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

Towards a Decision Support Tool for 3d Visualisation: Application to Selectivity Purpose of Single Object in a 3d City Scene

NASA Astrophysics Data System (ADS)

Neuville, R.; Pouliot, J.; Poux, F.; Hallot, P.; De Rudder, L.; Billen, R.

2017-10-01

This paper deals with the establishment of a comprehensive methodological framework that defines 3D visualisation rules and its application in a decision support tool. Whilst the use of 3D models grows in many application fields, their visualisation remains challenging from the point of view of mapping and rendering aspects to be applied to suitability support the decision making process. Indeed, there exists a great number of 3D visualisation techniques but as far as we know, a decision support tool that facilitates the production of an efficient 3D visualisation is still missing. This is why a comprehensive methodological framework is proposed in order to build decision tables for specific data, tasks and contexts. Based on the second-order logic formalism, we define a set of functions and propositions among and between two collections of entities: on one hand static retinal variables (hue, size, shape…) and 3D environment parameters (directional lighting, shadow, haze…) and on the other hand their effect(s) regarding specific visual tasks. It enables to define 3D visualisation rules according to four categories: consequence, compatibility, potential incompatibility and incompatibility. In this paper, the application of the methodological framework is demonstrated for an urban visualisation at high density considering a specific set of entities. On the basis of our analysis and the results of many studies conducted in the 3D semiotics, which refers to the study of symbols and how they relay information, the truth values of propositions are determined. 3D visualisation rules are then extracted for the considered context and set of entities and are presented into a decision table with a colour coding. Finally, the decision table is implemented into a plugin developed with three.js, a cross-browser JavaScript library. The plugin consists of a sidebar and warning windows that help the designer in the use of a set of static retinal variables and 3D environment parameters.

Utilization of multiple-criteria decision analysis (MCDA) to support healthcare decision-making FIFARMA, 2016

PubMed Central

Drake, Julia I.; de Hart, Juan Carlos Trujillo; Monleón, Clara; Toro, Walter; Valentim, Joice

2017-01-01

ABSTRACT Background and objectives:   MCDA is a decision-making tool with increasing use in the healthcare sector, including HTA (Health Technology Assessment). By applying multiple criteria, including innovation, in a comprehensive, structured and explicit manner, MCDA fosters a transparent, participative, consistent decision-making process taking into consideration values of all stakeholders. This paper by FIFARMA (Latin American Federation of Pharmaceutical Industry) proposes the deliberative (partial) MCDA as a more pragmatic, agile approach, especially when newly implemented. Methods: Literature review including real-world examples of effective MCDA implementation in healthcare decision making in both the public and private sector worldwide and in LA. Results and conclusion: It is the view of FIFARMA that MCDA should strongly be considered as a tool to support HTA and broader healthcare decision making such as the contracts and tenders process in order to foster transparency, fairness, and collaboration amongst stakeholders. PMID:29081919

Web-Based Cancer Communication and Decision Making Systems: Connecting Patients, Caregivers, and Clinicians for Improved Health Outcomes

PubMed Central

DuBenske, Lori L.; Gustafson, David H.; Shaw, Bret R.; Cleary, James F.

2011-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS—the Comprehensive Health Enhancement Support System (CHESS)—for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS. An interactive health communication system (IHCS) offers one platform for providing the information, communication, and coaching resources that cancer patients and their families need to understand the disease, find support, and develop decision-making and coping skills. One such IHCS—the Comprehensive Health Enhancement Support System (CHESS)—has evolved over the past 20 years. Based on our recent experience creating and testing a new version of CHESS—“Coping with Lung Cancer: A Network of Support”—this article outlines the issues faced in developing and implementing such a system within the cancer context. PMID:21041539

Design and evaluation of an imaging informatics system for analytics-based decision support in radiation therapy

NASA Astrophysics Data System (ADS)

Deshpande, Ruchi; DeMarco, John; Liu, Brent J.

2015-03-01

We have developed a comprehensive DICOM RT specific database of retrospective treatment planning data for radiation therapy of head and neck cancer. Further, we have designed and built an imaging informatics module that utilizes this database to perform data mining. The end-goal of this data mining system is to provide radiation therapy decision support for incoming head and neck cancer patients, by identifying best practices from previous patients who had the most similar tumor geometries. Since the performance of such systems often depends on the size and quality of the retrospective database, we have also placed an emphasis on developing infrastructure and strategies to encourage data sharing and participation from multiple institutions. The infrastructure and decision support algorithm have both been tested and evaluated with 51 sets of retrospective treatment planning data of head and neck cancer patients. We will present the overall design and architecture of our system, an overview of our decision support mechanism as well as the results of our evaluation.

Development of a decision support system for tsunami evacuation: application to the Jiyang District of Sanya city in China

NASA Astrophysics Data System (ADS)

Hou, Jingming; Yuan, Ye; Wang, Peitao; Ren, Zhiyuan; Li, Xiaojuan

2017-03-01

Major tsunami disasters often cause great damage in the first few hours following an earthquake. The possible severity of such events requires preparations to prevent tsunami disasters or mitigate them. This paper is an attempt to develop a decision support system for rapid tsunami evacuation for local decision makers. Based on the numerical results database of tsunami disasters, this system can quickly obtain the tsunami inundation and travel time. Because numerical models are calculated in advance, this system can reduce decision-making time. Population distribution, as a vulnerability factor, was analyzed to identify areas of high risk for tsunami disasters. Combined with spatial data, this system can comprehensively analyze the dynamic and static evacuation process and identify problems that negatively impact evacuation, thus supporting the decision-making for tsunami evacuation in high-risk areas. When an earthquake and tsunami occur, this system can rapidly obtain the tsunami inundation and travel time and provide information to assist with tsunami evacuation operations.

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.

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.

Integrating conflict analysis and consensus reaching in a decision support system for water resource management.

PubMed

Giordano, R; Passarella, G; Uricchio, V F; Vurro, M

2007-07-01

The importance of shared decision processes in water management derives from the awareness of the inadequacy of traditional--i.e. engineering--approaches in dealing with complex and ill-structured problems. It is becoming increasingly obvious that traditional problem solving and decision support techniques, based on optimisation and factual knowledge, have to be combined with stakeholder based policy design and implementation. The aim of our research is the definition of an integrated decision support system for consensus achievement (IDSS-C) able to support a participative decision-making process in all its phases: problem definition and structuring, identification of the possible alternatives, formulation of participants' judgments, and consensus achievement. Furthermore, the IDSS-C aims at structuring, i.e. systematising the knowledge which has emerged during the participative process in order to make it comprehensible for the decision-makers and functional for the decision process. Problem structuring methods (PSM) and multi-group evaluation methods (MEM) have been integrated in the IDSS-C. PSM are used to support the stakeholders in providing their perspective of the problem and to elicit their interests and preferences, while MEM are used to define not only the degree of consensus for each alternative, highlighting those where the agreement is high, but also the consensus label for each alternative and the behaviour of individuals during the participative decision-making. The IDSS-C is applied experimentally to a decision process regarding the use of treated wastewater for agricultural irrigation in the Apulia Region (southern Italy).

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.

Comprehensive evaluation of garment assembly line with simulation

NASA Astrophysics Data System (ADS)

Xu, Y.; Thomassey, S.; Chen, Y.; Zeng, X.

2017-10-01

In this paper, a comprehensive evaluation system is established to assess the garment production performance. It is based on performance indicators and supported with the corresponding results obtained by manual calculation or computer simulation. The assembly lines of a typical men’s shirt are taken as the study objects. With the comprehensive evaluation results, garments production arrangement scenarios are better analysed and then the appropriate one is supposed to be put into actual production. This will be a guidance given to companies on quick decision-making and multi-objective optimization of garment production.

Comprehensive integrated planning: A process for the Oak Ridge Reservation, Oak Ridge, Tennessee

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

NONE

1998-05-01

The Oak Ridge Comprehensive Integrated Plan is intended to assist the US Department of Energy (DOE) and contractor personnel in implementing a comprehensive integrated planning process consistent with DOE Order 430.1, Life Cycle Asset Management and Oak Ridge Operations Order 430. DOE contractors are charged with developing and producing the Comprehensive Integrated Plan, which serves as a summary document, providing information from other planning efforts regarding vision statements, missions, contextual conditions, resources and facilities, decision processes, and stakeholder involvement. The Comprehensive Integrated Plan is a planning reference that identifies primary issues regarding major changes in land and facility use andmore » serves all programs and functions on-site as well as the Oak Ridge Operations Office and DOE Headquarters. The Oak Ridge Reservation is a valuable national resource and is managed on the basis of the principles of ecosystem management and sustainable development and how mission, economic, ecological, social, and cultural factors are used to guide land- and facility-use decisions. The long-term goals of the comprehensive integrated planning process, in priority order, are to support DOE critical missions and to stimulate the economy while maintaining a quality environment.« less

Knowledge representation and management enabling intelligent interoperability - principles and standards.

PubMed

Blobel, Bernd

2013-01-01

Based on the paradigm changes for health, health services and underlying technologies as well as the need for at best comprehensive and increasingly automated interoperability, the paper addresses the challenge of knowledge representation and management for medical decision support. After introducing related definitions, a system-theoretical, architecture-centric approach to decision support systems (DSSs) and appropriate ways for representing them using systems of ontologies is given. Finally, existing and emerging knowledge representation and management standards are presented. The paper focuses on the knowledge representation and management part of DSSs, excluding the reasoning part from consideration.

Research on tobacco enterprise spatial decision support system based on GIS

NASA Astrophysics Data System (ADS)

Mei, Xin; Cui, Weihong

2006-10-01

Tobacco enterprise is a special enterprise, which has strong correlation to regional geography. But in the past research and application, the combination between tobacco and GIS is limited to use digital maps to assist cigarette distribution. How to comprehensively import 3S technique taking GIS as representation to construct spatial decision support system of tobacco enterprise is the main research aspect in this paper. The paper concretely analyzes the GIS requirements in tobacco enterprise for planning location of production, monitoring production management and product sale at the beginning. Then holistic solution is presented and frame design for tobacco enterprise spatial decision is given. At last the example of tobacco enterprise spatial CRM (client relation management) system is set up.

Ecological models supporting environmental decision making: a strategy for the future

USGS Publications Warehouse

Schmolke, Amelie; Thorbek, Pernille; DeAngelis, Donald L.; Grimm, Volker

2010-01-01

Ecological models are important for environmental decision support because they allow the consequences of alternative policies and management scenarios to be explored. However, current modeling practice is unsatisfactory. A literature review shows that the elements of good modeling practice have long been identified but are widely ignored. The reasons for this might include lack of involvement of decision makers, lack of incentives for modelers to follow good practice, and the use of inconsistent terminologies. As a strategy for the future, we propose a standard format for documenting models and their analyses: transparent and comprehensive ecological modeling (TRACE) documentation. This standard format will disclose all parts of the modeling process to scrutiny and make modeling itself more efficient and coherent.

A comprehensive infectious disease management system.

PubMed

Marcu, Alex; Farley, John D

2009-01-01

An efficient electronic management system is now an essential tool for the successful management and monitoring of those affected by communicable infectious diseases (Human Immunodeficiency Virus - HIV, hepatitis C - HEP C) during the course of the treatment. The current methods which depend heavily on manual collecting, compiling and disseminating treatment information are labor-intensive and time consuming. Clinics specialized in the treatment of infectious diseases use a mix of electronic systems that fail to interact with each other, result in data duplication, and do not support treatment of the patient as a whole. The purpose of the Infectious Disease Management System is to reduce the administrative overhead associated with data collection and analysis while providing correlation abilities and decision support in accordance with defined treatment guidelines. This Infectious Disease Management System was developed to: Ensure cost effectiveness by means of low software licensing costs, Introduce a centralized mechanism of collecting and monitoring all infectious disease management data, Automate electronic retrieval of laboratory findings, Introduce a decision support mechanism as per treatment guidelines, Seamlessly integrate of application modules, Provide comprehensive reporting capabilities, Maintain a high level of user friendliness.

Deep learning aided decision support for pulmonary nodules diagnosing: a review.

PubMed

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping; He, Jianxing; Liu, Bo

2018-04-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing.

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis

PubMed Central

Miller, Matthew James; McGuire, Kerry M.; Feigh, Karen M.

2016-01-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity. The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design. PMID:28491008

Decision Support System Requirements Definition for Human Extravehicular Activity Based on Cognitive Work Analysis.

PubMed

Miller, Matthew James; McGuire, Kerry M; Feigh, Karen M

2017-06-01

The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity . The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design.

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.

Patient Education and Support During CKD Transitions: When the Possible Becomes Probable.

PubMed

Green, Jamie A; Boulware, L Ebony

2016-07-01

Patients transitioning from kidney disease to kidney failure require comprehensive patient-centered education and support. Efforts to prepare patients for this transition often fail to meet patients' needs due to uncertainty about which patients will progress to kidney failure, nonindividualized patient education programs, inadequate psychosocial support, or lack of assistance to guide patients through complex treatment plans. Resources are available to help overcome barriers to providing optimal care during this time, including prognostic tools, educational lesson plans, decision aids, communication skills training, peer support, and patient navigation programs. New models are being studied to comprehensively address patients' needs and improve the lives of kidney patients during this high-risk time. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Warehouse location and freight attraction in the greater El Paso region.

DOT National Transportation Integrated Search

2013-12-01

This project analyzes the current and future warehouse and distribution center locations along the El Paso-Juarez regions in the U.S.-Mexico border. This research seeks has developed a comprehensive database to aid in decision support process for ide...

76 FR 13427 - Ellicott Slough National Wildlife Refuge, Santa Cruz County, CA; Final Comprehensive Conservation...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

... Santa Cruz long-toed salamander, and currently supports 2 of the 20 known breeding populations of the salamander. We announce our decision and the availability of the FONSI for the final CCP for Ellicott Slough...

Development of a dredge planning and decision support tool.

DOT National Transportation Integrated Search

2004-12-01

The report presented herein is a comprehensive overview of the practice of harbor dredging : at the Port of New York and New Jersey, USA. The study was commissioned by the Port : Authority of Piraeus, Greece with the objective of creating a database ...

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.

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

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders.

PubMed

Hamilton, Jada G; Lillie, Sarah E; Alden, Dana L; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Craddock Lee, Simon; Goldstein, Mary K; Jacobson, Robert M; Myers, Ronald E; Zikmund-Fisher, Brian J; Waters, Erika A

2017-02-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process.

The Student Affairs Committee. Effective Committees. Board Basics.

ERIC Educational Resources Information Center

Goodale, Thomas G.

1997-01-01

Responsibilities of the college or university governing board's student affairs committee include representing students' interests in all policy decisions, ensuring provision of adequate financial resources to support a comprehensive student affairs program, ensuring that board policies keep pace with students' diverse and changing needs, and…

Spatial decision support system for tobacco enterprise based on spatial data mining

NASA Astrophysics Data System (ADS)

Mei, Xin; Liu, Junyi; Zhang, Xuexia; Cui, Weihong

2007-11-01

Tobacco enterprise is a special enterprise, which has strong correlation to regional geography. But in the past research and application, the combination between tobacco and GIS is limited to use digital maps to assist cigarette distribution. How to comprehensively import 3S technique and spatial data mining (SDM) to construct spatial decision support system (SDSS) of tobacco enterprise is the main research aspect in this paper. The paper concretely analyzes the GIS requirements in tobacco enterprise for planning location of production, monitoring production management and product sale at the beginning. Then holistic solution is presented and frame design for tobacco enterprise spatial decision based on SDM is given. This paper describes how to use spatial analysis and data mining to realize the spatial decision processing such as monitoring tobacco planted acreage, analyzing and planning the cigarette sale network and so on.

Use of Probabilistic Risk Assessment in Shuttle Decision Making Process

NASA Technical Reports Server (NTRS)

Boyer, Roger L.; Hamlin, Teri, L.

2011-01-01

This slide presentation reviews the use of Probabilistic Risk Assessment (PRA) to assist in the decision making for the shuttle design and operation. Probabilistic Risk Assessment (PRA) is a comprehensive, structured, and disciplined approach to identifying and analyzing risk in complex systems and/or processes that seeks answers to three basic questions: (i.e., what can go wrong? what is the likelihood of these occurring? and what are the consequences that could result if these occur?) The purpose of the Shuttle PRA (SPRA) is to provide a useful risk management tool for the Space Shuttle Program (SSP) to identify strengths and possible weaknesses in the Shuttle design and operation. SPRA was initially developed to support upgrade decisions, but has evolved into a tool that supports Flight Readiness Reviews (FRR) and near real-time flight decisions. Examples of the use of PRA for the shuttle are reviewed.

Integration of the Response Surface Methodology with the Compromise Decision Support Problem in Developing a General Robust Design Procedure

NASA Technical Reports Server (NTRS)

Chen, Wei; Tsui, Kwok-Leung; Allen, Janet K.; Mistree, Farrokh

1994-01-01

In this paper we introduce a comprehensive and rigorous robust design procedure to overcome some limitations of the current approaches. A comprehensive approach is general enough to model the two major types of robust design applications, namely, robust design associated with the minimization of the deviation of performance caused by the deviation of noise factors (uncontrollable parameters), and robust design due to the minimization of the deviation of performance caused by the deviation of control factors (design variables). We achieve mathematical rigor by using, as a foundation, principles from the design of experiments and optimization. Specifically, we integrate the Response Surface Method (RSM) with the compromise Decision Support Problem (DSP). Our approach is especially useful for design problems where there are no closed-form solutions and system performance is computationally expensive to evaluate. The design of a solar powered irrigation system is used as an example. Our focus in this paper is on illustrating our approach rather than on the results per se.

Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion.

PubMed

Shah, Neil; Baker, Steven A; Spain, David; Shieh, Lisa; Shepard, John; Hadhazy, Eric; Maggio, Paul; Goodnough, Lawrence T

2017-08-01

To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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

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.

Interruptions disrupt reading comprehension.

PubMed

Foroughi, Cyrus K; Werner, Nicole E; Barragán, Daniela; Boehm-Davis, Deborah A

2015-06-01

Previous research suggests that being interrupted while reading a text does not disrupt the later recognition or recall of information from that text. This research is used as support for Ericsson and Kintsch's (1995) long-term working memory (LT-WM) theory, which posits that disruptions while reading (e.g., interruptions) do not impair subsequent text comprehension. However, to fully comprehend a text, individuals may need to do more than recognize or recall information that has been presented in the text at a later time. Reading comprehension often requires individuals to connect and synthesize information across a text (e.g., successfully identifying complex topics such as themes and tones) and not just make a familiarity-based decision (i.e., recognition). The goal for this study was to determine whether interruptions while reading disrupt reading comprehension when the questions assessing comprehension require participants to connect and synthesize information across the passage. In Experiment 1, interruptions disrupted reading comprehension. In Experiment 2, interruptions disrupted reading comprehension but not recognition of information from the text. In Experiment 3, the addition of a 15-s time-out prior to the interruption successfully removed these negative effects. These data suggest that the time it takes to process the information needed to successfully comprehend text when reading is greater than that required for recognition. Any interference (e.g., an interruption) that occurs during the comprehension process may disrupt reading comprehension. This evidence supports the need for transient activation of information in working memory for successful text comprehension and does not support LT-WM theory. (c) 2015 APA, all rights reserved).

MATREX Leads the Way in Implementing New DOD VV&A Documentation Standards

DTIC Science & Technology

2007-05-24

Acquisition Operations & Support B C Sustainment FRP Decision Review FOC LRIP/IOT& ECritical Design Review Pre-Systems Acquisition Concept...Communications Human Performance Model • C3GRID – Command & Control, Computer GRID • CES – Communications Effects Server • CMS2 – Comprehensive

An Intelligent Polar Cyberinfrastrucuture to Support Spatiotemporal Decision Making

NASA Astrophysics Data System (ADS)

Song, M.; Li, W.; Zhou, X.

2014-12-01

In the era of big data, polar sciences have already faced an urgent demand of utilizing intelligent approaches to support precise and effective spatiotemporal decision-making. Service-oriented cyberinfrastructure has advantages of seamlessly integrating distributed computing resources, and aggregating a variety of geospatial data derived from Earth observation network. This paper focuses on building a smart service-oriented cyberinfrastructure to support intelligent question answering related to polar datasets. The innovation of this polar cyberinfrastructure includes: (1) a problem-solving environment that parses geospatial question in natural language, builds geoprocessing rules, composites atomic processing services and executes the entire workflow; (2) a self-adaptive spatiotemporal filter that is capable of refining query constraints through semantic analysis; (3) a dynamic visualization strategy to support results animation and statistics in multiple spatial reference systems; and (4) a user-friendly online portal to support collaborative decision-making. By means of this polar cyberinfrastructure, we intend to facilitate integration of distributed and heterogeneous Arctic datasets and comprehensive analysis of multiple environmental elements (e.g. snow, ice, permafrost) to provide a better understanding of the environmental variation in circumpolar regions.

Decision Support in a Changing and Contentious World--Successfully Supporting the Development of a 50-year Comprehensive Coastal Master Plan in Louisiana

NASA Astrophysics Data System (ADS)

Groves, D.

2014-12-01

After the devastating 2005 hurricane season, Louisiana embarked on an ambitious and daunting effort to develop and implement a comprehensive Coastal Master Plan. The Master Plan sought to achieve two key goals simultaneously: reduce hurricane flood risk and halt the net conversion of its coastal landscape to open ocean. Numerous prior efforts to achieve these goals had been tried without significant success. In 2012, however, the Louisiana Coastal Protection and Restoration Authority (CPRA) produced a 50-year, $50 billion Master Plan. It had broad support from a diverse and often adversarial set of stakeholders, and it was unanimously passed by the Louisiana legislature. In contrast to other efforts, CPRA took an approach to planning called by the U.S. National Research Council as "deliberation with analysis". Specifically, CPRA used data, models, and decision support tools not to define an optimal or best strategy, but instead to support stakeholder dialogue and deliberations over alterative coastal management strategies. RAND researchers, with the support of CPRA and other collaborators, developed the planning tool at the center of this process. The CPRA planning tool synthesized large amounts of information about how the coast might evolve over time with and without different combinations of hundreds of different projects and programs. The tool helped CPRA propose alternative strategies that could achieve the State's goals while also highlighting to stakeholders the key tradeoffs among them. Importantly, this process helped bring diverse communities together to support a single vision and specific set of projects and programs to meet many of Louisiana's coastal water resources challenges. This presentation will describe the planning approach and decision support tools developed to support the Master Plan's participatory stakeholder process. The presentation will also highlight several important key takeaway messages that have broad applicability to other water resources planning efforts. Lastly, it will describe several on-going efforts in other parts of the U.S. that are employing this same approach.

Research on Bidding Decision-making of International Public-Private Partnership Projects

NASA Astrophysics Data System (ADS)

Hu, Zhen Yu; Zhang, Shui Bo; Liu, Xin Yan

2018-06-01

In order to select the optimal quasi-bidding project for an investment enterprise, a bidding decision-making model for international PPP projects was established in this paper. Firstly, the literature frequency statistics method was adopted to screen out the bidding decision-making indexes, and accordingly the bidding decision-making index system for international PPP projects was constructed. Then, the group decision-making characteristic root method, the entropy weight method, and the optimization model based on least square method were used to set the decision-making index weights. The optimal quasi-bidding project was thus determined by calculating the consistent effect measure of each decision-making index value and the comprehensive effect measure of each quasi-bidding project. Finally, the bidding decision-making model for international PPP projects was further illustrated by a hypothetical case. This model can effectively serve as a theoretical foundation and technical support for the bidding decision-making of international PPP projects.

Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

NASA Astrophysics Data System (ADS)

Spahr, K.; Hogue, T. S.

2016-12-01

Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

Visualizing risks in cancer communication: A systematic review of computer-supported visual aids.

PubMed

Stellamanns, Jan; Ruetters, Dana; Dahal, Keshav; Schillmoeller, Zita; Huebner, Jutta

2017-08-01

Health websites are becoming important sources for cancer information. Lay users, patients and carers seek support for critical decisions, but they are prone to common biases when quantitative information is presented. Graphical representations of risk data can facilitate comprehension, and interactive visualizations are popular. This review summarizes the evidence on computer-supported graphs that present risk data and their effects on various measures. The systematic literature search was conducted in several databases, including MEDLINE, EMBASE and CINAHL. Only studies with a controlled design were included. Relevant publications were carefully selected and critically appraised by two reviewers. Thirteen studies were included. Ten studies evaluated static graphs and three dynamic formats. Most decision scenarios were hypothetical. Static graphs could improve accuracy, comprehension, and behavioural intention. But the results were heterogeneous and inconsistent among the studies. Dynamic formats were not superior or even impaired performance compared to static formats. Static graphs show promising but inconsistent results, while research on dynamic visualizations is scarce and must be interpreted cautiously due to methodical limitations. Well-designed and context-specific static graphs can support web-based cancer risk communication in particular populations. The application of dynamic formats cannot be recommended and needs further research. Copyright © 2017 Elsevier B.V. All rights reserved.

Deep learning aided decision support for pulmonary nodules diagnosing: a review

PubMed Central

Yang, Yixin; Feng, Xiaoyi; Chi, Wenhao; Li, Zhengyang; Duan, Wenzhe; Liu, Haiping; Liang, Wenhua; Wang, Wei; Chen, Ping

2018-01-01

Deep learning techniques have recently emerged as promising decision supporting approaches to automatically analyze medical images for different clinical diagnosing purposes. Diagnosing of pulmonary nodules by using computer-assisted diagnosing has received considerable theoretical, computational, and empirical research work, and considerable methods have been developed for detection and classification of pulmonary nodules on different formats of images including chest radiographs, computed tomography (CT), and positron emission tomography in the past five decades. The recent remarkable and significant progress in deep learning for pulmonary nodules achieved in both academia and the industry has demonstrated that deep learning techniques seem to be promising alternative decision support schemes to effectively tackle the central issues in pulmonary nodules diagnosing, including feature extraction, nodule detection, false-positive reduction, and benign-malignant classification for the huge volume of chest scan data. The main goal of this investigation is to provide a comprehensive state-of-the-art review of the deep learning aided decision support for pulmonary nodules diagnosing. As far as the authors know, this is the first time that a review is devoted exclusively to deep learning techniques for pulmonary nodules diagnosing. PMID:29780633

Education and parental involvement in decision-making about newborn screening: understanding goals to clarify content.

PubMed

Potter, Beth K; Etchegary, Holly; Nicholls, Stuart G; Wilson, Brenda J; Craigie, Samantha M; Araia, Makda H

2015-06-01

A challenge in designing effective education for parents about newborn screening (NBS) has been uncertainty about appropriate content. Arguing that the goals of education may be usefully tied to parental decision-making, we sought to: (1) explore how different ways of implementing NBS differ in their approaches to parental engagement in decision-making; (2) map the potential goals of education onto these "implementation models"; and (3) consider the content that may be needed to support these goals. The resulting conceptual framework supports the availability of comprehensive information about NBS for parents, irrespective of the model of implementation. This is largely because we argue that meeting parental expectations and preferences for communication is an important goal regardless of whether or notparents are actively involved in making a decision. Our analysis supports a flexible approach, in which some educational messages are emphasized as important for all parents to understand while others are made available depending on parents' preferences. We have begun to define the content of NBS education for parents needed to support specific goals. Further research and discussion is important to determine the most appropriate strategies for delivering the tailored approach to education that emerged from our analysis.

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.

An Expertise Based Energy Information System.

ERIC Educational Resources Information Center

Rosenberg, S.

This paper describes an intelligent decision support system for information on petroleum resources and use currently being designed by the Information Methodology Research Project as the first step in the development of a comprehensive intelligent information system for dealing with energy resources in the United States. The system draws on…

What Can Local Foundations Do to Support Youth Service System Change Efforts?

ERIC Educational Resources Information Center

Weah, Wokie; Pope, Marcus

2013-01-01

Making sound decisions in funding youth-serving organizations can be greatly enhanced by implementing a comprehensive and inclusive learning process that embraces the perspectives of and input from a variety of stakeholders, including program staff and leadership, various community partners, and, most important, the youth. Youthprise effectively…

Data Mining and Knowledge Management in Higher Education -Potential Applications.

ERIC Educational Resources Information Center

Luan, Jing

This paper introduces a new decision support tool, data mining, in the context of knowledge management. The most striking features of data mining techniques are clustering and prediction. The clustering aspect of data mining offers comprehensive characteristics analysis of students, while the predicting function estimates the likelihood for a…

A Whole Language Flight Plan: An Interview with Three Teachers.

ERIC Educational Resources Information Center

Griffith, Priscilla L.; Klesius, Janell

1990-01-01

Provides suggestions to teachers planning to implement a whole language program, based on interviews with three whole language teachers. Focuses on support for the whole language program; decisions about curriculum and evaluation; development of vocabulary and comprehension; strengths and weaknesses of the whole language approach; and preparation…

MATREX: A Unifying Modeling and Simulation Architecture for Live-Virtual-Constructive Applications

DTIC Science & Technology

2007-05-23

Deployment Systems Acquisition Operations & Support B C Sustainment FRP Decision Review FOC LRIP/IOT& ECritical Design Review Pre-Systems...CMS2 – Comprehensive Munitions & Sensor Server • CSAT – C4ISR Static Analysis Tool • C4ISR – Command & Control, Communications, Computers

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.

Set-up of a decision support system to support sustainable development of the Laguna de Bay, Philippines.

PubMed

Nauta, Tjitte A; Bongco, Alicia E; Santos-Borja, Adelina C

2003-01-01

Over recent decades, population expansion, deforestation, land conversion, urbanisation, intense fisheries and industrialisation have produced massive changes in the Laguna de Bay catchment, Philippines. The resulting problems include rapid siltation of the lake, eutrophication, inputs of toxics, flooding problems and loss of biodiversity. Rational and systematic resolution of conflicting water use and water allocation interests is now urgently needed in order to ensure sustainable use of the water resources. With respect to the competing and conflicting pressures on the water resources, the Laguna Lake Development Authority (LLDA) needs to achieve comprehensive management and development of the area. In view of these problems and needs, the Government of the Netherlands was funding a two-year project entitled 'Sustainable Development of the Laguna de Bay Environment'.A comprehensive tool has been developed to support decision-making at catchment level. This consists of an ArcView GIS-database linked to a state-of-the-art modelling suite, including hydrological and waste load models for the catchment area and a three-dimensional hydrodynamic and water quality model (Delft3D) linked to a habitat evaluation module for the lake. In addition, MS Office based tools to support a stakeholder analysis and financial and economic assessments have been developed. The project also focused on technical studies relating to dredging, drinking water supply and infrastructure works. These aimed to produce technically and economically feasible solutions to water quantity and quality problems. The paper also presents the findings of a study on the development of polder islands in the Laguna de Bay, addressing the water quantity and quality problems and focusing on the application of the decision support system.

From design to implementation--the Joint Asia Diabetes Evaluation (JADE) program: a descriptive report of an electronic web-based diabetes management program.

PubMed

Ko, Gary T; So, Wing-Yee; Tong, Peter C; Le Coguiec, Francois; Kerr, Debborah; Lyubomirsky, Greg; Tamesis, Beaver; Wolthers, Troels; Nan, Jennifer; Chan, Juliana

2010-05-13

The Joint Asia Diabetes Evaluation (JADE) Program is a web-based program incorporating a comprehensive risk engine, care protocols, and clinical decision support to improve ambulatory diabetes care. The JADE Program uses information technology to facilitate healthcare professionals to create a diabetes registry and to deliver an evidence-based care and education protocol tailored to patients' risk profiles. With written informed consent from participating patients and care providers, all data are anonymized and stored in a databank to establish an Asian Diabetes Database for research and publication purpose. The JADE electronic portal (e-portal: http://www.jade-adf.org) is implemented as a Java application using the Apache web server, the mySQL database and the Cocoon framework. The JADE e-portal comprises a risk engine which predicts 5-year probability of major clinical events based on parameters collected during an annual comprehensive assessment. Based on this risk stratification, the JADE e-portal recommends a care protocol tailored to these risk levels with decision support triggered by various risk factors. Apart from establishing a registry for quality assurance and data tracking, the JADE e-portal also displays trends of risk factor control at each visit to promote doctor-patient dialogues and to empower both parties to make informed decisions. The JADE Program is a prototype using information technology to facilitate implementation of a comprehensive care model, as recommended by the International Diabetes Federation. It also enables health care teams to record, manage, track and analyze the clinical course and outcomes of people with diabetes.

Single-process versus multiple-strategy models of decision making: evidence from an information intrusion paradigm.

PubMed

Söllner, Anke; Bröder, Arndt; Glöckner, Andreas; Betsch, Tilmann

2014-02-01

When decision makers are confronted with different problems and situations, do they use a uniform mechanism as assumed by single-process models (SPMs) or do they choose adaptively from a set of available decision strategies as multiple-strategy models (MSMs) imply? Both frameworks of decision making have gathered a lot of support, but only rarely have they been contrasted with each other. Employing an information intrusion paradigm for multi-attribute decisions from givens, SPM and MSM predictions on information search, decision outcomes, attention, and confidence judgments were derived and tested against each other in two experiments. The results consistently support the SPM view: Participants seemingly using a "take-the-best" (TTB) strategy do not ignore TTB-irrelevant information as MSMs would predict, but adapt the amount of information searched, choose alternative choice options, and show varying confidence judgments contingent on the quality of the "irrelevant" information. The uniformity of these findings underlines the adequacy of the novel information intrusion paradigm and comprehensively promotes the notion of a uniform decision making mechanism as assumed by single-process models. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders

PubMed Central

Hamilton, Jada G.; Lillie, Sarah E.; Alden, Dana L.; Scherer, Laura; Oser, Megan; Rini, Christine; Tanaka, Miho; Baleix, John; Brewster, Mikki; Lee, Simon Craddock; Goldstein, Mary K.; Jacobson, Robert M.; Myers, Ronald E.; Zikmund-Fisher, Brian J.; Waters, Erika A.

2016-01-01

Informed and shared decision making are critical aspects of patient-centered care, which has contributed to an emphasis on decision support interventions to promote good medical decision making. However, researchers and healthcare providers have not reached a consensus on what defines a good decision, nor how to evaluate it. This position paper, informed by conference sessions featuring diverse stakeholders held at the 2015 Society of Behavioral Medicine and Society for Medical Decision Making annual meetings, describes key concepts that influence the decision making process itself and that may change what it means to make a good decision: interpersonal factors, structural constraints, affective influences, and values clarification methods. This paper also proposes specific research questions within each of these priority areas, with the goal of moving medical decision making research to a more comprehensive definition of a good medical decision, and enhancing the ability to measure and improve the decision making process. PMID:27566316

Direct and Electronic Health Record Access to the Clinical Decision Support for Immunizations in the Minnesota Immunization Information System.

PubMed

Rajamani, Sripriya; Bieringer, Aaron; Wallerius, Stephanie; Jensen, Daniel; Winden, Tamara; Muscoplat, Miriam Halstead

2016-01-01

Immunization information systems (IIS) are population-based and confidential computerized systems maintained by public health agencies containing individual data on immunizations from participating health care providers. IIS hold comprehensive vaccination histories given across providers and over time. An important aspect to IIS is the clinical decision support for immunizations (CDSi), consisting of vaccine forecasting algorithms to determine needed immunizations. The study objective was to analyze the CDSi presentation by IIS in Minnesota (Minnesota Immunization Information Connection [MIIC]) through direct access by IIS interface and by access through electronic health records (EHRs) to outline similarities and differences. The immunization data presented were similar across the three systems examined, but with varying ability to integrate data across MIIC and EHR, which impacts immunization data reconciliation. Study findings will lead to better understanding of immunization data display, clinical decision support, and user functionalities with the ultimate goal of promoting IIS CDSi to improve vaccination rates.

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study.

PubMed

Reumkens, Kelly; Tummers, Marly H E; Gietel-Habets, Joyce J G; van Kuijk, Sander M J; Aalfs, Cora M; van Asperen, Christi J; Ausems, Margreet G E M; Collée, Margriet; Dommering, Charlotte J; Kets, C Marleen; van der Kolk, Lizet E; Oosterwijk, Jan C; Tjan-Heijnen, Vivianne C G; van der Weijden, Trudy; de Die-Smulders, Christine E M; van Osch, Liesbeth A D M

2018-05-30

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples' decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest-posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision.

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.

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.

Towards a web-based decision support tool for selecting appropriate statistical test in medical and biological sciences.

PubMed

Suner, Aslı; Karakülah, Gökhan; Dicle, Oğuz

2014-01-01

Statistical hypothesis testing is an essential component of biological and medical studies for making inferences and estimations from the collected data in the study; however, the misuse of statistical tests is widely common. In order to prevent possible errors in convenient statistical test selection, it is currently possible to consult available test selection algorithms developed for various purposes. However, the lack of an algorithm presenting the most common statistical tests used in biomedical research in a single flowchart causes several problems such as shifting users among the algorithms, poor decision support in test selection and lack of satisfaction of potential users. Herein, we demonstrated a unified flowchart; covers mostly used statistical tests in biomedical domain, to provide decision aid to non-statistician users while choosing the appropriate statistical test for testing their hypothesis. We also discuss some of the findings while we are integrating the flowcharts into each other to develop a single but more comprehensive decision algorithm.

Fuzzy Comprehensive Evaluation (FCE) in Military Decision Support Processes

DTIC Science & Technology

2013-12-01

detection in military aircraft (Brotherton & Johnson, 2001). Today, as reported by the international journal Advances in Fuzzy Systems (2013), as of March... detection for advanced military aircraft using neural networks. In IEEE Proceedings Aerospace Conference, 2001, 6, 3113–3123. Cheng, C . H. (1996... C .   OBJECTIVE ................................................................................................... 3   II.   THE FUZZY

Evaluation of the operational and demonstration test of short-range weather forecasting decision support within an advanced rural traveler information system

DOT National Transportation Integrated Search

1996-11-01

THIS IS THE TECHNICAL SUMMARY OF THE RESEARCH REPORT, COMMERCIAL MOTOR VEHICLE DRIVER FATIOUE AND ALERTNESS STUDY BY WYLIE ET AL., THE LARGEST AND MOST COMPREHENSIVE OVER-THE-ROAD STUDY ON THIS SUBJECT EVER CONDUCTED IN NORTH AMERICA. THE DATA COLLEC...

Australia State of the Environment 2011--A Resource for Science Teachers

ERIC Educational Resources Information Center

Marsack, Peter; Shepherd, Lee-Anne; Bartlett, Anni

2013-01-01

Australia State of the Environment 2011 (SoE 2011) is a comprehensive review of the Australian environment, providing an independent and authoritative snapshot of the state of our continent. The report presents relevant and useful information to the public and decision makers to improve understanding of environmental issues and support better…

Readability Levels of Health-Based Websites: From Content to Comprehension

ERIC Educational Resources Information Center

Schutten, Mary; McFarland, Allison

2009-01-01

Three of the national health education standards include decision-making, accessing information and analyzing influences. WebQuests are a popular inquiry-oriented method used by secondary teachers to help students achieve these content standards. While WebQuests support higher level thinking skills, the readability level of the information on the…

I-WASTE: EPA’s Suite of Homeland Security Decision Support Tools for the Waste and Disaster Debris Management and Disposal

EPA Science Inventory

In the U.S., a single comprehensive approach to all-hazards domestic incident management has been established by the Department of Homeland Security through the National Response Framework. This helps prevent, prepare for, respond to, and recover from terrorist attacks, major di...

Web-based health services and clinical decision support.

PubMed

Jegelevicius, Darius; Marozas, Vaidotas; Lukosevicius, Arunas; Patasius, Martynas

2004-01-01

The purpose of this study was the development of a Web-based e-health service for comprehensive assistance and clinical decision support. The service structure consists of a Web server, a PHP-based Web interface linked to a clinical SQL database, Java applets for interactive manipulation and visualization of signals and a Matlab server linked with signal and data processing algorithms implemented by Matlab programs. The service ensures diagnostic signal- and image analysis-sbased clinical decision support. By using the discussed methodology, a pilot service for pathology specialists for automatic calculation of the proliferation index has been developed. Physicians use a simple Web interface for uploading the pictures under investigation to the server; subsequently a Java applet interface is used for outlining the region of interest and, after processing on the server, the requested proliferation index value is calculated. There is also an "expert corner", where experts can submit their index estimates and comments on particular images, which is especially important for system developers. These expert evaluations are used for optimization and verification of automatic analysis algorithms. Decision support trials have been conducted for ECG and ophthalmology ultrasonic investigations of intraocular tumor differentiation. Data mining algorithms have been applied and decision support trees constructed. These services are under implementation by a Web-based system too. The study has shown that the Web-based structure ensures more effective, flexible and accessible services compared with standalone programs and is very convenient for biomedical engineers and physicians, especially in the development phase.

Information warehouse - a comprehensive informatics platform for business, clinical, and research applications.

PubMed

Kamal, Jyoti; Liu, Jianhua; Ostrander, Michael; Santangelo, Jennifer; Dyta, Ravi; Rogers, Patrick; Mekhjian, Hagop S

2010-11-13

Since its inception in 1997, the IW (Information Warehouse) at the Ohio State University Medical Center (OSUMC) has gradually transformed itself from a single purpose business decision support system to a comprehensive informatics platform supporting basic, clinical, and translational research. The IW today is the combination of four integrated components: a clinical data repository containing over a million patients; a research data repository housing various research specific data; an application development platform for building business and research enabling applications; a business intelligence environment assisting in reporting in all function areas. The IW is structured and encoded using standard terminologies such as SNOMED-CT, ICD, and CPT. The IW is an important component of OSUMC's Clinical and Translational Science Award (CTSA) informatics program.

A stochastic multicriteria model for evidence-based decision making in drug benefit-risk analysis.

PubMed

Tervonen, Tommi; van Valkenhoef, Gert; Buskens, Erik; Hillege, Hans L; Postmus, Douwe

2011-05-30

Drug benefit-risk (BR) analysis is based on firm clinical evidence regarding various safety and efficacy outcomes. In this paper, we propose a new and more formal approach for constructing a supporting multi-criteria model that fully takes into account the evidence on efficacy and adverse drug reactions. Our approach is based on the stochastic multi-criteria acceptability analysis methodology, which allows us to compute the typical value judgments that support a decision, to quantify decision uncertainty, and to compute a comprehensive BR profile. We construct a multi-criteria model for the therapeutic group of second-generation antidepressants. We assess fluoxetine and venlafaxine together with placebo according to incidence of treatment response and three common adverse drug reactions by using data from a published study. Our model shows that there are clear trade-offs among the treatment alternatives. Copyright © 2011 John Wiley & Sons, Ltd.

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

Comprehensive mitigation framework for concurrent application of multiple clinical practice guidelines.

PubMed

Wilk, Szymon; Michalowski, Martin; Michalowski, Wojtek; Rosu, Daniela; Carrier, Marc; Kezadri-Hamiaz, Mounira

2017-02-01

In this work we propose a comprehensive framework based on first-order logic (FOL) for mitigating (identifying and addressing) interactions between multiple clinical practice guidelines (CPGs) applied to a multi-morbid patient while also considering patient preferences related to the prescribed treatment. With this framework we respond to two fundamental challenges associated with clinical decision support: (1) concurrent application of multiple CPGs and (2) incorporation of patient preferences into the decision making process. We significantly expand our earlier research by (1) proposing a revised and improved mitigation-oriented representation of CPGs and secondary medical knowledge for addressing adverse interactions and incorporating patient preferences and (2) introducing a new mitigation algorithm. Specifically, actionable graphs representing CPGs allow for parallel and temporal activities (decisions and actions). Revision operators representing secondary medical knowledge support temporal interactions and complex revisions across multiple actionable graphs. The mitigation algorithm uses the actionable graphs, revision operators and available (and possibly incomplete) patient information represented in FOL. It relies on a depth-first search strategy to find a valid sequence of revisions and uses theorem proving and model finding techniques to identify applicable revision operators and to establish a management scenario for a given patient if one exists. The management scenario defines a safe (interaction-free) and preferred set of activities together with possible patient states. We illustrate the use of our framework with a clinical case study describing two patients who suffer from chronic kidney disease, hypertension, and atrial fibrillation, and who are managed according to CPGs for these diseases. While in this paper we are primarily concerned with the methodological aspects of mitigation, we also briefly discuss a high-level proof of concept implementation of the proposed framework in the form of a clinical decision support system (CDSS). The proposed mitigation CDSS "insulates" clinicians from the complexities of the FOL representations and provides semantically meaningful summaries of mitigation results. Ultimately we plan to implement the mitigation CDSS within our MET (Mobile Emergency Triage) decision support environment. Copyright © 2016 Elsevier Inc. All rights reserved.

Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men.

PubMed

Berry, Donna L; Halpenny, Barbara; Bosco, Jaclyn L F; Bruyere, John; Sanda, Martin G

2015-07-24

The Personal Patient Profile-Prostate (P3P), a web-based decision aid, was demonstrated to reduce decisional conflict in English-speaking men with localized prostate cancer early after initial diagnosis. The purpose of this study was to explore and enhance usability and cultural appropriateness of a Spanish P3P by Latino men with a diagnosis of prostate cancer. P3P was translated to Spanish and back-translated by three native Spanish-speaking translators working independently. Spanish-speaking Latino men with a diagnosis of localized prostate cancer, who had made treatment decisions in the past 24 months, were recruited from two urban clinical care sites. Individual cognitive interviews were conducted by two bilingual research assistants as each participant used the Spanish P3P. Notes of user behavior, feedback, and answers to direct questions about comprehension, usability and perceived usefulness were analyzed and categorized. Seven participants with a range of education levels identified 25 unique usability issues in navigation, content comprehension and completeness, sociocultural appropriateness, and methodology. Revisions were prioritized to refine the usability and cultural and linguistic appropriateness of the decision aid. Usability issues were discovered that are potential barriers to effective decision support. Successful use of decision aids requires adaptation and testing beyond translation. Our findings led to revisions further refining the usability and linguistic and cultural appropriateness of Spanish P3P.

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…

An international comparison of legal frameworks for supported and substitute decision-making in mental health services.

PubMed

Davidson, Gavin; Brophy, Lisa; Campbell, Jim; Farrell, Susan J; Gooding, Piers; O'Brien, Ann-Marie

2016-01-01

There have been important recent developments in law, research, policy and practice relating to supporting people with decision-making impairments, in particular when a person's wishes and preferences are unclear or inaccessible. A driver in this respect is the United Nations Convention on the Rights of Persons with Disabilities (CRPD); the implications of the CRPD for policy and professional practices are currently debated. This article reviews and compares four legal frameworks for supported and substitute decision-making for people whose decision-making ability is impaired. In particular, it explores how these frameworks may apply to people with mental health problems. The four jurisdictions are: Ontario, Canada; Victoria, Australia; England and Wales, United Kingdom (UK); and Northern Ireland, UK. Comparisons and contrasts are made in the key areas of: the legal framework for supported and substitute decision-making; the criteria for intervention; the assessment process; the safeguards; and issues in practice. Thus Ontario has developed a relatively comprehensive, progressive and influential legal framework over the past 30 years but there remain concerns about the standardisation of decision-making ability assessments and how the laws work together. In Australia, the Victorian Law Reform Commission (2012) has recommended that the six different types of substitute decision-making under the three laws in that jurisdiction, need to be simplified, and integrated into a spectrum that includes supported decision-making. In England and Wales the Mental Capacity Act 2005 has a complex interface with mental health law. In Northern Ireland it is proposed to introduce a new Mental Capacity (Health, Welfare and Finance) Bill that will provide a unified structure for all substitute decision-making. The discussion will consider the key strengths and limitations of the approaches in each jurisdiction and identify possible ways that further progress can be made in law, policy and practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

From design to implementation - The Joint Asia Diabetes Evaluation (JADE) program: A descriptive report of an electronic web-based diabetes management program

PubMed Central

2010-01-01

Background The Joint Asia Diabetes Evaluation (JADE) Program is a web-based program incorporating a comprehensive risk engine, care protocols, and clinical decision support to improve ambulatory diabetes care. Methods The JADE Program uses information technology to facilitate healthcare professionals to create a diabetes registry and to deliver an evidence-based care and education protocol tailored to patients' risk profiles. With written informed consent from participating patients and care providers, all data are anonymized and stored in a databank to establish an Asian Diabetes Database for research and publication purpose. Results The JADE electronic portal (e-portal: http://www.jade-adf.org) is implemented as a Java application using the Apache web server, the mySQL database and the Cocoon framework. The JADE e-portal comprises a risk engine which predicts 5-year probability of major clinical events based on parameters collected during an annual comprehensive assessment. Based on this risk stratification, the JADE e-portal recommends a care protocol tailored to these risk levels with decision support triggered by various risk factors. Apart from establishing a registry for quality assurance and data tracking, the JADE e-portal also displays trends of risk factor control at each visit to promote doctor-patient dialogues and to empower both parties to make informed decisions. Conclusions The JADE Program is a prototype using information technology to facilitate implementation of a comprehensive care model, as recommended by the International Diabetes Federation. It also enables health care teams to record, manage, track and analyze the clinical course and outcomes of people with diabetes. PMID:20465815

A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers

PubMed Central

2013-01-01

Background Tools to support clinical or patient decision-making in the treatment/management of a health condition are used in a range of clinical settings for numerous preference-sensitive healthcare decisions. Their impact in clinical practice is largely dependent on their quality across a range of domains. We critically analysed currently available tools to support decision making or patient understanding in the treatment of acute ischaemic stroke with intravenous thrombolysis, as an exemplar to provide clinicians/researchers with practical guidance on development, evaluation and implementation of such tools for other preference-sensitive treatment options/decisions in different clinical contexts. Methods Tools were identified from bibliographic databases, Internet searches and a survey of UK and North American stroke networks. Two reviewers critically analysed tools to establish: information on benefits/risks of thrombolysis included in tools, and the methods used to convey probabilistic information (verbal descriptors, numerical and graphical); adherence to guidance on presenting outcome probabilities (IPDASi probabilities items) and information content (Picker Institute Checklist); readability (Fog Index); and the extent that tools had comprehensive development processes. Results Nine tools of 26 identified included information on a full range of benefits/risks of thrombolysis. Verbal descriptors, frequencies and percentages were used to convey probabilistic information in 20, 19 and 18 tools respectively, whilst nine used graphical methods. Shortcomings in presentation of outcome probabilities (e.g. omitting outcomes without treatment) were identified. Patient information tools had an aggregate median Fog index score of 10. None of the tools had comprehensive development processes. Conclusions Tools to support decision making or patient understanding in the treatment of acute stroke with thrombolysis have been sub-optimally developed. Development of tools should utilise mixed methods and strategies to meaningfully involve clinicians, patients and their relatives in an iterative design process; include evidence-based methods to augment interpretability of textual and probabilistic information (e.g. graphical displays showing natural frequencies) on the full range of outcome states associated with available options; and address patients with different levels of health literacy. Implementation of tools will be enhanced when mechanisms are in place to periodically assess the relevance of tools and where necessary, update the mode of delivery, form and information content. PMID:23777368

Global payment contract attitudes and comprehension among internal medicine physicians.

