Creating a Shared Formulary in 7 Critical Access Hospitals

ERIC Educational Resources Information Center

Wakefield, Douglas S.; Ward, Marcia M.; Loes, Jean L.; O'Brien, John; Abbas, Nancy

2010-01-01

Purpose: This paper reports a case study of 7 Critical Access Hospitals' (CAH) and 1 rural referral hospital's successful collaboration to develop a shared formulary. Methods: Study methods included document reviews, interviews with key informants, and use of descriptive statistics. Findings: Through a systematic review and decision process, CAH…

Doubt and belief in physicians' ability to prognosticate during critical illness: The perspective of surrogate decision makers

PubMed Central

Zier, Lucas S.; Burack, Jeffrey H.; Micco, Guy; Chipman, Anne K.; Frank, James A.; Luce, John M.; White, Douglas B.

2009-01-01

Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. Design, Setting, and Patients: Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. Measurements and Main Results: Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the possibility that a patient may not survive. Conclusions: Although many surrogate decision-makers harbor some doubt about the accuracy of physicians' prognostications, they highly value discussions about prognosis and use the information for multiple purposes. (Crit Care Med 2008; 36: 2341–2347) PMID:18596630

[Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies].

PubMed

Müller-Staub, Maria; Stuker-Studer, Ursula

2006-10-01

Case studies, based on actual patients' situations, provide a method of clinical decision making to foster critical thinking in nurses. This paper describes the method and process of group case studies applied in continuous education settings. This method bases on Balints' case supervision and was further developed and combined with the nursing diagnostic process. A case study contains different phases: Pre-phase, selection phase, case delineation and case work. The case provider narratively tells the situation of a patient. This allows the group to analyze and cluster signs and symptoms, to state nursing diagnoses and to derive nursing interventions. Results of the case study are validated by applying the theoretical background and critical appraisal of the case provider. Learning effects of the case studies were evaluated by means of qualitative questionnaires and analyzed according to Mayring. Findings revealed the following categories: a) Patients' problems are perceived in a patient centred way, accurate nursing diagnoses are stated and effective nursing interventions implemented. b) Professional nursing tasks are more purposefully perceived and named more precise. c) Professional nursing relationship, communication and respectful behaviour with patients were perceived in differentiated ways. The theoretical framework is described in the paper "Clinical decision making and critical thinking in the nursing diagnostic process". (Müller-Staub, 2006).

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.

Decision Making Analysis: Critical Factors-Based Methodology

DTIC Science & Technology

2010-04-01

the pitfalls associated with current wargaming methods such as assuming a western view of rational values in decision - making regardless of the cultures...Utilization theory slightly expands the rational decision making model as it states that “actors try to maximize their expected utility by weighing the...items to categorize the decision - making behavior of political leaders which tend to demonstrate either a rational or cognitive leaning. Leaders

Ending on a positive: Examining the role of safety leadership decisions, behaviours and actions in a safety critical situation.

PubMed

Donovan, Sarah-Louise; Salmon, Paul M; Horberry, Timothy; Lenné, Michael G

2018-01-01

Safety leadership is an important factor in supporting safe performance in the workplace. The present case study examined the role of safety leadership during the Bingham Canyon Mine high-wall failure, a significant mining incident in which no fatalities or injuries were incurred. The Critical Decision Method (CDM) was used in conjunction with a self-reporting approach to examine safety leadership in terms of decisions, behaviours and actions that contributed to the incidents' safe outcome. Mapping the analysis onto Rasmussen's Risk Management Framework (Rasmussen, 1997), the findings demonstrate clear links between safety leadership decisions, and emergent behaviours and actions across the work system. Communication and engagement based decisions featured most prominently, and were linked to different leadership practices across the work system. Further, a core sub-set of CDM decision elements were linked to the open flow and exchange of information across the work system, which was critical to supporting the safe outcome. The findings provide practical implications for the development of safety leadership capability to support safety within the mining industry. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Framework to Determine New System Requirements Under Design Parameter and Demand Uncertainties

DTIC Science & Technology

2015-04-30

relegates quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the...quantitative complexities of decision-making to the method and designates trade-space exploration to the practitioner. We demonstrate the approach...play a critical role in determining new system requirements. Scope and Method of Approach The early stages of the design process have substantial

A proposed approach for quantitative benefit-risk assessment in diagnostic radiology guideline development: the American College of Radiology Appropriateness Criteria Example.

PubMed

Agapova, Maria; Bresnahan, Brian B; Higashi, Mitchell; Kessler, Larry; Garrison, Louis P; Devine, Beth

2017-02-01

The American College of Radiology develops evidence-based practice guidelines to aid appropriate utilization of radiological procedures. Panel members use expert opinion to weight trade-offs and consensus methods to rate appropriateness of imaging tests. These ratings include an equivocal range, assigned when there is disagreement about a technology's appropriateness and the evidence base is weak or for special circumstances. It is not clear how expert consensus merges with the evidence base to arrive at an equivocal rating. Quantitative benefit-risk assessment (QBRA) methods may assist decision makers in this capacity. However, many methods exist and it is not clear which methods are best suited for this application. We perform a critical appraisal of QBRA methods and propose several steps that may aid in making transparent areas of weak evidence and barriers to consensus in guideline development. We identify QBRA methods with potential to facilitate decision making in guideline development and build a decision aid for selecting among these methods. This study identified 2 families of QBRA methods suited to guideline development when expert opinion is expected to contribute substantially to decision making. Key steps to deciding among QBRA methods involve identifying specific benefit-risk criteria and developing a state-of-evidence matrix. For equivocal ratings assigned for reasons other than disagreement or weak evidence base, QBRA may not be needed. In the presence of disagreement but the absence of a weak evidence base, multicriteria decision analysis approaches are recommended; and in the presence of weak evidence base and the absence of disagreement, incremental net health benefit alone or combined with multicriteria decision analysis is recommended. Our critical appraisal further extends investigation of the strengths and limitations of select QBRA methods in facilitating diagnostic radiology clinical guideline development. The process of using the decision aid exposes and makes transparent areas of weak evidence and barriers to consensus. © 2016 John Wiley & Sons, Ltd.

Bayesian methodology for the design and interpretation of clinical trials in critical care medicine: a primer for clinicians.

PubMed

Kalil, Andre C; Sun, Junfeng

2014-10-01

To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. Clinical, epidemiological, and biostatistical studies on Bayesian methods in PubMed and Embase from their inception to December 2013. Bayesian methods have been extensively used by a wide range of scientific fields, including astronomy, engineering, chemistry, genetics, physics, geology, paleontology, climatology, cryptography, linguistics, ecology, and computational sciences. The application of medical knowledge in clinical research is analogous to the application of medical knowledge in clinical practice. Bedside physicians have to make most diagnostic and treatment decisions on critically ill patients every day without clear-cut evidence-based medicine (more subjective than objective evidence). Similarly, clinical researchers have to make most decisions about trial design with limited available data. Bayesian methodology allows both subjective and objective aspects of knowledge to be formally measured and transparently incorporated into the design, execution, and interpretation of clinical trials. In addition, various degrees of knowledge and several hypotheses can be tested at the same time in a single clinical trial without the risk of multiplicity. Notably, the Bayesian technology is naturally suited for the interpretation of clinical trial findings for the individualized care of critically ill patients and for the optimization of public health policies. We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.

Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review.

PubMed

Lin, Yanxia; Myall, Michelle; Jarrett, Nikki

2017-12-01

To understand how decisions are made to transfer dying patients home from critical care units. Many people prefer a home death, but a high proportion die in critical care units. Transferring dying patients home is recognized to be complex but transfer decision-making itself remains unclear. Integrative review. Seven bibliographic databases (origin-2015), grey literature and reference lists were searched. An integrative review method was used to synthesize data from diverse sources. Papers were selected through title and abstract screening and full-text reviewing, using inclusion and exclusion criteria derived from review questions. Following quality appraisal, data were extracted and synthesized using normalization process theory as a framework. The number of patients transferred home ranged from 1-346, with most papers reporting on the transfer of one or two patients. Four themes regarding transfer decision-making work were generated: divergent views and practice, multiple stakeholders' involvement in decision-making, collective work and limited understanding of individuals' experiences. The practice of transferring patients home to die and its decision-making varies internationally and is usually influenced by the care system, culture or religion. It is less common to transfer patients home to die from critical care units in western societies. A better understanding of the decision-making work was obtained but mainly from the perspective of hospital-based healthcare professionals. Further research is needed to develop decision-making practice guidance to facilitate patients' wishes to die at home. © 2017 John Wiley & Sons Ltd.

Practitioner approaches to the integration of clinical decision support system technology in critical care.

PubMed

Weber, Scott; Crago, Elizabeth A; Sherwood, Paula R; Smith, Tara

2009-11-01

The aim of this study was to explore the experiences of nurses and physicians who use a clinical decision support system (CDSS) in the critical care area, focusing on clinicians' motives and values related to decisions to either use or not use this optional technology. Information technology (IT) has been demonstrated to positively impact quality of patient care. Decision-support technology serves as an adjunct to, not as a replacement for, actual clinical decision making. Nurse administrators play an imperative role in the planning and implementation of IT projects and can benefit from understanding clinicians' affective considerations and approaches to the technology. This qualitative study used grounded theory methods. A total of 33 clinicians participated in in-depth structured interviews probing their professional concerns with how the technology is used. Data were analyzed using the constant comparative method. Medical staff were frustrated by perceived lack of planning input before system implementation. Both nurse and physician cohort groups were dissatisfied with preimplementation education. Barriers to system use were identified in significant detail by the participants. Both nurses and physicians should be involved in preimplementation planning and ongoing evaluation of CDSSs. There is a need for a systematic review or Cochrane meta-analysis describing the affective aspects of successful implementations of decisional technology in critical care, specifically from the perspective of nursing administrators.

Does good critical thinking equal effective decision-making among critical care nurses? A cross-sectional survey.

PubMed

Ludin, Salizar Mohamed

2018-02-01

A critical thinker may not necessarily be a good decision-maker, but critical care nurses are expected to utilise outstanding critical thinking skills in making complex clinical judgements. Studies have shown that critical care nurses' decisions focus mainly on doing rather than reflecting. To date, the link between critical care nurses' critical thinking and decision-making has not been examined closely in Malaysia. To understand whether critical care nurses' critical thinking disposition affects their clinical decision-making skills. This was a cross-sectional study in which Malay and English translations of the Short Form-Critical Thinking Disposition Inventory-Chinese Version (SF-CTDI-CV) and the Clinical Decision-making Nursing Scale (CDMNS) were used to collect data from 113 nurses working in seven critical care units of a tertiary hospital on the east coast of Malaysia. Participants were recruited through purposive sampling in October 2015. Critical care nurses perceived both their critical thinking disposition and decision-making skills to be high, with a total score of 71.5 and a mean of 48.55 for the SF-CTDI-CV, and a total score of 161 and a mean of 119.77 for the CDMNS. One-way ANOVA test results showed that while age, gender, ethnicity, education level and working experience factors significantly impacted critical thinking (p<0.05), only age and working experience significantly impacted clinical decision-making (p<0.05). Pearson's correlation analysis showed a strong and positive relationship between critical care nurses' critical thinking and clinical decision-making (r=0.637, p=0.001). While this small-scale study has shown a relationship exists between critical care nurses' critical thinking disposition and clinical decision-making in one hospital, further investigation using the same measurement tools is needed into this relationship in diverse clinical contexts and with greater numbers of participants. Critical care nurses' perceived high level of critical thinking and decision-making also needs further investigation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers

PubMed Central

Vickers, Andrew J; Cronin, Angel M; Elkin, Elena B; Gonen, Mithat

2008-01-01

Background Decision curve analysis is a novel method for evaluating diagnostic tests, prediction models and molecular markers. It combines the mathematical simplicity of accuracy measures, such as sensitivity and specificity, with the clinical applicability of decision analytic approaches. Most critically, decision curve analysis can be applied directly to a data set, and does not require the sort of external data on costs, benefits and preferences typically required by traditional decision analytic techniques. Methods In this paper we present several extensions to decision curve analysis including correction for overfit, confidence intervals, application to censored data (including competing risk) and calculation of decision curves directly from predicted probabilities. All of these extensions are based on straightforward methods that have previously been described in the literature for application to analogous statistical techniques. Results Simulation studies showed that repeated 10-fold crossvalidation provided the best method for correcting a decision curve for overfit. The method for applying decision curves to censored data had little bias and coverage was excellent; for competing risk, decision curves were appropriately affected by the incidence of the competing risk and the association between the competing risk and the predictor of interest. Calculation of decision curves directly from predicted probabilities led to a smoothing of the decision curve. Conclusion Decision curve analysis can be easily extended to many of the applications common to performance measures for prediction models. Software to implement decision curve analysis is provided. PMID:19036144

The process of processing: exploring the validity of Neisser's perceptual cycle model with accounts from critical decision-making in the cockpit.

PubMed

Plant, Katherine L; Stanton, Neville A

2015-01-01

The perceptual cycle model (PCM) has been widely applied in ergonomics research in domains including road, rail and aviation. The PCM assumes that information processing occurs in a cyclical manner drawing on top-down and bottom-up influences to produce perceptual exploration and actions. However, the validity of the model has not been addressed. This paper explores the construct validity of the PCM in the context of aeronautical decision-making. The critical decision method was used to interview 20 helicopter pilots about critical decision-making. The data were qualitatively analysed using an established coding scheme, and composite PCMs for incident phases were constructed. It was found that the PCM provided a mutually exclusive and exhaustive classification of the information-processing cycles for dealing with critical incidents. However, a counter-cycle was also discovered which has been attributed to skill-based behaviour, characteristic of experts. The practical applications and future research questions are discussed. Practitioner Summary: This paper explores whether information processing, when dealing with critical incidents, occurs in the manner anticipated by the perceptual cycle model. In addition to the traditional processing cycle, a reciprocal counter-cycle was found. This research can be utilised by those who use the model as an accident analysis framework.

Life support decision making in critical care: Identifying and appraising the qualitative research evidence.

PubMed

Giacomini, Mita; Cook, Deborah; DeJean, Deirdre

2009-04-01

The objective of this study is to identify and appraise qualitative research evidence on the experience of making life-support decisions in critical care. In six databases and supplementary sources, we sought original research published from January 1990 through June 2008 reporting qualitative empirical studies of the experience of life-support decision making in critical care settings. Fifty-three journal articles and monographs were included. Of these, 25 reported prospective studies and 28 reported retrospective studies. We abstracted methodologic characteristics relevant to the basic critical appraisal of qualitative research (prospective data collection, ethics approval, purposive sampling, iterative data collection and analysis, and any method to corroborate findings). Qualitative research traditions represented include grounded theory (n = 15, 28%), ethnography or naturalistic methods (n = 15, 28%), phenomenology (n = 9, 17%), and other or unspecified approaches (n = 14, 26%). All 53 documents describe the research setting; 97% indicate purposive sampling of participants. Studies vary in their capture of multidisciplinary clinician and family perspectives. Thirty-one (58%) report research ethics board review. Only 49% report iterative data collection and analysis, and eight documents (15%) describe an analytically driven stopping point for data collection. Thirty-two documents (60%) indicated a method for corroborating findings. Qualitative evidence often appears outside of clinical journals, with most research from the United States. Prospective, observation-based studies follow life-support decision making directly. These involve a variety of participants and yield important insights into interactions, communication, and dynamics. Retrospective, interview-based studies lack this direct engagement, but focus on the recollections of fewer types of participants (particularly patients and physicians), and typically address specific issues (communication and stress). Both designs can provide useful reflections for improving care. Given the diversity of qualitative research in critical care, room for improvement exists regarding both the quality and transparency of reported methodology.

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

PubMed

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

2017-01-01

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

Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers.

PubMed

Vickers, Andrew J; Cronin, Angel M; Elkin, Elena B; Gonen, Mithat

2008-11-26

Decision curve analysis is a novel method for evaluating diagnostic tests, prediction models and molecular markers. It combines the mathematical simplicity of accuracy measures, such as sensitivity and specificity, with the clinical applicability of decision analytic approaches. Most critically, decision curve analysis can be applied directly to a data set, and does not require the sort of external data on costs, benefits and preferences typically required by traditional decision analytic techniques. In this paper we present several extensions to decision curve analysis including correction for overfit, confidence intervals, application to censored data (including competing risk) and calculation of decision curves directly from predicted probabilities. All of these extensions are based on straightforward methods that have previously been described in the literature for application to analogous statistical techniques. Simulation studies showed that repeated 10-fold crossvalidation provided the best method for correcting a decision curve for overfit. The method for applying decision curves to censored data had little bias and coverage was excellent; for competing risk, decision curves were appropriately affected by the incidence of the competing risk and the association between the competing risk and the predictor of interest. Calculation of decision curves directly from predicted probabilities led to a smoothing of the decision curve. Decision curve analysis can be easily extended to many of the applications common to performance measures for prediction models. Software to implement decision curve analysis is provided.

Teaching reproductive options through the use of fiction: the Cider House Rules project.

PubMed

Engstrom, Janet L; Hunter, Ramona G

2007-01-01

Alternative teaching strategies such as storytelling and the critical reading of literature are thought to help students develop their critical thinking, emotional intelligence, and cultural sensitivity and thereby better understand the context in which their patients live and make decisions. Such teaching methods are ideally suited for examining morally complex issues such as reproductive options. This article describes an alternative approach to teaching the complex personal, social, and moral issues surrounding the topic of reproductive options. The critical reading of the book, The Cider House Rules, provides a unique opportunity for students to obtain insight and understanding of the complex circumstances under which women and their families make reproductive decisions.

To pass or to fail? Understanding the factors considered by faculty in the clinical evaluation of nursing students.

PubMed

DeBrew, Jacqueline Kayler; Lewallen, Lynne Porter

2014-04-01

Making the decision to pass or to fail a nursing student is difficult for nurse educators, yet one that all educators face at some point in time. To make this decision, nurse educators draw from their past experiences and personal reflections on the situation. Using the qualitative method of critical incident technique, the authors asked educators to describe a time when they had to make a decision about whether to pass or fail a student in the clinical setting. The findings describe student and faculty factors important in clinical evaluation decisions, demonstrate the benefits of reflective practice to nurse educators, and support the utility of critical incident technique not only as research methodology, but also as a technique for reflective practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Enhancing students' critical thinking in science: A two-year design based exploration in a large undergraduate science course

NASA Astrophysics Data System (ADS)

Yoo, Suhyun

The purpose of this study was to explore how to enhance students' critical thinking in an introductory undergraduate science course. As a design experiment, this study aimed to design, develop, implement, and refine learning activities, and investigate how the learning activities worked in fostering students' critical thinking in a large size classroom context. In this study, critical thinking in science was framed with six categories, 1) identifying decisions, 2) evaluating decisions, 3) providing own decision, 4) argument and justification for own decision, 5) presenting supporting data/evidence, and 6) integrating other perspectives, as the result of literature review. To enhance critical thinking, three design principles, 1) authentic task, 2) question prompts, and 3) peer interaction, were associated with the learning activities for two consecutive years. The research context was within a large general science course and the learning activities for a module were designed, implemented and refined for two years. Specially, changes in design strategies were made in the two design principles, question prompts and peer interaction, after the 1st implementation. With regard to the use of question prompts, the students of the 2nd year were provided with procedural and elaborative question prompts, while those of the 1st year only received procedural question prompts embedded in the Group and Community Discussion Charts. Second, instead of being engaged six times in two types of discussions, group and community discussions, the students of the 2nd year were required to take part in a community discussion twice and to prepare for the discussion by learning about and understanding important aspects of dealing with the hurricane situation. For individual preparation, elaborative question prompts were embedded in the Individual Worksheet. Quantitative and qualitative research methods were taken to investigate how the two different designs of the 1st and 2nd years worked for enhancing critical thinking in a large-size classroom. Data came from the students' written documents during and after the learning activities. The result from the descriptive and comparative analysis on the written documents for two years indicated that there were changes in patterns of reasoning between the two years. It was evident that the groups engaged in decision-making for communities of the 2nd year showed more concrete and shaped reasoning than those of the 1st year. The result of the t-test indicated that there was a significant difference in critical thinking demonstrated in individual reports between the students of the 1st and the 2nd years. The students of the 2nd year demonstrated better levels of critical thinking than those of the 1st year. Specially, among the six categories of critical thinking, the students of the 2nd year demonstrated better levels in three categories, 1) providing one's own decision, 2) argumentation and justification for one's own decision, and 3) integrating other perspectives, than those of the 1st year. By the multiple-case study method, four themes were found to explain what made students demonstrated higher levels of critical thinking: 1) understanding of one's assigned role, 2) linking roles to make decisions, 3) answers to the question prompts, and 4) use of data and source, were raised in explaining the different pattern between the students with higher and lower levels of critical thinking. Also, a trend was visible across artifacts for higher performing students in both years.

An engineering approach to modelling, decision support and control for sustainable systems.

PubMed

Day, W; Audsley, E; Frost, A R

2008-02-12

Engineering research and development contributes to the advance of sustainable agriculture both through innovative methods to manage and control processes, and through quantitative understanding of the operation of practical agricultural systems using decision models. This paper describes how an engineering approach, drawing on mathematical models of systems and processes, contributes new methods that support decision making at all levels from strategy and planning to tactics and real-time control. The ability to describe the system or process by a simple and robust mathematical model is critical, and the outputs range from guidance to policy makers on strategic decisions relating to land use, through intelligent decision support to farmers and on to real-time engineering control of specific processes. Precision in decision making leads to decreased use of inputs, less environmental emissions and enhanced profitability-all essential to sustainable systems.

