comprehension of text; yet, we know less about how to build students' knowledge in order to support comprehension and vocabulary learning. In the current study, we test the hypothesis that knowledge can be built and leveraged simultaneously in…

Improving Student Comprehension in Content Areas through the Use of Reading Strategies.

ERIC Educational Resources Information Center

Langford, Patricia A.; Rizzo, Sandra K.; Roth, Jean M.

This study was an action research project designed to improve students' reading comprehension. Students in the targeted kindergarten, second, and third grade classes exhibited a lack of reading comprehension, which interfered with their academic achievement. Data was collected by student and parent surveys, observations, and document analysis.…

Cognitive Development Effects of Teaching Probabilistic Decision Making to Middle School Students

ERIC Educational Resources Information Center

Mjelde, James W.; Litzenberg, Kerry K.; Lindner, James R.

2011-01-01

This study investigated the comprehension and effectiveness of teaching formal, probabilistic decision-making skills to middle school students. Two specific objectives were to determine (1) if middle school students can comprehend a probabilistic decision-making approach, and (2) if exposure to the modeling approaches improves middle school…

Exploring the Decision Landscape: Integration of Human and Natural Systems Using the Driver-Pressure-State-Impact-Response Framework and Dynamic Web Application

EPA Science Inventory

Making decisions to increase community or regional sustainability requires a comprehensive understanding of the linkages between environmental, social, and economic systems. We present a visualization tool that can improve decision processes and improve interdisciplinary research...

76 FR 31303 - Notice of Availability or Record of Decision and Final Findings of Approvability to the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... continued comprehensive protection of Washington's coastal resources. OCRM did not select either Alternative... Record of Decision and Final Findings of Approvability to the Washington Coastal Zone Management Program... and Coastal Resource Management. ACTION: Notice of Availability or Record of Decision and Final...

The Relationship between Reading Ability and Lateralized Lexical Decision

ERIC Educational Resources Information Center

Weems, Scott A.; Zaidel, Eran

2004-01-01

Although lexical decision remains one of the most extensively studied cognitive tasks, very little is known about its relationship to broader linguistic performance such as reading ability. In a correlational study, several aspects of lateralized lexical decision performance were related to vocabulary and reading comprehension measures, as…

77 FR 20688 - 29th Meeting: RTCA Special Committee 206, Aeronautical Information and Meteorological Data Link...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

.... SC-206 Related Work in SESAR--Progress Status. Discuss previously proposed TOR changes and DO-252 Revision. [cir] Discuss TOR changes for the June PMC meeting. PMC decision on OSED document. ConUse FRAC... dates. Decision to approve the ConUse document for release to the PMC. Agree upon TOR changes for June...

Issues in Peer Review of the Scientific Basis for Regulatory Decisions.

ERIC Educational Resources Information Center

American Chemical Society, Washington, DC.

This document is intended to provide a discussion of the issues that need to be addressed in the development of peer review guidelines, the options for addressing the issues, and a range of views about such options. The document focuses on peer review with regard to regulatory decisions and contains major sections which deal with: (1) what should…

Global Grid Telemedicine System: Expert Consult Manager

DTIC Science & Technology

2000-10-01

Department of the Army position, policy or decision unless so designated by other documentation. DTIC QUALITY iw^^rxi 20010122 014 REPORT DOCUMENTATION...processes and personnel for collecting, processing, storing, disseminating and managing information on demand to warfighters, policy makers, and...to be responsive to and incorporate current and future policy decisions. (7) Be continuously aware, along with Network and Bandwidth managers, of

International consensus statement on allergy and rhinology: allergic rhinitis-executive summary.

PubMed

Wise, Sarah K; Lin, Sandra Y; Toskala, Elina

2018-02-01

The available allergic rhinitis (AR) literature continues to grow. Critical evaluation and understanding of this literature is important to appropriately utilize this knowledge in the care of AR patients. The International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has been produced as a multidisciplinary international effort. This Executive Summary highlights and summarizes the findings of the comprehensive ICAR:AR document. The ICAR:AR document was produced using previously described methodology. Specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. Over 100 individual topics related to AR diagnosis, pathophysiology, epidemiology, disease burden, risk factors, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR were addressed in the comprehensive ICAR:AR document. Herein, the Executive Summary provides a synopsis of these findings. In the ICAR:AR critical review of the literature, several strengths were identified. In addition, significant knowledge gaps exist in the AR literature where current practice is not based on the best quality evidence; these should be seen as opportunities for additional research. The ICAR:AR document evaluates the strengths and weaknesses of the AR literature. This Executive Summary condenses these findings into a short summary. The reader is also encouraged to consult the comprehensive ICAR:AR document for a thorough description of this work. © 2018 ARS-AAOA, LLC.

Unesco Integrated Documentation Network; Computerized Documentation System (CDS).

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France). Dept. of Documentation, Libraries, and Archives.

Intended for use by the Computerized Documentation System (CDS), the Unesco version of ISIS (Integrated Set of Information Systems)--originally developed by the International Labour Organization--was developed in 1975 and named CDS/ISIS. This system has a comprehensive collection of programs for input, management, and output, running in batch or…

Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

PubMed

Johnson, Claire E; Chong, Jeffrey C; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

2017-07-01

Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care. © 2017 Royal Australasian College of Physicians.

Are the American Psychological Association’s Detainee Interrogation Policies Ethical and Effective?

PubMed Central

Pope, Kenneth S.

2011-01-01

After 9–11, the United States began interrogating detainees at settings such as Abu Ghraib, Bagram, and Guantanamo. The American Psychological Association (APA) supported psychologists’ involvement in interrogations, adopted formal policies, and made an array of public assurances. This article’s purpose is to highlight key APA decisions, policies, procedures, documents, and public statements in urgent need of rethinking and to suggest questions that may be useful in a serious assessment, such as, “However well intended, were APA’s interrogation policies ethically sound?”; “Were they valid, realistic, and able to achieve their purpose?”; “Were other approaches available that would address interrogation issues more directly, comprehensively, and actively, that were more ethically and scientifically based, and that would have had a greater likelihood of success?”; and “Should APA continue to endorse its post-9–11 detainee interrogation policies?” PMID:22096660

[Guidelines for the diagnosis and treatment of patients with bacteriemia. Guidelines of the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica].

PubMed

Cisneros-Herreros, José Miguel; Cobo-Reinoso, Javier; Pujol-Rojo, Miquel; Rodríguez-Baño, Jesús; Salavert-Lletí, Miguel

2007-02-01

Bacteremia is a complex clinical syndrome in constant transformation that is an important, growing cause of morbidity and mortality. Even though there is a great deal of specific information about bacteremia, few comprehensive reviews integrate this information with a practical AIM. The main objective of these Guidelines, which target hospital physicians, is to improve the clinical care provided to patients with bacteremia by integrating blood culture results with clinical data, and optimizing the use of diagnostic procedures and antimicrobial testing. The document is structured into sections that cover the epidemiology and etiology of bacteremia, stratified according to the various patient populations, and the diagnostic work-up, therapy, and follow-up of patients with bacteremia. Diagnostic and therapeutic decisions are presented as recommendations based on the grade of available scientific evidence.

511 travel information service development & documentation.

DOT National Transportation Integrated Search

2011-10-01

"511 New York was deployed as a free, comprehensive travel information system geared to meet the multimodal needs of commuters, long-distance and local travelers, tourists and commercial-vehicle operators. The up-to-the-minute, comprehensive transpor...

Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.

PubMed

Yano, Elizabeth M; Darling, Jill E; Hamilton, Alison B; Canelo, Ismelda; Chuang, Emmeline; Meredith, Lisa S; Rubenstein, Lisa V

2016-07-19

The Veterans Health Administration (VA) has undertaken a major initiative to transform care through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home (PCMH) concept, PACT aims to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient-driven and patient-centered. However, how VA should adapt PACT to meet the needs of special populations, such as women Veterans (WVs), was not considered in initial implementation guidance. WVs' numerical minority in VA healthcare settings (approximately 7-8 % of users) creates logistical challenges to delivering gender-sensitive comprehensive care. The main goal of this study is to test an evidence-based quality improvement approach (EBQI) to tailoring PACT to meet the needs of WVs, incorporating comprehensive primary care services and gender-specific care in gender-sensitive environments, thereby accelerating achievement of PACT tenets for women (Women's Health (WH)-PACT). EBQI is a systematic approach to developing a multilevel research-clinical partnership that engages senior organizational leaders and local quality improvement (QI) teams in adapting and implementing new care models in the context of prior evidence and local practice conditions, with researchers providing technical support, formative feedback, and practice facilitation. In a 12-site cluster randomized trial, we will evaluate WH-PACT model achievement using patient, provider, staff, and practice surveys, in addition to analyses of secondary administrative and chart-based data. We will explore impacts of receipt of WH-PACT care on quality of chronic disease care and prevention, health status, patient satisfaction and experience of care, provider experience, utilization, and costs. Using mixed methods, we will assess pre-post practice contexts; document EBQI activities undertaken in participating facilities and their relationship to provider/staff and team actions/attitudes; document WH-PACT implementation; and examine barriers/facilitators to EBQI-supported WH-PACT implementation through a combination of semi-structured interviews and monthly formative progress narratives and administrative data. Lack of gender-sensitive comprehensive care has demonstrated consequences for the technical quality and ratings of care among WVs and may contribute to decisions to continue use or seek care elsewhere under the US Affordable Care Act. We hypothesize that tailoring PACT implementation through EBQI may improve the experience and quality of care at many levels. ClinicalTrials.gov, NCT02039856.

How IRBs View and Make Decisions About Consent Forms

PubMed Central

Klitzman, Robert L.

2013-01-01

IRBs have been criticized for long and complicated consent forms, but how IRBs make decisions about these issues hasn’t been examined. I contacted leaders of 60 IRBs, and interviewed IRB leaders from 34 (response rate = 55%), and 13 members and administrators. IRBs confront challenges and dilemmas regarding these documents: what and how much these forms should include (e.g., how “perfect” forms should be). While IRBs generally seek to decrease the length and complexity, institutions and industry funders often want these forms to be legal documents. IRBs may also “nitpick” these documents without realizing the costs. This study, the first to explore how IRBs view and make decisions about consent forms, suggests underlying tensions, ambiguities, and subjectivities that have important implications for future policy, practice, education, and research. PMID:23485667

Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study.

PubMed

Eggenberger, Noëmi; Preisig, Basil C; Schumacher, Rahel; Hopfner, Simone; Vanbellingen, Tim; Nyffeler, Thomas; Gutbrod, Klemens; Annoni, Jean-Marie; Bohlhalter, Stephan; Cazzoli, Dario; Müri, René M

2016-01-01

Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task. Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration. In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls. Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients' comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes.

36 CFR 220.4 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency decisionmaking by: (1) Completing the environmental document review before making a decision on...(s) before rendering a decision on the proposal; and (5) Making a decision encompassed within the... preparing to make a decision on one or more alternative means of accomplishing that goal and the effects can...

Traffic signal timing manual.

DOT National Transportation Integrated Search

2008-06-01

This report serves as a comprehensive guide to traffic signal timing and documents the tasks completed in association with its : development. The focus of this document is on traffic signal control principles, practices, and procedures. It describes ...

Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol

PubMed Central

2014-01-01

Background To improve quality of care and patient outcomes, health system decision-makers need to identify and implement effective interventions. An increasing number of systematic reviews document the effects of quality improvement programs to assist decision-makers in developing new initiatives. However, limitations in the reporting of primary studies and current meta-analysis methods (including approaches for exploring heterogeneity) reduce the utility of existing syntheses for health system decision-makers. This study will explore the role of innovative meta-analysis approaches and the added value of enriched and updated data for increasing the utility of systematic reviews of complex interventions. Methods/Design We will use the dataset from our recent systematic review of 142 randomized trials of diabetes quality improvement programs to evaluate novel approaches for exploring heterogeneity. These will include exploratory methods, such as multivariate meta-regression analyses and all-subsets combinatorial meta-analysis. We will then update our systematic review to include new trials and enrich the dataset by surveying authors of all included trials. In doing so, we will explore the impact of variables not, reported in previous publications, such as details of study context, on the effectiveness of the intervention. We will use innovative analytical methods on the enriched and updated dataset to identify key success factors in the implementation of quality improvement interventions for diabetes. Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results. Discussion This study will inform future systematic reviews of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta-analysis. It will also result in an updated comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes. Systematic review registration PROSPERO registration no. CRD42013005165 PMID:25115289

Documenting Employee Conduct

ERIC Educational Resources Information Center

Dalton, Jason

2009-01-01

One of the best ways for a child care program to lose an employment-related lawsuit is failure to document the performance of its employees. Documentation of an employee's performance can provide evidence of an employment-related decision such as discipline, promotion, or discharge. When properly implemented, documentation of employee performance…

Semantic Metadata for Heterogeneous Spatial Planning Documents

NASA Astrophysics Data System (ADS)

Iwaniak, A.; Kaczmarek, I.; Łukowicz, J.; Strzelecki, M.; Coetzee, S.; Paluszyński, W.

2016-09-01

Spatial planning documents contain information about the principles and rights of land use in different zones of a local authority. They are the basis for administrative decision making in support of sustainable development. In Poland these documents are published on the Web according to a prescribed non-extendable XML schema, designed for optimum presentation to humans in HTML web pages. There is no document standard, and limited functionality exists for adding references to external resources. The text in these documents is discoverable and searchable by general-purpose web search engines, but the semantics of the content cannot be discovered or queried. The spatial information in these documents is geographically referenced but not machine-readable. Major manual efforts are required to integrate such heterogeneous spatial planning documents from various local authorities for analysis, scenario planning and decision support. This article presents results of an implementation using machine-readable semantic metadata to identify relationships among regulations in the text, spatial objects in the drawings and links to external resources. A spatial planning ontology was used to annotate different sections of spatial planning documents with semantic metadata in the Resource Description Framework in Attributes (RDFa). The semantic interpretation of the content, links between document elements and links to external resources were embedded in XHTML pages. An example and use case from the spatial planning domain in Poland is presented to evaluate its efficiency and applicability. The solution enables the automated integration of spatial planning documents from multiple local authorities to assist decision makers with understanding and interpreting spatial planning information. The approach is equally applicable to legal documents from other countries and domains, such as cultural heritage and environmental management.

Readability assessment of concussion and traumatic brain injury publications by Centers for Disease Control and Prevention

PubMed Central

Gill, Preetinder S; Gill, Tejkaran S; Kamath, Ashwini; Whisnant, Billy

2012-01-01

Health literacy is associated with a person’s capacity to find, access, contextualize, and understand information needed for health care-related decisions. The level of health literacy thus has an influence on an individual’s health status. It can be argued that low health literacy is associated with poor health status. Health care literature (eg, pamphlets, brochures, postcards, posters, forms) are published by public and private organizations worldwide to provide information to the general public. The ability to read, use, and understand is critical to the successful application of knowledge disseminated by this literature. This study assessed the readability, suitability, and usability of health care literature associated with concussion and traumatic brain injury published by the United States Centers for Disease Control and Prevention. The Flesch–Kincaid Grade Level, Flesch Reading Ease, Gunning Fog, Simple Measure of Gobbledygook, and Suitability Assessment of Materials indices were used to assess 40 documents obtained from the Centers for Disease Control and Prevention website. The documents analyzed were targeted towards the general public. It was found that in order to be read properly, on average, these documents needed more than an eleventh grade/high school level education. This was consistent with the findings of other similar studies. However, the qualitative Suitability Assessment of Materials index showed that, on average, usability and suitability of these documents was superior. Hence, it was concluded that formatting, illustrations, layout, and graphics play a pivotal role in improving health care-related literature and, in turn, promoting health literacy. Based on the comprehensive literature review and assessment of the 40 documents associated with concussion and traumatic brain injury, recommendations have been made for improving the readability, suitability, and usability of health care-related documents. The recommendations are presented in the form of an incremental improvement process cycle and a list of dos and don’ts. PMID:23204856

Advanced decision support for winter road maintenance

DOT National Transportation Integrated Search

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

An Overview of R in Health Decision Sciences.

PubMed

Jalal, Hawre; Pechlivanoglou, Petros; Krijkamp, Eline; Alarid-Escudero, Fernando; Enns, Eva; Hunink, M G Myriam

2017-10-01

As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it. These functions facilitate applications of health decision science methodology as well as the visualization and communication of results. Although R's popularity is increasing among health decision scientists, methodological extensions of R in the field of decision analysis remain isolated. The purpose of this article is to provide an overview of existing R functionality that is applicable to the various stages of decision analysis, including model design, input parameter estimation, and analysis of model outputs.

Quality Document Examples (Record of Decision of the Year Contest)

EPA Pesticide Factsheets

This page provides document examples with clear documentation that are consistent with the Superfund Program's policy and regulations. The examples provided here are the winners of the Superfund ROD of the Year Contest (1999-2004)

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

Zining, Jin, E-mail: jinzn@pkusz.edu.cn

The article explores the practices of Environmental Impact Assessment (EIA) Law in China's courts by examining 107 judicial decisions. Each of the 107 judicial decisions has been analyzed to determine the time/location of the decision, what type of EIA document was referred to, what specific claim was made by the plaintiffs, and what the court's ruling was on the case. The results indicate that: unlike in Germany or Japan, all kinds of EIA decisions made by environment protect bureaus (EPBs) in China were widely taken as justiciable, and China's courts generally allowed local residents to have standing and thus challengemore » the EPBs' decisions made during the EIA process. On the other hand, the research also shows the EPBs overwhelmingly prevailed in those EIA lawsuits. It is also found that China's reviewing judges were highly self-restrained, giving obvious deference to the technocrat with the substantial contents of EIA documents. Also, the concept of “flaw” was created when it came to procedural issues. These two factors, among others, were both helping the EPBs' prevailing successes. - Highlights: • 107 judicial decisions referring to China's EIA law are examined. • The justiciability of EPB's EIA decisions were taken for granted. • The defenders overwhelmingly prevailed in those EIA lawsuits. • The reviewing judges were highly self-restrained, defering to the technocrat with the EIA documents. • A functional concept, “flaw”, was created by reviewing judges when it came to procedural issues.« less

Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy

PubMed Central

Borello, Alessandro; Passera, Roberto; Surace, Alessandra; Marola, Silvia; Buccelli, Claudio; Niola, Massimo; Di Lorenzo, Pierpaolo; Amato, Maurizio; Di Domenico, Lorenza; Solej, Mario; Martino, Valter

2016-01-01

Abstract Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Results Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Conclusions Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding. PMID:28352847

Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy.

PubMed

Borello, Alessandro; Ferrarese, Alessia; Passera, Roberto; Surace, Alessandra; Marola, Silvia; Buccelli, Claudio; Niola, Massimo; Di Lorenzo, Pierpaolo; Amato, Maurizio; Di Domenico, Lorenza; Solej, Mario; Martino, Valter

2016-01-01

Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding.

DECISION-COMPONENTS OF NICE'S TECHNOLOGY APPRAISALS ASSESSMENT FRAMEWORK.

PubMed

de Folter, Joost; Trusheim, Mark; Jonsson, Pall; Garner, Sarah

2018-01-01

Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way. A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors. We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created. This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

The Role of Documentation Quality in Anesthesia-Related Closed Claims: A Descriptive Qualitative Study.

PubMed

Wilbanks, Bryan A; Geisz-Everson, Marjorie; Boust, Rebecca R

2016-09-01

Clinical documentation is a critical tool in supporting care provided to patients. Sound documentation provides a picture of clinical events that can be used to improve patient care. However, many other uses for clinical documentation are equally important. Such documentation informs clinical decision support tools, creates a legal record of patient care, assists in financial reimbursement of services, and serves as a repository for secondary data analysis. Conversely, poor documentation can impair patient safety and increase malpractice risk exposure by reflecting poor or inaccurate information that ultimately may guide patient care decisions.Through an examination of anesthesia-related closed claims, a descriptive qualitative study emerged, which explored the antecedents and consequences of documentation quality in the claims reviewed. A secondary data analysis utilized a database generated by the American Association of Nurse Anesthetists Foundation closed claim review team. Four major themes emerged from the analysis. Themes 1, 2, and 4 primarily describe how poor documentation quality can have negative consequences for clinicians. The third theme primarily describes how poor documentation quality that can negatively affect patient safety.

Human Judgment and Decision Making: Models and Applications.

ERIC Educational Resources Information Center

Loke, Wing Hong

This document notes that researchers study the processes involved in judgment and decision making and prescribe theories and models that reflect the behavior of the decision makers. It addresses the various models that are used to represent judgment and decision making, with particular interest in models that more accurately represent human…

Superfund record of decision amendment (EPA Region 5): Arrowhead Refinery Company, Hermantown, MN, February 9, 1994

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

NONE

This decision document amends the selected remedial action for the Arrowhead Refinery Superfund Site (Arrowhead). This AROD does not make `fundamental changes` to the groundwater remedy selected in the ROD. Therefore, this AROD does not constitute an amendment of the groundwater remedy. However, this AROD does document minor differences in the groundwater remedy which the Agency intends to implement.

Reconstructing the Prostate Cancer Transcriptional Regulatory Network

DTIC Science & Technology

2010-07-01

the Medical Scientist Training Program. The funders had no role in study design , data collection and analysis , decision to publish, or preparation of...reverse analysis , building a cell line subtype classifier to classify 86 breast tumors (from the original Stanford/Norway study defining the five tumor...Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public

Econ's optimal decision model of wheat production and distribution-documentation

NASA Technical Reports Server (NTRS)

1977-01-01

The report documents the computer programs written to implement the ECON optical decision model. The programs were written in APL, an extremely compact and powerful language particularly well suited to this model, which makes extensive use of matrix manipulations. The algorithms used are presented and listings of and descriptive information on the APL programs used are given. Possible changes in input data are also given.

25 CFR 162.588 - What happens if BIA does not meet a deadline for issuing a decision on a lease document?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What happens if BIA does not meet a deadline for issuing a decision on a lease document? 162.588 Section 162.588 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease...