PubMed

Allen-Dicker, Joshua; Herzig, Shoshana J; Kerbel, Russell

2015-08-01

Global payment contracts (GPCs) are increasingly common agreements between insurance payers and healthcare providers that incorporate aspects of risk adjustment, capitation, and pay-for-performance. Physicians are often viewed as potential barriers to implementation of organizational change, but little is known about internist opinion on GPC involvement or specific internist attributes that might predict GPC support. We aimed to investigate internist and internal medicine subspecialist support of GPC involvement, and to identify associations among physician attributes, GPC knowledge, and GPC support. Cross-sectional. General medicine and internal medicine subspecialist physicians within the Beth Israel Deaconess Department of Medicine in Boston, Massachusetts, were surveyed 4 years after care organization entry into a GPC. Measurements collected included reported support for GPC involvement, reason for support, and demonstrated comprehension of key GPC details. Of the 281 respondents (49% response rate), 85% reported supporting involvement in a GPC. In a multivariate ordinal logistic regression model, exposure to prior information about GPCs, demonstrated comprehension of key GPC details, longer time since completion of residency, and lower clinical time commitment were all independently associated with higher levels of GPC involvement support. Four years since first engaging in a global payment contract, a majority of internal medicine physician respondents support this decision. Understanding predictors of physician support for GPC involvement within our care organization may help other health systems to approach organizational change. Health system leaders debating GPC involvement should consider engaging physicians via educational interventions geared toward improving GPC support.

Tier 2 Team Processes and Decision-Making in a Comprehensive Three-Tiered Model

ERIC Educational Resources Information Center

Pool, Juli L.; Carter, Deborah Russell; Johnson, Evelyn S.

2013-01-01

Three-tiered models of academic and behavioral support are being increasingly adopted across the nation, and with that adoption has come an increasing message that designing and implementing effective practices alone is not enough. Systems are needed to help staff to collectively implement best practices. These systems, as well as effective…

Kentucky's Early Childhood Continuous Assessment and Accountability System: Local Decisions and State Supports

ERIC Educational Resources Information Center

Rous, Beth; McCormick, Katherine; Gooden, Caroline; Townley, Kim F.

2007-01-01

Kentucky has developed an assessment and accountability system that provides outcome data for a set of state early childhood standards for children birth to 5 years of age that are aligned with early childhood outcomes designated by the Office of Special Education Programs (OSEP). Within this flexible and comprehensive state assessment system,…

School-Based Clinics: A Guide for Advocates. Developing Policy Statements, Educating Decision Makers, Enlisting Local Support.

ERIC Educational Resources Information Center

Center for Population Options, Washington, DC.

School-based clinics (SBCs) are comprehensive primary health care facilities located within or on the grounds of middle, junior, or senior high schools. Varying in size and organizational structure, SBCs have emerged as an effective model for advancing adolescent health. They have gained attention because of their potential for treating problems…

Teradata University Network: A No Cost Web-Portal for Teaching Database, Data Warehousing, and Data-Related Subjects

ERIC Educational Resources Information Center

Jukic, Nenad; Gray, Paul

2008-01-01

This paper describes the value that information systems faculty and students in classes dealing with database management, data warehousing, decision support systems, and related topics, could derive from the use of the Teradata University Network (TUN), a free comprehensive web-portal. A detailed overview of TUN functionalities and content is…

Application of HTA research on policy decision-making.

PubMed

Youngkong, Sitaporn

2014-05-01

This article provides an overview of the potential uses of health technology assessment (HTA) in health technology or health intervention-related policy decision-making. It summarises the role of HTA in policy planning, health system investment, price negotiation, development of clinical practice guidelines, and communication with health professionals. While the multifaceted nature of HTA means that some aspects of the data can result in conflicting conclusions, the comprehensive approach of HTA is still recommended. To help minimise the potential conflicts within HTA data, a multicriteria decision analysis (MCDA) approach is recommended as a way to assess a number of decision criteria simultaneously. A combination of HTA with MCDA allows policy decision-making to be undertaken in an empirically rigorous and rational way. This combination can be used to support policy decision-makers in Thailand and help them prioritise topics for assessment and make informed health benefit package coverage decisions. This approach enhances the legitimacy of policy decisions by increasing the transparency, systematic nature, and inclusiveness of the process.

Launching a virtual decision lab: development and field-testing of a web-based patient decision support research platform.

PubMed

Hoffman, Aubri S; Llewellyn-Thomas, Hilary A; Tosteson, Anna N A; O'Connor, Annette M; Volk, Robert J; Tomek, Ivan M; Andrews, Steven B; Bartels, Stephen J

2014-12-12

Over 100 trials show that patient decision aids effectively improve patients' information comprehension and values-based decision making. However, gaps remain in our understanding of several fundamental and applied questions, particularly related to the design of interactive, personalized decision aids. This paper describes an interdisciplinary development process for, and early field testing of, a web-based patient decision support research platform, or virtual decision lab, to address these questions. An interdisciplinary stakeholder panel designed the web-based research platform with three components: a) an introduction to shared decision making, b) a web-based patient decision aid, and c) interactive data collection items. Iterative focus groups provided feedback on paper drafts and online prototypes. A field test assessed a) feasibility for using the research platform, in terms of recruitment, usage, and acceptability; and b) feasibility of using the web-based decision aid component, compared to performance of a videobooklet decision aid in clinical care. This interdisciplinary, theory-based, patient-centered design approach produced a prototype for field-testing in six months. Participants (n = 126) reported that: the decision aid component was easy to use (98%), information was clear (90%), the length was appropriate (100%), it was appropriately detailed (90%), and it held their interest (97%). They spent a mean of 36 minutes using the decision aid and 100% preferred using their home/library computer. Participants scored a mean of 75% correct on the Decision Quality, Knowledge Subscale, and 74 out of 100 on the Preparation for Decision Making Scale. Completing the web-based decision aid reduced mean Decisional Conflict scores from 31.1 to 19.5 (p < 0.01). Combining decision science and health informatics approaches facilitated rapid development of a web-based patient decision support research platform that was feasible for use in research studies in terms of recruitment, acceptability, and usage. Within this platform, the web-based decision aid component performed comparably with the videobooklet decision aid used in clinical practice. Future studies may use this interactive research platform to study patients' decision making processes in real-time, explore interdisciplinary approaches to designing web-based decision aids, and test strategies for tailoring decision support to meet patients' needs and preferences.

Pew Memorial Trust policy synthesis: 5. State coverage for organ transplantation: a framework for decision making.

PubMed

Lindsey, P A; McGlynn, E A

1988-02-01

Transplantation of hearts and livers for both adults and children is increasingly viewed as therapeutic and lifesaving, but access to these procedures is impeded by their high cost as well as by a limited supply of organs. In the absence of comprehensive federal coverage, pressure is being brought to bear on states to provide broader access to these procedures. This synthesis provides a framework for the consideration of coverage decisions at the state level. While there are no "right" answers about whether a state should support such coverage, the analytic tools of cost analysis, demand estimation, and assessment of capacity described in this synthesis can better inform the decision-making process.

Web-based cancer communication and decision making systems: connecting patients, caregivers, and clinicians for improved health outcomes.

PubMed

DuBenske, Lori L; Gustafson, David H; Shaw, Bret R; Cleary, James F

2010-01-01

Over the cancer disease trajectory, from diagnosis and treatment to remission or end of life, patients and their families face difficult decisions. The provision of information and support when most relevant can optimize cancer decision making and coping. An interactive health communication system (IHCS) offers the potential to bridge the communication gaps that occur among patients, family, and clinicians and to empower each to actively engage in cancer care and shared decision making. This is a report of the authors' experience (with a discussion of relevant literature) in developing and testing a Web-based IHCS-the Comprehensive Health Enhancement Support System (CHESS)-for patients with advanced lung cancer and their family caregivers. CHESS provides information, communication, and coaching resources as well as a symptom tracking system that reports health status to the clinical team. Development of an IHCS includes a needs assessment of the target audience and applied theory informed by continued stakeholder involvement in early testing. Critical issues of IHCS implementation include 1) need for interventions that accommodate a variety of format preferences and technology comfort ranges; 2) IHCS user training, 3) clinician investment in IHCS promotion, and 4) IHCS integration with existing medical systems. In creating such comprehensive systems, development strategies need to be grounded in population needs with appropriate use of technology that serves the target users, including the patient/family, clinical team, and health care organization. Implementation strategies should address timing, personnel, and environmental factors to facilitate continued use and benefit from IHCS.

Information Warehouse – A Comprehensive Informatics Platform for Business, Clinical, and Research Applications

PubMed Central

Kamal, Jyoti; Liu, Jianhua; Ostrander, Michael; Santangelo, Jennifer; Dyta, Ravi; Rogers, Patrick; Mekhjian, Hagop S.

2010-01-01

Since its inception in 1997, the IW (Information Warehouse) at the Ohio State University Medical Center (OSUMC) has gradually transformed itself from a single purpose business decision support system to a comprehensive informatics platform supporting basic, clinical, and translational research. The IW today is the combination of four integrated components: a clinical data repository containing over a million patients; a research data repository housing various research specific data; an application development platform for building business and research enabling applications; a business intelligence environment assisting in reporting in all function areas. The IW is structured and encoded using standard terminologies such as SNOMED-CT, ICD, and CPT. The IW is an important component of OSUMC’s Clinical and Translational Science Award (CTSA) informatics program. PMID:21347019

Measuring the impact of diagnostic decision support on the quality of clinical decision making: development of a reliable and valid composite score.

PubMed

Ramnarayan, Padmanabhan; Kapoor, Ritika R; Coren, Michael; Nanduri, Vasantha; Tomlinson, Amanda L; Taylor, Paul M; Wyatt, Jeremy C; Britto, Joseph F

2003-01-01

Few previous studies evaluating the benefits of diagnostic decision support systems have simultaneously measured changes in diagnostic quality and clinical management prompted by use of the system. This report describes a reliable and valid scoring technique to measure the quality of clinical decision plans in an acute medical setting, where diagnostic decision support tools might prove most useful. Sets of differential diagnoses and clinical management plans generated by 71 clinicians for six simulated cases, before and after decision support from a Web-based pediatric differential diagnostic tool (ISABEL), were used. A composite quality score was calculated separately for each diagnostic and management plan by considering the appropriateness value of each component diagnostic or management suggestion, a weighted sum of individual suggestion ratings, relevance of the entire plan, and its comprehensiveness. The reliability and validity (face, concurrent, construct, and content) of these two final scores were examined. Two hundred fifty-two diagnostic and 350 management suggestions were included in the interrater reliability analysis. There was good agreement between raters (intraclass correlation coefficient, 0.79 for diagnoses, and 0.72 for management). No counterintuitive scores were demonstrated on visual inspection of the sets. Content validity was verified by a consultation process with pediatricians. Both scores discriminated adequately between the plans of consultants and medical students and correlated well with clinicians' subjective opinions of overall plan quality (Spearman rho 0.65, p < 0.01). The diagnostic and management scores for each episode showed moderate correlation (r = 0.51). The scores described can be used as key outcome measures in a larger study to fully assess the value of diagnostic decision aids, such as the ISABEL system.

Back-support large laser mirror unit: mounting modeling and analysis

NASA Astrophysics Data System (ADS)

Wang, Hui; Zhang, Zheng; Long, Kai; Liu, Tianye; Li, Jun; Liu, Changchun; Xiong, Zhao; Yuan, Xiaodong

2018-01-01

In high-power laser system, the surface wavefront of large optics has a close link with its structure design and mounting method. The back-support transport mirror design is presently being investigated as a means in China's high-power laser system to hold the optical component firmly while minimizing the distortion of its reflecting surface. We have proposed a comprehensive analytical framework integrated numerical modeling and precise metrology for the mirror's mounting performance evaluation while treating the surface distortion as a key decision variable. The combination of numerical simulation and field tests demonstrates that the comprehensive analytical framework provides a detailed and accurate approach to evaluate the performance of the transport mirror. It is also verified that the back-support transport mirror is effectively compatible with state-of-the-art optical quality specifications. This study will pave the way for future research to solidify the design of back-support large laser optics in China's next generation inertial confinement fusion facility.

Efficient GIS-based model-driven method for flood risk management and its application in central China

NASA Astrophysics Data System (ADS)

Liu, Y.; Zhou, J.; Song, L.; Zou, Q.; Guo, J.; Wang, Y.

2014-02-01

In recent years, an important development in flood management has been the focal shift from flood protection towards flood risk management. This change greatly promoted the progress of flood control research in a multidisciplinary way. Moreover, given the growing complexity and uncertainty in many decision situations of flood risk management, traditional methods, e.g., tight-coupling integration of one or more quantitative models, are not enough to provide decision support for managers. Within this context, this paper presents a beneficial methodological framework to enhance the effectiveness of decision support systems, through the dynamic adaptation of support regarding the needs of the decision-maker. In addition, we illustrate a loose-coupling technical prototype for integrating heterogeneous elements, such as multi-source data, multidisciplinary models, GIS tools and existing systems. The main innovation is the application of model-driven concepts, which put the system in a state of continuous iterative optimization. We define the new system as a model-driven decision support system (MDSS ). Two characteristics that differentiate the MDSS are as follows: (1) it is made accessible to non-technical specialists; and (2) it has a higher level of adaptability and compatibility. Furthermore, the MDSS was employed to manage the flood risk in the Jingjiang flood diversion area, located in central China near the Yangtze River. Compared with traditional solutions, we believe that this model-driven method is efficient, adaptable and flexible, and thus has bright prospects of application for comprehensive flood risk management.

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.

A new spatial multi-criteria decision support tool for site selection for implementation of managed aquifer recharge.

PubMed

Rahman, M Azizur; Rusteberg, Bernd; Gogu, R C; Lobo Ferreira, J P; Sauter, Martin

2012-05-30

This study reports the development of a new spatial multi-criteria decision analysis (SMCDA) software tool for selecting suitable sites for Managed Aquifer Recharge (MAR) systems. The new SMCDA software tool functions based on the combination of existing multi-criteria evaluation methods with modern decision analysis techniques. More specifically, non-compensatory screening, criteria standardization and weighting, and Analytical Hierarchy Process (AHP) have been combined with Weighted Linear Combination (WLC) and Ordered Weighted Averaging (OWA). This SMCDA tool may be implemented with a wide range of decision maker's preferences. The tool's user-friendly interface helps guide the decision maker through the sequential steps for site selection, those steps namely being constraint mapping, criteria hierarchy, criteria standardization and weighting, and criteria overlay. The tool offers some predetermined default criteria and standard methods to increase the trade-off between ease-of-use and efficiency. Integrated into ArcGIS, the tool has the advantage of using GIS tools for spatial analysis, and herein data may be processed and displayed. The tool is non-site specific, adaptive, and comprehensive, and may be applied to any type of site-selection problem. For demonstrating the robustness of the new tool, a case study was planned and executed at Algarve Region, Portugal. The efficiency of the SMCDA tool in the decision making process for selecting suitable sites for MAR was also demonstrated. Specific aspects of the tool such as built-in default criteria, explicit decision steps, and flexibility in choosing different options were key features, which benefited the study. The new SMCDA tool can be augmented by groundwater flow and transport modeling so as to achieve a more comprehensive approach to the selection process for the best locations of the MAR infiltration basins, as well as the locations of recovery wells and areas of groundwater protection. The new spatial multicriteria analysis tool has already been implemented within the GIS based Gabardine decision support system as an innovative MAR planning tool. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Two-Stage Fracturing Wastewater Management in Shale Gas Development

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

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

Two-Stage Fracturing Wastewater Management in Shale Gas Development

DOE PAGES

Zhang, Xiaodong; Sun, Alexander Y.; Duncan, Ian J.; ...

2017-01-19

Here, management of shale gas wastewater treatment, disposal, and reuse has become a significant environmental challenge, driven by an ongoing boom in development of U.S. shale gas reservoirs. Systems-analysis based decision support is helpful for effective management of wastewater, and provision of cost-effective decision alternatives from a whole-system perspective. Uncertainties are inherent in many modeling parameters, affecting the generated decisions. In order to effectively deal with the recourse issue in decision making, in this work a two-stage stochastic fracturing wastewater management model, named TSWM, is developed to provide decision support for wastewater management planning in shale plays. Using the TSWMmore » model, probabilistic and nonprobabilistic uncertainties are effectively handled. The TSWM model provides flexibility in generating shale gas wastewater management strategies, in which the first-stage decision predefined by decision makers before uncertainties are unfolded is corrected in the second stage to achieve the whole-system’s optimality. Application of the TSWM model to a comprehensive synthetic example demonstrates its practical applicability and feasibility. Optimal results are generated for allowable wastewater quantities, excess wastewater, and capacity expansions of hazardous wastewater treatment plants to achieve the minimized total system cost. The obtained interval solutions encompass both optimistic and conservative decisions. Trade-offs between economic and environmental objectives are made depending on decision makers’ knowledge and judgment, as well as site-specific information. In conclusion, the proposed model is helpful in forming informed decisions for wastewater management associated with shale gas development.« less

[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.

To Stay or to Leave: Factors Influencing Victims' Decisions to Stay or Leave a Domestic Violence Emergency Shelter.

PubMed

Fisher, Elisa M; Stylianou, Amanda M

2016-04-28

Domestic violence (DV) emergency shelters play a vital role in supporting victims who seek to leave abusive partners and gain independence. Research indicates that numerous positive outcomes for victims and their children are associated with utilization of DV shelter programs. Yet, research also suggests that DV shelter programs may be unable to comprehensively meet the needs of all victims, and many choose to leave shelters soon after their arrival. To better understand the ways in which DV shelter programs support victims but also fail to meet their needs, this article explores the factors that influence victims' decisions to stay or leave a DV emergency shelter program through qualitative interviews with 33 DV shelter residents. Study participants indicate that three types of factors influence their decision to stay or leave the shelter program: (a) contextual factors, (b) partner or family relationship factors, and (c) shelter-specific factors. Shelter-specific factors cited as important contributors to satisfaction or dissatisfaction with shelter living include policies, staff and services, displacement from one's home community, and facilities. Findings provide information from the perspective of victims on the factors that influence one's decision to stay or leave a DV program and can be used to support service providers and advocates in building programs that are both supportive of victims' needs and conductive to longer shelter stays. © The Author(s) 2016.

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

A collaborative approach to supporting communication in the assessment of decision-making capacity.

PubMed

Zuscak, Simon John; Peisah, Carmelle; Ferguson, Alison

2016-01-01

This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals. All clinicians have an obligation to maximise client autonomy and participation in decision-making. Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient. The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder. Impairments in different aspects of auditory comprehension require different accommodations.

Airborne Tactical Intent-Based Conflict Resolution Capability

NASA Technical Reports Server (NTRS)

Wing, David J.; Vivona, Robert A.; Roscoe, David A.

2009-01-01

Trajectory-based operations with self-separation involve the aircraft taking the primary role in the management of its own trajectory in the presence of other traffic. In this role, the flight crew assumes the responsibility for ensuring that the aircraft remains separated from all other aircraft by at least a minimum separation standard. These operations are enabled by cooperative airborne surveillance and by airborne automation systems that provide essential monitoring and decision support functions for the flight crew. An airborne automation system developed and used by NASA for research investigations of required functionality is the Autonomous Operations Planner. It supports the flight crew in managing their trajectory when responsible for self-separation by providing monitoring and decision support functions for both strategic and tactical flight modes. The paper focuses on the latter of these modes by describing a capability for tactical intent-based conflict resolution and its role in a comprehensive suite of automation functions supporting trajectory-based operations with self-separation.

Informed decision-making with and for people with dementia: Developing and pilot testing an education program for legal representatives (PRODECIDE).

PubMed

Lühnen, Julia; Mühlhauser, Ingrid; Richter, Tanja

2017-01-01

Background People living with dementia are often appointed a legal representative, to support and protect their ethical and legal rights to informed healthcare decisions. However, legal representatives usually have no qualifications in healthcare. Objective The aim of this study was to explore decision-making processes with participation of legal representatives and, resulting from this, to develop and pilot test an education program for legal representatives in Germany. Methods We conducted interviews with legal representatives and senior citizens about decision-making processes in healthcare, with special focus on percutaneous endoscopic gastrostomy, physical restraints, and prescription of antipsychotics for people with dementia. We generated a curriculum based on systematic literature searches and the results of these interviews. We tested the education program for comprehensibility, feasibility, usability, and acceptance. Results Personal interviews with voluntary ( n = 12) and professional ( n = 12) representatives, and senior citizens ( n = 14) were conducted. Preferences, attitudes, and wishes regarding percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics, and the process of decision-making, were heterogeneous. A structural approach is lacking. The education program proxy-decison-making (PRODECIDE) comprises four modules: (A) decision-making processes and methods; (B-D) evidence-based knowledge about percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics. We conducted eight trainings with 47 legal representatives. PRODECIDE was well accepted. Comprehensibility of contents and materials was rated high. The program seems feasible for implementation. Conclusion PRODECIDE seems suitable to improve the decision-making processes of legal representatives in Germany. Implementation will be appropriate if efficacy is proven; a randomized controlled trial is currently underway.

Examination of the consumer decision process for residential energy use

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

Dinan, T.M.

1987-01-01

Numerous studies have examined the factors that influence consumers' energy-using behavior. A comprehensive review of these studies was conducted in which articles from different research disciplines (economics, sociology, psychology, and marketing) were examined. This paper provides a discussion of a subset of these studies, and based on findings of the review, offers recommendations for future research. The literature review revealed a need to develop an integrated framework for examining consumers' energy-using behavior. This integrated framework should simultaneously consider both price and nonprice related factors which underlie energy use decisions. It should also examined the process by which decisions are made,more » as well as the factors that affect the decision outcome. This paper provides a suggested integrated framework for future research and discusses the data required to support this framework. 23 references, 3 figures.« less

Artificial Intelligence (AI), Operations Research (OR), and Decision Support Systems (DSS): A conceptual framework

NASA Technical Reports Server (NTRS)

Parnell, Gregory S.; Rowell, William F.; Valusek, John R.

1987-01-01

In recent years there has been increasing interest in applying the computer based problem solving techniques of Artificial Intelligence (AI), Operations Research (OR), and Decision Support Systems (DSS) to analyze extremely complex problems. A conceptual framework is developed for successfully integrating these three techniques. First, the fields of AI, OR, and DSS are defined and the relationships among the three fields are explored. Next, a comprehensive adaptive design methodology for AI and OR modeling within the context of a DSS is described. These observations are made: (1) the solution of extremely complex knowledge problems with ill-defined, changing requirements can benefit greatly from the use of the adaptive design process, (2) the field of DSS provides the focus on the decision making process essential for tailoring solutions to these complex problems, (3) the characteristics of AI, OR, and DSS tools appears to be converging rapidly, and (4) there is a growing need for an interdisciplinary AI/OR/DSS education.

Bayesian updating in a fault tree model for shipwreck risk assessment.

PubMed

Landquist, H; Rosén, L; Lindhe, A; Norberg, T; Hassellöv, I-M

2017-07-15

Shipwrecks containing oil and other hazardous substances have been deteriorating on the seabeds of the world for many years and are threatening to pollute the marine environment. The status of the wrecks and the potential volume of harmful substances present in the wrecks are affected by a multitude of uncertainties. Each shipwreck poses a unique threat, the nature of which is determined by the structural status of the wreck and possible damage resulting from hazardous activities that could potentially cause a discharge. Decision support is required to ensure the efficiency of the prioritisation process and the allocation of resources required to carry out risk mitigation measures. Whilst risk assessments can provide the requisite decision support, comprehensive methods that take into account key uncertainties related to shipwrecks are limited. The aim of this paper was to develop a method for estimating the probability of discharge of hazardous substances from shipwrecks. The method is based on Bayesian updating of generic information on the hazards posed by different activities in the surroundings of the wreck, with information on site-specific and wreck-specific conditions in a fault tree model. Bayesian updating is performed using Monte Carlo simulations for estimating the probability of a discharge of hazardous substances and formal handling of intrinsic uncertainties. An example application involving two wrecks located off the Swedish coast is presented. Results show the estimated probability of opening, discharge and volume of the discharge for the two wrecks and illustrate the capability of the model to provide decision support. Together with consequence estimations of a discharge of hazardous substances, the suggested model enables comprehensive and probabilistic risk assessments of shipwrecks to be made. Copyright © 2017 Elsevier B.V. All rights reserved.

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

PubMed

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

2016-04-01

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

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

PubMed Central

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

2016-01-01

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

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…

Treatment decision-making in chronic diseases: What are the family members' roles, needs and attitudes? A systematic review.

PubMed

Lamore, Kristopher; Montalescot, Lucile; Untas, Aurélie

2017-12-01

This systematic review aims to examine the roles of family members (FMs) in treatment decision-making for adult patients without cognitive or psychiatric disorders affecting their ability to participate in decision-making. A comprehensive, systematic search of the Cochrane Library, PsycINFO, PubMed and ScienceDirect databases, with relevant keywords, was conducted. Two authors evaluated the eligibility of the studies independently, then cross-checked for accuracy. The quality of included studies were assessed using standardized criteria. Out of the 12.137 studies identified, 40 were included. Results highlighted the different roles and influences FMs have in the decision-making process. Moreover, several factors ranging from personal to cultural and family-related factors influence their level of involvement. Regardless of the illness, some similarities in family influence exist (e.g., social support). However, the type of family involvement varies according to the illness, the treatment choice and the patients' culture. FMs have an important role in the decision-making process. In fact, the final decision is often made by the patients after consulting their families. FMs can support both patients and medical teams, and thus facilitate the process. Physicians should include FMs in treatment decision-making when the patients and their FMs wish to be included. Copyright © 2017 Elsevier B.V. All rights reserved.

Comprehensible knowledge model creation for cancer treatment decision making.

PubMed

Afzal, Muhammad; Hussain, Maqbool; Ali Khan, Wajahat; Ali, Taqdir; Lee, Sungyoung; Huh, Eui-Nam; Farooq Ahmad, Hafiz; Jamshed, Arif; Iqbal, Hassan; Irfan, Muhammad; Abbas Hydari, Manzar

2017-03-01

A wealth of clinical data exists in clinical documents in the form of electronic health records (EHRs). This data can be used for developing knowledge-based recommendation systems that can assist clinicians in clinical decision making and education. One of the big hurdles in developing such systems is the lack of automated mechanisms for knowledge acquisition to enable and educate clinicians in informed decision making. An automated knowledge acquisition methodology with a comprehensible knowledge model for cancer treatment (CKM-CT) is proposed. With the CKM-CT, clinical data are acquired automatically from documents. Quality of data is ensured by correcting errors and transforming various formats into a standard data format. Data preprocessing involves dimensionality reduction and missing value imputation. Predictive algorithm selection is performed on the basis of the ranking score of the weighted sum model. The knowledge builder prepares knowledge for knowledge-based services: clinical decisions and education support. Data is acquired from 13,788 head and neck cancer (HNC) documents for 3447 patients, including 1526 patients of the oral cavity site. In the data quality task, 160 staging values are corrected. In the preprocessing task, 20 attributes and 106 records are eliminated from the dataset. The Classification and Regression Trees (CRT) algorithm is selected and provides 69.0% classification accuracy in predicting HNC treatment plans, consisting of 11 decision paths that yield 11 decision rules. Our proposed methodology, CKM-CT, is helpful to find hidden knowledge in clinical documents. In CKM-CT, the prediction models are developed to assist and educate clinicians for informed decision making. The proposed methodology is generalizable to apply to data of other domains such as breast cancer with a similar objective to assist clinicians in decision making and education. Copyright © 2017 Elsevier Ltd. All rights reserved.

Automated Modular Magnetic Resonance Imaging Clinical Decision Support System (MIROR): An Application in Pediatric Cancer Diagnosis

PubMed Central

Zarinabad, Niloufar; Meeus, Emma M; Manias, Karen; Foster, Katharine

2018-01-01

Background Advances in magnetic resonance imaging and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyze relevant information from magnetic resonance imaging data to aid decision making, prevent errors, and enhance health care. Objective The aim of this study was to design and develop a modular medical image region of interest analysis tool and repository (MIROR) for automatic processing, classification, evaluation, and representation of advanced magnetic resonance imaging data. Methods The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumors in children (cohort of 48 children, with 37 malignant and 11 benign tumors). Mevislab software and Python have been used for the development of MIROR. Regions of interests were drawn around benign and malignant body tumors on different diffusion parametric maps, and extracted information was used to discriminate the malignant tumors from benign tumors. Results Using MIROR, the various histogram parameters derived for each tumor case when compared with the information in the repository provided additional information for tumor characterization and facilitated the discrimination between benign and malignant tumors. Clinical decision support system cross-validation showed high sensitivity and specificity in discriminating between these tumor groups using histogram parameters. Conclusions MIROR, as a diagnostic tool and repository, allowed the interpretation and analysis of magnetic resonance imaging images to be more accessible and comprehensive for clinicians. It aims to increase clinicians’ skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision making. The modular-based format of the tool allows integration of analyses that are not readily available clinically and streamlines the future developments. PMID:29720361

Health impact assessment of global climate change: expanding on comparative risk assessment approaches for policy making.

PubMed

Patz, Jonathan; Campbell-Lendrum, Diarmid; Gibbs, Holly; Woodruff, Rosalie

2008-01-01

Climate change is projected to have adverse impacts on public health. Cobenefits may be possible from more upstream mitigation of greenhouse gases causing climate change. To help measure such cobenefits alongside averted disease-specific risks, a health impact assessment (HIA) framework can more comprehensively serve as a decision support tool. HIA also considers health equity, clearly part of the climate change problem. New choices for energy must be made carefully considering such effects as additional pressure on the world's forests through large-scale expansion of soybean and oil palm plantations, leading to forest clearing, biodiversity loss and disease emergence, expulsion of subsistence farmers, and potential increases in food prices and emissions of carbon dioxide to the atmosphere. Investigators must consider the full range of policy options, supported by more comprehensive, flexible, and transparent assessment methods.

Advancements in Risk-Informed Performance-Based Asset Management for Commercial Nuclear Power Plants

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

Liming, James K.; Ravindra, Mayasandra K.

2006-07-01

Over the past several years, ABSG Consulting Inc. (ABS Consulting) and the South Texas Project Nuclear Operating Company (STPNOC) have developed a decision support process and associated software for risk-informed, performance-based asset management (RIPBAM) of nuclear power plant facilities. RIPBAM applies probabilistic risk assessment (PRA) tools and techniques in the realm of plant physical and financial asset management. The RIPBAM process applies a tiered set of models and supporting performance measures (or metrics) that can ultimately be applied to support decisions affecting the allocation and management of plant resources (e.g., funding, staffing, scheduling, etc.). In general, the ultimate goal ofmore » the RIPBAM process is to continually support decision-making to maximize a facility's net present value (NPV) and long-term profitability for its owners. While the initial applications of RIPBAM have been for nuclear power stations, the methodology can easily be adapted to other types of power station or complex facility decision-making support. RIPBAM can also be designed to focus on performance metrics other than NPV and profitability (e.g., mission reliability, operational availability, probability of mission success per dollar invested, etc.). Recent advancements in the RIPBAM process focus on expanding the scope of previous RIPBAM applications to include not only operations, maintenance, and safety issues, but also broader risk perception components affecting plant owner (stockholder), operator, and regulator biases. Conceptually, RIPBAM is a comprehensive risk-informed cash flow model for decision support. It originated as a tool to help manage plant refueling outage scheduling, and was later expanded to include the full spectrum of operations and maintenance decision support. However, it differs from conventional business modeling tools in that it employs a systems engineering approach with broadly based probabilistic analysis of organizational 'value streams'. The scope of value stream inclusion in the process can be established by the user, but in its broadest applications, RIPBAM can be used to address how risk perceptions of plant owners and regulators are impacted by plant performance. Plant staffs can expand and refine RIPBAM models scope via a phased program of activities over time. This paper shows how the multi-metric uncertainty analysis feature of RIPBAM can apply a wide spectrum of decision-influencing factors to support decisions designed to maximize the probability of achieving, maintaining, and improving upon plant goals and objectives. In this paper, the authors show how this approach can be extremely valuable to plant owners and operators in supporting plant value-impacting decision-making processes. (authors)« less

Evaluation Framework for Telemedicine Using the Logical Framework Approach and a Fishbone Diagram

PubMed Central

2015-01-01

Objectives Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies. Methods This study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram. Results It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension. Conclusions To implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions. PMID:26618028

Evaluation Framework for Telemedicine Using the Logical Framework Approach and a Fishbone Diagram.

PubMed

Chang, Hyejung

2015-10-01

Technological advances using telemedicine and telehealth are growing in healthcare fields, but the evaluation framework for them is inconsistent and limited. This paper suggests a comprehensive evaluation framework for telemedicine system implementation and will support related stakeholders' decision-making by promoting general understanding, and resolving arguments and controversies. This study focused on developing a comprehensive evaluation framework by summarizing themes across the range of evaluation techniques and organized foundational evaluation frameworks generally applicable through studies and cases of diverse telemedicine. Evaluation factors related to aspects of information technology; the evaluation of satisfaction of service providers and consumers, cost, quality, and information security are organized using the fishbone diagram. It was not easy to develop a monitoring and evaluation framework for telemedicine since evaluation frameworks for telemedicine are very complex with many potential inputs, activities, outputs, outcomes, and stakeholders. A conceptual framework was developed that incorporates the key dimensions that need to be considered in the evaluation of telehealth implementation for a formal structured approach to the evaluation of a service. The suggested framework consists of six major dimensions and the subsequent branches for each dimension. To implement telemedicine and telehealth services, stakeholders should make decisions based on sufficient evidence in quality and safety measured by the comprehensive evaluation framework. Further work would be valuable in applying more comprehensive evaluations to verify and improve the comprehensive framework across a variety of contexts with more factors and participant group dimensions.

Utilization of Telehealth Technology to Develop and Implement a Comprehensive Management Initiative for Chronic Diseases

DTIC Science & Technology

2012-10-01

SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS Telemedicine, diabetes, technology, care-management, decision support, nursing education ...and burden of diabetes can be mitigated with appropriate education , care, and self-management. This project, a collaboration among Walter Reed...Disease (CMICD) and included the following: a) virtual education techniques for training nurses (VNE); b) a video cell phone approach to providing

From Data Poor, Information Poor to Data Rich, Information Rich Decision-Making: Design and Implementation of a Student Information System

ERIC Educational Resources Information Center

Burger, John M.; Nadirova, Anna

2013-01-01

In this paper, we report on the design and implementation of a state of the art Student Information System (SIS) being developed in a moderate size Alberta, Canada school jurisdiction. The SIS design is premised upon transparency, balanced, comprehensive, and multi-method assessments that links qualitative and quantitative data in support of…

Ecological requirements for pallid sturgeon reproduction and recruitment in the Lower Missouri River: Annual report 2009

USGS Publications Warehouse

DeLonay, Aaron J.; Jacobson, Robert B.; Papoulias, Diana M.; Wildhaber, Mark L.; Chojnacki, Kimberly A.; Pherigo, Emily K.; Bergthold, Casey L.; Mestl, Gerald E.

2010-01-01

The Comprehensive Sturgeon Research Project is a multiyear, multiagency collaborative research framework developed to provide information to support pallid sturgeon recovery and Missouri River management decisions. The general Comprehensive Sturgeon Research Project strategy is to integrate field and laboratory studies of sturgeon reproductive ecology, habitat requirements, and physiology to produce a predictive understanding of sturgeon population dynamics. The project scope of work is developed annually with cooperating research partners and in collaboration with the U.S. Army Corps of Engineers, Missouri River Recovery-Integrated Science Program. The research consists of several interdependent and complementary research tasks engaging multiple disciplines that primarily address spawning as a probable limiting factor in reproduction and survival of the pallid sturgeon. The research is multifaceted and is designed to provide information needed for management decisions impacting habitat restoration, flow modification, and pallid sturgeon population augmentation on the Missouri River, and throughout the range of the species. Research activities and progress towards understanding of the species are reported to the U.S. Army Corps of Engineers annually. This annual report details the research effort and progress made by Comprehensive Sturgeon Research Project during 2009.

A modelling tool for policy analysis to support the design of efficient and effective policy responses for complex public health problems.

PubMed

Atkinson, Jo-An; Page, Andrew; Wells, Robert; Milat, Andrew; Wilson, Andrew

2015-03-03

In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems. This paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool. In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems, improve targeting of public health policy, and offers a foundation for strengthening relationships between policy makers, stakeholders, and researchers.

Offshore oil spill response practices and emerging challenges.

PubMed

Li, Pu; Cai, Qinhong; Lin, Weiyun; Chen, Bing; Zhang, Baiyu

2016-09-15

Offshore oil spills are of tremendous concern due to their potential impact on economic and ecological systems. A number of major oil spills triggered worldwide consciousness of oil spill preparedness and response. Challenges remain in diverse aspects such as oil spill monitoring, analysis, assessment, contingency planning, response, cleanup, and decision support. This article provides a comprehensive review of the current situations and impacts of offshore oil spills, as well as the policies and technologies in offshore oil spill response and countermeasures. Correspondingly, new strategies and a decision support framework are recommended for improving the capacities and effectiveness of oil spill response and countermeasures. In addition, the emerging challenges in cold and harsh environments are reviewed with recommendations due to increasing risk of oil spills in the northern regions from the expansion of the Arctic Passage. Copyright © 2016 Elsevier Ltd. All rights reserved.

A study of diverse clinical decision support rule authoring environments and requirements for integration

PubMed Central

2012-01-01

Background Efficient rule authoring tools are critical to allow clinical Knowledge Engineers (KEs), Software Engineers (SEs), and Subject Matter Experts (SMEs) to convert medical knowledge into machine executable clinical decision support rules. The goal of this analysis was to identify the critical success factors and challenges of a fully functioning Rule Authoring Environment (RAE) in order to define requirements for a scalable, comprehensive tool to manage enterprise level rules. Methods The authors evaluated RAEs in active use across Partners Healthcare, including enterprise wide, ambulatory only, and system specific tools, with a focus on rule editors for reminder and medication rules. We conducted meetings with users of these RAEs to discuss their general experience and perceived advantages and limitations of these tools. Results While the overall rule authoring process is similar across the 10 separate RAEs, the system capabilities and architecture vary widely. Most current RAEs limit the ability of the clinical decision support (CDS) interventions to be standardized, sharable, interoperable, and extensible. No existing system meets all requirements defined by knowledge management users. Conclusions A successful, scalable, integrated rule authoring environment will need to support a number of key requirements and functions in the areas of knowledge representation, metadata, terminology, authoring collaboration, user interface, integration with electronic health record (EHR) systems, testing, and reporting. PMID:23145874

Screening assessment and requirements for a comprehensive assessment: Volume 1, Draft. Columbia River comprehensive impact assessment

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

NONE

1997-04-01

To evaluate the impact to the Columbia River from the Hanford Site-derived contaminants, the U.S. Department of Energy, U.S. Environmental Protection Agency, and Washington State Department of Ecology initiated a study referred to as the Columbia River Comprehensive Impact Assessment (CRCIA). To address concerns about the scope and direction of CRCIA as well as enhance regulator, tribal, stockholder, and public involvement, the CRCIA Management Team was formed in August 1995. The Team agreed to conduct CRCIA using a phased approach. The initial phase, includes two components: 1) a screening assessment to evaluate the potential impact to the river, resulting frommore » current levels of Hanford-derived contaminants in order to support decisions on Interim Remedial Measures, and 2) a definition of the essential work remaining to provide an acceptable comprehensive river impact assessment. The screening assessment is described in Part I of this report. The essential work remaining is Part II of this report. The objective of the screening assessment is to identify areas where the greatest potential exists for adverse effects on humans or the environment. Part I of this report discusses the scope, technical approach, and results of the screening assessment. Part II defines a new paradigm for predecisional participation by those affected by Hanford cleanup decisions.« less

Elements of an environmental decision support system for seasonal wetland salt management in a river basin subjected to water quality regulation

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

Quinn, N.W.T.

Seasonally managed wetlands in the Grasslands Basin on the west-side of California's San Joaquin Valley provide food and shelter for migratory wildfowl during winter months and sport for waterfowl hunters during the annual duck season. Surface water supply to these wetlands contain salt which, when drained to the San Joaquin River during the annual drawdown period, can negatively impact water quality and cause concern to downstream agricultural riparian water diverters. Recent environmental regulation, limiting discharges salinity to the San Joaquin River and primarily targeting agricultural non-point sources, now also targets return flows from seasonally managed wetlands. Real-time water quality managementmore » has been advocated as a means of continuously matching salt loads discharged from agricultural, wetland and municipal operations to the assimilative capacity of the San Joaquin River. Past attempts to build environmental monitoring and decision support systems (EDSS's) to implement this concept have enjoyed limited success for reasons that are discussed in this paper. These reasons are discussed in the context of more general challenges facing the successful implementation of a comprehensive environmental monitoring, modelling and decision support system for the San Joaquin River Basin.« less

Fertility preservation and cancer: Challenges for adolescent and young adult patients

PubMed Central

Benedict, Catherine; Thom, Bridgette; Kelvin, Joanne

2016-01-01

Purpose of review With increasing survival rates, fertility is an important quality of life concern for many young cancer patients. There is a critical need for improvements in clinical care to ensure patients are well informed about infertility risks and fertility preservation (FP) options and to support them in their reproductive decision-making prior to treatment. Recent findings A number of barriers prevent fertility from being adequately addressed in the clinical context. Providers’ and patients’ incomplete or inaccurate understanding of infertility risks exacerbate patients’ reproductive concerns. For female patients in particular, making decisions about FP before treatment often leads to decision conflict, reducing the likelihood of making informed, values-based decisions, and post-treatment regret and distress. Recent empirically-based interventions to improve provider training around fertility issues and to support patient decision-making about FP show promise. Summary Providers should be knowledgeable about the infertility risks associated with cancer therapies and proactively address fertility with all patients who might one day wish to have a child. Comprehensive counseling should also include related issues such as contraceptive use and health implications of early menopause, regardless of desire for future children. Although the negative psychosocial impact of cancer-related infertility is now well accepted, limited work has been done to explore how to improve clinical management of fertility issues in the context of cancer care. Evidence-based interventions should be developed to address barriers and provide psychosocial and decision-making support to patients who are concerned about their fertility and interested in FP options. PMID:26730794

A pathway to personalization of integrated treatment: informatics and decision science in psychiatric rehabilitation.

PubMed

Spaulding, William; Deogun, Jitender

2011-09-01

Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention.

PubMed

Stieler-Hunt, Colleen; Jones, Christian M; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken.

Examining key design decisions involved in developing a serious game for child sexual abuse prevention

PubMed Central

Stieler-Hunt, Colleen; Jones, Christian M.; Rolfe, Ben; Pozzebon, Kay

2014-01-01

This paper presents a case study of the key decisions made in the design of Orbit, a child sexual abuse prevention computer game targeted at school students between 8 and 10 years of age. Key decisions include providing supported delivery for the target age group, featuring adults in the program, not over-sanitizing game content, having a focus on building healthy self-concept of players, making the game engaging and relatable for all players and evaluating the program. This case study has implications for the design of Serious Games more generally, including that research should underpin game design decisions, game designers should consider ways of bridging the game to real life, the learning that arises from the game should go beyond rote-learning, designers should consider how the player can make the game-world their own and comprehensive evaluations of Serious Games should be undertaken. PMID:24550880

Patchy 'coherence': using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC).

PubMed

Lloyd, Amy; Joseph-Williams, Natalie; Edwards, Adrian; Rix, Andrew; Elwyn, Glyn

2013-09-05

Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals' perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign ('Ask 3 Questions'); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: 'coherence,' 'cognitive participation,' 'collective action,' and 'reflexive monitoring.' Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose ('coherence'). Shared decision making was facilitated when teams engaged in developing and delivering interventions ('cognitive participation'), and when those interventions fit with existing skill sets and organizational priorities ('collective action') resulting in demonstrable improvements to practice ('reflexive monitoring'). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; 'coherence' was often missing. The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation.

Patchy ‘coherence’: using normalization process theory to evaluate a multi-faceted shared decision making implementation program (MAGIC)

PubMed Central

2013-01-01

Background Implementing shared decision making into routine practice is proving difficult, despite considerable interest from policy-makers, and is far more complex than merely making decision support interventions available to patients. Few have reported successful implementation beyond research studies. MAking Good Decisions In Collaboration (MAGIC) is a multi-faceted implementation program, commissioned by The Health Foundation (UK), to examine how best to put shared decision making into routine practice. In this paper, we investigate healthcare professionals’ perspectives on implementing shared decision making during the MAGIC program, to examine the work required to implement shared decision making and to inform future efforts. Methods The MAGIC program approached implementation of shared decision making by initiating a range of interventions including: providing workshops; facilitating development of brief decision support tools (Option Grids); initiating a patient activation campaign (‘Ask 3 Questions’); gathering feedback using Decision Quality Measures; providing clinical leads meetings, learning events, and feedback sessions; and obtaining executive board level support. At 9 and 15 months (May and November 2011), two rounds of semi-structured interviews were conducted with healthcare professionals in three secondary care teams to explore views on the impact of these interventions. Interview data were coded by two reviewers using a framework derived from the Normalization Process Theory. Results A total of 54 interviews were completed with 31 healthcare professionals. Partial implementation of shared decision making could be explained using the four components of the Normalization Process Theory: ‘coherence,’ ‘cognitive participation,’ ‘collective action,’ and ‘reflexive monitoring.’ Shared decision making was integrated into routine practice when clinical teams shared coherent views of role and purpose (‘coherence’). Shared decision making was facilitated when teams engaged in developing and delivering interventions (‘cognitive participation’), and when those interventions fit with existing skill sets and organizational priorities (‘collective action’) resulting in demonstrable improvements to practice (‘reflexive monitoring’). The implementation process uncovered diverse and conflicting attitudes toward shared decision making; ‘coherence’ was often missing. Conclusions The study showed that implementation of shared decision making is more complex than the delivery of patient decision support interventions to patients, a portrayal that often goes unquestioned. Normalizing shared decision making requires intensive work to ensure teams have a shared understanding of the purpose of involving patients in decisions, and undergo the attitudinal shifts that many health professionals feel are required when comprehension goes beyond initial interpretations. Divergent views on the value of engaging patients in decisions remain a significant barrier to implementation. PMID:24006959

NASA Biomedical Informatics Capabilities and Needs

NASA Technical Reports Server (NTRS)

Johnson-Throop, Kathy A.

2009-01-01

To improve on-orbit clinical capabilities by developing and providing operational support for intelligent, robust, reliable, and secure, enterprise-wide and comprehensive health care and biomedical informatics systems with increasing levels of autonomy, for use on Earth, low Earth orbit & exploration class missions. Biomedical Informatics is an emerging discipline that has been defined as the study, invention, and implementation of structures and algorithms to improve communication, understanding and management of medical information. The end objective of biomedical informatics is the coalescing of data, knowledge, and the tools necessary to apply that data and knowledge in the decision-making process, at the time and place that a decision needs to be made.

Decision-analytic modeling studies: An overview for clinicians using multiple myeloma as an example.

PubMed

Rochau, U; Jahn, B; Qerimi, V; Burger, E A; Kurzthaler, C; Kluibenschaedl, M; Willenbacher, E; Gastl, G; Willenbacher, W; Siebert, U

2015-05-01

The purpose of this study was to provide a clinician-friendly overview of decision-analytic models evaluating different treatment strategies for multiple myeloma (MM). We performed a systematic literature search to identify studies evaluating MM treatment strategies using mathematical decision-analytic models. We included studies that were published as full-text articles in English, and assessed relevant clinical endpoints, and summarized methodological characteristics (e.g., modeling approaches, simulation techniques, health outcomes, perspectives). Eleven decision-analytic modeling studies met our inclusion criteria. Five different modeling approaches were adopted: decision-tree modeling, Markov state-transition modeling, discrete event simulation, partitioned-survival analysis and area-under-the-curve modeling. Health outcomes included survival, number-needed-to-treat, life expectancy, and quality-adjusted life years. Evaluated treatment strategies included novel agent-based combination therapies, stem cell transplantation and supportive measures. Overall, our review provides a comprehensive summary of modeling studies assessing treatment of MM and highlights decision-analytic modeling as an important tool for health policy decision making. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

How to Choose? Using the Delphi Method to Develop Consensus Triggers and Indicators for Disaster Response.

PubMed

Lis, Rebecca; Sakata, Vicki; Lien, Onora

2017-08-01

To identify key decisions along the continuum of care (conventional, contingency, and crisis) and the critical triggers and data elements used to inform those decisions concerning public health and health care response during an emergency. A classic Delphi method, a consensus-building survey technique, was used with clinicians around Washington State to identify regional triggers and indicators. Additionally, using a modified Delphi method, we combined a workshop and single-round survey with panelists from public health (state and local) and health care coalitions to identify consensus state-level triggers and indicators. In the clinical survey, 122 of 223 proposed triggers or indicators (43.7%) reached consensus and were deemed important in regional decision-making during a disaster. In the state-level survey, 110 of 140 proposed triggers or indicators (78.6%) reached consensus and were deemed important in state-level decision-making during a disaster. The identification of consensus triggers and indicators for health care emergency response is crucial in supporting a comprehensive health care situational awareness process. This can inform the creation of standardized questions to ask health care, public health, and other partners to support decision-making during a response. (Disaster Med Public Health Preparedness. 2017;11:467-472).

Factors and outcomes of decision making for cancer clinical trial participation.