Emergency material allocation with time-varying supply-demand based on dynamic optimization method for river chemical spills.

PubMed

Liu, Jie; Guo, Liang; Jiang, Jiping; Jiang, Dexun; Wang, Peng

2018-04-13

Aiming to minimize the damage caused by river chemical spills, efficient emergency material allocation is critical for an actual emergency rescue decision-making in a quick response. In this study, an emergency material allocation framework based on time-varying supply-demand constraint is developed to allocate emergency material, minimize the emergency response time, and satisfy the dynamic emergency material requirements in post-accident phases dealing with river chemical spills. In this study, the theoretically critical emergency response time is firstly obtained for the emergency material allocation system to select a series of appropriate emergency material warehouses as potential supportive centers. Then, an enumeration method is applied to identify the practically critical emergency response time, the optimum emergency material allocation and replenishment scheme. Finally, the developed framework is applied to a computational experiment based on south-to-north water transfer project in China. The results illustrate that the proposed methodology is a simple and flexible tool for appropriately allocating emergency material to satisfy time-dynamic demands during emergency decision-making. Therefore, the decision-makers can identify an appropriate emergency material allocation scheme in a balance between time-effective and cost-effective objectives under the different emergency pollution conditions.

Towards Methodologically Inclusive Research Syntheses: Expanding Possibilities. Routledge Research in Education

ERIC Educational Resources Information Center

Suri, Harsh

2013-01-01

Primary research in education and social sciences is marked by a diversity of methods and perspectives. How can we accommodate and reflect such diversity at the level of synthesizing research? What are the critical methodological decisions in the process of a research synthesis, and how do these decisions open up certain possibilities, while…

Researching Together: A CTSA Partnership of Academicians and Communities for Translation

PubMed Central

Nearing, Kathryn; Felzien, Maret; Green, Larry; Calonge, Ned; Pineda‐Reyes, Fernando; Jones, Grant; Tamez, Montelle; Miller, Sara; Kramer, Andrew

2013-01-01

Abstract Background The Colorado Clinical and Translational Sciences Institute (CCTSI) aims to translate discovery into clinical practice. The Partnership of Academicians and Communities for Translation (PACT) represents a robust campus–community partnership. Methods The CCTSI collected data on all PACT activities including meeting notes, staff activity logs, stakeholder surveys and interviews, and several key component in‐depth evaluations. Data analysis by Evaluation and Community Engagement Core and PACT Council members identified critical shifts that changed the trajectory of community engagement efforts. Results Ten “critical shifts” in six broad rubrics created change in the PACT. Critical shifts were decision points in the development of the PACT that represented quantitative and qualitative changes in the work and trajectory. Critical shifts occurred in PACT management and leadership, financial control and resource allocation, and membership and voice. Discussion The development of a campus–community partnership is not a smooth linear path. Incremental changes lead to major decision points that represent an opportunity for critical shifts in developmental trajectory. We provide an enlightening, yet cautionary, tale to others considering a campus–community partnership so they may prepare for crucial decisions and critical shifts. The PACT serves as a genuine foundational platform for dynamic research efforts aimed at eliminating health disparities. PMID:24127922

The effects of critical thinking instruction on training complex decision making.

PubMed

Helsdingen, Anne S; van den Bosch, Karel; van Gog, Tamara; van Merriënboer, Jeroen J G

2010-08-01

Two field studies assessed the effects of critical thinking instruction on training and transfer of a complex decision-making skill. Critical thinking instruction is based on studies of how experienced decision makers approach complex problems. Participants conducted scenario-based exercises in both simplified (Study I) and high-fidelity (Study 2) training environments. In both studies, half of the participants received instruction in critical thinking. The other half conducted the same exercises but without critical thinking instruction. After the training, test scenarios were administered to both groups. The first study showed that critical thinking instruction enhanced decision outcomes during both training and the test. In the second study, critical thinking instruction benefited both decision outcomes and processes, specifically on the transfer to untrained problems. The results suggest that critical thinking instruction improves decision strategy and enhances understanding of the general principles of the domain. The results of this study warrant the implementation of critical thinking instruction in training programs for professional decision makers that have to operate in complex and highly interactive, dynamic environments.

A systematic and critical review of the evolving methods and applications of value of information in academia and practice.

PubMed

Steuten, Lotte; van de Wetering, Gijs; Groothuis-Oudshoorn, Karin; Retèl, Valesca

2013-01-01

This article provides a systematic and critical review of the evolving methods and applications of value of information (VOI) in academia and practice and discusses where future research needs to be directed. Published VOI studies were identified by conducting a computerized search on Scopus and ISI Web of Science from 1980 until December 2011 using pre-specified search terms. Only full-text papers that outlined and discussed VOI methods for medical decision making, and studies that applied VOI and explicitly discussed the results with a view to informing healthcare decision makers, were included. The included papers were divided into methodological and applied papers, based on the aim of the study. A total of 118 papers were included of which 50 % (n = 59) are methodological. A rapidly accumulating literature base on VOI from 1999 onwards for methodological papers and from 2005 onwards for applied papers is observed. Expected value of sample information (EVSI) is the preferred method of VOI to inform decision making regarding specific future studies, but real-life applications of EVSI remain scarce. Methodological challenges to VOI are numerous and include the high computational demands, dealing with non-linear models and interdependency between parameters, estimations of effective time horizons and patient populations, and structural uncertainties. VOI analysis receives increasing attention in both the methodological and the applied literature bases, but challenges to applying VOI in real-life decision making remain. For many technical and methodological challenges to VOI analytic solutions have been proposed in the literature, including leaner methods for VOI. Further research should also focus on the needs of decision makers regarding VOI.

Shared Decision Making in Intensive Care Units: An American College of Critical Care Medicine and American Thoracic Society Policy Statement

PubMed Central

Kon, Alexander A.; Davidson, Judy E.; Morrison, Wynne; Danis, Marion; White, Douglas B.

2015-01-01

Objectives Shared decision-making (SDM) is endorsed by critical care organizations, however there remains confusion about what SDM is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define SDM, recommend when SDM should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. Methods The American College of Critical Care Medicine (ACCM) and American Thoracic Society (ATS) Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of ACCM and ATS were included in the statement. Main Results Six recommendations were endorsed: 1) Definition: Shared decision-making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together, taking into account the best scientific evidence available, as well as the patient’s values, goals, and preferences. 2) Clinicians should engage in a SDM process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their “default” approach a SDM process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Conclusions Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate. PMID:26509317

ANFIS multi criteria decision making for overseas construction projects: a methodology

NASA Astrophysics Data System (ADS)

Utama, W. P.; Chan, A. P. C.; Zulherman; Zahoor, H.; Gao, R.; Jumas, D. Y.

2018-02-01

A critical part when a company targeting a foreign market is how to make a better decision in connection with potential project selection. Since different attributes of information are often incomplete, imprecise and ill-defined in overseas projects selection, the process of decision making by relying on the experiences and intuition is a risky attitude. This paper aims to demonstrate a decision support method in deciding overseas construction projects (OCPs). An Adaptive Neuro-Fuzzy Inference System (ANFIS), the amalgamation of Neural Network and Fuzzy Theory, was used as decision support tool to decide to go or not go on OCPs. Root mean square error (RMSE) and coefficient of correlation (R) were employed to identify the ANFIS system indicating an optimum and efficient result. The optimum result was obtained from ANFIS network with two input membership functions, Gaussian membership function (gaussmf) and hybrid optimization method. The result shows that ANFIS may help the decision-making process for go/not go decision in OCPs.

Improving Leadership Through Better Decision Making: Fostering Critical Thinking

DTIC Science & Technology

1997-03-01

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

Critical thinking: concept analysis from the perspective of Rodger's evolutionary method of concept analysis

PubMed Central

Carbogim, Fábio da Costa; de Oliveira, Larissa Bertacchini; Püschel, Vilanice Alves de Araújo

2016-01-01

ABSTRACT Objective: to analyze the concept of critical thinking (CT) in Rodger's evolutionary perspective. Method: documentary research undertaken in the Cinahl, Lilacs, Bdenf and Dedalus databases, using the keywords of 'critical thinking' and 'Nursing', without limitation based on year of publication. The data were analyzed in accordance with the stages of Rodger's conceptual model. The following were included: books and articles in full, published in Portuguese, English or Spanish, which addressed CT in the teaching and practice of Nursing; articles which did not address aspects related to the concept of CT were excluded. Results: the sample was made up of 42 works. As a substitute term, emphasis is placed on 'analytical thinking', and, as a related factor, decision-making. In order, the most frequent preceding and consequent attributes were: ability to analyze, training of the student nurse, and clinical decision-making. As the implications of CT, emphasis is placed on achieving effective results in care for the patient, family and community. Conclusion: CT is a cognitive skill which involves analysis, logical reasoning and clinical judgment, geared towards the resolution of problems, and standing out in the training and practice of the nurse with a view to accurate clinical decision-making and the achieving of effective results. PMID:27598376

Integrating Climate and Risk-Informed Science to Support Critical Decisions

ScienceCinema

None

2018-01-16

The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.

Integrating Climate and Risk-Informed Science to Support Critical Decisions

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

None

2016-07-27

The PNNL Environmental Health and Remediation Sector stewards several decision support capabilities to integrate climate- and risk-informed science to support critical decisions. Utilizing our expertise in risk and decision analysis, integrated Earth systems modeling, and remote sensing and geoinformatics, PNNL is influencing the way science informs high level decisions at national, regional and local scales to protect and preserve our most critical assets.

Concept mapping in a critical care orientation program: a pilot study to develop critical thinking and decision-making skills in novice nurses.

PubMed

Wahl, Stacy E; Thompson, Anita M

2013-10-01

Newly graduated registered nurses who were hired into a critical care intensive care unit showed a lack of critical thinking skills to inform their clinical decision-making abilities. This study evaluated the effectiveness of concept mapping as a teaching tool to improve critical thinking and clinical decision-making skills in novice nurses. A self-evaluation tool was administered before and after the learning intervention. The 25-item tool measured five key indicators of the development of critical thinking skills: problem recognition, clinical decision-making, prioritization, clinical implementation, and reflection. Statistically significant improvements were seen in 10 items encompassing all five indicators. Concept maps are an effective tool for educators to use in assisting novice nurses to develop their critical thinking and clinical decision-making skills. Copyright 2013, SLACK Incorporated.

Critical care physician cognitive task analysis: an exploratory study

PubMed Central

Fackler, James C; Watts, Charles; Grome, Anna; Miller, Thomas; Crandall, Beth; Pronovost, Peter

2009-01-01

Introduction For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine. The study objective was to assess the usefulness of CTA as an analytical tool in order that physician cognitive tasks may be understood and redistributed within the work-hour limited medical decision-making teams. Methods After approval from each Institutional Review Board, two intensive care units (ICUs) within major university teaching hospitals served as data collection sites for CTA observations and interviews of critical care providers. Results Five broad categories of cognitive activities were identified: pattern recognition; uncertainty management; strategic vs. tactical thinking; team coordination and maintenance of common ground; and creation and transfer of meaning through stories. Conclusions CTA within the framework of Naturalistic Decision Making is a useful tool to understand the critical care process of decision-making and communication. The separation of strategic and tactical thinking has implications for workflow redesign. Given the global push for work-hour limitations, such workflow redesign is occurring. Further work with CTA techniques will provide important insights toward rational, rather than random, workflow changes. PMID:19265517

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.

Method of calculation of critical values of financial indicators for developing food security strategy

NASA Astrophysics Data System (ADS)

Aigyl Ilshatovna, Sabirova; Svetlana Fanilevna, Khasanova; Vildanovna, Nagumanova Regina

2018-05-01

On the basis of decision making theory (minimax and maximin approaches) the authors propose a technique with the results of calculations of the critical values of effectiveness indicators of agricultural producers in the Republic of Tatarstan for 2013-2015. There is justified necessity of monitoring the effectiveness of the state support and the direction of its improvement.

Prognostic categories and timing of negative prognostic communication from critical care physicians to family members at end-of-life in an intensive care unit.

PubMed

Gutierrez, Karen M

2013-09-01

Negative prognostic communication is often delayed in intensive care units, which limits time for families to prepare for end-of-life. This descriptive study, informed by ethnographic methods, was focused on exploring critical care physician communication of negative prognoses to families and identifying timing influences. Prognostic communication of critical care physicians to nurses and family members was observed and physicians and family members were interviewed. Physician perception of prognostic certainty, based on an accumulation of empirical data, and the perceived need for decision-making, drove the timing of prognostic communication, rather than family needs. Although prognoses were initially identified using intuitive knowledge for patients in one of the six identified prognostic categories, utilizing decision-making to drive prognostic communication resulted in delayed prognostic communication to families until end-of-life (EOL) decisions could be justified with empirical data. Providers will better meet the needs of families who desire earlier prognostic information by separating prognostic communication from decision-making and communicating the possibility of a poor prognosis based on intuitive knowledge, while acknowledging the uncertainty inherent in prognostication. This sets the stage for later prognostic discussions focused on EOL decisions, including limiting or withdrawing treatment, which can be timed when empirical data substantiate intuitive prognoses. This allows additional time for families to anticipate and prepare for end-of-life decision-making. © 2012 John Wiley & Sons Ltd.

Sustainability Assessment Model in Product Development

NASA Astrophysics Data System (ADS)

Turan, Faiz Mohd; Johan, Kartina; Nor, Nik Hisyamudin Muhd; Omar, Badrul

2017-08-01

Faster and more efficient development of innovative and sustainable products has become the focus for manufacturing companies in order to remain competitive in today’s technologically driven world. Design concept evaluation which is the end of conceptual design is one of the most critical decision points. It relates to the final success of product development, because poor criteria assessment in design concept evaluation can rarely compensated at the later stages. Furthermore, consumers, investors, shareholders and even competitors are basing their decisions on what to buy or invest in, from whom, and also on what company report, and sustainability is one of a critical component. In this research, a new methodology of sustainability assessment in product development for Malaysian industry has been developed using integration of green project management, new scale of “Weighting criteria” and Rough-Grey Analysis. This method will help design engineers to improve the effectiveness and objectivity of the sustainable design concept evaluation, enable them to make better-informed decisions before finalising their choice and consequently create value to the company or industry. The new framework is expected to provide an alternative to existing methods.

Using Visualization in Cockpit Decision Support Systems

NASA Technical Reports Server (NTRS)

Aragon, Cecilia R.

2005-01-01

In order to safely operate their aircraft, pilots must make rapid decisions based on integrating and processing large amounts of heterogeneous information. Visual displays are often the most efficient method of presenting safety-critical data to pilots in real time. However, care must be taken to ensure the pilot is provided with the appropriate amount of information to make effective decisions and not become cognitively overloaded. The results of two usability studies of a prototype airflow hazard visualization cockpit decision support system are summarized. The studies demonstrate that such a system significantly improves the performance of helicopter pilots landing under turbulent conditions. Based on these results, design principles and implications for cockpit decision support systems using visualization are presented.

The application of reduced-processing decision support systems to facilitate the acquisition of decision-making skills.

PubMed

Perry, Nathan C; Wiggins, Mark W; Childs, Merilyn; Fogarty, Gerard

2013-06-01

The study was designed to examine whether the availability of reduced-processing decision support system interfaces could improve the decision making of inexperienced personnel in the context of Although research into reduced-processing decision support systems has demonstrated benefits in minimizing cognitive load, these benefits have not typically translated into direct improvements in decision accuracy because of the tendency for inexperienced personnel to focus on less-critical information. The authors investigated whether reduced-processing interfaces that direct users' attention toward the most critical cues for decision making can produce improvements in decision-making performance. Novice participants made incident command-related decisions in experimental conditions that differed according to the amount of information that was available within the interface, the level of control that they could exert over the presentation of information, and whether they had received decision training. The results revealed that despite receiving training, participants improved in decision accuracy only when they were provided with an interface that restricted information access to the most critical cues. It was concluded that an interface that restricts information access to only the most critical cues in the scenario can facilitate improvements in decision performance. Decision support system interfaces that encourage the processing of the most critical cues have the potential to improve the accuracy and timeliness of decisions made by inexperienced personnel.

Critical review of methods for risk ranking of food-related hazards, based on risks for human health.

PubMed

Van der Fels-Klerx, H J; Van Asselt, E D; Raley, M; Poulsen, M; Korsgaard, H; Bredsdorff, L; Nauta, M; D'agostino, M; Coles, D; Marvin, H J P; Frewer, L J

2018-01-22

This study aimed to critically review methods for ranking risks related to food safety and dietary hazards on the basis of their anticipated human health impacts. A literature review was performed to identify and characterize methods for risk ranking from the fields of food, environmental science and socio-economic sciences. The review used a predefined search protocol, and covered the bibliographic databases Scopus, CAB Abstracts, Web of Sciences, and PubMed over the period 1993-2013. All references deemed relevant, on the basis of predefined evaluation criteria, were included in the review, and the risk ranking method characterized. The methods were then clustered-based on their characteristics-into eleven method categories. These categories included: risk assessment, comparative risk assessment, risk ratio method, scoring method, cost of illness, health adjusted life years (HALY), multi-criteria decision analysis, risk matrix, flow charts/decision trees, stated preference techniques and expert synthesis. Method categories were described by their characteristics, weaknesses and strengths, data resources, and fields of applications. It was concluded there is no single best method for risk ranking. The method to be used should be selected on the basis of risk manager/assessor requirements, data availability, and the characteristics of the method. Recommendations for future use and application are provided.

Reinforcement learning for resource allocation in LEO satellite networks.

PubMed

Usaha, Wipawee; Barria, Javier A

2007-06-01

In this paper, we develop and assess online decision-making algorithms for call admission and routing for low Earth orbit (LEO) satellite networks. It has been shown in a recent paper that, in a LEO satellite system, a semi-Markov decision process formulation of the call admission and routing problem can achieve better performance in terms of an average revenue function than existing routing methods. However, the conventional dynamic programming (DP) numerical solution becomes prohibited as the problem size increases. In this paper, two solution methods based on reinforcement learning (RL) are proposed in order to circumvent the computational burden of DP. The first method is based on an actor-critic method with temporal-difference (TD) learning. The second method is based on a critic-only method, called optimistic TD learning. The algorithms enhance performance in terms of requirements in storage, computational complexity and computational time, and in terms of an overall long-term average revenue function that penalizes blocked calls. Numerical studies are carried out, and the results obtained show that the RL framework can achieve up to 56% higher average revenue over existing routing methods used in LEO satellite networks with reasonable storage and computational requirements.

Lessons of War: Turning Data Into Decisions.

PubMed

Forsberg, Jonathan A; Potter, Benjamin K; Wagner, Matthew B; Vickers, Andrew; Dente, Christopher J; Kirk, Allan D; Elster, Eric A

2015-09-01

Recent conflicts in Afghanistan and Iraq produced a substantial number of critically wounded service-members. We collected biomarker and clinical information from 73 patients who sustained 116 life-threatening combat wounds, and sought to determine if the data could be used to predict the likelihood of wound failure. From each patient, we collected clinical information, serum, wound effluent, and tissue prior to and at each surgical débridement. Inflammatory cytokines were quantified in both the serum and effluent, as were gene expression targets. The primary outcome was successful wound healing. Computer intensive methods were used to derive prognostic models that were internally validated using target shuffling and cross-validation methods. A second cohort of eighteen critically injured civilian patients was evaluated to determine if similar inflammatory responses were observed. The best-performing models enhanced clinical observation with biomarker data from the serum and wound effluent, an indicator that systemic inflammatory conditions contribute to local wound failure. A Random Forest model containing ten variables demonstrated the highest accuracy (AUC 0.79). Decision Curve Analysis indicated that the use of this model would improve clinical outcomes and reduce unnecessary surgical procedures. Civilian trauma patients demonstrated similar inflammatory responses and an equivalent wound failure rate, indicating that the model may be generalizable to civilian settings. Using advanced analytics, we successfully codified clinical and biomarker data from combat patients into a potentially generalizable decision support tool. Analysis of inflammatory data from critically ill patients with acute injury may inform decision-making to improve clinical outcomes and reduce healthcare costs. United States Department of Defense Health Programs.

76 FR 23769 - Protection of Stratospheric Ozone: The 2011 Critical Use Exemption From the Phaseout of Methyl...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-28

... 13, 2011. EPA will post information regarding a hearing, if one is requested, on the Ozone Protection.... Proposed Critical Uses D. Proposed Critical Use Amounts E. The Criteria in Decisions IX/6 and Ex. I/4 F... issued several Decisions pertaining to the critical use exemption. These include Decisions IX/6 and Ex. I...

The effectiveness of tools used to evaluate successful critical decision making skills for applicants to healthcare graduate educational programs: a systematic review.