25 CFR 162.588 - What happens if BIA does not meet a deadline for issuing a decision on a lease document?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What happens if BIA does not meet a deadline for issuing a decision on a lease document? 162.588 Section 162.588 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease...

10 CFR 95.37 - Classification and preparation of documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... classification decisions. (c) Markings required on face of documents. (1) For derivative classification of... to a document must be placed in a conspicuous fashion in letters at the top and bottom of the outside... on the face of the document: Reproduction or Further Dissemination Requires Approval of If any...

10 CFR 95.37 - Classification and preparation of documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... classification decisions. (c) Markings required on face of documents. (1) For derivative classification of... to a document must be placed in a conspicuous fashion in letters at the top and bottom of the outside... on the face of the document: Reproduction or Further Dissemination Requires Approval of If any...

Pedagogical Documentation as a Lens for Examining Equality in Early Childhood Education

ERIC Educational Resources Information Center

Paananen, Maiju; Lipponen, Lasse

2018-01-01

In this paper, we consider pedagogical quality particularly as equal opportunities for participating in decision-making in preschool. Relying on Ferraris' [2013. "Documentality: Why it is necessary to leave traces." New York: Fordham University Press] theory of Documentality, we demonstrate how pedagogical documentation can contribute to…

Effectiveness of Selected Supplemental Reading Comprehension Interventions: Impacts on a First Cohort of Fifth-Grade Students. NCEE 2009-4032

ERIC Educational Resources Information Center

James-Burdumy, Susanne; Mansfield, Wendy; Deke, John; Carey, Nancy; Lugo-Gil, Julieta; Hershey, Alan; Douglas, Aaron; Gersten, Russell; Newman-Gonchar, Rebecca; Dimino, Joseph; Faddis, Bonnie

2009-01-01

This document reports on the impacts on student achievement for four supplemental reading curricula that use similar overlapping instructional strategies designed to improve reading comprehension in social studies and science text. Fifth-grade reading comprehension for each of three commercially-available curricula (Project CRISS, ReadAbout, and…

Exploring the Decision Landscape: Integration and Display of Ecosystem Services & Indicators Using the Driver-Pressure-State-Impact-Response Framework and Dynamic Web Application

EPA Science Inventory

Making decisions to increase community or regional sustainability requires a comprehensive understanding of the linkages between environmental, social, and economic systems. We present a visualization tool that can improve decision processes by enhancing understanding of system c...

School District Approval for Staff Development: "Garbage Can" Decision-Making.

ERIC Educational Resources Information Center

Furman, Gail Chase

This paper explores the decision-making process leading to school district approval for staff development. A retrospective field study approach was used to investigate the decision of a small, rural school district in eastern Washington (enrollment 2,200) to adopt a comprehensive English composition teaching program throughout the curriculum. This…

An EGR performance evaluation and decision-making approach based on grey theory and grey entropy analysis

PubMed Central

2018-01-01

Exhaust gas recirculation (EGR) is one of the main methods of reducing NOX emissions and has been widely used in marine diesel engines. This paper proposes an optimized comprehensive assessment method based on multi-objective grey situation decision theory, grey relation theory and grey entropy analysis to evaluate the performance and optimize rate determination of EGR, which currently lack clear theoretical guidance. First, multi-objective grey situation decision theory is used to establish the initial decision-making model according to the main EGR parameters. The optimal compromise between diesel engine combustion and emission performance is transformed into a decision-making target weight problem. After establishing the initial model and considering the characteristics of EGR under different conditions, an optimized target weight algorithm based on grey relation theory and grey entropy analysis is applied to generate the comprehensive evaluation and decision-making model. Finally, the proposed method is successfully applied to a TBD234V12 turbocharged diesel engine, and the results clearly illustrate the feasibility of the proposed method for providing theoretical support and a reference for further EGR optimization. PMID:29377956

An EGR performance evaluation and decision-making approach based on grey theory and grey entropy analysis.

PubMed

Zu, Xianghuan; Yang, Chuanlei; Wang, Hechun; Wang, Yinyan

2018-01-01

Exhaust gas recirculation (EGR) is one of the main methods of reducing NOX emissions and has been widely used in marine diesel engines. This paper proposes an optimized comprehensive assessment method based on multi-objective grey situation decision theory, grey relation theory and grey entropy analysis to evaluate the performance and optimize rate determination of EGR, which currently lack clear theoretical guidance. First, multi-objective grey situation decision theory is used to establish the initial decision-making model according to the main EGR parameters. The optimal compromise between diesel engine combustion and emission performance is transformed into a decision-making target weight problem. After establishing the initial model and considering the characteristics of EGR under different conditions, an optimized target weight algorithm based on grey relation theory and grey entropy analysis is applied to generate the comprehensive evaluation and decision-making model. Finally, the proposed method is successfully applied to a TBD234V12 turbocharged diesel engine, and the results clearly illustrate the feasibility of the proposed method for providing theoretical support and a reference for further EGR optimization.

From genetics to genomics: ethics, policy, and parental decision-making.

PubMed

Wilfond, Benjamin; Ross, Lainie Friedman

2009-07-01

Ethical evaluation of genetic testing in children is traditionally based on balancing clinical benefits and risks. However, this focus can be inconsistent with the general practice of respecting parental decision-making about their children's health care. We argue that respect for parental decision-making should play a larger role in shaping pediatric genetic testing practices, and play a similar role regarding decisions to use emerging genomic technologies. Genomic testing involves the examination of thousands of DNA markers spanning genes throughout the genome and their interrelationships, yielding virtually limitless interpretations. We presume that parents and providers should proceed cautiously in applying genomic testing in children, as we explore how genomic testing will stress the fault lines of the traditional ethical analysis. Empirical data about the psychosocial risks and benefits of genetic testing of children do not reveal serious harms, yet virtually no such data exist yet about genomic testing. Unless empirical social and behavioral data indicate that genomic testing is highly likely to cause serious harms to the children, parental decisions to obtain comprehensive genomic testing in their children should be respected. Once comprehensive genomic testing of children becomes routine, resultant information may be more easily integrated by families than anticipated. Research on the social and behavioral impact of comprehensive genomic testing on children and their families is needed to further inform parents, clinicians, and policy makers.

Traffic signal timing manual

DOT National Transportation Integrated Search

2008-06-01

This report serves as a comprehensive guide to traffic signal timing and documents the tasks completed in association with its development. The focus of this document is on traffic signal control principles, practices, and procedures. It describes th...

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

40 CFR 305.5 - Filing, service, and form of pleadings and documents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS COMPREHENSIVE ENVIRONMENTAL... SUPERFUND General § 305.5 Filing, service, and form of pleadings and documents. (a) Filing of pleadings and...

ProUCL version 4.1.00 Documentation Downloads

EPA Pesticide Factsheets

ProUCL version 4.1.00 represents a comprehensive statistical software package equipped with statistical methods and graphical tools needed to address many environmental sampling and statistical issues as described in various these guidance documents.

Funding Based on Needs? A Study on the Use of Needs Assessment Data by a Major Humanitarian Health Assistance Donor in its Decisions to Allocate Funds

PubMed Central

Olin, Emma; von Schreeb, Johan

2014-01-01

Background: International humanitarian assistance is essential for disaster-affected populations, particularly in resource scarce settings. To target such assistance, needs assessments are required. According to internationally endorsed principles, donor governments should provide funding for humanitarian assistance based on need. Aim: The aim of this study is to explore a major donor’s use of needs assessment data in decision-making for allocations of funds for health-related humanitarian assistance contributions. Setting: This is a case study of the Swedish International Development Cooperation Agency (Sida), a major and respected international donor of humanitarian assistance. Methods: To explore Sida’s use of needs assessment data in practice for needs-based allocations, we reviewed all decision documents and assessment memoranda for humanitarian assistance contributions for 2012 using content analysis; this was followed by interviews with key personnel at Sida. Results: Our document analysis found that needs assessment data was not systematically included in Sida’s assessment memoranda and decision documents. In the interviews, we observed various descriptions of the concept of needs assessments, the importance of contextual influences as well as previous collaborations with implementing humanitarian assistance organizations. Our findings indicate that policies guiding funding decisions on humanitarian assistance need to be matched with available needs assessment data and that terminologies and concepts have to be clearly defined. Conclusion: Based on the document analysis and the interviews, it is unclear how well Sida used needs assessment data for decisions to allocate funds. However, although our observations show that needs assessments are seldom used in decision making, Sida’s use of needs assessments has improved compared to a previous study. To improve project funds allocations based on needs assessment data, it will be critical to develop distinct frameworks for allocation distributions based on needs assessment and clear definitions, measurements and interpretations of needs. Key words: Needs assessment, humanitarian assistance, disasters, donor decision-making PMID:24894417

Screening Algorithm to Guide Decisions on Whether to Conduct a Health Impact Assessment

EPA Pesticide Factsheets

Provides a visual aid in the form of a decision algorithm that helps guide discussions about whether to proceed with an HIA. The algorithm can help structure, standardize, and document the decision process.

Use of technology to support information needs for continuity of operations planning in public health: a systematic review.

PubMed

Reeder, Blaine; Turner, Anne; Demiris, George

2010-01-01

Continuity of operations planning focuses on an organization's ability to deliver essential services before, during and after an emergency. Public health leaders must make decisions based on information from many sources and their information needs are often facilitated or hindered by technology. The aim of this study is to provide a systematic review of studies of technology projects that address public health continuity of operations planning information needs and to discuss patterns, themes, and challenges to inform the design of public health continuity of operations information systems. To return a comprehensive results set in an under-explored area, we searched broadly in the Medline and EBSCOHost bibliographic databases using terms from prior work in public health emergency management and continuity of operations planning in other domains. In addition, we manually searched the citation lists of publications included for review. A total of 320 publications were reviewed. Twenty studies were identified for inclusion (twelve risk assessment decision support tools, six network and communications-enabled decision support tools, one training tool and one dedicated video-conferencing tool). Levels of implementation for information systems in the included studies range from proposed frameworks to operational systems. There is a general lack of documented efforts in the scientific literature for technology projects about public health continuity of operations planning. Available information about operational information systems suggest inclusion of public health practitioners in the design process as a factor in system success.

Foundations of the participatory approach in the Mekong River basin management.

PubMed

Budryte, Paulina; Heldt, Sonja; Denecke, Martin

2018-05-01

Integrated Water Resource Management (IWRM) was acknowledged as a leading concept in the water management for the last two decades by academia, political decision-makers and experts. It strongly promotes holistic management and participatory approaches. The flexibility and adaptability of IWRM concept are especially important for large, transboundary river basins - e.g. the Mekong river basin - where natural processes and hazards, as well as, human-made "disasters" are demanding for a comprehensive approach. In the Mekong river basin, the development and especially the enforcement of one common strategy has always been a struggle. The past holds some unsuccessful experiences. In 2016 Mekong River Commission published IWRM-based Basin Development Strategy 2016-2020 and The Mekong River Commission Strategic Plan 2016-2020. They should be the main guiding document for the Mekong river development in the near future. This study analyzes how the concept of public participation resembles the original IWRM participatory approach in these documents. Therefore, IWRM criteria for public participation in international literature and official documents from the Mekong river basin are compared. As there is often a difference between "de jure" and "de facto" implementation of public participation in management concepts, the perception of local stakeholders was assessed in addition. The results of social survey give an insight if local people are aware of Mekong river basin development and present their dominant attitudes about the issue. The findings enable recommendations how to mitigate obstacles in the implementation of common development strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

Do People Experience Cognitive Biases while Searching for Information?

PubMed Central

Lau, Annie Y.S.; Coiera, Enrico W.

2007-01-01

Objective To test whether individuals experience cognitive biases whilst searching using information retrieval systems. Biases investigated are anchoring, order, exposure and reinforcement. Design A retrospective analysis and a prospective experiment were conducted to investigate whether cognitive biases affect the way that documentary evidence is interpreted while searching online. The retrospective analysis was conducted on the search and decision behaviors of 75 clinicians (44 doctors, 31 nurses), answering questions for 8 clinical scenarios within 80 minutes in a controlled setting. The prospective study was conducted on 227 undergraduate students, who used the same search engine to answer two of six randomly assigned consumer health questions. Measurements Frequencies of correct answers pre- and post- search, and confidence in answers were collected. The impact of reading a document on the final decision was measured by the population likelihood ratio (LR) of the frequency of reading the document and the frequency of obtaining a correct answer. Documents with a LR > 1 were most likely to be associated with a correct answer, and those with a LR < 1 were most likely to be associated with an incorrect answer to a question. Agreement between a subject and the evidence they read was estimated by a concurrence rate, which measured the frequency that subjects’ answers agreed with the likelihood ratios of a group of documents, normalized for document order, time exposure or reinforcement through repeated access. Serial position curves were plotted for the relationship between subjects’ pre-search confidence, document order, the number of times and length of time a document was accessed, and concurrence with post-search answers. Chi-square analyses tested for the presence of biases, and the Kolmogorov-Smirnov test checked for equality of distribution of evidence in the comparison populations. Results A person’s prior belief (anchoring) has a significant impact on their post-search answer (retrospective: P < 0.001; prospective: P < 0.001). Documents accessed at different positions in a search session (order effect [retrospective: P = 0.76; prospective: P = 0.026]), and documents processed for different lengths of time (exposure effect [retrospective: P = 0.27; prospective: P = 0.0081]) also influenced decision post-search more than expected in the prospective experiment but not in the retrospective analysis. Reinforcement through repeated exposure to a document did not yield statistical differences in decision outcome post-search (retrospective: P = 0.31; prospective: P = 0.81). Conclusion People may experience anchoring, exposure and order biases while searching for information, and these biases may influence the quality of decision making during and after the use of information retrieval systems. PMID:17600097

RISK COMMUNICATION IN COMMUNITY PARTICIPATION: COMPARING REGIONAL PROGRAMS IN SOUTH FLORIDA

EPA Science Inventory

Comparison of the U.S. Environmental Protection Agency’s Superfund Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) and the U.S. Army Corps of Engineers’ Comprehensive Everglades Restoration Plan (CERP) decision-making regimes revealed...

Valuation of Electric Power System Services and Technologies

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

Kintner-Meyer, Michael C. W.; Homer, Juliet S.; Balducci, Patrick J.

Accurate valuation of existing and new technologies and grid services has been recognized to be important to stimulate investment in grid modernization. Clear, transparent, and accepted methods for estimating the total value (i.e., total benefits minus cost) of grid technologies and services are necessary for decision makers to make informed decisions. This applies to home owners interested in distributed energy technologies, as well as to service providers offering new demand response services, and utility executives evaluating best investment strategies to meet their service obligation. However, current valuation methods lack consistency, methodological rigor, and often the capabilities to identify and quantifymore » multiple benefits of grid assets or new and innovative services. Distributed grid assets often have multiple benefits that are difficult to quantify because of the locational context in which they operate. The value is temporally, operationally, and spatially specific. It varies widely by distribution systems, transmission network topology, and the composition of the generation mix. The Electric Power Research Institute (EPRI) recently established a benefit-cost framework that proposes a process for estimating multiple benefits of distributed energy resources (DERs) and the associated cost. This document proposes an extension of this endeavor that offers a generalizable framework for valuation that quantifies the broad set of values for a wide range of technologies (including energy efficiency options, distributed resources, transmission, and generation) as well as policy options that affect all aspects of the entire generation and delivery system of the electricity infrastructure. The extension includes a comprehensive valuation framework of monetizable and non-monetizable benefits of new technologies and services beyond the traditional reliability objectives. The benefits are characterized into the following categories: sustainability, affordability, and security, flexibility, and resilience. This document defines the elements of a generic valuation framework and process as well as system properties and metrics by which value streams can be derived. The valuation process can be applied to determine the value on the margin of incremental system changes. This process is typically performed when estimating the value of a particular project (e.g., value of a merchant generator, or a distributed photovoltaic (PV) rooftop installation). Alternatively, the framework can be used when a widespread change in the grid operation, generation mix, or transmission topology is to be valued. In this case a comprehensive system analysis is required.« less

Probability and surprisal in auditory comprehension of morphologically complex words.

PubMed

Balling, Laura Winther; Baayen, R Harald

2012-10-01

Two auditory lexical decision experiments document for morphologically complex words two points at which the probability of a target word given the evidence shifts dramatically. The first point is reached when morphologically unrelated competitors are no longer compatible with the evidence. Adapting terminology from Marslen-Wilson (1984), we refer to this as the word's initial uniqueness point (UP1). The second point is the complex uniqueness point (CUP) introduced by Balling and Baayen (2008), at which morphologically related competitors become incompatible with the input. Later initial as well as complex uniqueness points predict longer response latencies. We argue that the effects of these uniqueness points arise due to the large surprisal (Levy, 2008) carried by the phonemes at these uniqueness points, and provide independent evidence that how cumulative surprisal builds up in the course of the word co-determines response latencies. The presence of effects of surprisal, both at the initial uniqueness point of complex words, and cumulatively throughout the word, challenges the Shortlist B model of Norris and McQueen (2008), and suggests that a Bayesian approach to auditory comprehension requires complementation from information theory in order to do justice to the cognitive cost of updating probability distributions over lexical candidates. Copyright © 2012 Elsevier B.V. All rights reserved.

Nanomaterial Case Studies: Nanoscale Titanium Dioxide in ...

EPA Pesticide Factsheets

EPA announced the availability of the final report, Nanomaterial Case Studies: Nanoscale Titanium Dioxide in Water Treatment and in Topical Sunscreen. This report is a starting point to determine what is known and what needs to be known about selected nanomaterials as part of a process to identify and prioritize research to inform future assessments of the potential ecological and health implications of these materials. Two specific applications of nanoscale titanium dioxide (nano-TiO2) are considered: (1) as an agent for removing arsenic from drinking water; and (2) as an active ingredient in topical sunscreen. These case studies are organized around a comprehensive environmental assessment (CEA) framework that combines a product life cycle perspective with the risk assessment paradigm. They are intended to help identify what may need to be known in order to conduct a comprehensive environmental assessment of the potential risks related to nano-TiO2. These “case studies” do not represent completed or even preliminary assessments, nor are they intended to serve as a basis for risk management decisions in the near term on these specific uses of nano TiO2. Rather, the intent is to use this document in developing the scientific and technical information needed for future assessment efforts.

Shallow Processing and Underspecification

ERIC Educational Resources Information Center

Sanford, Anthony J.; Graesser, Arthur C.

2006-01-01

Discourse comprehension theories frequently assume that discourse comprehension involves a complete analysis of lexical, syntactic, semantic, and discourse levels of processing. However, discourse psychologists have documented some conditions when a partial processing and underspecification of the resulting representations occurs. The articles in…

A rapid review of treatment literacy materials for tuberculosis patients.

PubMed

Brumwell, A; Noyes, E; Kulkarni, S; Lin, V; Becerra, M C; Yuen, C M

2018-03-01

To assess available treatment literacy materials for patients undergoing treatment for tuberculosis (TB). We conducted a rapid review by searching the US Centers for Disease Control's Find TB Resources website and the websites of health departments and TB-focused organizations. We included English-language documents intended to educate TB patients about anti-tuberculosis treatment. We evaluated the format, readability, and content of documents, and audience. We defined 12 essential content elements based on those previously identified as facilitating human immunodeficiency virus treatment literacy. Of the 205 documents obtained, 45 were included in our review. The median reading grade level was 7 (IQR 5-8). The median number of essential content elements present was 6 (IQR 4-8), with the most comprehensive document containing 11 of the 12 elements. Only two documents were written for children with TB or their care givers, and two for patients with drug-resistant TB. Many documents contained paternalistic and non-patient-centered language. We found few examples of comprehensive, patient-centered documents. Work is needed to achieve consensus as to the essential elements of TB treatment literacy and to create additional materials for children, patients with drug-resistant TB, and those with lower literacy levels.

Performance Assessment for Pump-and-Treat Closure or Transition

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

Truex, Michael J.; Johnson, Christian D.; Becker, Dave J.

2015-09-29

A structured performance assessment approach is useful to evaluate pump-and-treat (P&T) groundwater remediation, which has been applied at numerous sites. Consistent with the U.S. Environmental Protection Agency’s Groundwater Road Map, performance assessment during remedy implementation may be needed, and should consider remedy optimization, transition to alternative remedies, or remedy closure. In addition, a recent National Research Council study examined groundwater remediation at complex contaminated sites and concluded that it may be beneficial to evaluate remedy performance and the potential need for transition to alternative approaches at these sites. The intent of this document is to provide a structured approach formore » assessing P&T performance to support a decision to optimize, transition, or close a P&T remedy. The process presented in this document for gathering information and performing evaluations to support P&T remedy decisions includes use of decision elements to distinguish between potential outcomes of a remedy decision. Case studies are used to augment descriptions of decision elements and to illustrate each type of outcome identified in the performance assessment approach. The document provides references to resources for tools and other guidance relevant to conducting the P&T assessment.« less

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Documents for SBAR Panel: CERCLA 108(b) Hard Rock Mining Financial Assurance Rule

EPA Pesticide Factsheets

SBAR panel documents for small business advocacy review panel on the financial responsibilities of the hard rock mining industry under Section 108(b) of the Comprehensive Environmental Response, Compensation, and Liability Act

Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project

PubMed Central

Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki

2014-01-01

Background The 4-year (2007–2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a ‘research user’ from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Objective Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Results Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Conclusions Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include:  Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures) Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation) Support for community advocacy and engagement in health and social systems decision making These characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures. PMID:25150030

Is the Alma Ata vision of comprehensive primary health care viable? Findings from an international project.