PubMed

Biedrzycki, Barbara A

2011-09-01

To describe factors and outcomes related to the decision-making process regarding participation in a cancer clinical trial. Cross-sectional, descriptive. Urban, academic, National Cancer Institute-designated comprehensive cancer center in the mid-Atlantic United States. 197 patients with advanced gastrointestinal cancer. Mailed survey using one investigator-developed instrument, eight instruments used in published research, and a medical record review. disease context, sociodemographics, hope, quality of life, trust in healthcare system, trust in health professional, preference for research decision control, understanding risks, and information. decision to accept or decline research participation and satisfaction with this decision. All of the factors within the Research Decision Making Model together predicted cancer clinical trial participation and satisfaction with this decision. The most frequently preferred decision-making style for research participation was shared (collaborative) (83%). Multiple factors affect decision making for cancer clinical trial participation and satisfaction with this decision. Shared decision making previously was an unrecognized factor and requires further investigation. Enhancing the process of research decision making may facilitate an increase in cancer clinical trial enrollment rates. Oncology nurses have unique opportunities as educators and researchers to support shared decision making by those who prefer this method for deciding whether to accept or decline cancer clinical trial participation.

E-DECIDER Disaster Response and Decision Support Cyberinfrastructure: Technology and Challenges

NASA Astrophysics Data System (ADS)

Glasscoe, M. T.; Parker, J. W.; Pierce, M. E.; Wang, J.; Eguchi, R. T.; Huyck, C. K.; Hu, Z.; Chen, Z.; Yoder, M. R.; Rundle, J. B.; Rosinski, A.

2014-12-01

Timely delivery of critical information to decision makers during a disaster is essential to response and damage assessment. Key issues to an efficient emergency response after a natural disaster include rapidly processing and delivering this critical information to emergency responders and reducing human intervention as much as possible. Essential elements of information necessary to achieve situational awareness are often generated by a wide array of organizations and disciplines, using any number of geospatial and non-geospatial technologies. A key challenge is the current state of practice does not easily support information sharing and technology interoperability. NASA E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) has worked with the California Earthquake Clearinghouse and its partners to address these issues and challenges by adopting the XChangeCore Web Service Data Orchestration technology and participating in several earthquake response exercises. The E-DECIDER decision support system provides rapid delivery of advanced situational awareness data products to operations centers and emergency responders in the field. Remote sensing and hazard data, model-based map products, information from simulations, damage detection, and crowdsourcing is integrated into a single geospatial view and delivered through a service oriented architecture for improved decision-making and then directly to mobile devices of responders. By adopting a Service Oriented Architecture based on Open Geospatial Consortium standards, the system provides an extensible, comprehensive framework for geospatial data processing and distribution on Cloud platforms and other distributed environments. While the Clearinghouse and its partners are not first responders, they do support the emergency response community by providing information about the damaging effects earthquakes. It is critical for decision makers to maintain a situational awareness that is knowledgeable of potential and current conditions, possible impacts on populations and infrastructure, and other key information. E-DECIDER and the Clearinghouse have worked together to address many of these issues and challenges to deliver interoperable, authoritative decision support products.

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.

Descriptive Summaries of the Research, Development, Test and Evaluation, Army Appropriation. Supporting Data FY 1994, Budget Estimates Submitted to Congress, April 1993

DTIC Science & Technology

1993-04-01

determining effective group functioning, leader-group interaction , and decision making; (2) factors that determine effective, low error human performance...infectious disease and biological defense vaccines and drugs , vision, neurotxins, neurochemistry, molecular neurobiology, neurodegenrative diseases...Potential Rotor/Comprehensive Analysis Model for Rotor Aerodynamics-Johnson Aeronautics (FPR/CAMRAD-JA) code to predict Blade Vortex Interaction (BVI

Loglines. May - June 2010

DTIC Science & Technology

2010-06-01

able to get construction materials, food and spare parts into a land-locked country . More than 80 percent of the containers shipped through this...procurement management at DLA Oklahoma City, has developed a strategic roadmap for DLR decision-makers. “Trying to get our arms around all the contracts...currently in place and develop - ing a comprehensive approach to future support has been challenging,” Yort said. Transferring procurement of DLRs to

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context.

PubMed

Ng, Chirk-Jenn; Lee, Ping-Yein; Lee, Yew-Kong; Chew, Boon-How; Engkasan, Julia P; Irmi, Zarina-Ismail; Hanafi, Nik-Sherina; Tong, Seng-Fah

2013-10-11

Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients' desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient' programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia.

An overview of patient involvement in healthcare decision-making: a situational analysis of the Malaysian context

PubMed Central

2013-01-01

Background Involving patients in decision-making is an important part of patient-centred care. Research has found a discrepancy between patients’ desire to be involved and their actual involvement in healthcare decision-making. In Asia, there is a dearth of research in decision-making. Using Malaysia as an exemplar, this study aims to review the current research evidence, practices, policies, and laws with respect to patient engagement in shared decision-making (SDM) in Asia. Methods In this study, we conducted a comprehensive literature review to collect information on healthcare decision-making in Malaysia. We also consulted medical education researchers, key opinion leaders, governmental organisations, and patient support groups to assess the extent to which patient involvement was incorporated into the medical curriculum, healthcare policies, and legislation. Results There are very few studies on patient involvement in decision-making in Malaysia. Existing studies showed that doctors were aware of informed consent, but few practised SDM. There was limited teaching of SDM in undergraduate and postgraduate curricula and a lack of accurate and accessible health information for patients. In addition, peer support groups and 'expert patient’ programmes were also lacking. Professional medical bodies endorsed patient involvement in decision-making, but there was no definitive implementation plan. Conclusion In summary, there appears to be little training or research on SDM in Malaysia. More research needs to be done in this area, including baseline information on the preferred and actual decision-making roles. The authors have provided a set of recommendations on how SDM can be effectively implemented in Malaysia. PMID:24119237

Pharmacogenomic Approaches for Automated Medication Risk Assessment in People with Polypharmacy

PubMed Central

Liu, Jiazhen; Friedman, Carol; Finkelstein, Joseph

2018-01-01

Abstract Medication regimen may be optimized based on individual drug efficacy identified by pharmacogenomic testing. However, majority of current pharmacogenomic decision support tools provide assessment only of single drug-gene interactions without taking into account complex drug-drug and drug-drug-gene interactions which are prevalent in people with polypharmacy and can result in adverse drug events or insufficient drug efficacy. The main objective of this project was to develop comprehensive pharmacogenomic decision support for medication risk assessment in people with polypharmacy that simultaneously accounts for multiple drug and gene effects. To achieve this goal, the project addressed two aims: (1) development of comprehensive knowledge repository of actionable pharmacogenes; (2) introduction of scoring approaches reflecting potential adverse effect risk levels of complex medication regimens accounting for pharmacogenomic polymorphisms and multiple drug metabolizing pathways. After pharmacogenomic knowledge repository was introduced, a scoring algorithm has been built and pilot-tested using a limited data set. The resulting total risk score for frequently hospitalized older adults with polypharmacy (72.04±17.84) was statistically significantly different (p<0.05) from the total risk score for older adults with polypharmacy with low hospitalization rate (8.98±2.37). An initial prototype assessment demonstrated feasibility of our approach and identified steps for improving risk scoring algorithms.

Titrating decision processes in the mental rotation task.

PubMed

Provost, Alexander; Heathcote, Andrew

2015-10-01

Shepard and Metzler's (1971) seminal mental-rotation task-which requires participants to decide if 1 object is a rotated version of another or its mirror image-has played a central role in the study of spatial cognition. We provide the first quantitative model of behavior in this task that is comprehensive in the sense of simultaneously providing an account of both error rates and the full distribution of response times. We used Brown and Heathcote's (2008) model of choice processing to separate out the contributions of mental rotation and decision stages. This model-based titration process was applied to data from a paradigm where converging evidence supported performance being based on rotation rather than other strategies. Stimuli were similar to Shepard and Metzler's block figures except a long major axis made rotation angle well defined for mirror stimuli, enabling comprehensive modeling of both mirror and normal responses. Results supported a mental rotation stage based on Larsen's (2014) model, where rotation takes a variable amount of time with a mean and variance that increase linearly with rotation angle. Differences in response threshold differences were largely responsible for mirror responses being slowed, and for errors increasing with rotation angle for some participants. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

An Overview of Judgment and Decision Making Research Through the Lens of Fuzzy Trace Theory.

PubMed

Setton, Roni; Wilhelms, Evan; Weldon, Becky; Chick, Christina; Reyna, Valerie

2014-12-01

We present the basic tenets of fuzzy trace theory, a comprehensive theory of memory, judgment, and decision making that is grounded in research on how information is stored as knowledge, mentally represented, retrieved from storage, and processed. In doing so, we highlight how it is distinguished from traditional models of decision making in that gist reasoning plays a central role. The theory also distinguishes advanced intuition from primitive impulsivity. It predicts that different sorts of errors occur with respect to each component of judgment and decision making: background knowledge, representation, retrieval, and processing. Classic errors in the judgment and decision making literature, such as risky-choice framing and the conjunction fallacy, are accounted for by fuzzy trace theory and new results generated by the theory contradict traditional approaches. We also describe how developmental changes in brain and behavior offer crucial insight into adult cognitive processing. Research investigating brain and behavior in developing and special populations supports fuzzy trace theory's predictions about reliance on gist processing.

An Overview of Judgment and Decision Making Research Through the Lens of Fuzzy Trace Theory

PubMed Central

Setton, Roni; Wilhelms, Evan; Weldon, Becky; Chick, Christina; Reyna, Valerie

2017-01-01

We present the basic tenets of fuzzy trace theory, a comprehensive theory of memory, judgment, and decision making that is grounded in research on how information is stored as knowledge, mentally represented, retrieved from storage, and processed. In doing so, we highlight how it is distinguished from traditional models of decision making in that gist reasoning plays a central role. The theory also distinguishes advanced intuition from primitive impulsivity. It predicts that different sorts of errors occur with respect to each component of judgment and decision making: background knowledge, representation, retrieval, and processing. Classic errors in the judgment and decision making literature, such as risky-choice framing and the conjunction fallacy, are accounted for by fuzzy trace theory and new results generated by the theory contradict traditional approaches. We also describe how developmental changes in brain and behavior offer crucial insight into adult cognitive processing. Research investigating brain and behavior in developing and special populations supports fuzzy trace theory’s predictions about reliance on gist processing. PMID:28725239

Assessing and forecasting population health: integrating knowledge and beliefs in a comprehensive framework.

PubMed

Van Meijgaard, Jeroen; Fielding, Jonathan E; Kominski, Gerald F

2009-01-01

A comprehensive population health-forecasting model has the potential to interject new and valuable information about the future health status of the population based on current conditions, socioeconomic and demographic trends, and potential changes in policies and programs. Our Health Forecasting Model uses a continuous-time microsimulation framework to simulate individuals' lifetime histories by using birth, risk exposures, disease incidence, and death rates to mark changes in the state of the individual. The model generates a reference forecast of future health in California, including details on physical activity, obesity, coronary heart disease, all-cause mortality, and medical expenditures. We use the model to answer specific research questions, inform debate on important policy issues in public health, support community advocacy, and provide analysis on the long-term impact of proposed changes in policies and programs, thus informing stakeholders at all levels and supporting decisions that can improve the health of populations.

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.

Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation.

PubMed

Dale, Craig M; Sinuff, Tasnim; Morrison, Laurie J; Golan, Eyal; Scales, Damon C

2016-07-01

Early withdrawal of life-sustaining therapy contributes to the majority of deaths following out-of-hospital cardiac arrest (OHCA), despite current recommendations for delayed neurological prognostication (≥72 h) after treatment with targeted temperature management. Little is known about clinicians' experiences of early withdrawal of life support decisions in patients with OHCA. To explore clinicians' experiences and perceptions of early withdrawal of life support decisions and barriers to guideline-concordant neurological prognostication in comatose survivors of OHCA treated with targeted temperature management. We conducted qualitative interviews with intensive care unit (ICU) physicians and nurses following withdrawal of life support in comatose patients with OHCA treated with targeted temperature management. The study was carried out across 18 academic and community hospitals participating in a multicenter, stepped-wedge, cluster-randomized controlled trial designed to improve quality-of-care processes for patients after OHCA in Ontario, Canada. We used a focused thematic analysis to capture barriers to guideline-concordant neurological prognostication and used these barriers to identify potentially modifiable issues. The core thematic finding was a high emotional burden of ICU family-team communication in which strong feelings inhibited information transfer and delayed decision making following OHCA. Four subthemes describing sources of communication strain were identified: (1) requests from family members to provide early outcome predictions, (2) incomplete family comprehension of critical care, (3) family requests for early withdrawal of life support based on their understanding of patients' preferences and values, and (4) family-team communication gaps related to prognostic uncertainty. Participants worried that gaps in timely and clear prognostic information contributed to surrogates' perceptions of a poor outcome and to inappropriately early decisions to withdraw life support. Family-team communication difficulties may be an underestimated factor leading to early withdrawal of life support in ICUs for individuals who initially survive OHCA.

Comprehensive Environmental Assessment: A Meta-Assessment Approach

PubMed Central

2012-01-01

With growing calls for changes in the field of risk assessment, improved systematic approaches for addressing environmental issues with greater transparency and stakeholder engagement are needed to ensure sustainable trade-offs. Here we describe the comprehensive environmental assessment (CEA) approach as a holistic way to manage complex information and to structure input from diverse stakeholder perspectives to support environmental decision-making for the near- and long-term. We further note how CEA builds upon and incorporates other available tools and approaches, describe its current application at the U.S. Environmental Protection Agency, and point out how it could be extended in evaluating a major issue such as the sustainability of biofuels. PMID:22889372

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.

Gaming in Nursing Education: A Literature Review.

PubMed

Pront, Leeanne; Müller, Amanda; Koschade, Adam; Hutton, Alison

The aim of this research was to investigate videogame-based learning in nursing education and establish how videogames are currently employed and how they link to the development of decision-making, motivation, and other benefits. Although digital game-based learning potentially offers a safe and convenient environment that can support nursing students developing essential skills, nurse educators are typically slow to adopt such resources. A comprehensive search of electronic databases was conducted, followed by a thematic analysis of the literature. Evaluations of identified games found generally positive results regarding usability and effectiveness of videogames in nursing education. Analysis of advantages of videogames in nursing education identified potential benefits for decision-making, motivation, repeated exposure, logistical, and financial value. Despite the paucity of games available and the methodological limitations identified, findings provide evidence to support the potential effectiveness of videogames as a learning resource in nursing education.

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

Design of a Multi-mode Flight Deck Decision Support System for Airborne Conflict Management

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Krishnamurthy, Karthik

2004-01-01

NASA Langley has developed a multi-mode decision support system for pilots operating in a Distributed Air-Ground Traffic Management (DAG-TM) environment. An Autonomous Operations Planner (AOP) assists pilots in performing separation assurance functions, including conflict detection, prevention, and resolution. Ongoing AOP design has been based on a comprehensive human factors analysis and evaluation results from previous human-in-the-loop experiments with airline pilot test subjects. AOP considers complex flight mode interactions and provides flight guidance to pilots consistent with the current aircraft control state. Pilots communicate goals to AOP by setting system preferences and actively probing potential trajectories for conflicts. To minimize training requirements and improve operational use, AOP design leverages existing alerting philosophies, displays, and crew interfaces common on commercial aircraft. Future work will consider trajectory prediction uncertainties, integration with the TCAS collision avoidance system, and will incorporate enhancements based on an upcoming air-ground coordination experiment.

Accruals for HANDI 2000 business management system

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

Wilson, D.

The Data Integration 2000 Project will result in an integrated and comprehensive set of functional applications containing core information necessary to support the Project Hanford Management Contract. It is based on the Commercial-Off-The-Shelf product solution with commercially proven business processes. The COTS product solution set, of PassPort and People Soft software, supports finance, supply and chemical management/Material Safety Data Sheet, human resources. Accruals are made at the project level. At the inception of each project, Project Management and the Accounts Payable Group make a mutual decision on whether periodic accrual entries should be made for it.

A Review and Analysis of Remote Sensing Capability for Air Quality Measurements as a Potential Decision Support Tool Conducted by the NASA DEVELOP Program

NASA Technical Reports Server (NTRS)

Ross, A.; Richards, A.; Keith, K.; Frew, C.; Boseck, J.; Sutton, S.; Watts, C.; Rickman, D.

2007-01-01

This project focused on a comprehensive utilization of air quality model products as decision support tools (DST) needed for public health applications. A review of past and future air quality measurement methods and their uncertainty, along with the relationship of air quality to national and global public health, is vital. This project described current and future NASA satellite remote sensing and ground sensing capabilities and the potential for using these sensors to enhance the prediction, prevention, and control of public health effects that result from poor air quality. The qualitative uncertainty of current satellite remotely sensed air quality, the ground-based remotely sensed air quality, the air quality/public health model, and the decision making process is evaluated in this study. Current peer-reviewed literature suggests that remotely sensed air quality parameters correlate well with ground-based sensor data. A satellite remote-sensed and ground-sensed data complement is needed to enhance the models/tools used by policy makers for the protection of national and global public health communities

Management decision of optimal recharge water in groundwater artificial recharge conditions- A case study in an artificial recharge test site

NASA Astrophysics Data System (ADS)

He, H. Y.; Shi, X. F.; Zhu, W.; Wang, C. Q.; Ma, H. W.; Zhang, W. J.

2017-11-01

The city conducted groundwater artificial recharge test which was taken a typical site as an example, and the purpose is to prevent and control land subsidence, increase the amount of groundwater resources. To protect groundwater environmental quality and safety, the city chose tap water as recharge water, however, the high cost makes it not conducive to the optimal allocation of water resources and not suitable to popularize widely. To solve this, the city selects two major surface water of River A and B as the proposed recharge water, to explore its feasibility. According to a comprehensive analysis of the cost of recharge, the distance of the water transport, the quality of recharge water and others. Entropy weight Fuzzy Comprehensive Evaluation Method is used to prefer tap water and water of River A and B. Evaluation results show that water of River B is the optimal recharge water, if used; recharge cost will be from 0.4724/m3 to 0.3696/m3. Using Entropy weight Fuzzy Comprehensive Evaluation Method to confirm water of River B as optimal water is scientific and reasonable. The optimal water management decisions can provide technical support for the city to carry out overall groundwater artificial recharge engineering in deep aquifer.

The Cognitive Impact of Past Behavior: Influences on Beliefs, Attitudes, and Future Behavioral Decisions

PubMed Central

Albarracín, Dolores; Wyer, Robert S.

2016-01-01

To study the processes by which past behavior influences future behavior, participants were led to believe that without being aware of it, they had expressed either support for or opposition to the institution of comprehensive exams. Judgment and response time data suggested that participants’ perceptions of their past behavior often influenced their decisions to repeat the behavior. This influence was partly the result of cognitive activity that influenced participants’ cognitions about specific behavioral consequences and the attitude they based on these cognitions. More generally, however, feedback about past behavior had a direct effect on participants’ attitudes and ultimate behavioral decisions that was independent of the outcome-specific cognitions. Results are discussed in terms of their implications for biased scanning of memory, dissonance reduction, self-perception, and the use of behavior as a heuristic. PMID:10909874

Disaster Management with a Next Generation Disaster Decision Support System

NASA Astrophysics Data System (ADS)

Chen, Y.

2015-12-01

As populations become increasingly concentrated in large cities, the world is experiencing an inevitably growing trend towards the urbanisation of disasters. Scientists have contributed significant advances in understanding the geophysical causes of natural hazards and have developed sophisticated tools to predict their effects; while, much less attention has been devoted to tools that increase situational awareness, facilitate leadership, provide effective communication channels and data flow and enhance the cognitive abilities of decision makers and first responders. In this paper, we envisioned the capabilities of a next generation disaster decision support system and hence proposed a state-of-the-art system architecture design to facilitate the decision making process in natural catastrophes such as flood and bushfire by utilising a combination of technologies for multi-channel data aggregation, disaster modelling, visualisation and optimisation. Moreover, we put our thoughts into action by implementing an Intelligent Disaster Decision Support System (IDDSS). The developed system can easily plug in to external disaster models and aggregate large amount of heterogeneous data from government agencies, sensor networks, and crowd sourcing platforms in real-time to enhance the situational awareness of decision makers and offer them a comprehensive understanding of disaster impacts from diverse perspectives such as environment, infrastructure and economy, etc. Sponsored by the Australian Government and the Victorian Department of Justice (Australia), the system was built upon a series of open-source frameworks (see attached figure) with four key components: data management layer, model application layer, processing service layer and presentation layer. It has the potential to be adopted by a range of agencies across Australian jurisdictions to assist stakeholders in accessing, sharing and utilising available information in their management of disaster events.

Development of a Framework Based on Reflective MCDA to Support Patient-Clinician Shared Decision-Making: The Case of the Management of Gastroenteropancreatic Neuroendocrine Tumors (GEP-NET) in the United States.

PubMed

Wagner, Monika; Samaha, Dima; Khoury, Hanane; O'Neil, William M; Lavoie, Louis; Bennetts, Liga; Badgley, Danielle; Gabriel, Sylvie; Berthon, Anthony; Dolan, James; Kulke, Matthew H; Goetghebeur, Mireille

2018-01-01

Well- or moderately differentiated gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are often slow-growing, and some patients with unresectable, asymptomatic, non-functioning tumors may face the choice between watchful waiting (WW), or somatostatin analogues (SSA) to delay progression. We developed a comprehensive multi-criteria decision analysis (MCDA) framework to help patients and physicians clarify their values and preferences, consider each decision criterion, and support communication and shared decision-making. The framework was adapted from a generic MCDA framework (EVIDEM) with patient and clinician input. During a workshop, patients and clinicians expressed their individual values and preferences (criteria weights) and, on the basis of two scenarios (treatment vs WW; SSA-1 [lanreotide] vs SSA-2 [octreotide]) with evidence from a literature review, expressed how consideration of each criterion would impact their decision in favor of either option (score), and shared their knowledge and insights verbally and in writing. The framework included benefit-risk criteria and modulating factors, such as disease severity, quality of evidence, costs, and constraints. Overall and progression-free survival being most important, criteria weights ranged widely, highlighting variations in individual values and the need to share them. Scoring and considering each criterion prompted a rich exchange of perspectives and uncovered individual assumptions and interpretations. At the group level, type of benefit, disease severity, effectiveness, and quality of evidence favored treatment; cost aspects favored WW (scenario 1). For scenario 2, most criteria did not favor either option. Patients and clinicians consider many aspects in decision-making. The MCDA framework provided a common interpretive frame to structure this complexity, support individual reflection, and share perspectives. Ipsen Pharma.

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.

A mixed-methods exploration of the contraceptive experiences of female teens with epilepsy.

PubMed

Manski, Ruth; Dennis, Amanda

2014-09-01

We explored the contraceptive experiences of female teens with epilepsy, including their knowledge and perceptions of interactions between antiepileptic drugs and hormonal contraception and contraceptive decision-making processes. From November 2012 to May 2013, we conducted one online survey (n=114) and 12 online focus group discussions (n=26) with female teens with epilepsy about their contraceptive experiences and unmet needs. Survey data were analyzed using descriptive statistics and focus group transcripts were analyzed thematically using modified grounded theory methods. Both survey and focus group participants reported believing that interactions between epilepsy medications and hormonal contraceptives could lead to reductions in contraceptive efficacy and seizure control. However, their knowledge about these types of medication interactions was often incomplete. Many study participants viewed contraceptive decision making as a difficult process, and some participants reported avoiding hormonal contraceptives because of potential interactions with antiepileptic drugs. Study participants reported relying on health care providers and parents for contraceptive decision-making support. Focus group participants also reported they wanted health care providers to provide more in-depth and comprehensive counseling about contraception, and that they desired peer support with contraceptive decisions. The ability to make informed contraceptive decisions is important for teens with epilepsy as interactions between anti-epileptic drugs and hormonal contraceptives can impact seizure occurrence and lead to an increased risk of unplanned pregnancy. Guidance for providers offering contraceptive care to this population is needed, as well as a contraceptive support tool that empowers teens with epilepsy to advocate for desired health care. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Automated Modular Magnetic Resonance Imaging Clinical Decision Support System (MIROR): An Application in Pediatric Cancer Diagnosis.

PubMed

Zarinabad, Niloufar; Meeus, Emma M; Manias, Karen; Foster, Katharine; Peet, Andrew

2018-05-02

Advances in magnetic resonance imaging and the introduction of clinical decision support systems has underlined the need for an analysis tool to extract and analyze relevant information from magnetic resonance imaging data to aid decision making, prevent errors, and enhance health care. The aim of this study was to design and develop a modular medical image region of interest analysis tool and repository (MIROR) for automatic processing, classification, evaluation, and representation of advanced magnetic resonance imaging data. The clinical decision support system was developed and evaluated for diffusion-weighted imaging of body tumors in children (cohort of 48 children, with 37 malignant and 11 benign tumors). Mevislab software and Python have been used for the development of MIROR. Regions of interests were drawn around benign and malignant body tumors on different diffusion parametric maps, and extracted information was used to discriminate the malignant tumors from benign tumors. Using MIROR, the various histogram parameters derived for each tumor case when compared with the information in the repository provided additional information for tumor characterization and facilitated the discrimination between benign and malignant tumors. Clinical decision support system cross-validation showed high sensitivity and specificity in discriminating between these tumor groups using histogram parameters. MIROR, as a diagnostic tool and repository, allowed the interpretation and analysis of magnetic resonance imaging images to be more accessible and comprehensive for clinicians. It aims to increase clinicians' skillset by introducing newer techniques and up-to-date findings to their repertoire and make information from previous cases available to aid decision making. The modular-based format of the tool allows integration of analyses that are not readily available clinically and streamlines the future developments. ©Niloufar Zarinabad, Emma M Meeus, Karen Manias, Katharine Foster, Andrew Peet. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.05.2018.

Show Me My Health Plans: a study protocol of a randomized trial testing a decision support tool for the federal health insurance marketplace in Missouri.

PubMed

Politi, Mary C; Barker, Abigail R; Kaphingst, Kimberly A; McBride, Timothy; Shacham, Enbal; Kebodeaux, Carey S

2016-02-16

The implementation of the ACA has improved access to quality health insurance, a necessary first step to improving health outcomes. However, access must be supplemented by education to help individuals make informed choices for plans that meet their individual financial and health needs. Drawing on a model of information processing and on prior research, we developed a health insurance decision support tool called Show Me My Health Plans. Developed with extensive stakeholder input, the current tool (1) simplifies information through plain language and graphics in an educational component; (2) assesses and reviews knowledge interactively to ensure comprehension of key material; (3) incorporates individual and/or family health status to personalize out-of-pocket cost estimates; (4) assesses preferences for plan features; and (5) helps individuals weigh information appropriate to their interests and needs through a summary page with "good fit" plans generated from a tailored algorithm. The current study will evaluate whether the online decision support tool improves health insurance decisions compared to a usual care condition (the healthcare.gov marketplace website). The trial will include 362 individuals (181 in each group) from rural, suburban, and urban settings within a 90 mile radius around St. Louis. Eligibility criteria includes English-speaking individuals 18-64 years old who are eligible for the ACA marketplace plans. They will be computer randomized to view the intervention or usual care condition. Presenting individuals with options that they can understand tailored to their needs and preferences could help improve decision quality. By helping individuals narrow down the complexity of health insurance plan options, decision support tools such as this one could prepare individuals to better navigate enrollment in a plan that meets their individual needs. The randomized trial was registered in clinicaltrials.gov (NCT02522624) on August 6, 2015.

Risk Communication Emergency Response Preparedness: Contextual Assessment of the Protective Action Decision Model.

PubMed

Heath, Robert L; Lee, Jaesub; Palenchar, Michael J; Lemon, Laura L

2018-02-01

Studies are continuously performed to improve risk communication campaign designs to better prepare residents to act in the safest manner during an emergency. To that end, this article investigates the predictive ability of the protective action decision model (PADM), which links environmental and social cues, predecision processes (attention, exposure, and comprehension), and risk decision perceptions (threat, alternative protective actions, and stakeholder norms) with protective action decision making. This current quasi-longitudinal study of residents (N = 400 for each year) in a high-risk (chemical release) petrochemical manufacturing community investigated whether PADM core risk perceptions predict protective action decision making. Telephone survey data collected at four intervals (1995, 1998, 2002, 2012) reveal that perceptions of protective actions and stakeholder norms, but not of threat, currently predict protective action decision making (intention to shelter in place). Of significance, rather than threat perceptions, perception of Wally Wise Guy (a spokes-character who advocates shelter in place) correlates with perceptions of protective action, stakeholder norms, and protective action decision making. Wally's response-efficacy advice predicts residents' behavioral intentions to shelter in place, thereby offering contextually sensitive support and refinement for PADM. © 2017 Society for Risk Analysis.

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. .

Clinical-decision support based on medical literature: A complex network approach

NASA Astrophysics Data System (ADS)

Jiang, Jingchi; Zheng, Jichuan; Zhao, Chao; Su, Jia; Guan, Yi; Yu, Qiubin

2016-10-01

In making clinical decisions, clinicians often review medical literature to ensure the reliability of diagnosis, test, and treatment because the medical literature can answer clinical questions and assist clinicians making clinical decisions. Therefore, finding the appropriate literature is a critical problem for clinical-decision support (CDS). First, the present study employs search engines to retrieve relevant literature about patient records. However, the result of the traditional method is usually unsatisfactory. To improve the relevance of the retrieval result, a medical literature network (MLN) based on these retrieved papers is constructed. Then, we show that this MLN has small-world and scale-free properties of a complex network. According to the structural characteristics of the MLN, we adopt two methods to further identify the potential relevant literature in addition to the retrieved literature. By integrating these potential papers into the MLN, a more comprehensive MLN is built to answer the question of actual patient records. Furthermore, we propose a re-ranking model to sort all papers by relevance. We experimentally find that the re-ranking model can improve the normalized discounted cumulative gain of the results. As participants of the Text Retrieval Conference 2015, our clinical-decision method based on the MLN also yields higher scores than the medians in most topics and achieves the best scores for topics: #11 and #12. These research results indicate that our study can be used to effectively assist clinicians in making clinical decisions, and the MLN can facilitate the investigation of CDS.

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease

PubMed Central

Burns, Aine; Moranne, Olivier; Morton, Rachael L.; Naicker, Saraladevi

2016-01-01

Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care. PMID:27510453

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.

Knowledge-based and model-based hybrid methodology for comprehensive waste minimization in electroplating plants

NASA Astrophysics Data System (ADS)

Luo, Keqin

1999-11-01

The electroplating industry of over 10,000 planting plants nationwide is one of the major waste generators in the industry. Large quantities of wastewater, spent solvents, spent process solutions, and sludge are the major wastes generated daily in plants, which costs the industry tremendously for waste treatment and disposal and hinders the further development of the industry. It becomes, therefore, an urgent need for the industry to identify technically most effective and economically most attractive methodologies and technologies to minimize the waste, while the production competitiveness can be still maintained. This dissertation aims at developing a novel WM methodology using artificial intelligence, fuzzy logic, and fundamental knowledge in chemical engineering, and an intelligent decision support tool. The WM methodology consists of two parts: the heuristic knowledge-based qualitative WM decision analysis and support methodology and fundamental knowledge-based quantitative process analysis methodology for waste reduction. In the former, a large number of WM strategies are represented as fuzzy rules. This becomes the main part of the knowledge base in the decision support tool, WMEP-Advisor. In the latter, various first-principles-based process dynamic models are developed. These models can characterize all three major types of operations in an electroplating plant, i.e., cleaning, rinsing, and plating. This development allows us to perform a thorough process analysis on bath efficiency, chemical consumption, wastewater generation, sludge generation, etc. Additional models are developed for quantifying drag-out and evaporation that are critical for waste reduction. The models are validated through numerous industrial experiments in a typical plating line of an industrial partner. The unique contribution of this research is that it is the first time for the electroplating industry to (i) use systematically available WM strategies, (ii) know quantitatively and accurately what is going on in each tank, and (iii) identify all WM opportunities through process improvement. This work has formed a solid foundation for the further development of powerful WM technologies for comprehensive WM in the following decade.

Copernicus: a quantum leap in Earth Observation

NASA Astrophysics Data System (ADS)

Aschbacher, Josef

2015-04-01

Copernicus is the most ambitious, most comprehensive Earth observation system world-wide. It aims at giving decision-makers better information to act upon, at global, continental, national and regional level. The European Union (EU) leads the overall programme, while the European Space Agency (ESA) coordinates the space component. Similar to meteorology, satellite data is combined with data from airborne and ground sensors to provide a holistic view of the state of the planet. All these data are fed into a range of thematic information services designed to benefit the environment and to support policy-makers and other stakeholders to make decisions, coordinate policy areas, and formulate strategies relating to the environment. Moreover, the data will also be used for predicting future climate trends. Never has such a comprehensive Earth-observation based system been in place before. It will be fully integrated into an informed decision making process, thus enabling economic and social benefits through better access to information globally. A key feature of Copernicus is the free and open data policy of the Sentinel satellite data. This will enable that Earth observation based information enters completely new domains of daily life. High quality, regularly updated satellite observations become available for basically everyone. To ensure universal access new ground segment and data access concepts need to be developed. As more data are made available, better decisions can made, more business will be created and science and research can be achieved through the upcoming Sentinel data.

Derivation and validation of the Personal Support Algorithm: an evidence-based framework to inform allocation of personal support services in home and community care.

PubMed

Sinn, Chi-Ling Joanna; Jones, Aaron; McMullan, Janet Legge; Ackerman, Nancy; Curtin-Telegdi, Nancy; Eckel, Leslie; Hirdes, John P

2017-11-25

Personal support services enable many individuals to stay in their homes, but there are no standard ways to classify need for functional support in home and community care settings. The goal of this project was to develop an evidence-based clinical tool to inform service planning while allowing for flexibility in care coordinator judgment in response to patient and family circumstances. The sample included 128,169 Ontario home care patients assessed in 2013 and 25,800 Ontario community support clients assessed between 2014 and 2016. Independent variables were drawn from the Resident Assessment Instrument-Home Care and interRAI Community Health Assessment that are standardised, comprehensive, and fully compatible clinical assessments. Clinical expertise and regression analyses identified candidate variables that were entered into decision tree models. The primary dependent variable was the weekly hours of personal support calculated based on the record of billed services. The Personal Support Algorithm classified need for personal support into six groups with a 32-fold difference in average billed hours of personal support services between the highest and lowest group. The algorithm explained 30.8% of the variability in billed personal support services. Care coordinators and managers reported that the guidelines based on the algorithm classification were consistent with their clinical judgment and current practice. The Personal Support Algorithm provides a structured yet flexible decision-support framework that may facilitate a more transparent and equitable approach to the allocation of personal support services.

Consensus oriented fuzzified decision support for oil spill contingency management.

PubMed

Liu, Xin; Wirtz, Kai W

2006-06-30

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

A Prototype Indicators System for U.S. Climate Changes, Impacts, Vulnerabilities, and Responses

NASA Astrophysics Data System (ADS)

Kenney, M. A.; Janetos, A.; Gerst, M.; Lloyd, A.; Wolfinger, J. F.; Reyes, J. J.; Anderson, S. M.; Pouyat, R. V.

2015-12-01

Indicators are observations or calculations that are used to systematically report or forecast social and biophysical conditions over time. When the purpose of indicators is to, in part, provide complex scientific information that is understood by non-scientists and included in decision processes, the choice of indicators requires a structured process that includes co-production among a range of actors, including scientists, decision-makers, and a range of stakeholders. Here we describe recommendations on a vision and a prototype created for an indicators system, we term the National Climate Indicators System (NCIS). The goal of the NCIS is to create a system of physical, natural, and societal indicators to communicate and inform decisions about climate changes, impacts, vulnerabilities, and responses. The process of generating the indicator system involved input from over 200 subject-matter experts. Organized into 13 teams, experts created conceptual models of their respective sectors to generate an initial recommended set of indicators. A subset of indicators, which could be immediately implemented, were prototyped for the U.S. Global Change Research Program (USGCRP) a Federal program that coordinates and supports integration of global change research across the government. USGCRP reviewed the recommendations (Kenney et al., 2014) and prototypes provided by the scientific experts, and recently launched 14 indicators as proof-of-concept in support of a sustained National Climate Assessment and to solicit feedback from the users. Social science research is currently being undertaken in order to evaluate how well the prototype indicators communicate science to non-scientists, the usability of indicator system portal by scientists and decision-makers, and the development of information visualization guidelines to improve visual communication effectiveness. The goal of such efforts would be to provide input into the development of a more comprehensive USGCRP indicator set, building on recommendations from Kenney et al. (2014), and improve our understanding of the comprehension and use of indicators by non-scientists.

Decision Support Model to Optimize Site Characterization Activities Taken in Compliance with the Comprehensive Environmental Response Compensation and Liability Act

DTIC Science & Technology

1995-12-01

Contingency Plan ............................... 10 Table 2: Summary of Inhalation Emission Factors (K) for Equation ( 1 ...surveys for exposure factors commonly used in risk assessment (EPA, 1989a: 1 - 1 ). Exposure can take place via three possible routes, the inhalation ...Equation ( 1 ) calculates the dose for the inhalation route (USEPA, 1991 a:51-52; USEPA, 1989b:6-44). Dose - (C)(IRXETXEFXED) (K)(BWXAT) where C

US HealthLink: a national information resource for health care professionals.

PubMed

Yasnoff, W A

1992-06-01

US HealthLink is a new, comprehensive online medical information system designed specifically for health care professionals. Available to individuals for a fixed fee, it includes literature, news, diagnostic decision support, drug interactions, electronic mail, and bulletin boards. It also provides user-specific current awareness via clipping service, and fax delivery of both clipping and electronic mail information. US HealthLink can now be utilized to access a wide variety of medical information sources inexpensively.

A system to improve medication safety in the setting of acute kidney injury: initial provider response.

PubMed

McCoy, Allison B; McCoy, Allison Beck; Peterson, Josh F; Gadd, Cynthia S; Gadd, Cindy; Danciu, Ioana; Waitman, Lemuel R

2008-11-06

Clinical decision support systems can decrease common errors related to inappropriate or excessive dosing for nephrotoxic or renally cleared drugs. We developed a comprehensive medication safety intervention with varying levels of workflow intrusiveness within computerized provider order entry to continuously monitor for and alert providers about early-onset acute kidney injury. Initial provider response to the interventions shows potential success in improving medication safety and suggests future enhancements to increase effectiveness.

Views of general practitioners on the use of STOPP&START in primary care: a qualitative study.

PubMed

Dalleur, O; Feron, J-M; Spinewine, A

2014-08-01

STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert Doctors to Right Treatment) criteria aim at detecting potentially inappropriate prescribing in older people. The objective was to explore general practitioners' (GPs) perceptions regarding the use of the STOPP&START tool in their practice. We conducted three focus groups which were conveniently sampled. Vignettes with clinical cases were provided for discussion as well as a full version of the STOPP&START tool. Knowledge, strengths and weaknesses of the tool and its implementation were discussed. Two researchers independently performed content analysis, classifying quotes and creating new categories for emerging themes. Discussions highlighted incentives (e.g. systematic procedure for medication review) and barriers (e.g. time-consuming application) influencing the use of STOPP&START in primary care. Usefulness, comprehensiveness, and relevance of the tool were also questioned. Another important category emerging from the content analysis was the projected use of the tool. The GPs imagined key elements for the implementation in daily practice: computerized clinical decision support system, education, and multidisciplinary collaborations, especially at care transitions and in nursing homes. Despite variables views on the usefulness, comprehensiveness, and relevance of STOPP&START, GPs suggest the implementation of this tool in primary care within computerized clinical decision support systems, through education, and used as part of multidisciplinary collaborations.

Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.

PubMed

Keesara, Sirina R; Juma, Pamela A; Harper, Cynthia C

2015-08-20

Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

Measuring occupational stress: development of the pressure management indicator.

PubMed

Williams, S; Cooper, C L

1998-10-01

The study of occupational stress is hindered by the lack of compact and comprehensive standardized measurement tools. The Pressure Management Indicator (PMI) is a 120-item self-report questionnaire developed from the Occupational Stress Indicator (OSI). The PMI is more reliable, more comprehensive, and shorter than the OSI. It provides an integrated measure of the major dimensions of occupational stress. The outcome scales measure job satisfaction, organizational satisfaction, organizational security, organizational commitment, anxiety--depression, resilience, worry, physical symptoms, and exhaustion. The stressor scales cover pressure from workload, relationships, career development, managerial responsibility, personal responsibility, home demands, and daily hassles. The moderator variables measure drive, impatience, control, decision latitude, and the coping strategies of problem focus, life work balance, and social support.

A Decision Support System For The Real-Time Allocation Of The Water Resource Of The Tarim River Basin, China

NASA Astrophysics Data System (ADS)

Wei, J.; Wang, G.; Liu, R.

2008-12-01

The Tarim River Basin is the longest inland river in China. Due to water scarcity, ecologically-fragile is becoming a significant constraint to sustainable development in this region. To effectively manage the limited water resources for ecological purposes and for conventional water utilization purposes, a real-time water resources allocation Decision Support System (DSS) has been developed. Based on workflows of the water resources regulations and comprehensive analysis of the efficiency and feasibility of water management strategies, the DSS includes information systems that perform data acquisition, management and visualization, and model systems that perform hydrological forecast, water demand prediction, flow routing simulation and water resources optimization of the hydrological and water utilization process. An optimization and process control strategy is employed to dynamically allocate the water resources among the different stakeholders. The competitive targets and constraints are taken into considered by multi-objective optimization and with different priorities. The DSS of the Tarim River Basin has been developed and been successfully utilized to support the water resources management of the Tarim River Basin since 2005.

Construct validity of the Iowa Gambling Task.

PubMed

Buelow, Melissa T; Suhr, Julie A

2009-03-01

The Iowa Gambling Task (IGT) was created to assess real-world decision making in a laboratory setting and has been applied to various clinical populations (i.e., substance abuse, schizophrenia, pathological gamblers) outside those with orbitofrontal cortex damage, for whom it was originally developed. The current review provides a critical examination of lesion, functional neuroimaging, developmental, and clinical studies in order to examine the construct validity of the IGT. The preponderance of evidence provides support for the use of the IGT to detect decision making deficits in clinical populations, in the context of a more comprehensive evaluation. The review includes a discussion of three critical issues affecting the validity of the IGT, as it has recently become available as a clinical instrument: the lack of a concise definition as to what aspect of decision making the IGT measures, the lack of data regarding reliability of the IGT, and the influence of personality and state mood on IGT performance.

A multimedia comprehensive informatics system with decision support tools for a multi-site collaboration research of stroke rehabilitation

NASA Astrophysics Data System (ADS)

Wang, Ximing; Documet, Jorge; Garrison, Kathleen A.; Winstein, Carolee J.; Liu, Brent

2012-02-01

Stroke is a major cause of adult disability. The Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (I-CARE) clinical trial aims to evaluate a therapy for arm rehabilitation after stroke. A primary outcome measure is correlative analysis between stroke lesion characteristics and standard measures of rehabilitation progress, from data collected at seven research facilities across the country. Sharing and communication of brain imaging and behavioral data is thus a challenge for collaboration. A solution is proposed as a web-based system with tools supporting imaging and informatics related data. In this system, users may upload anonymized brain images through a secure internet connection and the system will sort the imaging data for storage in a centralized database. Users may utilize an annotation tool to mark up images. In addition to imaging informatics, electronic data forms, for example, clinical data forms, are also integrated. Clinical information is processed and stored in the database to enable future data mining related development. Tele-consultation is facilitated through the development of a thin-client image viewing application. For convenience, the system supports access through desktop PC, laptops, and iPAD. Thus, clinicians may enter data directly into the system via iPAD while working with participants in the study. Overall, this comprehensive imaging informatics system enables users to collect, organize and analyze stroke cases efficiently.

Decision support system in an international-voice-services business company

NASA Astrophysics Data System (ADS)

Hadianti, R.; Uttunggadewa, S.; Syamsuddin, M.; Soewono, E.

2017-01-01

We consider a problem facing by an international telecommunication services company in maximizing its profit. From voice services by controlling cost and business partnership. The competitiveness in this industry is very high, so that any efficiency from controlling cost and business partnership can help the company to survive in the very high competitiveness situation. The company trades voice traffic with a large number of business partners. There are four trading schemes that can be chosen by this company, namely, flat rate, class tiering, volume commitment, and revenue capped. Each scheme has a specific characteristic on the rate and volume deal, where the last three schemes are regarded as strategic schemes to be offered to business partner to ensure incoming traffic volume for both parties. This company and each business partner need to choose an optimal agreement in a certain period of time that can maximize the company’s profit. In this agreement, both parties agree to use a certain trading scheme, rate and rate/volume/revenue deal. A decision support system is then needed in order to give a comprehensive information to the sales officers to deal with the business partners. This paper discusses the mathematical model of the optimal decision for incoming traffic volume control, which is a part of the analysis needed to build the decision support system. The mathematical model is built by first performing data analysis to see how elastic the incoming traffic volume is. As the level of elasticity is obtained, we then derive a mathematical modelling that can simulate the impact of any decision on trading to the revenue of the company. The optimal decision can be obtained from these simulations results. To evaluate the performance of the proposed method we implement our decision model to the historical data. A software tool incorporating our methodology is currently in construction.

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

Conceptualizing Couples’ Decision Making in PGD: Emerging Cognitive, Emotional, and Moral Dimensions

PubMed Central

Hershberger, Patricia E.; Pierce, Penny F.

2009-01-01

Objective To illuminate and synthesize what is known about the underlying decision making processes surrounding couples’ preimplantation genetic diagnosis (PGD) use or disuse and to formulate an initial conceptual framework that can guide future research and practice. Methods This systematic review targeted empirical studies published in English from 1990 to 2008 that examined the decision making process of couples or individual partners that had used, were eligible for, or had contemplated PGD. Sixteen studies met the eligibility requirements. To provide a more comprehensive review, empirical studies that examined healthcare professionals’ perceptions of couples’ decision making surrounding PGD use and key publications from a variety of disciplines supplemented the analysis. Results The conceptual framework formulated from the review demonstrates that couples’ PGD decision making is composed of three iterative and dynamic dimensions: cognitive appraisals, emotional responses, and moral judgments. Conclusion Couples think critically about uncertain and probabilistic information, grapple with conflicting emotions and incorporate moral perspectives into their decision making about whether or not to use PGD. Practice Implications The quality of care and decisional support for couples who are contemplating PGD use can be improved by incorporating focused questions and discussion from each of the dimensions into counseling sessions. PMID:20060677

Head and Neck Cancer in the Elderly: Frailty, Shared Decisions, and Avoidance of Low Value Care.

PubMed

Mady, Leila J; Nilsen, Marci L; Johnson, Jonas T

2018-05-01

Head and neck cancer (HNC) is a disease of older adults. Recurrent and metastatic head and neck squamous cell carcinoma portends a poor prognosis, with median overall survival of less than 12 months. Within this vulnerable population, significant treatment-related toxicities and physical and psychosocial sequelae can be devastating to quality of life at the end of life. Shared decision making and early comprehensive palliative and support services are at the crux of the approach to older adults with HNC. In doing so, low-value care that fails to meet the goals of patients and their caregivers at the end-of-life may be avoided. Copyright © 2018 Elsevier Inc. All rights reserved.

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.

Modelling emergency decisions: recognition-primed decision making. The literature in relation to an ophthalmic critical incident.

PubMed

Bond, Susan; Cooper, Simon

2006-08-01

To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Systematic literature review with critical incident reflection. Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety.

The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature.

PubMed

Georgiou, Andrew; Prgomet, Mirela; Paoloni, Richard; Creswick, Nerida; Hordern, Antonia; Walter, Scott; Westbrook, Johanna

2013-06-01

We undertake a systematic review of the quantitative literature related to the effect of computerized provider order entry systems in the emergency department (ED). We searched MEDLINE, EMBASE, Inspec, CINAHL, and CPOE.org for English-language studies published between January 1990 and May 2011. We identified 1,063 articles, of which 22 met our inclusion criteria. Sixteen used a pre/post design; 2 were randomized controlled trials. Twelve studies reported outcomes related to patient flow/clinical work, 7 examined decision support systems, and 6 reported effects on patient safety. There were no studies that measured decision support systems and its effect on patient flow/clinical work. Computerized provider order entry was associated with an increase in time spent on computers (up to 16.2% for nurses and 11.3% for physicians), with no significant change in time spent on patient care. Computerized provider order entry with decision support systems was related to significant decreases in prescribing errors (ranging from 17 to 201 errors per 100 orders), potential adverse drug events (0.9 per 100 orders), and prescribing of excessive dosages (31% decrease for a targeted set of renal disease medications). There are tangible benefits associated with computerized provider order entry/decision support systems in the ED environment. Nevertheless, when considered as part of a framework of technical, clinical, and organizational components of the ED, the evidence base is neither consistent nor comprehensive. Multimethod research approaches (including qualitative research) can contribute to understanding of the multiple dimensions of ED care delivery, not as separate entities but as essential components of a highly integrated system of care. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

A methodology and decision support tool for informing state-level bioenergy policymaking: New Jersey biofuels as a case study

NASA Astrophysics Data System (ADS)

Brennan-Tonetta, Margaret

This dissertation seeks to provide key information and a decision support tool that states can use to support long-term goals of fossil fuel displacement and greenhouse gas reductions. The research yields three outcomes: (1) A methodology that allows for a comprehensive and consistent inventory and assessment of bioenergy feedstocks in terms of type, quantity, and energy potential. Development of a standardized methodology for consistent inventorying of biomass resources fosters research and business development of promising technologies that are compatible with the state's biomass resource base. (2) A unique interactive decision support tool that allows for systematic bioenergy analysis and evaluation of policy alternatives through the generation of biomass inventory and energy potential data for a wide variety of feedstocks and applicable technologies, using New Jersey as a case study. Development of a database that can assess the major components of a bioenergy system in one tool allows for easy evaluation of technology, feedstock and policy options. The methodology and decision support tool is applicable to other states and regions (with location specific modifications), thus contributing to the achievement of state and federal goals of renewable energy utilization. (3) Development of policy recommendations based on the results of the decision support tool that will help to guide New Jersey into a sustainable renewable energy future. The database developed in this research represents the first ever assessment of bioenergy potential for New Jersey. It can serve as a foundation for future research and modifications that could increase its power as a more robust policy analysis tool. As such, the current database is not able to perform analysis of tradeoffs across broad policy objectives such as economic development vs. CO2 emissions, or energy independence vs. source reduction of solid waste. Instead, it operates one level below that with comparisons of kWh or GGE generated by different feedstock/technology combinations at the state and county level. Modification of the model to incorporate factors that will enable the analysis of broader energy policy issues as those mentioned above, are recommended for future research efforts.