PubMed

Benham, Brian; Hawley, Diane

2015-05-15

Students leave healthcare academic programs for a variety of reasons. When they attrite, it is disappointing for the student as well as their faculty. Advanced practice nursing and other healthcare professions require not only extensive academic preparation, but also the ability to critically evaluate patient care situations. The ability to critically evaluate a situation is not innate. Critical decision making skills are high level skills that are difficult to assess. For the purpose of this review, critical decision making and critical thinking skills refer to the same constructs and will be referred to globally as critical decision making skills. The objective of this review was to identify the effectiveness of tools used to evaluate critical decision making skills for applicants to healthcare graduate educational programs. Adult (18 years of age or older) applicants, students enrolled and/or recent graduates (within one year from completion) of healthcare graduate educational programs. Types of interventions: This review considered studies that evaluated the utilization of unique tools as well as standard tools, such as the Graduate Record Exam or grade point average, to evaluate critical decision making skills in graduate healthcare program applicants. Types of studies: Experimental and non-experimental studies were considered for inclusion. Types of outcomes: Successful quantitative evaluations based on specific field of study standards. The search strategy aimed to find both published and unpublished studies. Studies published in English after 1969 were considered for inclusion in this review. Databases that included both published and unpublished (grey) literature were searched. Additionally, reference lists from all articles retrieved were examined for articles for inclusion. Selected papers were assessed by two independent reviewers using standardized critical appraisal instruments from Joanna Briggs Institute. Any disagreement between reviewers was resolved through discussion or with a third reviewer. Data was extracted independently by each reviewer from papers included in the review using a Microsoft Excel spreadsheet. Included data included study type, 'r' values, number of subjects and reported 'p' values. These were indexed by author, year and study title. The meta-analysis was performed using the method for effect size analysis from Hunter and Schmidt. The syntax for equations was transposed into a Microsoft Excel spreadsheet for data entry, analysis and graph creation. No articles or paper addressing unique tools for ascertaining critical decision making skills met the inclusion criteria. Standard tools, which were represented in the literature, assess critical decision making skills via prediction of academic and clinical success, which indicates the presence of critical decision making skills in graduate healthcare students. A total of 16 studies addressing standard tools were included in this review. All were retrospective case series studies. The date range for the included studies was 1970 to 2009. The strongest relationship was undergraduate grade point average's correlation to graduate grade point average (small effect size with an 'r' value of 0.27, credibility interval of 0.18-0.37). The second strongest relationship was between Graduate Record Examination’s verbal section and graduate grade point average (small effect size with an r value of 0.24, CrI of 0.11-0.37). An applicant’s undergraduate GPA has the strongest correlation with graduate healthcare program success of the indicators analyzed (r = 0.27, small effect size). The next best predictor of graduate healthcare program success was the GRE Verbal score (r = 0.24, small effect size). However, all of the variables carried positive correlations with graduate success, just of lesser effect size strength. This review supports the continued use of traditional indicators of graduate school potential in the undergraduate grade point average and the various sections of the Graduate Record Examination for the selection of graduate healthcare applicants. Primary studies should be funded and performed to assess the use of unique tools in assessing critical thinking in graduate healthcare students. The Joanna Briggs Institute.

See Change: Classifying single observation transients from HST using SNCosmo

NASA Astrophysics Data System (ADS)

Sofiatti Nunes, Caroline; Perlmutter, Saul; Nordin, Jakob; Rubin, David; Lidman, Chris; Deustua, Susana E.; Fruchter, Andrew S.; Aldering, Greg Scott; Brodwin, Mark; Cunha, Carlos E.; Eisenhardt, Peter R.; Gonzalez, Anthony H.; Jee, Myungkook J.; Hildebrandt, Hendrik; Hoekstra, Henk; Santos, Joana; Stanford, S. Adam; Stern, Dana R.; Fassbender, Rene; Richard, Johan; Rosati, Piero; Wechsler, Risa H.; Muzzin, Adam; Willis, Jon; Boehringer, Hans; Gladders, Michael; Goobar, Ariel; Amanullah, Rahman; Hook, Isobel; Huterer, Dragan; Huang, Jiasheng; Kim, Alex G.; Kowalski, Marek; Linder, Eric; Pain, Reynald; Saunders, Clare; Suzuki, Nao; Barbary, Kyle H.; Rykoff, Eli S.; Meyers, Joshua; Spadafora, Anthony L.; Hayden, Brian; Wilson, Gillian; Rozo, Eduardo; Hilton, Matt; Dixon, Samantha; Yen, Mike

2016-01-01

The Supernova Cosmology Project (SCP) is executing "See Change", a large HST program to look for possible variation in dark energy using supernovae at z>1. As part of the survey, we often must make time-critical follow-up decisions based on multicolor detection at a single epoch. We demonstrate the use of the SNCosmo software package to obtain simulated fluxes in the HST filters for type Ia and core-collapse supernovae at various redshifts. These simulations allow us to compare photometric data from HST with the distribution of the simulated SNe through methods such as Random Forest, a learning method for classification, and Gaussian Kernel Estimation. The results help us make informed decisions about triggered follow up using HST and ground based observatories to provide time-critical information needed about transients. Examples of this technique applied in the context of See Change are shown.

The effect of high-fidelity patient simulation on the critical thinking and clinical decision-making skills of new graduate nurses.

PubMed

Maneval, Rhonda; Fowler, Kimberly A; Kays, John A; Boyd, Tiffany M; Shuey, Jennifer; Harne-Britner, Sarah; Mastrine, Cynthia

2012-03-01

This study was conducted to determine whether the addition of high-fidelity patient simulation to new nurse orientation enhanced critical thinking and clinical decision-making skills. A pretest-posttest design was used to assess critical thinking and clinical decision-making skills in two groups of graduate nurses. Compared with the control group, the high-fidelity patient simulation group did not show significant improvement in mean critical thinking or clinical decision-making scores. When mean scores were analyzed, both groups showed an increase in critical thinking scores from pretest to posttest, with the high-fidelity patient simulation group showing greater gains in overall scores. However, neither group showed a statistically significant increase in mean test scores. The effect of high-fidelity patient simulation on critical thinking and clinical decision-making skills remains unclear. Copyright 2012, SLACK Incorporated.

Cases in TESOL Teacher Education: Creating a Forum for Reflection.

ERIC Educational Resources Information Center

Jackson, Jane

1997-01-01

Reviews the case method from an historical perspective and explores why and how "decision" cases might be used by teacher educators in the professional preparation of teachers as reflective English-as-a-Second-Language specialists. Argues that the case method can enhance the critical thinking, analytical, and communication skills of novice and…

Quality assurance, training, and certification in ozone air pollution studies

Treesearch

Susan Schilling; Paul Miller; Brent Takemoto

1996-01-01

Uniform, or standard, measurement methods of data are critical to projects monitoring change to forest systems. Standardized methods, with known or estimable errors, contribute greatly to the confidence associated with decisions on the basis of field data collections (Zedaker and Nicholas 1990). Quality assurance (QA) for the measurement process includes operations and...

Examining the relationship between critical-thinking skills and decision-making ability of emergency medicine students.

PubMed

Heidari, Mohammad; Ebrahimi, Parvin

2016-10-01

Critical-thinking ability would enable students to think creatively and make better decisions and makes them make a greater effort to concentrate on situations related to clinical matters and emergencies. This can bridge the gap between the clinical and theoretical training. Therefore, the aim of the present study is to examine the relationship between critical-thinking ability and decision-making skills of the students of Emergency Medicine. This descriptive and analytical research was conducted on all the students of medical emergency students ( n = 86) in Shahrekord, Iran. The demographic information questionnaire, the California Critical Thinking Skills Test, and a decision-making researcher-made questionnaire were used to collect data. The data were analyzed by SPSS software version 16 using descriptive and analytical statistical tests and Pearson's correlation coefficient. The results of the present study indicate that the total mean score for the critical thinking was 8.32 ± 2.03 and for decision making 8.66 ± 1.89. There is a significant statistical relationship between the critical-thinking score and decision-making score ( P < 0.05). Although critical-thinking skills and decision-making ability are essential for medical emergency professional competence, the results of this study show that these skills are poor among the students.

Critical habitat for threatened and endangered species: how should the economic costs be evaluated?

PubMed

Plantinga, Andrew J; Helvoigt, Ted L; Walker, Kirsten

2014-02-15

The designation of critical habitat is a feature of endangered species protection laws in many countries. Under the U.S. Endangered Species Act, economics cannot enter into decisions to list species as threatened or endangered, but can be considered when critical habitat is designated. Areas can be excluded from proposed critical habitat if the economic cost of including them is determined to exceed the benefits of inclusion, and exclusion would not result in extinction of the species. The economic analysis done to support critical habitat exclusions has been controversial, and the focus of much litigation. We evaluate a sample of these analyses, and discuss the exclusions that were made in each case. We discuss how the methodology used to measure economic costs of critical habitat has changed over time and provide a critique of these alternative methods. We find that the approach currently in use is sound from an economic perspective. Nevertheless, quantification of the costs of critical habitat faces numerous challenges, including great uncertainty about future events, questions about the appropriate scale for the analysis, and the need to account for complex market feedbacks and values of non-market goods. For the studies we reviewed, there was no evidence that the results of the economic analyses provided information that was useful for making decisions about exemptions from critical habitat designations. If economics is to play a meaningful role in determining endangered species protections, an alternative would be to allow listing decisions to be based on economic as well as biological factors, as is typical for species conservation laws in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Assessing Storm Vulnerabilities and Resilience Strategies: A Scenario-Method for Engaging Stakeholders of Public/Private Maritime Infrastructure

NASA Astrophysics Data System (ADS)

Becker, A.; Burroughs, R.

2014-12-01

This presentation discusses a new method to assess vulnerability and resilience strategies for stakeholders of coastal-dependent transportation infrastructure, such as seaports. Much coastal infrastructure faces increasing risk to extreme events resulting from sea level rise and tropical storms. As seen after Hurricane Sandy, natural disasters result in economic costs, damages to the environment, and negative consequences on resident's quality of life. In the coming decades, tough decisions will need to be made about investment measures to protect critical infrastructure. Coastal communities will need to weigh the costs and benefits of a new storm barrier, for example, against those of retrofitting, elevating or simply doing nothing. These decisions require understanding the priorities and concerns of stakeholders. For ports, these include shippers, insurers, tenants, and ultimate consumers of the port cargo on a local and global scale, all of whom have a stake in addressing port vulnerabilities.Decision-makers in exposed coastal areas need tools to understand stakeholders concerns and perceptions of potential resilience strategies. For ports, they need answers to: 1) How will stakeholders be affected? 2) What strategies could be implemented to build resilience? 3) How effectively would the strategies mitigate stakeholder concerns? 4) What level of time and investment would strategies require? 5) Which stakeholders could/should take responsibility? Our stakeholder-based method provides answers to questions 1-3 and forms the basis for further work to address 4 and 5.Together with an expert group, we developed a pilot study for stakeholders of Rhode Island's critical energy port, the Port of Providence. Our method uses a plausible extreme storm scenario with localized visualizations and a portfolio of potential resilience strategies. We tailor a multi-criteria decision analysis tool and, through a series of workshops, we use the storm scenario, resilience strategies, and decision tool to elicit perceptions and priorities of port stakeholders. Results provide new knowledge to assist decision-makers allocate investments of time, money, and staff resources. We intend for our method to be utilized in other port communities around Rhode Island and in other coastal states.

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

The effect of reading assignments in guided inquiry learning on students’ critical thinking skills

NASA Astrophysics Data System (ADS)

Syarkowi, A.

2018-05-01

The purpose of this study was to determine the effect of reading assignment in guided inquiry learning on senior high school students’ critical thinking skills. The research method which was used in this research was quasi-experiment research method with reading task as the treatment. Topic of inquiry process was Kirchhoff law. The instrument was used for this research was 25 multiple choice interpretive exercises with justification. The multiple choice test was divided on 3 categories such as involve basic clarification, the bases for a decision and inference skills. The result of significance test proved the improvement of students’ critical thinking skills of experiment class was significantly higher when compared with the control class, so it could be concluded that reading assignment can improve students’ critical thinking skills.

The Three-Part Harmony of Adult Learning, Critical Thinking, and Decision-Making

ERIC Educational Resources Information Center

Moore, Kyle

2010-01-01

Adult learning, critical thinking, and decision-making are fields that receive attention individually, although they are interspersed with elements of each other's theories and philosophies. In addressing adult learning precepts, it is essential to include critical thinking and decision-making. One without the other creates weakness; all must be…

SU-E-T-170: Characterization of the Location, Extent, and Proximity to Critical Structures of Target Volumes Provides Detail for Improved Outcome Predictions Among Pancreatic Cancer Patients

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

Cheng, Z; Moore, J; Rosati, L

Purpose: In radiotherapy, size, location and proximity of the target to critical structures influence treatment decisions. It has been shown that proximity of the target predicts dosimetric sparing of critical structures. In addition to dosimetry, precise location of disease has further implications such as tumor invasion, or proximity to major arteries that inhibit surgery. Knowledge of which patients can be converted to surgical candidates by radiation may have high impact on future treat/no-treat decisions. We propose a method to improve our characterization of the location of pancreatic cancer and treatment volume extent with respect to nearby arteries with the goalmore » of developing features to improve clinical predictions and decisions. Methods: Oncospace is a local learning health system that systematically captures clinical outcomes and all aspects of radiotherapy treatment plans, including overlap volume histograms (OVH) – a measure of spatial relationships between two structures. Minimum and maximum distances of PTV and OARs based on OVH, PTV volume, anatomic location by ICD-9 code, and surgical outcome were queried. Normalized distance to center from the left and right kidney was calculated to indicate tumor location and laterality. Distance to critical arteries (celiac, superior mesenteric, common hepatic) is validated by surgical status (borderline resectable, locally advanced converted to resectable). Results: There were 205 pancreas stereotactic body radiotherapy patients treated from 2009–2015 queried. Location/laterality of tumor based on kidney OVH show strong trends between location by OVH and by ICD-9. Compared to the locally advanced group, the borderline resectable group showed larger geometrical distance from critical arteries (p=0.03). Conclusion: Our platform enabled analysis of shape/size-location relationships. These data suggest that PTV volume and attention to distance between PTVs and surrounding OARs and major arteries may be promising for improving characterization of treatment anatomy that can refine our ability for outcome predictions and decision making. Elekta, Toshiba.« less

Socio-Hydrology Modelling for an Uncertain Future, with Examples from the USA and Canada (Invited)

NASA Astrophysics Data System (ADS)

White, D. D.; Gober, P.; Sampson, D. A.; Quay, R.; Kirkwood, C.

2013-12-01

Socio-hydrology brings an interest in human values, markets, social organizations and public policy to the traditional emphasis of water science on climate, hydrology, toxicology,and ecology. It also conveys a decision focus in the form of decision support tools, engagement, and new knowledge about the science-policy interface. This paper demonstrates how policy decisions and human behavior can be better integrated into climate and hydrological models to improve their usefulness for support in decision making. Examples from the Southwest USA and Western Canada highlight uncertainties, vulnerabilities, and critical tradeoffs facing water decision makers in the face of rapidly changing environmental and societal conditions. Irreducible uncertainties in downscaled climate and hydrological models limit the usefulness of climate-driven, predict-and-plan methods of water resource planning and management. Thus, it is argued that such methods should be replaced by approaches that use exploratory modelling, scenario planning, and risk assessment in which the emphasis is on managing uncertainty rather than on reducing it.

Preparing future fisheries professionals to make good decisions

USGS Publications Warehouse

Colvin, Michael E.; Peterson, James T.

2017-01-01

Future fisheries professionals will face decision-making challenges in an increasingly complex field of fisheries management. Though fisheries students are well trained in the use of the scientific method to understand the natural world, they are rarely exposed to structured decision making (SDM) as part of an undergraduate or graduate education. Specifically, SDM encourages users (e.g., students, managers) to think critically and communicate the problem and then identify specific, measurable objectives as they relate to the problem. Next, users must think critically and creatively about management alternatives that can be used to meet the objectives—there must be more than one alternative or there is no decision to be made. Lastly, the management alternatives are evaluated with regard to how likely they are to succeed in terms of multiple, possibly completing, objectives, such as how stakeholder groups value outcomes of management actions versus monetary cost. We believe that exposure to SDM and its elements is an important part of preparing future fisheries professional to meet the challenges they may face. These challenges include reduced budgets, the growth of potentially competing natural resource interest groups, and stakeholder desire to be involved in management decisions affecting public trust resources, just to name a few.

[Factors influencing nurses' clinical decision making--focusing on critical thinking disposition].

PubMed

Park, Seungmi; Kwon, In Gak

2007-10-01

The purpose of this study was to investigate the factors influencing nurses' clinical decision making focusing on critical thinking disposition. The subjects of this study consisted of 505 nurses working at one of the general hospitals located in Seoul. Data was collected by a self-administered questionnaire between December 2006 and January 2007. Data was analyzed by one way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS Win 14.0. The mean scores of critical thinking disposition and clinical decision making were 99.10 and 134.32 respectively. Clinical decision making scores were significantly higher in groups under continuing education, with a master or higher degree, with clinical experience more than 5 years, or with experts. Critical thinking disposition and its subscales have a significant correlation with clinical decision making. Intellectual eagerness/curiosity, prudence, clinical experience, intellectual honesty, self-confidence, and healthy skepticism were important factors influencing clinical decision making(adjusted R(2)=33%). Results of this study suggest that various strategies such as retaining experienced nurses, encouraging them to continue with education and enhancing critical thinking disposition are warranted for development of clinical decision making.

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation.

PubMed

Jiang, Yun; Sereika, Susan M; DeVito Dabbs, Annette; Handler, Steven M; Schlenk, Elizabeth A

2016-10-01

Lung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH(®), a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators. To examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation. A cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support. Of the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n=23) were less likely to follow technology decision support than the high (odds ratio [OR]=0.11, p=0.02) and low (OR=0.04, p=0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR=0.01, p=0.01) or who had longer hospital stays (OR=0.94, p=0.004). A significant interaction was found between gender and past technology experience (OR=0.21, p=0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women. The majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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.

An intelligent, knowledge-based multiple criteria decision making advisor for systems design

NASA Astrophysics Data System (ADS)

Li, Yongchang

In systems engineering, design and operation of systems are two main problems which always attract researcher's attentions. The accomplishment of activities in these problems often requires proper decisions to be made so that the desired goal can be achieved, thus, decision making needs to be carefully fulfilled in the design and operation of systems. Design is a decision making process which permeates through out the design process, and is at the core of all design activities. In modern aircraft design, more and more attention is paid to the conceptual and preliminary design phases so as to increase the odds of choosing a design that will ultimately be successful at the completion of the design process, therefore, decisions made during these early design stages play a critical role in determining the success of a design. Since aerospace systems are complex systems with interacting disciplines and technologies, the Decision Makers (DMs) dealing with such design problems are involved in balancing the multiple, potentially conflicting attributes/criteria, transforming a large amount of customer supplied guidelines into a solidly defined set of requirement definitions. Thus, one could state with confidence that modern aerospace system design is a Multiple Criteria Decision Making (MCDM) process. A variety of existing decision making methods are available to deal with this type of decision problems. The selection of the most appropriate decision making method is of particular importance since inappropriate decision methods are likely causes of misleading engineering design decisions. With no sufficient knowledge about each of the methods, it is usually difficult for the DMs to find an appropriate analytical model capable of solving their problems. In addition, with the complexity of the decision problem and the demand for more capable methods increasing, new decision making methods are emerging with time. These various methods exacerbate the difficulty of the selection of an appropriate decision making method. Furthermore, some DMs may be exclusively using one or two specific methods which they are familiar with or trust and not realizing that they may be inappropriate to handle certain classes of the problems, thus yielding erroneous results. These issues reveal that in order to ensure a good decision a suitable decision method should be chosen before the decision making process proceeds. The first part of this dissertation proposes an MCDM process supported by an intelligent, knowledge-based advisor system referred to as Multi-Criteria Interactive Decision-Making Advisor and Synthesis process (MIDAS), which is able to facilitate the selection of the most appropriate decision making method and which provides insight to the user for fulfilling different preferences. The second part of this dissertation presents an autonomous decision making advisor which is capable of dealing with ever-evolving real time information and making autonomous decisions under uncertain conditions. The advisor encompasses a Markov Decision Process (MDP) formulation which takes uncertainty into account when determines the best action for each system state. (Abstract shortened by UMI.)

Testing a simple field method for assessing nitrate removal in riparian zones

Treesearch

Philippe Vidon; Michael G. Dosskey

2008-01-01

Being able to identify riparian sites that function better for nitrate removal from groundwater is critical to using efficiently the riparian zones for water quality management. For this purpose, managers need a method that is quick, inexpensive, and accurate enough to enable effective management decisions. This study assesses the precision and accuracy of a simple...

12 CFR Appendix B to Part 741 - Guidance for an Interest Rate Risk Policy and an Effective Program

Code of Federal Regulations, 2013 CFR

2013-01-01

... Measurement Methods C. Components of IRR Measurement Methods V. Internal Controls VI. Decision-Making Informed... effective IRR management program identifies, measures, monitors, and controls IRR and is central to safe and... critical to the control of IRR exposure. All FICUs required to have an IRR policy and program should...

12 CFR Appendix B to Part 741 - Guidance for an Interest Rate Risk Policy and an Effective Program

Code of Federal Regulations, 2014 CFR

2014-01-01

... Measurement Methods C. Components of IRR Measurement Methods V. Internal Controls VI. Decision-Making Informed... effective IRR management program identifies, measures, monitors, and controls IRR and is central to safe and... critical to the control of IRR exposure. All FICUs required to have an IRR policy and program should...