PubMed

Labonté, Ronald; Sanders, David; Packer, Corinne; Schaay, Nikki

2014-01-01

The 4-year (2007-2011) Revitalizing Health for All international research program (http://www.globalhealthequity.ca/projects/proj_revitalizing/index.shtml) supported 20 research teams located in 15 low- and middle-income countries to explore the strengths and weaknesses of comprehensive primary health care (CPHC) initiatives at their local or national levels. Teams were organized in a triad comprised of a senior researcher, a new researcher, and a 'research user' from government, health services, or other organizations with the authority or capacity to apply the research findings. Multiple regional and global team capacity-enhancement meetings were organized to refine methods and to discuss and assess cross-case findings. Most research projects used mixed methods, incorporating analyses of qualitative data (interviews and focus groups), secondary data, and key policy and program documents. Some incorporated historical case study analyses, and a few undertook new surveys. The synthesis of findings in this report was derived through qualitative analysis of final project reports undertaken by three different reviewers. Evidence of comprehensiveness (defined in this research program as efforts to improve equity in access, community empowerment and participation, social and environmental health determinants, and intersectoral action) was found in many of the cases. Despite the important contextual differences amongst the different country studies, the similarity of many of their findings, often generated using mixed methods, attests to certain transferable health systems characteristics to create and sustain CPHC practices. These include:1. Well-trained and supported community health workers (CHWs) able to work effectively with marginalized communities2. Effective mechanisms for community participation, both informal (through participation in projects and programs, and meaningful consultation) and formal (though program management structures)3. Co-partnership models in program and policy development (in which financial and knowledge supports from governments or institutions are provided to communities, which retain decision-making powers in program design and implementation)4. Support for community advocacy and engagement in health and social systems decision makingThese characteristics, in turn, require a political context that supports state responsibilities for redistributive health and social protection measures.

TERMTrial--terminology-based documentation systems for cooperative clinical trials.

PubMed

Merzweiler, A; Weber, R; Garde, S; Haux, R; Knaup-Gregori, P

2005-04-01

Within cooperative groups of multi-center clinical trials a standardized documentation is a prerequisite for communication and sharing of data. Standardizing documentation systems means standardizing the underlying terminology. The management and consistent application of terminology systems is a difficult and fault-prone task, which should be supported by appropriate software tools. Today, documentation systems for clinical trials are often implemented as so-called Remote-Data-Entry-Systems (RDE-systems). Although there are many commercial systems, which support the development of RDE-systems there is none offering a comprehensive terminological support. Therefore, we developed the software system TERMTrial which consists of a component for the definition and management of terminology systems for cooperative groups of clinical trials and two components for the terminology-based automatic generation of trial databases and terminology-based interactive design of electronic case report forms (eCRFs). TERMTrial combines the advantages of remote data entry with a comprehensive terminological control.

Geoscience and a Lunar Base: A Comprehensive Plan for Lunar Exploration

NASA Technical Reports Server (NTRS)

Taylor, G. Jeffrey (Editor); Spudis, Paul D. (Editor)

1990-01-01

This document represents the proceedings of the Workshop on Geoscience from a Lunar Base. It describes a comprehensive plan for the geologic exploration of the Moon. The document begins by explaining the scientific importance of studying the Moon and outlines the many unsolved problems in lunar science. Subsequent chapters detail different, complementary approaches to geologic studies: global surveys, including orbiting spacecraft such as Lunar Observer and installation of a global geophysical network; reconnaissance sample return mission, by either automated rovers or landers, or by piloted forays; detailed field studies, which involve astronauts and teleoperated robotic field geologists. The document then develops a flexible scenario for exploration and sketches the technological developments needed to carry out the exploration scenario.

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

Surface transportation weather decision support requirements : operational concept description : advanced-integrated decision support using weather information for surface transportation decisions makers : draft version 2.0

DOT National Transportation Integrated Search

2000-07-14

This is a draft document for the Surface Transportation Weather Decision Support Requirements (STWDSR) project. The STWDSR project is being conducted for the FHWAs Office of Transportation Operations (HOTO) Road Weather Management Program by Mitre...

8 CFR 103.9 - Availability of decisions and interpretive material under the Freedom of Information Act.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Availability of decisions and interpretive... of decisions and interpretive material under the Freedom of Information Act. (a) Precedent decisions. There may be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington...

Installation Restoration Program Decision Document. Site 15. Alpena Combat Readiness Training Center, Michigan Air National Guard, Alpena County Regional Airport, Alpena, Michigan.

DTIC Science & Technology

1996-05-01

This Decision Document (DD) supports the no further action alternative for Site 15 - Oiled Roads at the Alpena Combat Readiness Training Center (CRTC...in Alpena , Michigan. The purpose of the DD is to summarize the existing data for the site and describe the Air National Guard’s rational for selecting the no further action alternative.

Leveraging certified nursing assistant documentation and knowledge to improve clinical decision making: the on-time quality improvement program to prevent pressure ulcers.

PubMed

Sharkey, Siobhan; Hudak, Sandra; Horn, Susan D; Spector, William

2011-04-01

The goal of this article was to enhance understanding of the On-Time Quality Improvement for Long-term Care Program, a practical approach to embed health information technology into quality improvement in nursing homes that leverages certified nursing assistant documentation and knowledge, supports frontline clinical decision making, and establishes proactive intervention for pressure ulcer prevention.

25 CFR 162.569 - Will BIA require an appeal bond for an appeal of a decision on a WSR lease document?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Will BIA require an appeal bond for an appeal of a decision on a WSR lease document? 162.569 Section 162.569 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162...

25 CFR 162.569 - Will BIA require an appeal bond for an appeal of a decision on a WSR lease document?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Will BIA require an appeal bond for an appeal of a decision on a WSR lease document? 162.569 Section 162.569 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162...

Reconstructing the Prostate Cancer Transcriptional Regulatory Network

DTIC Science & Technology

2010-09-01

funders had no role in study design , data collection and analysis , decision to publish, or preparation of the manuscript. Competing Interests: The authors...basal-like or ERBB2 tumors (despite that none were ERBB2-positive). We also carried out the reverse analysis , building a cell line subtype classifier to...Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No

Crossing Borders in Educational Innovation: Framing Foreign Examples in Discussing Comprehensive Education in the Netherlands, 1969-1979

ERIC Educational Resources Information Center

Greveling, Linda; Amsing, Hilda T. A.; Dekker, Jeroen J. H.

2014-01-01

In the Netherlands, crossing borders to study comprehensive schools was an important strategy in the 1970s, a decisive period for the start and the end of the innovation. According to policy-borrowing theory, actors that engage in debating educational issues are framing foreign examples of comprehensive schooling to convince their audiences.…

International Doctorates: Trends Analysis on Their Decision to Stay in US

ERIC Educational Resources Information Center

Kim, Dongbin; Bankart, Charles A. S.; Isdell, Laura

2011-01-01

Despite the significant implications of the foreign doctorates' stay or return decision on a personal level, as well as for the home and host countries, there is very little research that provides a comprehensive understanding of the factors that predict international doctorates' decision to stay in the US and how those factors differ by country…

Decision-Making as a Struggle and a Play: On Alternative Rationalities in Schools as Organizations

ERIC Educational Resources Information Center

Salo, Petri

2008-01-01

In this article an alternative interpretation of the functions of decision-making and the inherent activities at teachers' meetings at schools are presented. The metaphor of "play" is introduced in order to make the teachers' actions during decision-making comprehensible, not only for outsiders, but more importantly for "involved insiders", such…

Comprehension of Co-Speech Gestures in Aphasic Patients: An Eye Movement Study

PubMed Central

Eggenberger, Noëmi; Preisig, Basil C.; Schumacher, Rahel; Hopfner, Simone; Vanbellingen, Tim; Nyffeler, Thomas; Gutbrod, Klemens; Annoni, Jean-Marie; Bohlhalter, Stephan; Cazzoli, Dario; Müri, René M.

2016-01-01

Background Co-speech gestures are omnipresent and a crucial element of human interaction by facilitating language comprehension. However, it is unclear whether gestures also support language comprehension in aphasic patients. Using visual exploration behavior analysis, the present study aimed to investigate the influence of congruence between speech and co-speech gestures on comprehension in terms of accuracy in a decision task. Method Twenty aphasic patients and 30 healthy controls watched videos in which speech was either combined with meaningless (baseline condition), congruent, or incongruent gestures. Comprehension was assessed with a decision task, while remote eye-tracking allowed analysis of visual exploration. Results In aphasic patients, the incongruent condition resulted in a significant decrease of accuracy, while the congruent condition led to a significant increase in accuracy compared to baseline accuracy. In the control group, the incongruent condition resulted in a decrease in accuracy, while the congruent condition did not significantly increase the accuracy. Visual exploration analysis showed that patients fixated significantly less on the face and tended to fixate more on the gesturing hands compared to controls. Conclusion Co-speech gestures play an important role for aphasic patients as they modulate comprehension. Incongruent gestures evoke significant interference and deteriorate patients’ comprehension. In contrast, congruent gestures enhance comprehension in aphasic patients, which might be valuable for clinical and therapeutic purposes. PMID:26735917

A Comprehensive review on the open source hackable text editor-ATOM

NASA Astrophysics Data System (ADS)

Sumangali, K.; Borra, Lokesh; Suraj Mishra, Amol

2017-11-01

This document represents a comprehensive study of “Atom”, one of the best open-source code editors available with many features built-in to support multitude of programming environments and to provide a more productive toolset for developers.

Research on Radar Importance with Decision Matrix

NASA Astrophysics Data System (ADS)

Meng, Lingjie; Du, Yu; Wang, Liuheng

2017-12-01

Considering the characteristic of radar, constructed the evaluation index system of radar importance, established the comprehensive evaluation model based on decision matrix. Finally, by means of an example, the methods of this evaluation on radar importance was right and feasibility.

Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision-Making Abilities and the Amount of Information in Their Choice Environment

PubMed Central

Barnes, Andrew J; Hanoch, Yaniv; Rice, Thomas

2015-01-01

Objective To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace. Study Setting Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161). Study Design We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available). Data Collection Primary data were collected using an online questionnaire. Principal Findings Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available. Conclusions Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces. PMID:24779769

Decision support in vaccination policies.

PubMed

Piso, B; Wild, C

2009-10-09

Looking across boarders reveals that the national immunization programs of various countries differ in their vaccination schedules and decisions regarding the implementation and funding of new vaccines. The aim of this review is to identify decision aids and crucial criteria for a rational decision-making process on vaccine introduction and to develop a theoretical framework for decision-making based on available literature. Systematic literature search supplemented by hand-search. We identified five published decision aids for vaccine introduction and program planning in industrialized countries. Their comparison revealed an overall similarity with some differences in the approach as well as criteria. Burden of disease and vaccine characteristics play a key role in all decision aids, but authors vary in their views on the significance of cost-effectiveness analyses. Other relevant factors that should be considered before vaccine introduction are discussed to highly differing extents. These factors include the immunization program itself as well as its conformity with other programs, its feasibility, acceptability, and equity, as well as ethical, legal and political considerations. Assuming that the most comprehensive framework possible will not provide a feasible tool for decision-makers, we suggest a stepwise procedure. Though even the best rational approach and most comprehensive evaluation is limited by remaining uncertainties, frameworks provide at least a structured approach to evaluate the various aspects of vaccine implementation decision-making. This process is essential in making consistently sound decisions and will facilitate the public's confidence in the decision and its realization.

77 FR 48974 - Applications for New Awards; Comprehensive Centers Program (CFDA 84.283B); Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... version of this document is the document published in the Federal Register. Free Internet access to the... Federal Relay Service (FRS), toll free, at 1- 800-877-8339. SUPPLEMENTARY INFORMATION: We make the... Document Format (PDF). To use PDF you must have Adobe Acrobat Reader, which is available free at the site...

EFL Learners' Multiple Documents Literacy: Effects of a Strategy-Directed Intervention Program

ERIC Educational Resources Information Center

Karimi, Mohammad Nabi

2015-01-01

There is a substantial body of L2 research documenting the central role of strategy instruction in reading comprehension. However, this line of research has been conducted mostly within the single text paradigm of reading research. With reading literacy undergoing a marked shift from single source reading to multiple documents literacy, little is…

36 CFR 1010.4 - NEPA Compliance Coordinator.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Develop procedures within the Trust's planning and decision-making processes to ensure that environmental... and documentation of the environmental aspects of the Trust's planning and decision-making processes... decisions of the NEPA Compliance Coordinator in accordance with the Trust's regulations and procedures. (b...

Gold Run Pass - Div. of Mining, Land, and Water

Science.gov Websites

issuing a Final Findings of Fact and Decision for the renewal of the Gold Run Pass Mine permits. Documents : Final Findings and Decision(PDF)(Posted 9/2/2016) Public Notice of Final Findings and Decision (PDF

Comparison of not for resuscitation (NFR) forms across five Victorian health services.

PubMed

Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

2014-07-01

Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

User's perspectives of barriers and facilitators to implementing quality colonoscopy services in Canada: a study protocol.

PubMed

Jobin, Gilles; Gagnon, Marie Pierre; Candas, Bernard; Dubé, Catherine; Ben Abdeljelil, Anis; Grenier, Sonya

2010-11-02

Colorectal cancer (CRC) represents a serious and growing health problem in Canada. Colonoscopy is used for screening and diagnosis of symptomatic or high CRC risk individuals. Although a number of countries are now implementing quality colonoscopy services, knowledge synthesis of barriers and facilitators perceived by healthcare professionals and patients during implementation has not been carried out. In addition, the perspectives of various stakeholders towards the implementation of quality colonoscopy services and the need of an efficient organisation of such services have been reported in the literature but have not been synthesised yet. The present study aims to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators perceived by all stakeholders to the implementation of quality colonoscopy services in Canada. First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to implementing quality colonoscopy services. Standardised literature searches and data extraction methods will be used. The quality of the studies and their relevance to informing decisions on colonoscopy services implementation will be assessed. For each group of users identified, barriers and facilitators will be categorised and compiled using narrative synthesis and meta-analytical techniques. The principle factors identified for each group of users will then be validated for its applicability to various Canadian contexts using the Delphi study method. Following this study, a set of strategies will be identified to inform decision makers involved in the implementation of quality colonoscopy services across Canadian jurisdictions. This study will be the first to systematically summarise the barriers and facilitators to implementation of quality colonoscopy services perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. Linkages with strategic partners and decision makers in the realisation of this project will favour the utilisation of its results to support strategies for implementing quality colonoscopy services and CRC screening programs in the Canadian health system.

Information Retrieval: A Sequential Learning Process.

ERIC Educational Resources Information Center

Bookstein, Abraham

1983-01-01

Presents decision-theoretic models which intrinsically include retrieval of multiple documents whereby system responds to request by presenting documents to patron in sequence, gathering feedback, and using information to modify future retrievals. Document independence model, set retrieval model, sequential retrieval model, learning model,…

Indicators of the environmental impacts of transportation : highway, rail, aviation, and maritime transport

DOT National Transportation Integrated Search

1996-10-01

This document presents quantitative national estimates of the magnitude of transportations impacts on the natural environment. It is the most comprehensive compilation of environmental and transportation data to date. This document addresses all p...

Games policy makers and providers play: introducing case-mix-based payment to hospital chronic care units in Japan.

PubMed

Ikegami, Naoki

2009-06-01

Case-mix-based payment was developed for hospital chronic care units in Japan to replace the flat per diem rate and encourage the admission of patients with higher medical acuity and was part of a policy initiative to make the tariff more evidence based. However, although the criteria for grouping patients were developed from a statistical analysis of resource use, the tariff was subsequently set below costs, particularly for the groups with the lowest medical acuity, both because of the prime minister's decision to decrease total health expenditures and because of the health ministry's decision to target the reductions on chronic care units. Providers quickly adapted to the new payment system mainly by reclassifying their patients to higher medical acuity groups. Some hospitals reported high prevalence rates of urinary tract infections and pressure ulcers. The government responded by issuing directives to providers to calculate the prevalence rates and document the care that has been mandated for the patients at risk. However, in order to monitor compliance and to evaluate whether the patient is being billed for the appropriate case-mix group, the government must invest in developing a comprehensive patient-level database and in training staff for making on-site inspections.

Evaluation of risk communication in a mammography patient decision aid.

PubMed

Klein, Krystal A; Watson, Lindsey; Ash, Joan S; Eden, Karen B

2016-07-01

We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Evaluation of risk communication in a mammography patient decision aid

PubMed Central

Klein, Krystal A.; Watson, Lindsey; Ash, Joan S.; Eden, Karen B.

2016-01-01

Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics PMID:26965020

Refusal of recommended maternity care: Time to make a pact with women?

PubMed

Jenkinson, Bec; Kruske, Sue; Kildea, Sue

2018-03-28

The right to refuse medical treatment can be contentious in maternity care. Professional guidance for midwives and obstetricians emphasises informed consent and respect for patient autonomy, but there is little guidance available to clinicians about the appropriate clinical responses when women decline recommended care. We propose a comprehensive, woman-centred, systems-level framework for documentation and communication with the goal of supporting women, clinicians and health services in situations of maternal refusal. We term this the Personalised Alternative Care and Treatment framework. The Personalised Alternative Care and Treatment framework addresses Australian policy, practice, education and professional issues to underpin woman-centred care in the context of maternal refusal. It embeds Respectful Maternity Care in system-level maternity care policy; highlights the woman's role as decision maker about her maternity care; documents information exchanged with women; creates a 'living' plan that respects the woman's birth intentions and can be reviewed as circumstances change; enables communication between clinicians; permits flexible initiation pathways; provides for professional education for clinicians, and incorporates a mediation role to act as a failsafe. The Personalised Alternative Care and Treatment framework has the potential to meet the needs of women, clinicians and health services when pregnant women decline recommended maternity care. Copyright © 2018. Published by Elsevier Ltd.

Factors associated with integrating self-management support into primary care.

PubMed

Crespo, Richard; Shrewsberry, Molly

2007-06-01

The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care. Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. A standardized set of questions was used in the interviews. The data from the interviews were analyzed using content analysis techniques. One of the principle findings is that self-management support requires putting a system in place, not just adding a new component to primary care. The health centers that fully implemented the self-management program made an organizational commitment to keep self-management on the agenda in management meetings, clinical staff set the example by adopting self-management behaviors, and patient self-management support was implemented in multiple patient care venues. Primary care centers with limited financial resources are able to integrate self-management support into their system of chronic illness care.

Key Decision Record Creation and Approval Module

NASA Technical Reports Server (NTRS)

Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted

2012-01-01

Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications

WikiHyperGlossary (WHG): an information literacy technology for chemistry documents.

PubMed

Bauer, Michael A; Berleant, Daniel; Cornell, Andrew P; Belford, Robert E

2015-01-01

The WikiHyperGlossary is an information literacy technology that was created to enhance reading comprehension of documents by connecting them to socially generated multimedia definitions as well as semantically relevant data. The WikiHyperGlossary enhances reading comprehension by using the lexicon of a discipline to generate dynamic links in a document to external resources that can provide implicit information the document did not explicitly provide. Currently, the most common method to acquire additional information when reading a document is to access a search engine and browse the web. This may lead to skimming of multiple documents with the novice actually never returning to the original document of interest. The WikiHyperGlossary automatically brings information to the user within the current document they are reading, enhancing the potential for deeper document understanding. The WikiHyperGlossary allows users to submit a web URL or text to be processed against a chosen lexicon, returning the document with tagged terms. The selection of a tagged term results in the appearance of the WikiHyperGlossary Portlet containing a definition, and depending on the type of word, tabs to additional information and resources. Current types of content include multimedia enhanced definitions, ChemSpider query results, 3D molecular structures, and 2D editable structures connected to ChemSpider queries. Existing glossaries can be bulk uploaded, locked for editing and associated with multiple social generated definitions. The WikiHyperGlossary leverages both social and semantic web technologies to bring relevant information to a document. This can not only aid reading comprehension, but increases the users' ability to obtain additional information within the document. We have demonstrated a molecular editor enabled knowledge framework that can result in a semantic web inductive reasoning process, and integration of the WikiHyperGlossary into other software technologies, like the Jikitou Biomedical Question and Answer system. Although this work was developed in the chemical sciences and took advantage of open science resources and initiatives, the technology is extensible to other knowledge domains. Through the DeepLit (Deeper Literacy: Connecting Documents to Data and Discourse) startup, we seek to extend WikiHyperGlossary technologies to other knowledge domains, and integrate them into other knowledge acquisition workflows.

Participants' recall and understanding of genomic research and large-scale data sharing.

PubMed

Robinson, Jill Oliver; Slashinski, Melody J; Wang, Tao; Hilsenbeck, Susan G; McGuire, Amy L

2013-10-01

As genomic researchers are urged to openly share generated sequence data with other researchers, it is important to examine the utility of informed consent documents and processes, particularly as these relate to participants' engagement with and recall of the information presented to them, their objective or subjective understanding of the key elements of genomic research (e.g., data sharing), as well as how these factors influence or mediate the decisions they make. We conducted a randomized trial of three experimental informed consent documents (ICDs) with participants (n = 229) being recruited to genomic research studies; each document afforded varying control over breadth of release of genetic information. Recall and understanding, their impact on data sharing decisions, and comfort in decision making were assessed in a follow-up structured interview. Over 25% did not remember signing an ICD to participate in a genomic study, and the majority (54%) could not correctly identify with whom they had agreed to share their genomic data. However, participants felt that they understood enough to make an informed decision, and lack of recall did not impact final data sharing decisions or satisfaction with participation. These findings raise questions about the types of information participants need in order to provide valid informed consent, and whether subjective understanding and comfort with decision making are sufficient to satisfy the ethical principle of respect for persons.

[Written information for patients: From papers to documents].

PubMed

Cortés-Criado, M C

2014-01-01

There is a high variability in the level of information intended for patients, with different content, format and presentation. To determine the perceived safety of the patients treated at the Country Hospital of Melilla (HCML) and to assess the quality of the documents using criteria adapted to the «International Patient Decision Aid Standards» (IPDAS). Descriptive study of the documents given to patients by the HCML. They included questionnaires on perceived safety, classification of the documents, and the level of adherence to the IPDAS criteria. The Information given to patients during their stay in the HCML, their participation in decision-making, and the information about medication, did not exceed the average on the acceptance scale. Only 40 documents were studied (of the 131 collected), on being published in-house, and were classified, following the definitions of the RAE, into instructions (20), recommendations (14) and guidelines (6). Of these, only the 27.5% showed hospital logo. In the content analysis according to the IPDAS criteria, there was an overall adherence rate of 24.1% in instructions, 24.8% in recommendations, and 61.5% in guidelines. The perception of patient safety expressed in the questionnaire, and its assessment according IPDAS criteria, shows there may be a significant improvement within the organization. Furthermore, the quality of patient documentation provided can help decision making. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids

PubMed Central

2013-01-01

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. PMID:24624947

Planning Study for Low Speed Damage Reduction Systems

DOT National Transportation Integrated Search

1977-06-01

This report documents the planning study intended to provide the basis from which a comprehensive study of low speed damage systems may be conducted. This planning study and the comprehensive study are in response to Title I of the Motor Vehicle Info...