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.

Understanding the Needs of Young Women Regarding Breast Cancer Risk Assessment and Genetic Testing: Convergence and Divergence among Patient-Counselor Perceptions and the Promise of Peer Support.

PubMed

Evans, Chalanda; Hamilton, Rebekah J; Tercyak, Kenneth P; Peshkin, Beth N; Rabemananjara, Kantoniony; Isaacs, Claudine; O'Neill, Suzanne C

2016-06-28

Young women from hereditary breast and ovarian cancer (HBOC) families face a series of medical decisions regarding their cancer risk management and integrating this information into their life planning. This presents unique medical and psychosocial challenges that exist without comprehensive intervention. To help lay the groundwork for intervention, we conducted a qualitative study among young women from HBOC families (N = 12; Mean age = 22) and cancer genetic counselors (N = 12) to explicate domains most critical to caring for this population. Women and counselors were interviewed by telephone. The predominant interview themes included preventative care planning and risk management, decision making around the pros and cons of cancer risk assessment, medical management, and psychosocial stresses experienced. Young women endorsed psychosocial stress significantly more frequently than did counselors. Both groups noted the short- and long-term decision making challenges and the support and conflict engendered among familial relationships. Our results suggest young women value the support they receive from their families and their genetic counselors, but additional, external supports are needed to facilitate adaptation to HBOC risk. In feedback interviews focused on intervention planning with a subset of these young women (N = 9), they endorsed the predominant interview themes discovered as important intervention content, a structure that would balance discussion of medical information and psychosocial skill-building that could be tailored to the young women's needs, and delivery by trained peers familiar with HBOC risk.

Load index model: An advanced tool to support decision making during mass-casualty incidents.

PubMed

Adini, Bruria; Aharonson-Daniel, Limor; Israeli, Avi

2015-03-01

In mass-casualty events, accessing information concerning hospital congestion levels is crucial to improving patient distribution and optimizing care. The study aimed to develop a decision support tool for distributing casualties to hospitals in an emergency scenario involving multiple casualties. A comprehensive literature review and structured interviews with 20 content experts produced a shortlist of relevant criteria for inclusion in the model. A "load index model" was prepared, incorporating results of a modified Delphi survey of 100 emergency response experts. The model was tested in three simulation exercises in which an emergency scenario was presented to six groups of senior emergency managers. Information was provided regarding capacities of 11 simulated admitting hospitals in the region, and evacuation destinations were requested for 600 simulated casualties. Of the three simulation rounds, two were performed without the model and one after its presentation. Following simulation experiments and implementation during a real-life security threat, the efficacy of the model was assessed. Variability between experts concerning casualties' evacuation destinations decreased significantly following the model's introduction. Most responders (92%) supported the need for standardized data, and 85% found that the model improved policy setting regarding casualty evacuation in an emergency situation. These findings were reaffirmed in a real-life emergency scenario. The proposed model improved capacity to ensure evacuation of patients to less congested medical facilities in emergency situations, thereby enhancing lifesaving medical services. The model supported decision-making processes in both simulation exercises and an actual emergency situation.

Understanding the Needs of Young Women Regarding Breast Cancer Risk Assessment and Genetic Testing: Convergence and Divergence among Patient-Counselor Perceptions and the Promise of Peer Support

PubMed Central

Evans, Chalanda; Hamilton, Rebekah J.; Tercyak, Kenneth P.; Peshkin, Beth N.; Rabemananjara, Kantoniony; Isaacs, Claudine; O’Neill, Suzanne C.

2016-01-01

Young women from hereditary breast and ovarian cancer (HBOC) families face a series of medical decisions regarding their cancer risk management and integrating this information into their life planning. This presents unique medical and psychosocial challenges that exist without comprehensive intervention. To help lay the groundwork for intervention, we conducted a qualitative study among young women from HBOC families (N = 12; Mean age = 22) and cancer genetic counselors (N = 12) to explicate domains most critical to caring for this population. Women and counselors were interviewed by telephone. The predominant interview themes included preventative care planning and risk management, decision making around the pros and cons of cancer risk assessment, medical management, and psychosocial stresses experienced. Young women endorsed psychosocial stress significantly more frequently than did counselors. Both groups noted the short- and long-term decision making challenges and the support and conflict engendered among familial relationships. Our results suggest young women value the support they receive from their families and their genetic counselors, but additional, external supports are needed to facilitate adaptation to HBOC risk. In feedback interviews focused on intervention planning with a subset of these young women (N = 9), they endorsed the predominant interview themes discovered as important intervention content, a structure that would balance discussion of medical information and psychosocial skill-building that could be tailored to the young women’s needs, and delivery by trained peers familiar with HBOC risk. PMID:27417623

A decision support tool for selecting the optimal sewage sludge treatment.

PubMed

Turunen, Ville; Sorvari, Jaana; Mikola, Anna

2018-02-01

Sewage sludge contains significant amounts of resources, such as nutrients and organic matter. At the same time, the organic contaminants (OC) found in sewage sludge are of growing concern. Consequently, in many European countries incineration is currently favored over recycling in agriculture. This study presents a Multi-Attribute Value Theory (MAVT)-based decision support tool (DST) for facilitating sludge treatment decisions. Essential decision criteria were recognized and prioritized, i.e., weighted, by experts from water utilities. Since the fate of organic contaminants was in focus, a simple scoring method was developed to take into account their environmental risks. The final DST assigns each sludge treatment method a preference score expressing its superiority compared to alternative methods. The DST was validated by testing it with data from two Finnish municipal wastewater treatment plants (WWTP). The validation results of the first case study preferred sludge pyrolysis (preference score: 0.629) to other alternatives: composting and incineration (score 0.580, and 0.484 respectively). The preference scores were influenced by WWTP dependent factors, i.e., the operating environment and the weighting of the criteria. A lack of data emerged as the main practical limitation. Therefore, not all of the relevant criteria could be included in the value tree. More data are needed on the effects of treatment methods on the availability of nutrients, the quality of organic matter and sludge-borne OCs. Despite these shortcomings, the DST proved useful and adaptable in decision-making. It can also help achieve a more transparent, understandable and comprehensive decision-making process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Assessing infant and maternal readiness for newborn discharge.

PubMed

Jing, Ling; Bethancourt, Casidhe-Nicole; McDonagh, Thomas

2017-10-01

The review highlights the shift from prescribed length of stay (LOS) to mother-infant dyad readiness as the basis for making discharge decisions for healthy term newborns. We describe the components of readiness that should be considered in making the decision, focusing on infant clinical readiness, and maternal and familial readiness. Although the Newborns' and Mothers' Health Protection Act of 1996 aimed to protect infants and mothers by establishing a minimum LOS, the American Academy of Pediatrics 2015 policy on newborn discharge acknowledges the shift from LOS-based to readiness-based discharge decision-making. Healthcare providers must consider a variety of infant and maternal characteristics in determining the appropriate time to discharge a dyad, and mothers should be actively involved in the decision-making process. Criteria for infant clinical readiness include the following: establishment of effective feeding, evaluation of jaundice risk, review and discussion of infant and household vaccination status, obtainment of specimen for metabolic screening, tests of hearing ability, assessment of sepsis risk factors, screening for congenital heart disease, and evaluation of parental knowledge about infant safety measures. Important consideration should also be given to the mother's sociodemographic vulnerabilities, maternal confidence and perception of discharge readiness, and availability of postdischarge care continuity. The timing of newborn discharge should be a joint decision made by the mother and healthcare providers based on readiness. The decision should consider the infant's health status, the mother's health status, the mother's perception of readiness, and the availability of social and familial support for the mother and infant. Accessible and comprehensive support postdischarge is also important for helping infants achieve optimal health outcomes.

Supportive Care: Comprehensive Conservative Care in End-Stage Kidney Disease.

PubMed

Murtagh, Fliss E M; Burns, Aine; Moranne, Olivier; Morton, Rachael L; Naicker, Saraladevi

2016-10-07

Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care. Copyright © 2016 by the American Society of Nephrology.

Biomarkers in prostate cancer - Current clinical utility and future perspectives.

PubMed

Kretschmer, Alexander; Tilki, Derya

2017-12-01

Current tendencies in the treatment course of prostate cancer patients increase the need for reliable biomarkers that help in decision-making in a challenging clinical setting. Within the last decade, several novel biomarkers have been introduced. In the following comprehensive review article, we focus on diagnostic (PHI ® , 4K score, SelectMDx ® , ConfirmMDx ® , PCA3, MiPS, ExoDX ® , mpMRI) and prognostic (OncotypeDX GPS ® , Prolaris ® , ProMark ® , DNA-ploidy, Decipher ® ) biomarkers that are in widespread clinical use and are supported by evidence. Hereby, we focus on multiple clinical situations in which innovative biomarkers may guide decision-making in prostate cancer therapy. In addition, we describe novel liquid biopsy approaches (circulating tumor cells, cell-free DNA) that have been described as predictive biomarkers in metastatic castration-resistant prostate cancer and might support an individual patient-centred oncological approach in the nearer future. Copyright © 2017 Elsevier B.V. All rights reserved.

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

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.

Assessment, design and control strategy development of a fuel cell hybrid electric vehicle for CSU's EcoCAR

NASA Astrophysics Data System (ADS)

Fox, Matthew D.

Advanced automotive technology assessment and powertrain design are increasingly performed through modeling, simulation, and optimization. But technology assessments usually target many competing criteria making any individual optimization challenging and arbitrary. Further, independent design simulations and optimizations take considerable time to execute, and design constraints and objectives change throughout the design process. Changes in design considerations usually require re-processing of simulations and more time. In this thesis, these challenges are confronted through CSU's participation in the EcoCAR2 hybrid vehicle design competition. The complexity of the competition's design objectives leveraged development of a decision support system tool to aid in multi-criteria decision making across technologies and to perform powertrain optimization. To make the decision support system interactive, and bypass the problem of long simulation times, a new approach was taken. The result of this research is CSU's architecture selection and component sizing, which optimizes a composite objective function representing the competition score. The selected architecture is an electric vehicle with an onboard range extending hydrogen fuel cell system. The vehicle has a 145kW traction motor, 18.9kWh of lithium ion battery, a 15kW fuel cell system, and 5kg of hydrogen storage capacity. Finally, a control strategy was developed that improves the vehicles performance throughout the driving range under variable driving conditions. In conclusion, the design process used in this research is reviewed and evaluated against other common design methodologies. I conclude, through the highlighted case studies, that the approach is more comprehensive than other popular design methodologies and is likely to lead to a higher quality product. The upfront modeling work and decision support system formulation will pay off in superior and timely knowledge transfer and more informed design decisions. The hypothesis is supported by the three case studies examined in this thesis.

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.

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.

Usability evaluation of the interactive Personal Patient Profile-Prostate decision support system with African American men.

PubMed

Jaja, Cheedy; Pares-Avila, Jose; Wolpin, Seth; Berry, Donna

2010-04-01

The Personal Patient Profile-Prostate (P4) program is an interactive Web-based decision support system that provides men with localized prostate cancer customized education and coaching with which to make the best personal treatment decision. This study assessed functionality and usability of the P4 program and identified problems in user-computer interaction in a sample of African American men. Usability testing was conducted with 12 community-dwelling African American adult men. The health status of participants was not known or collected by the research team. Each participant worked with the P4 program and provided simultaneous feedback using the "think aloud" technique. Handwritten field notes were collated and assigned to 3 standard coded categories. Aspects of P4 program usability was made based on common issues in the assigned categories. Summary statistics were derived for types and frequency of usability issues noted in the coded data. Twelve participants reported a total of 122 usability comments, with a mean of 9 usability comments. The most common usability issue by participant was completeness of information content, which comprised 53 (43%) of the total issues. Comprehensibility of text and graphics was second, comprising 51 (42%) of the total issues. This study provided initial inventory of usability issues for community African American men that may potentially interfere with application of the P4 system in the community setting and overall system usability, confirming the need for usability testing of a culturally appropriate Internet-based decision support system before community application.

Design and implementation of a risk assessment module in a spatial decision support system

NASA Astrophysics Data System (ADS)

Zhang, Kaixi; van Westen, Cees; Bakker, Wim

2014-05-01

The spatial decision support system named 'Changes SDSS' is currently under development. The goal of this system is to analyze changing hydro-meteorological hazards and the effect of risk reduction alternatives to support decision makers in choosing the best alternatives. The risk assessment module within the system is to assess the current risk, analyze the risk after implementations of risk reduction alternatives, and analyze the risk in different future years when considering scenarios such as climate change, land use change and population growth. The objective of this work is to present the detailed design and implementation plan of the risk assessment module. The main challenges faced consist of how to shift the risk assessment from traditional desktop software to an open source web-based platform, the availability of input data and the inclusion of uncertainties in the risk analysis. The risk assessment module is developed using Ext JS library for the implementation of user interface on the client side, using Python for scripting, as well as PostGIS spatial functions for complex computations on the server side. The comprehensive consideration of the underlying uncertainties in input data can lead to a better quantification of risk assessment and a more reliable Changes SDSS, since the outputs of risk assessment module are the basis for decision making module within the system. The implementation of this module will contribute to the development of open source web-based modules for multi-hazard risk assessment in the future. This work is part of the "CHANGES SDSS" project, funded by the European Community's 7th Framework Program.

Psychosocial work environment and mental health--a meta-analytic review.

PubMed

Stansfeld, Stephen; Candy, Bridget

2006-12-01

To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.

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…

Pedestrians’ behavior in emergency evacuation: Modeling and simulation

NASA Astrophysics Data System (ADS)

Wang, Lei; Zheng, Jie-Hui; Zhang, Xiao-Shuang; Zhang, Jian-Lin; Wang, Qiu-Zhen; Zhang, Qian

2016-11-01

The social force model has been widely used to simulate pedestrian evacuation by analyzing attractive, repulsive, driving, and fluctuating forces among pedestrians. Many researchers have improved its limitations in simulating behaviors of large-scale population. This study modifies the well-accepted social force model by considering the impacts of interaction among companions and further develops a comprehensive model by combining that with a multi-exit utility function. Then numerical simulations of evacuations based on the comprehensive model are implemented in the waiting hall of the Wulin Square Subway Station in Hangzhou, China. The results provide safety thresholds of pedestrian density and panic levels in different operation situations. In spite of the operation situation and the panic level, a larger friend-group size results in lower evacuation efficiency. Our study makes important contributions to building a comprehensive multi-exit social force model and to applying it to actual scenarios, which produces data to facilitate decision making in contingency plans and emergency treatment. Project supported by the National Natural Science Foundation of China (Grant No. 71471163).

Strengthening Multipayer Collaboration: Lessons From the Comprehensive Primary Care Initiative.

PubMed

Anglin, Grace; Tu, H A; Liao, Kristie; Sessums, Laura; Taylor, Erin Fries

2017-09-01

Policy Points: Collaboration across payers to align financial incentives, quality measurement, and data feedback to support practice transformation is critical, but challenging due to competitive market dynamics and competing institutional priorities. The Centers for Medicare & Medicaid Services or other entities convening multipayer initiatives can build trust with other participants by clearly outlining each participant's role and the parameters of collaboration at the outset of the initiative. Multipayer collaboration can be improved if participating payers employ neutral, proactive meeting facilitators; develop formal decision-making processes; seek input on decisions from practice representatives; and champion the initiative within their organizations. With increasing frequency, public and private payers are joining forces to align goals and resources for primary care transformation. However, sustaining engagement and achieving coordination among payers can be challenging. The Comprehensive Primary Care (CPC) initiative is one of the largest multipayer initiatives ever tested. Drawing on the experience of the CPC initiative, this paper examines the factors that influence the effectiveness of multipayer collaboration. This paper draws largely on semistructured interviews with CPC-participating payers and payer conveners that facilitated CPC discussions and on observation of payer meetings. We coded and analyzed these qualitative data to describe collaborative dynamics and outcomes and assess the factors influencing them. We found that several factors appeared to increase the likelihood of successful payer collaboration: contracting with effective, neutral payer conveners; leveraging the support of payer champions, and seeking input on decisions from practice representatives. The presence of these factors helped some CPC regions overcome significant initial barriers to achieve common goals. We also found that leadership from the Centers for Medicare & Medicaid Services (CMS) was key to achieving broad payer engagement in CPC, but CMS's dual role as initiative convener and participating payer at times made collaboration challenging. CMS was able to build trust with other payers by clarifying which parts of CPC could be adapted to regional contexts, deferring to other payers for these decisions, and increasing opportunities for payers to meet with CMS representatives. CPC demonstrates that when certain facilitating factors are present, payers can overcome competitive market dynamics and competing institutional priorities to align financial incentives, quality measurement, and data feedback to support practice transformation. Lessons from this large-scale, multipayer initiative may be helpful for other multipayer efforts getting under way. © 2017 Milbank Memorial Fund.

Environmental impact assessment of transportation projects: An analysis using an integrated GIS, remote sensing, and spatial modeling approach

NASA Astrophysics Data System (ADS)

El-Gafy, Mohamed Anwar

Transportation projects will have impact on the environment. The general environmental pollution and damage caused by roads is closely associated with the level of economic activity. Although Environmental Impact Assessments (EIAs) are dependent on geo-spatial information in order to make an assessment, there are no rules per se how to conduct an environmental assessment. Also, the particular objective of each assessment is dictated case-by-case, based on what information and analyses are required. The conventional way of Environmental Impact Assessment (EIA) study is a time consuming process because it has large number of dependent and independent variables which have to be taken into account, which also have different consequences. With the emergence of satellite remote sensing technology and Geographic Information Systems (GIS), this research presents a new framework for the analysis phase of the Environmental Impact Assessment (EIA) for transportation projects based on the integration between remote sensing technology, geographic information systems, and spatial modeling. By integrating the merits of the map overlay method and the matrix method, the framework analyzes comprehensively the environmental vulnerability around the road and its impact on the environment. This framework is expected to: (1) improve the quality of the decision making process, (2) be applied both to urban and inter-urban projects, regardless of transport mode, and (3) present the data and make the appropriate analysis to support the decision of the decision-makers and allow them to present these data to the public hearings in a simple manner. Case studies, transportation projects in the State of Florida, were analyzed to illustrate the use of the decision support framework and demonstrate its capabilities. This cohesive and integrated system will facilitate rational decisions through cost effective coordination of environmental information and data management that can be tailored to specific projects. The framework would facilitate collecting, organizing, analyzing, archiving, and coordinating the information and data necessary to support technical and policy transportation decisions.

Respect for Autonomy in Light of Neuropsychiatry.

PubMed

Müller, Sabine

2017-06-01

Bioethics needs an elaborated concept of autonomy based on empirical knowledge about the prerequisites of the capacity of autonomy. Whereas Beauchamp and Childress, and many other bioethicists have discussed social influences on the capacity of autonomy in depth, neurobiological influences have received less attention. A comprehensive concept of autonomy should consider both social and biological factors that can diminish the capacity of autonomy. This article focuses on neurobiological influences that can reduce the capacity of autonomy. The thesis of this article is that the integration of neuropsychiatric knowledge into the concept of autonomy is essential for (1) evaluating demands for harmful medical treatments which might be caused by a brain disease, and (2) deciding on involuntary treatments of patients who suffer from substantial lack of autonomy due to neuropsychiatric disorders. Diametrically opposed to such a comprehensive concept of the capacity of autonomy is the concept of 'liberty of illness'. In Germany, this concept is supported not only by anti-psychiatric groups but also by the Federal Constitutional Court. Several real cases demonstrate how the brain can be 'hijacked' by parasites, antibodies or technical devices. Applying the concept of 'liberty of illness' to persons whose decision-making capacity is severely affected by neuropsychiatric disorders is cynical. These patients neither chose their disease nor would refuse effective treatment if their will was not disturbed by the disease. Respect for autonomy should be understood as the positive obligation to save, support or restore the biological prerequisites of the capacity for autonomous decision-making. © 2017 John Wiley & Sons Ltd.

Conceptualizing and Advancing Research Networking Systems

PubMed Central

SCHLEYER, TITUS; BUTLER, BRIAN S.; SONG, MEI; SPALLEK, HEIKO

2013-01-01

Science in general, and biomedical research in particular, is becoming more collaborative. As a result, collaboration with the right individuals, teams, and institutions is increasingly crucial for scientific progress. We propose Research Networking Systems (RNS) as a new type of system designed to help scientists identify and choose collaborators, and suggest a corresponding research agenda. The research agenda covers four areas: foundations, presentation, architecture, and evaluation. Foundations includes project-, institution- and discipline-specific motivational factors; the role of social networks; and impression formation based on information beyond expertise and interests. Presentation addresses representing expertise in a comprehensive and up-to-date manner; the role of controlled vocabularies and folksonomies; the tension between seekers’ need for comprehensive information and potential collaborators’ desire to control how they are seen by others; and the need to support serendipitous discovery of collaborative opportunities. Architecture considers aggregation and synthesis of information from multiple sources, social system interoperability, and integration with the user’s primary work context. Lastly, evaluation focuses on assessment of collaboration decisions, measurement of user-specific costs and benefits, and how the large-scale impact of RNS could be evaluated with longitudinal and naturalistic methods. We hope that this article stimulates the human-computer interaction, computer-supported cooperative work, and related communities to pursue a broad and comprehensive agenda for developing research networking systems. PMID:24376309

Conceptualizing and Advancing Research Networking Systems.

PubMed

Schleyer, Titus; Butler, Brian S; Song, Mei; Spallek, Heiko

2012-03-01

Science in general, and biomedical research in particular, is becoming more collaborative. As a result, collaboration with the right individuals, teams, and institutions is increasingly crucial for scientific progress. We propose Research Networking Systems (RNS) as a new type of system designed to help scientists identify and choose collaborators, and suggest a corresponding research agenda. The research agenda covers four areas: foundations, presentation, architecture , and evaluation . Foundations includes project-, institution- and discipline-specific motivational factors; the role of social networks; and impression formation based on information beyond expertise and interests. Presentation addresses representing expertise in a comprehensive and up-to-date manner; the role of controlled vocabularies and folksonomies; the tension between seekers' need for comprehensive information and potential collaborators' desire to control how they are seen by others; and the need to support serendipitous discovery of collaborative opportunities. Architecture considers aggregation and synthesis of information from multiple sources, social system interoperability, and integration with the user's primary work context. Lastly, evaluation focuses on assessment of collaboration decisions, measurement of user-specific costs and benefits, and how the large-scale impact of RNS could be evaluated with longitudinal and naturalistic methods. We hope that this article stimulates the human-computer interaction, computer-supported cooperative work, and related communities to pursue a broad and comprehensive agenda for developing research networking systems.

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…

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol

PubMed Central

Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Ève; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Béatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Thérèse; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel; Bigras, Magali

2017-01-01

Introduction Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). Methods and analysis This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs’ qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). Ethics and dissemination This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs’ decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. PROSPERO registration number CRD42015020558. PMID:29133314

Decisional needs assessment of patients with complex care needs in primary care: a participatory systematic mixed studies review protocol.

PubMed

Bujold, Mathieu; Pluye, Pierre; Légaré, France; Haggerty, Jeannie; Gore, Genevieve C; Sherif, Reem El; Poitras, Marie-Eve; Beaulieu, Marie-Claude; Beaulieu, Marie-Dominique; Bush, Paula L; Couturier, Yves; Débarges, Beatrice; Gagnon, Justin; Giguère, Anik; Grad, Roland; Granikov, Vera; Goulet, Serge; Hudon, Catherine; Kremer, Bernardo; Kröger, Edeltraut; Kudrina, Irina; Lebouché, Bertrand; Loignon, Christine; Lussier, Marie-Therese; Martello, Cristiano; Nguyen, Quynh; Pratt, Rebekah; Rihoux, Benoit; Rosenberg, Ellen; Samson, Isabelle; Senn, Nicolas; Li Tang, David; Tsujimoto, Masashi; Vedel, Isabelle; Ventelou, Bruno; Wensing, Michel

2017-11-12

Patients with complex care needs (PCCNs) often suffer from combinations of multiple chronic conditions, mental health problems, drug interactions and social vulnerability, which can lead to healthcare services overuse, underuse or misuse. Typically, PCCNs face interactional issues and unmet decisional needs regarding possible options in a cascade of interrelated decisions involving different stakeholders (themselves, their families, their caregivers, their healthcare practitioners). Gaps in knowledge, values clarification and social support in situations where options need to be deliberated hamper effective decision support interventions. This review aims to (1) assess decisional needs of PCCNs from the perspective of stakeholders, (2) build a taxonomy of these decisional needs and (3) prioritise decisional needs with knowledge users (clinicians, patients and managers). This review will be based on the interprofessional shared decision making (IP-SDM) model and the Ottawa Decision Support Framework. Applying a participatory research approach, we will identify potentially relevant studies through a comprehensive literature search; select relevant ones using eligibility criteria inspired from our previous scoping review on PCCNs; appraise quality using the Mixed Methods Appraisal Tool; conduct a three-step synthesis (sequential exploratory mixed methods design) to build taxonomy of key decisional needs; and integrate these results with those of a parallel PCCNs' qualitative decisional need assessment (semistructured interviews and focus group with stakeholders). This systematic review, together with the qualitative study (approved by the Centre Intégré Universitaire de Santé et Service Sociaux du Saguenay-Lac-Saint-Jean ethical committee), will produce a working taxonomy of key decisional needs (ontological contribution), to inform the subsequent user-centred design of a support tool for addressing PCCNs' decisional needs (practical contribution). We will adapt the IP-SDM model, normally dealing with a single decision, for PCCNs who experience cascade of decisions involving different stakeholders (theoretical contribution). Knowledge users will facilitate dissemination of the results in the Canadian primary care network. CRD42015020558. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design.

PubMed

Islam, Roosan; Weir, Charlene R; Jones, Makoto; Del Fiol, Guilherme; Samore, Matthew H

2015-11-30

Clinical experts' cognitive mechanisms for managing complexity have implications for the design of future innovative healthcare systems. The purpose of the study is to examine the constituents of decision complexity and explore the cognitive strategies clinicians use to control and adapt to their information environment. We used Cognitive Task Analysis (CTA) methods to interview 10 Infectious Disease (ID) experts at the University of Utah and Salt Lake City Veterans Administration Medical Center. Participants were asked to recall a complex, critical and vivid antibiotic-prescribing incident using the Critical Decision Method (CDM), a type of Cognitive Task Analysis (CTA). Using the four iterations of the Critical Decision Method, questions were posed to fully explore the incident, focusing in depth on the clinical components underlying the complexity. Probes were included to assess cognitive and decision strategies used by participants. The following three themes emerged as the constituents of decision complexity experienced by the Infectious Diseases experts: 1) the overall clinical picture does not match the pattern, 2) a lack of comprehension of the situation and 3) dealing with social and emotional pressures such as fear and anxiety. All these factors contribute to decision complexity. These factors almost always occurred together, creating unexpected events and uncertainty in clinical reasoning. Five themes emerged in the analyses of how experts deal with the complexity. Expert clinicians frequently used 1) watchful waiting instead of over- prescribing antibiotics, engaged in 2) theory of mind to project and simulate other practitioners' perspectives, reduced very complex cases into simple 3) heuristics, employed 4) anticipatory thinking to plan and re-plan events and consulted with peers to share knowledge, solicit opinions and 5) seek help on patient cases. The cognitive strategies to deal with decision complexity found in this study have important implications for design future decision support systems for the management of complex patients.

Towards an internal model in pilot training.

PubMed

Braune, R J; Trollip, S R

1982-10-01

Optimal decision making requires an information seeking behavior which reflects the comprehension of the overall system dynamics. Research in the area of human monitors in man-machine systems supports the notion of an internal model with built-in expectancies. It is doubtful that the current approach to pilot training helps develop this internal model in the most efficient way. But this is crucial since the role of the pilot is changing to a systems' manager and decision maker. An extension of the behavioral framework of pilot training might help to prepare the pilot better for the increasingly complex flight environment. This extension is based on the theoretical model of schema theory, which evolved out of psychological research. The technological advances in aircraft simulators and in-flight performance measurement devices allow investigation of the still-unresolved issues.

Rough Set Theory based prognostication of life expectancy for terminally ill patients.

PubMed

Gil-Herrera, Eleazar; Yalcin, Ali; Tsalatsanis, Athanasios; Barnes, Laura E; Djulbegovic, Benjamin

2011-01-01

We present a novel knowledge discovery methodology that relies on Rough Set Theory to predict the life expectancy of terminally ill patients in an effort to improve the hospice referral process. Life expectancy prognostication is particularly valuable for terminally ill patients since it enables them and their families to initiate end-of-life discussions and choose the most desired management strategy for the remainder of their lives. We utilize retrospective data from 9105 patients to demonstrate the design and implementation details of a series of classifiers developed to identify potential hospice candidates. Preliminary results confirm the efficacy of the proposed methodology. We envision our work as a part of a comprehensive decision support system designed to assist terminally ill patients in making end-of-life care decisions.

Enhancing stakeholder involvement in environmental decision making: Active Response Geographic Information System

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

Faber, B.G.; Thomas, V.L.; Thomas, M.R.

This paper describes a spatial decision support system that facilitates land-related negotiations and resolving conflicts. This system, called Active Response Geographic Information System (AR/GIS), uses a geographic information system to examine land resource management issues which involve multiple stakeholder groups. In this process, participants are given the opportunity and tools needed to share ideas in a facilitated land resource allocation negotiation session. Participants are able to assess current land status, develop objectives, propose alternative planning scenarios, and evaluate the effects or impacts of each alternative. AR/GIS is a unique tool that puts geographic information directly at the fingertips of non-technicalmore » policy analysts, decision makers, and representatives of stakeholder groups during the negotiation process. AR/GIS enhances individual comprehension and ownership of the decision making process and increasing the efficiency and effectiveness of group debate. It is most beneficial to planning tasks which are inherently geographic in nature, which require consideration of a large number of physical constraints and economic implications, and which involve publicly sensitive tradeoffs.« 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.

[Value-based cancer care. From traditional evidence-based decision making to balanced decision making within frameworks of shared values].

PubMed

Palazzo, Salvatore; Filice, Aldo; Mastroianni, Candida; Biamonte, Rosalbino; Conforti, Serafino; Liguori, Virginia; Turano, Salvatore; De Simone, Rosanna; Rovito, Antonio; Manfredi, Caterina; Minardi, Stefano; Vilardo, Emmanuelle; Loizzo, Monica; Oriolo, Carmela

2016-04-01

Clinical decision making in oncology is based so far on the evidence of efficacy from high-quality clinical research. Data collection and analysis from experimental studies provide valuable insight into response rates and progression-free or overall survival. Data processing generates valuable information for medical professionals involved in cancer patient care, enabling them to make objective and unbiased choices. The increased attention of many scientific associations toward a more rational resource consumption in clinical decision making is mirrored in the Choosing Wisely campaign against the overuse or misuse of exams and procedures of little or no benefit for the patient. This cultural movement has been actively promoting care solutions based on the concept of "value". As a result, the value-based decision-making process for cancer care should not be dissociated from economic sustainability and from ethics of the affordability, also given the growing average cost of the most recent cancer drugs. In support of this orientation, the National Comprehensive Cancer Network (NCCN) has developed innovative and "complex" guidelines based on values, defined as "evidence blocks", with the aim of assisting the medical community in making overall sustainable choices.

Bridging the Gap: Need for a Data Repository to Support Vaccine Prioritization Efforts*

PubMed Central

Madhavan, Guruprasad; Phelps, Charles; Sangha, Kinpritma; Levin, Scott; Rappuoli, Rino

2015-01-01

As the mechanisms for discovery, development, and delivery of new vaccines become increasingly complex, strategic planning and priority setting have become ever more crucial. Traditional single value metrics such as disease burden or cost-effectiveness no longer suffice to rank vaccine candidates for development. The Institute of Medicine—in collaboration with the National Academy of Engineering—has developed a novel software system to support vaccine prioritization efforts. The Strategic Multi-Attribute Ranking Tool for Vaccines—SMART Vaccines—allows decision makers to specify their own value structure, selecting from among 28 pre-defined and up to 7 user-defined attributes relevant to the ranking of vaccine candidates. Widespread use of SMART Vaccines will require compilation of a comprehensive data repository for numerous relevant populations—including their demographics, disease burdens and associated treatment costs, as well as characterizing performance features of potential or existing vaccines that might be created, improved, or deployed. While the software contains preloaded data for a modest number of populations, a large gap exists between the existing data and a comprehensive data repository necessary to make full use of SMART Vaccines. While some of these data exist in disparate sources and forms, constructing a data repository will require much new coordination and focus. Finding strategies to bridge the gap to a comprehensive data repository remains the most important task in bringing SMART Vaccines to full fruition, and to support strategic vaccine prioritization efforts in general. PMID:26022565

Multi-test decision tree and its application to microarray data classification.

PubMed

Czajkowski, Marcin; Grześ, Marek; Kretowski, Marek

2014-05-01

The desirable property of tools used to investigate biological data is easy to understand models and predictive decisions. Decision trees are particularly promising in this regard due to their comprehensible nature that resembles the hierarchical process of human decision making. However, existing algorithms for learning decision trees have tendency to underfit gene expression data. The main aim of this work is to improve the performance and stability of decision trees with only a small increase in their complexity. We propose a multi-test decision tree (MTDT); our main contribution is the application of several univariate tests in each non-terminal node of the decision tree. We also search for alternative, lower-ranked features in order to obtain more stable and reliable predictions. Experimental validation was performed on several real-life gene expression datasets. Comparison results with eight classifiers show that MTDT has a statistically significantly higher accuracy than popular decision tree classifiers, and it was highly competitive with ensemble learning algorithms. The proposed solution managed to outperform its baseline algorithm on 14 datasets by an average 6%. A study performed on one of the datasets showed that the discovered genes used in the MTDT classification model are supported by biological evidence in the literature. This paper introduces a new type of decision tree which is more suitable for solving biological problems. MTDTs are relatively easy to analyze and much more powerful in modeling high dimensional microarray data than their popular counterparts. Copyright © 2014 Elsevier B.V. All rights reserved.

Primary motor cortex functionally contributes to language comprehension: An online rTMS study.

PubMed

Vukovic, Nikola; Feurra, Matteo; Shpektor, Anna; Myachykov, Andriy; Shtyrov, Yury

2017-02-01

Among various questions pertinent to grounding human cognitive functions in a neurobiological substrate, the association between language and motor brain structures is a particularly debated one in neuroscience and psychology. While many studies support a broadly distributed model of language and semantics grounded, among other things, in the general modality-specific systems, theories disagree as to whether motor and sensory cortex activity observed during language processing is functional or epiphenomenal. Here, we assessed the role of motor areas in linguistic processing by investigating the responses of 28 healthy volunteers to different word types in semantic and lexical decision tasks, following repetitive transcranial magnetic stimulation (rTMS) of primary motor cortex. We found that early rTMS (delivered within 200ms of word onset) produces a left-lateralised and meaning-specific change in reaction speed, slowing down behavioural responses to action-related words, and facilitating abstract words - an effect present only during semantic, but not lexical, decision. We interpret these data in light of action-perception theory of language, bolstering the claim that motor cortical areas play a functional role in language comprehension. Copyright © 2017 Elsevier Ltd. All rights reserved.

Ecological requirements for pallid sturgeon reproduction and recruitment in the Lower Missouri River: Annual report 2010

USGS Publications Warehouse

DeLonay, Aaron J.; Jacobson, Robert B.; Papoulias, Diana M.; Wildhaber, Mark L.; Chojnacki, Kimberly A.; Pherigo, Emily K.; Haas, Justin D.; Mestl, Gerald E.

2012-01-01

The Comprehensive Sturgeon Research Project is a multiyear, multiagency collaborative research framework developed to provide information to support pallid sturgeon recovery and Missouri River management decisions. The project strategy integrates field and laboratory studies of sturgeon reproductive ecology, early life history, habitat requirements, and physiology. The project scope of work is developed annually with cooperating research partners and in collaboration with the U.S. Army Corps of Engineers, Missouri River Recovery—Integrated Science Program. The research consists of several interdependent and complementary tasks that engage multiple disciplines. The research tasks in the 2010 scope of work primarily address spawning as a probable factor limiting pallid sturgeon survival and recovery, although limited pilot studies also have been initiated to examine the requirements of early life stages. The research is designed to inform management decisions affecting channel re-engineering, flow modification, and pallid sturgeon population augmentation on the Missouri River, and throughout the range of the species. Research and progress made through this project are reported to the U.S. Army Corps of Engineers annually. This annual report details the research effort and progress made by the Comprehensive Sturgeon Research Project during 2010.

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

A Computational Architecture Based on RFID Sensors for Traceability in Smart Cities.

PubMed

Mora-Mora, Higinio; Gilart-Iglesias, Virgilio; Gil, David; Sirvent-Llamas, Alejandro

2015-06-10

Information Technology and Communications (ICT) is presented as the main element in order to achieve more efficient and sustainable city resource management, while making sure that the needs of the citizens to improve their quality of life are satisfied. A key element will be the creation of new systems that allow the acquisition of context information, automatically and transparently, in order to provide it to decision support systems. In this paper, we present a novel distributed system for obtaining, representing and providing the flow and movement of people in densely populated geographical areas. In order to accomplish these tasks, we propose the design of a smart sensor network based on RFID communication technologies, reliability patterns and integration techniques. Contrary to other proposals, this system represents a comprehensive solution that permits the acquisition of user information in a transparent and reliable way in a non-controlled and heterogeneous environment. This knowledge will be useful in moving towards the design of smart cities in which decision support on transport strategies, business evaluation or initiatives in the tourism sector will be supported by real relevant information. As a final result, a case study will be presented which will allow the validation of the proposal.

A Computational Architecture Based on RFID Sensors for Traceability in Smart Cities

PubMed Central

Mora-Mora, Higinio; Gilart-Iglesias, Virgilio; Gil, David; Sirvent-Llamas, Alejandro

2015-01-01

Information Technology and Communications (ICT) is presented as the main element in order to achieve more efficient and sustainable city resource management, while making sure that the needs of the citizens to improve their quality of life are satisfied. A key element will be the creation of new systems that allow the acquisition of context information, automatically and transparently, in order to provide it to decision support systems. In this paper, we present a novel distributed system for obtaining, representing and providing the flow and movement of people in densely populated geographical areas. In order to accomplish these tasks, we propose the design of a smart sensor network based on RFID communication technologies, reliability patterns and integration techniques. Contrary to other proposals, this system represents a comprehensive solution that permits the acquisition of user information in a transparent and reliable way in a non-controlled and heterogeneous environment. This knowledge will be useful in moving towards the design of smart cities in which decision support on transport strategies, business evaluation or initiatives in the tourism sector will be supported by real relevant information. As a final result, a case study will be presented which will allow the validation of the proposal. PMID:26067195

WeightLifter: Visual Weight Space Exploration for Multi-Criteria Decision Making.

PubMed

Pajer, Stephan; Streit, Marc; Torsney-Weir, Thomas; Spechtenhauser, Florian; Muller, Torsten; Piringer, Harald

2017-01-01

A common strategy in Multi-Criteria Decision Making (MCDM) is to rank alternative solutions by weighted summary scores. Weights, however, are often abstract to the decision maker and can only be set by vague intuition. While previous work supports a point-wise exploration of weight spaces, we argue that MCDM can benefit from a regional and global visual analysis of weight spaces. Our main contribution is WeightLifter, a novel interactive visualization technique for weight-based MCDM that facilitates the exploration of weight spaces with up to ten criteria. Our technique enables users to better understand the sensitivity of a decision to changes of weights, to efficiently localize weight regions where a given solution ranks high, and to filter out solutions which do not rank high enough for any plausible combination of weights. We provide a comprehensive requirement analysis for weight-based MCDM and describe an interactive workflow that meets these requirements. For evaluation, we describe a usage scenario of WeightLifter in automotive engineering and report qualitative feedback from users of a deployed version as well as preliminary feedback from decision makers in multiple domains. This feedback confirms that WeightLifter increases both the efficiency of weight-based MCDM and the awareness of uncertainty in the ultimate decisions.

Toward Optimal Decision Making among Vulnerable Patients Referred for Cardiac Surgery: A Qualitative Analysis of Patient and Provider Perspectives.

PubMed

Gainer, Ryan A; Curran, Janet; Buth, Karen J; David, Jennie G; Légaré, Jean-Francois; Hirsch, Gregory M

2017-07-01

Comprehension of risks, benefits, and alternative treatment options has been shown to be poor among patients referred for cardiac interventions. Patients' values and preferences are rarely explicitly sought. An increasing proportion of frail and older patients are undergoing complex cardiac surgical procedures with increased risk of both mortality and prolonged institutional care. We sought input from patients and caregivers to determine the optimal approach to decision making in this vulnerable patient population. Focus groups were held with both providers and former patients. Three focus groups were convened for Coronary Artery Bypass Graft (CABG), Valve, or CABG +Valve patients ≥ 70 y old (2-y post-op, ≤ 8-wk post-op, complicated post-op course) (n = 15). Three focus groups were convened for Intermediate Medical Care Unit (IMCU) nurses, Intensive Care Unit (ICU) nurses, surgeons, anesthesiologists and cardiac intensivists (n = 20). We used a semi-structured interview format to ask questions surrounding the informed consent process. Transcribed audio data was analyzed to develop consistent and comprehensive themes. We identified 5 main themes that influence the decision making process: educational barriers, educational facilitators, patient autonomy and perceived autonomy, patient and family expectations of care, and decision making advocates. All themes were influenced by time constraints experienced in the current consent process. Patient groups expressed a desire to receive information earlier in their care to allow time to identify personal values and preferences in developing plans for treatment. Both groups strongly supported a formal approach for shared decision making with a decisional coach to provide information and facilitate communication with the care team. Identifying the barriers and facilitators to patient and caretaker engagement in decision making is a key step in the development of a structured, patient-centered SDM approach. Intervention early in the decision process, the use of individualized decision aids that employ graphic risk presentations, and a dedicated decisional coach were identified by patients and providers as approaches with a high potential for success. The impact of such a formalized shared decision making process in cardiac surgery on decisional quality will need to be formally assessed. Given the trend toward older and frail patients referred for complex cardiac procedures, the need for an effective shared decision making process is compelling.

A qualitative analysis of coronary heart disease patient views of dietary adherence and web-based and mobile-based nutrition tools

PubMed Central

Yehle, Karen S.; Chen, Aleda M. H.; Plake, Kimberly S.; Yi, Ji Soo; Mobley, Amy R.

2012-01-01

PURPOSE Dietary adherence can be challenging for patients with coronary heart disease (CHD), as they may require multiple dietary changes. Choosing appropriate food items may be difficult or take extensive amounts of time without the aid of technology. The objective of this project was to (1) examine the dietary challenges faced by patients with CHD, (2) examine methods of coping with dietary challenges, (3) explore the feasibility of a web-based food decision support system, and (4) explore the feasibility of a mobile-based food decision support system. METHODS Food for the Heart (FFH), a website-based food decision support system, and Mobile Magic Lens (MML), a mobile-based system, were developed to aid in daily dietary choices. Three CHD patient focus groups were conducted and focused on CHD-associated dietary changes as well as the FFH and MML prototypes. A total of 20 CHD patients and 7 informal caregivers participated. Qualitative, content analysis was performed to find themes grounded in the responses. RESULTS Five predominant themes emerged: 1) decreasing carbohydrate intake and portion control are common dietary challenges, 2) clinician and social support makes dietary adherence easier, 3) FFH could make meal-planning and dietary adherence less complicated, 4) MML could save time and assist with healthy choices, and 5) additional features need to be added to make both tools more comprehensive. CONCLUSIONS FFH and MML may be tools that CHD patients would value in making food choices and adhering to dietary recommendations, especially if additional features are added to assist patients with changes. PMID:22760245

TethysCluster: A comprehensive approach for harnessing cloud resources for hydrologic modeling

NASA Astrophysics Data System (ADS)

Nelson, J.; Jones, N.; Ames, D. P.

2015-12-01

Advances in water resources modeling are improving the information that can be supplied to support decisions affecting the safety and sustainability of society. However, as water resources models become more sophisticated and data-intensive they require more computational power to run. Purchasing and maintaining the computing facilities needed to support certain modeling tasks has been cost-prohibitive for many organizations. With the advent of the cloud, the computing resources needed to address this challenge are now available and cost-effective, yet there still remains a significant technical barrier to leverage these resources. This barrier inhibits many decision makers and even trained engineers from taking advantage of the best science and tools available. Here we present the Python tools TethysCluster and CondorPy, that have been developed to lower the barrier to model computation in the cloud by providing (1) programmatic access to dynamically scalable computing resources, (2) a batch scheduling system to queue and dispatch the jobs to the computing resources, (3) data management for job inputs and outputs, and (4) the ability to dynamically create, submit, and monitor computing jobs. These Python tools leverage the open source, computing-resource management, and job management software, HTCondor, to offer a flexible and scalable distributed-computing environment. While TethysCluster and CondorPy can be used independently to provision computing resources and perform large modeling tasks, they have also been integrated into Tethys Platform, a development platform for water resources web apps, to enable computing support for modeling workflows and decision-support systems deployed as web apps.

Patient Perspectives on Low-Dose Computed Tomography for Lung Cancer Screening, New Mexico, 2014

PubMed Central

Sussman, Andrew L.; Murrietta, Ambroshia M.; Getrich, Christina M.; Rhyne, Robert; Crowell, Richard E.; Taylor, Kathryn L.; Reifler, Ellen J.; Wescott, Pamela H.; Saeed, Ali I.; Hoffman, Richard M.

2016-01-01

Introduction National guidelines call for annual lung cancer screening for high-risk smokers using low-dose computed tomography (LDCT). The objective of our study was to characterize patient knowledge and attitudes about lung cancer screening, smoking cessation, and shared decision making by patient and health care provider. Methods We conducted semistructured qualitative interviews with patients with histories of heavy smoking who received care at a Federally Qualified Health Center (FQHC Clinic) and at a comprehensive cancer center-affiliated chest clinic (Chest Clinic) in Albuquerque, New Mexico. The interviews, conducted from February through September 2014, focused on perceptions about health screening, knowledge and attitudes about LDCT screening, and preferences regarding decision aids. We used a systematic iterative analytic process to identify preliminary and emergent themes and to create a coding structure. Results We reached thematic saturation after 22 interviews (10 at the FQHC Clinic, 12 at the Chest Clinic). Most patients were unaware of LDCT screening for lung cancer but were receptive to the test. Some smokers said they would consider quitting smoking if their screening result were positive. Concerns regarding screening were cost, radiation exposure, and transportation issues. To support decision making, most patients said they preferred one-on-one discussions with a provider. They also valued decision support tools (print materials, videos), but raised concerns about readability and Internet access. Conclusion Implementing lung cancer screening in sociodemographically diverse populations poses significant challenges. The value of tobacco cessation counseling cannot be overemphasized. Effective interventions for shared decision making to undergo lung cancer screening will need the active engagement of health care providers and will require the use of accessible decision aids designed for people with low health literacy. PMID:27536900

Eradicating the grey squirrel Sciurus carolinensis from urban areas: an innovative decision-making approach based on lessons learnt in Italy.

PubMed

La Morgia, Valentina; Paoloni, Daniele; Genovesi, Piero

2017-02-01

Eradication of invasive alien species supports the recovery of native biodiversity. A new European Union Regulation introduces obligations to eradicate the most harmful invasive species. However, eradications of charismatic mammals may encounter strong opposition. Considering the case study of the eastern grey squirrel (Sciurus carolinensis Gmelin, 1788) in central Italy, we developed a structured decision-making technique based on a Bayesian decision network model and explicitly considering the plurality of environmental values of invasive species management to reduce potential social conflicts. The model identified priority areas for management activities. These areas corresponded to the core of the grey squirrel range, but they also included peripheral zones, where rapid eradication is fundamental to prevent the spread of squirrels. However, when the model was expanded to integrate the attitude of citizens towards the project, the intervention strategy slightly changed. In some areas, the citizens' support was limited, and this resulted in a reduced overall utility of intervention. The suggested approach extends the scientific basis for management decisions, evaluated in terms of technical efficiency, feasibility and social impact. Here, the Bayesian decision network model analysed the potential technical and social consequences of management actions, and it responded to the need for transparency in the decision-making process, but it can easily be extended to consider further issues that are common in many mammal eradication programmes. Owing to its flexibility and comprehensiveness, it provides an innovative example of how to plan rapid eradication or control activities, as required by the new EU Regulation. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

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.

Green material selection for sustainability: A hybrid MCDM approach.

PubMed

Zhang, Honghao; Peng, Yong; Tian, Guangdong; Wang, Danqi; Xie, Pengpeng

2017-01-01

Green material selection is a crucial step for the material industry to comprehensively improve material properties and promote sustainable development. However, because of the subjectivity and conflicting evaluation criteria in its process, green material selection, as a multi-criteria decision making (MCDM) problem, has been a widespread concern to the relevant experts. Thus, this study proposes a hybrid MCDM approach that combines decision making and evaluation laboratory (DEMATEL), analytical network process (ANP), grey relational analysis (GRA) and technique for order performance by similarity to ideal solution (TOPSIS) to select the optimal green material for sustainability based on the product's needs. A nonlinear programming model with constraints was proposed to obtain the integrated closeness index. Subsequently, an empirical application of rubbish bins was used to illustrate the proposed method. In addition, a sensitivity analysis and a comparison with existing methods were employed to validate the accuracy and stability of the obtained final results. We found that this method provides a more accurate and effective decision support tool for alternative evaluation or strategy selection.