A Critical Analysis of the Body of Work Method for Setting Cut-Scores

ERIC Educational Resources Information Center

Radwan, Nizam; Rogers, W. Todd

2006-01-01

The recent increase in the use of constructed-response items in educational assessment and the dissatisfaction with the nature of the decision that the judges must make using traditional standard-setting methods created a need to develop new and effective standard-setting procedures for tests that include both multiple-choice and…

Technological Literacy for Students Aged 6-18: A New Method for Holistic Measuring of Knowledge, Capabilities, Critical Thinking and Decision-Making

ERIC Educational Resources Information Center

Avsec, Stanislav; Jamšek, Janez

2016-01-01

Technological literacy is identified as a vital achievement of technology- and engineering-intensive education. It guides the design of technology and technical components of educational systems and defines competitive employment in technological society. Existing methods for measuring technological literacy are incomplete or complicated,…

Web-Based Distance Learning: Substitute or Alternative to the Traditional Classroom--Making the Delivery Method Decision

ERIC Educational Resources Information Center

Hunt, David Marshall

2005-01-01

When a distance learning program administrator makes the critical choice of delivery methods, she/he needs to consider factors such as program developer centrism, international experience, cultural similarity, and desired level of control which will all be elaborated on in this article. The aim of this manuscript is to assist international…

Knowledge base and sensor bus messaging service architecture for critical tsunami warning and decision-support

NASA Astrophysics Data System (ADS)

Sabeur, Z. A.; Wächter, J.; Middleton, S. E.; Zlatev, Z.; Häner, R.; Hammitzsch, M.; Loewe, P.

2012-04-01

The intelligent management of large volumes of environmental monitoring data for early tsunami warning requires the deployment of robust and scalable service oriented infrastructure that is supported by an agile knowledge-base for critical decision-support In the TRIDEC project (TRIDEC 2010-2013), a sensor observation service bus of the TRIDEC system is being developed for the advancement of complex tsunami event processing and management. Further, a dedicated TRIDEC system knowledge-base is being implemented to enable on-demand access to semantically rich OGC SWE compliant hydrodynamic observations and operationally oriented meta-information to multiple subscribers. TRIDEC decision support requires a scalable and agile real-time processing architecture which enables fast response to evolving subscribers requirements as the tsunami crisis develops. This is also achieved with the support of intelligent processing services which specialise in multi-level fusion methods with relevance feedback and deep learning. The TRIDEC knowledge base development work coupled with that of the generic sensor bus platform shall be presented to demonstrate advanced decision-support with situation awareness in context of tsunami early warning and crisis management.

Graduate nurses: critical thinkers or better decision makers?

PubMed

Girot, E A

2000-02-01

This study evaluates the difference in development of critical thinking across four groups of nurses at different stages of the academic process and their perception of their decision-making ability in practice. With the move of nurse education into institutes of higher education nationally, there are no empirical data in the UK to suggest that graduates practice any differently from their non-graduate colleagues. An opportunistic sample of 82 nurses, was chosen from recent admission on a pre-registration degree programme, to mature graduates, as well as a group of experienced, non-graduate practitioners. A quasi-experimental, between-subjects design was used. A series of one-way ANOVAs was used to analyse the difference in critical thinking across all four groups, employing the Watson-Glaser Critical Thinking Appraisal. Additionally, the Jenkins Clinical Decision-Making in Nursing Scale was used to determine the differences in decision-making ability in practice across three of the groups with clinical experience. Furthermore, a correlation was undertaken to determine what relationship, if any, existed between critical thinking and decision-making in practice. It was found that there was no significant difference in the critical thinking skills across all groups studied, supporting the findings of other studies in the USA, which examined the cognitive skills of students undertaking graduate programmes. However, in their practice, it was found that those exposed to the academic process were significantly better at decision-making than their non-academic colleagues. Finally, no relationship could be found between the development of critical thinking and decision-making in practice, suggesting that more work needs to be done to look carefully at both critical thinking skills and decision-making in practice and the tools used to measure these.

How Critical Thinking Shapes the Military Decision Making Process

DTIC Science & Technology

2004-05-17

emotional rebuttal. Conversely, people cannot make good rational decisions without at least a twinge of emotion attached to the decision . 2) Our minds... decision they make . If emotions overwhelm reason, then decisions should be postponed.27 Service biases are one of the strongest emotional bias. Any...FINAL 3. DATES COVERED (From - To) 4. TITLE AND SUBTITLE How Critical Thinking Shapes the Military Decision Making Process 5a. CONTRACT

A Critical Analysis of HRD Evaluation Models from a Decision-Making Perspective

ERIC Educational Resources Information Center

Holton, Elwood F., III; Naquin, Sharon

2005-01-01

HRD evaluation models are recommended for use by organizations to improve decisions made about HRD interventions. However, the organizational decision-making literature has been virtually ignored by evaluation researchers. In this article, we review the organizational decision-making literature and critically review HRD evaluation research through…

[The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

PubMed

Su, Szu-Huei; Wu, Li-Min

2018-04-01

The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p < .01), and whether the patient had signed a currently valid advance healthcare directive (Eta = .223, p = .002). Furthermore, a significantly negative correlation was found between these intentions and length of stay in the ICU (r = -.263, p < .01). Patient age, whether the patient had signed a currently valid advance healthcare directive, and length of stay in the ICU were all predictive factors for the behavioral intentions underlying the medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

Classification and Progression Based on CFS-GA and C5.0 Boost Decision Tree of TCM Zheng in Chronic Hepatitis B.

PubMed

Chen, Xiao Yu; Ma, Li Zhuang; Chu, Na; Zhou, Min; Hu, Yiyang

2013-01-01

Chronic hepatitis B (CHB) is a serious public health problem, and Traditional Chinese Medicine (TCM) plays an important role in the control and treatment for CHB. In the treatment of TCM, zheng discrimination is the most important step. In this paper, an approach based on CFS-GA (Correlation based Feature Selection and Genetic Algorithm) and C5.0 boost decision tree is used for zheng classification and progression in the TCM treatment of CHB. The CFS-GA performs better than the typical method of CFS. By CFS-GA, the acquired attribute subset is classified by C5.0 boost decision tree for TCM zheng classification of CHB, and C5.0 decision tree outperforms two typical decision trees of NBTree and REPTree on CFS-GA, CFS, and nonselection in comparison. Based on the critical indicators from C5.0 decision tree, important lab indicators in zheng progression are obtained by the method of stepwise discriminant analysis for expressing TCM zhengs in CHB, and alterations of the important indicators are also analyzed in zheng progression. In conclusion, all the three decision trees perform better on CFS-GA than on CFS and nonselection, and C5.0 decision tree outperforms the two typical decision trees both on attribute selection and nonselection.

An Evaluation of Health Impact Assessments in the United States, 2011–2014

PubMed Central

Charbonneau, Diana; Cahill, Carol; Dannenberg, Andrew L.

2015-01-01

Introduction The Center for Community Health and Evaluation conducted a 3-year evaluation to assess results of health impact assessments (HIAs) in the United States and to identify elements critical for their success. Methods The study used a retrospective, mixed-methods comparative case study design, including a literature review; site visits; interviews with investigators, stakeholders, and decision makers for 23 HIAs in 16 states that were completed from 2005 through 2013; and a Web-based survey of 144 HIA practitioners. Results Analysis of interviews with decision makers suggests HIAs can directly influence decisions in nonhealth-related sectors. HIAs may also influence changes beyond the decision target, build consensus and relationships among decision makers and their constituents, and give community members a stronger voice in decisions that affect them. Factors that may increase HIA success include care in choosing a project or policy to be examined’ selecting an appropriate team to conduct the HIA; engaging stakeholders and decision makers throughout the process; crafting clear, actionable recommendations; delivering timely, compelling messages to appropriate audiences; and using multiple dissemination methods. Challenges to successful HIAs include underestimating the level of effort required, political changes during the conduct of the HIA, accessing relevant local data, engaging vulnerable populations, and following up on recommendations. Conclusion Results of this study suggest HIAs are a useful tool to promote public health because they can influence decisions in nonhealth-related sectors, strengthen cross-sector collaborations, and raise awareness of health issues among decision makers. PMID:25695261

Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review

NASA Astrophysics Data System (ADS)

Uhde, Britta; Andreas Hahn, W.; Griess, Verena C.; Knoke, Thomas

2015-08-01

Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

Hybrid MCDA Methods to Integrate Multiple Ecosystem Services in Forest Management Planning: A Critical Review.

PubMed

Uhde, Britta; Hahn, W Andreas; Griess, Verena C; Knoke, Thomas

2015-08-01

Multi-criteria decision analysis (MCDA) is a decision aid frequently used in the field of forest management planning. It includes the evaluation of multiple criteria such as the production of timber and non-timber forest products and tangible as well as intangible values of ecosystem services (ES). Hence, it is beneficial compared to those methods that take a purely financial perspective. Accordingly, MCDA methods are increasingly popular in the wide field of sustainability assessment. Hybrid approaches allow aggregating MCDA and, potentially, other decision-making techniques to make use of their individual benefits and leading to a more holistic view of the actual consequences that come with certain decisions. This review is providing a comprehensive overview of hybrid approaches that are used in forest management planning. Today, the scientific world is facing increasing challenges regarding the evaluation of ES and the trade-offs between them, for example between provisioning and regulating services. As the preferences of multiple stakeholders are essential to improve the decision process in multi-purpose forestry, participatory and hybrid approaches turn out to be of particular importance. Accordingly, hybrid methods show great potential for becoming most relevant in future decision making. Based on the review presented here, the development of models for the use in planning processes should focus on participatory modeling and the consideration of uncertainty regarding available information.

Interpreting support vector machine models for multivariate group wise analysis in neuroimaging

PubMed Central

Gaonkar, Bilwaj; Shinohara, Russell T; Davatzikos, Christos

2015-01-01

Machine learning based classification algorithms like support vector machines (SVMs) have shown great promise for turning a high dimensional neuroimaging data into clinically useful decision criteria. However, tracing imaging based patterns that contribute significantly to classifier decisions remains an open problem. This is an issue of critical importance in imaging studies seeking to determine which anatomical or physiological imaging features contribute to the classifier’s decision, thereby allowing users to critically evaluate the findings of such machine learning methods and to understand disease mechanisms. The majority of published work addresses the question of statistical inference for support vector classification using permutation tests based on SVM weight vectors. Such permutation testing ignores the SVM margin, which is critical in SVM theory. In this work we emphasize the use of a statistic that explicitly accounts for the SVM margin and show that the null distributions associated with this statistic are asymptotically normal. Further, our experiments show that this statistic is a lot less conservative as compared to weight based permutation tests and yet specific enough to tease out multivariate patterns in the data. Thus, we can better understand the multivariate patterns that the SVM uses for neuroimaging based classification. PMID:26210913

Screening for anthracnose disease resistance in strawberry using a detached leaf assay

USDA-ARS?s Scientific Manuscript database

Inoculation of detached strawberry leaves with Colletotrichum species may provide a rapid, non-destructive method of identifying anthracnose resistant germplasm. The reliability and validity of assessing disease severity is critical to disease management decisions. We inoculated detached strawberr...

A description of nurses' decision-making in managing electrocardiographic monitor alarms.

PubMed

Gazarian, Priscilla K; Carrier, Natalie; Cohen, Rachel; Schram, Haley; Shiromani, Samara

2015-01-01

To describe the cues and factors that nurses use in their decision-making when responding to clinical alarms. Alarms are designed to be very sensitive, and as a result, they are not very specific. Lack of adherence to the practice standards for electrocardiographic monitoring in hospital settings has been observed, resulting in overuse of the electrocardiographic monitoring. Monitoring without consideration of clinical indicators uses scarce healthcare resources and may even produce untoward circumstances because of alarm fatigue. With so many false alarms, alarm fatigue represents a symptom of a larger problem. It cannot be fixed until all of the factors that contribute to its existence have been examined. This was a qualitative descriptive study. This study was conducted at an academic medical centre located in the Northeast United States. Eight participants were enrolled using purposive sampling. Nurses were observed for two three-hour periods. Following each observation, the nurse was interviewed using the critical decision method to describe the cognitive processes related to the alarm activities. Qualitative data from the conducted interviews were analysed via an a priori framework founded in the critical decision method. This study reveals information, experience, guidance and decision-making as the four prominent categories contributing to nurses' decision-making in relation to alarm management. Managing technology was a category not identified a priori that emerged in the data analysis. Nurses revealed a breadth of information needed to adequately identify and interpret monitor alarms, and how they used that information to put the alarms into the particular context of an individual patient's situations. Understanding the cues and factors nurses use when responding to cardiac alarms will guide the development of learning experiences and inform policies to guide practice. © 2014 John Wiley & Sons Ltd.

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention

PubMed Central

Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-01-01

Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications. PMID:28895928

Collaborative Visual Analytics: A Health Analytics Approach to Injury Prevention.

PubMed

Al-Hajj, Samar; Fisher, Brian; Smith, Jennifer; Pike, Ian

2017-09-12

Background : Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods : Inspired by the Delphi method, we introduced a novel methodology-group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders' observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results : The GA methodology triggered the emergence of ' common g round ' among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders' verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusion s : Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ' common ground' among diverse stakeholders about health data and their implications.

Budget- and Priority-Setting Criteria at State Health Agencies in Times of Austerity: A Mixed-Methods Study

PubMed Central

Resnick, Beth; Kass, Nancy; Sellers, Katie; Young, Jessica; Bernet, Patrick; Jarris, Paul

2014-01-01

Objectives. We examined critical budget and priority criteria for state health agencies to identify likely decision-making factors, pressures, and opportunities in times of austerity. Methods. We have presented findings from a 2-stage, mixed-methods study with state public health leaders regarding public health budget- and priority-setting processes. In stage 1, we conducted hour-long interviews in 2011 with 45 health agency executive and division or bureau leaders from 6 states. Stage 2 was an online survey of 207 executive and division or bureau leaders from all state health agencies (66% response rate). Results. Respondents identified 5 key criteria: whether a program was viewed as “mission critical,” the seriousness of the consequences of not funding the program, financing considerations, external directives and mandates, and the magnitude of the problem the program addressed. Conclusions. We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications. PMID:24825212

The STRATEGY project: decision tools to aid sustainable restoration and long-term management of contaminated agricultural ecosystems.

PubMed

Howard, B J; Beresford, N A; Nisbet, A; Cox, G; Oughton, D H; Hunt, J; Alvarez, B; Andersson, K G; Liland, A; Voigt, G

2005-01-01

The STRATEGY project (Sustainable Restoration and Long-Term Management of Contaminated Rural, Urban and Industrial Ecosystems) aimed to provide a holistic decision framework for the selection of optimal restoration strategies for the long-term sustainable management of contaminated areas in Western Europe. A critical evaluation was carried out of countermeasures and waste disposal options, from which compendia of state-of-the-art restoration methods were compiled. A decision support system capable of optimising spatially varying restoration strategies, that considered the level of averted dose, costs (including those of waste disposal) and environmental side effects was developed. Appropriate methods of estimating indirect costs associated with side effects and of communicating with stakeholders were identified. The importance of stakeholder consultation at a local level and of ensuring that any response is site and scenario specific were emphasised. A value matrix approach was suggested as a method of addressing social and ethical issues within the decision-making process, and was designed to be compatible with both the countermeasure compendia and the decision support system. The applicability and usefulness of STRATEGY outputs for food production systems in the medium to long term is assessed.

Modeling Adversaries in Counterterrorism Decisions Using Prospect Theory.

PubMed

Merrick, Jason R W; Leclerc, Philip

2016-04-01

Counterterrorism decisions have been an intense area of research in recent years. Both decision analysis and game theory have been used to model such decisions, and more recently approaches have been developed that combine the techniques of the two disciplines. However, each of these approaches assumes that the attacker is maximizing its utility. Experimental research shows that human beings do not make decisions by maximizing expected utility without aid, but instead deviate in specific ways such as loss aversion or likelihood insensitivity. In this article, we modify existing methods for counterterrorism decisions. We keep expected utility as the defender's paradigm to seek for the rational decision, but we use prospect theory to solve for the attacker's decision to descriptively model the attacker's loss aversion and likelihood insensitivity. We study the effects of this approach in a critical decision, whether to screen containers entering the United States for radioactive materials. We find that the defender's optimal decision is sensitive to the attacker's levels of loss aversion and likelihood insensitivity, meaning that understanding such descriptive decision effects is important in making such decisions. © 2014 Society for Risk Analysis.

Decision making in critically ill patients with hematologic malignancy.

PubMed Central

Crawford, S. W.

1991-01-01

Hematologic neoplasms that were previously considered fatal are now potentially curable with techniques such as bone marrow transplantation. Such therapies also carry significant morbidity and mortality. With the increasing application of these therapies, a growing number of physicians are using medical decision making regarding critical care for these patients. The process by which ethical decisions are reached for these critically ill patients may be baffling because of several factors: rapidly evolving treatments, uncertain probabilities of the cure of the malignant disorder, the relatively young age of many of these patients, and the poor prognosis with critical illness. I discuss a process to reach acceptable decisions, providing a case example of the application of the process. This process is derived from the ethical principles that drive decision making in general medicine and attempts to maximize patients' autonomy. It involves a consideration of accurate information regarding the disease process and the prognosis, a clear delineation of the goals of the medical care, and communication with patients. Appropriate, ethical, and consistent decisions regarding the critical care of patients with hematologic malignancy can be reached when these considerations are addressed. PMID:1815387

Material selection and assembly method of battery pack for compact electric vehicle

NASA Astrophysics Data System (ADS)

Lewchalermwong, N.; Masomtob, M.; Lailuck, V.; Charoenphonphanich, C.

2018-01-01

Battery packs become the key component in electric vehicles (EVs). The main costs of which are battery cells and assembling processes. The battery cell is indeed priced from battery manufacturers while the assembling cost is dependent on battery pack designs. Battery pack designers need overall cost as cheap as possible, but it still requires high performance and more safety. Material selection and assembly method as well as component design are very important to determine the cost-effectiveness of battery modules and battery packs. Therefore, this work presents Decision Matrix, which can aid in the decision-making process of component materials and assembly methods for a battery module design and a battery pack design. The aim of this study is to take the advantage of incorporating Architecture Analysis method into decision matrix methods by capturing best practices for conducting design architecture analysis in full account of key design components critical to ensure efficient and effective development of the designs. The methodology also considers the impacts of choice-alternatives along multiple dimensions. Various alternatives for materials and assembly techniques of battery pack are evaluated, and some sample costs are presented. Due to many components in the battery pack, only seven components which are positive busbar and Z busbar are represented in this paper for using decision matrix methods.

Software for rapid prototyping in the pharmaceutical and biotechnology industries.

PubMed

Kappler, Michael A

2008-05-01

The automation of drug discovery methods continues to develop, especially techniques that process information, represent workflow and facilitate decision-making. The magnitude of data and the plethora of questions in pharmaceutical and biotechnology research give rise to the need for rapid prototyping software. This review describes the advantages and disadvantages of three solutions: Competitive Workflow, Taverna and Pipeline Pilot. Each of these systems processes large amounts of data, integrates diverse systems and assists novice programmers and human experts in critical decision-making steps.

Critical product features' identification using an opinion analyzer.

PubMed

Shamim, Azra; Balakrishnan, Vimala; Tahir, Muhammad; Shiraz, Muhammad

2014-01-01

The increasing use and ubiquity of the Internet facilitate dissemination of word-of-mouth through blogs, online forums, newsgroups, and consumer's reviews. Online consumer's reviews present tremendous opportunities and challenges for consumers and marketers. One of the challenges is to develop interactive marketing practices for making connections with target consumers that capitalize consumer-to-consumer communications for generating product adoption. Opinion mining is employed in marketing to help consumers and enterprises in the analysis of online consumers' reviews by highlighting the strengths and weaknesses of the products. This paper describes an opinion mining system based on novel review and feature ranking methods to empower consumers and enterprises for identifying critical product features from enormous consumers' reviews. Consumers and business analysts are the main target group for the proposed system who want to explore consumers' feedback for determining purchase decisions and enterprise strategies. We evaluate the proposed system on real dataset. Results show that integration of review and feature-ranking methods improves the decision making processes significantly.

Critical Product Features' Identification Using an Opinion Analyzer

PubMed Central

Shamim, Azra; Balakrishnan, Vimala

2014-01-01

The increasing use and ubiquity of the Internet facilitate dissemination of word-of-mouth through blogs, online forums, newsgroups, and consumer's reviews. Online consumer's reviews present tremendous opportunities and challenges for consumers and marketers. One of the challenges is to develop interactive marketing practices for making connections with target consumers that capitalize consumer-to-consumer communications for generating product adoption. Opinion mining is employed in marketing to help consumers and enterprises in the analysis of online consumers' reviews by highlighting the strengths and weaknesses of the products. This paper describes an opinion mining system based on novel review and feature ranking methods to empower consumers and enterprises for identifying critical product features from enormous consumers' reviews. Consumers and business analysts are the main target group for the proposed system who want to explore consumers' feedback for determining purchase decisions and enterprise strategies. We evaluate the proposed system on real dataset. Results show that integration of review and feature-ranking methods improves the decision making processes significantly. PMID:25506612

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study

PubMed Central

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-01-01

ABSTRACT Purpose: Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. Method: The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. Results: The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. Conclusion: The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures. PMID:29405889

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

PubMed

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

2008-12-01

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

Escalation research: Providing new frontiers for applying behavior analysis to organizational behavior

PubMed Central

Goltz, Sonia M.

2000-01-01

Decision fiascoes such as escalation of commitment, the tendency of decision makers to “throw good money after bad,” can have serious consequences for organizations and are therefore of great interest in applied research. This paper discusses the use of behavior analysis in organizational behavior research on escalation. Among the most significant aspects of behavior-analytic research on escalation is that it has indicated that both the patterns of outcomes that decision makers have experienced for past decisions and the patterns of responses that they make are critical for understanding escalation. This research has also stimulated the refinement of methods by researchers to better assess decision making and the role reinforcement plays in it. Finally, behavior-analytic escalation research has not only indicated the utility of reinforcement principles for predicting more complex human behavior but has also suggested some additional areas for future exploration of decision making using behavior analysis. PMID:22478347

C-621/15 - W and Others v Sanofi Pasteur: An Example of Judicial Distortion and Indifference to Science.