Comprehensive School Alienation Program, Guidelines.

ERIC Educational Resources Information Center

Hawaii State Dept. of Education, Honolulu. Office of Instructional Services.

This document presents guidelines developed by the Hawaii State Department of Education's Comprehensive School Alienation Program to consolidate and strengthen the delivery of services to alienated students. It is intended to assist district staff, school administrators, and project personnel in planning and implementing program activities and…

Corrective Action Decision Document/Closure Report for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada with ROTC 1, Revision 0

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

Sloop, Christy

2013-04-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 569: Area 3 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 569 comprises the following nine corrective action sites (CASs): • 03-23-09, T-3 Contamination Area • 03-23-10, T-3A Contamination Area • 03-23-11, T-3B Contamination Area • 03-23-12, T-3S Contamination Area • 03-23-13, T-3T Contamination Area • 03-23-14, T-3V Contamination Area • 03-23-15, S-3G Contamination Area • 03-23-16, S-3H Contamination Area • 03-23-21, Pike Contamination Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supportingmore » the recommendation that no further corrective action is needed for CAU 569 based on the implementation of the corrective actions listed in Table ES-2.« less

LEEDS Decision Tools for E-Craft

DTIC Science & Technology

2011-02-15

currently valid 0MB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE (DD-MM-YYYY) 15-Feb-2011 2. REPORT TYPE Final... RIT has received no feedback regarding which system monitoring would be most beneficial to MSB. TASKS 1. Decision support research Data/analysis...project, a Project Initiation Document (PID) was written by RIT and submitted to MSB for its approval. This document is attached in Appendix A. It

Self-Aligned, Extremely High Frequency III-V Metal-Oxide-Semiconductor Field-Effect Transistors on Rigid and Flexible Substrates

DTIC Science & Technology

2012-06-29

resistances, respectively, and gd is the output conductance. The reduced parasitic capacitances and resistances provided by the self-aligned T-gate design ...Department of the Army position, policy or decision, unless so designated by other documentation. 12. DISTRIBUTION AVAILIBILITY STATEMENT Approved for...position, policy or decision, unless so designated by other documentation. Approved for public release; distribution is unlimited. ... 59654.5-MS-DRP Self

Terahertz Photovoltaic Detection of Cyclotron Resonance in the Regime of Radiation-Induced Magnetoresistance Oscillations

DTIC Science & Technology

2013-06-17

should not contrued as an official Department of the Army position, policy or decision, unless so designated by other documentation. 9. SPONSORING...construed as an official Department of the Army position, policy or decision, unless so designated by other documentation. ... PHYSICAL REVIEW B 87, 245308...oscillations in the diagonal magnetoresistance, Rxx , of the 2DES at cryogenic temperatures, T , with oscillatory nodes near integral and half- integral

Rise and Fall of Decentralized School Governance--Decision-Making Practices in Georgia

ERIC Educational Resources Information Center

Gorgodze, Sophia

2016-01-01

The current study investigates educational decision-making in the former Soviet Republic of Georgia. The focus is on decisions concerning issues of school governance decentralization/recentralization in the period of 2003-2012. The research draws on in-depth interviews with over 20 top decision-makers, and an extensive review of legal documents,…

System Sketch: A Visualization Tool to Improve Community Decision Making

EPA Science Inventory

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

43 CFR 46.20 - How to use this part.

Code of Federal Regulations, 2010 CFR

2010-10-01

....4501505.2 (b) The Responsible Official will ensure that the decision making process for proposals subject to this part includes appropriate NEPA review. (c) During the decision making process for each... the relevant environmental document. The Responsible Official's decision may combine elements of...

36 CFR 228.102 - Leasing analyses and decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decisions. 228.102 Section 228.102 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Oil and Gas Resources Leasing § 228.102 Leasing analyses and decisions. (a) Compliance... further planning in Executive Communication 1504, Ninety-Sixth Congress (House Document No. 96-119...

Creating a comprehensive customer service program to help convey critical and acute results of radiology studies.

PubMed

Towbin, Alexander J; Hall, Seth; Moskovitz, Jay; Johnson, Neil D; Donnelly, Lane F

2011-01-01

Communication of acute or critical results between the radiology department and referring clinicians has been a deficiency of many radiology departments. The failure to perform or document these communications can lead to poor patient care, patient safety issues, medical-legal issues, and complaints from referring clinicians. To mitigate these factors, a communication and documentation tool was created and incorporated into our departmental customer service program. This article will describe the implementation of a comprehensive customer service program in a hospital-based radiology department. A comprehensive customer service program was created in the radiology department. Customer service representatives were hired to answer the telephone calls to the radiology reading rooms and to help convey radiology results. The radiologists, referring clinicians, and customer service representatives were then linked via a novel workflow management system. This workflow management system provided tools to help facilitate the communication needs of each group. The number of studies with results conveyed was recorded from the implementation of the workflow management system. Between the implementation of the workflow management system on August 1, 2005, and June 1, 2009, 116,844 radiology results were conveyed to the referring clinicians and documented in the system. This accounts for more than 14% of the 828,516 radiology cases performed in this time frame. We have been successful in creating a comprehensive customer service program to convey and document communication of radiology results. This program has been widely used by the ordering clinicians as well as radiologists since its inception.

24 CFR 55.27 - Documentation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... FLOODPLAIN MANAGEMENT Procedures for Making Determinations on Floodplain Management § 55.27 Documentation. (a... outside the floodplain, but within the local housing market area, the local public utility service area..., documentation of compliance with this part must be included as a part of the record of decision (or...

[Development, implementation, and analysis of a "collaborative decision-making for reasonable care" document in pediatric palliative care].

PubMed

Paoletti, M; Litnhouvongs, M-N; Tandonnet, J

2015-05-01

In France, a legal framework and guidelines state that decisions to limit treatments (DLT) require a collaborative decision meeting and a transcription of decisions in the patient's file. The do-not-attempt-resuscitation order involves the same decision-making process for children in palliative care. To fulfill the law's requirements and encourage communication within the teams, the Resource Team in Pediatric Palliative Care in Aquitaine created a document shared by all children's hospital units, tracing the decision-making process. This study analyzed the decision-making process, quality of information transmission, and most particularly the relevance of this new "collaborative decision-making for reasonable care" card. Retrospective study evaluating the implementation of a traceable document relating the DLT process. All the data sheets collected between January and December 2013 were analyzed. A total of 58 data sheets were completed between January and December 2013. We chose to collect the most relevant data to evaluate the relevance of the items to be completed and the transmission of the document, to draw up the patients' profile, and the contents of discussions with families. Of the 58 children for whom DLT was discussed, 41 data sheets were drawn up in the pediatric intensive care unit, seven in the oncology and hematology unit, five in the neonatology unit, four in the neurology unit, and one in the pneumology unit. For 30 children, one sheet was created, for 11 children, two sheets and for two children, three sheets were filled out. Thirty-nine decisions were made for withholding lifesaving treatment, 11 withdrawing treatment, and for five children, no limitation was set. Nine children survived after DLT. Of the 58 data sheets, only 31 discussions with families were related to the content of the data sheet. Of the 14 children transferred out of the unit with a completed data sheet, it was transmitted to the new unit for 11 children (79%). The number of data sheets collected in 1 year shows the value of this document. The participation of several pediatric specialities' referents in its creation, then its progressive presentation in the children's hospital units, were essential steps in introducing and establishing its use. Items describing the situation, management proposals, and adaptation of the children's supportive care were completed in the majority of cases. They correspond to a clinical description, the object of the discussion, and the daily caregiver's practices, respectively. On the other hand, discussions with families were related to the card's contents in only 53% of the cases. This can be explained by the time required to complete the DLT process. It is difficult for referring doctors to systematically, faithfully, and objectively transcribe discussions with parents. Although this process has been used for a long time in intensive care units, this document made possible an indispensable formalisation in the decision-making process. In other pediatric specialities, the sheet allowed introducing the palliative approach and was a starter and a tool for reflection on the do-not-attempt-resuscitation order, thus suggesting the need for anticipation in these situations. With the implementation of this new document, the DLT, data transmission, and continuity of care conditions were improved in the children's hospital units. Sharing this sheet with all professionals in charge of these children would support homogeneity and quality of management and care for children and their parents. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Documentation of validity for the AT-SAT computerized test battery. Volume 2

DOT National Transportation Integrated Search

2001-03-01

This document is a comprehensive report on a large-scale research project to develop and validate a : computerized selection battery to hire Air Traffic Control Specialists (ATCSs) for the Federal Aviation : Administration (FAA). The purpose of this ...

Documentation of validity for the AT-SAT computerized test battery. Volume 1

DOT National Transportation Integrated Search

2001-03-01

This document is a comprehensive report on a large-scale research project to develop and validate a : computerized selection battery to hire Air Traffic Control Specialists (ATCSs) for the Federal Aviation : Administration (FAA). The purpose of this ...

Prototyping a bedside documentation system.

PubMed

Bachand, P; Bobis, K

1993-01-01

The implementation of a comprehensive bedside documentation system is a major project that demands careful analysis and planning. Since the cost of a typical bedside system can easily exceed $3 million, a design oversight could have disastrous effects on the benefits of the system.

77 FR 8298 - Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-14

... a quantitative, comprehensive or even representative survey or study of the burdens associated with... existing registered money market fund: Documentation of credit risk analyses, and determinations regarding... for documentation of credit analyses and other determinations) = 2340 responses. (30 funds x 12...

From the Patient Perspective, Consent Forms Fall Short of Providing Information to Guide Decision Making

PubMed Central

Manta, Christine J.; Ortiz, Jacqueline; Moulton, Benjamin W.; Sonnad, Seema S.

2016-01-01

Objective This study aimed to gather qualitative feedback on patient perceptions of informed consent forms and elicit recommendations to improve readability and utility for enhanced patient safety and engagement in shared decision making. Methods Sixty in person interviews were conducted consisting of a literacy and numeracy assessment, a comprehension quiz to assess retention of key information and open ended questions to determine reactions, clarity of information and suggestions for improvement. Results While 68% of the participants had education beyond high school, many still missed comprehension questions and found the forms difficult to read. Recurrent suggestions included: specific formatting changes to enhance readability, a need for additional sources of information, mixed attitudes towards inclusion of risk information and the recognized importance of physician-patient conversations. Conclusion This study provides evidence from the patient perspective that consent forms are too complex and fail to achieve comprehension. Future studies should be conducted using patients’ suggestions for form redesign and inclusion of supplemental educational tools in order to optimize communication and safety to achieve more informed health care decision making. PMID:27490160

Medical decision making: guide to improved CPT coding.

PubMed

Holt, Jim; Warsy, Ambreen; Wright, Paula

2010-04-01

The Current Procedural Terminology (CPT) coding system for office visits, which has been in use since 1995, has not been well studied, but it is generally agreed that the system contains much room for error. In fact, the available literature suggests that only slightly more than half of physicians will agree on the same CPT code for a given visit, and only 60% of professional coders will agree on the same code for a particular visit. In addition, the criteria used to assign a code are often related to the amount of written documentation. The goal of this study was to evaluate two novel methods to assess if the most appropriate CPT code is used: the level of medical decision making, or the sum of all problems mentioned by the patient during the visit. The authors-a professional coder, a residency faculty member, and a PGY-3 family medicine resident-reviewed 351 randomly selected visit notes from two residency programs in the Northeast Tennessee region for the level of documentation, the level of medical decision making, and the total number of problems addressed. The authors assigned appropriate CPT codes at each of those three levels. Substantial undercoding occurred at each of the three levels. Approximately 33% of visits were undercoded based on the written documentation. Approximately 50% of the visits were undercoded based on the level of documented medical decision making. Approximately 80% of the visits were undercoded based on the total number of problems which the patient presented during the visit. Interrater agreement was fair, and similar to that noted in other coding studies. Undercoding is not only common in a family medicine residency program but it also occurs at levels that would not be evident from a simple audit of the documentation on the visit note. Undercoding also occurs from not exploring problems mentioned by the patient and not documenting additional work that was performed. Family physicians may benefit from minor alterations in their documentation of office visit notes.

Using Perilog to Explore "Decision Making at NASA"

NASA Technical Reports Server (NTRS)

McGreevy, Michael W.

2005-01-01

Perilog, a context intensive text mining system, is used as a discovery tool to explore topics and concerns in "Decision Making at NASA," chapter 6 of the Columbia Accident Investigation Board (CAIB) Report, Volume I. Two examples illustrate how Perilog can be used to discover highly significant safety-related information in the text without prior knowledge of the contents of the document. A third example illustrates how "if-then" statements found by Perilog can be used in logical analysis of decision making. In addition, in order to serve as a guide for future work, the technical details of preparing a PDF document for input to Perilog are included in an appendix.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 1

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

Matthews, Patrick

2014-01-01

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 105 based on the implementation of the corrective actions. Corrective action investigation (CAI) activities were performed from October 22, 2012, through May 23, 2013, as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 105: Area 2 Yucca Flat Atmospheric Test Sites; and in accordance with the Soils Activity Quality Assurance Plan, which establishes requirements, technical planning, and general quality practices.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada, Revision 0

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

Matthews, Patrick

2013-11-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 570: Area 9 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. This complies with the requirements of the Federal Facility Agreement and Consent Order (FFACO) that was agreed to by the State of Nevada; U.S. Department of Energy (DOE), Environmental Management; U.S. Department of Defense; and DOE, Legacy Management. The purpose of the CADD/CR is to provide justification and documentation supporting the recommendation that no further corrective action is needed.

On the Road to Empowerment: A Comprehensive Analysis of Teacher Involvement in Decision Making Processes.

ERIC Educational Resources Information Center

Murray, David R.; And Others

Within the arena of public school reform, teacher empowerment and participation in the decision making process at the building level are of paramount importance. A collaborative team of teacher educators and public school staff was assembled to assess various perceptions of site-based decision making throughout Georgia. A random sample of 400…

Sexuality Education: Building an Evidence- and Rights-Based Approach to Healthy Decision-Making

ERIC Educational Resources Information Center

Bridges, Emily; Hauser, Debra

2014-01-01

As they grow up, young people face important decisions about relationships, sexuality, and sexual behavior. The decisions they make can impact their health and well-being for the rest of their lives. Young people have the right to lead healthy lives, and society has the responsibility to prepare youth by providing them with comprehensive sexual…

Superfund record of decision amendment (EPA Region 5): Ninth Avenue Dump, Gary, IN, September 13, 1994

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

Not Available

The decision document, together with Records of Decision dated June 30, 1989 (PB90-114810) and September 20, 1988 (PB89-153837) and an Explanation of Significant Differences dated October 1991, present the selected remedial action for the Ninth Avenue Dump site. The remedial action for the site consists of two operable units. The first operable unit addressed an oil layer floating on the groundwater by means of oil and groundwater extraction, oil storage, reintroduction of the groundwater, containment with a slurry wall, and management of excess surface water. The extracted groundwater was treated prior to reintroduction. The second operable unit, which is beingmore » amended by this decision document, addresses the remaining threats at the site.« less

Development and pilot testing of a decision aid for surrogates of patients with prolonged mechanical ventilation

PubMed Central

Cox, Christopher E.; Lewis, Carmen L.; Hanson, Laura C.; Hough, Catherine L.; Kahn, Jeremy M.; White, Douglas B.; Song, Mi-Kyung; Tulsky, James A.; Carson, Shannon S.

2013-01-01

Objective Shared decision making is inadequate in intensive care units (ICUs). Decision aids can improve decision making quality, though their role in an ICU setting is unclear. We aimed to develop and pilot test a decision aid for shared decision makers of patients undergoing prolonged mechanical ventilation. Setting ICUs at three medical centers. Subjects 53 surrogate decision makers and 58 physicians. Design and interventions We developed the decision aid using defined methodological guidelines. After an iterative revision process, formative cognitive testing was performed among surrogate-physician dyads. Next, we compared the decision aid to usual care control in a prospective, before/after design study. Measurements and main results Primary outcomes were physician-surrogate discordance for expected patient survival, comprehension of relevant medical information, and the quality of communication. Compared to control, the intervention group had lower surrogate-physician discordance (7 [10] vs 43 [21]), greater comprehension (11.4 [0.7] vs 6.1 [3.7]), and improved quality of communication (8.7 [1.3] vs 8.4 [1.3]) (all p<0.05) post-intervention. Hospital costs were lower in the intervention group ($110,609 vs $178,618; p=0.044); mortality did not differ by group (38% vs 50%, p=0.95). 94% of surrogates and 100% of physicians reported that the decision aid was useful in decision making. Conclusion We developed a prolonged mechanical ventilation decision aid that is feasible, acceptable, and associated with both improved decision making quality and less resource utilization. Further evaluation using a randomized controlled trial design is needed to evaluate the decision aid's effect on long-term patient and surrogate outcomes. PMID:22635048

Request for OMB Clearance with Supporting Documents for the Evaluation of the State Capacity Building Program in Dissemination. Revised.

ERIC Educational Resources Information Center

NTS Research Corp., Durham, NC.

This document presents the research proposal and supporting documents for a study to evaluate the process of developing a comprehensive dissemination capacity in State Education Agencies (SEAs) and to assess the impact of the capacity building activities in the states, addressing two questions: Is dissemination capacity being built and, if so,…

When Law Students Read Multiple Documents about Global Warming: Examining the Role of Topic-Specific Beliefs about the Nature of Knowledge and Knowing

ERIC Educational Resources Information Center

Braten, Ivar; Stromso, Helge I.

2010-01-01

In this study, law students (n = 49) read multiple authentic documents presenting conflicting information on the topic of climate change and responded to verification tasks assessing their superficial as well as their deeper-level within- and across-documents comprehension. Hierarchical multiple regression analyses showed that even after variance…

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... decision-making process. Because of the diversity of FEMA, it is not feasible to describe in this part the... shall provide further guidance, commensurate with their programs and organization, for integration of... the decision. Rather it is a concise document that sets forth the decision and describes the...

32 CFR Appendix F to Part 651 - Glossary

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental documentation and its thorough consideration in the decision-making process. Major Federal Action... necessary to coordinate and staff analyses or present the results of the analyses to the public or decision.... Headquarters, Department of the Army proponent As the principal planner, implementer, and decision authority...

75 FR 1615 - Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition Final Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... DEPARTMENT OF ENERGY Amended Record of Decision: Idaho High-Level Waste and Facilities Disposition...-Level Waste and Facilities Disposition Final Environmental Impact Statement. This document corrects an... Record of Decision: Idaho High-Level Waste and Facilities [[Page 1616

Let the Rewriter Beware.

ERIC Educational Resources Information Center

Charrow, Veda R.

Translating legal and bureaucratic language into plain, comprehensible English is not amenable to simple rules and procedures. Rewriting comprehensibly requires specialized knowledge about language and an awareness of a number of misconceptions and pitfalls. This paper discusses what not to do in rewriting, based upon rewritten documents presently…

Comprehensive College Plan for 2000-2001.

ERIC Educational Resources Information Center

San Antonio Coll., TX.

The document describes San Antonio College's (Texas) strategic goals and objectives for 2000-2001. San Antonio College's comprehensive planning and evaluation process monitors the achievement of college-wide goals and initiatives supporting the college's Vision and Mission Statement and the Alamo Community College District's Strategic Plan. The…

Comprehensive Safety Analysis 2010 Safety Measurement System (SMS) Methodology, Version 2.1 Revised December 2010

DOT National Transportation Integrated Search

2010-12-01

This report documents the Safety Measurement System (SMS) methodology developed to support the Comprehensive Safety Analysis 2010 (CSA 2010) Initiative for the Federal Motor Carrier Safety Administration (FMCSA). The SMS is one of the major tools for...

Negotiating the Digital Library: Document Delivery.

ERIC Educational Resources Information Center

Jacobs, Neil; Morris, Anne

1999-01-01

The eLib-funded FIDDO (Focused Investigation of Document Delivery Options) project provides library managers/others with information to support policy decisions. Senior libraries were interviewed about the future of document delivery and interviews were analyzed with the support of NUD*IST (Nonnumerical Unstructured Data by Indexing, Searching and…

[Involving patients, the insured and the general public in healthcare decision making].

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

Method Development for Clinical Comprehensive Evaluation of Pediatric Drugs Based on Multi-Criteria Decision Analysis: Application to Inhaled Corticosteroids for Children with Asthma.

PubMed

Yu, Yuncui; Jia, Lulu; Meng, Yao; Hu, Lihua; Liu, Yiwei; Nie, Xiaolu; Zhang, Meng; Zhang, Xuan; Han, Sheng; Peng, Xiaoxia; Wang, Xiaoling

2018-04-01

Establishing a comprehensive clinical evaluation system is critical in enacting national drug policy and promoting rational drug use. In China, the 'Clinical Comprehensive Evaluation System for Pediatric Drugs' (CCES-P) project, which aims to compare drugs based on clinical efficacy and cost effectiveness to help decision makers, was recently proposed; therefore, a systematic and objective method is required to guide the process. An evidence-based multi-criteria decision analysis model that involved an analytic hierarchy process (AHP) was developed, consisting of nine steps: (1) select the drugs to be reviewed; (2) establish the evaluation criterion system; (3) determine the criterion weight based on the AHP; (4) construct the evidence body for each drug under evaluation; (5) select comparative measures and calculate the original utility score; (6) place a common utility scale and calculate the standardized utility score; (7) calculate the comprehensive utility score; (8) rank the drugs; and (9) perform a sensitivity analysis. The model was applied to the evaluation of three different inhaled corticosteroids (ICSs) used for asthma management in children (a total of 16 drugs with different dosage forms and strengths or different manufacturers). By applying the drug analysis model, the 16 ICSs under review were successfully scored and evaluated. Budesonide suspension for inhalation (drug ID number: 7) ranked the highest, with comprehensive utility score of 80.23, followed by fluticasone propionate inhaled aerosol (drug ID number: 16), with a score of 79.59, and budesonide inhalation powder (drug ID number: 6), with a score of 78.98. In the sensitivity analysis, the ranking of the top five and lowest five drugs remains unchanged, suggesting this model is generally robust. An evidence-based drug evaluation model based on AHP was successfully developed. The model incorporates sufficient utility and flexibility for aiding the decision-making process, and can be a useful tool for the CCES-P.