Green material selection for sustainability: A hybrid MCDM approach

PubMed Central

Zhang, Honghao; Peng, Yong; Tian, Guangdong; Wang, Danqi; Xie, Pengpeng

2017-01-01

Green material selection is a crucial step for the material industry to comprehensively improve material properties and promote sustainable development. However, because of the subjectivity and conflicting evaluation criteria in its process, green material selection, as a multi-criteria decision making (MCDM) problem, has been a widespread concern to the relevant experts. Thus, this study proposes a hybrid MCDM approach that combines decision making and evaluation laboratory (DEMATEL), analytical network process (ANP), grey relational analysis (GRA) and technique for order performance by similarity to ideal solution (TOPSIS) to select the optimal green material for sustainability based on the product's needs. A nonlinear programming model with constraints was proposed to obtain the integrated closeness index. Subsequently, an empirical application of rubbish bins was used to illustrate the proposed method. In addition, a sensitivity analysis and a comparison with existing methods were employed to validate the accuracy and stability of the obtained final results. We found that this method provides a more accurate and effective decision support tool for alternative evaluation or strategy selection. PMID:28498864

UNDERSTANDING THE PAST, MANAGING THE FUTURE - Remotely sensed analysis of the urban sprawl of Istanbul for supporting decision making for a sustainable future

NASA Astrophysics Data System (ADS)

Altan, O.; Kemper, G.

2012-07-01

The GIS based analysis of the land use change of Istanbul delivers a huge and comprehensive database that can be used for further analysis. Trend analysis and scenarios enable a view to the future that highlights the needs for a proper planning. Also the understanding via comparison to other cities assists in order not to copy errors from other cities. GIS in combination with ancillary data open a wide field for managing the future of Istanbul.

Five shared decision-making tools in 5 months: use of rapid reviews to develop decision boxes for seniors living with dementia and their caregivers.

PubMed

Lawani, Moulikatou Adouni; Valéra, Béatriz; Fortier-Brochu, Émilie; Légaré, France; Carmichael, Pierre-Hugues; Côté, Luc; Voyer, Philippe; Kröger, Edeltraut; Witteman, Holly; Rodriguez, Charo; Giguere, Anik M C

2017-03-15

Decision support tools build upon comprehensive and timely syntheses of literature. Rapid reviews may allow supporting their development by omitting certain components of traditional systematic reviews. We thus aimed to describe a rapid review approach underlying the development of decision support tools, i.e., five decision boxes (DB) for shared decision-making between seniors living with dementia, their caregivers, and healthcare providers. We included studies based on PICO questions (Participant, Intervention, Comparison, Outcome) describing each of the five specific decision. We gave priority to higher quality evidence (e.g., systematic reviews). For each DB, we first identified secondary sources of literature, namely, clinical summaries, clinical practice guidelines, and systematic reviews. After an initial extraction, we searched for primary studies in academic databases and grey literature to fill gaps in evidence. We extracted study designs, sample sizes, populations, and probabilities of benefits/harms of the health options. A single reviewer conducted the literature search and study selection. The data extracted by one reviewer was verified by a second experienced reviewer. Two reviewers assessed the quality of the evidence. We converted all probabilities into absolute risks for ease of understanding. Two to five experts validated the content of each DB. We conducted descriptive statistical analyses on the review processes and resources required. The approach allowed screening of a limited number of references (range: 104 to 406/review). For each review, we included 15 to 26 studies, 2 to 10 health options, 11 to 62 health outcomes and we conducted 9 to 47 quality assessments. A team of ten reviewers with varying levels of expertise was supported at specific steps by an information specialist, a biostatistician, and a graphic designer. The time required to complete a rapid review varied from 7 to 31 weeks per review (mean ± SD, 19 ± 10 weeks). Data extraction required the most time (8 ± 6.8 weeks). The average estimated cost of a rapid review was C$11,646 (SD = C$10,914). This approach enabled the development of clinical tools more rapidly than with a traditional systematic review. Future studies should evaluate the applicability of this approach to other teams/tools.

Managing perceived operational risk factors for effective supply-chain management

NASA Astrophysics Data System (ADS)

Sylla, Cheickna

2014-12-01

This research is part of a large scale comprehensive mathematical and empirical modeling investigation projects aimed at developing a better understanding of supply-chain risk management by offering a comprehensive framework including theoretical elements and empirical evidence based on managers' perception of improved organizational level of preparedness to safeguard against the threats of disruptions, delays and stoppage in the supply chain. More specifically, this paper reports the empirical investigation conducted using 92 companies in several eastern USA regions involved in international trades with global supply chains. Among the 56 general hypotheses investigated, the results support that managers strive to balance their control and decision impacts to mold their responses to risk factors with knowledge of the extent of cost consequences as stated in previous research. However, the results also propose new findings which significantly vary from previous research reports.

[Self-consciousness, consciousness of the other and dementias].

PubMed

Gil, Roger

2007-06-01

Studies of self-consciousness in dementia concern essentially anosognosia or the loss of insight. However, Self-consciousness is multifaceted: it includes awareness of the body, perceptions, one's own history, identity, and one's own projects. Self-consciousness is linked to consciousness of others i.e. to social cognition supported by identification of others, but also by comprehension of facial expression of emotions, comprehension and expression of emotional prosody, pragmatic abilities, ability to infer other's people's mental states, thoughts, and feelings (theory of mind and empathy), knowledge of social norms and rules, social reasoning. The subtypes of dementias (and namely Alzheimer's disease and frontotemporal dementia) affect heterogeneously the different aspects of the self-and other-consciousness. Further studies are needed for a better knowledge of the complex relationship between Self-consciousness, social cognition, decision making and neuropsychiatric symptoms and behavioral disturbances occurring in demented patients.

Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

PubMed

Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

2016-08-01

The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

Characteristics and Methodological Quality of Meta-Analyses on Hypertension Treatments-A Cross-Sectional Study.

PubMed

Wu, Xin Yin; Du, Xin Jian; Ho, Robin S T; Lee, Clarence C Y; Yip, Benjamin H K; Wong, Martin C S; Wong, Samuel Y S; Chung, Vincent C H

2017-02-01

Methodological quality of meta-analyses on hypertension treatments can affect treatment decision-making. The authors conducted a cross-sectional study to investigate the methodological quality of meta-analyses on hypertension treatments. One hundred and fifty-eight meta-analyses were identified. Overall, methodological quality was unsatisfactory in the following aspects: comprehensive reporting of financial support (1.9%), provision of included and excluded lists of studies (22.8%), inclusion of grey literature (27.2%), and inclusion of protocols (32.9%). The 126 non-Cochrane meta-analyses had poor performance on almost all the methodological items. Non-Cochrane meta-analyses focused on nonpharmacologic treatments were more likely to consider scientific quality of included studies when making conclusions. The 32 Cochrane meta-analyses generally had good methodological quality except for comprehensive reporting of the sources of support. These results highlight the need for cautious interpretation of these meta-analyses, especially among physicians and policy makers when guidelines are formulated. Future meta-analyses should pay attention to improving these methodological aspects. ©2016 Wiley Periodicals, Inc.

Adoption Decisions for Medical Devices in the Field of Cardiology: Results from a European Survey.

PubMed

Hatz, Maximilian H M; Schreyögg, Jonas; Torbica, Aleksandra; Boriani, Giuseppe; Blankart, Carl R B

2017-02-01

Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

Application of best practice approaches for designing decision support tools: The preparatory education about clinical trials (PRE-ACT) study

PubMed Central

Fleisher, Linda; Ruggieri, Dominique G.; Miller, Suzanne M.; Manne, Sharon; Albrecht, Terrance; Buzaglo, Joanne; Collins, Michael A.; Katz, Michael; Kinzy, Tyler G.; Liu, Tasnuva; Manning, Cheri; Charap, Ellen Specker; Millard, Jennifer; Miller, Dawn M.; Poole, David; Raivitch, Stephanie; Roach, Nancy; Ross, Eric A.; Meropol, Neal J.

2014-01-01

Objective This article describes the rigorous development process and initial feedback of the PRE-ACT (Preparatory Education About Clinical Trials) web-based- intervention designed to improve preparation for decision making in cancer clinical trials. Methods The multi-step process included stakeholder input, formative research, user testing and feedback. Diverse teams (researchers, advocates and developers) participated including content refinement, identification of actors, and development of video scripts. Patient feedback was provided in the final production period and through a vanguard group (N = 100) from the randomized trial. Results Patients/advocates confirmed barriers to cancer clinical trial participation, including lack of awareness and knowledge, fear of side effects, logistical concerns, and mistrust. Patients indicated they liked the tool’s user-friendly nature, the organized and comprehensive presentation of the subject matter, and the clarity of the videos. Conclusion The development process serves as an example of operationalizing best practice approaches and highlights the value of a multi-disciplinary team to develop a theory-based, sophisticated tool that patients found useful in their decision making process. Practice implications Best practice approaches can be addressed and are important to ensure evidence-based tools that are of value to patients and supports the usefulness of a process map in the development of e-health tools. PMID:24813474

Benchmarks in Clinical Productivity: A National Comprehensive Cancer Network Survey

PubMed Central

Stewart, F. Marc; Wasserman, Robert L.; Bloomfield, Clara D.; Petersdorf, Stephen; Witherspoon, Robert P.; Appelbaum, Frederick R.; Ziskind, Andrew; McKenna, Brian; Dodson, Jennifer M.; Weeks, Jane; Vaughan, William P.; Storer, Barry; Perkel, Sara; Waldinger, Marcy

2007-01-01

Purpose Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. Methods We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Results and Conclusion Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support. PMID:20859362

Benchmarks in clinical productivity: a national comprehensive cancer network survey.

PubMed

Stewart, F Marc; Wasserman, Robert L; Bloomfield, Clara D; Petersdorf, Stephen; Witherspoon, Robert P; Appelbaum, Frederick R; Ziskind, Andrew; McKenna, Brian; Dodson, Jennifer M; Weeks, Jane; Vaughan, William P; Storer, Barry; Perkel, Sara; Waldinger, Marcy

2007-01-01

Oncologists in academic cancer centers usually generate professional fees that are insufficient to cover salaries and other expenses, despite significant clinical activity; therefore, supplemental funding is frequently required in order to support competitive levels of physician compensation. Relative value units (RVUs) allow comparisons of productivity across institutions and practice locations and provide a reasonable point of reference on which funding decisions can be based. We reviewed the clinical productivity and other characteristics of oncology physicians practicing in 13 major academic cancer institutions with membership or shared membership in the National Comprehensive Cancer Network (NCCN). The objectives of this study were to develop tools that would lead to better-informed decision making regarding practice management and physician deployment in comprehensive cancer centers and to determine benchmarks of productivity using RVUs accrued by physicians at each institution. Three hundred fifty-three individual physician practices across the 13 NCCN institutions in the survey provided data describing adult hematology/medical oncology and bone marrow/stem-cell transplantation programs. Data from the member institutions participating in the survey included all American Medical Association Current Procedural Terminology (CPT®) codes generated (billed) by each physician during each organization's fiscal year 2003 as a measure of actual clinical productivity. Physician characteristic data included specialty, clinical full-time equivalent (CFTE) status, faculty rank, faculty track, number of years of experience, and total salary by funding source. The average adult hematologist/medical oncologist in our sample would produce 3,745 RVUs if he/she worked full-time as a clinician (100% CFTE), compared with 4,506 RVUs for a 100% CFTE transplant oncologist. Our results suggest specific clinical productivity targets for academic oncologists and provide a methodology for analyzing potential factors associated with clinical productivity and developing clinical productivity targets specific for physicians with a mix of research, administrative, teaching, and clinical salary support.

A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Involving people in decisions about their care is good practice and ensures optimal outcomes. Despite considerable research, in practice family involvement in decision making can be challenging for both care staff and families. The aim of this review was to identify and appraise existing knowledge about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute meta-synthesis considered studies that investigate involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this article presents the qualitative findings. A comprehensive search of studies was conducted in 15 electronic databases. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as relevant for this review; 16 were qualitative papers reporting on 15 studies. Two independent reviewers assessed the studies for methodological validity and extracted the data using the standardized Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The findings were synthesized using JBI-QARI. The findings related to the decisions encountered and made by family surrogates, family perceptions of, and preferences for, their role/s, factors regarding treatment decisions and the collaborative decision-making process, and outcomes for family decision makers. Results indicate varied and complex experiences and multiple factors influencing decision making. Communication and contacts between staff and families and the support available for families should be addressed, as well as the role of different stakeholders in decisions.

Patient decision aids in routine maternity care: Benefits, barriers, and new opportunities.

PubMed

Stevens, Gabrielle; Thompson, Rachel; Watson, Bernadette; Miller, Yvette D

2016-02-01

Participation in decision-making, supported by comprehensive and quality information provision, is increasingly emphasised as a priority for women in maternity care. Patient decision aids are tools that can offer women greater access to information and guidance to participate in maternity care decision-making. Relative to their evaluation in controlled settings, the implementation of patient decision aids in routine maternity care has received little attention and our understanding of which approaches may be effective is limited. This paper critically discusses the application of patient decision aids in routine maternity care and explores viable solutions for promoting their successful uptake. A range of patient decision aids have been developed for use within maternity care, and controlled trials have highlighted their positive impact on the decision-making process for women. Nevertheless, evidence of successful patient decision aid implementation in real world health care settings is lacking due to practical and ideological barriers that exist. Patient-directed social marketing campaigns are a relatively novel approach to patient decision aid delivery that may facilitate their adoption in maternity care, at least in the short-term, by overcoming common implementation barriers. Social marketing may also be particularly well suited to maternity care, given the unique characteristics of this health context. The potential of social marketing campaigns to facilitate patient decision aid adoption in maternity care highlights the need for pragmatic trials to evaluate their effectiveness. Identifying which sub-groups of women are more or less likely to respond to these strategies will further direct implementation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

A framework for evaluating the appropriateness of clinical decision support alerts and responses

PubMed Central

Waitman, Lemuel R; Lewis, Julia B; Wright, Julie A; Choma, David P; Miller, Randolph A; Peterson, Josh F

2011-01-01

Objective Alerting systems, a type of clinical decision support, are increasingly prevalent in healthcare, yet few studies have concurrently measured the appropriateness of alerts with provider responses to alerts. Recent reports of suboptimal alert system design and implementation highlight the need for better evaluation to inform future designs. The authors present a comprehensive framework for evaluating the clinical appropriateness of synchronous, interruptive medication safety alerts. Methods Through literature review and iterative testing, metrics were developed that describe successes, justifiable overrides, provider non-adherence, and unintended adverse consequences of clinical decision support alerts. The framework was validated by applying it to a medication alerting system for patients with acute kidney injury (AKI). Results Through expert review, the framework assesses each alert episode for appropriateness of the alert display and the necessity and urgency of a clinical response. Primary outcomes of the framework include the false positive alert rate, alert override rate, provider non-adherence rate, and rate of provider response appropriateness. Application of the framework to evaluate an existing AKI medication alerting system provided a more complete understanding of the process outcomes measured in the AKI medication alerting system. The authors confirmed that previous alerts and provider responses were most often appropriate. Conclusion The new evaluation model offers a potentially effective method for assessing the clinical appropriateness of synchronous interruptive medication alerts prior to evaluating patient outcomes in a comparative trial. More work can determine the generalizability of the framework for use in other settings and other alert types. PMID:21849334

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.

Adoption of clinical decision support systems in a developing country: Antecedents and outcomes of physician's threat to perceived professional autonomy.

PubMed

Esmaeilzadeh, Pouyan; Sambasivan, Murali; Kumar, Naresh; Nezakati, Hossein

2015-08-01

The basic objective of this research is to study the antecedents and outcomes of professional autonomy which is a central construct that affects physicians' intention to adopt clinical decision support systems (CDSS). The antecedents are physicians' attitude toward knowledge sharing and interactivity perception (about CDSS) and the outcomes are performance expectancy and intention to adopt CDSS. Besides, we include (1) the antecedents of attitude toward knowledge sharing-subjective norms, social factors and OCB (helping behavior) and (2) roles of physicians' involvement in decision making, computer self-efficacy and effort expectancy in our framework. Data from a stratified sample of 335 Malaysian physicians working in 12 public and private hospitals in Malaysia were collected to test the hypotheses using Structural Equation Modeling (SEM). The important findings of our research are: (1) factors such as perceived threat to professional autonomy, performance expectancy, and physicians' involvement in making decision about CDSS have significant impact on physicians' intention to adopt CDSS; (2) physicians' attitude toward knowledge sharing, interactivity perception and computer self-efficacy of physicians play a crucial role in influencing their perceived threat to professional autonomy; and (3) social network, shared goals and OCB (helping behavior) impact physicians' attitude toward knowledge sharing. The findings provide a comprehensive understanding of the factors that influence physicians' intention to adopt CDSS in a developing country. The results can help hospital managers manage CDSS implementation in an effective manner. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) system

PubMed Central

Colombet, Isabelle; Dart, Thierry; Leneveut, Laurence; Zunino, Sylvain; Ménard, Joël; Chatellier, Gilles

2003-01-01

Background Many preventable diseases such as ischemic heart diseases and breast cancer prevail at a large scale in the general population. Computerized decision support systems are one of the solutions for improving the quality of prevention strategies. Methods The system called EsPeR (Personalised Estimate of Risks) combines calculation of several risks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer, colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suicide risk). We present a qualitative evaluation of its ergonomics, as well as it's understanding and acceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the help of EsPeR, and three senior investigators leaded structured discussion sessions. Results The initial sessions identified several ergonomic flaws of the system that were easily corrected. Both clinical scenarios and discussion sessions identified several problems related to the insufficient comprehension (expression of risks, definition of familial history of disease), and difficulty for the physicians to accept some of the recommendations. Conclusion Educational, socio-professional and organisational components (i.e. time constraints for training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decision support systems, or their application in randomised trials. PMID:14641924

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.

Integrated data visualisation: an approach to capture older adults’ wellness

PubMed Central

Wilamowska, Katarzyna; Demiris, George; Thompson, Hilaire

2013-01-01

Informatics tools can help support the health and independence of older adults. In this paper, we present an approach towards integrating health-monitoring data and describe several techniques for the assessment and visualisation of integrated health and well-being of older adults. We present three different visualisation techniques to provide distinct alternatives towards display of the same information, focusing on reducing the cognitive load of data interpretation. We demonstrate the feasibility of integrating health-monitoring information into a comprehensive measure of wellness, while also highlighting the challenges of designing visual displays targeted at multiple user groups. These visual displays of wellness can be incorporated into personal health records and can be an effective support for informed decision-making. PMID:23079025

Apollo experience report: S-band system signal design and analysis

NASA Technical Reports Server (NTRS)

Rosenberg, H. R. (Editor)

1972-01-01

A description is given of the Apollo communications-system engineering-analysis effort that ensured the adequacy, performance, and interface compatibility of the unified S-band system elements for a successful lunar-landing mission. The evolution and conceptual design of the unified S-band system are briefly reviewed from a historical viewpoint. A comprehensive discussion of the unified S-band elements includes the salient design features of the system and serves as a basis for a better understanding of the design decisions and analyses. The significant design decisions concerning the Apollo communications-system signal design are discussed providing an insight into the role of systems analysis in arriving at the current configuration of the Apollo communications system. Analyses are presented concerning performance estimation (mathematical-model development through real-time mission support) and system deficiencies, modifications, and improvements.

Sustainable nanotechnology decision support system: bridging risk management, sustainable innovation and risk governance

NASA Astrophysics Data System (ADS)

Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Zabeo, Alex; Malsch, Ineke; McAlea, Eamonn; Murphy, Finbarr; Mullins, Martin; van Harmelen, Toon; Ligthart, Tom; Linkov, Igor; Marcomini, Antonio

2016-04-01

The significant uncertainties associated with the (eco)toxicological risks of engineered nanomaterials pose challenges to the development of nano-enabled products toward greatest possible societal benefit. This paper argues for the use of risk governance approaches to manage nanotechnology risks and sustainability, and considers the links between these concepts. Further, seven risk assessment and management criteria relevant to risk governance are defined: (a) life cycle thinking, (b) triple bottom line, (c) inclusion of stakeholders, (d) risk management, (e) benefit-risk assessment, (f) consideration of uncertainty, and (g) adaptive response. These criteria are used to compare five well-developed nanotechnology frameworks: International Risk Governance Council framework, Comprehensive Environmental Assessment, Streaming Life Cycle Risk Assessment, Certifiable Nanospecific Risk Management and Monitoring System and LICARA NanoSCAN. A Sustainable Nanotechnology Decision Support System (SUNDS) is proposed to better address current nanotechnology risk assessment and management needs, and makes. Stakeholder needs were solicited for further SUNDS enhancement through a stakeholder workshop that included representatives from regulatory, industry and insurance sectors. Workshop participants expressed the need for the wider adoption of sustainability assessment methods and tools for designing greener nanomaterials.

Formal ontologies in biomedical knowledge representation.

PubMed

Schulz, S; Jansen, L

2013-01-01

Medical decision support and other intelligent applications in the life sciences depend on increasing amounts of digital information. Knowledge bases as well as formal ontologies are being used to organize biomedical knowledge and data. However, these two kinds of artefacts are not always clearly distinguished. Whereas the popular RDF(S) standard provides an intuitive triple-based representation, it is semantically weak. Description logics based ontology languages like OWL-DL carry a clear-cut semantics, but they are computationally expensive, and they are often misinterpreted to encode all kinds of statements, including those which are not ontological. We distinguish four kinds of statements needed to comprehensively represent domain knowledge: universal statements, terminological statements, statements about particulars and contingent statements. We argue that the task of formal ontologies is solely to represent universal statements, while the non-ontological kinds of statements can nevertheless be connected with ontological representations. To illustrate these four types of representations, we use a running example from parasitology. We finally formulate recommendations for semantically adequate ontologies that can efficiently be used as a stable framework for more context-dependent biomedical knowledge representation and reasoning applications like clinical decision support systems.

Challenges to Applying a Metamodel for Groundwater Flow Beyond Underlying Numerical Model Boundaries

NASA Astrophysics Data System (ADS)

Reeves, H. W.; Fienen, M. N.; Feinstein, D.

2015-12-01

Metamodels of environmental behavior offer opportunities for decision support, adaptive management, and increased stakeholder engagement through participatory modeling and model exploration. Metamodels are derived from calibrated, computationally demanding, numerical models. They may potentially be applied to non-modeled areas to provide screening or preliminary analysis tools for areas that do not yet have the benefit of more comprehensive study. In this decision-support mode, they may be fulfilling a role often accomplished by application of analytical solutions. The major challenge to transferring a metamodel to a non-modeled area is how to quantify the spatial data in the new area of interest in such a way that it is consistent with the data used to derive the metamodel. Tests based on transferring a metamodel derived from a numerical groundwater-flow model of the Lake Michigan Basin to other glacial settings across the northern U.S. show that the spatial scale of the numerical model must be appropriately scaled to adequately represent different settings. Careful GIS analysis of the numerical model, metamodel, and new area of interest is required for successful transfer of results.

"Ultimately, mom has the call": Viewing clinical trial decision making among patients with ovarian cancer through the lens of relational autonomy.

PubMed

Asiedu, Gladys B; Ridgeway, Jennifer L; Carroll, Katherine; Jatoi, Aminah; Radecki Breitkopf, Carmen

2018-04-14

This study employs the concept of relational autonomy to understand how relational encounters with family members (FMs) and care providers may shape decisions around ovarian cancer patients' clinical trial (CT) participation. The study also offers unique insights into how FMs view patients' decision making. In-depth interviews were conducted with 33 patients with ovarian cancer who had been offered a CT and 39 FMs. Data were inductively analysed using a thematic approach and deductively informed by constructs derived from the theory of relational autonomy (RA). Patients' relationships, experiences and social status were significant resources that shaped their decisions. Patients did not give equal weight to all relationships and created boundaries around whom to include in decision making. Doctors' recommendations and perceived enthusiasm were described as influential in CT decisions. Both patients with ovarian cancer and their FMs maintained that patients have the "final say," indicating an individualistic autonomy. However, maintaining the "final say" in the decision-making process is constitutive of patients' relationships, emphasizing a relational approach to autonomy. FMs support patients' autonomy and they do so particularly when they believe the patient is capable of making the right choices. Although ethical principles underlying informed consent for CT participation emphasize individual autonomy, greater attention to relational autonomy is warranted for a more comprehensive understanding of CT decision making. © 2018 Mayo Clinic. Health Expectations published by John Wiley & Sons Ltd.

Use of the Decision Support System for VA cost-effectiveness research.

PubMed

Barnett, P G; Rodgers, J H

1999-04-01

The Department of Veterans Affairs is adopting the Decision Support System (DSS), computer software and databases which include a cost-accounting system which determines the cost of health care products and patient encounters. A system for providing cost data for cost-effectiveness analysis should be provide valid, detailed, and comprehensive data that can be aggregated. The design of DSS is described and compared with those criteria. Utilization data from DSS was compared with other VA utilization data. Aggregate DSS cost data from 35 medical centers was compared with relative resource weights developed for the Medicare program. Data on hospital stays at 3 facilities found that 3.7% of the stays in DSS were not in the VA discharge database, whereas 7.6% of the stays in the discharge data were not in DSS. DSS reported between 68.8% and 97.1% of the outpatient encounters reported by six facilities in the ambulatory care data base. Relative weights for each Diagnosis Related Group based on DSS data from 35 VA facilities correlated with Medicare weights (correlation coefficient of .853). DSS will be useful for research if certain problems are overcome. It is difficult to distinguish long-term from acute hospital care. VA does not have a complete database of all inpatient procedures, so DSS has not assigned them a specific cost. The authority to access encounter-level DSS data needs to be centralized. Researchers can provide the feedback needed to improve DSS cost estimates. A comprehensive encounter-level extract would facilitate use of DSS for research.

The James Supportive Care Screening: integrating science and practice to meet the NCCN guidelines for distress management at a Comprehensive Cancer Center.

PubMed

Wells-Di Gregorio, Sharla; Porensky, Emily K; Minotti, Matthew; Brown, Susan; Snapp, Janet; Taylor, Robert M; Adolph, Michael D; Everett, Sherman; Lowther, Kenneth; Callahan, Kelly; Streva, Devita; Heinke, Vicki; Leno, Debra; Flower, Courtney; McVey, Anne; Andersen, Barbara Lee

2013-09-01

Selecting a measure for oncology distress screening can be challenging. The measure must be brief, but comprehensive, capturing patients' most distressing concerns. The measure must provide meaningful coverage of multiple domains, assess symptom and problem-related distress, and ideally be suited for both clinical and research purposes. From March 2006 to August 2012, the James Supportive Care Screening (SCS) was developed and validated in three phases including content validation, factor analysis, and measure validation. Exploratory factor analyses were completed with 596 oncology patients followed by a confirmatory factor analysis with 477 patients. Six factors were identified and confirmed including (i) emotional concerns; (ii) physical symptoms; (iii) social/practical problems; (iv) spiritual problems; (v) cognitive concerns; and (vi) healthcare decision making/communication issues. Subscale evaluation reveals good to excellent internal consistency, test-retest reliability, and convergent, divergent, and predictive validity. Specificity of individual items was 0.90 and 0.87, respectively, for identifying patients with DSM-IV-TR diagnoses of major depression and generalized anxiety disorder. Results support use of the James SCS to quickly detect the most frequent and distressing symptoms and concerns of cancer patients. The James SCS is an efficient, reliable, and valid clinical and research outcomes measure. Copyright © 2013 John Wiley & Sons, Ltd.

Best of enemies: Using social network analysis to explore a policy network in European smoke-free policy.

PubMed

Weishaar, Heide; Amos, Amanda; Collin, Jeff

2015-05-01

Networks and coalitions of stakeholders play a crucial role in the development and implementation of policies, with previous research highlighting that networks in tobacco control are characterised by an antagonism between supporters and opponents of comprehensive tobacco control policies. This UK-based study used quantitative and qualitative network analysis (drawing on 176 policy submissions and 32 interviews) to systematically map and analyse a network of actors involved in the development of European Union (EU) smoke-free policy. Policy debates were dominated by two coalitions of stakeholders with starkly opposing positions on the issue. One coalition, consisting primarily of health-related organisations, supported comprehensive EU smoke-free policy, whereas the other, led by tobacco manufacturers' organisations, opposed the policy initiative. The data suggest that, aided by strong political commitment of EU decision makers to develop smoke-free policy, advocates supporting comprehensive EU policy were able to frame policy debates in ways which challenged the tobacco industry's legitimacy. They then benefited from the stark polarisation between the two coalitions. The paper provides empirical evidence of the division between two distinct coalitions in tobacco policy debates and draws attention to the complex processes of consensus-seeking, alliance-building and strategic action which are integral to the development of EU policy. Highlighting network polarisation and industry isolation as factors which seemed to increase tobacco control success, the study demonstrates the potential significance and value of FCTC article 5.3 for tobacco control policy-making. Copyright © 2015 Elsevier Ltd. All rights reserved.

Contextual Exploration of a New Family Caregiver Support Concept for Geriatric Settings Using a Participatory Health Research Strategy.

PubMed

Dorant, Elisabeth; Krieger, Theresia

2017-11-28

Family caregivers are the backbone of the long-term care support system within the home environment. Comprehensive caregiver support programs require collaboration and coordination within the system. A new public health concept, Vade Mecum, aims to harmonize and professionalize family caregiver support initiatives in geriatric care settings in the Euregion Maas-Rhine. Exploration of the new concept recently started in Germany to gain in-depth insight into current support and the needs of the geriatric care team and family caregivers. Within the context of an exploratory qualitative study, a participatory health research (PHR) strategy was applied to make optimal use of experience and knowledge from the system. Care professionals, engaged as co-researchers, were responsible for decisions about the research question, data collection methods and procedures of engaging family caregivers. A research team representing all professions within the geriatric department was formed. Research objectives were formulated and an appropriate mix of qualitative data collection methods consisting of interviews, focus groups and story-telling was chosen. Needs and expectations of the new concept, and practical solutions for involving family caregivers were discussed. A PHR strategy resulted in initiating a qualitative study in a geriatric care setting carried out by care professionals from the department. Knowledge was generated in a co-creative manner, and co-researchers were empowered. A comprehensive understanding of the system serves as a starting point for advancement of the new family caregiver concept.

TreePOD: Sensitivity-Aware Selection of Pareto-Optimal Decision Trees.

PubMed

Muhlbacher, Thomas; Linhardt, Lorenz; Moller, Torsten; Piringer, Harald

2018-01-01

Balancing accuracy gains with other objectives such as interpretability is a key challenge when building decision trees. However, this process is difficult to automate because it involves know-how about the domain as well as the purpose of the model. This paper presents TreePOD, a new approach for sensitivity-aware model selection along trade-offs. TreePOD is based on exploring a large set of candidate trees generated by sampling the parameters of tree construction algorithms. Based on this set, visualizations of quantitative and qualitative tree aspects provide a comprehensive overview of possible tree characteristics. Along trade-offs between two objectives, TreePOD provides efficient selection guidance by focusing on Pareto-optimal tree candidates. TreePOD also conveys the sensitivities of tree characteristics on variations of selected parameters by extending the tree generation process with a full-factorial sampling. We demonstrate how TreePOD supports a variety of tasks involved in decision tree selection and describe its integration in a holistic workflow for building and selecting decision trees. For evaluation, we illustrate a case study for predicting critical power grid states, and we report qualitative feedback from domain experts in the energy sector. This feedback suggests that TreePOD enables users with and without statistical background a confident and efficient identification of suitable decision trees.

An expanded framework to define and measure shared decision-making in dialogue: A 'top-down' and 'bottom-up' approach.

PubMed

Callon, Wynne; Beach, Mary Catherine; Links, Anne R; Wasserman, Carly; Boss, Emily F

2018-03-11

We aimed to develop a comprehensive, descriptive framework to measure shared decision making (SDM) in clinical encounters. We combined a top-down (theoretical) approach with a bottom-up approach based on audio-recorded dialogue to identify all communication processes related to decision making. We coded 55 pediatric otolaryngology visits using the framework and report interrater reliability. We identified 14 clinician behaviors and 5 patient behaviors that have not been previously described, and developed a new SDM framework that is descriptive (what does happen) rather than normative (what should happen). Through the bottom-up approach we identified three broad domains not present in other SDM frameworks: socioemotional support, understandability of clinician dialogue, and recommendation-giving. We also specify the ways in which decision-making roles are assumed implicitly rather than discussed explicitly. Interrater reliability was >75% for 92% of the coded behaviors. This SDM framework allows for a more expansive understanding and analysis of how decision making takes place in clinical encounters, including new domains and behaviors not present in existing measures. We hope that this new framework will bring attention to a broader conception of SDM and allow researchers to further explore the new domains and behaviors identified. Copyright © 2018. Published by Elsevier B.V.

Ecosystem services in risk assessment and management. ...

EPA Pesticide Factsheets

The ecosystem services (ES) concept holds much promise for environmental decision making. Even so, the concept has yet to gain full traction in the decisions and policies of environmental agencies in the United States, Europe, and elsewhere. Here we examine the opportunities for and implications of including ES in risk assessments and the risk management decisions that they inform. We assert that use of ES will: 1) lead to more comprehensive environmental protection; 2) help to articulate the benefits of environmental decisions, policies, and actions; 3) better inform the derivation of environmental quality standards; 4) enable integration of human health and ecological risk assessment; and 5) facilitate horizontal integration of policies, regulations, and programs. We provide the technical basis and supporting rationale for each assertion, relying on examples taken from experiences in the United States and European Union. Specific recommendations are offered for use of ES in risk assessment and risk management, and issues and challenges to advancing use of ES are described along with some of the science needed to improve the value of the ES concept to environmental protection. This paper is one of 4 papers generated from the 2014 Pellston Workshop “Ecosystem Services, Environmental Stressors and Decision Making,” organized jointly by the Society of Environmental Toxicology and Chemistry and the Ecological Society of America. The main workshop objective was

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

Applying multi-criteria decision-making to improve the waste reduction policy in Taiwan.

PubMed

Su, Jun-Pin; Hung, Ming-Lung; Chao, Chia-Wei; Ma, Hwong-wen

2010-01-01

Over the past two decades, the waste reduction problem has been a major issue in environmental protection. Both recycling and waste reduction policies have become increasingly important. As the complexity of decision-making has increased, it has become evident that more factors must be considered in the development and implementation of policies aimed at resource recycling and waste reduction. There are many studies focused on waste management excluding waste reduction. This study paid more attention to waste reduction. Social, economic, and management aspects of waste treatment policies were considered in this study. Further, a life-cycle assessment model was applied as an evaluation system for the environmental aspect. Results of both quantitative and qualitative analyses on the social, economic, and management aspects were integrated via the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method into the comprehensive decision-making support system of multi-criteria decision-making (MCDM). A case study evaluating the waste reduction policy in Taoyuan County is presented to demonstrate the feasibility of this model. In the case study, reinforcement of MSW sorting was shown to be the best practice. The model in this study can be applied to other cities faced with the waste reduction problems.

Decision-making experiences of family members of older adults with moderate dementia towards community and residential care home services: a grounded theory study protocol.

PubMed

Le Low, Lisa Pau; Lam, Lai Wah; Fan, Kim Pong

2017-06-05

Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services. A large multi-site constructivist grounded theory in a range of non-government organizations and a private aged home will frame this Hong Kong study. Purposive sampling will begin the recruitment of family members, followed by theoretical sampling. It is estimated that more than 100 family members using CS and RCH services will participate in an interview. The process of successive constant comparative analysis will be undertaken. The final product, a theory, will generate an integrated and comprehensive conceptual understanding which will explain the processes associated with decision-making of family members for dementia sufferers. Deeper understanding of issues including, but not exclusive to, service needs, expectations and hopes among family carers for improving service support to serve dementia sufferers in CS and RCH services will also be revealed. Importantly, this study seeks to illustrate the practical and strategic aspects of the theory and how it may be useful to transfer its applicability to various service settings to better support those who deliver formal and informal care to the dementia population.

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.

Hanford Site Raptor Nest Monitoring Report for Calendar Year 2013

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

Nugent, John J.; Lindsey, Cole T.; Wilde, Justin W.

2014-02-13

The U.S. Department of Energy, Richland Operations Office (DOE-RL) conducts ecological monitoring on the Hanford Site to collect and track data needed to ensure compliance with an array of environmental laws, regulations, and policies governing DOE activities. Ecological monitoring data provide baseline information about the plants, animals, and habitat under DOE-RL stewardship at Hanford required for decision-making under the National Environmental Policy Act (NEPA) and Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). The Hanford Site Comprehensive Land Use Plan (CLUP, DOE/EIS-0222-F) which is the Environmental Impact Statement for Hanford Site activities, helps ensure that DOE-RL, its contractors, and othermore » entities conducting activities on the Hanford Site are in compliance with NEPA. The Hanford Site supports a large and diverse community of raptorial birds (Fitzner et al. 1981), with 26 species of raptors observed on the Hanford Site.« less

Separable Processes Before, During, and After the N400 Elicited by Previously Inferred and New Information: Evidence from Time-Frequency Decompositions

PubMed Central

Steele, Vaughn R.; Bernat, Edward M.; van den Broek, Paul; Collins, Paul F.; Patrick, Christopher J.; Marsolek, Chad J.

2012-01-01

Successful comprehension during reading often requires inferring information not explicitly presented. This information is readily accessible when subsequently encountered, and a neural correlate of this is an attenuation of the N400 event-related potential (ERP). We used ERPs and time-frequency (TF) analysis to investigate neural correlates of processing inferred information after a causal coherence inference had been generated during text comprehension. Participants read short texts, some of which promoted inference generation. After each text, they performed lexical decisions to target words that were unrelated or inference-related to the preceding text. Consistent with previous findings, inference-related words elicited an attenuated N400 relative to unrelated words. TF analyses revealed unique contributions to the N400 from activity occurring at 1–6 Hz (theta) and 0–2 Hz (delta), supporting the view that multiple, sequential processes underlie the N400. PMID:23165117

Use of Decision Models in the Development of Evidence-Based Clinical Preventive Services Recommendations: Methods of the U.S. Preventive Services Task Force.

PubMed

Owens, Douglas K; Whitlock, Evelyn P; Henderson, Jillian; Pignone, Michael P; Krist, Alex H; Bibbins-Domingo, Kirsten; Curry, Susan J; Davidson, Karina W; Ebell, Mark; Gillman, Matthew W; Grossman, David C; Kemper, Alex R; Kurth, Ann E; Maciosek, Michael; Siu, Albert L; LeFevre, Michael L

2016-10-04

The U.S. Preventive Services Task Force (USPSTF) develops evidence-based recommendations about preventive care based on comprehensive systematic reviews of the best available evidence. Decision models provide a complementary, quantitative approach to support the USPSTF as it deliberates about the evidence and develops recommendations for clinical and policy use. This article describes the rationale for using modeling, an approach to selecting topics for modeling, and how modeling may inform recommendations about clinical preventive services. Decision modeling is useful when clinical questions remain about how to target an empirically established clinical preventive service at the individual or program level or when complex determinations of magnitude of net benefit, overall or among important subpopulations, are required. Before deciding whether to use decision modeling, the USPSTF assesses whether the benefits and harms of the preventive service have been established empirically, assesses whether there are key issues about applicability or implementation that modeling could address, and then defines the decision problem and key questions to address through modeling. Decision analyses conducted for the USPSTF are expected to follow best practices for modeling. For chosen topics, the USPSTF assesses the strengths and limitations of the systematically reviewed evidence and the modeling analyses and integrates the results of each to make preventive service recommendations.

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...

Understanding USGS user needs and Earth observing data use for decision making

NASA Astrophysics Data System (ADS)

Wu, Z.

2016-12-01

US Geological Survey (USGS) initiated the Requirements, Capabilities and Analysis for Earth Observations (RCA-EO) project in the Land Remote Sensing (LRS) program, collaborating with the National Oceanic and Atmospheric Administration (NOAA) to jointly develop the supporting information infrastructure - The Earth Observation Requirements Evaluation Systems (EORES). RCA-EO enables us to collect information on current data products and projects across the USGS and evaluate the impacts of Earth observation data from all sources, including spaceborne, airborne, and ground-based platforms. EORES allows users to query, filter, and analyze usage and impacts of Earth observation data at different organizational level within the bureau. We engaged over 500 subject matter experts and evaluated more than 1000 different Earth observing data sources and products. RCA-EO provides a comprehensive way to evaluate impacts of Earth observing data on USGS mission areas and programs through the survey of 345 key USGS products and services. We paid special attention to user feedback about Earth observing data to inform decision making on improving user satisfaction. We believe the approach and philosophy of RCA-EO can be applied in much broader scope to derive comprehensive knowledge of Earth observing systems impacts and usage and inform data products development and remote sensing technology innovation.

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

How do students navigate and learn from nonlinear science texts: Can metanavigation support promote science learning?

NASA Astrophysics Data System (ADS)

Stylianou, Agni

2003-06-01

Digital texts which are based on hypertext and hypermedia technologies are now being used to support science learning. Hypertext offers certain opportunities for learning as well as difficulties that challenge readers to become metacognitively aware of their navigation decisions in order to trade both meaning and structure while reading. The goal of this study was to investigate whether supporting sixth grade students to monitor and regulate their navigation behavior while reading from hypertext would lead to better navigation and learning. Metanavigation support in the form of prompts was provided to groups of students who used a hypertext system called CoMPASS to complete a design challenge. The metanavigation prompts aimed at encouraging students to understand the affordances of the navigational aids in CoMPASS and use them to guide their navigation. The study was conducted in a real classroom setting during the implementation of CoMPASS in sixth grade science classes. Multiple sources of group and individual data were collected and analyzed. Measures included student's individual performance in a pre-science knowledge test, the Metacognitive Awareness of Reading Strategies Inventory (MARSI), a reading comprehension test and a concept map test. Process measures included log file information that captured group navigation paths during the use of CoMPASS. The results suggested that providing metanavigation support enabled the groups to make coherent transitions among the text units. Findings also revealed that reading comprehension, presence of metanavigation support and prior domain knowledge significantly predicted students' individual understanding of science. Implications for hypertext design and literacy research fields are discussed.

SymptomCare@Home: Developing an Integrated Symptom Monitoring and Management System for Outpatients Receiving Chemotherapy.

PubMed

Beck, Susan L; Eaton, Linda H; Echeverria, Christina; Mooney, Kathi H

2017-10-01

SymptomCare@Home, an integrated symptom monitoring and management system, was designed as part of randomized clinical trials to help patients with cancer who receive chemotherapy in ambulatory clinics and often experience significant symptoms at home. An iterative design process was informed by chronic disease management theory and features of assessment and clinical decision support systems used in other diseases. Key stakeholders participated in the design process: nurse scientists, clinical experts, bioinformatics experts, and computer programmers. Especially important was input from end users, patients, and nurse practitioners participating in a series of studies testing the system. The system includes both a patient and clinician interface and fully integrates two electronic subsystems: a telephone computer-linked interactive voice response system and a Web-based Decision Support-Symptom Management System. Key features include (1) daily symptom monitoring, (2) self-management coaching, (3) alerting, and (4) nurse practitioner follow-up. The nurse practitioner is distinctively positioned to provide assessment, education, support, and pharmacologic and nonpharmacologic interventions to intensify management of poorly controlled symptoms at home. SymptomCare@Home is a model for providing telehealth. The system facilitates using evidence-based guidelines as part of a comprehensive symptom management approach. The design process and system features can be applied to other diseases and conditions.

A Comparison of Five FMRI Protocols for Mapping Speech Comprehension Systems

PubMed Central

Binder, Jeffrey R.; Swanson, Sara J.; Hammeke, Thomas A.; Sabsevitz, David S.

2008-01-01

Aims Many fMRI protocols for localizing speech comprehension have been described, but there has been little quantitative comparison of these methods. We compared five such protocols in terms of areas activated, extent of activation, and lateralization. Methods FMRI BOLD signals were measured in 26 healthy adults during passive listening and active tasks using words and tones. Contrasts were designed to identify speech perception and semantic processing systems. Activation extent and lateralization were quantified by counting activated voxels in each hemisphere for each participant. Results Passive listening to words produced bilateral superior temporal activation. After controlling for pre-linguistic auditory processing, only a small area in the left superior temporal sulcus responded selectively to speech. Active tasks engaged an extensive, bilateral attention and executive processing network. Optimal results (consistent activation and strongly lateralized pattern) were obtained by contrasting an active semantic decision task with a tone decision task. There was striking similarity between the network of brain regions activated by the semantic task and the network of brain regions that showed task-induced deactivation, suggesting that semantic processing occurs during the resting state. Conclusions FMRI protocols for mapping speech comprehension systems differ dramatically in pattern, extent, and lateralization of activation. Brain regions involved in semantic processing were identified only when an active, non-linguistic task was used as a baseline, supporting the notion that semantic processing occurs whenever attentional resources are not controlled. Identification of these lexical-semantic regions is particularly important for predicting language outcome in patients undergoing temporal lobe surgery. PMID:18513352

The impact of programmatic assessment on student learning: theory versus practice.

PubMed

Heeneman, Sylvia; Oudkerk Pool, Andrea; Schuwirth, Lambert W T; van der Vleuten, Cees P M; Driessen, Erik W

2015-05-01

It is widely acknowledged that assessment can affect student learning. In recent years, attention has been called to 'programmatic assessment', which is intended to optimise both learning functions and decision functions at the programme level of assessment, rather than according to individual methods of assessment. Although the concept is attractive, little research into its intended effects on students and their learning has been conducted. This study investigated the elements of programmatic assessment that students perceived as supporting or inhibiting learning, and the factors that influenced the active construction of their learning. The study was conducted in a graduate-entry medical school that implemented programmatic assessment. Thus, all assessment information, feedback and reflective activities were combined into a comprehensive, holistic programme of assessment. We used a qualitative approach and interviewed students (n = 17) in the pre-clinical phase of the programme about their perceptions of programmatic assessment and learning approaches. Data were scrutinised using theory-based thematic analysis. Elements from the comprehensive programme of assessment, such as feedback, portfolios, assessments and assignments, were found to have both supporting and inhibiting effects on learning. These supporting and inhibiting elements influenced students' construction of learning. Findings showed that: (i) students perceived formative assessment as summative; (ii) programmatic assessment was an important trigger for learning, and (iii) the portfolio's reflective activities were appreciated for their generation of knowledge, the lessons drawn from feedback, and the opportunities for follow-up. Some students, however, were less appreciative of reflective activities. For these students, the elements perceived as inhibiting seemed to dominate the learning response. The active participation of learners in their own learning is possible when learning is supported by programmatic assessment. Certain features of the comprehensive programme of assessment were found to influence student learning, and this influence can either support or inhibit students' learning responses. © 2015 John Wiley & Sons Ltd.

A platform for population-based weight management: description of a health plan-based integrated systems approach.

PubMed

Pronk, Nicolaas P; Boucher, Jackie L; Gehling, Eve; Boyle, Raymond G; Jeffery, Robert W

2002-10-01

To describe an integrated, operational platform from which mail- and telephone-based health promotion programs are implemented and to specifically relate this approach to weight management programming in a managed care setting. In-depth description of essential systems structures, including people, computer technology, and decision-support protocols. The roles of support staff, counselors, a librarian, and a manager in delivering a weight management program are described. Information availability using computer technology is a critical component in making this system effective and is presented according to its architectural layout and design. Protocols support counselors and administrative support staff in decision making, and a detailed flowchart presents the layout of this part of the system. This platform is described in the context of a weight management program, and we present baseline characteristics of 1801 participants, their behaviors, self-reported medical conditions, and initial pattern of enrollment in the various treatment options. Considering the prevalence and upward trend of overweight and obesity in the United States, a need exists for robust intervention platforms that can systematically support multiple types of programs. Weight management interventions implemented using this platform are scalable to the population level and are sustainable over time despite the limits of defined resources and budgets. The present article describes an innovative approach to reaching a large population with effective programs in an integrated, coordinated, and systematic manner. This comprehensive, robust platform represents an example of how obesity prevention and treatment research may be translated into the applied setting.

The menu-setting problem and subsidized prices: drug formulary illustration.

PubMed

Olmstead, T; Zeckhauser, R

1999-10-01

The menu-setting problem (MSP) determines the goods and services an institution offers and the prices charged. It appears widely in health care, from choosing the services an insurance arrangement offers, to selecting the health plans an employer proffers. The challenge arises because purchases are subsidized, and consumers (or their physician agents) may make cost-ineffective choices. The intuitively comprehensible MSP model--readily solved by computer using actual data--helps structure thinking and support decision making about such problems. The analysis uses drug formularies--lists of approved drugs in a plan or institution--to illustrate the framework.

Social impact analysis: monetary valuation

USGS Publications Warehouse

Wainger, Lisa A.; Johnston, Robert J.; Bagstad, Kenneth J.; Casey, Frank; Vegh, Tibor

2014-01-01

This section provides basic guidance for using and conducting economic valuation, including criteria for judging whether valuation is appropriate for supporting decisions. It provides an introduction to the economic techniques used to measure changes in social welfare and describes which methods may be most appropriate for use in valuing particular ecosystem services. Rather than providing comprehensive valuation instructions,it directs readers to additional resources.More generally, it establishes that the valuation of ecosystem services is grounded in a long history of non-market valuation and discusses how ecosystem services valuation can be conducted within established economic theory and techniques.

A model of individualized canonical microcircuits supporting cognitive operations

PubMed Central

Peterson, Andre D. H.; Haueisen, Jens; Knösche, Thomas R.

2017-01-01

Major cognitive functions such as language, memory, and decision-making are thought to rely on distributed networks of a large number of basic elements, called canonical microcircuits. In this theoretical study we propose a novel canonical microcircuit model and find that it supports two basic computational operations: a gating mechanism and working memory. By means of bifurcation analysis we systematically investigate the dynamical behavior of the canonical microcircuit with respect to parameters that govern the local network balance, that is, the relationship between excitation and inhibition, and key intrinsic feedback architectures of canonical microcircuits. We relate the local behavior of the canonical microcircuit to cognitive processing and demonstrate how a network of interacting canonical microcircuits enables the establishment of spatiotemporal sequences in the context of syntax parsing during sentence comprehension. This study provides a framework for using individualized canonical microcircuits for the construction of biologically realistic networks supporting cognitive operations. PMID:29200435

RPD-based Hypothesis Reasoning for Cyber Situation Awareness

NASA Astrophysics Data System (ADS)

Yen, John; McNeese, Michael; Mullen, Tracy; Hall, David; Fan, Xiaocong; Liu, Peng

Intelligence workers such as analysts, commanders, and soldiers often need a hypothesis reasoning framework to gain improved situation awareness of the highly dynamic cyber space. The development of such a framework requires the integration of interdisciplinary techniques, including supports for distributed cognition (human-in-the-loop hypothesis generation), supports for team collaboration (identification of information for hypothesis evaluation), and supports for resource-constrained information collection (hypotheses competing for information collection resources). We here describe a cognitively-inspired framework that is built upon Klein’s recognition-primed decision model and integrates the three components of Endsley’s situation awareness model. The framework naturally connects the logic world of tools for cyber situation awareness with the mental world of human analysts, enabling the perception, comprehension, and prediction of cyber situations for better prevention, survival, and response to cyber attacks by adapting missions at the operational, tactical, and strategic levels.