PubMed

Smillie, Laura R; Eccleston-Turner, Mark R; Cooper, Sarah L

2018-02-01

This case commentary examines the CJEU's recent decision in C-621/15 W and Others v Sanofi Pasteur MSD SNC [2017] ECR I. This commentary critically examines the decision through the lens of the cultural conflict between law and science. We argue that the CJEU's decision reflects both a distortion of scientific knowledge and an improper indifference to the legitimate methods by which scientific knowledge is generated in the context of vaccines. These judicial approaches may, the authors argue, inadvertently fuel the vaccine scepticism that is growing across the developed world, and in particular in Europe.

[Clinical decision making and critical thinking in the nursing diagnostic process].

PubMed

Müller-Staub, Maria

2006-10-01

The daily routine requires complex thinking processes of nurses, but clinical decision making and critical thinking are underestimated in nursing. A great demand for educational measures in clinical judgement related with the diagnostic process was found in nurses. The German literature hardly describes nursing diagnoses as clinical judgements about human reactions on health problems / life processes. Critical thinking is described as an intellectual, disciplined process of active conceptualisation, application and synthesis of information. It is gained through observation, experience, reflection and communication and leads thinking and action. Critical thinking influences the aspects of clinical decision making a) diagnostic judgement, b) therapeutic reasoning and c) ethical decision making. Human reactions are complex processes and in their course, human behavior is interpreted in the focus of health. Therefore, more attention should be given to the nursing diagnostic process. This article presents the theoretical framework of the paper "Clinical decision making: Fostering critical thinking in the nursing diagnostic process through case studies".

Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy.

PubMed

Blumenthal-Barby, J S; Krieger, Heather

2015-05-01

The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients. © The Author(s) 2014.

Using cognitive task analysis to identify critical decisions in the laparoscopic environment.

PubMed

Craig, Curtis; Klein, Martina I; Griswold, John; Gaitonde, Krishnanath; McGill, Thomas; Halldorsson, Ari

2012-12-01

The aim of this study was to identify the critical decisions surgeons need to make regarding laparoscopic surgery, the information these decisions are based on, the strategies employed by surgeons to reach their objectives, and the difficulties experienced by novices. Laparoscopic training focuses on the development of technical skills. However, successful surgical outcomes are also dependent on appropriate decisions made during surgery, which are influenced by critical cues and the use of appropriate strategies. Novices might not be as adept at cue detection and strategy use. Participants were eight attending surgeons. The authors employed task-analytic techniques to identify critical decisions inherent in laparoscopy and the cues, strategies, and novice traps associated with these decisions. The authors used decision requirements tables to organize the data into the key decisions made during the preoperative, operative, and postoperative phases as well as the cues, strategies, and novice traps associated with these decisions. Key decisions identified for the preoperative phase included but were not limited to the decision of performing a laparoscopic versus open surgery, necessity to review the literature, practicing the procedure, and trocar placement. Some key decisions identified for the operative phase included converting to open surgery, performing angiograms, cutting tissue or organs, and reevaluation of the approach. Only one key decision was identified for the postoperative phrase: whether the surgeon's technique needs to be evaluated and revised. The laparoscopic environment requires complex decision making, and novices are prone to errors in their decisions. The information elicited in this study is applicable to laparoscopic training.

Health economics, equity, and efficiency: are we almost there?

PubMed

Ferraz, Marcos Bosi

2015-01-01

Health care is a highly complex, dynamic, and creative sector of the economy. While health economics has to continue its efforts to improve its methods and tools to better inform decisions, the application needs to be aligned with the insights and models of other social sciences disciplines. Decisions may be guided by four concept models based on ethical and distributive justice: libertarian, communitarian, egalitarian, and utilitarian. The societal agreement on one model or a defined mix of models is critical to avoid inequity and unfair decisions in a public and/or private insurance-based health care system. The excess use of methods and tools without fully defining the basic goals and philosophical principles of the health care system and without evaluating the fitness of these measures to reaching these goals may not contribute to an efficient improvement of population health.

Health economics, equity, and efficiency: are we almost there?

PubMed Central

Ferraz, Marcos Bosi

2015-01-01

Health care is a highly complex, dynamic, and creative sector of the economy. While health economics has to continue its efforts to improve its methods and tools to better inform decisions, the application needs to be aligned with the insights and models of other social sciences disciplines. Decisions may be guided by four concept models based on ethical and distributive justice: libertarian, communitarian, egalitarian, and utilitarian. The societal agreement on one model or a defined mix of models is critical to avoid inequity and unfair decisions in a public and/or private insurance-based health care system. The excess use of methods and tools without fully defining the basic goals and philosophical principles of the health care system and without evaluating the fitness of these measures to reaching these goals may not contribute to an efficient improvement of population health. PMID:25709481

Research on Application of FMECA in Missile Equipment Maintenance Decision

NASA Astrophysics Data System (ADS)

Kun, Wang

2018-03-01

Fault mode effects and criticality analysis (FMECA) is a method widely used in engineering. Studying the application of FMEA technology in military equipment maintenance decision-making, can help us build a better equipment maintenance support system, and increase the using efficiency of weapons and equipment. Through Failure Modes, Effects and Criticality Analysis (FMECA) of equipment, known and potential failure modes and their causes are found out, and the influence on the equipment performance, operation success, personnel security are determined. Furthermore, according to the synthetical effects of the severity of effects and the failure probability, possible measures for prevention and correction are put forward. Through replacing or adjusting the corresponding parts, corresponding maintenance strategy is decided for preventive maintenance of equipment, which helps improve the equipment reliability.

Vulnerability analysis and critical areas identification of the power systems under terrorist attacks

NASA Astrophysics Data System (ADS)

Wang, Shuliang; Zhang, Jianhua; Zhao, Mingwei; Min, Xu

2017-05-01

This paper takes central China power grid (CCPG) as an example, and analyzes the vulnerability of the power systems under terrorist attacks. To simulate the intelligence of terrorist attacks, a method of critical attack area identification according to community structures is introduced. Meanwhile, three types of vulnerability models and the corresponding vulnerability metrics are given for comparative analysis. On this basis, influence of terrorist attacks on different critical areas is studied. Identifying the vulnerability of different critical areas will be conducted. At the same time, vulnerabilities of critical areas under different tolerance parameters and different vulnerability models are acquired and compared. Results show that only a few number of vertex disruptions may cause some critical areas collapse completely, they can generate great performance losses the whole systems. Further more, the variation of vulnerability values under different scenarios is very large. Critical areas which can cause greater damage under terrorist attacks should be given priority of protection to reduce vulnerability. The proposed method can be applied to analyze the vulnerability of other infrastructure systems, they can help decision makers search mitigation action and optimum protection strategy.

Development and Evaluation of Assessments for Counseling Professionals

ERIC Educational Resources Information Center

Lenz, A. Stephen; Wester, Kelly L.

2017-01-01

It is imperative that counselors understand how to critically evaluate assessments before using them to make clinical decisions. This evaluation can be conducted through integrating the 5 sources of validity. Each source of validity is discussed, along with methods to appraise psychometric quality, throughout this special issue.

Networked Resources, Assessment and Collection Development

ERIC Educational Resources Information Center

Samson, Sue; Derry, Sebastian; Eggleston, Holly

2004-01-01

This project provides a critical evaluation of networked resources as they relate to the library's collection development policy, identifies areas of the curriculum not well represented, establishes a reliable method of assessing usage across all resources, and develops a framework of quantitative data for collection development decision making.

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

Shared decision making in designing new healthcare environments-time to begin improving quality.

PubMed

Elf, Marie; Fröst, Peter; Lindahl, Göran; Wijk, Helle

2015-03-21

Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users' perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

PubMed Central

Hitchcock, Elaine R.; Ferron, John

2017-01-01

Purpose Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. Method This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Conclusions Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders. PMID:28595354

Interpreting “statistical hypothesis testing” results in clinical research

PubMed Central

Sarmukaddam, Sanjeev B.

2012-01-01

Difference between “Clinical Significance and Statistical Significance” should be kept in mind while interpreting “statistical hypothesis testing” results in clinical research. This fact is already known to many but again pointed out here as philosophy of “statistical hypothesis testing” is sometimes unnecessarily criticized mainly due to failure in considering such distinction. Randomized controlled trials are also wrongly criticized similarly. Some scientific method may not be applicable in some peculiar/particular situation does not mean that the method is useless. Also remember that “statistical hypothesis testing” is not for decision making and the field of “decision analysis” is very much an integral part of science of statistics. It is not correct to say that “confidence intervals have nothing to do with confidence” unless one understands meaning of the word “confidence” as used in context of confidence interval. Interpretation of the results of every study should always consider all possible alternative explanations like chance, bias, and confounding. Statistical tests in inferential statistics are, in general, designed to answer the question “How likely is the difference found in random sample(s) is due to chance” and therefore limitation of relying only on statistical significance in making clinical decisions should be avoided. PMID:22707861

[Decisions on limiting treatment in critically-ill neonates: a multicenter study].

PubMed

2002-12-01

Backgrounds Some patients with a poor prognosis cause serious doubts about the real benefit of life-sustaining treatment. In some cases the possibility of limiting those treatments is raised. Such end-of-life decisions provoke ethical dilemmas and questions about procedure.ObjectivesTwo determine the frequency of end-of-life decisions in neonates, patient characteristics, and the criteria used by those taking decisions.Patients and methodsWe performed a multicenter, descriptive, prospective study. Neonates from 15 neonatal intensive care units who died during their stay in the hospital between 1999 and 2000, as well as those in whom end-of-life decisions were taken, were included. End-of-life decisions were defined as clinical decisions to withhold or withdraw life-sustaining treatment.ResultsA total of 330 patients were included. End-of-life decisions were taken in 171 (52 %); of these, 169 (98.8 %) died. The remaining 159 patients (48.2 %) died without treatment limitation. The main disorders involving end-of-life decisions were congenital malformation (47 %), neurologic disorders secondary to perinatal asphyxia and intracranial hemorrhage-periventricular leukomalacia (37 %). Of the 171 neonates, treatment was withheld in 80 and vital support was withdrawn in 91. The most frequently withdrawn life-sustaining treatment was mechanical ventilation (68 %). The criteria most commonly used in end-of-life decisions were poor vital prognosis (79.5 %), and current and future quality of life (37 % and 48 % respectively). The patient's external factors such as unfavorable family environment or possible negative consequences for familial equilibrium were a factor in 5 % of decisions.ConclusionsThe present study, the first of this type performed in Spain, reveals little-known aspects about the clinical practice of withholding and/or withdrawing life-sustaining treatment in critically ill neonates. End-of-life decisions were frequent (52 %) and were followed by death in most of the patients (98,8 %). The main criteria in decision-making were poor vital prognosis and the patient's current and future quality of life.

Clinical decision-making of rural novice nurses.

PubMed

Seright, T J

2011-01-01

Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in their careers. These novice nurses were often working with a limited staff, while managing an ever-changing census and acuity of patients. The significance of interdependence and welcoming relationships with their co-workers and directors of nursing was pivotal in the clinical decision-making process. Despite access to a number of resources at their disposal (including policy books, decision trees, standing orders, textbooks, and in some cases internet resources), the 12 nurses in this study indicated collaboration with co-workers was a major means of facilitating their decision-making. Rural novice nurses require facilitation of social skills as much as critical thinking skills both within their programs of nursing and during their new employee orientation; however, decision-making must be guided by more experienced nurses who are willing to mentor novice nurses and advise them to to reflect upon their decisions as they care for patients using evidenced based practice. In a rural setting, this is especially important because novice nurses are tasked early in their career with decision-making, which often involves ill-structured problems set in dynamic and changing environments, in high-stakes situations where patient safety is a concern.

Nursing care plans versus concept maps in the enhancement of critical thinking skills in nursing students enrolled in a baccalaureate nursing program.

PubMed

Sinatra-Wilhelm, Tina

2012-01-01

Appropriate and effective critical thinking and problem solving is necessary for all nurses in order to make complex decisions that improve patient outcomes, safety, and quality of nursing care. With the current emphasis on quality improvement, critical thinking ability is a noteworthy concern within the nursing profession. An in-depth review of literature related to critical thinking was performed. The use of nursing care plans and concept mapping to improve critical thinking skills was among the recommendations identified. This study compares the use of nursing care plans and concept mapping as a teaching strategy for the enhancement of critical thinking skills in baccalaureate level nursing students. The California Critical Thinking Skills Test was used as a method of comparison and evaluation. Results indicate that concept mapping enhances critical thinking skills in baccalaureate nursing students.

The development of control and monitoring system on marine current renewable energy Case study: strait of Toyapakeh - Nusa Penida, Bali

NASA Astrophysics Data System (ADS)

Arief, I. S.; Suherman, I. H.; Wardani, A. Y.; Baidowi, A.

2017-05-01

Control and monitoring system is a continuous process of securing the asset in the Marine Current Renewable Energy. A control and monitoring system is existed each critical components which is embedded in Failure Mode Effect Analysis (FMEA) method. As the result, the process in this paper developed through a matrix sensor. The matrix correlated to critical components and monitoring system which supported by sensors to conduct decision-making.

A Three-Question Framework to Facilitate Clinical Decision Making

ERIC Educational Resources Information Center

Sibold, Jeremy

2012-01-01

Context: Highly developed critical thinking and the ability to discriminate among many possible therapeutic interventions is a core behavior for the practicing athletic trainer. However, while athletic training students receive a great deal of clinically applicable information, many are not explicitly trained in efficient methods for channeling…

Monitoring changes in exotic vegetation

Treesearch

Robert D. Sutter

1998-01-01

Ecological monitoring provides critical information for management decisions by measuring changes in managed and unmanaged populations, communities and ecological systems. It integrates ecology, goal and objective setting, sampling design, sampling methods, and statistical analysis. It is a topic that I, with a team of Nature Conservancy ecologists, teach in a six day...

Mission and Methods of Democratizing the Classroom.

ERIC Educational Resources Information Center

Slaton, Christa Daryl

1993-01-01

Too many college students seem conditioned (by authoritarian teaching styles) to serve as "clerks" to the decision makers and power holders. To help students learn to think critically and independently, this article advises faculty to create practica based on televotes and mediation training, creative projects (such as monopoly games and…

Critical thinking in clinical nurse education: application of Paul's model of critical thinking.

PubMed

Andrea Sullivan, E

2012-11-01

Nurse educators recognize that many nursing students have difficulty in making decisions in clinical practice. The ability to make effective, informed decisions in clinical practice requires that nursing students know and apply the processes of critical thinking. Critical thinking is a skill that develops over time and requires the conscious application of this process. There are a number of models in the nursing literature to assist students in the critical thinking process; however, these models tend to focus solely on decision making in hospital settings and are often complex to actualize. In this paper, Paul's Model of Critical Thinking is examined for its application to nursing education. I will demonstrate how the model can be used by clinical nurse educators to assist students to develop critical thinking skills in all health care settings in a way that makes critical thinking skills accessible to students. Copyright © 2012 Elsevier Ltd. All rights reserved.

Assessment of Teaching Methods and Critical Thinking in a Course for Science Majors

NASA Astrophysics Data System (ADS)

Speck, Angela; Ruzhitskaya, L.; Whittington, A. G.

2014-01-01

Ability to think critically is a key ingredient to the scientific mindset. Students who take science courses may or may not be predisposed to critical thinking - the ability to evaluate information analytically. Regardless of their initial stages, students can significantly improve their critical thinking through learning and practicing their reasoning skills, critical assessments, conducting and reflecting on observations and experiments, building their questioning and communication skills, and through the use of other techniques. While, there are several of teaching methods that may help to improve critical thinking, there are only a few assessment instruments that can help in evaluating the efficacy of these methods. Critical thinking skills and improvement in those skills are notoriously difficult to measure. Assessments that are based on multiple-choice questions demonstrate students’ final decisions but not their thinking processes. In addition, during the course of studies students may develop subject-based critical thinking while not being able to extend the skills to the general critical thinking. As such, we wanted to design and conduct a study on efficacy of several teaching methods in which we would learn how students’ improve their thinking processes within a science discipline as well as in everyday life situations. We conducted a study among 20 astronomy, physics and geology majors-- both graduate and undergraduate students-- enrolled in our Solar System Science course (mostly seniors and early graduate students) at the University of Missouri. We used the Ennis-Weir Critical Thinking Essay test to assess students’ general critical thinking and, in addition, we implemented our own subject-based critical thinking assessment. Here, we present the results of this study and share our experience on designing a subject-based critical thinking assessment instrument.

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).

Shared Decision Making in ICUs: An American College of Critical Care Medicine and American Thoracic Society Policy Statement.

PubMed

Kon, Alexander A; Davidson, Judy E; Morrison, Wynne; Danis, Marion; White, Douglas B

2016-01-01

Shared decision making is endorsed by critical care organizations; however, there remains confusion about what shared decision making is, when it should be used, and approaches to promote partnerships in treatment decisions. The purpose of this statement is to define shared decision making, recommend when shared decision making should be used, identify the range of ethically acceptable decision-making models, and present important communication skills. The American College of Critical Care Medicine and American Thoracic Society Ethics Committees reviewed empirical research and normative analyses published in peer-reviewed journals to generate recommendations. Recommendations approved by consensus of the full Ethics Committees of American College of Critical Care Medicine and American Thoracic Society were included in the statement. Six recommendations were endorsed: 1) DEFINITION: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make healthcare decisions together, taking into account the best scientific evidence available, as well as the patient's values, goals, and preferences. 2) Clinicians should engage in a shared decision making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences. 3) Clinicians should use as their "default" approach a shared decision making process that includes three main elements: information exchange, deliberation, and making a treatment decision. 4) A wide range of decision-making approaches are ethically supportable, including patient- or surrogate-directed and clinician-directed models. Clinicians should tailor the decision-making process based on the preferences of the patient or surrogate. 5) Clinicians should be trained in communication skills. 6) Research is needed to evaluate decision-making strategies. Patient and surrogate preferences for decision-making roles regarding value-laden choices range from preferring to exercise significant authority to ceding such authority to providers. Clinicians should adapt the decision-making model to the needs and preferences of the patient or surrogate.

Improving supplementary feeding in species conservation.

PubMed

Ewen, John G; Walker, Leila; Canessa, Stefano; Groombridge, Jim J

2015-04-01

Supplementary feeding is often a knee-jerk reaction to population declines, and its application is not critically evaluated, leading to polarized views among managers on its usefulness. Here, we advocate a more strategic approach to supplementary feeding so that the choice to use it is clearly justified over, or in combination with, other management actions and the predicted consequences are then critically assessed following implementation. We propose combining methods from a set of specialist disciplines that will allow critical evaluation of the need, benefit, and risks of food supplementation. Through the use of nutritional ecology, population ecology, and structured decision making, conservation managers can make better choices about what and how to feed by estimating consequences on population recovery across a range of possible actions. This structured approach also informs targeted monitoring and more clearly allows supplementary feeding to be integrated in recovery plans and reduces the risk of inefficient decisions. In New Zealand, managers of the endangered Hihi (Notiomystis cincta) often rely on supplementary feeding to support reintroduced populations. On Kapiti island the reintroduced Hihi population has responded well to food supplementation, but the logistics of providing an increasing demand recently outstretched management capacity. To decide whether and how the feeding regime should be revised, managers used a structured decision making approach informed by population responses to alternative feeding regimes. The decision was made to reduce the spatial distribution of feeders and invest saved time in increasing volume of food delivered into a smaller core area. The approach used allowed a transparent and defendable management decision in regard to supplementary feeding, reflecting the multiple objectives of managers and their priorities. © 2014 The Authors. Conservation Biology published by Wiley Periodicals, Inc., on behalf of Society for Conservation Biology.

Reconciling patient and provider priorities for improving the care of critically ill patients: A consensus method and qualitative analysis of decision making.

PubMed

McKenzie, Emily; Potestio, Melissa L; Boyd, Jamie M; Niven, Daniel J; Brundin-Mather, Rebecca; Bagshaw, Sean M; Stelfox, Henry T

2017-12-01

Providers have traditionally established priorities for quality improvement; however, patients and their family members have recently become involved in priority setting. Little is known about how to reconcile priorities of different stakeholder groups into a single prioritized list that is actionable for organizations. To describe the decision-making process for establishing consensus used by a diverse panel of stakeholders to reconcile two sets of quality improvement priorities (provider/decision maker priorities n=9; patient/family priorities n=19) into a single prioritized list. We employed a modified Delphi process with a diverse group of panellists to reconcile priorities for improving care of critically ill patients in the intensive care unit (ICU). Proceedings were audio-recorded, transcribed and analysed using qualitative content analysis to explore the decision-making process for establishing consensus. Nine panellists including three providers, three decision makers and three family members of previously critically ill patients. Panellists rated and revised 28 priorities over three rounds of review and reached consensus on the "Top 5" priorities for quality improvement: transition of patient care from ICU to hospital ward; family presence and effective communication; delirium screening and management; early mobilization; and transition of patient care between ICU providers. Four themes were identified as important for establishing consensus: storytelling (sharing personal experiences), amalgamating priorities (negotiating priority scope), considering evaluation criteria and having a priority champion. Our study demonstrates the feasibility of incorporating families of patients into a multistakeholder prioritization exercise. The approach described can be used to guide consensus building and reconcile priorities of diverse stakeholder groups. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning.