Developing Disciplinary Literacy in a Multilingual History Classroom

ERIC Educational Resources Information Center

Achugar, Mariana; Carpenter, Brian D.

2012-01-01

This paper reports on a design experiment (Brown, 1992) where we explored how providing a linguistic support for understanding historical documents affected students comprehension of historical documents and their disciplinary literacy. The functional approach to disciplinary literacy parallels historians' reading practices while supporting…

77 FR 23515 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... from a quantitative, comprehensive or even representative survey or study of the burdens associated... existing registered money market fund: Documentation of credit risk analyses, and determinations regarding... for documentation of credit analyses and other determinations) = 2340 responses. (30 funds x 12...

Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems

PubMed Central

Sittig, Dean F; Ash, Joan S; Feblowitz, Joshua; Meltzer, Seth; McMullen, Carmit; Guappone, Ken; Carpenter, Jim; Richardson, Joshua; Simonaitis, Linas; Evans, R Scott; Nichol, W Paul; Middleton, Blackford

2011-01-01

Background Clinical decision support (CDS) is a valuable tool for improving healthcare quality and lowering costs. However, there is no comprehensive taxonomy of types of CDS and there has been limited research on the availability of various CDS tools across current electronic health record (EHR) systems. Objective To develop and validate a taxonomy of front-end CDS tools and to assess support for these tools in major commercial and internally developed EHRs. Study design and methods We used a modified Delphi approach with a panel of 11 decision support experts to develop a taxonomy of 53 front-end CDS tools. Based on this taxonomy, a survey on CDS tools was sent to a purposive sample of commercial EHR vendors (n=9) and leading healthcare institutions with internally developed state-of-the-art EHRs (n=4). Results Responses were received from all healthcare institutions and 7 of 9 EHR vendors (response rate: 85%). All 53 types of CDS tools identified in the taxonomy were found in at least one surveyed EHR system, but only 8 functions were present in all EHRs. Medication dosing support and order facilitators were the most commonly available classes of decision support, while expert systems (eg, diagnostic decision support, ventilator management suggestions) were the least common. Conclusion We developed and validated a comprehensive taxonomy of front-end CDS tools. A subsequent survey of commercial EHR vendors and leading healthcare institutions revealed a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content. PMID:21415065

43 CFR 30.101 - What definitions do I need to know?

Code of Federal Regulations, 2010 CFR

2010-10-01

....S.C. 450f or 458cc. Attorney decision maker (ADM) means an attorney with OHA who conducts a summary proceeding and renders a decision that is subject to de novo review by an administrative law judge or Indian... person who is deceased. Decision or order (or decision and order) means: (1) A written document issued by...

The effects of the application of SIMPRO on the completeness and time efficiency of nursing documentation in the outpatient instalation at Dompet Dhuafa Hospital Parung

NASA Astrophysics Data System (ADS)

Dwisatyadini, M.; Hariyati, R. T. S.; Afifah, E.

2018-03-01

Nursing documentation is clinical information that has a vital role in nursing services. The nursing process includes assessment, diagnosis, intervention, implementation, and evaluation. The purpose of this study was to determine the effects of the application of SIMPRO on the completeness and the efficiency of nursing documentation in the outpatient installation at Dompet Dhuafa Hospital Parung. This study used quantitative method with pre experimental (pre and posttest without control group) design. The mean of the documentation completeness marks before the application of SIMPRO was 1.87 (SD 0.922), and after SIMPRO was applied increased to 3.61 (0.588). This increase indicated an improvement of the nursing documentation completeness after the implementation of SIMPRO. The mean of time needed by nurses in documenting the nursing care before the application of SIMPRO was 476.13 seconds (SD 78.896). The mean of documenting time decreased more than a half after the application of SIMPRO which was 202.52 seconds (SD 196.723). SIMPRO made a nurse easier to take a decision analysis and decision support system to nursing care plan and documentation.

Incentivizing shared decision making in the USA--where are we now?

PubMed

Durand, Marie-Anne; Barr, Paul J; Walsh, Thom; Elwyn, Glyn

2015-06-01

The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward. We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment." We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging. Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

Transportation cost index : a comprehensive performance measure for transportation and land and its application in OR, FL, and UT : final report.

DOT National Transportation Integrated Search

2017-04-01

MAP-21 and state laws are placing increasing emphasis on using comprehensive transportation performance measures that include mobility, : safety, economy, livability, equity, and environmental to guide transportation decision-making. One of the tough...

Beyond Recall in Reading Comprehension: Five Key Planning Decisions.

ERIC Educational Resources Information Center

Sinatra, Richard; Annacone, Dominic

Over the years, teacher questions have consistently aimed at literal comprehension, indicating that teachers lack understanding of the reading-thinking-questioning hierarchy. Benjamin Bloom's "Cognitive Taxonomy" can serve as a hierarchical framework for the design of questions. Within this framework, a teacher can confront decision…

76 FR 4345 - A Method To Assess Climate-Relevant Decisions: Application in the Chesapeake Bay

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-25

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9257-2] A Method To Assess Climate-Relevant Decisions... external peer review workshop to review the external review draft document titled, ``A Method to Assess.../peerreview/register-chesapeake.htm . The draft ``A Method to Assess Climate-Relevant Decisions: Application...

Superfund record of decision (EPA Region 1): Bennington Municipal Sanitary Landfill, Bennington, VT, September 29, 1998

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

NONE

1999-03-01

This decision document presents the selected No Further Action decision for the Bennington Landfill Site (the Site), located in Bennington, Vermont. EPA will perform 10 years of additional monitoring of the groundwater, surface water, and sediments starting with the completion of the NTCRA.

7 CFR 283.10 - Consent decision.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Consent decision. 283.10 Section 283.10 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE... of the document. Such decision shall be final and shall take effect 30 days after the date of the...

7 CFR 283.10 - Consent decision.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 4 2011-01-01 2011-01-01 false Consent decision. 283.10 Section 283.10 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE... of the document. Such decision shall be final and shall take effect 30 days after the date of the...

32 CFR 651.26 - Record of decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 4 2010-07-01 2010-07-01 true Record of decision. 651.26 Section 651.26 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) ENVIRONMENTAL QUALITY ENVIRONMENTAL ANALYSIS OF ARMY ACTIONS (AR 200-2) Records and Documents § 651.26 Record of decision. The Record...

77 FR 4319 - Notification of Two Public Teleconferences of the Science Advisory Board Ecological Processes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

..., ``Integrating Ecological Assessment and Decision-Making at EPA, 2011 RAF Ecological Assessment Action Plan... the EPA Risk Assessment Forum (RAF) document, ``Integrating Ecological Assessment and Decision-Making... Ecological Risk Assessment in Environmental Decision-Making'' (EPA-SAB-08-002), the EPA Risk Assessment Forum...

43 CFR 4.201 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... means a person who is deceased. Decision or order (or decision and order) means: (1) A written document issued by a judge making determinations as to heirs, wills, devisees, and the claims of creditors, and ordering distribution of trust or restricted land or trust personalty; (2) The decision issued by an...

32 CFR 989.11 - Combining EIAP with other documentation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... documentation. (a) The EPF combines environmental analysis with other related documentation when practicable (40 CFR 1506.4) following the procedures prescribed by the CEQ regulations and this part. (b) The EPF must... the EIAP. Prior to making a decision to proceed, the EPF must analyze the environmental impacts that...

Predicting Document Retrieval System Performance: An Expected Precision Measure.

ERIC Educational Resources Information Center

Losee, Robert M., Jr.

1987-01-01

Describes an expected precision (EP) measure designed to predict document retrieval performance. Highlights include decision theoretic models; precision and recall as measures of system performance; EP graphs; relevance feedback; and computing the retrieval status value of a document for two models, the Binary Independent Model and the Two Poisson…

Linking Cognition and Literacy in Students with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Carnahan, Christina R.; Williamson, Pamela S.; Christman, Jennifer

2011-01-01

Literacy skills, especially silent reading comprehension, serve as the foundation for learning, independence, and quality of life for all individuals. It is well documented that students on the autism spectrum have difficulties with reading comprehension even though they demonstrate adequate decoding skills. Unfortunately, communication…

Instructional Implications of Inquiry in Reading Comprehension.

ERIC Educational Resources Information Center

Snow, David

A contract deliverable on the NIE Communication Skills Project, this report consists of three separate documents describing the instructional implications of the analytic and empirical work carried out for the "Classroom Instruction in Reading Comprehension" part of the project: (1) Guidelines for Phrasal Segmentation; (2) Parsing Tasks…

Active engagement in a web-based tutorial to prevent obesity grounded in Fuzzy-Trace Theory predicts higher knowledge and gist comprehension.

PubMed

Brust-Renck, Priscila G; Reyna, Valerie F; Wilhelms, Evan A; Wolfe, Christopher R; Widmer, Colin L; Cedillos-Whynott, Elizabeth M; Morant, A Kate

2017-08-01

We used Sharable Knowledge Objects (SKOs) to create an Intelligent Tutoring System (ITS) grounded in Fuzzy-Trace Theory to teach women about obesity prevention: GistFit, getting the gist of healthy eating and exercise. The theory predicts that reliance on gist mental representations (as opposed to verbatim) is more effective in reducing health risks and improving decision making. Technical information was translated into decision-relevant gist representations and gist principles (i.e., healthy values). The SKO was hypothesized to facilitate extracting these gist representations and principles by engaging women in dialogue, "understanding" their responses, and replying appropriately to prompt additional engagement. Participants were randomly assigned to either the obesity prevention tutorial (GistFit) or a control tutorial containing different content using the same technology. Participants were administered assessments of knowledge about nutrition and exercise, gist comprehension, gist principles, behavioral intentions and self-reported behavior. An analysis of engagement in tutorial dialogues and responses to multiple-choice questions to check understanding throughout the tutorial revealed significant correlations between these conversations and scores on subsequent knowledge tests and gist comprehension. Knowledge and comprehension measures correlated with healthier behavior and greater intentions to perform healthy behavior. Differences between GistFit and control tutorials were greater for participants who engaged more fully. Thus, results are consistent with the hypothesis that active engagement with a new gist-based ITS, rather than a passive memorization of verbatim details, was associated with an array of known psychosocial mediators of preventive health decisions, such as knowledge acquisition, and gist comprehension.

Assessing Contractor Capabilities for Streamlined Site Investigations

EPA Pesticide Factsheets

The purpose of this document is to familiarize and encourage brownfields decision makers to investigate and employ innovative methods for characterizing their sites, to assist brownfields decision makers in assessing contractors' capabilities.

Operational Design Guidelines For High Occupancy Vehicle Lanes On Arterial Roadways, Including Planning Strategies And Supporting Measures

DOT National Transportation Integrated Search

1994-11-01

">THIS REPORT IS A COMPANION TO THE 1993 MINISTRY OF TRANSPORTATION OF ONTARIO DOCUMENT, "OPERATION & DESIGN GUIDELINES FOR HOV LANES ON PROVINCIAL FREEWAYS". SINCE THAT DOCUMENT DEALS EXCLUSIVELY AND COMPREHENSIVELY WITH FREEWAY HOV APPLICATIONS, TH...

Addendum to the Corrective Action Decision Document/Closure Report for Corrective Action Unit 529: Area 25 Contaminated Materials, Nevada Test Site, Nevada, Revision 1

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

Krauss, Mark J

This document constitutes an addendum to the Corrective Action Decision Document/Closure Report for Corrective Action Unit 529: Area 25 Contaminated Materials, Nevada Test Site, Nevada as described in the document Recommendations and Justifications To Remove Use Restrictions Established under the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office Federal Facility Agreement and Consent Order dated September 2013. The Use Restriction (UR) Removal document was approved by the Nevada Division of Environmental Protection on October 16, 2013. The approval of the UR Removal document constituted approval of each of the recommended UR removals. In conformance with the URmore » Removal document, this addendum consists of: This page that refers the reader to the UR Removal document for additional information The cover, title, and signature pages of the UR Removal document The NDEP approval letter The corresponding section of the UR Removal document This addendum provides the documentation justifying the cancellation of the UR for CAS 25-23-17, Contaminated Wash (Parcel H). This UR was established as part of FFACO corrective actions and was based on the presence of total petroleum hydrocarbon diesel-range organics contamination at concentrations greater than the NDEP action level at the time of the initial investigation.« less

Risk Quantification of Systems Engineering Documents Improves Probability of DOD Project Success

DTIC Science & Technology

2009-09-01

comprehensive risk model for DoD milestone review documentation as well as recommended changes to the Capability Maturity Model Integration ( CMMI ) Project...Milestone Documentation, Project Planning, Rational Frame, Political Frame, CMMI Project Planning Process Area, CMMI Risk Management Process Area...well as recommended changes to the Capability Maturity Model Integration ( CMMI ) Project Planning and Risk Management process areas. The intent is to

Report on the remedial investigation of Bear Creek Valley at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 6: Appendix G -- Baseline ecological risk assessment report

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

NONE

1996-09-01

This Remedial Investigation (RI) Report characterizes the nature and extent of contamination, evaluates the fate and transport of contaminants, and assesses risk to human health and the environment resulting from waste disposal and other US Department of Energy (DOE) operations in Bear Creek Valley (BCV). BCV, which is located within the DOE Oak Ridge Reservation (ORR) encompasses multiple waste units containing hazardous and radioactive wastes arising from operations at the adjacent Oak Ridge Y-12 Plant. The primary waste units discussed in this RI Report are the S-3 Site, Oil Landfarm (OLF), Boneyard/Burnyard (BYBY), Sanitary Landfill 1 (SL 1), and Bearmore » Creek Burial Grounds (BCBG). These waste units, plus the contaminated media resulting from environmental transport of the wastes from these units, are the subject of this RI. This BCV RI Report represents the first major step in the decision-making process for the BCV watershed. The RI results, in concert with the follow-on FS will form the basis for the Proposed Plan and Record of Decision for all BCV sites. This comprehensive decision document process will meet the objectives of the watershed approach for BCV. Appendix G contains ecological risks for fish, benthic invertebrates, soil invertebrates, plants, small mammals, deer, and predator/scavengers (hawks and fox). This risk assessment identified significant ecological risks from chemicals in water, sediment, soil, and shallow ground water. Metals and PCBs are the primary contaminants of concern.« less

Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world: part II. Ethical considerations.

PubMed

Schneider, William J; Migliori, Mark R; Gosain, Arun K; Gregory, George; Flick, Randall

2011-09-01

Many international volunteer groups provide free reconstructive plastic surgery for the poor and underserved in developing countries. An essential issue in providing this care is that it meets consistent guidelines for both quality and safety-a topic that has been addressed previously. An equally important consideration is how to provide that care in an ethical manner. No literature presently addresses the various issues involved in making those decisions. With these ethical considerations in mind, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Foundation undertook a project to create a comprehensive set of guidelines for volunteer groups planning to provide this type of reconstructive plastic surgery in developing countries. The committee worked in conjunction with the Society for Pediatric Anesthesia on this project. The Board of the American Society of Plastic Surgeons/Plastic Surgery Foundation has approved the ethical guidelines created for the delivery of care in developing countries. The guidelines address the variety of ethical decisions that may be faced by a team working in an underdeveloped country. These guidelines make it possible for a humanitarian effort to anticipate the types of ethical decisions that are often encountered and be prepared to deal with them appropriately. Any group seeking to undertake an international mission trip in plastic surgery should be able to go to one source to find a detailed discussion of the perceived needs in providing ethical humanitarian care. This document was created to satisfy that need and is a companion to our original guidelines addressing safety and quality.

Communication tools for end-of-life decision-making in the intensive care unit: a systematic review and meta-analysis.

PubMed

Oczkowski, Simon J W; Chung, Han-Oh; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

2016-04-09

For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU. We searched multiple databases including MEDLINE, Embase, CINAHL, ERIC, and Cochrane from database inception until July 2014. Two reviewers independently screened articles, assessed eligibility, verified data extraction, and assessed risk of bias using the tool described by the Cochrane Collaboration and the Newcastle Ottawa Scale. Pooled estimates of effect (relative risk, standardized mean difference, or mean difference), were calculated where sufficient data existed. GRADE was used to evaluate the overall quality of evidence for each outcome. We screened 5785 abstracts and reviewed the full text of 424 articles, finding 168 eligible articles, including 19 studies in the ICU setting. The use of communication tools increased documentation of goals-of-care discussions (RR 3.47, 95% CI 1.55, 7.75, p = 0.020, very low-quality evidence), but did not have an effect on code status documentation (RR 1.03, 95% CI 0.96, 1.10, p = 0.540, low-quality evidence) or decisions to withdraw or withhold life-sustaining treatments (RR 0.98, 95% CI 0.89, 1.08, p = 0.70, low-quality evidence). The use of such tools was associated with a decrease in multiple measures of health care resource utilization, including duration of mechanical ventilation (MD -1.9 days, 95% CI -3.26, -0.54, p = 0.006, very low-quality evidence), length of ICU stay (MD -1.11 days, 95% CI -2.18, -0.03, p = 0.04, very low-quality evidence), and health care costs (SMD -0.32, 95% CI -0.5, -0.15, p < 0.001, very low-quality evidence). Structured communication tools may improve documentation of EOL decision making and may result in lower resource use. The supporting evidence is low to very low in quality. Further high-quality randomized studies of simple communication interventions are needed to determine whether structured, rather than ad hoc, approaches to end-of-life decision-making improve patient-level, family-level, and system-level outcomes. PROSPERO CRD42014012913.

Inert Reassessment Document for PEG Fatty Acid Esters

EPA Pesticide Factsheets

The tolerance reassessment decision document and action memorandum for the PEG fatty acid ester date September 28, 2005, included two tolerance exemptions (under 40 CFR 180.910 and $) CFR 180.930, respectively)

TransGuide : model deployment initiative design report

DOT National Transportation Integrated Search

1998-09-01

This report documents the high-level design of the TransGuide MDI project and discusses the design trade-off decisions. A detailed, specific project level design is provided in each projects System Design document.

Supporting shared decision-making and people’s understanding of medicines: An exploration of the acceptability and comprehensibility of patient information

PubMed Central

Booth, Jill L.; McIver, Laura

2017-01-01

Background: Patient information may assist in promoting shared decision-making, however it is imperative that the information presented is comprehensible and acceptable to the target audience. Objective: This study sought to explore the acceptability and comprehensibility of the ‘ Medicines in Scotland: What’s the right treatment for you?’ factsheet to the general public. Methods: Qualitative semi-structured telephone interviews were conducted with members of the public. An interview schedule was developed to explore the acceptability and comprehensibility of the factsheet. Participants were recruited by a researcher who distributed information packs to attendees (n=70) of four community pharmacies. Interviews, (12-24 minutes duration), were audio recorded, transcribed verbatim and analysed using a framework approach. Results: Nineteen participants returned a consent form (27.1%), twelve were interviewed. Six themes were identified: formatting of the factsheet and interpretation; prior health knowledge and the factsheet; information contained in the factsheet; impact of the factsheet on behaviour; uses for the factsheet; and revisions to the factsheet. Conclusions: The factsheet was generally perceived as helpful and comprehensive. It was highlighted that reading the leaflet may generate new knowledge and may have a positive impact on behaviour. PMID:29317925

An updated comprehensive annotated list of the butterflies (Lepidoptera: Rhopalocera) occurring at Chase Lake National Wildlife Refuge Complex Stutsman County, North Dakota 1995-1996

USGS Publications Warehouse

Royer, Ron

1996-01-01

A project to produce a comprehensive, site-specific butterfly list that could serve as a basis for future monitoring of butterfly populations and as an aid in making management decisions for the area.

An updated comprehensive annotated list of the butterflies (Lepidoptera: Rhopalocera) occuring at Sullys Hill National Game Preserve Benson County, North Dakota 1995-1996

USGS Publications Warehouse

Royer, Ron

1996-01-01

A project to produce a comprehensive, site-specific butterfly list that could serve as a basis for future monitoring of butterfly populations and as an aid in making management decisions for the area.

Human-like machines: Transparency and comprehensibility.

PubMed

Patrzyk, Piotr M; Link, Daniela; Marewski, Julian N

2017-01-01

Artificial intelligence algorithms seek inspiration from human cognitive systems in areas where humans outperform machines. But on what level should algorithms try to approximate human cognition? We argue that human-like machines should be designed to make decisions in transparent and comprehensible ways, which can be achieved by accurately mirroring human cognitive processes.

Efficacy of a Web-based Intelligent Tutoring System for Communicating Genetic Risk of Breast Cancer: A Fuzzy-Trace Theory Approach

PubMed Central

Wolfe, Christopher R.; Reyna, Valerie F.; Widmer, Colin L.; Cedillos, Elizabeth M.; Fisher, Christopher R.; Brust-Renck, Priscila G.; Weil, Audrey M.