The development of a disease oriented eFolder for multiple sclerosis decision support

NASA Astrophysics Data System (ADS)

Ma, Kevin; Jacobs, Colin; Fernandez, James; Amezcua, Lilyana; Liu, Brent

2010-03-01

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. The chronic nature of MS necessitates multiple MRI studies to track disease progression. Currently, MRI assessment of multiple sclerosis requires manual lesion measurement and yields an estimate of lesion volume and change that is highly variable and user-dependent. In the setting of a longitudinal study, disease trends and changes become difficult to extrapolate from the lesions. In addition, it is difficult to establish a correlation between these imaged lesions and clinical factors such as treatment course. To address these clinical needs, an MS specific e-Folder for decision support in the evaluation and assessment of MS has been developed. An e-Folder is a disease-centric electronic medical record in contrast to a patient-centric electronic health record. Along with an MS lesion computer aided detection (CAD) package for lesion load, location, and volume, clinical parameters such as patient demographics, disease history, clinical course, and treatment history are incorporated to make the e-Folder comprehensive. With the integration of MRI studies together with related clinical data and informatics tools designed for monitoring multiple sclerosis, it provides a platform to improve the detection of treatment response in patients with MS. The design and deployment of MS e-Folder aims to standardize MS lesion data and disease progression to aid in decision making and MS-related research.

Systematic review and meta-analysis of factors that help or hinder treatment decision-making capacity in psychosis.

PubMed

Larkin, Amanda; Hutton, Paul

2017-10-01

Background The evidence on factors that may influence treatment decisional capacity ('capacity') in psychosis has yet to be comprehensively synthesised, which limits the development of effective strategies to improve or support it. Aims To determine the direction, magnitude and reliability of the relationship between capacity in psychosis and a range of clinical, demographic and treatment-related factors, thus providing a thorough synthesis of current knowledge. Method We conducted a systematic review, meta-analytical and narrative synthesis of factors that help or hinder treatment decision-making capacity in psychosis, assessing the direction, magnitude, significance and reliability of reported associations. Results We identified 23 relevant studies ( n = l823). Psychotic symptoms had small, moderate and strong associations with appreciation, understanding and reasoning respectively. Both verbal cognitive functioning and duration of education had small to moderate correlations with understanding and reasoning. Better capacity was also associated with better insight, better metacognitive ability, higher anxiety and lower perceived coercion. No linear relationship with depression was observed. Interventions linked to improved capacity over time were in-patient care, information simplification, shared decision-making and metacognitive training. Conclusions Although much is known about the role of symptoms and other clinical variables, effective and acceptable psychological interventions to support capacity in this group are lacking. © The Royal College of Psychiatrists 2017.

Applying the Land Use Portfolio Model with Hazus to analyse risk from natural hazard events

USGS Publications Warehouse

Dinitz, Laura B.; Taketa, Richard A.

2013-01-01

This paper describes and demonstrates the integration of two geospatial decision-support systems for natural-hazard risk assessment and management. Hazus is a risk-assessment tool developed by the Federal Emergency Management Agency to identify risks and estimate the severity of risk from natural hazards. The Land Use Portfolio Model (LUPM) is a risk-management tool developed by the U.S. Geological Survey to evaluate plans or actions intended to reduce risk from natural hazards. We analysed three mitigation policies for one earthquake scenario in the San Francisco Bay area to demonstrate the added value of using Hazus and the LUPM together. The demonstration showed that Hazus loss estimates can be input to the LUPM to obtain estimates of losses avoided through mitigation, rates of return on mitigation investment, and measures of uncertainty. Together, they offer a more comprehensive approach to help with decisions for reducing risk from natural hazards.

Automated recommendation for cervical cancer screening and surveillance.

PubMed

Wagholikar, Kavishwar B; MacLaughlin, Kathy L; Casey, Petra M; Kastner, Thomas M; Henry, Michael R; Hankey, Ronald A; Peters, Steve G; Greenes, Robert A; Chute, Christopher G; Liu, Hongfang; Chaudhry, Rajeev

2014-01-01

Because of the complexity of cervical cancer prevention guidelines, clinicians often fail to follow best-practice recommendations. Moreover, existing clinical decision support (CDS) systems generally recommend a cervical cytology every three years for all female patients, which is inappropriate for patients with abnormal findings that require surveillance at shorter intervals. To address this problem, we developed a decision tree-based CDS system that integrates national guidelines to provide comprehensive guidance to clinicians. Validation was performed in several iterations by comparing recommendations generated by the system with those of clinicians for 333 patients. The CDS system extracted relevant patient information from the electronic health record and applied the guideline model with an overall accuracy of 87%. Providers without CDS assistance needed an average of 1 minute 39 seconds to decide on recommendations for management of abnormal findings. Overall, our work demonstrates the feasibility and potential utility of automated recommendation system for cervical cancer screening and surveillance.

A work-centered cognitively based architecture for decision support: the work-centered infomediary layer (WIL) model

NASA Astrophysics Data System (ADS)

Zachary, Wayne; Eggleston, Robert; Donmoyer, Jason; Schremmer, Serge

2003-09-01

Decision-making is strongly shaped and influenced by the work context in which decisions are embedded. This suggests that decision support needs to be anchored by a model (implicit or explicit) of the work process, in contrast to traditional approaches that anchor decision support to either context free decision models (e.g., utility theory) or to detailed models of the external (e.g., battlespace) environment. An architecture for cognitively-based, work centered decision support called the Work-centered Informediary Layer (WIL) is presented. WIL separates decision support into three overall processes that build and dynamically maintain an explicit context model, use the context model to identify opportunities for decision support and tailor generic decision-support strategies to the current context and offer them to the system-user/decision-maker. The generic decision support strategies include such things as activity/attention aiding, decision process structuring, work performance support (selective, contextual automation), explanation/ elaboration, infosphere data retrieval, and what if/action-projection and visualization. A WIL-based application is a work-centered decision support layer that provides active support without intent inferencing, and that is cognitively based without requiring classical cognitive task analyses. Example WIL applications are detailed and discussed.

Decision support methods for the detection of adverse events in post-marketing data.

PubMed

Hauben, M; Bate, A

2009-04-01

Spontaneous reporting is a crucial component of post-marketing drug safety surveillance despite its significant limitations. The size and complexity of some spontaneous reporting system databases represent a challenge for drug safety professionals who traditionally have relied heavily on the scientific and clinical acumen of the prepared mind. Computer algorithms that calculate statistical measures of reporting frequency for huge numbers of drug-event combinations are increasingly used to support pharamcovigilance analysts screening large spontaneous reporting system databases. After an overview of pharmacovigilance and spontaneous reporting systems, we discuss the theory and application of contemporary computer algorithms in regular use, those under development, and the practical considerations involved in the implementation of computer algorithms within a comprehensive and holistic drug safety signal detection program.

From psychological need satisfaction to intentional behavior: testing a motivational sequence in two behavioral contexts.

PubMed

Hagger, Martin S; Chatzisarantis, Nikos L D; Harris, Jemma

2006-02-01

The present study tested a motivational sequence in which global-level psychological need satisfaction from self-determination theory influenced intentions and behavior directly and indirectly through contextual-level motivation and situational-level decision-making constructs from the theory of planned behavior. Two samples of university students (N = 511) completed measures of global-level psychological need satisfaction, contextual-level autonomous motivation, and situational-level attitudes, subjective norms, perceived behavioral control, intentions, and behavior in two behavioral contexts: exercise and dieting. A structural equation model supported the proposed sequence in both samples. The indirect effect was present for exercise behavior, whereas both direct and indirect effects were found for dieting behavior. Findings independently supported the component theories and provided a comprehensive integrated explanation of volitional behavior.

Overcoming barriers to cancer-helpline professionals providing decision support for callers: an implementation study.

PubMed

Stacey, Dawn; Chambers, Suzanne K; Jacobsen, Mary Jane; Dunn, Jeff

2008-11-01

To evaluate the effect of an intervention on healthcare professionals' perceptions of barriers influencing their provision of decision support for callers facing cancer-related decisions. A pre- and post-test study guided by the Ottawa Model of Research Use. Australian statewide cancer call center that provides public access to information and supportive cancer services. 34 nurses, psychologists, and other allied healthcare professionals at the cancer call center. Participants completed baseline measures and, subsequently, were exposed to an intervention that included a decision support tutorial, coaching protocol, and skill-building workshop. Strategies were implemented to address organizational barriers. Perceived barriers and facilitators influencing provision of decision support, decision support knowledge, quality of decision support provided to standardized callers, and call length. Postintervention participants felt more prepared, confident in providing decision support, and aware of decision support resources. They had a stronger belief that providing decision support was within their role. Participants significantly improved their knowledge and provided higher-quality decision support to standardized callers without changing call length. The implementation intervention overcame several identified barriers that influenced call center professionals when providing decision support. Nurses and other helpline professionals have the potential to provide decision support designed to help callers understand cancer information, clarify their values associated with their options, and reduce decisional conflict. However, they require targeted education and organizational interventions to reduce their perceived barriers to providing decision support.

Testing a Nursing-Specific Model of Electronic Patient Record documentation with regard to information completeness, comprehensiveness and consistency.

PubMed

von Krogh, Gunn; Nåden, Dagfinn; Aasland, Olaf Gjerløw

2012-10-01

To present the results from the test site application of the documentation model KPO (quality assurance, problem solving and caring) designed to impact the quality of nursing information in electronic patient record (EPR). The KPO model was developed by means of consensus group and clinical testing. Four documentation arenas and eight content categories, nursing terminologies and a decision-support system were designed to impact the completeness, comprehensiveness and consistency of nursing information. The testing was performed in a pre-test/post-test time series design, three times at a one-year interval. Content analysis of nursing documentation was accomplished through the identification, interpretation and coding of information units. Data from the pre-test and post-test 2 were subjected to statistical analyses. To estimate the differences, paired t-tests were used. At post-test 2, the information is found to be more complete, comprehensive and consistent than at pre-test. The findings indicate that documentation arenas combining work flow and content categories deduced from theories on nursing practice can influence the quality of nursing information. The KPO model can be used as guide when shifting from paper-based to electronic-based nursing documentation with the aim of obtaining complete, comprehensive and consistent nursing information. © 2012 Blackwell Publishing Ltd.

From reading numbers to seeing ratios: a benefit of icons for risk comprehension.

PubMed

Tubau, Elisabet; Rodríguez-Ferreiro, Javier; Barberia, Itxaso; Colomé, Àngels

2018-06-21

Promoting a better understanding of statistical data is becoming increasingly important for improving risk comprehension and decision-making. In this regard, previous studies on Bayesian problem solving have shown that iconic representations help infer frequencies in sets and subsets. Nevertheless, the mechanisms by which icons enhance performance remain unclear. Here, we tested the hypothesis that the benefit offered by icon arrays lies in a better alignment between presented and requested relationships, which should facilitate the comprehension of the requested ratio beyond the represented quantities. To this end, we analyzed individual risk estimates based on data presented either in standard verbal presentations (percentages and natural frequency formats) or as icon arrays. Compared to the other formats, icons led to estimates that were more accurate, and importantly, promoted the use of equivalent expressions for the requested probability. Furthermore, whereas the accuracy of the estimates based on verbal formats depended on their alignment with the text, all the estimates based on icons were equally accurate. Therefore, these results support the proposal that icons enhance the comprehension of the ratio and its mapping onto the requested probability and point to relational misalignment as potential interference for text-based Bayesian reasoning. The present findings also argue against an intrinsic difficulty with understanding single-event probabilities.

Reading comprehension of ambiguous sentences by school-age children with autism spectrum disorder.

PubMed

Davidson, Meghan M; Ellis Weismer, Susan

2017-12-01

Weak central coherence (processing details over gist), poor oral language abilities, poor suppression, semantic interference, and poor comprehension monitoring have all been implicated to affect reading comprehension in individuals with autism spectrum disorder (ASD). This study viewed the contributions of different supporting skills as a collective set of skills necessary for context integration-a multi-component view-to examine individual differences in reading comprehension in school-age children (8-14 years) with ASD (n = 23) and typically developing control peers (n = 23). Participants completed a written ambiguous sentence comprehension task in which participants had to integrate context to determine the correct homonym meaning via picture selection. Both comprehension products (i.e., offline representations after reading) and processes (i.e., online processing during reading) were evaluated. Results indicated that children with ASD, similar to their TD peers, integrated the context to access the correct homonym meanings while reading. However, after reading the sentences, when participants were asked to select the meanings, both groups experienced semantic interference between the two meanings. This semantic interference hindered the children with ASD's sentence representation to a greater degree than their peers. Individual differences in age/development, word recognition, vocabulary breadth (i.e., number of words in the lexicon), and vocabulary depth (i.e., knowledge of the homonym meanings) contributed to sentence comprehension in both children with ASD and their peers. Together, this evidence supports a multi-component view, and that helping children with ASD develop vocabulary depth may have cascading effects on their reading comprehension. Autism Res 2017, 10: 2002-2022. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Like their peers, children with ASD were able to integrate context, or link words while reading sentences with ambiguous words (words with two meanings). After reading the sentences, both groups found it hard to pick the correct meaning of the ambiguous sentence and this decision was more difficult for the participants with ASD. Older children, children with better word reading abilities, and children with higher vocabularies were better at understanding ambiguous sentences. Helping children with ASD to develop richer vocabularies could be important for improving their reading comprehension. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

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.

The prescribing of specialist medicines: what factors influence GPs' decision making?

PubMed

Crowe, Sarah; Tully, Mary P; Cantrill, Judith A

2009-08-01

As Governments worldwide strive to integrate efficient health care delivery across the primary-secondary care divide, particular significance has been placed on the need to understand GPs' prescribing of specialist drugs. To explore the factors which influence GPs' decision-making process when requested to prescribe specialist drugs. A qualitative approach was used to explore the perspectives of a wide range of practice-, primary care trust-, strategic health authority-level staff and other relevant stakeholders in the North-West of England. All semi-structured interviews (n = 47) were analysed comprehensively using the five-stage 'framework' approach. Six diverse factors were identified as having a crucial bearing on how GPs evaluate initial requests and subsequently decide whether or not to prescribe. These include GPs' lack of knowledge and expertise in using specialist drugs, the shared care arrangement, the influence of a locally agreed advisory list, financial and resource considerations, patient convenience and understanding and GPs' specific areas of interest. This exploration of GPs' decision-making process is needed to support future integrated health care delivery.

Contribution of working conditions to occupational inequalities in depressive symptoms: results from the national French SUMER survey.

PubMed

Niedhammer, Isabelle; Lesuffleur, Thomas; Coutrot, Thomas; Chastang, Jean-François

2016-08-01

Social inequalities in mental health have been observed, but explanations are still lacking. The objectives were to evaluate the contribution of a large set of psychosocial work factors and other occupational exposures to social inequalities in mental health in a national representative sample of employees. The sample from the cross-sectional national French survey SUMER 2010 included 46,962 employees: 26,883 men and 20,079 women. Anxiety and depression symptoms were measured using the Hospital Anxiety and Depression scale. Occupation was used as a marker of social position. Psychosocial work factors included various variables related to the classical job strain model, psychological demands, decision latitude, social support, and other understudied variables related to reward, job insecurity, job promotion, esteem, working time/hours, and workplace violence. Other occupational exposures of chemical, biological, physical, and biomechanical nature were also studied. Weighted age-adjusted linear regression analyses were performed. Occupational gradients were found in the exposure to most psychosocial work factors and other occupational exposures. Occupational inequalities were observed for depressive symptoms, but not for anxiety symptoms. The factors related to decision latitude (and its sub-dimensions, skill discretion, and decision authority), social support, and reward (and its sub-dimensions, job promotion, job insecurity, and esteem) contributed to explain occupational inequalities in depressive symptoms. Decision latitude played a major role in the explanation. Workplace violence variables contributed among men only. Other exposures of physical and biomechanical nature also displayed significant contributions. Comprehensive prevention policies at the workplace may help to reduce social inequalities in mental health in the working population.

Use of an Online Clinical Process Support System as an Aid to Identification and Management of Developmental and Mental Health Problems.

PubMed

Howard, Barbara J; Sturner, Raymond

2017-12-01

To describe benefits and problems with screening and addressing developmental and behavioral problems in primary care and using an online clinical process support system as a solution. Screening has been found to have various implementation barriers including time costs, accuracy, workflow and knowledge of tools. In addition, training of clinicians in dealing with identified issues is lacking. Patients disclose more to and prefer computerized screening. An online clinical process support system (CHADIS) shows promise in addressing these issues. Use of a comprehensive panel of online pre-visit screens; linked decision support to provide moment-of-care training; and post-visit activities and resources for patient-specific education, monitoring and care coordination is an efficient way to make the entire process of screening and follow up care feasible in primary care. CHADIS fulfills these requirements and provides Maintenance of Certification credit to physicians as well as added income for screening efforts.

The Development of an eHealth Tool Suite for Prostate Cancer Patients and Their Partners

PubMed Central

Van Bogaert, Donna; Hawkins, Robert; Pingree, Suzanne; Jarrard, David

2013-01-01

Background eHealth resources for people facing health crises must balance the expert knowledge and perspective of developers and clinicians against the very different needs and perspectives of prospective users. This formative study explores the information and support needs of posttreatment prostate cancer patients and their partners as a way to improve an existing eHealth information and support system called CHESS (Comprehensive Health Enhancement Support System). Methods Focus groups with patient survivors and their partners were used to identify information gaps and information-seeking milestones. Results Both patients and partners expressed a need for assistance in decision making, connecting with experienced patients, and making sexual adjustments. Female partners of patients are more active in searching for cancer information. All partners have information and support needs distinct from those of the patient. Conclusions Findings were used to develop a series of interactive tools and navigational features for the CHESS prostate cancer computer-mediated system. PMID:22591675

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…

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…

Elicitation of neurological knowledge with argument-based machine learning.

PubMed

Groznik, Vida; Guid, Matej; Sadikov, Aleksander; Možina, Martin; Georgiev, Dejan; Kragelj, Veronika; Ribarič, Samo; Pirtošek, Zvezdan; Bratko, Ivan

2013-02-01

The paper describes the use of expert's knowledge in practice and the efficiency of a recently developed technique called argument-based machine learning (ABML) in the knowledge elicitation process. We are developing a neurological decision support system to help the neurologists differentiate between three types of tremors: Parkinsonian, essential, and mixed tremor (comorbidity). The system is intended to act as a second opinion for the neurologists, and most importantly to help them reduce the number of patients in the "gray area" that require a very costly further examination (DaTSCAN). We strive to elicit comprehensible and medically meaningful knowledge in such a way that it does not come at the cost of diagnostic accuracy. To alleviate the difficult problem of knowledge elicitation from data and domain experts, we used ABML. ABML guides the expert to explain critical special cases which cannot be handled automatically by machine learning. This very efficiently reduces the expert's workload, and combines expert's knowledge with learning data. 122 patients were enrolled into the study. The classification accuracy of the final model was 91%. Equally important, the initial and the final models were also evaluated for their comprehensibility by the neurologists. All 13 rules of the final model were deemed as appropriate to be able to support its decisions with good explanations. The paper demonstrates ABML's advantage in combining machine learning and expert knowledge. The accuracy of the system is very high with respect to the current state-of-the-art in clinical practice, and the system's knowledge base is assessed to be very consistent from a medical point of view. This opens up the possibility to use the system also as a teaching tool. Copyright © 2012 Elsevier B.V. All rights reserved.

Environmental Biosciences Program Second Quarter Report

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

Lawrence C. Mohr, M.D.

2004-12-31

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation's need for new and better approaches to the solution of a complex and expansive array of environment-related health problems. Themore » intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene (TCE), polychlorinated biphenyls (PCBs), and low-dose ionizing radiation. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk-based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less

Environmental Biosciences Program Quarterly Report

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

Lawrence C. Mohr, M.D.

2006-10-31

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation's need for new and better approaches to the solution of a complex and expansive array of environment-related health problems. Themore » intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene and low-dose ionizing radiation. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk-based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less

Environmental Biosciences Program Fourth Quarter Report

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

Lawrence C. Mohr, M.D.

2005-06-30

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation s need for new and better approaches to the solution of a complex and expansive array of environment-related health problems.more » The intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems. Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene (TCE), polychlorinated biphenyles (PCBs), and low-dose ionizing radiation. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk-based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less

Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams.

PubMed

Jones, Audrey L; Hausmann, Leslie R M; Kertesz, Stefan; Suo, Ying; Cashy, John P; Mor, Maria K; Schaefer, James H; Gundlapalli, Adi V; Gordon, Adam J

2018-05-12

Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.

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

PubMed

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

2007-01-01

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

Epidemiological characteristics and methodological quality of meta-analyses on diabetes mellitus treatment: a systematic review.

PubMed

Wu, Xin Yin; Lam, Victor C K; Yu, Yue Feng; Ho, Robin S T; Feng, Ye; Wong, Charlene H L; Yip, Benjamin H K; Tsoi, Kelvin K F; Wong, Samuel Y S; Chung, Vincent C H

2016-11-01

Well-conducted meta-analyses (MAs) are considered as one of the best sources of clinical evidence for treatment decision. MA with methodological flaws may introduce bias and mislead evidence users. The aim of this study is to investigate the characteristics and methodological quality of MAs on diabetes mellitus (DM) treatments. Systematic review. Cochrane Database of Systematic Review and Database of Abstract of Reviews of Effects were searched for relevant MAs. Assessing methodological quality of systematic reviews (AMSTAR) tool was used to evaluate the methodological quality of included MAs. Logistic regression analysis was used to identify association between characteristics of MA and AMSTAR results. A total of 252 MAs including 4999 primary studies and 13,577,025 patients were included. Over half of the MAs (65.1%) only included type 2 DM patients and 160 MAs (63.5%) focused on pharmacological treatments. About 89.7% MAs performed comprehensive literature search and 89.3% provided characteristics of included studies. Included MAs generally had poor performance on the remaining AMSTAR items, especially in assessing publication bias (39.3%), providing lists of studies (19.0%) and declaring source of support comprehensively (7.5%). Only 62.7% MAs mentioned about harm of interventions. MAs with corresponding author from Asia performed less well in providing MA protocol than those from Europe. Methodological quality of MA on DM treatments was unsatisfactory. There is considerable room for improvement, especially in assessing publication bias, providing lists of studies and declaring source of support comprehensively. Also, there is an urgent need for MA authors to report treatment harm comprehensively. © 2016 European Society of Endocrinology.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE).

PubMed

Paquette-Warren, Jann; Harris, Stewart B; Naqshbandi Hayward, Mariam; Tompkins, Jordan W

2016-10-01

Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real-world evaluation. Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real-world comprehensive evaluations in health care settings. The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub-steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built-in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale-up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Case study of evaluations that go beyond clinical outcomes to assess quality improvement diabetes programmes using the Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE)

PubMed Central

Harris, Stewart B.; Naqshbandi Hayward, Mariam; Tompkins, Jordan W.

2016-01-01

Abstract Rationale, aims and objectives Investments in efforts to reduce the burden of diabetes on patients and health care are critical; however, more evaluation is needed to provide evidence that informs and supports future policies and programmes. The newly developed Diabetes Evaluation Framework for Innovative National Evaluations (DEFINE) incorporates the theoretical concepts needed to facilitate the capture of critical information to guide investments, policy and programmatic decision making. The aim of the study is to assess the applicability and value of DEFINE in comprehensive real‐world evaluation. Method Using a critical and positivist approach, this intrinsic and collective case study retrospectively examines two naturalistic evaluations to demonstrate how DEFINE could be used when conducting real‐world comprehensive evaluations in health care settings. Results The variability between the cases and the evaluation designs are described and aligned to the DEFINE goals, steps and sub‐steps. The majority of the theoretical steps of DEFINE were exemplified in both cases, although limited for knowledge translation efforts. Application of DEFINE to evaluate diverse programmes that target various chronic diseases is needed to further test the inclusivity and built‐in flexibility of DEFINE and its role in encouraging more comprehensive knowledge translation. Conclusions This case study shows how DEFINE could be used to structure or guide comprehensive evaluations of programmes and initiatives implemented in health care settings and support scale‐up of successful innovations. Future use of the framework will continue to strengthen its value in guiding programme evaluation and informing health policy to reduce the burden of diabetes and other chronic diseases. PMID:26804339

Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

PubMed

Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle; Lasser, Karen E; Borrelli, Belinda; Au, David H; Slatore, Christopher G; Clark, Jack A; Kathuria, Hasmeena

2018-02-21

Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. Qualitative study entailing semi-structured interviews and focus groups. We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process.

How Decision Support Systems Can Benefit from a Theory of Change Approach.

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

How Decision Support Systems Can Benefit from a Theory of Change Approach

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

Decision support systems are now mostly computer and internet-based information systems designed to support land managers with complex decision-making. However, there is concern that many environmental and agricultural decision support systems remain underutilized and ineffective. Recent efforts to improve decision support systems use have focused on enhancing stakeholder participation in their development, but a mismatch between stakeholders' expectations and the reality of decision support systems outputs continues to limit uptake. Additional challenges remain in problem-framing and evaluation. We propose using an outcomes-based approach called theory of change in conjunction with decision support systems development to support both wider problem-framing and outcomes-based monitoring and evaluation. The theory of change helps framing by placing the decision support systems within a wider context. It highlights how decision support systems use can "contribute" to long-term outcomes, and helps align decision support systems outputs with these larger goals. We illustrate the benefits of linking decision support systems development and application with a theory of change approach using an example of pest rabbit management in Australia. We develop a theory of change that outlines the activities required to achieve the outcomes desired from an effective rabbit management program, and two decision support systems that contribute to specific aspects of decision making in this wider problem context. Using a theory of change in this way should increase acceptance of the role of decision support systems by end-users, clarify their limitations and, importantly, increase effectiveness of rabbit management. The use of a theory of change should benefit those seeking to improve decision support systems design, use and, evaluation.

Florida Best Practice Psychotherapeutic Medication Guidelines for Adults With Major Depressive Disorder.

PubMed

McIntyre, Roger S; Suppes, Trisha; Tandon, Rajiv; Ostacher, Michael

2017-06-01

Herein we provide the 2015 update for the Florida Best Practice Psychotherapeutic Medication Guidelines (FPG) for major depressive disorder (MDD). The FPG represent evidence-based decision support for practitioners providing care to adults with MDD. The consensus meeting included representatives from the Florida Agency for Health Care Administration (FAHCA), advocacy members, academic experts in MDD, and multidisciplinary mental health clinicians, as well as health policy experts. The FAHCA provided funding support for the FPG. Evidence was limited to results from adequately powered, randomized, double-blind, placebo-controlled trials; in addition, pooled-, meta-, and network-analyses were included. Recommendations were based on consensus arrived at by the multistakeholder Florida Expert Panel. Articles selected were identified on the electronic search engine PubMed with the dates 2010 to present. The search terms were major depressive disorder, psychopharmacology, antidepressants, psychotherapy, neuromodulation, complementary alternative medicines, pooled-analysis, meta-analysis, and network-analysis. Bibliographies of the identified articles were manually searched for additional citations not identified in the original search. A consensus meeting comprising all representatives took place on September 25-26, 2015, in Tampa, Florida. Guiding principles (eg, emphasis on the most rigorous evidence for efficacy, safety, and tolerability) were discussed, defined, and operationalized prior to review of extant data. As MDD often pursues a recurrent and chronic course, principles of practice, measurement-based care, and comprehensive assessment and management of overall physical and mental health were emphasized. Evidence supporting pretreatment major depressive episode specifiers (eg, mixed features, anxious distress) and the role of pharmacogenomics (and other biological-behavioral markers) in informing treatment selection were comprehensively discussed. Algorithmic priority was assigned to agents with relatively greater therapeutic index (ie, efficacy) and minimal propensity for safety and tolerability disadvantages. The updated 2015 FPG provide concise, pragmatic, evidence-based decision support for treatment selection and sequencing for adults with MDD. Principles of practice include measurement-based care, priority to both psychiatric and medical comorbidity, identification of DSM-5-defined specifiers (eg, mixed features), suicide risk assessment, and evaluation of cognitive symptoms. The FPG have purposefully aimed to minimize emphasis on "expert opinion" and instead differentially emphasized extant evidence for pharmacologic treatments. © Copyright 2017 Physicians Postgraduate Press, Inc.

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

Decision Support | Solar Research | NREL

Science.gov Websites

informed solar decision making with credible, objective, accessible, and timely resources. Solar Energy Decision Support Decision Support NREL provides technical and analytical support to support provide unbiased information on solar policies and issues for state and local government decision makers

Our Selections and Decisions: Inherent Features of the Nervous System?

NASA Astrophysics Data System (ADS)

Rösler, Frank

The chapter summarizes findings on the neuronal bases of decisionmaking. Taking the phenomenon of selection it will be explained that systems built only from excitatory and inhibitory neuron (populations) have the emergent property of selecting between different alternatives. These considerations suggest that there exists a hierarchical architecture with central selection switches. However, in such a system, functions of selection and decision-making are not localized, but rather emerge from an interaction of several participating networks. These are, on the one hand, networks that process specific input and output representations and, on the other hand, networks that regulate the relative activation/inhibition of the specific input and output networks. These ideas are supported by recent empirical evidence. Moreover, other studies show that rather complex psychological variables, like subjective probability estimates, expected gains and losses, prediction errors, etc., do have biological correlates, i.e., they can be localized in time and space as activation states of neural networks and single cells. These findings suggest that selections and decisions are consequences of an architecture which, seen from a biological perspective, is fully deterministic. However, a transposition of such nomothetic functional principles into the idiographic domain, i.e., using them as elements for comprehensive 'mechanistic' explanations of individual decisions, seems not to be possible because of principle limitations. Therefore, individual decisions will remain predictable by means of probabilistic models alone.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study.

PubMed

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-04-01

To explore multiple stakeholders' perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators', clinicians', parents' and youths' perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders' knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital's culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors' paediatric hospital.

Performance evaluation of the machine learning algorithms used in inference mechanism of a medical decision support system.

PubMed

Bal, Mert; Amasyali, M Fatih; Sever, Hayri; Kose, Guven; Demirhan, Ayse

2014-01-01

The importance of the decision support systems is increasingly supporting the decision making process in cases of uncertainty and the lack of information and they are widely used in various fields like engineering, finance, medicine, and so forth, Medical decision support systems help the healthcare personnel to select optimal method during the treatment of the patients. Decision support systems are intelligent software systems that support decision makers on their decisions. The design of decision support systems consists of four main subjects called inference mechanism, knowledge-base, explanation module, and active memory. Inference mechanism constitutes the basis of decision support systems. There are various methods that can be used in these mechanisms approaches. Some of these methods are decision trees, artificial neural networks, statistical methods, rule-based methods, and so forth. In decision support systems, those methods can be used separately or a hybrid system, and also combination of those methods. In this study, synthetic data with 10, 100, 1000, and 2000 records have been produced to reflect the probabilities on the ALARM network. The accuracy of 11 machine learning methods for the inference mechanism of medical decision support system is compared on various data sets.

An integrated review of the correlation between critical thinking ability and clinical decision-making in nursing.

PubMed

Lee, Daphne Sk; Abdullah, Khatijah Lim; Subramanian, Pathmawathi; Bachmann, Robert Thomas; Ong, Swee Leong

2017-12-01

To explore whether there is a correlation between critical thinking ability and clinical decision-making among nurses. Critical thinking is currently considered as an essential component of nurses' professional judgement and clinical decision-making. If confirmed, nursing curricula may be revised emphasising on critical thinking with the expectation to improve clinical decision-making and thus better health care. Integrated literature review. The integrative review was carried out after a comprehensive literature search using electronic databases Ovid, EBESCO MEDLINE, EBESCO CINAHL, PROQuest and Internet search engine Google Scholar. Two hundred and 22 articles from January 1980 to end of 2015 were retrieved. All studies evaluating the relationship between critical thinking and clinical decision-making, published in English language with nurses or nursing students as the study population, were included. No qualitative studies were found investigating the relationship between critical thinking and clinical decision-making, while 10 quantitative studies met the inclusion criteria and were further evaluated using the Quality Assessment and Validity Tool. As a result, one study was excluded due to a low-quality score, with the remaining nine accepted for this review. Four of nine studies established a positive relationship between critical thinking and clinical decision-making. Another five studies did not demonstrate a significant correlation. The lack of refinement in studies' design and instrumentation were arguably the main reasons for the inconsistent results. Research studies yielded contradictory results as regard to the relationship between critical thinking and clinical decision-making; therefore, the evidence is not convincing. Future quantitative studies should have representative sample size, use critical thinking measurement tools related to the healthcare sector and evaluate the predisposition of test takers towards their willingness and ability to think. There is also a need for qualitative studies to provide a fresh approach in exploring the relationship between these variables uncovering currently unknown contributing factors. This review confirmed that evidence to support the existence of relationships between critical thinking and clinical decision-making is still unsubstantiated. Therefore, it serves as a call for nurse leaders and nursing academics to produce quality studies in order to firmly support or reject the hypothesis that there is a statistically significant correlation between critical thinking and clinical decision-making. © 2017 John Wiley & Sons Ltd.

A Middleware with Comprehensive Quality of Context Support for the Internet of Things Applications

PubMed Central

Gomes, Berto de Tácio Pereira; Muniz, Luiz Carlos Melo; dos Santos, Davi Viana; Lopes, Rafael Fernandes; Coutinho, Luciano Reis; Carvalho, Felipe Oliveira; Endler, Markus

2017-01-01

Context aware systems are able to adapt their behavior according to the environment in which the user is. They can be integrated into an Internet of Things (IoT) infrastructure, allowing a better perception of the user’s physical environment by collecting context data from sensors embedded in devices known as smart objects. An IoT extension called the Internet of Mobile Things (IoMT) suggests new scenarios in which smart objects and IoT gateways can move autonomously or be moved easily. In a comprehensive view, Quality of Context (QoC) is a term that can express quality requirements of context aware applications. These requirements can be those related to the quality of information provided by the sensors (e.g., accuracy, resolution, age, validity time) or those referring to the quality of the data distribution service (e.g, reliability, delay, delivery time). Some functionalities of context aware applications and/or decision-making processes of these applications and their users depend on the level of quality of context available, which tend to vary over time for various reasons. Reviewing the literature, it is possible to verify that the quality of context support provided by IoT-oriented middleware systems still has limitations in relation to at least four relevant aspects: (i) quality of context provisioning; (ii) quality of context monitoring; (iii) support for heterogeneous device and technology management; (iv) support for reliable data delivery in mobility scenarios. This paper presents two main contributions: (i) a state-of-the-art survey specifically aimed at analyzing the middleware with quality of context support and; (ii) a new middleware with comprehensive quality of context support for Internet of Things Applications. The proposed middleware was evaluated and the results are presented and discussed in this article, which also shows a case study involving the development of a mobile remote patient monitoring application that was developed using the proposed middleware. This case study highlights how middleware components were used to meet the quality of context requirements of the application. In addition, the proposed middleware was compared to other solutions in the literature. PMID:29292791

A Middleware with Comprehensive Quality of Context Support for the Internet of Things Applications.

PubMed

Gomes, Berto de Tácio Pereira; Muniz, Luiz Carlos Melo; da Silva E Silva, Francisco José; Dos Santos, Davi Viana; Lopes, Rafael Fernandes; Coutinho, Luciano Reis; Carvalho, Felipe Oliveira; Endler, Markus

2017-12-08

Context aware systems are able to adapt their behavior according to the environment in which the user is. They can be integrated into an Internet of Things (IoT) infrastructure, allowing a better perception of the user's physical environment by collecting context data from sensors embedded in devices known as smart objects. An IoT extension called the Internet of Mobile Things (IoMT) suggests new scenarios in which smart objects and IoT gateways can move autonomously or be moved easily. In a comprehensive view, Quality of Context (QoC) is a term that can express quality requirements of context aware applications. These requirements can be those related to the quality of information provided by the sensors (e.g., accuracy, resolution, age, validity time) or those referring to the quality of the data distribution service (e.g, reliability, delay, delivery time). Some functionalities of context aware applications and/or decision-making processes of these applications and their users depend on the level of quality of context available, which tend to vary over time for various reasons. Reviewing the literature, it is possible to verify that the quality of context support provided by IoT-oriented middleware systems still has limitations in relation to at least four relevant aspects: (i) quality of context provisioning; (ii) quality of context monitoring; (iii) support for heterogeneous device and technology management; (iv) support for reliable data delivery in mobility scenarios. This paper presents two main contributions: (i) a state-of-the-art survey specifically aimed at analyzing the middleware with quality of context support and; (ii) a new middleware with comprehensive quality of context support for Internet of Things Applications. The proposed middleware was evaluated and the results are presented and discussed in this article, which also shows a case study involving the development of a mobile remote patient monitoring application that was developed using the proposed middleware. This case study highlights how middleware components were used to meet the quality of context requirements of the application. In addition, the proposed middleware was compared to other solutions in the literature.

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…

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.

Development and Validation of the PREMM5 Model for Comprehensive Risk Assessment of Lynch Syndrome.

PubMed

Kastrinos, Fay; Uno, Hajime; Ukaegbu, Chinedu; Alvero, Carmelita; McFarland, Ashley; Yurgelun, Matthew B; Kulke, Matthew H; Schrag, Deborah; Meyerhardt, Jeffrey A; Fuchs, Charles S; Mayer, Robert J; Ng, Kimmie; Steyerberg, Ewout W; Syngal, Sapna

2017-07-01

Purpose Current Lynch syndrome (LS) prediction models quantify the risk to an individual of carrying a pathogenic germline mutation in three mismatch repair (MMR) genes: MLH1, MSH2, and MSH6. We developed a new prediction model, PREMM 5 , that incorporates the genes PMS2 and EPCAM to provide comprehensive LS risk assessment. Patients and Methods PREMM 5 was developed to predict the likelihood of a mutation in any of the LS genes by using polytomous logistic regression analysis of clinical and germline data from 18,734 individuals who were tested for all five genes. Predictors of mutation status included sex, age at genetic testing, and proband and family cancer histories. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and clinical impact was determined by decision curve analysis; comparisons were made to the existing PREMM 1,2,6 model. External validation of PREMM 5 was performed in a clinic-based cohort of 1,058 patients with colorectal cancer. Results Pathogenic mutations were detected in 1,000 (5%) of 18,734 patients in the development cohort; mutations included MLH1 (n = 306), MSH2 (n = 354), MSH6 (n = 177), PMS2 (n = 141), and EPCAM (n = 22). PREMM 5 distinguished carriers from noncarriers with an AUC of 0.81 (95% CI, 0.79 to 0.82), and performance was similar in the validation cohort (AUC, 0.83; 95% CI, 0.75 to 0.92). Prediction was more difficult for PMS2 mutations (AUC, 0.64; 95% CI, 0.60 to 0.68) than for other genes. Performance characteristics of PREMM 5 exceeded those of PREMM 1,2,6 . Decision curve analysis supported germline LS testing for PREMM 5 scores ≥ 2.5%. Conclusion PREMM 5 provides comprehensive risk estimation of all five LS genes and supports LS genetic testing for individuals with scores ≥ 2.5%. At this threshold, PREMM 5 provides performance that is superior to the existing PREMM 1,2,6 model in the identification of carriers of LS, including those with weaker phenotypes and individuals unaffected by cancer.

Development and Validation of the PREMM5 Model for Comprehensive Risk Assessment of Lynch Syndrome

PubMed Central

Uno, Hajime; Ukaegbu, Chinedu; Alvero, Carmelita; McFarland, Ashley; Yurgelun, Matthew B.; Kulke, Matthew H.; Schrag, Deborah; Meyerhardt, Jeffrey A.; Fuchs, Charles S.; Mayer, Robert J.; Ng, Kimmie; Steyerberg, Ewout W.; Syngal, Sapna

2017-01-01

Purpose Current Lynch syndrome (LS) prediction models quantify the risk to an individual of carrying a pathogenic germline mutation in three mismatch repair (MMR) genes: MLH1, MSH2, and MSH6. We developed a new prediction model, PREMM5, that incorporates the genes PMS2 and EPCAM to provide comprehensive LS risk assessment. Patients and Methods PREMM5 was developed to predict the likelihood of a mutation in any of the LS genes by using polytomous logistic regression analysis of clinical and germline data from 18,734 individuals who were tested for all five genes. Predictors of mutation status included sex, age at genetic testing, and proband and family cancer histories. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and clinical impact was determined by decision curve analysis; comparisons were made to the existing PREMM1,2,6 model. External validation of PREMM5 was performed in a clinic-based cohort of 1,058 patients with colorectal cancer. Results Pathogenic mutations were detected in 1,000 (5%) of 18,734 patients in the development cohort; mutations included MLH1 (n = 306), MSH2 (n = 354), MSH6 (n = 177), PMS2 (n = 141), and EPCAM (n = 22). PREMM5 distinguished carriers from noncarriers with an AUC of 0.81 (95% CI, 0.79 to 0.82), and performance was similar in the validation cohort (AUC, 0.83; 95% CI, 0.75 to 0.92). Prediction was more difficult for PMS2 mutations (AUC, 0.64; 95% CI, 0.60 to 0.68) than for other genes. Performance characteristics of PREMM5 exceeded those of PREMM1,2,6. Decision curve analysis supported germline LS testing for PREMM5 scores ≥ 2.5%. Conclusion PREMM5 provides comprehensive risk estimation of all five LS genes and supports LS genetic testing for individuals with scores ≥ 2.5%. At this threshold, PREMM5 provides performance that is superior to the existing PREMM1,2,6 model in the identification of carriers of LS, including those with weaker phenotypes and individuals unaffected by cancer. PMID:28489507

Application of validity theory and methodology to patient-reported outcome measures (PROMs): building an argument for validity.

PubMed

Hawkins, Melanie; Elsworth, Gerald R; Osborne, Richard H

2018-07-01

Data from subjective patient-reported outcome measures (PROMs) are now being used in the health sector to make or support decisions about individuals, groups and populations. Contemporary validity theorists define validity not as a statistical property of the test but as the extent to which empirical evidence supports the interpretation of test scores for an intended use. However, validity testing theory and methodology are rarely evident in the PROM validation literature. Application of this theory and methodology would provide structure for comprehensive validation planning to support improved PROM development and sound arguments for the validity of PROM score interpretation and use in each new context. This paper proposes the application of contemporary validity theory and methodology to PROM validity testing. The validity testing principles will be applied to a hypothetical case study with a focus on the interpretation and use of scores from a translated PROM that measures health literacy (the Health Literacy Questionnaire or HLQ). Although robust psychometric properties of a PROM are a pre-condition to its use, a PROM's validity lies in the sound argument that a network of empirical evidence supports the intended interpretation and use of PROM scores for decision making in a particular context. The health sector is yet to apply contemporary theory and methodology to PROM development and validation. The theoretical and methodological processes in this paper are offered as an advancement of the theory and practice of PROM validity testing in the health sector.

Tailoring implementation strategies for evidence-based recommendations using computerised clinical decision support systems: protocol for the development of the GUIDES tools.

PubMed

Van de Velde, Stijn; Roshanov, Pavel; Kortteisto, Tiina; Kunnamo, Ilkka; Aertgeerts, Bert; Vandvik, Per Olav; Flottorp, Signe

2016-03-05

A computerised clinical decision support system (CCDSS) is a technology that uses patient-specific data to provide relevant medical knowledge at the point of care. It is considered to be an important quality improvement intervention, and the implementation of CCDSS is growing substantially. However, the significant investments do not consistently result in value for money due to content, context, system and implementation issues. The Guideline Implementation with Decision Support (GUIDES) project aims to improve the impact of CCDSS through optimised implementation based on high-quality evidence-based recommendations. To achieve this, we will develop tools that address the factors that determine successful CCDSS implementation. We will develop the GUIDES tools in four steps, using the methods and results of the Tailored Implementation for Chronic Diseases (TICD) project as a starting point: (1) a review of research evidence and frameworks on the determinants of implementing recommendations using CCDSS; (2) a synthesis of a comprehensive framework for the identified determinants; (3) the development of tools for use of the framework and (4) pilot testing the utility of the tools through the development of a tailored CCDSS intervention in Norway, Belgium and Finland. We selected the conservative management of knee osteoarthritis as a prototype condition for the pilot. During the process, the authors will collaborate with an international expert group to provide input and feedback on the tools. This project will provide guidance and tools on methods of identifying implementation determinants and selecting strategies to implement evidence-based recommendations through CCDSS. We will make the GUIDES tools available to CCDSS developers, implementers, researchers, funders, clinicians, managers, educators, and policymakers internationally. The tools and recommendations will be generic, which makes them scalable to a large spectrum of conditions. Ultimately, the better implementation of CCDSS may lead to better-informed decisions and improved care and patient outcomes for a wide range of conditions. PROSPERO, CRD42016033738.

Modernizing Distribution System Restoration to Achieve Grid Resiliency Against Extreme Weather Events: An Integrated Solution

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

Chen, Chen; Wang, Jianhui; Ton, Dan

Recent severe power outages caused by extreme weather hazards have highlighted the importance and urgency of improving the resilience of the electric power grid. As the distribution grids still remain vulnerable to natural disasters, the power industry has focused on methods of restoring distribution systems after disasters in an effective and quick manner. The current distribution system restoration practice for utilities is mainly based on predetermined priorities and tends to be inefficient and suboptimal, and the lack of situational awareness after the hazard significantly delays the restoration process. As a result, customers may experience an extended blackout, which causes largemore » economic loss. On the other hand, the emerging advanced devices and technologies enabled through grid modernization efforts have the potential to improve the distribution system restoration strategy. However, utilizing these resources to aid the utilities in better distribution system restoration decision-making in response to extreme weather events is a challenging task. Therefore, this paper proposes an integrated solution: a distribution system restoration decision support tool designed by leveraging resources developed for grid modernization. We first review the current distribution restoration practice and discuss why it is inadequate in response to extreme weather events. Then we describe how the grid modernization efforts could benefit distribution system restoration, and we propose an integrated solution in the form of a decision support tool to achieve the goal. The advantages of the solution include improving situational awareness of the system damage status and facilitating survivability for customers. The paper provides a comprehensive review of how the existing methodologies in the literature could be leveraged to achieve the key advantages. The benefits of the developed system restoration decision support tool include the optimal and efficient allocation of repair crews and resources, the expediting of the restoration process, and the reduction of outage durations for customers, in response to severe blackouts due to extreme weather hazards.« less

EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project for Retrieval of Evidence-Based Clinical Guideline Information and Decision Support

PubMed Central

2013-01-01

Background In Belgium, the construction of a national electronic point-of-care information service, EBMPracticeNet, was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, evidence-based medicine (EBM) partners, and vendors of electronic health records (EHR) is unique to this project. All Belgian health care professionals get free access to an up-to-date database of validated Belgian and nearly 1000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. Objective The objective of this paper was to describe the development strategy, the overall content, and the management of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Methods Several candidate providers of comprehensive guideline solutions were evaluated and one database was selected. Translation of the guidelines to Dutch and French was done with translation software, post-editing by translators and medical proofreading. A strategy is determined to adapt the guideline content to the Belgian context. Acceptance of the computerized clinical decision support tool has been tested and a randomized controlled trial is planned to evaluate the effect on process and patient outcomes. Results Currently, EBMPracticeNet is in "work in progress" state. Reference is made to the results of a pilot study and to further planned research including a randomized controlled trial. Conclusions The collaboration of government, health care providers, EBM partners, and vendors of EHRs is unique. The potential value of the project is great. The link between all the EHRs from different vendors and a national database held on a single platform that is controlled by all EBM organizations in Belgium are the strengths of EBMPracticeNet. PMID:23842038

Integrated Decision Support for Global Environmental Change Adaptation

NASA Astrophysics Data System (ADS)

Kumar, S.; Cantrell, S.; Higgins, G. J.; Marshall, J.; VanWijngaarden, F.

2011-12-01

Environmental changes are happening now that has caused concern in many parts of the world; particularly vulnerable are the countries and communities with limited resources and with natural environments that are more susceptible to climate change impacts. Global leaders are concerned about the observed phenomena and events such as Amazon deforestation, shifting monsoon patterns affecting agriculture in the mountain slopes of Peru, floods in Pakistan, water shortages in Middle East, droughts impacting water supplies and wildlife migration in Africa, and sea level rise impacts on low lying coastal communities in Bangladesh. These environmental changes are likely to get exacerbated as the temperatures rise, the weather and climate patterns change, and sea level rise continues. Large populations and billions of dollars of infrastructure could be affected. At Northrop Grumman, we have developed an integrated decision support framework for providing necessary information to stakeholders and planners to adapt to the impacts of climate variability and change at the regional and local levels. This integrated approach takes into account assimilation and exploitation of large and disparate weather and climate data sets, regional downscaling (dynamic and statistical), uncertainty quantification and reduction, and a synthesis of scientific data with demographic and economic data to generate actionable information for the stakeholders and decision makers. Utilizing a flexible service oriented architecture and state-of-the-art visualization techniques, this information can be delivered via tailored GIS portals to meet diverse set of user needs and expectations. This integrated approach can be applied to regional and local risk assessments, predictions and decadal projections, and proactive adaptation planning for vulnerable communities. In this paper we will describe this comprehensive decision support approach with selected applications and case studies to illustrate how this system of systems approach could help the local governments and concerned institutions worldwide to adapt to gradually changing environmental conditions as well as manage impacts of extreme events such as droughts, floods, heat waves, wildfires, hurricanes, and storm surges.

A National Approach to Quantify and Map Biodiversity ...