PubMed

Williams, Charlene R; McLaughlin, Jacqueline E; Cox, Wendy C; Shepherd, Greene

2016-09-25

Objective. To determine if student pharmacists' preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs. Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores. Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades. Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection.

Relationship between Student Pharmacist Decision Making Preferences and Experiential Learning

PubMed Central

McLaughlin, Jacqueline E.; Cox, Wendy C.; Shepherd, Greene

2016-01-01

Objective. To determine if student pharmacists’ preferences towards experiential and rational thinking are associated with performance on advanced pharmacy practice experiences (APPEs) and whether thinking style preference changes following APPEs. Methods. The Rational Experiential Inventory (REI), a validated survey of thinking style, was administered to student pharmacists before starting APPEs and re-administered after completing APPEs. APPE grades were compared to initial REI scores. Results. Rational Experiential Inventory scores remained consistent before and after APPEs. Overall, APPE grades were independent of REI scores. In a regression model, the REI experiential score was a significant negative predictor of hospital APPE grades. Conclusion. These findings suggest that overall APPE performance is independent of decision-making preference, and decision-making style does not change following immersion into APPEs. Instead of targeting teaching strategies towards a specific decision-making style, preceptors may use pedagogical approaches that promote sound clinical decision-making skills through critical thinking and reflection. PMID:27756927

Critical Thinking as a Leadership Attribute.

PubMed

Werner, Stacy H; Bleich, Michael R

2017-01-01

Leaders are tasked with making decisions that have substantial impact on an organization's well-being. Decision making requires critical thinking and requisite action taking. The nature of critical thinking and how professional development educators can strengthen this attribute are presented. J Contin Educ Nurs. 2017;48(1):9-11. Copyright 2017, SLACK Incorporated.

Challenges of postgraduate critical care nursing program in Iran.

PubMed

Dehghan Nayeri, Nahid; Shariat, Esmaeil; Tayebi, Zahra; Ghorbanzadeh, Majid

2017-01-01

Background: The main philosophy of postgraduate preparation for working in critical care units is to ensure the safety and quality of patients' care. Increasing the complexity of technology, decision-making challenges and the high demand for advanced communication skills necessitate the need to educate learners. Within this aim, a master's degree in critical care nursing has been established in Iran. Current study was designed to collect critical care nursing students' experiences as well as their feedback to the field critical care nursing. Methods: This study used qualitative content analysis through in-depth semi-structured interviews. Graneheim and Lundman method was used for data analysis. Results: The results of the total 15 interviews were classified in the following domains: The vision of hope and illusion; shades of grey attitude; inefficient program and planning; inadequacy to run the program; and multiple outcomes: Far from the effectiveness. Overall findings indicated the necessity to review the curriculum and the way the program is implemented. Conclusion: The findings of this study provided valuable information to improve the critical care-nursing program. It also facilitated the next review of the program by the authorities.

Analysis of Critical Thinking Skills on The Topic of Static Fluid

NASA Astrophysics Data System (ADS)

Puspita, I.; Kaniawati, I.; Suwarma, I. R.

2017-09-01

This study aimed to know the critical thinking skills profil of senior high school students. This research using a descriptive study to analysis student test results of critical thinking skill of 40 students XI grade in one of the senior high school in Bogor District. The method used is survey research with sample determined by purposive sampling technique. The instrument used is test of critical thinking skill by 5 indicators on static fluid topics. Questions consist of 11 set. It is has been developed by researcher and validated by experts. The results showed students critical thinking skills are still low. Is almost every indicator of critical thinking skills only reaches less than 30%. 28% for elementary clarification, 10% for the basic for decisions/basic support, 6% for inference, 6% for advanced clarification, 4% for strategies and tactics.

Respiratory therapists and critical-thinking behaviors: a self-assessment.

PubMed

Goodfellow, L T

2001-01-01

The purpose of this study was to assess critical-thinking behaviors of respiratory therapists through self-report. Using a quantitative survey research method, respiratory therapists rated themselves on seven critical thinking skills. The effects of personal variables on the self-assessments were also investigated. The respiratory therapists self-assessed their critical-thinking behaviors highest in the categories of prioritizing, troubleshooting, and communicating. Anticipating was self-assessed as the lowest-ranked critical-thinking behavior. Age and educational level were found to have no effect on the self-assessed behaviors, while years of experience in respiratory care and gender were found to affect self-assessed troubleshooting, decision making, and anticipating. The results of this study suggest that educators and clinicians should consider learning strategies that incorporate the use of experience when targeting novice practitioners.

Risk factors for invasive fungal disease in critically ill adult patients: a systematic review

PubMed Central

2011-01-01

Introduction Over 5,000 cases of invasive Candida species infections occur in the United Kingdom each year, and around 40% of these cases occur in critical care units. Invasive fungal disease (IFD) in critically ill patients is associated with increased morbidity and mortality at a cost to both the individual and the National Health Service. In this paper, we report the results of a systematic review performed to identify and summarise the important risk factors derived from published multivariable analyses, risk prediction models and clinical decision rules for IFD in critically ill adult patients to inform the primary data collection for the Fungal Infection Risk Evaluation Study. Methods An internet search was performed to identify articles which investigated risk factors, risk prediction models or clinical decisions rules for IFD in critically ill adult patients. Eligible articles were identified in a staged process and were assessed by two investigators independently. The methodological quality of the reporting of the eligible articles was assessed using a set of questions addressing both general and statistical methodologies. Results Thirteen articles met the inclusion criteria, of which eight articles examined risk factors, four developed a risk prediction model or clinical decision rule and one evaluated a clinical decision rule. Studies varied in terms of objectives, risk factors, definitions and outcomes. The following risk factors were found in multiple studies to be significantly associated with IFD: surgery, total parenteral nutrition, fungal colonisation, renal replacement therapy, infection and/or sepsis, mechanical ventilation, diabetes, and Acute Physiology and Chronic Health Evaluation II (APACHE II) or APACHE III score. Several other risk factors were also found to be statistically significant in single studies only. Risk factor selection process and modelling strategy also varied across studies, and sample sizes were inadequate for obtaining reliable estimates. Conclusions This review shows a number of risk factors to be significantly associated with the development of IFD in critically ill adults. Methodological limitations were identified in the design and conduct of studies in this area, and caution should be used in their interpretation. PMID:22126425

Introduction to positivism, interpretivism and critical theory.

PubMed

Ryan, Gemma

2018-03-16

There are three commonly known philosophical research paradigms used to guide research methods and analysis: positivism, interpretivism and critical theory. Being able to justify the decision to adopt or reject a philosophy should be part of the basis of research. It is therefore important to understand these paradigms, their origins and principles, and to decide which is appropriate for a study and inform its design, methodology and analysis. To help those new to research philosophy by explaining positivism, interpretivism and critical theory. Positivism resulted from foundationalism and empiricism; positivists value objectivity and proving or disproving hypotheses. Interpretivism is in direct opposition to positivism; it originated from principles developed by Kant and values subjectivity. Critical theory originated in the Frankfurt School and considers the wider oppressive nature of politics or societal influences, and often includes feminist research. This paper introduces the historical context of three well-referenced research philosophies and explains the common principles and values of each. The paper enables nurse researchers to make informed and rational decisions when embarking on research. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

The factors facilitating and inhibiting effective clinical decision-making in nursing: a qualitative study

PubMed Central

Hagbaghery, Mohsen Adib; Salsali, Mahvash; Ahmadi, Fazlolah

2004-01-01

Background Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied. Methods Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data. Results Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making. Conclusion As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making. PMID:15068484

Managing stress in a crisis.

PubMed

Wright-Reid, Alison

2018-01-01

Crisis situations are inherently uncertain and threatening. Although the primal stress reactions they provoke deliver some advantages, they so severely restrict intellect and behaviour that consultants observe crisis teams making the same mistakes over and again. Stress risks can be managed before, during and after a crisis. Crisis planning can select the right people, control the crisis team environment, and mitigate fatigue risks and memory demands. Because stress reactions are primitive, stress can be manipulated at a remarkably primitive level and teams can increase their resilience through such basics as sleep and breathing skills. Teams can learn to manipulate perceptions of danger, to tolerate uncertainty and to become comfortable making decisions which were reasonable at the time. Crisis leaders can frame the crisis as a challenge and options as gains, and can ensure the team avoids groupthink and challenges the paradigm. Where individuals are trained to apply critical thinking processes, intuitive decision-making is not only fast, but also accurate, and helps to challenge assumptions, predictions and groupthink. Crises are more easily recognised and managed where training has covered critical decision methods.

How can surgeons facilitate resident intraoperative decision-making?

PubMed

Hill, Katherine A; Dasari, Mohini; Littleton, Eliza B; Hamad, Giselle G

2017-10-01

Cognitive skills such as decision-making are critical to developing operative autonomy. We explored resident decision-making using a recollection of specific examples, from the attending surgeon and resident, after laparoscopic cholecystectomy. In a separate semi-structured interview, the attending and resident both answered five questions, regarding the resident's operative roles and decisions, ways the attending helped, times when the attending operated, and the effect of the relationship between attending and resident. Themes were extracted using inductive methods. Thirty interviews were completed after 15 cases. Facilitators of decision-making included dialogue, safe struggle, and appreciation for retraction. Aberrant case characteristics, anatomic uncertainties, and time pressures provided barriers. Attending-resident mismatches included descriptions of transitioning control to the attending. Reciprocal dialogue, including concept-driven feedback, is helpful during intraoperative teaching. Unanticipated findings impede resident decision-making, and we describe differences in understanding transfers of operative control. Given these factors, we suggest that pre-operative discussions may be beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Bernard, Michael Lewis; Smith, Bruce W., 1959-

Understanding the role of emotional states is critical for predicting the kind of decisions people will make in risky situations. Currently, there is little understanding as to how emotion influences decision-making in situations such as terrorist attacks, natural disasters, pandemics, and combat. To help address this, we used behavioral and neuroimaging methods to examine how emotion states and traits influence decisions. Specifically, this study used a wheel of fortune behavioral task and functional magnetic resonance imaging (fMRI) to examine the effects of emotional states and traits on decision-making pertaining to the degree of risk people are willing to make inmore » specific situations. The behavioral results are reported here. The neural data requires additional time to analyze and will be reported at a future date. Biases caused by emotion states and traits were found regarding the likelihood of making risky decisions. The behavioral results will help provide a solid empirical foundation for modeling the effects of emotion on decision in risky situations.« less

Mission, Margin, and the Role of Consumer Governance in Decision-Making at Community Health Centers

PubMed Central

Wright, Brad; Martin, Graham P.

2017-01-01

Objective We explore the role of consumer trustees in decision-making as community health centers (CHCs) work to navigate the tension between pursuing their mission to provide primary care to all regardless of ability to pay and maintaining their limited finances. Methods We interviewed 30 trustees from 16 CHCs in 14 different states, asking extensively about decision-making processes at their CHC related to services and finances, as well as perceived advantages and disadvantages of consumer governance. Results Respondents described mission-dominant, margin-dominant, and balanced decision-making philosophies, and different decision-making pathways for service provision and finances. Consumer trustees were lauded for their role in informing the board of service quality and community needs, but criticized for being professionally unskilled and exhibiting a lack of objective decision-making. Conclusions While CHC boards do play a role in navigating the tension between mission and margin, executive directors and staff appear to be more influential. PMID:24858895

Understanding Decision Making in Critical Care

PubMed Central

Lighthall, Geoffrey K.; Vazquez-Guillamet, Cristina

2015-01-01

Background Human decision making involves the deliberate formulation of hypotheses and plans as well as the use of subconscious means of judging probability, likely outcome, and proper action. Rationale There is a growing recognition that intuitive strategies such as use of heuristics and pattern recognition described in other industries are applicable to high-acuity environments in medicine. Despite the applicability of theories of cognition to the intensive care unit, a discussion of decision-making strategies is currently absent in the critical care literature. Content This article provides an overview of known cognitive strategies, as well as a synthesis of their use in critical care. By understanding the ways by which humans formulate diagnoses and make critical decisions, we may be able to minimize errors in our own judgments as well as build training activities around known strengths and limitations of cognition. PMID:26387708

Negotiated dying: a grounded theory of how nurses shape withdrawal of treatment in hospital critical care units.

PubMed

Long-Sutehall, Tracy; Willis, Helen; Palmer, Rachel; Ugboma, Debra; Addington-Hall, Julia; Coombs, Maureen

2011-12-01

The process of withdrawal of treatment in critical care environments has created ethical and moral dilemmas in relation to end of life care in the UK and elsewhere. Common within this discourse is the differing demands made on health professionals as they strive to provide care for the dying patient and family members. Despite reports that withdrawal of treatment is a source of tension between those nurses and doctors involved in the process, the role of the nurse in facilitating withdrawal of treatment has received relatively little attention. To illustrate how differing dying trajectories impact on decision-making underpinning withdrawal of treatment processes, and what nurses do to shape withdrawal of treatment. Qualitative methods of enquiry using clinical vignettes and applying Charmaz's grounded theory method. Single audio-recorded qualitative interviews with thirteen critical care nurses from four intensive care specialities: cardiac; general; neurological and renal were carried out. Interviews were facilitated by an end-of-life vignette developed with clinical collaborators. Across critical care areas four key dying trajectories were identified. These trajectories were shaped by contested boundaries associated with delayed or stalled decision-making around how withdrawal of treatment should proceed. Nurses provided end of life care (including collaborative and action-oriented skills) to shape the dying trajectory of patients so as to satisfy the wishes of the patient and family, and their own professional aims. Differing views as to when withdrawal of treatment should commence and how it should be operationalised appeared to be underpinned by the requirements of the role that health professionals fulfil, with doctors focusing on making withdrawal of treatment decisions, and nurse's being tasked with operationalising the processes that constitute it. Multidisciplinary teams need a 'shared' understanding of each other's roles, responsibilities, aims, and motivations when planning and implementing the dying trajectory of withdrawal of treatment. 2011 Elsevier Ltd. All rights reserved.

Collaborative Interactivity and Integrated Thinking in Brazilian Business Schools Using Cognitive Flexibility Hypertexts: The Panteon Project

ERIC Educational Resources Information Center

Lima, Marcos; Koehler, Matthew J.; Spiro, Rand J.

2004-01-01

In this article, we discuss how the Harvard Method of case study, Interactive Communication Technologies, and Cognitive Flexibility Theory may contribute to case-based learning about business decision-making. In particular, we are interested in designing learning environments that foster critical thinking, creativity, and reasoning that entertains…

Improving fungal disease forecasts in winter wheat: a critical role of intra-day variations of meteorological conditions

USDA-ARS?s Scientific Manuscript database

Meteorological conditions are important factors in the development of fungal diseases in winter wheat and are the main inputs of the decision support systems used to forecast disease and thus determine timing for efficacious fungicide application. This study uses the Fourier transform method (FTM) t...

Budget- and priority-setting criteria at state health agencies in times of austerity: a mixed-methods study.

PubMed

Leider, Jonathon P; Resnick, Beth; Kass, Nancy; Sellers, Katie; Young, Jessica; Bernet, Patrick; Jarris, Paul

2014-06-01

We examined critical budget and priority criteria for state health agencies to identify likely decision-making factors, pressures, and opportunities in times of austerity. We have presented findings from a 2-stage, mixed-methods study with state public health leaders regarding public health budget- and priority-setting processes. In stage 1, we conducted hour-long interviews in 2011 with 45 health agency executive and division or bureau leaders from 6 states. Stage 2 was an online survey of 207 executive and division or bureau leaders from all state health agencies (66% response rate). Respondents identified 5 key criteria: whether a program was viewed as "mission critical," the seriousness of the consequences of not funding the program, financing considerations, external directives and mandates, and the magnitude of the problem the program addressed. We have presented empirical findings on criteria used in state health agency budgetary decision-making. These criteria suggested a focus and interest on core public health and the largest public health problems with the most serious ramifications.

Naturalistic Decision Making in Power Grid Operations: Implications for Dispatcher Training and Usability Testing

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

Greitzer, Frank L.; Podmore, Robin

2008-11-17

The focus of the present study is on improved training approaches to accelerate learning and improved methods for analyzing effectiveness of tools within a high-fidelity power grid simulated environment. A theory-based model has been developed to document and understand the mental processes that an expert power system operator uses when making critical decisions. The theoretical foundation for the method is based on the concepts of situation awareness, the methods of cognitive task analysis, and the naturalistic decision making (NDM) approach of Recognition Primed Decision Making. The method has been systematically explored and refined as part of a capability demonstration ofmore » a high-fidelity real-time power system simulator under normal and emergency conditions. To examine NDM processes, we analyzed transcripts of operator-to-operator conversations during the simulated scenario to reveal and assess NDM-based performance criteria. The results of the analysis indicate that the proposed framework can be used constructively to map or assess the Situation Awareness Level of the operators at each point in the scenario. We can also identify the mental models and mental simulations that the operators employ at different points in the scenario. This report documents the method, describes elements of the model, and provides appendices that document the simulation scenario and the associated mental models used by operators in the scenario.« less

Bedside nurse involvement in end-of-life decision making: a brief review of the literature.

PubMed

Erickson, Jodi

2013-01-01

Bedside nurses in the critical care setting deal with death on a regular basis. Historically, end-of-life decision making has been addressed by physicians with the family and patient, yet nurses may be a better resource for families during the decision-making process. The purpose of this article was to provide a brief review of literature surrounding end-of-life decision making. As patient advocates, nurses should be more actively involved with facilitating the end-of-life decision-making process for critically ill patients and their families.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

Methodology for fleet deployment decisions. Final report

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

Stremel, J.; Matousek, M.

1995-01-01

In today`s more competitive energy market, selecting investment and operating plans for a generating system, specific plants, and major plant components is becoming increasingly critical and complex. As utilities consider off-system sales, the key factor for fleet deployment decisions is no longer simply minimizing revenue requirements. Rather, system-level value dominates. This is a measure that can be difficult to determine in the context of traditional decision making methods. Selecting the best fleet deployment option requires the ability to account for multiple sources of value under uncertain conditions for multiple utility stakeholders. The object of this paper was to develope andmore » test an approach for assessing the system-wide value of alternative fleet deployment decisions. This was done, and the approach was tested at Consolidated Edison and at Central Illinois Public Service Company.« less

Linking climate projections to performance: A yield-based decision scaling assessment of a large urban water resources system

NASA Astrophysics Data System (ADS)

Turner, Sean W. D.; Marlow, David; Ekström, Marie; Rhodes, Bruce G.; Kularathna, Udaya; Jeffrey, Paul J.

2014-04-01

Despite a decade of research into climate change impacts on water resources, the scientific community has delivered relatively few practical methodological developments for integrating uncertainty into water resources system design. This paper presents an application of the "decision scaling" methodology for assessing climate change impacts on water resources system performance and asks how such an approach might inform planning decisions. The decision scaling method reverses the conventional ethos of climate impact assessment by first establishing the climate conditions that would compel planners to intervene. Climate model projections are introduced at the end of the process to characterize climate risk in such a way that avoids the process of propagating those projections through hydrological models. Here we simulated 1000 multisite synthetic monthly streamflow traces in a model of the Melbourne bulk supply system to test the sensitivity of system performance to variations in streamflow statistics. An empirical relation was derived to convert decision-critical flow statistics to climatic units, against which 138 alternative climate projections were plotted and compared. We defined the decision threshold in terms of a system yield metric constrained by multiple performance criteria. Our approach allows for fast and simple incorporation of demand forecast uncertainty and demonstrates the reach of the decision scaling method through successful execution in a large and complex water resources system. Scope for wider application in urban water resources planning is discussed.

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.

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

PubMed

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

2013-01-01

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

The explanatory power of Schema Theory: theoretical foundations and future applications in Ergonomics.

PubMed

Plant, Katherine L; Stanton, Neville A

2013-01-01

Schema Theory is intuitively appealing although it has not always received positive press; critics of the approach argue that the concept is too ambiguous and vague and there are inherent difficulties associated with measuring schemata. As such, the term schema can be met with scepticism and wariness. The purpose of this paper is to address the criticisms that have been levelled at Schema Theory by demonstrating how Schema Theory has been utilised in Ergonomics research, particularly in the key areas of situation awareness, naturalistic decision making and error. The future of Schema Theory is also discussed in light of its potential roles as a unifying theory in Ergonomics and in contributing to our understanding of distributed cognition. We conclude that Schema Theory has made a positive contribution to Ergonomics and with continued refinement of methods to infer and represent schemata it is likely that this trend will continue. This paper reviews the contribution that Schema Theory has made to Ergonomics research. The criticisms of the theory are addressed using examples from the areas of situation awareness, decision making and error.

Advance directives lessen the decisional burden of surrogate decision-making for the chronically critically ill.

PubMed

Hickman, Ronald L; Pinto, Melissa D

2014-03-01

To identify the relationships between advance directive status, demographic characteristics and decisional burden (role stress and depressive symptoms) of surrogate decision-makers (SDMs) of patients with chronic critical illness. Although the prevalence of advance directives among Americans has increased, SDMs are ultimately responsible for complex medical decisions of the chronically critically ill patient. Decisional burden has lasting psychological effects on SDMs. There is insufficient evidence on the influence of advance directives on the decisional burden of surrogate decision-makers of patients with chronic critical illness. The study was a secondary data analysis of cross-sectional data. Data were obtained from 489 surrogate decision-makers of chronically critically ill patients at two academic medical centres in Northeast Ohio, United States, between September 2005-May 2008. Data were collected using demographic forms and questionnaires. A single-item measure of role stress and the Center for Epidemiological Studies Depression (CESD) scale were used to capture the SDM's decisional burden. Descriptive statistics, t-tests, chi-square and path analyses were performed. Surrogate decision-makers who were nonwhite, with low socioeconomic status and low education level were less likely to have advance directive documentation for their chronically critically ill patient. The presence of an advance directive mitigates the decisional burden by directly reducing the SDM's role stress and indirectly lessening the severity of depressive symptoms. Most SDMs of chronically critically ill patients will not have the benefit of knowing the patient's preferences for life-sustaining therapies and consequently be at risk of increased decisional burden. Study results are clinically useful for patient education on the influence of advance directives. Patients may be informed that SDMs without advance directives are at risk of increased decisional burden and will require decisional support to facilitate patient-centred decision-making. © 2013 John Wiley & Sons Ltd.