2014-01-01

Background Many healthy women consider genetic testing for breast cancer risk, yet BRCA testing issues are complex. Objective Determining whether an intelligent tutor, BRCA Gist, grounded in fuzzy-trace theory (FTT), increases gist comprehension and knowledge about genetic testing for breast cancer risk, improving decision-making. Design In two experiments, 410 healthy undergraduate women were randomly assigned to one of three groups: an online module using a web-based tutoring system (BRCA Gist) that uses artificial intelligence technology, a second group read highly similar content from the NCI web site, and a third completed an unrelated tutorial. Intervention BRCA Gist applied fuzzy trace theory and was designed to help participants develop gist comprehension of topics relevant to decisions about BRCA genetic testing, including how breast cancer spreads, inherited genetic mutations, and base rates. Measures We measured content knowledge, gist comprehension of decision-relevant information, interest in testing, and genetic risk and testing judgments. Results Control knowledge scores ranged from 54% to 56%, NCI improved significantly to 65% and 70%, and BRCA Gist improved significantly more to 75% and 77%, p<.0001. BRCA Gist scored higher on gist comprehension than NCI and control, p<.0001. Control genetic risk-assessment mean was 48% correct; BRCA Gist (61%), and NCI (56%) were significantly higher, p<.0001. BRCA Gist participants recommended less testing for women without risk factors (not good candidates), (24% and 19%) than controls (50%, both experiments) and NCI, (32%) Experiment 2, p<.0001. BRCA Gist testing interest was lower than controls, p<.0001. Limitations BRCA Gist has not been tested with older women from diverse groups. Conclusions Intelligent tutors, such as BRCA Gist, are scalable, cost effective ways of helping people understand complex issues, improving decision-making. PMID:24829276

NCPP's Use of Standard Metadata to Promote Open and Transparent Climate Modeling

NASA Astrophysics Data System (ADS)

Treshansky, A.; Barsugli, J. J.; Guentchev, G.; Rood, R. B.; DeLuca, C.

2012-12-01

The National Climate Predictions and Projections (NCPP) Platform is developing comprehensive regional and local information about the evolving climate to inform decision making and adaptation planning. This includes both creating and providing tools to create metadata about the models and processes used to create its derived data products. NCPP is using the Common Information Model (CIM), an ontology developed by a broad set of international partners in climate research, as its metadata language. This use of a standard ensures interoperability within the climate community as well as permitting access to the ecosystem of tools and services emerging alongside the CIM. The CIM itself is divided into a general-purpose (UML & XML) schema which structures metadata documents, and a project or community-specific (XML) Controlled Vocabulary (CV) which constraints the content of metadata documents. NCPP has already modified the CIM Schema to accommodate downscaling models, simulations, and experiments. NCPP is currently developing a CV for use by the downscaling community. Incorporating downscaling into the CIM will lead to several benefits: easy access to the existing CIM Documents describing CMIP5 models and simulations that are being downscaled, access to software tools that have been developed in order to search, manipulate, and visualize CIM metadata, and coordination with national and international efforts such as ES-DOC that are working to make climate model descriptions and datasets interoperable. Providing detailed metadata descriptions which include the full provenance of derived data products will contribute to making that data (and, the models and processes which generated that data) more open and transparent to the user community.

The ultimate challenge of cloacal exstrophy.

PubMed

Schober, Justine M; Carmichael, Polly A; Hines, Melissa; Ransley, Philip G

2002-01-01

Our review addresses the various system abnormalities associated with cloacal exstrophy and revisits the question of gender assignment. Gender assignment decisions and psychological aspects of gender issues have become the "ultimate challenge." Exploration of gender identity, gender role behavior and sexual orientation has just begun. A comprehensive literature review was performed with all world literature regarding the current management of cloacal exstrophy. Research focused on management principles, outcomes and documentation of concurrent anomalies. We also describe original research evaluating gender identity in our own series of patients raised as girls to illustrate the challenge of treatment and augment the available literature, which is scant. Abnormalities of the vertebral column ranged from hemivertebra to myelomeningocele. With magnetic resonance imaging, the incidence of spinal dysraphism approached 100% and cord tethering was also more frequently recognized. For children with the short bowel syndrome, advances in antibiotic usage, and parenteral and enteral nutrition have increased the survival rate and reduced morbidity. A neurological component has been recognized for bladder function, bladder neck continence, lower extremity function and erectile capacity. Mitrofanoff-type reconstruction with bladder neck closure and continent catheterizable stoma dramatically increased continence. Diminutive or absent penis has been documented in 30% of males, and no documentation of paternity exists. The majority of females have bicornuate uterus. However, ovaries and tubes were generally normal. No reports of proven fertility exist. The strategy and timing of surgery relating to gender assignment remain controversial. A desperate need exists for research focusing on gender development and quality of life. Until that time, a cautious watchful approach may be most appropriate as our patients with cloacal exstrophy mature into adulthood.

Nevada National Security Site Industrial Sites Project Closeout - 12498

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

Cabble, Kevin; Krauss, Mark; Matthews, Pat

The U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office is responsible for environmental restoration (ER) at the Nevada National Security Site (NNSS). This includes remediation at Industrial Sites where past nuclear testing activities and activities that supported nuclear testing may have or are known to have resulted in the release of contaminants into the environment. Industrial Sites at the NNSS have included nuclear facilities that supported the nuclear rocket/missile development programs, gas stations, landfills, spill sites, ordnance sites, and numerous other waste disposal and release sites. The NNSS Industrial Sites activities neared completion at the endmore » of fiscal year 2011 while other activities required under the Federal Facility Agreement and Consent Order (FFACO) and part of the same NNSS ER Project are forecasted to extend to 2027 or beyond. With the majority of Industrial Sites corrective action units (CAUs) completed (more than 250 CAUs and over 1,800 corrective action sites), it was determined that an activity closeout process should be implemented to ensure that the work completed over the past 15 years is well documented in a comprehensive and concise summary. While the process used to close each individual CAU is described in approved documents, no single document describes in summary fashion the work completed to close the many individual Industrial Sites. The activity closeout process will be used to develop an Industrial Sites closeout document that describes these years of work. This document will summarize the number of Industrial Sites closed under the FFACO and provide general descriptions of projects, contaminants removed, and sites closed in place with corresponding Use Restrictions. Other pertinent information related to Industrial Sites work such as the project history, closure decisions, historical declarations, remediation strategies, and final CAU status will be included in the closeout document, along with a table listing each CAU and corresponding corrective action sites within each CAU. Using this process of conducting the activity closeout and developing a closeout document may prove useful for other ER projects within the DOE complex in describing how a long period of ER can be summarized in a single document. The NNSS Industrial Sites activities were completed over the span of 15 years and involved the investigation, cleanup or Use Restriction, and closure of more than 260 CAUs and over 1,800 sites. These activities will conclude in FY 2012 (with the exception of one CAU). In order to capture the work completed over this length of time and document decisions made during the activities, a closeout effort was initiated. The closeout will review the work conducted during the Industrial Sites activities and produce a single document that summarizes Industrial Sites activities. This closeout is being conducted at an interim stage in the overall NNSA/NSO ER Project since the Soils and UGTA activities will continue for a number of years, but the completion of the Industrial Sites project warrants conducting a closeout now while personnel are available and information is still current. The process followed by NNSA/NSO in conducing project closeout for the Industrial Sites portion of the ER program may prove useful within the DOE complex in demonstrating how a large ER project can be summarized. (authors)« less

Adjustment to Spinal Cord Injury: A Comprehensive Follow-Up Study.

ERIC Educational Resources Information Center

Cook, Daniel; And Others

This document reports a comprehensive followup study to describe postservice life status of former vocational rehabilitation clients and to develop an empirical index of postservice adjustment to spinal cord injury. Significant findings, conclusions, and implications are found at the beginning. The introduction section summarizes followup studies…

The Doctoral Portfolio: Centerpiece of a Comprehensive System of Evaluation

ERIC Educational Resources Information Center

Cobia, Debra C.; Carney, Jamie S.; Buckhalt, Joseph A.; Middleton, Renee A.; Shannon, David M.; Trippany, Robyn; Kunkel, Elizabeth

2005-01-01

The authors describe the process used to revise a traditional doctoral student evaluation system from one that consisted of written comprehensive and final oral examinations to one that features portfolio development. Student competence, expected student outcomes in each competency area, procedures for portfolio development, and documents and…

Comprehensive School Reform: Allocating Federal Funds.

ERIC Educational Resources Information Center

Education Commission of the States, Denver, CO.

This booklet is designed to assist state leaders as they develop their process for allocating funds to schools. It suggests components of a state-allocation process that are based on research and field experience with successfully implemented comprehensive school-reform (CSR) models. The document provides guidelines for defining the eligibility of…

Listen to the Voices: School Counselors and Comprehensive School Counseling Programs

ERIC Educational Resources Information Center

Dahir, Carol A.; Burnham, Joy J.; Stone, Carolyn

2009-01-01

Presently, many state departments of education and school counselor associations have published second-generation documents aligned with the ASCA National Model[R] (American School Counselor Association, 2005). This research study analyzed some school counselors' readiness to deliver comprehensive programs by assessing their attitudes, beliefs,…

How New Zealand Consumers Respond to Plain English.

ERIC Educational Resources Information Center

Campbell, Nittaya

1999-01-01

Considers how New Zealand has seen a need for providing readily understandable business and government documents. Reports a psycholinguistic study testing the level of consumer comprehension of bank contracts, and the effect of using plain English to rewrite them. Finds that the most effective means of enhancing comprehension was that which…

A Call to Action: Addressing the Childhood Obesity Epidemic through Comprehensive School Counseling Programs

ERIC Educational Resources Information Center

Belser, Christopher T.; Morris, Jessica A.; Hasselbeck, Jennifer M.

2012-01-01

The need for school-based interventions targeting the childhood obesity epidemic has been well documented. The risk factors associated with childhood obesity are physical, mental, psychosocial, academic, and economic. With training in developing comprehensive programs and interventions, professional school counselors are positioned to assist…

Comprehensive Career Guidance. Postsecondary & Adult. Programs and Model.

ERIC Educational Resources Information Center

Moore, Earl J.; Miller, Thomas B.

Divided into four parts, this document describes a comprehensive career guidance model for postsecondary and adult programs. In part 1, the rationale for extending career guidance and counseling into the lifelong learning perspective is explained, the Georgia Life Career Development Model is described, and the components of a process model for…

34 CFR 200.26 - Core elements of a schoolwide program.

Code of Federal Regulations, 2013 CFR

2013-07-01

... of a schoolwide program. (a) Comprehensive needs assessment. (1) A school operating a schoolwide program must conduct a comprehensive needs assessment of the entire school that— (i) Is based on academic... plan. (3) The school must document how it conducted the needs assessment, the results it obtained, and...

34 CFR 200.26 - Core elements of a schoolwide program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... of a schoolwide program. (a) Comprehensive needs assessment. (1) A school operating a schoolwide program must conduct a comprehensive needs assessment of the entire school that— (i) Is based on academic... plan. (3) The school must document how it conducted the needs assessment, the results it obtained, and...

34 CFR 200.26 - Core elements of a schoolwide program.

Code of Federal Regulations, 2014 CFR

2014-07-01

... of a schoolwide program. (a) Comprehensive needs assessment. (1) A school operating a schoolwide program must conduct a comprehensive needs assessment of the entire school that— (i) Is based on academic... plan. (3) The school must document how it conducted the needs assessment, the results it obtained, and...

34 CFR 200.26 - Core elements of a schoolwide program.

Code of Federal Regulations, 2012 CFR

2012-07-01

... of a schoolwide program. (a) Comprehensive needs assessment. (1) A school operating a schoolwide program must conduct a comprehensive needs assessment of the entire school that— (i) Is based on academic... plan. (3) The school must document how it conducted the needs assessment, the results it obtained, and...

Comprehensive School Physical Activity Programs. Position Statement

ERIC Educational Resources Information Center

National Association for Sport and Physical Education, 2008

2008-01-01

The National Association for Sport and Physical Education (NASPE) recommends that all PK-12 schools implement a Comprehensive School Physical Activity Program. Schools play an important role in public health, and the physical, mental, and social benefits of regular physical activity for youth are well documented. Leading public health, medical,…

10 CFR 710.7 - Application of the criteria.

Code of Federal Regulations, 2010 CFR

2010-01-01

... involved in the decision-making process shall consider: the nature, extent, and seriousness of the conduct... decision as to access authorization is a comprehensive, common-sense judgment, made after consideration of... will be made as to access authorization eligibility. (b) To assist in making these determinations, on...

GREENER CHEMICAL PROCESS DESIGN ALTERNATIVES ARE REVEALED USING THE WASTE REDUCTION DECISION SUPPORT SYSTEM (WAR DSS)

EPA Science Inventory

The Waste Reduction Decision Support System (WAR DSS) is a Java-based software product providing comprehensive modeling of potential adverse environmental impacts (PEI) predicted to result from newly designed or redesigned chemical manufacturing processes. The purpose of this so...

Pyrotechnic hazards classification and evaluation program. Phase 2, segment 1: Records and experience analysis

NASA Technical Reports Server (NTRS)

1970-01-01

A comprehensive search review and analysis was made of various technical documents relating to both pyrotechnics and high explosives testing, handling, storage, manufacturing, physical and chemical characteristics and accidents and incidents. Of approximately 5000 technical abstracts reviewed, 300 applicable documents were analyzed in detail. These 300 documents were then converted to a subject matrix so that they may be readily referenced for application to the current programs. It was generally concluded that information in several important categories was lacking. Two of the more important categories were in pyrotechnics sensitivity testing and TNT equivalency testing. A general recommendation resulting from this study was that this activity continue and a comprehensive data bank be generated that would allow immediate access to a large volume of pertinent information in a relatively short period of time.

A practical approach to communicating benefit-risk decisions of medicines to stakeholders.

PubMed

Leong, James; Walker, Stuart; Salek, Sam

2015-01-01

The importance of a framework for a systematic structured assessment of the benefits and risks has been established, but in addition, it is necessary that the benefit-risk decisions and the processes to derive those decisions are documented and communicated to various stakeholders for accountability. Hence there is now a need to find appropriate tools to enhance communication between regulators and other stakeholders, in a manner that would uphold transparency, consistency and standards. A retrospective, non-comparative study was conducted to determine the applicability and practicality of a summary template in documenting benefit-risk assessment and communicating benefit-risk balance and conclusions for reviewers to other stakeholders. The benefit-risk (BR) Summary Template and its User Manual was evaluated by 12 reviewers within a regulatory agency in Singapore, the Health Sciences Authority (HSA). The BR Summary Template was found to be adequate in documenting benefits, risks, relevant summaries and conclusions, while the User Manual was useful in guiding the reviewer in completing the template. The BR Summary Template was also considered a useful tool for communicating benefit-risk decisions to a variety of stakeholders. The use of a template may be of value for the communicating benefit-risk assessment of medicines to stakeholders.

Scientific literacy for democratic decision-making

NASA Astrophysics Data System (ADS)

Yacoubian, Hagop A.

2018-02-01

Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the ideological underpinnings behind a number of the statements within those documents that have defined the trajectory of scientific literacy and have shaped what ought to be considered as personal and societal benefits. I argue that science curricula and policy documents can truly endorse scientific literacy when they embed principles of democratic education at their core. The latter entails fostering learning experiences where some of the underlying assumptions and political ideologies are brought to the conscious level and future citizens encouraged to reflect upon them critically and explicitly. Such a proposal empowers the future citizens to engage in critical deliberation on science-based social issues without taking the underlying status quo for granted. I end up the paper by situating the preparation of scientifically literate citizens within a framework of democratic education, discuss conditions through which a curriculum for scientific literacy can serve democratic decision-making processes, and provide modest recommendations.

42 CFR 416.52 - Conditions for coverage-Patient admission, assessment and discharge.

Code of Federal Regulations, 2014 CFR

2014-10-01

... completion of the most recently documented medical history and physical assessment, including documentation of any allergies to drugs and biologicals. (3) The patient's medical history and physical assessment... have a comprehensive medical history and physical assessment completed by a physician (as defined in...

42 CFR 416.52 - Conditions for coverage-Patient admission, assessment and discharge.

Code of Federal Regulations, 2012 CFR

2012-10-01

... completion of the most recently documented medical history and physical assessment, including documentation of any allergies to drugs and biologicals. (3) The patient's medical history and physical assessment... have a comprehensive medical history and physical assessment completed by a physician (as defined in...

42 CFR 416.52 - Conditions for coverage-Patient admission, assessment and discharge.

Code of Federal Regulations, 2013 CFR

2013-10-01

... completion of the most recently documented medical history and physical assessment, including documentation of any allergies to drugs and biologicals. (3) The patient's medical history and physical assessment... have a comprehensive medical history and physical assessment completed by a physician (as defined in...

75 FR 53298 - A Method to Assess Climate-Relevant Decisions: Application in the Chesapeake Bay

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-31

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9195-4; Docket ID No. EPA-HQ-ORD-2010-0709] A Method to... comment period for the draft document titled, ``A Method to Assess Climate-Relevant Decision: Application... draft ``A Method To Assess Climate-Relevant Decisions: Application in the Chesapeake Bay'' is available...

36 CFR 215.7 - Legal notice of decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 2 2010-07-01 2010-07-01 false Legal notice of decision. 215..., COMMENT, AND APPEAL PROCEDURES FOR NATIONAL FOREST SYSTEM PROJECTS AND ACTIVITIES § 215.7 Legal notice of... Official shall publish a legal notice of any decision documented in a ROD or DN in the applicable newspaper...

36 CFR 215.7 - Legal notice of decision.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 36 Parks, Forests, and Public Property 2 2014-07-01 2014-07-01 false Legal notice of decision. 215..., COMMENT, AND APPEAL PROCEDURES FOR NATIONAL FOREST SYSTEM PROJECTS AND ACTIVITIES § 215.7 Legal notice of... Official shall publish a legal notice of any decision documented in a ROD or DN in the applicable newspaper...

Superfund explanation of significant difference for the record of decision (EPA Region 9): San Fernando Valley, Burbank Operable Unit, Los Angeles County, CA, November 21, 1990

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

Not Available

1995-01-01

The decision document presents this Explanation of Significant Differences (ESD) to the interim remedial action selected in the San Fernando Valley, Burbank Operable Unit Record of Decision (ROD) signed June 1989 (PB90-114844).

Protest Motherhood: Pregnancy Decision-Making Behavior and Attitudes Towards Abortion.

ERIC Educational Resources Information Center

Chesney-Lind, Meda

The document describes research on womens' attitudes toward abortion and their decision-making when pregnant leading to either birth or abortion. The objective was "to explore how womens' perceptions of the option of legal abortion have affected their pregnancy decision-making behavior" and to note the impact of their particular choices on their…

Professional Development to Improve Accommodations Decisions--A Review of the Literature. Synthesis Report 84

ERIC Educational Resources Information Center

Hodgson, Jennifer R.; Lazarus, Sheryl S.; Thurlow, Martha L.

2011-01-01

Teachers play an important role in making decisions about students' accommodations for instruction and assessment. Although teachers are a significant part of the decision-making process, "gaps" in teachers' accommodations knowledge are well documented. Some of these gaps may be due to challenges in providing teacher professional…

Scientific Literacy for Democratic Decision-Making

ERIC Educational Resources Information Center

Yacoubian, Hagop A.

2018-01-01

Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the…

78 FR 76829 - Approval of Application Submitted by Eastern Shoshone Tribe and Northern Arapaho Tribe for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-19

... regulatory authority under the Clean Air Act. DATES: EPA's decision approving the Tribes' TAS application was... Decision Document, Attachment 1 (Legal Analysis of the Wind River Indian Reservation Boundary), Attachment... decision to approve the application does not approve, Tribal authority to implement any Clean Air Act...

Operational considerations for implementing regional sediment management plans in the northern Gulf of Mexico

USGS Publications Warehouse

Underwood, Steven G.; Khalil, Syed M.; Byrnes, Mark R.; Steyer, Gregory D.; Raynie, Richard C

2015-01-01

Development of a comprehensive and stakeholder-driven Regional Sediment Management plan can provide the basis for long-term sustainable resource use and protection. This paper highlights three operational components that can positively influence sediment management at a regional scale, including (1) integration of an operational sediment budget, (2) development of a monitoring and adaptive management plan, and (3) development of a regional sediment availability and allocation program. These components seek to incorporate science and adaptive management through implementation of an organized and well-documented decision making process. They represent a coordinated framework that could serve as a guide for unifying financial investments in regional sediment management plans. Collectively, they establish an integrated process for addressing uncertainties about future system change in light of shrinking federal and state budgets, competing demands for sediment resources within riverine and marine waters, and policy considerations related to sediment/water use (e.g., navigation and commerce versus environmental management).

Perceptions of Race/Ethnicity-Based Discrimination: A Review of Measures and Evaluation of their Usefulness for the Health Care Setting

PubMed Central

Kressin, Nancy R.; Raymond, Kristal L.; Manze, Meredith

2010-01-01

Background To assess discrimination in health care, reliable, valid, and comprehensive measures of racism/discrimination are needed. Objective To review literature on measures of perceived race/ethnicity-based discrimination and evaluate their characteristics and usefulness in assessing discrimination from health care providers. Methods Literature review of measures of perceived race/ethnicity-based discrimination (1966–2007), using MEDLINE, PsycINFO, and Social Science Citation Index. Results We identified 34 measures of racism/discrimination; 16 specifically assessed dynamics in the health care setting. Few measures were theoretically based; most assessed only general dimensions of racism and focused specifically on the experiences of African American patients. Acceptable psychometric properties were documented for about half of the instruments. Conclusions Additional measures are needed for detailed assessments of perceived discrimination in the health care setting; they should be relevant for a wide variety of racial/ethnic groups, and they must assess how racism/discrimination affects health care decision making and treatments offered. PMID:18677066

Roadmap to a Comprehensive Clinical Data Warehouse for Precision Medicine Applications in Oncology

PubMed Central

Foran, David J; Chen, Wenjin; Chu, Huiqi; Sadimin, Evita; Loh, Doreen; Riedlinger, Gregory; Goodell, Lauri A; Ganesan, Shridar; Hirshfield, Kim; Rodriguez, Lorna; DiPaola, Robert S

2017-01-01

Leading institutions throughout the country have established Precision Medicine programs to support personalized treatment of patients. A cornerstone for these programs is the establishment of enterprise-wide Clinical Data Warehouses. Working shoulder-to-shoulder, a team of physicians, systems biologists, engineers, and scientists at Rutgers Cancer Institute of New Jersey have designed, developed, and implemented the Warehouse with information originating from data sources, including Electronic Medical Records, Clinical Trial Management Systems, Tumor Registries, Biospecimen Repositories, Radiology and Pathology archives, and Next Generation Sequencing services. Innovative solutions were implemented to detect and extract unstructured clinical information that was embedded in paper/text documents, including synoptic pathology reports. Supporting important precision medicine use cases, the growing Warehouse enables physicians to systematically mine and review the molecular, genomic, image-based, and correlated clinical information of patient tumors individually or as part of large cohorts to identify changes and patterns that may influence treatment decisions and potential outcomes. PMID:28469389

Action Memorandum for Decommissioning of TAN-607 Hot Shop Area

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

M. A. Pinzel

The Department of Energy is documenting the selection of an alternative for the TAN-607 Hot Shop Area using a Comprehensive Environmental Response, Compensation, and Liability Act non-time-critical removal action (NTCRA). The scope of the removal action is limited to TAN-607 Hot Shop Area. An engineering evaluation/cost analysis (EE/CA) has assisted the Department of Energy Idaho Operations Office in identifuomg the most effective method for performing the decommissioning of this structure whose mission has ended. TAN-607 Hot Shop Area is located at Test Area North Technical Support Facility within the Idaho National Laboratory Site. The selected alternative consists of demolishing themore » TAN-607 aboveground structures and components, removing belowground noninert components (e.g. wood products), and removing the radiologically contaminated debris that does not meet remedial action objectives (RAOs), as defined in the Record of Decision Amendment for the V-Tanks and Explanation of Significant Differences for the PM-2A Tanks at Test Area North, Operable Unit 1-10.« less

Maintenance program decision-making utilizing crash data.