EPA Pesticide Factsheets

Ecosystem services, i.e., "services provided to humans from natural systems," have become a key issue of this century in resource management, conservation planning, human well-being, and environmental decision analysis. Mapping and quantifying ecosystem services have become strategic national interests for integrating ecology with economics to help understand the effects of human policies and actions and their subsequent impacts on both ecosystem function and human welfare. The degradation of natural ecosystems and climate variation impact the environment and society by affecting ecological integrity and ecosystems’ capacity to provide critical services (i.e., the contributions of ecosystems to human well-being). These challenges will require complex management decisions that can often involve significant trade-offs between societal desires and environmental needs. Evaluating trade-offs in terms of ecosystem services and human well-being provides an intuitive and comprehensive way to assess the broad implications of our decisions and to help shape policies that enhance environmental and social sustainability. In answer to this challenge, the U.S. government has created a partnership among the U.S. Environmental Protection Agency, other Federal agencies, academic institutions, and, Non-Governmental Organizations to develop the EnviroAtlas, an online Decision Support Tool that allows users (e.g., planners, policy-makers, resource managers, NGOs, private indu

Spatial modeling and classification of corneal shape.

PubMed

Marsolo, Keith; Twa, Michael; Bullimore, Mark A; Parthasarathy, Srinivasan

2007-03-01

One of the most promising applications of data mining is in biomedical data used in patient diagnosis. Any method of data analysis intended to support the clinical decision-making process should meet several criteria: it should capture clinically relevant features, be computationally feasible, and provide easily interpretable results. In an initial study, we examined the feasibility of using Zernike polynomials to represent biomedical instrument data in conjunction with a decision tree classifier to distinguish between the diseased and non-diseased eyes. Here, we provide a comprehensive follow-up to that work, examining a second representation, pseudo-Zernike polynomials, to determine whether they provide any increase in classification accuracy. We compare the fidelity of both methods using residual root-mean-square (rms) error and evaluate accuracy using several classifiers: neural networks, C4.5 decision trees, Voting Feature Intervals, and Naïve Bayes. We also examine the effect of several meta-learning strategies: boosting, bagging, and Random Forests (RFs). We present results comparing accuracy as it relates to dataset and transformation resolution over a larger, more challenging, multi-class dataset. They show that classification accuracy is similar for both data transformations, but differs by classifier. We find that the Zernike polynomials provide better feature representation than the pseudo-Zernikes and that the decision trees yield the best balance of classification accuracy and interpretability.

Evaluation and determination of soil remediation schemes using a modified AHP model and its application in a contaminated coking plant.

PubMed

Li, Xingang; Li, Jia; Sui, Hong; He, Lin; Cao, Xingtao; Li, Yonghong

2018-07-05

Soil remediation has been considered as one of the most difficult pollution treatment tasks due to its high complexity in contaminants, geological conditions, usage, urgency, etc. The diversity in remediation technologies further makes quick selection of suitable remediation schemes much tougher even the site investigation has been done. Herein, a sustainable decision support hierarchical model has been developed to select, evaluate and determine preferred soil remediation schemes comprehensively based on modified analytic hierarchy process (MAHP). This MAHP method combines competence model and the Grubbs criteria with the conventional AHP. It not only considers the competence differences among experts in group decision, but also adjusts the big deviation caused by different experts' preference through sample analysis. This conversion allows the final remediation decision more reasonable. In this model, different evaluation criteria, including economic effect, environmental effect and technological effect, are employed to evaluate the integrated performance of remediation schemes followed by a strict computation using above MAHP. To confirm the feasibility of this developed model, it has been tested by a benzene workshop contaminated site in Beijing coking plant. Beyond soil remediation, this MAHP model would also be applied in other fields referring to multi-criteria group decision making. Copyright © 2018 Elsevier B.V. All rights reserved.

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...

Developing and pilot testing a comprehensive health literacy communication training for health professionals in three European countries.

PubMed

Kaper, Marise S; Sixsmith, Jane; Koot, Jaap A R; Meijering, Louise B; van Twillert, Sacha; Giammarchi, Cinzia; Bevilacqua, Roberta; Barry, Margaret M; Doyle, Priscilla; Reijneveld, Sijmen A; de Winter, Andrea F

2018-01-01

Skills to address different health literacy problems are lacking among health professionals. We sought to develop and pilot test a comprehensive health literacy communication training for various health professionals in Ireland, Italy and the Netherlands. Thirty health professionals participated in the study. A literature review focused on evidence-informed training-components. Focus group discussions (FGDs) explored perspectives from seventeen professionals on a prototype-program, and feedback from thirteen professionals following pilot-training. Pre-post questionnaires assessed self-rated health literacy communication skills. The literature review yielded five training-components to address functional, interactive and critical health literacy: health literacy education, gathering and providing information, shared decision-making, enabling self-management, and supporting behaviour change. In FGDs, professionals endorsed the prototype-program and reported that the pilot-training increased knowledge and patient-centred communication skills in addressing health literacy, as shown by self-rated pre-post questionnaires. A comprehensive training for health professionals in three European countries enhances perceived skills to address functional, interactive and critical health literacy. This training has potential for wider application in education and practice in Europe. Copyright © 2017 Elsevier B.V. All rights reserved.

Barriers to and facilitators of implementing shared decision making and decision support in a paediatric hospital: A descriptive study

PubMed Central

Boland, Laura; McIsaac, Daniel I; Lawson, Margaret L

2016-01-01

OBJECTIVE: To explore multiple stakeholders’ perceived barriers to and facilitators of implementing shared decision making and decision support in a tertiary paediatric hospital. METHODS: An interpretive descriptive qualitative study was conducted using focus groups and interviews to examine senior hospital administrators’, clinicians’, parents’ and youths’ perceived barriers to and facilitators of shared decision making and decision support implementation. Data were analyzed using inductive thematic analysis. RESULTS: Fifty-seven stakeholders participated. Six barrier and facilitator themes emerged. The main barrier was gaps in stakeholders’ knowledge of shared decision making and decision support. Facilitators included compatibility between shared decision making and the hospital’s culture and ideal practices, perceptions of positive patient and family outcomes associated with shared decision making, and positive attitudes regarding shared decision making and decision support. However, youth attitudes regarding the necessity and usefulness of a decision support program were a barrier. Two themes were both a barrier and a facilitator. First, stakeholder groups were uncertain which clinical situations are suitable for shared decision making (eg, new diagnoses, chronic illnesses, complex decisions or urgent decisions). Second, the clinical process may be hindered if shared decision making and decision support decrease efficiency and workflow; however, shared decision making may reduce repeat visits and save time over the long term. CONCLUSIONS: Specific knowledge translation strategies that improve shared decision making knowledge and match specific barriers identified by each stakeholder group may be required to promote successful shared decision making and decision support implementation in the authors’ paediatric hospital. PMID:27398058

An Unambiguous Nomenclature for the Acyl-quinic Acids Commonly Known as Chlorogenic Acids.

PubMed

Abrankó, László; Clifford, Michael N

2017-05-10

The history of the acyl-quinic acids is briefly reviewed, the merits and limitations of the various nomenclature systems applicable are critically compared, and their limitations are highlighted, in particular their inability to provide an unambiguous description of all quinic acid enantiomers and diastereoisomers and associated acyl-quinic acids. Recommendations are made for a nomenclature system that in combination with IUPAC numbering achieves this objective. A comprehensive set of structures for the quinic acid enantiomers and diastereoisomers is presented. The Supporting Information provides an explanation of trivial names and a decision tree to determine which quinic acid isomer a structure represents.

Advanced Technology Lifecycle Analysis System (ATLAS) Technology Tool Box (TTB)

NASA Technical Reports Server (NTRS)

Doyle, Monica; ONeil, Daniel A.; Christensen, Carissa B.

2005-01-01

The Advanced Technology Lifecycle Analysis System (ATLAS) is a decision support tool designed to aid program managers and strategic planners in determining how to invest technology research and development dollars. It is an Excel-based modeling package that allows a user to build complex space architectures and evaluate the impact of various technology choices. ATLAS contains system models, cost and operations models, a campaign timeline and a centralized technology database. Technology data for all system models is drawn from a common database, the ATLAS Technology Tool Box (TTB). The TTB provides a comprehensive, architecture-independent technology database that is keyed to current and future timeframes.

Attribution of Net Carbon Change by Disturbance Type across Forest Lands of the Continental United States

NASA Astrophysics Data System (ADS)

Hagen, S. C.; Harris, N.; Saatchi, S. S.; Domke, G. M.; Woodall, C. W.; Pearson, T.

2016-12-01

We generated spatially comprehensive maps of carbon stocks and net carbon changes from US forestlands between 2005 and 2010 and attributed the changes to natural and anthropogenic processes. The prototype system created to produce these maps is designed to assist with national GHG inventories and support decisions associated with land management. Here, we present the results and methodological framework of our analysis. In summary, combining estimates of net C losses and gains results in net carbon change of 269±49 Tg C yr-1 (sink) in the coterminous US forest land, with carbon loss from harvest acting as the predominent source process.

A Comprehensive Optimization Strategy for Real-time Spatial Feature Sharing and Visual Analytics in Cyberinfrastructure

NASA Astrophysics Data System (ADS)

Li, W.; Shao, H.

2017-12-01

For geospatial cyberinfrastructure enabled web services, the ability of rapidly transmitting and sharing spatial data over the Internet plays a critical role to meet the demands of real-time change detection, response and decision-making. Especially for the vector datasets which serve as irreplaceable and concrete material in data-driven geospatial applications, their rich geometry and property information facilitates the development of interactive, efficient and intelligent data analysis and visualization applications. However, the big-data issues of vector datasets have hindered their wide adoption in web services. In this research, we propose a comprehensive optimization strategy to enhance the performance of vector data transmitting and processing. This strategy combines: 1) pre- and on-the-fly generalization, which automatically determines proper simplification level through the introduction of appropriate distance tolerance (ADT) to meet various visualization requirements, and at the same time speed up simplification efficiency; 2) a progressive attribute transmission method to reduce data size and therefore the service response time; 3) compressed data transmission and dynamic adoption of a compression method to maximize the service efficiency under different computing and network environments. A cyberinfrastructure web portal was developed for implementing the proposed technologies. After applying our optimization strategies, substantial performance enhancement is achieved. We expect this work to widen the use of web service providing vector data to support real-time spatial feature sharing, visual analytics and decision-making.

Ecological requirements for pallid sturgeon reproduction and recruitment in the Missouri River: annual report 2011

USGS Publications Warehouse

DeLonay, Aaron J.; Jacobson, Robert B.; Chojnacki, Kimberly A.; Annis, Mandy L.; Braaten, P. J.; Elliott, Caroline M.; Fuller, D. B.; Haas, Justin D.; Haddix, Tyler M.; Ladd, Hallie L.A.; McElroy, Brandon J.; Mestl, Gerald E.; Papoulias, Diana M.; Rhoten, Jason C.; Wildhaber, Mark L.

2014-01-01

The Comprehensive Sturgeon Research Project is a multiyear, multiagency collaborative research framework developed to provide information to support pallid sturgeon recovery and Missouri River management decisions. The project strategy integrates field and laboratory studies of sturgeon reproductive ecology, early life history, habitat requirements, and physiology. The project scope of work is developed annually with cooperating research partners and in collaboration with the U.S. Army Corps of Engineers, Missouri River Recovery—Integrated Science Program. The research consists of several interdependent and complementary tasks that engage multiple disciplines. The research tasks in the 2011 scope of work emphasized understanding of reproductive migrations and spawning of adult sturgeon, and hatch and drift of larvae. These tasks were addressed in three hydrologically and geomorphologically distinct parts of the Missouri River Basin: the Lower Missouri River downstream from Gavins Point Dam, the Upper Missouri River downstream from Fort Peck Dam and including downstream reaches of the Milk River, and the Lower Yellowstone River. The research is designed to inform management decisions related to channel re-engineering, flow modification, and pallid sturgeon population augmentation on the Missouri River, and throughout the range of the species. Research and progress made through this project are reported to the U.S. Army Corps of Engineers annually. This annual report details the research effort and progress made by the Comprehensive Sturgeon Research Project during 2011.

Ecological requirements for pallid sturgeon reproduction and recruitment in the Missouri River—Annual report 2014

USGS Publications Warehouse

Delonay, Aaron J.; Chojnacki, Kimberly A.; Jacobson, Robert B.; Braaten, Patrick J.; Buhl, Kevin J.; Elliott, Caroline M.; Erwin, Susannah O.; Faulkner, Jacob D.A.; Candrl, James S.; Fuller, David B.; Backes, Kenneth M.; Haddix, Tyler M.; Rugg, Matthew L.; Wesolek, Christopher J.; Eder, Brandon L.; Mestl, Gerald E.

2016-03-16

The Comprehensive Sturgeon Research Project is a multiyear, multiagency collaborative research framework developed to provide information to support pallid sturgeon recovery and Missouri River management decisions. The project strategy integrates field and laboratory studies of sturgeon reproductive ecology, early life history, habitat requirements, and physiology. The project scope of work is developed annually with collaborating research partners and in cooperation with the U.S. Army Corps of Engineers, Missouri River Recovery Program–Integrated Science Program. The project research consists of several interdependent and complementary tasks that involve multiple disciplines.The project research tasks in the 2014 scope of work emphasized understanding of reproductive migrations and spawning of adult pallid sturgeon and hatch and drift of larvae. These tasks were addressed in three hydrologically and geomorphologically distinct parts of the Missouri River Basin: the Lower Missouri River downstream from Gavins Point Dam, the Upper Missouri River downstream from Fort Peck Dam and downstream reaches of the Milk River, and the Lower Yellowstone River. The project research is designed to inform management decisions related to channel re-engineering, flow modification, and pallid sturgeon population augmentation on the Missouri River and throughout the range of the species. Research and progress made through this project are reported to the U.S. Army Corps of Engineers annually. This annual report details the research effort and progress made by the Comprehensive Sturgeon Research Project during 2014.

Evaluating online diagnostic decision support tools for the clinical setting.

PubMed

Pryor, Marie; White, David; Potter, Bronwyn; Traill, Roger

2012-01-01

Clinical decision support tools available at the point of care are an effective adjunct to support clinicians to make clinical decisions and improve patient outcomes. We developed a methodology and applied it to evaluate commercially available online clinical diagnostic decision support (DDS) tools for use at the point of care. We identified 11 commercially available DDS tools and assessed these against an evaluation instrument that included 6 categories; general information, content, quality control, search, clinical results and other features. We developed diagnostically challenging clinical case scenarios based on real patient experience that were commonly missed by junior medical staff. The evaluation was divided into 2 phases; an initial evaluation of all identified and accessible DDS tools conducted by the Clinical Information Access Portal (CIAP) team and a second phase that further assessed the top 3 tools identified in the initial evaluation phase. An evaluation panel consisting of senior and junior medical clinicians from NSW Health conducted the second phase. Of the eleven tools that were assessed against the evaluation instrument only 4 tools completely met the DDS definition that was adopted for this evaluation and were able to produce a differential diagnosis. From the initial phase of the evaluation 4 DDS tools scored 70% or more (maximum score 96%) for the content category, 8 tools scored 65% or more (maximum 100%) for the quality control category, 5 tools scored 65% or more (maximum 94%) for the search category, and 4 tools score 70% or more (maximum 81%) for the clinical results category. The second phase of the evaluation was focused on assessing diagnostic accuracy for the top 3 tools identified in the initial phase. Best Practice ranked highest overall against the 6 clinical case scenarios used. Overall the differentiating factor between the top 3 DDS tools was determined by diagnostic accuracy ranking, ease of use and the confidence and credibility of the clinical information. The evaluation methodology used here to assess the quality and comprehensiveness of clinical DDS tools was effective in identifying the most appropriate tool for the clinical setting. The use of clinical case scenarios is fundamental in determining the diagnostic accuracy and usability of the tools.

Educating Patients about CKD: The Path to Self-Management and Patient-Centered Care

PubMed Central

Norton, Jenna M.; Boulware, L. Ebony

2016-01-01

Patient education is associated with better patient outcomes and supported by international guidelines and organizations, but a range of barriers prevent widespread implementation of comprehensive education for people with progressive kidney disease, especially in the United States. Among United States patients, obstacles to education include the complex nature of kidney disease information, low baseline awareness, limited health literacy and numeracy, limited availability of CKD information, and lack of readiness to learn. For providers, lack of time and clinical confidence combine with competing education priorities and confusion about diagnosing CKD to limit educational efforts. At the system level, lack of provider incentives, limited availability of practical decision support tools, and lack of established interdisciplinary care models inhibit patient education. Despite these barriers, innovative education approaches for people with CKD exist, including self-management support, shared decision making, use of digital media, and engaging families and communities. Education efficiency may be increased by focusing on people with progressive disease, establishing interdisciplinary care management including community health workers, and providing education in group settings. New educational approaches are being developed through research and quality improvement efforts, but challenges to evaluating public awareness and patient education programs inhibit identification of successful strategies for broader implementation. However, growing interest in improving patient-centered outcomes may provide new approaches to effective education of people with CKD. PMID:26536899

Adaptive Management Methods to Protect the California Sacramento-San Joaquin Delta Water Resource

NASA Technical Reports Server (NTRS)

Bubenheim, David

2016-01-01

The California Sacramento-San Joaquin River Delta is the hub for California's water supply, conveying water from Northern to Southern California agriculture and communities while supporting important ecosystem services, agriculture, and communities in the Delta. Changes in climate, long-term drought, water quality changes, and expansion of invasive aquatic plants threatens ecosystems, impedes ecosystem restoration, and is economically, environmentally, and sociologically detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California and local governments to develop science-based, adaptive-management strategies for the Sacramento-San Joaquin Delta. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and waterway managers make science-informed decisions regarding management and outcomes. The team provides a comprehensive understanding of agricultural and urban land use in the Delta and the major water sheds (San Joaquin/Sacramento) supplying the Delta and interaction with drought and climate impacts on the environment, water quality, and weed growth. The team recommends conservation and modified land-use practices and aids local Delta stakeholders in developing management strategies. New remote sensing tools have been developed to enhance ability to assess conditions, inform decision support tools, and monitor management practices. Science gaps in understanding how native and invasive plants respond to altered environmental conditions are being filled and provide critical biological response parameters for Delta-SWAT simulation modeling. Operational agencies such as the California Department of Boating and Waterways provide testing and act as initial adopter of decision support tools. Methods developed by the project can become routine land and water management tools in complex river delta systems.

Language differences in the brain network for reading in naturalistic story reading and lexical decision.

PubMed

Wang, Xiaojuan; Yang, Jianfeng; Yang, Jie; Mencl, W Einar; Shu, Hua; Zevin, Jason David

2015-01-01

Differences in how writing systems represent language raise important questions about whether there could be a universal functional architecture for reading across languages. In order to study potential language differences in the neural networks that support reading skill, we collected fMRI data from readers of alphabetic (English) and morpho-syllabic (Chinese) writing systems during two reading tasks. In one, participants read short stories under conditions that approximate natural reading, and in the other, participants decided whether individual stimuli were real words or not. Prior work comparing these two writing systems has overwhelmingly used meta-linguistic tasks, generally supporting the conclusion that the reading system is organized differently for skilled readers of Chinese and English. We observed that language differences in the reading network were greatly dependent on task. In lexical decision, a pattern consistent with prior research was observed in which the Middle Frontal Gyrus (MFG) and right Fusiform Gyrus (rFFG) were more active for Chinese than for English, whereas the posterior temporal sulcus was more active for English than for Chinese. We found a very different pattern of language effects in a naturalistic reading paradigm, during which significant differences were only observed in visual regions not typically considered specific to the reading network, and the middle temporal gyrus, which is thought to be important for direct mapping of orthography to semantics. Indeed, in areas that are often discussed as supporting distinct cognitive or linguistic functions between the two languages, we observed interaction. Specifically, language differences were most pronounced in MFG and rFFG during the lexical decision task, whereas no language differences were observed in these areas during silent reading of text for comprehension.

Helicobacter Pylori “Test-and-Treat” Strategy for Management of Dyspepsia: A Comprehensive Review

PubMed Central

Gisbert, Javier P; Calvet, Xavier

2013-01-01

OBJECTIVES: Deciding on whether the Helicobacter pylori test-and-treat strategy is an appropriate diagnostic–therapeutic approach for patients with dyspepsia invites a series of questions. The aim present article addresses the test-and-treat strategy and attempts to provide practical conclusions for the clinician who diagnoses and treats patients with dyspepsia. METHODS: Bibliographical searches were performed in MEDLINE using the keywords Helicobacter pylori, test-and-treat, and dyspepsia. We focused mainly on data from randomized controlled trials (RCTs), systematic reviews, meta-analyses, cost-effectiveness analyses, and decision analyses. RESULTS: Several prospective studies and decision analyses support the use of the test-and-treat strategy, although we must be cautious when extrapolating the results from one geographical area to another. Many factors determine whether this strategy is appropriate in each particular area. The test-and-treat strategy will cure most cases of underlying peptic ulcer disease, prevent most potential cases of gastroduodenal disease, and yield symptomatic benefit in a minority of patients with functional dyspepsia. Future studies should be able to stratify dyspeptic patients according to their likelihood of improving after treatment of infection by H. pylori. CONCLUSIONS: The test-and-treat strategy will cure most cases of underlying peptic ulcer disease and prevent most potential cases of gastroduodenal disease. In addition, a minority of infected patients with functional dyspepsia will gain symptomatic benefit. Several prospective studies and decision analyses support the use of the test-and-treat strategy. The test-and-treat strategy is being reinforced by the accumulating data that support the increasingly accepted idea that “the only good H. pylori is a dead H. pylori”. PMID:23535826

Remote Sensing and Modeling for Improving Operational Aquatic Plant Management

NASA Technical Reports Server (NTRS)

Bubenheim, Dave

2016-01-01

The California Sacramento-San Joaquin River Delta is the hub for California’s water supply, conveying water from Northern to Southern California agriculture and communities while supporting important ecosystem services, agriculture, and communities in the Delta. Changes in climate, long-term drought, water quality changes, and expansion of invasive aquatic plants threatens ecosystems, impedes ecosystem restoration, and is economically, environmentally, and sociologically detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California and local governments to develop science-based, adaptive-management strategies for the Sacramento-San Joaquin Delta. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and waterway managers make science-informed decisions regarding management and outcomes. The team provides a comprehensive understanding of agricultural and urban land use in the Delta and the major water sheds (San Joaquin/Sacramento) supplying the Delta and interaction with drought and climate impacts on the environment, water quality, and weed growth. The team recommends conservation and modified land-use practices and aids local Delta stakeholders in developing management strategies. New remote sensing tools have been developed to enhance ability to assess conditions, inform decision support tools, and monitor management practices. Science gaps in understanding how native and invasive plants respond to altered environmental conditions are being filled and provide critical biological response parameters for Delta-SWAT simulation modeling. Operational agencies such as the California Department of Boating and Waterways provide testing and act as initial adopter of decision support tools. Methods developed by the project can become routine land and water management tools in complex river delta systems.

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.…

Establishment of a Comprehensive Data System for Occupational Training in Kentucky--Phase I, Final Report.

ERIC Educational Resources Information Center

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

This document reports on the first of a 3-phase plan to adapt and install a state vocational-technical education comprehensive data system for occupational training in Kentucky. The objective of the system described is to provide more comprehensive analysis of data essential to education decision-makers. Primary users of the system are expected to…

The GMOseek matrix: a decision support tool for optimizing the detection of genetically modified plants.

PubMed

Block, Annette; Debode, Frédéric; Grohmann, Lutz; Hulin, Julie; Taverniers, Isabel; Kluga, Linda; Barbau-Piednoir, Elodie; Broeders, Sylvia; Huber, Ingrid; Van den Bulcke, Marc; Heinze, Petra; Berben, Gilbert; Busch, Ulrich; Roosens, Nancy; Janssen, Eric; Žel, Jana; Gruden, Kristina; Morisset, Dany

2013-08-22

Since their first commercialization, the diversity of taxa and the genetic composition of transgene sequences in genetically modified plants (GMOs) are constantly increasing. To date, the detection of GMOs and derived products is commonly performed by PCR-based methods targeting specific DNA sequences introduced into the host genome. Information available regarding the GMOs' molecular characterization is dispersed and not appropriately organized. For this reason, GMO testing is very challenging and requires more complex screening strategies and decision making schemes, demanding in return the use of efficient bioinformatics tools relying on reliable information. The GMOseek matrix was built as a comprehensive, online open-access tabulated database which provides a reliable, comprehensive and user-friendly overview of 328 GMO events and 247 different genetic elements (status: 18/07/2013). The GMOseek matrix is aiming to facilitate GMO detection from plant origin at different phases of the analysis. It assists in selecting the targets for a screening analysis, interpreting the screening results, checking the occurrence of a screening element in a group of selected GMOs, identifying gaps in the available pool of GMO detection methods, and designing a decision tree. The GMOseek matrix is an independent database with effective functionalities in a format facilitating transferability to other platforms. Data were collected from all available sources and experimentally tested where detection methods and certified reference materials (CRMs) were available. The GMOseek matrix is currently a unique and very valuable tool with reliable information on GMOs from plant origin and their present genetic elements that enables further development of appropriate strategies for GMO detection. It is flexible enough to be further updated with new information and integrated in different applications and platforms.

The financing gaps framework: using need, potential spending and expected spending to allocate development assistance for health

PubMed Central

Haakenstad, Annie; Templin, Tara; Lim, Stephen; Bump, Jesse B; Dieleman, Joseph

2018-01-01

Abstract As growth in development assistance for health levels off, development assistance partners must make allocation decisions within tighter budget constraints. Furthermore, with the advent of comprehensive and comparable burden of disease and health financing estimates, empirical evidence can increasingly be used to direct funding to those most in need. In our ‘financing gaps framework’, we propose a new approach for harnessing information to make decisions about health aid. The framework was designed to be forward-looking, goal-oriented, versatile and customizable to a range of organizational contexts and health aims. Our framework brings together expected health spending, potential health spending and spending need, to orient financing decisions around international health targets. As an example of how the framework could be applied, we develop a case study, focused on global goals for child health. The case study harnesses data from the Global Burden of Disease 2013 Study, Financing Global Health 2015, the WHO Global Health Observatory and National Health Accounts. Funding flows are tied to progress toward the Sustainable Development Goal’s target for reductions in under-five mortality. The flexibility and comprehensiveness of our framework makes it adaptable for use by a diverse set of governments, donors, policymakers and other stakeholders. The framework can be adapted to short‐ or long‐run time frames, cross‐country or subnational scales, and to a number of specific health focus areas. Depending on donor preferences, the framework can be deployed to incentivize local investments in health, ensuring the long-term sustainability of health systems in low- and middle-income countries, while also furnishing international support for progress toward global health goals. PMID:29415240

The GMOseek matrix: a decision support tool for optimizing the detection of genetically modified plants

PubMed Central

2013-01-01

Background Since their first commercialization, the diversity of taxa and the genetic composition of transgene sequences in genetically modified plants (GMOs) are constantly increasing. To date, the detection of GMOs and derived products is commonly performed by PCR-based methods targeting specific DNA sequences introduced into the host genome. Information available regarding the GMOs’ molecular characterization is dispersed and not appropriately organized. For this reason, GMO testing is very challenging and requires more complex screening strategies and decision making schemes, demanding in return the use of efficient bioinformatics tools relying on reliable information. Description The GMOseek matrix was built as a comprehensive, online open-access tabulated database which provides a reliable, comprehensive and user-friendly overview of 328 GMO events and 247 different genetic elements (status: 18/07/2013). The GMOseek matrix is aiming to facilitate GMO detection from plant origin at different phases of the analysis. It assists in selecting the targets for a screening analysis, interpreting the screening results, checking the occurrence of a screening element in a group of selected GMOs, identifying gaps in the available pool of GMO detection methods, and designing a decision tree. The GMOseek matrix is an independent database with effective functionalities in a format facilitating transferability to other platforms. Data were collected from all available sources and experimentally tested where detection methods and certified reference materials (CRMs) were available. Conclusions The GMOseek matrix is currently a unique and very valuable tool with reliable information on GMOs from plant origin and their present genetic elements that enables further development of appropriate strategies for GMO detection. It is flexible enough to be further updated with new information and integrated in different applications and platforms. PMID:23965170

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

Methods Clinical guideline adherence for diagnostic imaging (DI) and acceptance of electronic decision support in a rural community family practice clinic was assessed over 36 weeks. Physicians wrote 904 DI orders, 58% of which were addressed by the Canadian Association of Radiologists guidelines. Results Of those orders with guidelines, 76% were ordered correctly; 24% were inappropriate or unnecessary resulting in a prompt from clinical decision support. Physicians followed suggestions from decision support to improve their DI order on 25% of the initially inappropriate orders. The use of decision support was not mandatory, and there were significant variations in use rate. Initially, 40% reported decision support disruptive in their work flow, which dropped to 16% as physicians gained experience with the software. Conclusions Physicians supported the concept of clinical decision support but were reluctant to change clinical habits to incorporate decision support into routine work flow. PMID:21486884

Family involvement in decision making for people with dementia in residential aged care: a systematic review of quantitative literature.

PubMed

Petriwskyj, Andrea; Gibson, Alexandra; Parker, Deborah; Banks, Susan; Andrews, Sharon; Robinson, Andrew

2014-06-01

Ensuring older adults' involvement in their care is accepted as good practice and is vital, particularly for people with dementia, whose care and treatment needs change considerably over the course of the illness. However, involving family members in decision making on people's behalf is still practically difficult for staff and family. The aim of this review was to identify and appraise the existing quantitative evidence about family involvement in decision making for people with dementia living in residential aged care. The present Joanna Briggs Institute (JBI) metasynthesis assessed studies that investigated involvement of family members in decision making for people with dementia in residential aged care settings. While quantitative and qualitative studies were included in the review, this paper presents the quantitative findings. A comprehensive search of 15 electronic databases was performed. The search was limited to papers published in English, from 1990 to 2013. Twenty-six studies were identified as being relevant; 10 were quantitative, with 1 mixed method study. Two independent reviewers assessed the studies for methodological validity and extracted the data using the JBI Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). The findings were synthesized and presented in narrative form. The findings related to decisions encountered and made by family surrogates, variables associated with decisions, surrogates' perceptions of, and preferences for, their roles, as well as outcomes for people with dementia and their families. The results identified patterns within, and variables associated with, surrogate decision making, all of which highlight the complexity and variation regarding family involvement. Attention needs to be paid to supporting family members in decision making in collaboration with staff.

Supporting end of life decision making: Case studies of relational closeness in supported decision making for people with severe or profound intellectual disability.

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions. Five people with severe or profound intellectual disability's experiences of supported decision making were examined. This article is particularly focused on one participant's experiences at the end of his life. All five case studies identified that supporters were most effective in providing decision-making support for participants when they were relationally close to the person and had knowledge of the person's life story, particularly in relation to events that demonstrated preference. Findings from this study provide new understandings of supported decision making for people with severe or profound intellectual disability and have particular relevance for supporting decision making at the end of life. © 2017 John Wiley & Sons Ltd.

Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey

PubMed Central

2013-01-01

Background Population studies on end-of-life decisions have not been conducted in Cyprus. Our study aim was to evaluate the beliefs and attitudes of Greek Cypriots towards end-of-life issues regarding euthanasia and cremation. Methods A population-based telephone survey was conducted in Cyprus. One thousand randomly selected individuals from the population of Cyprus age 20 years or older were invited to participate. Beliefs and attitudes on end-of-life decisions were collected using an anonymous and validated questionnaire. Statistical analyses included cross-tabulations, Pearson’s chi-square tests and multivariable-adjusted logistic regression models. Results A total of 308 males and 689 females participated in the survey. About 70% of the respondents did not support euthanasia for people with incurable illness and/or elders with dementia when requested by them and 77% did not support euthanasia for people with incurable illness and/or elders with dementia when requested by relatives. Regarding cremation, 78% were against and only 14% reported being in favor. Further statistical analyses showed that male gender, being single and having reached higher educational level were factors positively associated with support for euthanasia in a statistically significant fashion. On the contrary, the more religiosity expressed by study participants, the less support they reported for euthanasia or cremation. Conclusions The vast majority of Greek Cypriots does not support euthanasia for people with incurable illness and/or elders with dementia and also do not support cremation. Certain demographic characteristics such as age and education have a positive influence towards attitudes for euthanasia and cremation, while religiosity exerts a strong negative influence on the above. Family bonding as well as social and cultural traditions may also play a role although not comprehensively evaluated in the current study. PMID:24060291

Attitudes towards euthanasia in severely ill and dementia patients and cremation in Cyprus: a population-based survey.

PubMed

Televantos, Anastasios; Talias, Michael A; Charalambous, Marianna; Soteriades, Elpidoforos S

2013-09-23

Population studies on end-of-life decisions have not been conducted in Cyprus. Our study aim was to evaluate the beliefs and attitudes of Greek Cypriots towards end-of-life issues regarding euthanasia and cremation. A population-based telephone survey was conducted in Cyprus. One thousand randomly selected individuals from the population of Cyprus age 20 years or older were invited to participate. Beliefs and attitudes on end-of-life decisions were collected using an anonymous and validated questionnaire. Statistical analyses included cross-tabulations, Pearson's chi-square tests and multivariable-adjusted logistic regression models. A total of 308 males and 689 females participated in the survey. About 70% of the respondents did not support euthanasia for people with incurable illness and/or elders with dementia when requested by them and 77% did not support euthanasia for people with incurable illness and/or elders with dementia when requested by relatives. Regarding cremation, 78% were against and only 14% reported being in favor. Further statistical analyses showed that male gender, being single and having reached higher educational level were factors positively associated with support for euthanasia in a statistically significant fashion. On the contrary, the more religiosity expressed by study participants, the less support they reported for euthanasia or cremation. The vast majority of Greek Cypriots does not support euthanasia for people with incurable illness and/or elders with dementia and also do not support cremation. Certain demographic characteristics such as age and education have a positive influence towards attitudes for euthanasia and cremation, while religiosity exerts a strong negative influence on the above. Family bonding as well as social and cultural traditions may also play a role although not comprehensively evaluated in the current study.

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…

Visual Analytics for the Food-Water-Energy Nexus in the Phoenix Active Management Area

NASA Astrophysics Data System (ADS)

Maciejewski, R.; Mascaro, G.; White, D. D.; Ruddell, B. L.; Aggarwal, R.; Sarjoughian, H.

2016-12-01

The Phoenix Active Management Area (AMA) is an administrative region of 14,500 km2 identified by the Arizona Department of Water Resources with the aim of reaching and maintaining the safe yield (i.e. balance between annual amount of groundwater withdrawn and recharged) by 2025. The AMA includes the Phoenix metropolitan area, which has experienced a dramatic population growth over the last decades with a progressive conversion of agricultural land into residential land. As a result of these changes, the water and energy demand as well as the food production in the region have significantly evolved over the last 30 years. Given the arid climate, a crucial role to support this growth has been the creation of a complex water supply system based on renewable and non-renewable resources, including the energy-intensive Central Arizona Project. In this talk, we present a preliminary characterization of the evolution in time of the feedbacks between food, water, and energy in the Phoenix AMA by analyzing secondary data (available from water and energy providers, irrigation districts, and municipalities), as well as satellite imagery and primary data collected by the authors. A preliminary visual analytics framework is also discussed describing current design practices and ideas for exploring networked components and cascading impacts within the FEW Nexus. This analysis and framework represent the first steps towards the development of an integrated modeling, visualization, and decision support infrastructure for comprehensive FEW systems decision making at decision-relevant temporal and spatial scales.

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 for the selection of reference sites using 137Cs as a soil erosion tracer

NASA Astrophysics Data System (ADS)

Arata, Laura; Meusburger, Katrin; Bürge, Alexandra; Zehringer, Markus; Ketterer, Michael E.; Mabit, Lionel; Alewell, Christine

2017-08-01

The classical approach of using 137Cs as a soil erosion tracer is based on the comparison between stable reference sites and sites affected by soil redistribution processes; it enables the derivation of soil erosion and deposition rates. The method is associated with potentially large sources of uncertainty with major parts of this uncertainty being associated with the selection of the reference sites. We propose a decision support tool to Check the Suitability of reference Sites (CheSS). Commonly, the variation among 137Cs inventories of spatial replicate reference samples is taken as the sole criterion to decide on the suitability of a reference inventory. Here we propose an extension of this procedure using a repeated sampling approach, in which the reference sites are resampled after a certain time period. Suitable reference sites are expected to present no significant temporal variation in their decay-corrected 137Cs depth profiles. Possible causes of variation are assessed by a decision tree. More specifically, the decision tree tests for (i) uncertainty connected to small-scale variability in 137Cs due to its heterogeneous initial fallout (such as in areas affected by the Chernobyl fallout), (ii) signs of erosion or deposition processes and (iii) artefacts due to the collection, preparation and measurement of the samples; (iv) finally, if none of the above can be assigned, this variation might be attributed to turbation processes (e.g. bioturbation, cryoturbation and mechanical turbation, such as avalanches or rockfalls). CheSS was exemplarily applied in one Swiss alpine valley where the apparent temporal variability called into question the suitability of the selected reference sites. In general we suggest the application of CheSS as a first step towards a comprehensible approach to test for the suitability of reference sites.

Separable processes before, during, and after the N400 elicited by previously inferred and new information: evidence from time-frequency decompositions.

PubMed

Steele, Vaughn R; Bernat, Edward M; van den Broek, Paul; Collins, Paul F; Patrick, Christopher J; Marsolek, Chad J

2013-01-25

Successful comprehension during reading often requires inferring information not explicitly presented. This information is readily accessible when subsequently encountered, and a neural correlate of this is an attenuation of the N400 event-related potential (ERP). We used ERPs and time-frequency (TF) analysis to investigate neural correlates of processing inferred information after a causal coherence inference had been generated during text comprehension. Participants read short texts, some of which promoted inference generation. After each text, they performed lexical decisions to target words that were unrelated or inference-related to the preceding text. Consistent with previous findings, inference-related words elicited an attenuated N400 relative to unrelated words. TF analyses revealed unique contributions to the N400 from activity occurring at 1-6 Hz (theta) and 0-2 Hz (delta), supporting the view that multiple, sequential processes underlie the N400. Copyright © 2012 Elsevier B.V. All rights reserved.

A comprehensive dairy valorization model.

PubMed

Banaszewska, A; Cruijssen, F; van der Vorst, J G A J; Claassen, G D H; Kampman, J L

2013-02-01

Dairy processors face numerous challenges resulting from both unsteady dairy markets and some specific characteristics of dairy supply chains. To maintain a competitive position on the market, companies must look beyond standard solutions currently used in practice. This paper presents a comprehensive dairy valorization model that serves as a decision support tool for mid-term allocation of raw milk to end products and production planning. The developed model was used to identify the optimal product portfolio composition. The model allocates raw milk to the most profitable dairy products while accounting for important constraints (i.e., recipes, composition variations, dairy production interdependencies, seasonality, demand, supply, capacities, and transportation flows). The inclusion of all relevant constraints and the ease of understanding dairy production dynamics make the model comprehensive. The developed model was tested at the international dairy processor FrieslandCampina (Amersfoort, the Netherlands). The structure of the model and its output were discussed in multiple sessions with and approved by relevant FrieslandCampina employees. The elements included in the model were considered necessary to optimally valorize raw milk. To illustrate the comprehensiveness and functionality of the model, we analyzed the effect of seasonality on milk valorization. A large difference in profit and a shift in the allocation of milk showed that seasonality has a considerable impact on the valorization of raw milk. Copyright © 2013 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

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

Promoting Persistence through Comprehensive Student Supports

ERIC Educational Resources Information Center

McDonnell, Rachel Pleasants; Soricone, Lisa

2014-01-01

This publication was developed to support the colleges Jobs For the Future (JFF) works with through Accelerating Opportunity, as well as other institutions in search of strategies to enhance their capacity to provide comprehensive supports. The goal of this paper is to provide clarity on what it means to provide comprehensive support services,…

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...

State Injury Programs’ Response to the Opioid Epidemic: The Role of CDC’s Core Violence and Injury Prevention Program

PubMed Central

Deokar, Angela J.; Dellapenna, Alan; DeFiore-Hyrmer, Jolene; Laidler, Matt; Millet, Lisa; Morman, Sara; Myers, Lindsey

2018-01-01

The Centers for Disease Control and Prevention’s (CDC’s) Core Violence and Injury Prevention Program (Core) supports capacity of state violence and injury prevention programs to implement evidence-based interventions. Several Core-funded states prioritized prescription drug overdose (PDO) and leveraged their systems to identify and respond to the epidemic before specific PDO prevention funding was available through CDC. This article describes activities employed by Core-funded states early in the epidemic. Four case examples illustrate states’ approaches within the context of their systems and partners. While Core funding is not sufficient to support a comprehensive PDO prevention program, having Core in place at the beginning of the emerging epidemic had critical implications for identifying the problem and developing systems that were later expanded as additional resources became available. Important components included staffing support to bolster programmatic and epidemiological capacity; diverse and collaborative partnerships; and use of surveillance and evidence-informed best practices to prioritize decision-making. PMID:29189501

Toward best practice: leveraging the electronic patient record as a clinical data warehouse.

PubMed

Ledbetter, C S; Morgan, M W

2001-01-01

Automating clinical and administrative processes via an electronic patient record (EPR) gives clinicians the point-of-care tools they need to deliver better patient care. However, to improve clinical practice as a whole and then evaluate it, healthcare must go beyond basic automation and convert EPR data into aggregated, multidimensional information. Unfortunately, few EPR systems have the established, powerful analytical clinical data warehouses (CDWs) required for this conversion. This article describes how an organization can support best practice by leveraging a CDW that is fully integrated into its EPR and clinical decision support (CDS) system. The article (1) discusses the requirements for comprehensive CDS, including on-line analytical processing (OLAP) of data at both transactional and aggregate levels, (2) suggests that the transactional data acquired by an OLTP EPR system must be remodeled to support retrospective, population-based, aggregate analysis of those data, and (3) concludes that this aggregate analysis is best provided by a separate CDW system.

Predictive modeling of addiction lapses in a mobile health application.

PubMed

Chih, Ming-Yuan; Patton, Timothy; McTavish, Fiona M; Isham, Andrew J; Judkins-Fisher, Chris L; Atwood, Amy K; Gustafson, David H

2014-01-01

The chronically relapsing nature of alcoholism leads to substantial personal, family, and societal costs. Addiction-comprehensive health enhancement support system (A-CHESS) is a smartphone application that aims to reduce relapse. To offer targeted support to patients who are at risk of lapses within the coming week, a Bayesian network model to predict such events was constructed using responses on 2,934 weekly surveys (called the Weekly Check-in) from 152 alcohol-dependent individuals who recently completed residential treatment. The Weekly Check-in is a self-monitoring service, provided in A-CHESS, to track patients' recovery progress. The model showed good predictability, with the area under receiver operating characteristic curve of 0.829 in the 10-fold cross-validation and 0.912 in the external validation. The sensitivity/specificity table assists the tradeoff decisions necessary to apply the model in practice. This study moves us closer to the goal of providing lapse prediction so that patients might receive more targeted and timely support. © 2013.

State Injury Programs' Response to the Opioid Epidemic: The Role of CDC's Core Violence and Injury Prevention Program.

PubMed

Deokar, Angela J; Dellapenna, Alan; DeFiore-Hyrmer, Jolene; Laidler, Matt; Millet, Lisa; Morman, Sara; Myers, Lindsey

The Centers for Disease Control and Prevention's (CDC's) Core Violence and Injury Prevention Program (Core) supports capacity of state violence and injury prevention programs to implement evidence-based interventions. Several Core-funded states prioritized prescription drug overdose (PDO) and leveraged their systems to identify and respond to the epidemic before specific PDO prevention funding was available through CDC. This article describes activities employed by Core-funded states early in the epidemic. Four case examples illustrate states' approaches within the context of their systems and partners. While Core funding is not sufficient to support a comprehensive PDO prevention program, having Core in place at the beginning of the emerging epidemic had critical implications for identifying the problem and developing systems that were later expanded as additional resources became available. Important components included staffing support to bolster programmatic and epidemiological capacity; diverse and collaborative partnerships; and use of surveillance and evidence-informed best practices to prioritize decision-making.

Predictive Modeling of Addiction Lapses in a Mobile Health Application

PubMed Central

Chih, Ming-Yuan; Patton, Timothy; McTavish, Fiona M.; Isham, Andrew; Judkins-Fisher, Chris L.; Atwood, Amy K.; Gustafson, David H.

2013-01-01

The chronically relapsing nature of alcoholism leads to substantial personal, family, and societal costs. Addiction-Comprehensive Health Enhancement Support System (A-CHESS) is a smartphone application that aims to reduce relapse. To offer targeted support to patients who are at risk of lapses within the coming week, a Bayesian network model to predict such events was constructed using responses on 2,934 weekly surveys (called the Weekly Check-in) from 152 alcohol-dependent individuals who recently completed residential treatment. The Weekly Check-in is a self-monitoring service, provided in A-CHESS, to track patients’ recovery progress. The model showed good predictability, with the area under receiver operating characteristic curve of 0.829 in the 10-fold cross-validation and 0.912 in the external validation. The sensitivity/specificity table assists the tradeoff decisions necessary to apply the model in practice. This study moves us closer to the goal of providing lapse prediction so that patients might receive more targeted and timely support. PMID:24035143

Development of the Supported Decision Making Inventory System.

PubMed

Shogren, Karrie A; Wehmeyer, Michael L; Uyanik, Hatice; Heidrich, Megan

2017-12-01

Supported decision making has received increased attention as an alternative to guardianship and a means to enable people with intellectual and developmental disabilities to exercise their right to legal capacity. Assessments are needed that can used by people with disabilities and their systems of supports to identify and plan for needed supports to enable decision making. This article describes the steps taken to develop such an assessment tool, the Supported Decision Making Inventory System (SDMIS), and initial feedback received from self-advocates with intellectual disability. The three sections of the SDMIS (Supported Decision Making Personal Factors Inventory, Supported Decision Making Environmental Demands Inventory, and Decision Making Autonomy Inventory) are described and implications for future research, policy, and practice are discussed.

Conceptualisation and development of the Conversational Health Literacy Assessment Tool (CHAT).

PubMed

O'Hara, Jonathan; Hawkins, Melanie; Batterham, Roy; Dodson, Sarity; Osborne, Richard H; Beauchamp, Alison

2018-03-22

The aim of this study was to develop a tool to support health workers' ability to identify patients' multidimensional health literacy strengths and challenges. The tool was intended to be suitable for administration in healthcare settings where health workers must identify health literacy priorities as the basis for person-centred care. Development was based on a qualitative co-design process that used the Health Literacy Questionnaire (HLQ) as a framework to generate questions. Health workers were recruited to participate in an online consultation, a workshop, and two rounds of pilot testing. Participating health workers identified and refined ten questions that target five areas of assessment: supportive professional relationships, supportive personal relationships, health information access and comprehension, current health behaviours, and health promotion barriers and support. Preliminary evidence suggests that application of the Conversational Health Literacy Assessment Tool (CHAT) can support health workers to better understand the health literacy challenges and supportive resources of their patients. As an integrated clinical process, the CHAT can supplement existing intake and assessment procedures across healthcare settings to give insight into patients' circumstances so that decisions about care can be tailored to be more appropriate and effective.

2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries

PubMed Central

Ekås, Guri Ranum; Grindem, Hege; Moksnes, Håvard; Anderson, Allen F; Chotel, Franck; Cohen, Moises; Forssblad, Magnus; Ganley, Theodore J; Feller, Julian A; Karlsson, Jón; Kocher, Minider S; LaPrade, Robert F; McNamee, Michael; Mandelbaum, Bert; Micheli, Lyle; Mohtadi, Nicholas; Reider, Bruce; Roe, Justin; Seil, Romain; Siebold, Rainer; Witvrouw, Erik; Engebretsen, Lars

2018-01-01

In October 2017, the International Olympic Committee hosted an international expert group of physiotherapists and orthopaedic surgeons who specialise in treating and researching paediatric ACL injuries. Representatives from the American Orthopaedic Society for Sports Medicine, European Paediatric Orthopaedic Society, European Society for Sports Traumatology, Knee Surgery & Arthroscopy, International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine, Pediatric Orthopaedic Society of North America and Sociedad Latinoamericana de Artroscopia, Rodilla y Deporte attended. Physiotherapists and orthopaedic surgeons with clinical and research experience in the field, and an ethics expert with substantial experience in the area of sports injuries also participated. Injury management is challenging in the current landscape of clinical uncertainty and limited scientific knowledge. Injury management decisions also occur against the backdrop of the complexity of shared decision-making with children and the potential long-term ramifications of the injury. This consensus statement addresses six fundamental clinical questions regarding the prevention, diagnosis and management of paediatric ACL injuries. The aim of this consensus statement is to provide a comprehensive, evidence-informed summary to support the clinician, and help children with ACL injury and their parents/guardians make the best possible decisions. PMID:29478021

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

'Mechanical restraint-confounders, risk, alliance score': testing the clinical validity of a new risk assessment instrument.

PubMed

Deichmann Nielsen, Lea; Bech, Per; Hounsgaard, Lise; Alkier Gildberg, Frederik

2017-08-01

Unstructured risk assessment, as well as confounders (underlying reasons for the patient's risk behaviour and alliance), risk behaviour, and parameters of alliance, have been identified as factors that prolong the duration of mechanical restraint among forensic mental health inpatients. To clinically validate a new, structured short-term risk assessment instrument called the Mechanical Restraint-Confounders, Risk, Alliance Score (MR-CRAS), with the intended purpose of supporting the clinicians' observation and assessment of the patient's readiness to be released from mechanical restraint. The content and layout of MR-CRAS and its user manual were evaluated using face validation by forensic mental health clinicians, content validation by an expert panel, and pilot testing within two, closed forensic mental health inpatient units. The three sub-scales (Confounders, Risk, and a parameter of Alliance) showed excellent content validity. The clinical validations also showed that MR-CRAS was perceived and experienced as a comprehensible, relevant, comprehensive, and useable risk assessment instrument. MR-CRAS contains 18 clinically valid items, and the instrument can be used to support the clinical decision-making regarding the possibility of releasing the patient from mechanical restraint. The present three studies have clinically validated a short MR-CRAS scale that is currently being psychometrically tested in a larger study.