76 FR 60736 - Protection of Stratospheric Ozone: The 2011 Critical Use Exemption From the Phaseout of Methyl...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... Allocations G. The Criteria in Decisions IX/6 and Ex. I/4 H. Emissions Minimization VI. Statutory and... issued several Decisions pertaining to the critical use exemption. These include Decisions IX/6 and Ex. I..., one for post-harvest uses and one for pre-plant uses. The USG transmitted responses to MBTOC on April...

Predicting adverse hemodynamic events in critically ill patients.

PubMed

Yoon, Joo H; Pinsky, Michael R

2018-06-01

The art of predicting future hemodynamic instability in the critically ill has rapidly become a science with the advent of advanced analytical processed based on computer-driven machine learning techniques. How these methods have progressed beyond severity scoring systems to interface with decision-support is summarized. Data mining of large multidimensional clinical time-series databases using a variety of machine learning tools has led to our ability to identify alert artifact and filter it from bedside alarms, display real-time risk stratification at the bedside to aid in clinical decision-making and predict the subsequent development of cardiorespiratory insufficiency hours before these events occur. This fast evolving filed is primarily limited by linkage of high-quality granular to physiologic rationale across heterogeneous clinical care domains. Using advanced analytic tools to glean knowledge from clinical data streams is rapidly becoming a reality whose clinical impact potential is great.

The decision-making threshold and the factors that affect it: A qualitative study of patients' decision-making in knee replacement surgery.

PubMed

Barlow, T; Scott, P; Thomson, L; Griffin, D; Realpe, A

2018-03-01

Osteoarthritis is a significant cause of burden to the ageing population and knee replacement is a common operation for treatment of end-stage disease. We aimed to explore these factors to help understand patients' decision-making, which is critical in informing patient-centred care. These can be used to enhance decision-making and dialogue between clinicians and patients, allowing a more informed choice. The study consisted of two focus groups, in a patient cohort after total knee replacement followed by more in-depth interviews to further test and explore themes from the focus groups, in patients in either the deliberation stage or the decision-making stage. Using qualitative research methods (iterative thematic analysis) reviewing decision-making and deliberation phases of making informed choices we found nine key themes that emerged from the study groups. An awareness of the deliberation phase, the factors that influence it, the stress associated with it, preferred models of care, and the influence of the decision-making threshold will aid useful communication between doctors and patients. Copyright © 2017 John Wiley & Sons, Ltd.

Understanding The Decision Context: DPSIR, Decision Landscape, And Social Network Analysis

EPA Science Inventory

Establishing the decision context for a management problem is the critical first step for effective decision analysis. Understanding the decision context allow stakeholders and decision-makers to integrate the societal, environmental, and economic considerations that must be con...

Critical thinking dispositions of nursing students in Asian and non-Asian countries: a literature review.

PubMed

Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad

2013-09-26

Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

Critical Thinking Dispositions of Nursing Students in Asian and Non-Asian Countries: A Literature Review

PubMed Central

Salsali, Mahvash; Tajvidi, Mansooreh; Ghiyasvandian, Shahrzad

2013-01-01

Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools. PMID:24171885

A Model of Risk Analysis in Analytical Methodology for Biopharmaceutical Quality Control.

PubMed

Andrade, Cleyton Lage; Herrera, Miguel Angel De La O; Lemes, Elezer Monte Blanco

2018-01-01

One key quality control parameter for biopharmaceutical products is the analysis of residual cellular DNA. To determine small amounts of DNA (around 100 pg) that may be in a biologically derived drug substance, an analytical method should be sensitive, robust, reliable, and accurate. In principle, three techniques have the ability to measure residual cellular DNA: radioactive dot-blot, a type of hybridization; threshold analysis; and quantitative polymerase chain reaction. Quality risk management is a systematic process for evaluating, controlling, and reporting of risks that may affects method capabilities and supports a scientific and practical approach to decision making. This paper evaluates, by quality risk management, an alternative approach to assessing the performance risks associated with quality control methods used with biopharmaceuticals, using the tool hazard analysis and critical control points. This tool provides the possibility to find the steps in an analytical procedure with higher impact on method performance. By applying these principles to DNA analysis methods, we conclude that the radioactive dot-blot assay has the largest number of critical control points, followed by quantitative polymerase chain reaction, and threshold analysis. From the analysis of hazards (i.e., points of method failure) and the associated method procedure critical control points, we conclude that the analytical methodology with the lowest risk for performance failure for residual cellular DNA testing is quantitative polymerase chain reaction. LAY ABSTRACT: In order to mitigate the risk of adverse events by residual cellular DNA that is not completely cleared from downstream production processes, regulatory agencies have required the industry to guarantee a very low level of DNA in biologically derived pharmaceutical products. The technique historically used was radioactive blot hybridization. However, the technique is a challenging method to implement in a quality control laboratory: It is laborious, time consuming, semi-quantitative, and requires a radioisotope. Along with dot-blot hybridization, two alternatives techniques were evaluated: threshold analysis and quantitative polymerase chain reaction. Quality risk management tools were applied to compare the techniques, taking into account the uncertainties, the possibility of circumstances or future events, and their effects upon method performance. By illustrating the application of these tools with DNA methods, we provide an example of how they can be used to support a scientific and practical approach to decision making and can assess and manage method performance risk using such tools. This paper discusses, considering the principles of quality risk management, an additional approach to the development and selection of analytical quality control methods using the risk analysis tool hazard analysis and critical control points. This tool provides the possibility to find the method procedural steps with higher impact on method reliability (called critical control points). Our model concluded that the radioactive dot-blot assay has the larger number of critical control points, followed by quantitative polymerase chain reaction and threshold analysis. Quantitative polymerase chain reaction is shown to be the better alternative analytical methodology in residual cellular DNA analysis. © PDA, Inc. 2018.

Characteristics of Child Abuse in Immigrant Korean Families and Correlates of Placement Decisions

ERIC Educational Resources Information Center

Chang, Janet; Rhee, Siyon; Weaver, Dale

2006-01-01

Objective: This study examined the characteristics and patterns of child abuse among immigrant Korean families in Los Angeles and critical variables that contribute to the type of placement made by the child protective services (CPS) system. Method: Data were obtained from reviewing and analyzing 170 active Korean case files maintained by the…

Career and Technical Education at a Crossroads: A Delphi Study

ERIC Educational Resources Information Center

Cutright, Michael W.

2011-01-01

Career and technical education in the United States has reached a critical juncture. A three round Delphi method was used to determine a consensus on the future events of career and technical education to better inform educational decision makers. Forty-one individual experts in the field were invited to serve as panelists for the Delphi study and…

Effect of Active Learning on Students' Academic Success in the Medical Classroom

ERIC Educational Resources Information Center

Hightower, Sandra

2014-01-01

Doctors in a Northern California community reported that medical assisting students did not use medical terminology in context, could not think critically, and faltered in decision making and problem solving during their internships in medical offices. The intent of this instrumental case study was to investigate the gap between current methods of…

Evaluating clinical librarian services: a systematic review.

PubMed

Brettle, Alison; Maden-Jenkins, Michelle; Anderson, Lucy; McNally, Rosalind; Pratchett, Tracey; Tancock, Jenny; Thornton, Debra; Webb, Anne

2011-03-01

  Previous systematic reviews have indicated limited evidence and poor quality evaluations of clinical librarian (CL) services. Rigorous evaluations should demonstrate the value of CL services, but guidance is needed before this can be achieved.   To undertake a systematic review which examines models of CL services, quality, methods and perspectives of clinical librarian service evaluations.   Systematic review methodology and synthesis of evidence, undertaken collaboratively by a group of 8 librarians to develop research and critical appraisal skills.   There are four clear models of clinical library service provision. Clinical librarians are effective in saving health professionals time, providing relevant, useful information and high quality services. Clinical librarians have a positive effect on clinical decision making by contributing to better informed decisions, diagnosis and choice of drug or therapy. The quality of CL studies is improving, but more work is needed on reducing bias and providing evidence of specific impacts on patient care. The Critical Incident Technique as part of a mixed method approach appears to offer a useful approach to demonstrating impact.   This systematic review provides practical guidance regarding the evaluation of CL services. It also provides updated evidence regarding the effectiveness and impact of CL services. The approach used was successful in developing research and critical appraisal skills in a group of librarians. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

The impact of management science on political decision making

NASA Technical Reports Server (NTRS)

White, M. J.

1971-01-01

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

The role of pharmaceutical marketing and other factors in prescribing decisions: the Yemeni experience.

PubMed

Al-Areefi, Mahmoud Abdullah; Hassali, Mohamed Azmi; Mohamed Ibrahim, Mohamed Izham B

2013-01-01

Prescribing decisions are a complex phenomenon and influenced by many pharmacological and non-pharmacological factors. Little is known about the actual prescribing behaviors of physicians or the factors behind their prescribing decisions. The objective of this study was to explore the factors that influence physicians' prescribing decisions and the role of the marketing activities by pharmaceutical companies in this decision-making process. A semi-structured interview with the critical incident technique method was used to encourage physicians to describe the particular situations of prescribing for specific newly marketed drugs. All interviews were transcribed verbatim and thematic content analysis with systematic and comprehensive coding was employed to identify categories of physicians' reasons for either prescribing or not of the study drugs. Factors that influence prescribing of the study drugs (223 critical incidents) were categorized in six major themes. Drug characteristics, the most frequently mentioned by physicians as reasons of prescribe, were implicated in 70 (31.4%) incidents, followed by pharmaceutical company mentioned in 53 (23.8%) incidents, indications, 31 (13.9%) incidents, and patient contexts, 26 (11.7%) incidents. Environmental factors as information and evidence were implicated in 22 (9.9%) incidents, and physician factor, 21 (9.4%) incidents. Prescribing is a complex process and physicians integrate different factors. Although physicians make a considerable on patient contexts and treatment outcomes, they still rely on their personal experiences when making prescribing in addition to firms' source of information and firms' marketing activities. Copyright © 2013 Elsevier Inc. All rights reserved.

Risky decision-making is associated with residential choice in healthy older adults.

PubMed

Seaman, Kendra L; Stillman, Chelsea M; Howard, Darlene V; Howard, James H

2015-01-01

As our society becomes more mobile and people reside farther away from their immediate families, competent decision-making has become critical for the older adults wishing to maintain their independence. However, very little is known about the relationship between residential choice and decision-making. Here we use the Balloon Analog Risk Task (BART) to examine risk-taking in two samples of older adults, one living in a retirement community and another living independently. We also used a cognitive model to gain insight into the cognitive factors underlying decision-making in these groups. We found that older adults living in a retirement community were more risk averse than their independent counterparts. Furthermore, this difference appeared to be motivated by group differences in initial perception of risk. This study suggests an intriguing difference between these two residential groups, and also points to the utility of using laboratory methods in research on real-world problems.

WHAT DOESNT GET MEASURED - DOESNT GET DONE: IMPLEMENTING CONTINUOUS PROCESS IMPROVEMENT IN THE AIR FORCE RESERVE

DTIC Science & Technology

2016-04-01

Practical Problem Solving Method RMD Resource Management Decision ROI Return on Investment SECAF Secretary of the Air Force SECNAV Secretary of...AFSO21 and now AF CPI, this program seeks to train and certify an organic cadre of CPI practitioners to support the use of its standard problem solving ...process known as the AF Practical Problem Solving Method (PPSM) to solve mission critical process deficiencies. The PPSM leverages several industry

A Critical Review for Developing Accurate and Dynamic Predictive Models Using Machine Learning Methods in Medicine and Health Care.

PubMed

Alanazi, Hamdan O; Abdullah, Abdul Hanan; Qureshi, Kashif Naseer

2017-04-01

Recently, Artificial Intelligence (AI) has been used widely in medicine and health care sector. In machine learning, the classification or prediction is a major field of AI. Today, the study of existing predictive models based on machine learning methods is extremely active. Doctors need accurate predictions for the outcomes of their patients' diseases. In addition, for accurate predictions, timing is another significant factor that influences treatment decisions. In this paper, existing predictive models in medicine and health care have critically reviewed. Furthermore, the most famous machine learning methods have explained, and the confusion between a statistical approach and machine learning has clarified. A review of related literature reveals that the predictions of existing predictive models differ even when the same dataset is used. Therefore, existing predictive models are essential, and current methods must be improved.

How Expert Pilots Think Cognitive Processes in Expert Decision Making

DTIC Science & Technology

1993-02-01

Management (CRM) This document is available to the public Advanced Qualification Program (AQP) through the National Technical Information Cognitive Task Analysis (CTA...8217 Selecting realistic EDM scenarios with critical events and performing a cognitive task analysis of novice vs. expert decision making for these events...scenarios with critical events and performing a cognitive task analysis of novice vs. expert decision making for these events is a basic requirement for

How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role.

PubMed

Li, Lingsheng; Nelson, Judith E; Hanson, Laura C; Cox, Christopher E; Carson, Shannon S; Chai, Emily J; Keller, Kristine L; Tulsky, James A; Danis, Marion

2018-05-01

Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. Medical ICUs at four U.S. hospitals. Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study. Family members participated in at least two content-guided, informational, and emotional support meetings led by a palliative care physician and nurse practitioner. Grounded theory was used for qualitative analysis of 66 audio recordings of meetings with 51 family members. Family members perceived their role in four main ways: voice of the patient, advocate for the patient, advocate for others, and advocate for oneself. Their decision-making was characterized by balancing goals, sharing their role, keeping perspective, remembering previous experiences, finding sources of strength, and coping with various burdens. Family members take a multifaceted approach as they participate in decision-making. Understanding how surrogates perceive and act in their roles may facilitate shared decision-making among clinicians and families during critical care.

Admission time to hospital: a varying standard for a critical definition for admissions to an intensive care unit from the emergency department.

PubMed

Nanayakkara, Shane; Weiss, Heike; Bailey, Michael; van Lint, Allison; Cameron, Peter; Pilcher, David

2014-11-01

Time spent in the emergency department (ED) before admission to hospital is often considered an important key performance indicator (KPI). Throughout Australia and New Zealand, there is no standard definition of 'time of admission' for patients admitted through the ED. By using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database, the aim was to determine the differing methods used to define hospital admission time and assess how these impact on the calculation of time spent in the ED before admission to an intensive care unit (ICU). Between March and December of 2010, 61 hospitals were contacted directly. Decision methods for determining time of admission to the ED were matched to 67,787 patient records. Univariate and multivariate analyses were conducted to assess the relationship between decision method and the reported time spent in the ED. Four mechanisms of recording time of admission were identified, with time of triage being the most common (28/61 hospitals). Reported median time spent in the ED varied from 2.5 (IQR 0.83-5.35) to 5.1 h (2.82-8.68), depending on the decision method. After adjusting for illness severity, hospital type and location, decision method remained a significant factor in determining measurement of ED length of stay. Different methods are used in Australia and New Zealand to define admission time to hospital. Professional bodies, hospitals and jurisdictions should ensure standardisation of definitions for appropriate interpretation of KPIs as well as for the interpretation of studies assessing the impact of admission time to ICU from the ED. WHAT IS KNOWN ABOUT THE TOPIC?: There are standards for the maximum time spent in the ED internationally, but these standards vary greatly across Australia. The definition of such a standard is critically important not only to patient care, but also in the assessment of hospital outcomes. Key performance indicators rely on quality data to improve decision-making. WHAT DOES THIS PAPER ADD?: This paper quantifies the variability of times measured and analyses why the variability exists. It also discusses the impact of this variability on assessment of outcomes and provides suggestions to improve standardisation. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: This paper provides a clearer view on standards regarding length of stay in the ICU, highlighting the importance of key performance indicators, as well as the quality of data that underlies them. This will lead to significant changes in the way we standardise and interpret data regarding length of stay.

End-of-life decision making in the ICU.

PubMed

Siegel, Mark D

2009-03-01

A large proportion of deaths, particularly in the developed world, follows admission to an ICU. Therefore, end-of life decision making is an essential facet of critical care practice. For intensivists, managing death in the critically ill has become a key professional skill. They must be thoroughly familiar with the ethical framework that guides end-of-life decision making. Decisions should generally be made collaboratively by clinicians partnering with patients' families. Treatment choices should be crafted to meet specific, achievable goals. A rational, empathic approach to working with families should encourage appropriate, mutually satisfactory outcomes.

Venous Small Bowel Infarction: Intraoperative Laser Doppler Flowmetry Discriminates Critical Blood Supply and Spares Bowel Length

PubMed Central

Käser, S. A.; Glauser, P. M.; Maurer, C. A.

2012-01-01

Introduction. In mesenteric infarction due to arterial occlusion, laser Doppler flowmetry and spectrometry are known reliable noninvasive methods for measuring microvascular blood flow and oxygen utilisation. Case Presentation. As an innovation we used these methods in a patient with acute extensive mesenteric infarction due to venous occlusion, occurring after radical right hemicolectomy. Aiming to avoid short bowel syndrome, we spared additional 110 cm of small bowel, instead of leaving only 80 centimetres of clinically viable small bowel in situ. The pathological examination showed only 5 mm of vital mucosa to be left distal to the dissection margin. No further interventions were necessary. Conclusion. Laser doppler flowmetry and spectrometry are potentially powerful methods to assist the surgeon's decision-making in critical venous mesenteric perfusion, thus having an important impact on clinical outcome. PMID:23093968

Argumentation: A Methodology to Facilitate Critical Thinking.

PubMed

Makhene, Agnes

2017-06-20

Caring is a difficult nursing activity that involves a complex nature of a human being in need of complex decision-making and problem solving through the critical thinking process. It is mandatory that critical thinking is facilitated in general and in nursing education particularly in order to render care in diverse multicultural patient care settings. This paper aims to describe how argumentation can be used to facilitate critical thinking in learners. A qualitative, exploratory and descriptive design that is contextual was used. Purposive sampling method was used to draw a sample and Miles and Huberman methodology of qualitative analysis was used to analyse data. Lincoln and Guba's strategies were employed to ensure trustworthiness, while Dhai and McQuoid-Mason's principles of ethical consideration were used. Following data analysis the findings were integrated within literature which culminated into the formulation of guidelines that can be followed when using argumentation as a methodology to facilitate critical thinking.

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

The effect of completing a surrogacy information and decision-making tool upon admission to an intensive care unit on length of stay and charges.

PubMed

Hatler, Carol W; Grove, Charlene; Strickland, Stephanie; Barron, Starr; White, Bruce D

2012-01-01

Many critically ill patients in intensive care units (ICUs) are unable to communicate their wishes about goals of care, particularly about the use of life-sustaining treatments. Surrogates and clinicians struggle with medical decisions because of a lack of clarity regarding patients' preferences, leading to prolonged hospitalizations and increased costs. This project focused on the development and implementation of a tool to facilitate a better communication process by (1) assuring the early identification of a surrogate if indicated on admission and (2) clarifying the decision-making standards that the surrogate was to use when participating in decision making. Before introducing the tool into the admissions routine, the staff were educated about its use and value to the decision-making process. PROJECT AND METHODS: The study was to determine if early use of a simple method of identifying a patient's surrogate and treatment preferences might impact length of stay (LOS) and total hospital charges. A pre- and post-intervention study design was used. Nurses completed the surrogacy information tool for all patients upon admission to the neuroscience ICU. Subjects (total N = 203) were critically ill patients who had been on a mechanical ventilator for 96 hours or longer, or in the ICU for seven days or longer.The project included staff education on biomedical ethics, critical communication skills, early identification of families and staff in crisis, and use of a simple tool to document patients' surrogates and previously expressed care wishes. Data on hospital LOS and hospital charges were collected through a retrospective review of medical records for similar four-month time frames pre- and post-implementation of the assessment tool. Significant differences were found between pre- and post-groups in terms of hospital LOS (F = 6.39, p = .01) and total hospital charges (F = 7.03, p = .009). Project findings indicate that the use of a simple admission assessment tool, supported by staff education about its completion, use, and available resources, can decrease LOS and lower total hospital charges. The reasons for the difference between the pre- and post-intervention groups remain unclear. Further research is needed to evaluate if the quality of communications between patients, their legally authorized representatives, and clinicians--as suggested in the literature--may have played a role in decreasing LOS and total hospital charges.

Methodological problems in the method used by IQWiG within early benefit assessment of new pharmaceuticals in Germany.