DOT National Transportation Integrated Search

2013-07-01

This document describes methods that may be used by UDOT Maintenance personnel to improve highway safety. Four programs have been recommended using crash data to make more informed decisions concerning maintenance programs as follows: : Snow & Ic...

Briefing Number 3 to Space Station Operations Task Force Oversight Committee

NASA Technical Reports Server (NTRS)

Lyman, Peter; Shelley, Carl

1987-01-01

This document reviews certain issues in relationship to the operation of the Space Station Freedom. The document is in outline format and includes some organizational hierarchy charts, pert charts and decision charts.

Tallgrass Prairie National Preserve Vehicle Decision Document.

DOT National Transportation Integrated Search

2004-07-31

This document serves as technical substantiation in support of a procurement for a vehicle to : be used to operate an interpretive bus tour at Tallgrass Prairie National Preserve (TAPR), : located just north of Strong City, Kansas.

EPA Guidance for Geospatially Related Quality Assurance Project Plans

EPA Pesticide Factsheets

This March 2003 document discusses EPA's Quality Assurance (QA) Project Plan as a tool for project managers and planners to document the type and quality of data and information needed for making environmental decisions

Document Management in Local Government.

ERIC Educational Resources Information Center

Williams, Bernard J. S.

1998-01-01

The latest in electronic document management in British local government is discussed. Finance, revenues, and benefits systems of leading vendors to local authorities are highlighted. A planning decisions archive management system and other information services are discussed. (AEF)

49 CFR 106.120 - Appeal deadline.

Code of Federal Regulations, 2010 CFR

2010-10-01

... withdrawal of a proposed rulemaking, your appeal document must reach us no later than 30 days after the date... you appeal PHMSA's decision on a petition for rulemaking, your appeal document must reach us no later...

49 CFR 106.120 - Appeal deadline.

Code of Federal Regulations, 2011 CFR

2011-10-01

... withdrawal of a proposed rulemaking, your appeal document must reach us no later than 30 days after the date... you appeal PHMSA's decision on a petition for rulemaking, your appeal document must reach us no later...

50 CFR 23.19 - What CITES documents are required to export Appendix-I plants?

Code of Federal Regulations, 2010 CFR

2010-10-01

... SERVICE, DEPARTMENT OF THE INTERIOR (CONTINUED) TAKING, POSSESSION, TRANSPORTATION, SALE, PURCHASE, BARTER... CITES documents are required to export Appendix-I plants? Answer the questions in the following decision...

Novel embryo selection techniques to increase embryo implantation in IVF attempts.

PubMed

Sigalos, George Α; Triantafyllidou, Olga; Vlahos, Nikos F

2016-11-01

The final success of an IVF attempt depends on several steps and decisions taken during the ovarian stimulation, the oocyte retrieval, the embryo culture and the embryo transfer. The final selection of the embryos most likely to implant is the final step in this process and the responsibility of the lab. Apart from strict morphologic criteria that historically have been used in embryo selection, additional information on genetic, metabolomic and morphokinetic characteristics of the embryo is recently combined to morphology to select the embryo most likely to produce a pregnancy. In this manuscript, we review the most recent information on the current methods used for embryo selection presenting the predictive capability of each one. A literature search was performed on Pubmed, Medline and Cochrane Database of Systematic Reviews for published studies using appropriate key words and phrases with no limits placed on time. It seems that the combination of morphologic criteria in conjunction to embryo kinetics as documented by time-lapse technology provides the most reliable information on embryo quality. Blastocyst biopsy with subsequent comprehensive chromosome analysis allows the selection of the euploid embryos with the higher implantation potential. Embryo time-lapse imaging and blastocyst biopsy combined to comprehensive chromosome analysis are the most promising technologies to increase pregnancy rates and reduce the possibility of multiple pregnancies. However, further studies will demonstrate the capability of routinely using these technologies to significantly improve IVF outcomes.

TRIAD VIII: Nationwide Multicenter Evaluation to Determine Whether Patient Video Testimonials Can Safely Help Ensure Appropriate Critical Versus End-of-Life Care.

PubMed

Mirarchi, Ferdinando L; Cooney, Timothy E; Venkat, Arvind; Wang, David; Pope, Thaddeus M; Fant, Abra L; Terman, Stanley A; Klauer, Kevin M; Williams-Murphy, Monica; Gisondi, Michael A; Clemency, Brian; Doshi, Ankur A; Siegel, Mari; Kraemer, Mary S; Aberger, Kate; Harman, Stephanie; Ahuja, Neera; Carlson, Jestin N; Milliron, Melody L; Hart, Kristopher K; Gilbertson, Chelsey D; Wilson, Jason W; Mueller, Larissa; Brown, Lori; Gordon, Bradley D

2017-06-01

End-of-life interventions should be predicated on consensus understanding of patient wishes. Written documents are not always understood; adding a video testimonial/message (VM) might improve clarity. Goals of this study were to (1) determine baseline rates of consensus in assigning code status and resuscitation decisions in critically ill scenarios and (2) determine whether adding a VM increases consensus. We randomly assigned 2 web-based survey links to 1366 faculty and resident physicians at institutions with graduate medical education programs in emergency medicine, family practice, and internal medicine. Each survey asked for code status interpretation of stand-alone Physician Orders for Life-Sustaining Treatment (POLST) and living will (LW) documents in 9 scenarios. Respondents assigned code status and resuscitation decisions to each scenario. For 1 of 2 surveys, a VM was included to help clarify patient wishes. Response rate was 54%, and most were male emergency physicians who lacked formal advanced planning document interpretation training. Consensus was not achievable for stand-alone POLST or LW documents (68%-78% noted "DNR"). Two of 9 scenarios attained consensus for code status (97%-98% responses) and treatment decisions (96%-99%). Adding a VM significantly changed code status responses by 9% to 62% (P ≤ 0.026) in 7 of 9 scenarios with 4 achieving consensus. Resuscitation responses changed by 7% to 57% (P ≤ 0.005) with 4 of 9 achieving consensus with VMs. For most scenarios, consensus was not attained for code status and resuscitation decisions with stand-alone LW and POLST documents. Adding VMs produced significant impacts toward achieving interpretive consensus.

Multi-Metric Sustainability Analysis

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

Cowlin, Shannon; Heimiller, Donna; Macknick, Jordan

2014-12-01

A readily accessible framework that allows for evaluating impacts and comparing tradeoffs among factors in energy policy, expansion planning, and investment decision making is lacking. Recognizing this, the Joint Institute for Strategic Energy Analysis (JISEA) funded an exploration of multi-metric sustainability analysis (MMSA) to provide energy decision makers with a means to make more comprehensive comparisons of energy technologies. The resulting MMSA tool lets decision makers simultaneously compare technologies and potential deployment locations.

DOD Financial Management: Effect of Continuing Weaknesses on Management and Operations and Status of Key Challenges

DTIC Science & Technology

2014-05-13

the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3) make cost- effective ... decision making, including the information needed to effectively (1) manage its assets, (2) assess program performance and make budget decisions , (3...incorporating key elements of a comprehensive management approach , such as a complete analysis of the return on investment, quantitatively -defined goals

Health Education Curriculum Standards K-12, Revised.

ERIC Educational Resources Information Center

Delaware State Dept. of Public Instruction, Dover.

The health education program focuses on wellness and health promotion, with emphasis on the need to influence children and youth to make early decisions about positive lifestyles that will continue into adulthood. These comprehensive health education curriculum standards focus on positive self-image, decision-making, nutrition, stress management,…

Social Capital in Data-Driven Community College Reform

ERIC Educational Resources Information Center

Kerrigan, Monica Reid

2015-01-01

The current rhetoric around using data to improve community college student outcomes with only limited research on data-driven decision-making (DDDM) within postsecondary education compels a more comprehensive understanding of colleges' capacity for using data to inform decisions. Based on an analysis of faculty and administrators' perceptions and…

Responding to and Supporting Students with Disabilities: Risk Management Considerations

ERIC Educational Resources Information Center

Lundquist, Anne; Shackelford, Allan

2011-01-01

Making the "right" risk management decisions involving students with significant psychological disabilities requires a clear and comprehensive understanding of the legal obligations and duties at issue. It also requires taking into consideration the best interests of these individual students. At the same time, decision makers must focus…

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism

PubMed Central

Khan, Mohammad J.; Chelliah, Shankar; Haron, Mahmod S.; Ahmed, Sahrish

2017-01-01

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation. PMID:28417022

Role of Travel Motivations, Perceived Risks and Travel Constraints on Destination Image and Visit Intention in Medical Tourism: Theoretical model.

PubMed

Khan, Mohammad J; Chelliah, Shankar; Haron, Mahmod S; Ahmed, Sahrish

2017-02-01

Travel motivations, perceived risks and travel constraints, along with the attributes and characteristics of medical tourism destinations, are important issues in medical tourism. Although the importance of these factors is already known, a comprehensive theoretical model of the decision-making process of medical tourists has yet to be established, analysing the intricate relationships between the different variables involved. This article examines a large body of literature on both medical and conventional tourism in order to propose a comprehensive theoretical framework of medical tourism decision-making. Many facets of this complex phenomenon require further empirical investigation.

Taking the pulse of a river system: first 20 years

USGS Publications Warehouse

Leake, Linda; Johnson, Barry

2006-01-01

Your doctor would not base decisions for your health care today on one physical examination when you were age three! You would reasonably expect decisions to be based on records from over your lifetime. Likewise, those responsible for monitoring the health of the Upper Mississippi River System want a more comprehensive way to diagnose problems and find treatment options. To begin developing a comprehensive view of the river, the five neighboring states of the Upper Mississippi River System and several Federal agencies formed a partnership in 1986 to monitor river conditions and long-term trends in the Upper Mississippi and Illinois Rivers.

Expertise and age differences in pilot decision making.

PubMed

Morrow, Daniel G; Miller, Lisa M Soederberg; Ridolfo, Heather E; Magnor, Clifford; Fischer, Ute M; Kokayeff, Nina K; Stine-Morrow, Elizabeth A L

2009-01-01

We examined the influence of age and expertise on pilot decision making. Older and younger expert and novice pilots read at their own pace scenarios describing simpler or more complex flight situations. Then in a standard interview they discussed the scenario problem and how they would respond. Protocols were coded for identification of problem and solutions to this problem, and frequency of elaborations on problem and solution. Scenario comprehension was measured as differential reading time allocation to problem-critical information and scenario memory by the accuracy of answering questions about the scenarios after the interview. All groups accurately identified the problems, but experts elaborated problem descriptions more than novices did. Experts also spent more time reading critical information in the complex scenarios, which may reflect time needed to develop elaborate situation models of the problems. Expertise comprehension benefits were similar for older and younger pilots. Older experts were especially likely to elaborate the problem compared to younger experts, while older novices were less likely to elaborate the problem and to identify appropriate solutions compared to their younger counterparts. The findings suggest age invariance in knowledge-based comprehension relevant to pilot decision making.

Improving Text Recall with Multiple Summaries

ERIC Educational Resources Information Center

van der Meij, Hans; van der Meij, Jan

2012-01-01

Background. QuikScan (QS) is an innovative design that aims to improve accessibility, comprehensibility, and subsequent recall of expository text by means of frequent within-document summaries that are formatted as numbered list items. The numbers in the QS summaries correspond to numbers placed in the body of the document where the summarized…

Teaching Basic Reading Skills in Secondary Schools.

ERIC Educational Resources Information Center

Carnine, Linda

1980-01-01

This document presents diagnostic and prescriptive techniques that will enable teachers to enhance secondary school students' learning through reading in content areas. Three terms used in the document are defined in Section I: "vocabulary skills" include word attack skills, sight word skills, and word meanings; "comprehension skills" are literal,…

42 CFR 416.52 - Conditions for coverage-Patient admission, assessment and discharge.

Code of Federal Regulations, 2011 CFR

2011-10-01

... recently documented medical history and physical assessment, including documentation of any allergies to drugs and biologicals. (3) The patient's medical history and physical assessment must be placed in the... comprehensive medical history and physical assessment completed by a physician (as defined in section 1861(r) of...

20 CFR 668.720 - What information must these planning documents contain?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What information must these planning... 166 Planning/Funding Process § 668.720 What information must these planning documents contain? (a) The... planning instructions issued by the Department, the comprehensive services plan must describe in narrative...

Design and Construction Documents Associated with N232, Sustainability Base

NASA Technical Reports Server (NTRS)

Zornetzer, Steven F.; Schuler, Raymond F.; Grymes, Rosalind A.

2014-01-01

This request comprehensively covers documents associated with the design and construction of Sustainability Base, N232. The intent of this project specifically envisioned broad dissemination of these materials to others undertaking the design and construction of high-performing energy- and resource-efficient buildings in comparable climate zones.

Comprehensive Planning Resource Document, 1990-91, for the Kern Community College District.

ERIC Educational Resources Information Center

Cook, Lauraine

This compilation of resources for district planning in 1990-91 provides an overview of demographic, personnel, financial, facilities, and curriculum issues for the Kern Community College District (California) and its member institutions, Bakersfield, Cerro Coso, and Porterville colleges. The 10 sections of the document cover: (1) General…

9 CFR 205.202 - “Effective financing statement” or EFS.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Uniform Commercial Code (or equivalent document under future successor State law), but can be an entirely separate document meeting the definition in (c)(4). Note that (c)(4) contains a comprehensive definition of... State allows electronic filing of financing statements without the signature of the debtor under...

9 CFR 205.202 - “Effective financing statement” or EFS.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Uniform Commercial Code (or equivalent document under future successor State law), but can be an entirely separate document meeting the definition in (c)(4). Note that (c)(4) contains a comprehensive definition of... State allows electronic filing of financing statements without the signature of the debtor under...

42 CFR 416.52 - Conditions for coverage-Patient admission, assessment and discharge.

Code of Federal Regulations, 2010 CFR

2010-10-01

... recently documented medical history and physical assessment, including documentation of any allergies to drugs and biologicals. (3) The patient's medical history and physical assessment must be placed in the... comprehensive medical history and physical assessment completed by a physician (as defined in section 1861(r) of...

CODAP: Control Card Specifications for the Univac 1108.

ERIC Educational Resources Information Center

Stacey, William D.; And Others

The document is one of three in a series of technical reports covering the control card and programing aspects of the Comprehensive Occupational Data Analysis Programs (CODAP), a highly interactive and efficient system of computer routines for analyzing, organizing, and reporting occupational information. The document contains control card…

The Sources of Innovation and Creativity

ERIC Educational Resources Information Center

Adams, Karlyn

2005-01-01

This document represents a comprehensive summary of current research and theory on the sources of innovation and creativity, both in individuals and organizations. Based on the recurring concepts in the existing literature, the document concludes with some recommendations for how education systems can best foster these attributes in students. Both…

The Importance of the Medical Record: A Critical Professional Responsibility.

PubMed

Ngo, Elizabeth; Patel, Nachiket; Chandrasekaran, Krishnaswamy; Tajik, A Jamil; Paterick, Timothy E

2016-01-01

Comprehensive, detailed documentation in the medical record is critical to patient care and to a physician when allegations of negligence arise. Physicians, therefore, would be prudent to have a clear understanding of this documentation. It is important to understand who is responsible for documentation, what is important to document, when to document, and how to document. Additionally, it should be understood who owns the medical record, the significance of the transition to the electronic medical record, problems and pitfalls when using the electronic medical record, and how the Health Information Technology for Economic and Clinical Health Act affects healthcare providers and health information technology.

Clinical decision support tools: personal digital assistant versus online dietary supplement databases.

PubMed

Clauson, Kevin A; Polen, Hyla H; Peak, Amy S; Marsh, Wallace A; DiScala, Sandra L

2008-11-01

Clinical decision support tools (CDSTs) on personal digital assistants (PDAs) and online databases assist healthcare practitioners who make decisions about dietary supplements. To assess and compare the content of PDA dietary supplement databases and their online counterparts used as CDSTs. A total of 102 question-and-answer pairs were developed within 10 weighted categories of the most clinically relevant aspects of dietary supplement therapy. PDA versions of AltMedDex, Lexi-Natural, Natural Medicines Comprehensive Database, and Natural Standard and their online counterparts were assessed by scope (percent of correct answers present), completeness (3-point scale), ease of use, and a composite score integrating all 3 criteria. Descriptive statistics and inferential statistics, including a chi(2) test, Scheffé's multiple comparison test, McNemar's test, and the Wilcoxon signed rank test were used to analyze data. The scope scores for PDA databases were: Natural Medicines Comprehensive Database 84.3%, Natural Standard 58.8%, Lexi-Natural 50.0%, and AltMedDex 36.3%, with Natural Medicines Comprehensive Database statistically superior (p < 0.01). Completeness scores were: Natural Medicines Comprehensive Database 78.4%, Natural Standard 51.0%, Lexi-Natural 43.5%, and AltMedDex 29.7%. Lexi-Natural was superior in ease of use (p < 0.01). Composite scores for PDA databases were: Natural Medicines Comprehensive Database 79.3, Natural Standard 53.0, Lexi-Natural 48.0, and AltMedDex 32.5, with Natural Medicines Comprehensive Database superior (p < 0.01). There was no difference between the scope for PDA and online database pairs with Lexi-Natural (50.0% and 53.9%, respectively) or Natural Medicines Comprehensive Database (84.3% and 84.3%, respectively) (p > 0.05), whereas differences existed for AltMedDex (36.3% vs 74.5%, respectively) and Natural Standard (58.8% vs 80.4%, respectively) (p < 0.01). For composite scores, AltMedDex and Natural Standard online were better than their PDA counterparts (p < 0.01). Natural Medicines Comprehensive Database achieved significantly higher scope, completeness, and composite scores compared with other dietary supplement PDA CDSTs in this study. There was no difference between the PDA and online databases for Lexi-Natural and Natural Medicines Comprehensive Database, whereas online versions of AltMedDex and Natural Standard were significantly better than their PDA counterparts.

Validation of the Activities of Community Transportation model for individuals with cognitive impairments.

PubMed

Sohlberg, McKay Moore; Fickas, Stephen; Lemoncello, Rik; Hung, Pei-Fang

2009-01-01

To develop a theoretical, functional model of community navigation for individuals with cognitive impairments: the Activities of Community Transportation (ACTs). Iterative design using qualitative methods (i.e. document review, focus groups and observations). Four agencies providing travel training to adults with cognitive impairments in the USA participated in the validation study. A thorough document review and series of focus groups led to the development of a comprehensive model (ACTs Wheels) delineating the requisite steps and skills for community navigation. The model was validated and updated based on observations of 395 actual trips by travellers with navigational challenges from the four participating agencies. Results revealed that the 'ACTs Wheel' models were complete and comprehensive. The 'ACTs Wheels' represent a comprehensive model of the steps needed to navigate to destinations using paratransit and fixed-route public transportation systems for travellers with cognitive impairments. Suggestions are made for future investigations of community transportation for this population.

Institutional Alliances to Reduce Cancer Disparities in Chicago

PubMed Central

Simon, Melissa A.; Malin, Emily L.; Hitsman, Brian L.; Ciecierski, Christina C.; Victorson, David E.; Banas, Jennifer R.; Stuart, Moira; Luedke, Tracy; Cella, David

2017-01-01

A partnership formed between Northeastern Illinois University (NEIU) and the Robert H. Lurie Comprehensive Cancer Center of Northwestern University sought to address well-documented cancer health disparities in Chicago by developing a collaborative research, training, and educational infrastructure between a minority-serving institution and a National Cancer Institute designated comprehensive cancer center. With a critical examination of partnership documentation and outputs, we describe the partnership’s community-engaged approaches, challenges, and lessons learned. Northeastern Illinois University and the Lurie Cancer Center engaged in a yearlong partnership-building phase, identified interdisciplinary research teams, formed a governance structure, and identified collective aims. Partnership outcomes included funded inter-institutional research projects, new curriculum, and an annual research trainee program. Significant challenges faced included uncertain fiscal climate, widespread turnover, and dissimilar institutional demands. Lessons learned from this minority serving institution and comprehensive cancer center partnership may be useful for bridging distinct academic communities in the pursuit of ameliorating health disparities. PMID:27763461

Models Matter--The Final Report of the National Longitudinal Evaluation of Comprehensive School Reform

ERIC Educational Resources Information Center

Aladjem, Daniel K.; LeFloch, Kerstin Carlson; Zhang, Yu; Kurki, Anja; Boyle, Andrea; Taylor, James E.; Herrmann, Suzannah; Uekawa, Kazuaki; Thomsen, Kerri; Fashola, Olatokunbo

2006-01-01

The National Longitudinal Evaluation of Comprehensive School Reform (NLECSR) is a quantitative and qualitative study of behavior, decisions, processes, and outcomes. It employs a quasi-experimental design with matched treatment and comparison schools. NLECSR seeks to determine the effects of CSR models on student achievement in about 650…

Transforming Reading Comprehension Instruction through Student Conferencing and Teacher Journaling

ERIC Educational Resources Information Center

Costello, David

2014-01-01

When I was asked to teach the entire literacy curriculum to my grade six students in only five months, I implemented reading conferences as an instructional practice to deepen students' reading comprehension. Classroom events related to reading conferences, student decision-making, and instructional planning were recorded in a journal. This…

What REALLY Works: Optimizing Classroom Discussions to Promote Comprehension and Critical-Analytic Thinking

ERIC Educational Resources Information Center

Murphy, P. Karen; Firetto, Carla M.; Wei, Liwei; Li, Mengyi; Croninger, Rachel M. V.