Supporting End of Life Decision Making: Case Studies of Relational Closeness in Supported Decision Making for People with Severe or Profound Intellectual Disability

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

Background: The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) promotes the use of supported decision making in lieu of substitute decision making. To date, there has been a lack of focus on supported decision making for people with severe or profound intellectual disability, including for end of life decisions.…

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…

Applying the Wildland Fire Decision Support System (WFDSS) to support risk-informed decision making: The Gold Pan Fire, Bitterroot National Forest, Montana, USA

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

In response to federal wildfire policy changes, risk-informed decision-making by way of improved decision support, is increasingly becoming a component of managing wildfires. As fire incidents escalate in size and complexity, the Wildland Fire Decision Support System (WFDSS) provides support with different analytical tools as fire conditions change. We demonstrate the...

Decision support for clinical laboratory capacity planning.

PubMed

van Merode, G G; Hasman, A; Derks, J; Goldschmidt, H M; Schoenmaker, B; Oosten, M

1995-01-01

The design of a decision support system for capacity planning in clinical laboratories is discussed. The DSS supports decisions concerning the following questions: how should the laboratory be divided into job shops (departments/sections), how should staff be assigned to workstations and how should samples be assigned to workstations for testing. The decision support system contains modules for supporting decisions at the overall laboratory level (concerning the division of the laboratory into job shops) and for supporting decisions at the job shop level (assignment of staff to workstations and sample scheduling). Experiments with these modules are described showing both the functionality and the validity.

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

Project Assessment Framework through Design (PAFTD) - A Project Assessment Framework in Support of Strategic Decision Making

NASA Technical Reports Server (NTRS)

Depenbrock, Brett T.; Balint, Tibor S.; Sheehy, Jeffrey A.

2014-01-01

Research and development organizations that push the innovation edge of technology frequently encounter challenges when attempting to identify an investment strategy and to accurately forecast the cost and schedule performance of selected projects. Fast moving and complex environments require managers to quickly analyze and diagnose the value of returns on investment versus allocated resources. Our Project Assessment Framework through Design (PAFTD) tool facilitates decision making for NASA senior leadership to enable more strategic and consistent technology development investment analysis, beginning at implementation and continuing through the project life cycle. The framework takes an integrated approach by leveraging design principles of useability, feasibility, and viability and aligns them with methods employed by NASA's Independent Program Assessment Office for project performance assessment. The need exists to periodically revisit the justification and prioritization of technology development investments as changes occur over project life cycles. The framework informs management rapidly and comprehensively about diagnosed internal and external root causes of project performance.

Improving the decision-making process for nonprescription drugs: a framework for benefit-risk assessment.

PubMed

Brass, E P; Lofstedt, R; Renn, O

2011-12-01

Nonprescription drugs pose unique challenges to regulators. The fact that the barriers to access are lower for nonprescription drugs as compared with prescription drugs may permit additional consumers to obtain effective drugs. However, the use of these drugs by consumers in the absence of supervision by a health-care professional may result in unacceptable rates of misuse and suboptimal clinical outcomes. A value-tree method is proposed that defines important benefit and risk domains relevant to nonprescription drugs. This value tree can be used to comprehensively identify product-specific attributes in each domain and can also support formal benefit-risk assessment using a variety of tools. This is illustrated here, using a modification of the International Risk Governance Council (IRGC) framework, a flexible tool previously applied in a number of fields, which systematizes an approach to issue review, early alignment of stakeholders, evaluation, and risk mitigation/management. The proposed approach has the potential to provide structured, transparent tools for regulatory decision making for nonprescription drugs.

A multicriteria decision analysis of augmentative treatment of upper limbs in persons with tetraplegia.

PubMed

Hummel, J M Marjan; Snoek, Govert J; van Til, Janine A; van Rossum, Wouter; Ijzerman, Maarten J

2005-01-01

This study supported the evaluation by a rehabilitation team of the performance of two treatment options that improve the arm-hand function in subjects with sixth cervical vertebra (C6) level Motor Group 2 tetraplegia. The analytic hierarchy process, a technique for multicriteria decision analysis, was used by a rehabilitation team and potential recipients to quantitatively compare a new technology, Functional Elec trical Stimulation (FES), with conventional surgery. Perform-ance was measured by functional improvement, treatment load, risks, user-friendliness, and social outcomes. Functional improvement after FES was considered better than that after conventional surgery. However, the rehabilitation team's overall rating for conventional surgery was slightly higher than that for FES (57% vs 44%). Compared with the rehabilitation team, potential recipients gave greater weight to burden of treatment and less weight to functional improvement. This study shows that evaluation of new technology must be more comprehensive than the evaluation of functional improvement alone, and that patient preferences may differ from those of the rehabilitation team.

Resource Use After Unwanted Sexual Experiences in Undergraduates: A Comprehensive Evaluation of Factors Related to the Decision to Seek Help.

PubMed

Fleming, C J Eubanks; Lynch, Kyle A; Hakas, Maggie B; Belanger, Elizabeth

2018-06-01

The risk for sexual victimization in college is high, and although there can be significant mental and physical consequences for the survivor, resource utilization for this issue is extremely low. The current study used the frameworks of both the ecological model and the theory of planned behavior to examine factors related to resource use in undergraduate survivors of unwanted sexual experiences. The sample consisted of 217 undergraduates who reported at least one unwanted sexual experience while in college (89% female, 76.5% Caucasian, M age 19.6). Data were collected in an online survey from a private liberal arts college, and were analyzed using decision tree modeling. Results suggested that resource use was less related to demographic or event characteristics, but rather related to victim response to the event as well as perceptions about control over potential resource use. In addition to key assault prevention efforts, it is thus important to also support survivor mental health and self-efficacy postassault.

Human-system interfaces for space cognitive awareness

NASA Astrophysics Data System (ADS)

Ianni, J.

Space situational awareness is a human activity. We have advanced sensors and automation capabilities but these continue to be tools for humans to use. The reality is, however, that humans cannot take full advantage of the power of these tools due to time constraints, cognitive limitations, poor tool integration, poor human-system interfaces, and other reasons. Some excellent tools may never be used in operations and, even if they were, they may not be well suited to provide a cohesive and comprehensive picture. Recognizing this, the Air Force Research Laboratory (AFRL) is applying cognitive science principles to increase the knowledge derived from existing tools and creating new capabilities to help space analysts and decision makers. At the center of this research is Sensemaking Support Environment technology. The concept is to create cognitive-friendly computer environments that connect critical and creative thinking for holistic decision making. AFRL is also investigating new visualization technologies for multi-sensor exploitation and space weather, human-to-human collaboration technologies, and other technology that will be discussed in this paper.

Applying artificial intelligence technology to support decision-making in nursing: A case study in Taiwan.

PubMed

Liao, Pei-Hung; Hsu, Pei-Ti; Chu, William; Chu, Woei-Chyn

2015-06-01

This study applied artificial intelligence to help nurses address problems and receive instructions through information technology. Nurses make diagnoses according to professional knowledge, clinical experience, and even instinct. Without comprehensive knowledge and thinking, diagnostic accuracy can be compromised and decisions may be delayed. We used a back-propagation neural network and other tools for data mining and statistical analysis. We further compared the prediction accuracy of the previous methods with an adaptive-network-based fuzzy inference system and the back-propagation neural network, identifying differences in the questions and in nurse satisfaction levels before and after using the nursing information system. This study investigated the use of artificial intelligence to generate nursing diagnoses. The percentage of agreement between diagnoses suggested by the information system and those made by nurses was as much as 87 percent. When patients are hospitalized, we can calculate the probability of various nursing diagnoses based on certain characteristics. © The Author(s) 2013.

A water resources simulation gaming model for the Invitational Drought Tournament.

PubMed

Wang, K; Davies, E G R

2015-09-01

A system dynamics-based simulation gaming model, developed as a component of Agriculture and Agri-Food Canada's Invitational Drought Tournament (IDT; Hill et al., 2014), is introduced in this paper as a decision support tool for drought management at the river-basin scale. This IDT Model provides a comprehensive and integrated overview of drought conditions, and illustrates the broad effects of socio-economic drought and mitigation strategies. It is intended to provide a safe, user-friendly experimental environment with fast run-times for testing management options, and to promote collaborative decision-making and consensus building. Examples of model results from several recent IDT events demonstrate potential effects of drought and the short-to longer-term effectiveness of policies selected by IDT teams; such results have also improved teams' understanding of the complexity of water resources systems and their management trade-offs. The IDT Model structure and framework can also be reconfigured quickly for application to different river basins. Copyright © 2015 Elsevier Ltd. All rights reserved.

An integrated multiscale river basin observing system in the Heihe River Basin, northwest China

NASA Astrophysics Data System (ADS)

Li, X.; Liu, S.; Xiao, Q.; Ma, M.; Jin, R.; Che, T.

2015-12-01

Using the watershed as the unit to establish an integrated watershed observing system has been an important trend in integrated eco-hydrologic studies in the past ten years. Thus far, a relatively comprehensive watershed observing system has been established in the Heihe River Basin, northwest China. In addition, two comprehensive remote sensing hydrology experiments have been conducted sequentially in the Heihe River Basin, including the Watershed Allied Telemetry Experimental Research (WATER) (2007-2010) and the Heihe Watershed Allied Telemetry Experimental Research (HiWATER) (2012-2015). Among these two experiments, an important result of WATER has been the generation of some multi-scale, high-quality comprehensive datasets, which have greatly supported the development, improvement and validation of a series of ecological, hydrological and quantitative remote-sensing models. The goal of a breakthrough for solving the "data bottleneck" problem has been achieved. HiWATER was initiated in 2012. This project has established a world-class hydrological and meteorological observation network, a flux measurement matrix and an eco-hydrological wireless sensor network. A set of super high-resolution airborne remote-sensing data has also been obtained. In addition, there has been important progress with regard to the scaling research. Furthermore, the automatic acquisition, transmission, quality control and remote control of the observational data has been realized through the use of wireless sensor network technology. The observation and information systems have been highly integrated, which will provide a solid foundation for establishing a research platform that integrates observation, data management, model simulation, scenario analysis and decision-making support to foster 21st-century watershed science in China.

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS: PUBLISHED REPORT

EPA Science Inventory

NRMRL-CIN-1351A Hofstetter**, P., and Hammitt, J. K. Human Health Metrics for Environmental Decision Support Tools: Lessons from Health Economics and Decision Analysis. EPA/600/R-01/104 (NTIS PB2002-102119). Decision makers using environmental decision support tools are often ...

Evidence and opportunities for integrating landscape ecology into natural resource planning across multiple-use landscapes

USGS Publications Warehouse

Trammel, E. Jamie; Carter, Sarah; Haby, Travis S.; Taylor, Jason J.

2018-01-01

Enhancing natural resource management has been a focus of landscape ecology since its inception, but numerous authors argue that landscape ecology has not yet been effective in achieving the underlying goal of planning and designing sustainable landscapes. We developed nine questions reflecting the application of fundamental research topics in landscape ecology to the landscape planning process and reviewed two recent landscape-scale plans in western North America for evidence of these concepts in plan decisions. Both plans considered multiple resources, uses, and values, including energy development, recreation, conservation, and protection of cultural and historic resources. We found that land use change and multiscale perspectives of resource uses and values were very often apparent in planning decisions. Pattern-process relationships, connectivity and fragmentation, ecosystem services, landscape history, and climate change were reflected less frequently. Landscape sustainability was considered only once in the 295 decisions reviewed, and outputs of landscape models were not referenced. We suggest six actionable opportunities for further integrating landscape ecology concepts into landscape planning efforts: 1) use landscape sustainability as an overarching goal, 2) adopt a broad ecosystem services framework, 3) explore the role of landscape history more comprehensively, 4) regularly consider and accommodate potential effects of climate change, 5) use landscape models to support plan decisions, and 6) promote a greater presence of landscape ecologists within agencies that manage large land bases and encourage active involvement in agency planning efforts. Together these actions may improve the defensibility, durability, and sustainability of landscape plan decisions.

76 FR 54004 - Agency Information Collection (Joint Application for Comprehensive Assistance and Support...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... Application for Comprehensive Assistance and Support Services for Family Caregivers) Activity Under OMB Review... INFORMATION: Title: Joint Application for Comprehensive Assistance and Support Services for Family Caregivers... financial benefits under the Caregiver Program. Individuals designated as primary or secondary family...

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.

Principles of medical ethics in supportive care: a reflection.

PubMed

O'Hare, Daniel G

2004-02-01

The possibility of medical-moral controversy in contemporary health care delivery is occasioned by the interfacing of expanding technology with both professional and personal value systems, frequent and significant knowledge deficits on the part of health care consumers, and increased circumspection of and economic constraints experienced by health care providers. Particularly in an era of increasing regulatory mandates and the frequent and lamentable decrease in the availability of human, natural, and institutional resources, an understanding of the function of ethical analysis is indigenous to care, which is simultaneously medically appropriate and morally indicated. But while a familiarity with and an appreciation of the potential contribution of ethical reasoning is essential in all health care delivery, it assumes critical importance in supportive care. In that venue, where the rigors and demands of aggressively therapeutic interventions have ceased and the goal and the demeanor of care have shifted to the palliative mode, heightened attention to the principles of medical ethics is necessary for the balancing of rights and responsibilities for health care consumers and providers alike. This issue ultimately can be singularly salient in providing care that is patient centered and directed. Individuals acting as moral agents, suggesting what "ought" to be done in a given situation, either for themselves or as they are involved in rendering or supporting decisions proffered for or by other moral agents, particularly those in extremis, those in the throes of terminal illness following the collapse of the curative mode, need recourse to principles to facilitate their reasoning. Although the employment of each principle of medical ethics offers guidelines for reflection on the most comprehensive and appropriate care, it is attention to autonomy, informed consent, and beneficence that promotes the most effective supportive care. For even as the question of medical viability is settled in favor of palliation over aggression, there remain the entanglements of psychological stability, conflicting value systems, and the impact of the social milieu as well as the issues of economic responsibility and resource accountability. It is in the attention to the medical ethical principles of autonomy and informed consent, especially as amplified by the creation of and respect for advance directives, that the most holistic and productive supportive care can be offered. It is also in this posture that appeal to the principle of beneficence is made. Just as the progress of disease and, therefore, the realistic goals of care change, so too can an individual's considered opinion with regard to end-of-life decisions. Preserving the integrity of patients and caregivers alike and engaging in fruitful and informative dialog prior to seeking volitional authorization or operationalizing a supportive approach demonstrates renewed concern for both patient autonomy and professional accountability in the provision of a comprehensive end-of-life care plan. Discussions will not be avoided until they can no longer effectively take place, salient questions will not go unanswered, and decisions around end-of-life questions, in the mode of supportive care, will not be absent where care was exercised to engage patients in significant dialog earlier rather than later in their disease processes.

[Concepts and monitoring of pulmonary mechanic in patients under ventilatory support in intensive care unit].

PubMed

Faustino, Eduardo Antonio

2007-06-01

In mechanical ventilation, invasive and noninvasive, the knowledge of respiratory mechanic physiology is indispensable to take decisions and into the efficient management of modern ventilators. Monitoring of pulmonary mechanic parameters is been recommended from all the review works and clinical research. The objective of this study was review concepts of pulmonary mechanic and the methods used to obtain measures in the bed side, preparing a rational sequence to obtain this data. It was obtained bibliographic review through data bank LILACS, MedLine and PubMed, from the last ten years. This review approaches parameters of resistance, pulmonary compliance and intrinsic PEEP as primordial into comprehension of acute respiratory failure and mechanic ventilatory support, mainly in acute respiratory distress syndrome (ARDS) and in chronic obstructive pulmonary disease (COPD). Monitoring pulmonary mechanics in patients under mechanical ventilation in intensive care units gives relevant informations and should be implemented in a rational and systematic way.

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…

SANDS: an architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Male and female experiences of having fertility matters raised alongside a cancer diagnosis during the teenage and young adult years.

PubMed

Crawshaw, M A; Glaser, A W; Hale, J P; Sloper, P

2009-07-01

Discussion and management of potential reproductive health sequelae of adolescent cancer are essential and challenging components of care for the multidisciplinary team. Despite this, research has been limited to specific experiences (e.g. sperm banking) or fertility-related concerns of adult survivors. This grounded theory study of 38 male and female survivors of adolescent cancer aged 16-30 years drew on in-depth single interviews to map the range of experiences of being advised that treatment might affect fertility. Strong support for being told at around diagnosis was found regardless of gender, age, incapacity or availability of fertility preservation services. Age and life stage appeared less significant for impact than the perceived level of threat to personal and social well-being. Women were more likely to achieve lower levels of comprehension about the physiological impact, to report later distress from lack of fertility preservation services and to revisit more frequently those decisions made by the few offered fertility preservation. Men found decision making about sperm banking straightforward on the whole and reported satisfaction with having the choice regardless of outcome. Findings suggest that young people can cope with this information alongside diagnosis especially when professional and parental support is proportionate to the particular impact on them.

Blood transfusion safety: a new philosophy.

PubMed

Franklin, I M

2012-12-01

Blood transfusion safety has had a chequered history, and there are current and future challenges. Internationally, there is no clear consensus for many aspects of the provision of safe blood, although pan-national legislation does provide a baseline framework in the European Union. Costs are rising, and new safety measures can appear expensive, especially when tested against some other medical interventions, such as cancer treatment and vaccination programmes. In this article, it is proposed that a comprehensive approach is taken to the issue of blood transfusion safety that considers all aspects of the process rather than considering only new measures. The need for an agreed level of safety for specified and unknown risks is also suggested. The importance of providing care and support for those inadvertently injured as a result of transfusion problems is also made. Given that the current blood safety decision process often uses a utilitarian principle for decision making--through the calculation of Quality Adjusted Life Years--an alternative philosophy is proposed. A social contract for blood safety, based on the principles of 'justice as fairness' developed by John Rawls, is recommended as a means of providing an agreed level of safety, containing costs and providing support for any adverse outcomes. © 2012 The Author. Transfusion Medicine © 2012 British Blood Transfusion Society.

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

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.

Modeling and Visualizing Flow of Chemical Agents Across Complex Terrain

NASA Technical Reports Server (NTRS)

Kao, David; Kramer, Marc; Chaderjian, Neal

2005-01-01

Release of chemical agents across complex terrain presents a real threat to homeland security. Modeling and visualization tools are being developed that capture flow fluid terrain interaction as well as point dispersal downstream flow paths. These analytic tools when coupled with UAV atmospheric observations provide predictive capabilities to allow for rapid emergency response as well as developing a comprehensive preemptive counter-threat evacuation plan. The visualization tools involve high-end computing and massive parallel processing combined with texture mapping. We demonstrate our approach across a mountainous portion of North California under two contrasting meteorological conditions. Animations depicting flow over this geographical location provide immediate assistance in decision support and crisis management.

Development strategy research of low-carbon tourist city

NASA Astrophysics Data System (ADS)

Dong, Xiaohong

2017-04-01

Construction of low-carbon tourist city has become a strategic choice for the development of city construction in our country, becoming the direction and goal of future city development in China. In this paper, the development strategy of low-carbon tourist city is put forward from the aspects of building low-carbon tourism culture, strengthening and perfecting the relevant rules and regulations, establishing and perfecting the decision-making management mechanism of low-carbon tourist city construction, establishing accurate, timely, efficient and comprehensive ecological environment monitoring and supervision network, building economical resource utilization system, strengthening science and technology supporting of low-carbon city construction, establishing low-carbon tourism scenic spot, low-carbon community or low-carbon demonstration area, etc.

Meta-T: TetrisⓇ as an experimental paradigm for cognitive skills research.

PubMed

Lindstedt, John K; Gray, Wayne D

2015-12-01

Studies of human performance in complex tasks using video games are an attractive prospect, but many existing games lack a comprehensive way to modify the game and track performance beyond basic levels of analysis. Meta-T provides experimenters a tool to study behavior in a dynamic task environment with time-stressed decision-making and strong perceptual-motor elements, offering a host of experimental manipulations with a robust and detailed logging system for all user events, system events, and screen objects. Its experimenter-friendly interface provides control over detailed parameters of the task environment without need for programming expertise. Support for eye-tracking and computational cognitive modeling extend the paradigm's scope.

Immunization Information System and Informatics to Promote Immunizations: Perspective From Minnesota Immunization Information Connection.

PubMed

Muscoplat, Miriam Halstead; Rajamani, Sripriya

2017-01-01

The vision for management of immunization information is availability of real-time consolidated data and services for all ages, to clinical, public health, and other stakeholders. This is being executed through Immunization Information Systems (IISs), which are population-based and confidential computerized systems present in most US states and territories. Immunization Information Systems offer many functionalities, such as immunization assessment reports, client follow-up, reminder/recall feature, vaccine management tools, state-supplied vaccine ordering, comprehensive immunization history, clinical decision support/vaccine forecasting and recommendations, data processing, and data exchange. This perspective article will present various informatics tools in an IIS, in the context of the Minnesota Immunization Information Connection.

Sustaining universal health coverage: the interaction of social, political, and economic sustainability.

PubMed

Borgonovi, Elio; Compagni, Amelia

2013-01-01

The sustainability of health care systems, particularly those supporting universal health care, is a matter of current discussion among policymakers and scholars. In this article, we summarize the controversies around the economic sustainability of health care. We attempt to extend the debate by including a more comprehensive conceptualization of sustainability in relation to health care systems and by examining the dimensions of social and political sustainability. In conclusion, we argue that policymakers when taking decisions around universal health care should carefully consider issues of social, political, and economic sustainability, their interaction, and often their inherent trade-offs. Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Using play therapy in paediatric palliative care: listening to the story and caring for the body.

PubMed

van Breemen, Camara

2009-10-01

To be truly comprehensive, palliative care for children must address more than pain control and symptom management. Holistic care also encompasses attention to the child's relationships, hopes, fears and wishes. Parents and caregivers of dying children are generally the primary decision-makers in the child's care and can find the transition from active, to palliative care, particularly difficult. Nurses who understand the parents' perspective can better support them. Children reveal their hopes and fears through play. By being attuned to symbols and themes in play, nurses can better interpret the dying child's journey. Nurses can facilitate communication and connection between parents and child and thereby promote healing during the dying process.

Toward a Multilingual, Experiential Environment for Learning Decision Technology.

ERIC Educational Resources Information Center

Yeo, Gee Kin; Tan, Seng Teen

1999-01-01

Describes work at the National University of Singapore on the Internet in expanding a simulation game used in supporting a course in decision technology. Topics include decision support systems, multilingual support for cross-cultural decision studies, process support in a World Wide Web-enhanced multiuser domain (MUD) learning environment, and…

Maintenance and operations decision support tool : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

Weather affects almost all maintenance activity decisions. The Federal Highway Administration (FHWA) tested a new decision support system for maintenance in Iowa, Indiana, and Illinois called the Maintenance and Operations Decision Support System (MO...

Comparing the sustainability impacts of solar thermal and natural gas combined cycle for electricity production in Mexico: Accounting for decision makers' priorities

NASA Astrophysics Data System (ADS)

Rodríguez-Serrano, Irene; Caldés, Natalia; Oltra, Christian; Sala, Roser

2017-06-01

The aim of this paper is to conduct a comprehensive sustainability assessment of the electricity generation with two alternative electricity generation technologies by estimating its economic, environmental and social impacts through the "Framework for Integrated Sustainability Assessment" (FISA). Based on a Multiregional Input Output (MRIO) model linked to a social risk database (Social Hotspot Database), the framework accounts for up to fifteen impacts across the three sustainability pillars along the supply chain of the electricity production from Solar Thermal Electricity (STE) and Natural Gas Combined Cycle (NGCC) technologies in Mexico. Except for value creation, results show larger negative impacts for NGCC, particularly in the environmental pillar. Next, these impacts are transformed into "Aggregated Sustainability Endpoints" (ASE points) as a way to support the decision making in selecting the best sustainable project. ASE points obtained are later compared to the resulting points weighted by the reported priorities of Mexican decision makers in the energy sector obtained from a questionnaire survey. The comparison shows that NGCC achieves a 1.94 times worse negative score than STE, but after incorporating decision makerś priorities, the ratio increases to 2.06 due to the relevance given to environmental impacts such as photochemical oxidants formation and climate change potential, as well as social risks like human rights risks.

How Numeracy Influences Risk Comprehension and Medical Decision Making

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Dieckmann, Nathan F.

2009-01-01

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. PMID:19883143

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction.

PubMed

Palmer-Wackerly, Angela L; Krieger, Janice L; Rhodes, Nancy D

2017-01-01

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

CIRUN: Climate Information Responding to User Needs

NASA Astrophysics Data System (ADS)

Busalacchi, A. J.

2009-12-01

The Earth System will experience real climate change over the next 50 years, exceeding the scope of natural climate variability. A paramount question facing society is how to adapt to this certainty of climate variability and change. In response, OSTP and NOAA are considering how comprehensive climate services would best inform decisions about adaptation. Similarly, NASA is considering the optimal configuration of the next generation of Earth, environmental, and climate observations to be deployed over the coming 10-20 years. Moreover, much of the added-value information for specific climate-related decisions will be provided by private, academic and non-governmental organizations. In this context, over the past several years the University of Maryland has established the CIRUN (Climate Information: Responding to User Needs) initiative to identify the nature of national needs for climate information and services from a decision support perspective. To date, CIRUN has brought together decisionmakers in a number of sectors to help understand their perspectives on climate with the goal of improving the usefulness of climate information, observations and prediction products to specific user communities. CIRUN began with a major workshop in October 2007 that convened 430 participants in agriculture, parks and recreation, terrestrial ecosystems, insurance/investment, energy, national security, state/local/municipal, water, human health, commerce and manufacturing, transportation, and coastal/marine sectors. Plenary speakers such as Norman Augustine, R. James Woolsey, James Mahoney, and former Senator Joseph Tydings, breakout panel sessions, and participants provided input based on the following: - How would you characterize the exposure or vulnerability to climate variability or change impacting your organization? - Does climate variability and/or change currently factor into your organization's objectives or operations? - Are any of your existing plans being affected by climate or projections of climate change? - Is your organization developing a plan for adapting to climate change? - What are your needs for climate observations, predictions, and services? Please cite one or more specific examples when possible. - Do you currently have access to the climate information your organization needs? - What next steps are needed to assure effective use of climate services in your decision making? As a result, a dialogue with various user communities and a subsequent series of more sector specific workshops has been established regarding how significantly enhanced climate observations, data management, modeling, and predictions can provide valuable decision support for business and policy decisions. In particular, CIRUN has helped - To identify how users, stakeholders, and decision makers are influenced by climate on time scales from seasons to decades - To identify the needs and requirements of users, stakeholders, and decision makers for climate information, observations, predictions, and services from global to local scales - To identify what adaptation measures are being considered in the private and public sectors, and how this might result in new classes of information for decision support - To recommend principal elements of the path forward toward more effective use of climate services in decision making.

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Feasibility study of a clinical decision support system for the management of multimorbid seniors in primary care: study protocol.

PubMed

Weltermann, Birgitta; Kersting, Christine

2016-01-01

Care for seniors is complex because patients often have more than one disease, one medication, and one physician. It is a key challenge for primary care physicians to structure the various aspects of each patient's care, to integrate each patient's preferences, and to maintain a long-term overview. This article describes the design for the development and feasibility testing of the clinical decision support system (CDSS) eCare*Seniors© which is electronic health record (EHR)-based allowing for a long-term, comprehensive, evidence-based, and patient preference-oriented management of multimorbid seniors. This mixed-methods study is designed in three steps. First, focus groups and practice observations will be conducted to develop criteria for software design from a physicians' and practice assistants' perspective. Second, based on these criteria, a CDSS prototype will be developed. Third, the prototype's feasibility will be tested by five primary care practices in the care of 30 multimorbid seniors. Primary outcome is the usability of the software measured by the validated system usability scale (SUS) after 3 months. Secondary outcomes are the (a) willingness to routinely use the CDSS, (b) degree of utilization of the CDSS, (c) acceptance of the CDSS, (d) willingness of the physicians to purchase the CDSS, and (e) willingness of the practice assistants to use the CDSS in the long term. These outcomes will be measured using semi-structured interviews and software usage data. If the SUS score reaches ≥70 %, feasibility testing will be judged successful. Otherwise, the CDSS prototype will be refined according to the users' needs and retested by the physicians and practice assistants until it is fully adapted to their requirements and reaches a usability score ≥70 %. The study will support the development of a CDSS which is primary care-defined, user-friendly, easy-to-comprehend, workflow-oriented, and comprehensive. The software will assist physicians and practices in their long-term, individualized care for multimorbid seniors. German Clinical Trials Register, DRKS00008777.

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

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

PubMed

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

An integrated decision support system for diagnosing and managing patients with community-acquired pneumonia.

PubMed Central

Aronsky, D.; Haug, P. J.

1999-01-01

Decision support systems that integrate guidelines have become popular applications to reduce variation and deliver cost-effective care. However, adverse characteristics of decision support systems, such as additional and time-consuming data entry or manually identifying eligible patients, result in a "behavioral bottleneck" that prevents decision support systems to become part of the clinical routine. This paper describes the design and the implementation of an integrated decision support system that explores a novel approach for bypassing the behavioral bottleneck. The real-time decision support system does not require health care providers to enter additional data and consists of a diagnostic and a management component. Images Fig. 1 Fig. 2 Fig. 3 PMID:10566348

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

USGS Publications Warehouse

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

2016-01-01

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

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Development of a decision support system for analysis and solutions of prolonged standing in the workplace.

PubMed

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-06-01

Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially.

Development of a Decision Support System for Analysis and Solutions of Prolonged Standing in the Workplace

PubMed Central

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-01-01

Background Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. Methods The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Results Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. Conclusion The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially. PMID:25180141

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...

Comprehensive genetic testing for female and male infertility using next-generation sequencing.

PubMed

Patel, Bonny; Parets, Sasha; Akana, Matthew; Kellogg, Gregory; Jansen, Michael; Chang, Chihyu; Cai, Ying; Fox, Rebecca; Niknazar, Mohammad; Shraga, Roman; Hunter, Colby; Pollock, Andrew; Wisotzkey, Robert; Jaremko, Malgorzata; Bisignano, Alex; Puig, Oscar

2018-05-19

To develop a comprehensive genetic test for female and male infertility in support of medical decisions during assisted reproductive technology (ART) protocols. We developed a next-generation sequencing (NGS) gene panel consisting of 87 genes including promoters, 5' and 3' untranslated regions, exons, and selected introns. In addition, sex chromosome aneuploidies and Y chromosome microdeletions were analyzed concomitantly using the same panel. The NGS panel was analytically validated by retrospective analysis of 118 genomic DNA samples with known variants in loci representative of female and male infertility. Our results showed analytical accuracy of > 99%, with > 98% sensitivity for single-nucleotide variants (SNVs) and > 91% sensitivity for insertions/deletions (indels). Clinical sensitivity was assessed with samples containing variants representative of male and female infertility, and it was 100% for SNVs/indels, CFTR IVS8-5T variants, sex chromosome aneuploidies, and copy number variants (CNVs) and > 93% for Y chromosome microdeletions. Cost analysis shows potential savings when comparing this single NGS assay with the standard approach, which includes multiple assays. A single, comprehensive, NGS panel can simplify the ordering process for healthcare providers, reduce turnaround time, and lower the overall cost of testing for genetic assessment of infertility in females and males, while maintaining accuracy.

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.

A Prototype Symbolic Model of Canonical Functional Neuroanatomy of the Motor System

PubMed Central

Rubin, Daniel L.; Halle, Michael; Musen, Mark; Kikinis, Ron

2008-01-01

Recent advances in bioinformatics have opened entire new avenues for organizing, integrating and retrieving neuroscientific data, in a digital, machine-processable format, which can be at the same time understood by humans, using ontological, symbolic data representations. Declarative information stored in ontological format can be perused and maintained by domain experts, interpreted by machines, and serve as basis for a multitude of decision-support, computerized simulation, data mining, and teaching applications. We have developed a prototype symbolic model of canonical neuroanatomy of the motor system. Our symbolic model is intended to support symbolic lookup, logical inference and mathematical modeling by integrating descriptive, qualitative and quantitative functional neuroanatomical knowledge. Furthermore, we show how our approach can be extended to modeling impaired brain connectivity in disease states, such as common movement disorders. In developing our ontology, we adopted a disciplined modeling approach, relying on a set of declared principles, a high-level schema, Aristotelian definitions, and a frame-based authoring system. These features, along with the use of the Unified Medical Language System (UMLS) vocabulary, enable the alignment of our functional ontology with an existing comprehensive ontology of human anatomy, and thus allow for combining the structural and functional views of neuroanatomy for clinical decision support and neuroanatomy teaching applications. Although the scope of our current prototype ontology is limited to a particular functional system in the brain, it may be possible to adapt this approach for modeling other brain functional systems as well. PMID:18164666

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

Decision Support for Ecosystem Management (Chapter 28)

Treesearch

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

1999-01-01

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

Emergency medical service provider decision-making in out of hospital cardiac arrest: an exploratory study.

PubMed

Brandling, J; Kirby, K; Black, S; Voss, S; Benger, J

2017-07-25

There are approximately 60,000 out-of-hospital cardiac arrests (OHCA) in the United Kingdom (UK) each year. Within the UK there are well-established clinical practice guidelines that define when resuscitation should be commenced in OHCA, and when resuscitation should cease. Background literature indicates that decision-making in the commencement and cessation of resuscitation efforts in OHCA is complex, and not comprehensively understood. No relevant research from the UK has been published to date and this research study seeks to explore the influences on UK Emergency Medical Service (EMS) provider decision-making when commencing and ceasing resuscitation attempts in OHCA. The aim of this research to explore the influences on UK Emergency Medical Services provider decision-making when commencing and ceasing resuscitation attempts in OHCA. Four focus groups were convened with 16 clinically active EMS providers. Four case vignettes were discussed to explore decision-making within the focus groups. Thematic analysis was used to analyse transcripts. This research found that there are three stages in the decision-making process when EMS providers consider whether to commence or cease resuscitation attempts in OHCA. These stages are: the call; arrival on scene; the protocol. Influential factors present at each of the three stages can lead to different decisions and variability in practice. These influences are: factual information available to the EMS provider; structural factors such as protocol, guidance and research; cultural beliefs and values; interpersonal factors; risk factors; personal values and beliefs. An improved understanding of the circumstantial, individual and interpersonal factors that mediate the decision-making process in clinical practice could inform the development of more effective clinical guidelines, education and clinical decision support in OHCA. These changes have the potential to lead to greater consistency. and EMS provider confidence, with the potential for improved patient outcome from OHCA.

Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid

PubMed Central

Hersch, Jolyn; Jansen, Jesse; Barratt, Alexandra; Irwig, Les; Houssami, Nehmat; Jacklyn, Gemma; Thornton, Hazel; Dhillon, Haryana; McCaffery, Kirsten

2014-01-01

Objective To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening. Design Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34). Setting New South Wales, Australia. Participants Women aged 43–59 years with no personal history of breast cancer. Interventions The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content. Outcomes Comprehension of key decision aid content and acceptability of the materials. Results Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people's expectations, but women appreciated the opportunity to become better informed. Conclusions The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening. PMID:25256188

SANDS: a service-oriented architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2008-12-01

In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

Use of an automated decision support tool optimizes clinicians' ability to interpret and appropriately respond to structured self-monitoring of blood glucose data.

PubMed

Rodbard, Helena W; Schnell, Oliver; Unger, Jeffrey; Rees, Christen; Amstutz, Linda; Parkin, Christopher G; Jelsovsky, Zhihong; Wegmann, Nathan; Axel-Schweitzer, Matthias; Wagner, Robin S

2012-04-01

We evaluated the impact of an automated decision support tool (DST) on clinicians' ability to identify glycemic abnormalities in structured self-monitoring of blood glucose (SMBG) data and then make appropriate therapeutic changes based on the glycemic patterns observed. In this prospective, randomized, controlled, multicenter study, 288 clinicians (39.6% family practice physicians, 37.9% general internal medicine physicians, and 22.6% nurse practitioners) were randomized to structured SMBG alone (STG; n = 72); structured SMBG with DST (DST; n = 72); structured SMBG with an educational DVD (DVD; n = 72); and structured SMBG with DST and the educational DVD (DST+DVD; n = 72). Clinicians analyzed 30 patient cases (type 2 diabetes), identified the primary abnormality, and selected the most appropriate therapy. A total of 222 clinicians completed all 30 patient cases with no major protocol deviations. Significantly more DST, DVD, and DST+DVD clinicians correctly identified the glycemic abnormality and selected the most appropriate therapeutic option compared with STG clinicians: 49, 51, and 55%, respectively, vs. 33% (all P < 0.0001) with no significant differences among DST, DVD, and DST+DVD clinicians. Use of structured SMBG, combined with the DST, the educational DVD, or both, enhances clinicians' ability to correctly identify significant glycemic patterns and make appropriate therapeutic decisions to address those patterns. Structured testing interventions using either the educational DVD or the DST are equally effective in improving data interpretation and utilization. The DST provides a viable alternative when comprehensive education is not feasible, and it may be integrated into medical practices with minimal training.

A New Framework and Prototype Solution for Clinical Decision Support and Research in Genomics and Other Data-intensive Fields of Medicine.

PubMed

Evans, James P; Wilhelmsen, Kirk C; Berg, Jonathan; Schmitt, Charles P; Krishnamurthy, Ashok; Fecho, Karamarie; Ahalt, Stanley C

2016-01-01

In genomics and other fields, it is now possible to capture and store large amounts of data in electronic medical records (EMRs). However, it is not clear if the routine accumulation of massive amounts of (largely uninterpretable) data will yield any health benefits to patients. Nevertheless, the use of large-scale medical data is likely to grow. To meet emerging challenges and facilitate optimal use of genomic data, our institution initiated a comprehensive planning process that addresses the needs of all stakeholders (e.g., patients, families, healthcare providers, researchers, technical staff, administrators). Our experience with this process and a key genomics research project contributed to the proposed framework. We propose a two-pronged Genomic Clinical Decision Support System (CDSS) that encompasses the concept of the "Clinical Mendeliome" as a patient-centric list of genomic variants that are clinically actionable and introduces the concept of the "Archival Value Criterion" as a decision-making formalism that approximates the cost-effectiveness of capturing, storing, and curating genome-scale sequencing data. We describe a prototype Genomic CDSS that we developed as a first step toward implementation of the framework. The proposed framework and prototype solution are designed to address the perspectives of stakeholders, stimulate effective clinical use of genomic data, drive genomic research, and meet current and future needs. The framework also can be broadly applied to additional fields, including other '-omics' fields. We advocate for the creation of a Task Force on the Clinical Mendeliome, charged with defining Clinical Mendeliomes and drafting clinical guidelines for their use.

A Dynamic Optimization Technique for Siting the NASA-Clark Atlanta Urban Rain Gauge Network (NCURN)

NASA Technical Reports Server (NTRS)

Shepherd, J. Marshall; Taylor, Layi

2003-01-01

NASA satellites and ground instruments have indicated that cities like Atlanta, Georgia may create or alter rainfall. Scientists speculate that the urban heat island caused by man-made surfaces in cities impact the heat and wind patterns that form clouds and rainfall. However, more conclusive evidence is required to substantiate findings from satellites. NASA, along with scientists at Clark Atlanta University, are implementing a dense, urban rain gauge network in the metropolitan Atlanta area to support a satellite validation program called Studies of PRecipitation Anomalies from Widespread Urban Landuse (SPRAWL). SPRAWL will be conducted during the summer of 2003 to further identify and understand the impact of urban Atlanta on precipitation variability. The paper provides an. overview of SPRAWL, which represents one of the more comprehensive efforts in recent years to focus exclusively on urban-impacted rainfall. The paper also introduces a novel technique for deploying rain gauges for SPRAWL. The deployment of the dense Atlanta network is unique because it utilizes Geographic Information Systems (GIS) and Decision Support Systems (DSS) to optimize deployment of the rain gauges. These computer aided systems consider access to roads, drainage systems, tree cover, and other factors in guiding the deployment of the gauge network. GIS and DSS also provide decision-makers with additional resources and flexibility to make informed decisions while considering numerous factors. Also, the new Atlanta network and SPRAWL provide a unique opportunity to merge the high-resolution, urban rain gauge network with satellite-derived rainfall products to understand how cities are changing rainfall patterns, and possibly climate.

Learning from professionals: Exploring cognitive rehabilitation strategies for the definition of the functional requirements of a telerehabilitation platform.

PubMed

Rosso, Giovanni; Frisiello, Antonella; Trizio, Marco; Mosso, Cristina O; Bazzani, Marco

2018-04-01

In the past few years, the advances in Information and Communication Technology (ICT) led to the development of platforms and applications that aim to support cognitive rehabilitation therapy that contributes to extend patients' treatment at home. In our research we adopted the Human Centered Approach to design a cognitive rehabilitation platform that is able to provide tools and features tailored to the professional needs and strategies and also able to engage patients in their treatment process. In order to explore the clinicians' point of view on the neuropsychological intervention strategies, we applied two different techniques often used in human factors research: the Critical Decision Method to study professionals' strategies with a descriptive perspective, and the Hierarchical Task Analysis to analyze the processes with a normative view. The results of our research showed that the hybrid approach adopted allowed us to have a better focus on the cognitive rehabilitation process and on the professionals' decision making mechanism. This led to a better understanding of functional requirements for supporting clinician's strategic decision making, in terms of personalization of treatments, cognitive exercises settings and feedback customization. In conclusion, our research highlights the value of the CDM to focus deeply on which functionalities professionals require from a cognitive telerehabilitation system and allowed us to design more precisely clinician-patients interactions inside the system compared to prescriptive methods currently used. Our study offers contribution to the comprehension of the rehabilitation processes, suggesting the positive impacts of an "extended" clinic treatment by adopting a flexible and adaptable tool. Copyright © 2017. Published by Elsevier Ltd.

Combining communication technology utilization and organizational innovation: evidence from Canadian healthcare decision makers.

PubMed

Jbilou, Jalila; Landry, Réjean; Amara, Nabil; El Adlouni, Salaheddine

2009-08-01

Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal's Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as engaging in activities of research acquisition, the administrative position (being a manager), the preference for applied research results as source of information, the degree of novelty of research results, and the gender. Modern Canadian healthcare organizations need contemporary decision makers who use ICT and develop OI, if performance is the target. Our results let us suggest that the isolated administrative agents profile is no more effective in a dynamic and changing world. Contemporary decision makers need to be more active intellectually and to take risks in their decisions. Relying exclusively on research results and on their social network is no more helpful for a real shift. Moreover, the traditional factors, i.e. organization size, time, experience ... are no more effective, especially when we consider combined roles. We propose some practical and theoretical recommendations to support these changes.

Toward the Modularization of Decision Support Systems

NASA Astrophysics Data System (ADS)

Raskin, R. G.

2009-12-01

Decision support systems are typically developed entirely from scratch without the use of modular components. This “stovepiped” approach is inefficient and costly because it prevents a developer from leveraging the data, models, tools, and services of other developers. Even when a decision support component is made available, it is difficult to know what problem it solves, how it relates to other components, or even that the component exists, The Spatial Decision Support (SDS) Consortium was formed in 2008 to organize the body of knowledge in SDS within a common portal. The portal identifies the canonical steps in the decision process and enables decision support components to be registered, categorized, and searched. This presentation describes how a decision support system can be assembled from modular models, data, tools and services, based on the needs of the Earth science application.

Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

PubMed

Medem, Anna V; Seidling, Hanna M; Eichler, Hans-Georg; Kaltschmidt, Jens; Metzner, Michael; Hubert, Carina M; Czock, David; Haefeli, Walter E

2017-05-01

Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

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

Systematic Review of Medical Informatics-Supported Medication Decision Making.

PubMed

Melton, Brittany L

2017-01-01

This systematic review sought to assess the applications and implications of current medical informatics-based decision support systems related to medication prescribing and use. Studies published between January 2006 and July 2016 which were indexed in PubMed and written in English were reviewed, and 39 studies were ultimately included. Most of the studies looked at computerized provider order entry or clinical decision support systems. Most studies examined decision support systems as a means of reducing errors or risk, particularly associated with medication prescribing, whereas a few studies evaluated the impact medical informatics-based decision support systems have on workflow or operations efficiency. Most studies identified benefits associated with decision support systems, but some indicate there is room for improvement.

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…

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.

How to guide - transit operations decision support systems (TODSS).

DOT National Transportation Integrated Search

2014-12-01

Transit Operations Decision Support Systems (TODSS) are decision support systems designed to support dispatchers in real-time bus operations management in response to incidents, special events, and other changing conditions in order to restore servic...

Using Comprehensive Science-based Disaster Scenarios to Support Seismic Safety Policy: A Case Study in Los Angeles, California

NASA Astrophysics Data System (ADS)

Jones, L.

2014-12-01

In 2014, the USGS entered a technical assistance agreement with the City of Los Angeles to apply the results of the 2008 ShakeOut Scenario of a M7.8 earthquake on the southern San Andreas fault to develop a comprehensive plan to increase the seismic resilience of the City. The results of this project are to be submitted to the Mayor of Los Angeles at the Great ShakeOut on October 16, 2014. The ShakeOut scenario detailed how the expected cascade of failures in a big earthquake could lead to significant delays in disaster recovery that could create financial losses that greatly exceed the direct losses in the event. The goal of the seismic resilience plan is to: protect the lives of residents during earthquakes improve the capacity of the City to respond to the earthquake prepare the City to recover quickly after the earthquake so as to protect the economy of the City and all of southern California To accomplish these goals, the project addresses three areas of seismic vulnerability that were identified in the original ShakeOut Scenario: Pre-1980 buildings that present an unacceptable risk to the lives of residents, including "non-ductile reinforced concrete," and "soft-first-story" buildings Water system infrastructure (including impact on firefighting capability) Communications infrastructure The critical science needed to support policy decisions is to understand the probable consequences to the regional long-term economy caused by decisions to undertake (or not) different levels of mitigation. The arguments against mitigation are the immediate financial costs, so a better understanding of the eventual benefit is required. However, the direct savings rarely justify the mitigation costs, so the arguments in favor of mitigation are driven by the potential for cascading failures and the potential to trigger the type of long term reduction in population and economic activity that has occurred in New Orleans since Hurricane Katrina.

Points of attention in designing tools for regional brownfield prioritization.

PubMed

Limasset, Elsa; Pizzol, Lisa; Merly, Corinne; Gatchett, Annette M; Le Guern, Cécile; Martinát, Stanislav; Klusáček, Petr; Bartke, Stephan

2018-05-01

The regeneration of brownfields has been increasingly recognized as a key instrument in sustainable land management, since free developable land (or so called "greenfields") has become a scare and more expensive resource, especially in densely populated areas. However, the complexity of these sites requires considerable efforts to successfully complete their revitalization projects, thus requiring the development and application of appropriate tools to support decision makers in the selection of promising sites where efficiently allocate the limited financial resources. The design of effective prioritization tools is a complex process, which requires the analysis and consideration of critical points of attention (PoAs) which has been identified considering the state of the art in literature, and lessons learned from previous developments of regional brownfield (BF) prioritization processes, frameworks and tools. Accordingly, we identified 5 PoAs, namely 1) Assessing end user needs and orientation discussions, 2) Availability and quality of the data needed for the BF prioritization tool, 3) Communication and stakeholder engagement 4) Drivers of regeneration success, and 5) Financing and application costs. To deepen and collate the most recent knowledge on the topics from scientists and practitioners, we organized a focus group discussion within a special session at the AquaConSoil (ACS) conference 2017, where participants were asked to add their experience and thoughts to the discussion in order to identify the most significant and urgent points of attention in BF prioritization tool design. The result of this assessment is a comprehensive table (Table 2), which can support problem owners, investors, service providers, regulators, public and private land managers, decision makers etc. in the identification of the main aspects (sub-topics) to be considered and their relative influences and in the comprehension of the general patterns and challenges to be faced when dealing with the development of BF prioritization tools. Copyright © 2017 Elsevier B.V. All rights reserved.

Environmental Biosciences Program Quarterly Report

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

Lawrence C. Mohr, M.D.

2007-07-31

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation's need for new and better approaches to the solution of a complex and expansive array of environment-related health problems. Themore » intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene and low-dose ionizing radiation. Work on the trichloroethylene research projects has been slowed as a result of funding uncertainties. The impact of these funding uncertainties has been discussed with the DOE. Plans for restructuring the performance schedule of the trichloroethylene projects have been submitted to the department. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk-based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less

Environmental Biosciences Program Report for Year 3

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

Lawrence C. Mohr, M.D.

2007-04-30

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation's need for new and better approaches to the solution of a complex and expansive array of environment-related health problems. Themore » intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems. Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene and low-dose ionizing radiation. Work on the trichloroethylene research projects has been slowed as a result of funding uncertainties. The impact of these funding uncertainties has been discussed with the DOE. Plans for restructuring the performance schedule of the trichloroethylene projects have been submitted to the department. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk-based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less

Environmental Biosciences Report for Year 3

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

Lawrence C. Mohr, M.D.

2007-10-31

In May 2002, the United States Department of Energy (DOE) signed Assistance Instrument Number DE-FC09-02CH11109 with the Medical University of South Carolina (MUSC) to support the Environmental Biosciences Program (EBP). This funding instrument replaces DOE Assistance Instrument Number DE-FC02-98CH10902. EBP is an integrated, multidisciplinary scientific research program, employing a range of research initiatives to identify, study and resolve environmental health risks. These initiatives are consistent with the MUSC role as a comprehensive state-supported health sciences institution and with the nation's need for new and better approaches to the solution of a complex and expansive array of environment-related health problems. Themore » intrinsic capabilities of a comprehensive health sciences institution enable MUSC to be a national resource for the scientific investigation of environmental health issues. EBPs success as a nationally prominent research program is due, in part, to its ability to task-organize scientific expertise from multiple disciplines in addressing these complex problems Current research projects have focused EBP talent and resources on providing the scientific basis for risk-based standards, risk-based decision making and the accelerated clean-up of widespread environmental hazards. These hazards include trichloroethylene and low-dose ionizing radiation. Work on the trichloroethylene research projects has been slowed as a result of funding uncertainties. The impact of these funding uncertainties has been discussed with the DOE. Plans for restructuring the performance schedule of the trichloroethylene projects have been submitted to the department. A project is also being conducted in the use of geographical information system technology to analyze population health risks related to environmental hazards as a tool for risk based decision-making. Questions, comments or requests for further information concerning the activities under this cooperative agreement can be forwarded to Dr. Lawrence C. Mohr in the EBP office of the Medical University of South Carolina at (843) 792-1532.« less