2016-01-01

Many American students struggle to perform even basic comprehension of text, such as locating information, determining the main idea, or supporting details of a story. Even more students are inadequately prepared to complete more complex tasks, such as critically or analytically interpreting information in text or making reasoned decisions from…

Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository

PubMed Central

Muggli, M; Pollay, R; Lew, R; Joseph, A

2002-01-01

Objective: The study objective was to review internal tobacco industry documents written between 1985 and 1995 regarding the Asian American and Pacific Islander (AAPI) population in the USA. These documents detail opportunities and barriers to promotion of tobacco products, as viewed by the tobacco industry and its market research firms. Data sources/methods: Researchers reviewed tobacco industry documents from the document depository in Minneapolis, Minnesota and the tobacco industry's website, The Tobacco Archive, in a systematic fashion. A combined technique was employed using title keywords, dates, and names to search the 4(b) index. Findings: A review of internal tobacco company documents reveal that during the late 1980s, the industry and its market research firms recognised the importance of the AAPI community as a potential business market. Documents describe the population growth in this community, the high prevalence of smoking in countries of origin, high purchasing power of AAPI immigrants, cultural predisposition to smoking, opportunities afforded by the high proportion of retail businesses under AAPI ownership, barriers to developing the AAPI market, comprehensive campaigns, and political and lobbying efforts. Comprehensive campaigns were designed to integrate promotion efforts in AAPI consumer, retail, and business communities. Conclusions: The documents show that the tobacco industry developed specific promotion strategies to target the AAPI population. Tobacco control initiatives in the AAPI group have been slower to develop than in other targeted ethnic groups, and may benefit by increased awareness of industry methods to promote tobacco use. PMID:12198269

Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository.

PubMed

Muggli, M E; Pollay, R W; Lew, R; Joseph, A M

2002-09-01

The study objective was to review internal tobacco industry documents written between 1985 and 1995 regarding the Asian American and Pacific Islander (AAPI) population in the USA. These documents detail opportunities and barriers to promotion of tobacco products, as viewed by the tobacco industry and its market research firms. /methods: Researchers reviewed tobacco industry documents from the document depository in Minneapolis, Minnesota and the tobacco industry's website, The Tobacco Archive, in a systematic fashion. A combined technique was employed using title keywords, dates, and names to search the 4(b) index. A review of internal tobacco company documents reveal that during the late 1980s, the industry and its market research firms recognised the importance of the AAPI community as a potential business market. Documents describe the population growth in this community, the high prevalence of smoking in countries of origin, high purchasing power of AAPI immigrants, cultural predisposition to smoking, opportunities afforded by the high proportion of retail businesses under AAPI ownership, barriers to developing the AAPI market, comprehensive campaigns, and political and lobbying efforts. Comprehensive campaigns were designed to integrate promotion efforts in AAPI consumer, retail, and business communities. The documents show that the tobacco industry developed specific promotion strategies to target the AAPI population. Tobacco control initiatives in the AAPI group have been slower to develop than in other targeted ethnic groups, and may benefit by increased awareness of industry methods to promote tobacco use.

EPA Region 9 Guidance for Quality Assurance Program Plans - R9qa/03.2

EPA Pesticide Factsheets

In order for decision makers to have confidence in the quality of environmental data used to support their decisions, the organization must have structured and documented process for quality in place.

Towards Rational Decision-Making in Secondary Education.

ERIC Educational Resources Information Center

Cohn, Elchanan

Without a conscious effort to achieve optimum resource allocation, there is a real danger that educational resources may be wasted. This document uses input-output analysis to develop a model for rational decision-making in secondary education. (LLR)

Enhancing User Customization through Novel Software Architecture for Utility Scale Solar Siting Software

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

Brant Peery; Sam Alessi; Randy Lee

2014-06-01

There is a need for a spatial decision support application that allows users to create customized metrics for comparing proposed locations of a new solar installation. This document discusses how PVMapper was designed to overcome the customization problem through the development of loosely coupled spatial and decision components in a JavaScript plugin architecture. This allows the user to easily add functionality and data to the system. The paper also explains how PVMapper provides the user with a dynamic and customizable decision tool that enables them to visually modify the formulas that are used in the decision algorithms that convert datamore » to comparable metrics. The technologies that make up the presentation and calculation software stack are outlined. This document also explains the architecture that allows the tool to grow through custom plugins created by the software users. Some discussion is given on the difficulties encountered while designing the system.« less

Grey situation group decision-making method based on prospect theory.

PubMed

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example.

Grey Situation Group Decision-Making Method Based on Prospect Theory

PubMed Central

Zhang, Na; Fang, Zhigeng; Liu, Xiaqing

2014-01-01

This paper puts forward a grey situation group decision-making method on the basis of prospect theory, in view of the grey situation group decision-making problems that decisions are often made by multiple decision experts and those experts have risk preferences. The method takes the positive and negative ideal situation distance as reference points, defines positive and negative prospect value function, and introduces decision experts' risk preference into grey situation decision-making to make the final decision be more in line with decision experts' psychological behavior. Based on TOPSIS method, this paper determines the weight of each decision expert, sets up comprehensive prospect value matrix for decision experts' evaluation, and finally determines the optimal situation. At last, this paper verifies the effectiveness and feasibility of the method by means of a specific example. PMID:25197706

Social Work Assessment Notes: A Comprehensive Outcomes-Based Hospice Documentation System.

PubMed

Hansen, Angela Gregory; Martin, Ellen; Jones, Barbara L; Pomeroy, Elizabeth C

2015-08-01

This article describes the development of an integrated psychosocial patient and caregiver assessment and plan of care for hospice social work documentation. A team of hospice social workers developed the Social Work Assessment Notes as a quality improvement project in collaboration with the information technology department. Using the Social Work Assessment Tool as an organizing framework, this comprehensive hospice social work documentation system is designed to integrate assessment, planning, and outcomes measurement. The system was developed to guide the assessment of patients' and caregivers' needs related to end-of-life psychosocial issues, to facilitate collaborative care plan development, and to measure patient- and family-centered outcomes. Goals established with the patient and the caregiver are documented in the plan of care and become the foundation for patient-centered, strengths-based interventions. Likert scales are used to assign numerical severity levels for identified issues and progress made toward goals and to track the outcome of social work interventions across nine psychosocial constructs. The documentation system was developed for use in an electronic health record but can be used for paper charting. Future plans include automated aggregate outcomes measurement to identify the most effective interventions and best practices in end-of-life care.

A human-dimensions review of human-wildlife disturbance: A literature review of impacts, frameworks, and management solutions

USGS Publications Warehouse

Cline, Robert; Sexton, Natalie; Stewart, Susan C.

2007-01-01

The following report was prepared for the U.S. Fish and Wildlife Service National Refuge System in support of their Comprehensive Conservation Planning (CCP) efforts by the Policy Analysis and Science Assistance Branch (PASA), Fort Collins Science Center, U.S. Geological Survey. While this document provides a summary of contemporary recreation management literature and methodologies, relevant to the subject of managing wildlife disturbances on national wildlife refuges, this document should be viewed as a starting point for management administrators. This document identifies general issues relating to wildlife disturbance and visitor impacts including a description of disturbance, recreational impacts, related human dimensions applications, management frameworks, and a general summary of management solutions. The section on descriptions of wildlife disturbance and impacts draws heavily from the report entitled 'Managing the Impacts of Visitor Use on Waterbirds -- A Literature Review of Impacts and Mitigation' (DeLong, 2002; Delong and Adamcik, in press) and is referenced in the text. This document is more comprehensive in its review of wildlife response to disturbance. This document is intended to discuss the human-dimensions aspect of wildlife disturbance, summarizing human dimensions and recreation management literature as it applies to this topic.

A Rural Community's Involvement in the Design and Usability Testing of a Computer-Based Informed Consent Process for the Personalized Medicine Research Project

PubMed Central

Mahnke, Andrea N; Plasek, Joseph M; Hoffman, David G; Partridge, Nathan S; Foth, Wendy S; Waudby, Carol J; Rasmussen, Luke V; McManus, Valerie D; McCarty, Catherine A

2014-01-01

Many informed consent studies demonstrate that research subjects poorly retain and understand information in written consent documents. Previous research in multimedia consent is mixed in terms of success for improving participants’ understanding, satisfaction, and retention. This failure may be due to a lack of a community-centered design approach to building the interventions. The goal of this study was to gather information from the community to determine the best way to undertake the consent process. Community perceptions regarding different computer-based consenting approaches were evaluated, and a computer-based consent was developed and tested. A second goal was to evaluate whether participants make truly informed decisions to participate in research. Simulations of an informed consent process were videotaped to document the process. Focus groups were conducted to determine community attitudes towards a computer-based informed consent process. Hybrid focus groups were conducted to determine the most acceptable hardware device. Usability testing was conducted on a computer-based consent prototype using a touch-screen kiosk. Based on feedback, a computer-based consent was developed. Representative study participants were able to easily complete the consent, and all were able to correctly answer the comprehension check questions. Community involvement in developing a computer-based consent proved valuable for a population-based genetic study. These findings may translate to other types of informed consents, such as genetic clinical trials consents. A computer-based consent may serve to better communicate consistent, clear, accurate, and complete information regarding the risks and benefits of study participation. Additional analysis is necessary to measure the level of comprehension of the check-question answers by larger numbers of participants. The next step will involve contacting participants to measure whether understanding of what they consented to is retained over time. PMID:24273095

A rural community's involvement in the design and usability testing of a computer-based informed consent process for the Personalized Medicine Research Project.

PubMed

Mahnke, Andrea N; Plasek, Joseph M; Hoffman, David G; Partridge, Nathan S; Foth, Wendy S; Waudby, Carol J; Rasmussen, Luke V; McManus, Valerie D; McCarty, Catherine A

2014-01-01

Many informed consent studies demonstrate that research subjects poorly retain and understand information in written consent documents. Previous research in multimedia consent is mixed in terms of success for improving participants' understanding, satisfaction, and retention. This failure may be due to a lack of a community-centered design approach to building the interventions. The goal of this study was to gather information from the community to determine the best way to undertake the consent process. Community perceptions regarding different computer-based consenting approaches were evaluated, and a computer-based consent was developed and tested. A second goal was to evaluate whether participants make truly informed decisions to participate in research. Simulations of an informed consent process were videotaped to document the process. Focus groups were conducted to determine community attitudes towards a computer-based informed consent process. Hybrid focus groups were conducted to determine the most acceptable hardware device. Usability testing was conducted on a computer-based consent prototype using a touch-screen kiosk. Based on feedback, a computer-based consent was developed. Representative study participants were able to easily complete the consent, and all were able to correctly answer the comprehension check questions. Community involvement in developing a computer-based consent proved valuable for a population-based genetic study. These findings may translate to other types of informed consents, including those for trials involving treatment of genetic disorders. A computer-based consent may serve to better communicate consistent, clear, accurate, and complete information regarding the risks and benefits of study participation. Additional analysis is necessary to measure the level of comprehension of the check-question answers by larger numbers of participants. The next step will involve contacting participants to measure whether understanding of what they consented to is retained over time. © 2013 Wiley Periodicals, Inc.

Using Sustainable Development as a Competitive Strategy

NASA Astrophysics Data System (ADS)

Spearman, Pat

Sustainable development reduces construction waste by 43%, generating 50% cost savings. Residential construction executives lacking adequate knowledge regarding the benefits of sustainable development practices are at a competitive disadvantage. Drawing from the diffusion of innovation theory, the purpose of this qualitative case study was to explore knowledge acquisition within the bounds of sustainable residential construction. The purposive sample size of 11 executive decision makers fulfilled the sample size requirements and enabled the extraction of meaningful data. Participants were members of the National Home Builders Association and had experience of a minimum of 5 years in residential construction. The research question addressed how to improve knowledge acquisition relating to the cost benefits of building green homes and increase the adoption rate of sustainable development among residential builders. Data were collected via semistructured telephone interviews, field observation, and document analysis. Transcribed data were validated via respondent validation, coded into 5 initial categories aligned to the focus of the research, then reduced to 3 interlocking themes of environment, competitive advantage, and marketing. Recommendations include developing comprehensive public policies, horizontal and vertical communications networks, and green banks to capitalize sustainable development programs to improve the diffusion of green innovation as a competitive advantage strategy. Business leaders could benefit from this data by integrating sustainable development practices into their business processes. Sustainable development reduces operational costs, increases competitive advantage for builders, and reduces greenhouse gas emissions. Implications for social change increase energy independence through conservation and developing a legislative policy template for comprehensive energy strategies. A comprehensive energy strategy promotes economic development, technological gains in all business sectors within the energy industry, and reduces energy costs for consumers.

Care for Our Children: A Comprehensive Plan for Child Care Services in Berkeley.

ERIC Educational Resources Information Center

Pacific Training and Technical Assistance Corp., Berkeley, CA.

This document reports research and recommendations made by the Pacific Training and Technical Assistance Corporation for a comprehensive child-care program in Berkeley. The report is divided into two sections. Section I, "Research and Planning," describes research methodology and findings and includes demographic information on the city…

Teenage Pregnancy and Primary Prevention: New Approaches to an Old Problem.

ERIC Educational Resources Information Center

Pate, David J., Jr.; Knight, Susan

This document describes the Parents Too Soon (PTS) program, a project which integrated a comprehensive array of services for teenagers in an effort to help prevent premature and unwanted pregnancies. Four components of the PTS program are listed: (1) comprehensive family planning medical services including provision of contraceptives; (2) social…

A Case Study of the Partnership Schools Comprehensive School Reform (CSR) Model

ERIC Educational Resources Information Center

Epstein, Joyce L.

2005-01-01

This case study reports the feasibility of the Partnership Schools Comprehensive School Reform (CSR) model for school improvement in a Title I elementary school. Interviews were conducted and documents were collected for 3 years to study whether and how the school implemented key policy attributes--specificity, consistency, authority, power, and…

Gender Differences in Toddlers' Language and Participation in Language Activities in Norwegian ECEC Institutions

ERIC Educational Resources Information Center

Brekke Stangeland, Elisabeth; Lundetrae, Kjersti; Reikerås, Elin

2018-01-01

A body of studies, which are mostly based on parental reports, have documented gender differences in early language proficiency, and girls tend to outperform boys in both language production and language comprehension. In this study, staff in Norwegian Early Childhood Education and Care institutions observed language comprehension, word…

An Ethnographic Case Study of the Administrative Organization, Processes, and Behavior in a Model Comprehensive High School.

ERIC Educational Resources Information Center

Zimman, Richard N.

Using ethnographic case study methodology (involving open-ended interviews, participant observation, and document analysis) theories of administrative organization, processes, and behavior were tested during a three-week observation of a model comprehensive (experimental) high school. Although the study is limited in its general application, it…

Vocational Education. Comprehensive Annual Performance Report, FY95.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational and Adult Education.

This document is a comprehensive report of Ohio activities related to the expenditures of federal funds under the Carl D. Perkins Vocational and Applied Technology Education Act of 1990 during the period July 1, 1994 through June 30, 1995. The report contains three sections, each formatted to meet different accountability standards. Section 1…

Teaching a Comprehensive Course on Stress and Work

ERIC Educational Resources Information Center

DeFrank, Richard S.

2012-01-01

Given the growing literature on and documented importance of workplace stress, it is suggested that this topic deserves more than a casual mention in introductory management classes. The current article reviews a comprehensive course dedicated to the phenomenon of stress in the work setting, which addresses issues such as theories, demands and…

The Relationship between Reading Comprehension, Decoding, and Fluency in Greek: A Cross-Sectional Study

ERIC Educational Resources Information Center

Padeliadu, Susana; Antoniou, Faye

2014-01-01

Experts widely consider decoding and fluency as the basis of reading comprehension, while at the same time consistently documenting problems in these areas as major characteristics of students with learning disabilities. However, scholars have developed most of the relevant research within phonologically deep languages, wherein decoding problems…

Effective Implementation of a Comprehension-Improvement Approach in Secondary Schools. Summary.

ERIC Educational Resources Information Center

Levine, Daniel U.; Sherk, John K.

This document summarizes a report on the implementation and impact of instructional strategies to improve students' comprehension skills at three diverse urban secondary schools. While activities and characteristics varied, educators at all three locations were implementing local variations of a school-improvement approach based on the use of the…

Development and Reliability of the Comprehensive Crisis Plan Checklist

ERIC Educational Resources Information Center

Aspiranti, Kathleen B.; Pelchar, Taylor K.; McCLeary, Daniel F.; Bain, Sherry K.; Foster, Lisa N.

2011-01-01

It is of vital importance that children are educated in a safe environment. Every school needs to have a well-developed crisis management document containing plans for prevention, intervention, and postvention. We developed the Comprehensive Crisis Plan Checklist (CCPC) to serve as a valuable tool that can be used to assist practitioners with…

Self Validation: Putting the Pieces Together. [Leader's Handbook].

ERIC Educational Resources Information Center

Beiman, Abbie; And Others

This document is one in a set of eight staff development training manuals developed to facilitate the efforts of educators in the planning and implementation of comprehensive career guidance programs on the secondary level (7-12). This series is based on the goals and developmental objectives identified by the Georgia Comprehensive Career Guidance…

Improved informed consent documents for biomedical research do not increase patients’ understanding but reduce enrolment: a study in real settings

PubMed Central

Paris, Adeline; Deygas, Béatrice; Cornu, Catherine; Thalamas, Claire; Maison, Patrick; Duale, Christian; Kane, Maty; Hodaj, Enkelejda; Cracowski, Jean-Luc

2015-01-01

Aims The aim was to evaluate the comprehension of participants of an improved informed consent document (ICD). Method This was a randomized controlled French multicentre study performed in real conditions. Participants were adult patients undergoing screening for enrolment in biomedical research studies, who agreed to answer a validated questionnaire evaluating objective and subjective comprehension scored from 0 (no comprehension) to 100 (excellent comprehension). Patients were provided either the original ICD or an ICD modified in terms of structure and readability. The primary end point was the score of objective comprehension. The secondary end-points were the enrolment rate in the clinical study and patient characteristics associated with the score of objective comprehension. Results Four hundred and eighty-one patients were included, 241 patients in the original ICD group and 240 patients in the modified ICD group. There was no difference between the two groups for the score of objective comprehension (original ICD 72.7 (95% CI 71.3, 74.1) vs. modified ICD 72.5 (95% CI 71.0, 74.0); P = 0.81). However, the rate of enrolment in the clinical study was lower in the group who received the modified ICD (64.4% (95% CI 58.3, 70.5)) than for the original ICD (73.0% (95% CI 67.4, 78.7)) (P = 0.042). Only female gender and high educational level were associated with a better objective comprehension. Conclusions Improving ICDs had no effect on participants’ understanding, whereas the rate of enrolment was lower in this group. In attempts at improving potential participants’ understanding of clinical research information, efforts and future trials should focus on other ways to improve comprehension. PMID:26147763

Proceedings of the workshop "Development of biological decision support systems for resource managers": Denver, Colorado, October 27-29, 1998

USGS Publications Warehouse

Getter, James; D'Erchia, Terry D.; Root, Ralph; Getter, James; D'Erchia, Terry D.; Root, Ralph

1999-01-01

The format for this 3-day workshop (27-29 October 1998) included plenary presentations by USGS Biological Resources Division (BRD) and U.S. Fish and Wildlife Service per onnel who u e and develop decision support systems (DSS); breakout ses ions addressing DSS technical information aspect , outreach/ customer requirements, and future perspectives; and a DSS Steering Committee meeting to evaluate work hop goals and to provide guidance for fu ture efforts. Steering committee action item developed from workshop inputs were to ( I) develop a "DSS framework" document for u e in biological research. (2) develop a "proof of concept" DSS based upon the framework document, and (3) integrate decision support ystem into BRD program elements.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-06-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-02-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-12-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-04-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.

General Motors, Inc. PSD Appeal No. 01-30 EAB Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Entergy - Monroe Electric Generating Plant Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Exxon - Baton Rouge Polyolefins Plant Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

BACT/LEAR Cutoff Date Policy and Recent PSD Appeal Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Indeck-Niles, LLC PSD Appeal No. 02-03 EAB Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the New Source Review (NSR) air permitting regulations including the Prevention of Significant Deterioration (PSD) requirements. This document is part of the NSR Policy and Guidance Database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Roosevelt Regional Landfill Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Shintech Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Pacificorp's Bridger and Naughton Decision

EPA Pesticide Factsheets

This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

Comprehensive school health education: suggested guidelines for action.

PubMed

1992-01-01

This document is an outcome of the WHO/UNESCO/UNICEF Consultation on Strategies for Implementing Comprehensive School Health Education/Promotion Programmes held in WHO, Geneva from 25 to 29 November 1991. Twenty-five experts attended from the health education sectors of sixteen countries, as well as six NGOs together with the three cosponsors WHO, UNESCO and UNICEF plus UNFPA. The Consultation arrived at a consensus on a comprehensive approach to school health education and guiding principles for action.