PubMed

Herpers, Matthias; Dintsios, Charalabos-Markos

2018-04-25

The decision matrix applied by the Institute for Quality and Efficiency in Health Care (IQWiG) for the quantification of added benefit within the early benefit assessment of new pharmaceuticals in Germany with its nine fields is quite complex and could be simplified. Furthermore, the method used by IQWiG is subject to manifold criticism: (1) it is implicitly weighting endpoints differently in its assessments favoring overall survival and, thereby, drug interventions in fatal diseases, (2) it is assuming that two pivotal trials are available when assessing the dossiers submitted by the pharmaceutical manufacturers, leading to far-reaching implications with respect to the quantification of added benefit, and, (3) it is basing the evaluation primarily on dichotomous endpoints and consequently leading to an information loss of usable evidence. To investigate if criticism is justified and to propose methodological adaptations. Analysis of the available dossiers up to the end of 2016 using statistical tests and multinomial logistic regression and simulations. It was shown that due to power losses, the method does not ensure that results are statistically valid and outcomes of the early benefit assessment may be compromised, though evidence on favoring overall survival remains unclear. Modifications, however, of the IQWiG method are possible to address the identified problems. By converging with the approach of approval authorities for confirmatory endpoints, the decision matrix could be simplified and the analysis method could be improved, to put the results on a more valid statistical basis.

Decision-Making in Pediatric Transport Team Dispatch Using Script Concordance Testing.

PubMed

Rajapreyar, Prakadeshwari; Marcdante, Karen; Zhang, Liyun; Simpson, Pippa; Meyer, Michael T

2017-11-01

Our objective was to compare decision-making in dispatching pediatric transport teams by Medical Directors of pediatric transport teams (serving as experts) to that of Pediatric Intensivists and Critical Care fellows who often serve as Medical Control physicians. Understanding decision-making around team composition and dispatch could impact clinical management, cost effectiveness, and educational needs. Survey was developed using Script Concordance Testing guidelines. The survey contained 15 transport case vignettes covering 20 scenarios (45 questions). Eleven scenarios assessed impact of intrinsic patient factors (e.g., procedural needs), whereas nine assessed extrinsic factors (e.g., weather). Pediatric Critical Care programs accredited by the Accreditation Council for Graduate Medical Education (the United States). Pediatric Intensivists and senior Critical Care fellows at Pediatric Critical Care programs were the target population with Transport Medical Directors serving as the expert panel. None. Survey results were scored per Script Concordance Testing guidelines. Concordance within groups was assessed using simple percentage agreement. There was little concordance in decision-making by Transport Medical Directors (median Script Concordance Testing percentage score [interquartile range] of 33.9 [30.4-37.3]). In addition, there was no statistically significant difference between the median Script Concordance Testing scores among the senior fellows and Pediatric Intensivists (31.1 [29.6-33.2] vs 29.7 [28.3-32.3], respectively; p = 0.12). Transport Medical Directors were more concordant on reasoning involving intrinsic patient factors rather than extrinsic factors (10/21 vs 4/24). Our study demonstrates pediatric transport team dispatch decision-making discordance by pediatric critical care physicians of varying levels of expertise and experience. Script Concordance Testing at a local level may better elucidate standards in medical decision-making within pediatric critical care physicians. The development of a curriculum, which provides education and trains our workforce on the logistics of pediatric transport team dispatch, would help standardize practice and evaluate outcomes based on decision-making.

Critical thinking by nurses on ethical issues like the termination of pregnancies.

PubMed

Botes, A

2000-09-01

This research forms part of a larger interdisciplinary research project on the termination of pregnancies. The focus of this part of the project is on the ethical issues related to termination of pregnancies. The practice of the professional nurse is confronted with ethical dilemmas and disputes. Whether the nurse chooses to participate in the termination of pregnancies or not, the core function of the nurse is that of counseling and ethical decision-making. Effective counseling requires empathy, respect for human rights and unconditional acceptance of a person. Making ethical decisions implies making critical decisions. It is self-evident, therefore, that such decisions should be based on sound arguments and logical reasoning. It is of vital importance that ethical decisions can be justified on rational ground. Decision-making is a critical thinking approach process for choosing the best action to meet a desired goal. The research question that is relevant for this paper is: Are nurses thinking critically about ethical issues like the termination of pregnancies? To answer the research question a qualitative, exploratory, descriptive design was used (Mouton, 1996:103-169). Registered nurses were selected purposively (Creswell, 1994:15). 1200 registered nurses completed the open-ended questionnaires. Focus group interviews were conducted with 22 registered nurses from a public hospital for women and child health services. Data analysis, using secondary data from open-ended questionnaires and transcribed focus group interviews, were based on the approach of Morse and Field (1994:25-34) and Strauss and Corbin (1990). The themes and categories from open coding were compared, conceptualized and linked with theories on critical thinking (Paul, 1994; Watson & Glaser, 1991 and the American Philosophical Association, 1990). The measures of Lincoln and Guba (1985) and Morse (1994) related to secondary data analysis were employed to ensure trustworthiness. Based on these findings the researcher concluded that nurses are not thinking critically when making ethical decisions concerning the termination of pregnancies. Recommendations are made as a possible solution for this problem.

SPATIAL ACCURACY: A CRITICAL FACTOR IN GIS-RELATED ACTIVITIES

EPA Science Inventory

Onsite analyses are critical to making timely decisions. The results of these decisions may not be realized for many years. In order to increase the value of onsite analyses and to create and utilize meaningful environmental models, the Environmental Protection Agency (EPA) dev...

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

PubMed

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

2009-01-01

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

Clinical evaluation of patients with patellofemoral disorders.

PubMed

Post, W R

1999-01-01

Accurate clinical evaluation of patients with patellofemoral disorders is the cornerstone of effective treatment. This article defines how a careful history and physical examination can direct strategies for nonoperative and operative management. A critical analysis of traditional methods of evaluation and a streamlined rational approach to clinical evaluation is presented. Key questions and important physical findings that affect treatment decisions are emphasized.

South African critical care nurses' views on end-of-life decision-making and practices.

PubMed

Langley, Gayle; Schmollgruber, Shelley; Fulbrook, Paul; Albarran, John W; Latour, Jos M

2014-01-01

Care of patients at the end-of-life (EOL) may be influenced by the experiences, attitudes and beliefs of nurses involved in their direct care. To investigate South African critical care nurses' experiences and perceptions of EOL care. Cross-sectional survey. South African critical care nurses completed a modified version of the 'VENICE' survey tool. Data were collected concerning: attitudes towards EOL care; involvement in EOL decision-making; and beliefs about EOL practices. Of 149 surveys distributed, 100 were returned (response rate 67%). Seventy-six percent stated that they had had direct involvement in EOL care of patients, but a minority (29%) had participated in EOL decision-making processes. Whilst most nurses (86%) were committed to family involvement in EOL decisions, less than two thirds (62%) reported this as routine practice. When withdrawing treatment, around half (54%) of the respondents indicated they would decrease the inspired oxygen level to room air, and the majority (84%) recommended giving effective pain relief. Continued nutritional support (84%) and hydration (85%) were advocated, with most nurses (62%) indicating that they were against keeping patients deeply sedated. Most respondents (68%) felt patients should remain in intensive care at the end of life, with the majority (72%) supporting open-visiting, no restriction on number of family members visiting (70%), and the practising of religious or traditional cultural EOL rituals (93%). The involvement of Johannesburg critical nurses in EOL care discussions and decisions is infrequent despite their participation in care delivery and definite views about the process. Use of formal guidelines and education is recommended to increase the nurses' involvement in and their confidence in participating in EOL decisions. Educators, managers, senior nurses and other members of the multi-disciplinary team should collaborate to enable critical care nurses to become more involved in EOL care. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

Configuration Management (CM) Support for KM Processes at NASA/Johnson Space Center (JSC)

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2010-01-01

Collection and processing of information are critical aspects of every business activity from raw data to information to an executable decision. Configuration Management (CM) supports KM practices through its automated business practices and its integrated operations within the organization. This presentation delivers an overview of JSC/Space Life Sciences Directorate (SLSD) and its methods to encourage innovation through collaboration and participation. Specifically, this presentation will illustrate how SLSD CM creates an embedded KM activity with an established IT platform to control and update baselines, requirements, documents, schedules, budgets, while tracking changes essentially managing critical knowledge elements.

Real Options in Defense R and D: A Decision Tree Analysis Approach for Options to Defer, Abandon, and Expand

DTIC Science & Technology

2016-12-01

chosen rather than complex ones , and responds to the criticism of the DTA approach. Chapter IV provides three separate case studies in defense R&D...defense R&D projects. To this end, the first section describes the case study method and the advantages of using simple models over more complex ones ...the analysis lacked empirical data and relied on subjective data, the analysis successfully combined the DTA approach with the case study method and

Clinical decision regret among critical care nurses: a qualitative analysis.

PubMed

Arslanian-Engoren, Cynthia; Scott, Linda D

2014-01-01

Decision regret is a negative cognitive emotion associated with experiences of guilt and situations of interpersonal harm. These negative affective responses may contribute to emotional exhaustion in critical care nurses (CCNs), increased staff turnover rates and high medication error rates. Yet, little is known about clinical decision regret among CCNs or the conditions or situations (e.g., feeling sleepy) that may precipitate its occurrence. To examine decision regret among CCNs, with an emphasis on clinical decisions made when nurses were most sleepy. A content analytic approach was used to examine the narrative descriptions of clinical decisions by CCNs when sleepy. Six decision regret themes emerged that represented deviations in practice or performance behaviors that were attributed to fatigued CCNs. While 157 CCNs disclosed a clinical decision they made at work while sleepy, the prevalence may be underestimated and warrants further investigation. Copyright © 2014 Elsevier Inc. All rights reserved.

Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

The concept of triage in healthcare has been around for centuries and continues to be applied today so that scarce resources are allocated according to need. A business impact analysis (BIA) is a form of triage in that it identifies which processes are most critical, which to address first and how to allocate limited resources. On its own, however, the BIA provides only a roadmap of the impacts and interdependencies of an event. When disaster strikes, organisational decision-makers often face difficult decisions with regard to allocating limited resources between multiple 'mission-critical' functions. Applying the concept of triage to business continuity provides those decision-makers navigating a rapidly evolving and unpredictable event with a path that protects the fundamental priorities of the organisation. A business triage methodology aids decision-makers in times of crisis by providing a simplified framework for decision-making based on objective, evidence-based criteria, which is universally accepted and understood. When disaster strikes, the survival of the organisation depends on critical decision-making and quick actions to stabilise the incident. This paper argues that organisations need to supplement BIA processes with a decision-making triage methodology that can be quickly applied during the chaos of an actual event.

[Interoception and decision-making].

PubMed

Ohira, Hideki

2015-02-01

We sometimes make decisions relying not necessarily on deliberative thoughts but on intuitive and emotional processes in uncertain situations. The somatic marker hypothesis proposed by Damasio argued that interoception, which means bodily responses such as sympathetic activity, can be represented in the insula and anterior cingulate cortex and can play critical roles in decision-making. Though this hypothesis has been criticized in its theoretical and empirical aspects, recent studies are expanding the hypothesis to elucidate multiple bodily responses including autonomic, endocrine, and immune activities that affect decision-making. In addition, cumulative findings suggest that the anterior insula where the inner model of interoception is represented can act as an interface between the brain and body in decision-making. This article aims to survey recent findings on the brain-body interplays underlying decision-making, and to propose hypotheses on the significance of the body in decision-making.

Empowering genomic medicine by establishing critical sequencing result data flows: the eMERGE example.

PubMed

Aronson, Samuel; Babb, Lawrence; Ames, Darren; Gibbs, Richard A; Venner, Eric; Connelly, John J; Marsolo, Keith; Weng, Chunhua; Williams, Marc S; Hartzler, Andrea L; Liang, Wayne H; Ralston, James D; Devine, Emily Beth; Murphy, Shawn; Chute, Christopher G; Caraballo, Pedro J; Kullo, Iftikhar J; Freimuth, Robert R; Rasmussen, Luke V; Wehbe, Firas H; Peterson, Josh F; Robinson, Jamie R; Wiley, Ken; Overby Taylor, Casey

2018-05-31

The eMERGE Network is establishing methods for electronic transmittal of patient genetic test results from laboratories to healthcare providers across organizational boundaries. We surveyed the capabilities and needs of different network participants, established a common transfer format, and implemented transfer mechanisms based on this format. The interfaces we created are examples of the connectivity that must be instantiated before electronic genetic and genomic clinical decision support can be effectively built at the point of care. This work serves as a case example for both standards bodies and other organizations working to build the infrastructure required to provide better electronic clinical decision support for clinicians.

The Ethics of Rationing of Critical Care Services: Should Technology Assessment Play a Role?

PubMed Central

Bloomfield, Eric L.

2009-01-01

The costs of health care continue to increase rapidly and steeply in the United States. One area of great expense is that of intensive care units (ICUs). The causes of inflation have not been addressed effectively. ICU resources could become stretched such that they may no longer be available. This paper discusses some of the ethics and concerns behind decision making when providing ICU services in the United States. In particular, the use of electronic records with decision making tools, risk-analysis methods, and documentation of patient wishes for extraordinary care may help with better utilization of resources in the future. PMID:20798878

Review of fluorescence guided surgery visualization and overlay techniques

PubMed Central

Elliott, Jonathan T.; Dsouza, Alisha V.; Davis, Scott C.; Olson, Jonathan D.; Paulsen, Keith D.; Roberts, David W.; Pogue, Brian W.

2015-01-01

In fluorescence guided surgery, data visualization represents a critical step between signal capture and display needed for clinical decisions informed by that signal. The diversity of methods for displaying surgical images are reviewed, and a particular focus is placed on electronically detected and visualized signals, as required for near-infrared or low concentration tracers. Factors driving the choices such as human perception, the need for rapid decision making in a surgical environment, and biases induced by display choices are outlined. Five practical suggestions are outlined for optimal display orientation, color map, transparency/alpha function, dynamic range compression, and color perception check. PMID:26504628

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

PubMed

Dando, Coral J; Ormerod, Thomas C

2017-12-01

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

Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

PubMed

AllahBakhshian, Maryam; Alimohammadi, Nasrollah; Taleghani, Fariba; Nik, Ahmadreza Yazdan; Abbasi, Saeed; Gholizadeh, Leila

The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Kenyan Nurses Involvement in National Policy Development Processes

PubMed Central

Juma, Pamela Atieno

2014-01-01

The aim of this study was to critically examine how nurses have been involved in national policy processes in the Kenyan health sector. The paper reports qualitative results from a larger mixed method study. National nonnursing decision-makers and nurse leaders, and provincial managers as well as frontline nurse managers from two Kenyan districts were purposefully selected for interviews. Interviews dealt with nurses' involvement in national policy processes, factors hindering nurses' engagement in policy processes, and ways to enhance nurses' involvement in policy processes. Critical theory and feminist perspectives guided the study process. Content analysis of data was conducted. Findings revealed that nurses' involvement in policy processes in Kenya was limited. Only a few nurse leaders were involved in national policy committees as a result of their positions in the sector. Critical analysis of the findings revealed that hierarchies and structural factors as well as nursing professional issues were the primary barriers constraining nurses' involvement in policy processes. Thus, there is need to address these factors both by nurses themselves and by nonnursing decision makers, in order to enhance nurses engagement in policy making and further the contribution to quality of services to the communities. PMID:25349731

Environmental and economic assessment methods for waste management decision-support: possibilities and limitations.

PubMed

Finnveden, Göran; Björklund, Anna; Moberg, Asa; Ekvall, Tomas

2007-06-01

A large number of methods and approaches that can be used for supporting waste management decisions at different levels in society have been developed. In this paper an overview of methods is provided and preliminary guidelines for the choice of methods are presented. The methods introduced include: Environmental Impact Assessment, Strategic Environmental Assessment, Life Cycle Assessment, Cost-Benefit Analysis, Cost-effectiveness Analysis, Life-cycle Costing, Risk Assessment, Material Flow Accounting, Substance Flow Analysis, Energy Analysis, Exergy Analysis, Entropy Analysis, Environmental Management Systems, and Environmental Auditing. The characteristics used are the types of impacts included, the objects under study and whether the method is procedural or analytical. The different methods can be described as systems analysis methods. Waste management systems thinking is receiving increasing attention. This is, for example, evidenced by the suggested thematic strategy on waste by the European Commission where life-cycle analysis and life-cycle thinking get prominent positions. Indeed, life-cycle analyses have been shown to provide policy-relevant and consistent results. However, it is also clear that the studies will always be open to criticism since they are simplifications of reality and include uncertainties. This is something all systems analysis methods have in common. Assumptions can be challenged and it may be difficult to generalize from case studies to policies. This suggests that if decisions are going to be made, they are likely to be made on a less than perfect basis.

Reflective Journaling for Critical Thinking Development in Advanced Practice Registered Nurse Students.

PubMed

Raterink, Ginger

2016-02-01

Critical thinking, clinical decision making, and critical reflection have been identified as skills required of nurses in every clinical situation. The Educating Nurses: A Call for Radical Transformation report suggested that critical reflection is a key to improving the educational process. Reflective journaling is a tool that helps develop such skills. This article presents the tool of reflective journaling and the use of this process by educators working with students. It describes the use of reflective journaling in graduate nursing education, as well as a scoring process to evaluate the reflection and provide feedback. Students and faculty found the journaling to be helpful for reflection of a clinical situation focused on critical thinking skill development. The rubric scoring tool provided faculty with a method for feedback. Reflective journaling is a tool that faculty and students can use to develop critical thinking skills for the role of the advanced practice RN. A rubric scoring system offers a consistent format for feedback. Copyright 2016, SLACK Incorporated.

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING IN TWO WESTERN U.S. WATERSHEDS

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions ...

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

PubMed

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

2015-01-01

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

Controlling equine influenza: policy networks and decision-making during the 2007 Australian equine influenza outbreak.

PubMed

Schemann, K; Gillespie, J A; Toribio, J-A L M L; Ward, M P; Dhand, N K

2014-10-01

Rapid, evidence-based decision-making is critical during a disease outbreak response; however, compliance by stakeholders is necessary to ensure that such decisions are effective - especially if the response depends on voluntary action. This mixed method study evaluated technical policy decision-making processes during the 2007 outbreak of equine influenza in Australia by identifying and analysing the stakeholder network involved and the factors driving policy decision-making. The study started with a review of the outbreak literature and published policy documents. This identified six policy issues regarding policy modifications or differing interpretations by different state agencies. Data on factors influencing the decision-making process for these six issues and on stakeholder interaction were collected using a pre-tested, semi-structured questionnaire. Face-to-face interviews were conducted with 24 individuals representing 12 industry and government organizations. Quantitative data were analysed using social network analysis. Qualitative data were coded and patterns matched to test a pre-determined general theory using a method called theory-oriented process-tracing. Results revealed that technical policy decisions were framed by social, political, financial, strategic and operational considerations. Industry stakeholders had influence through formal pre-existing channels, yet specific gaps in stakeholder interaction were overcome by reactive alliances formed during the outbreak response but outside the established system. Overall, the crisis management system and response were seen as positive, and 75-100% of individuals interviewed were supportive of, had interest in and considered the outcome as good for the majority of policy decisions, yet only 46-75% of those interviewed considered that they had influence on these decisions. Training to increase awareness and knowledge of emergency animal diseases (EADs) and response systems will improve stakeholder participation in emergency disease management and preparedness for future EAD incursions. © 2012 Blackwell Verlag GmbH.

Understanding health economic analysis in critical care: insights from recent randomized controlled trials.

PubMed

Sud, Sachin; Cuthbertson, Brian H

2011-10-01

The article reviews the methods of health economic analysis (HEA) in clinical trials of critically ill patients. Emphasis is placed on the usefulness of HEA in the context of positive and 'no effect' studies, with recent examples. The need to control costs and promote effective spending in caring for the critically ill has garnered considerable attention due to the high cost of critical illness. Many clinical trials focus on short-term mortality, ignoring costs and quality of life, and fail to change clinical practice or promote efficient use of resources. Incorporating HEA into clinical trials is a possible solution. Such studies have shown some interventions, although expensive, provide good value, whereas others should be withdrawn from clinical practice. Incorporating HEA into randomized controlled trials (RCTs) requires careful attention to collect all relevant costs. Decision trees, modeling assumptions and methods for collecting costs and measuring outcomes should be planned and published beforehand to minimize bias. Costs and cost-effectiveness are potentially useful outcomes in RCTs of critically ill patients. Future RCTs should incorporate parallel HEA to provide both economic outcomes, which are important to the community, alongside patient-centered outcomes, which are important to individuals.

Dynamic adaptive learning for decision-making supporting systems

NASA Astrophysics Data System (ADS)

He, Haibo; Cao, Yuan; Chen, Sheng; Desai, Sachi; Hohil, Myron E.

2008-03-01

This paper proposes a novel adaptive learning method for data mining in support of decision-making systems. Due to the inherent characteristics of information ambiguity/uncertainty, high dimensionality and noisy in many homeland security and defense applications, such as surveillances, monitoring, net-centric battlefield, and others, it is critical to develop autonomous learning methods to efficiently learn useful information from raw data to help the decision making process. The proposed method is based on a dynamic learning principle in the feature spaces. Generally speaking, conventional approaches of learning from high dimensional data sets include various feature extraction (principal component analysis, wavelet transform, and others) and feature selection (embedded approach, wrapper approach, filter approach, and others) methods. However, very limited understandings of adaptive learning from different feature spaces have been achieved. We propose an integrative approach that takes advantages of feature selection and hypothesis ensemble techniques to achieve our goal. Based on the training data distributions, a feature score function is used to provide a measurement of the importance of different features for learning purpose. Then multiple hypotheses are iteratively developed in different feature spaces according to their learning capabilities. Unlike the pre-set iteration steps in many of the existing ensemble learning approaches, such as adaptive boosting (AdaBoost) method, the iterative learning process will automatically stop when the intelligent system can not provide a better understanding than a random guess in that particular subset of feature spaces. Finally, a voting algorithm is used to combine all the decisions from different hypotheses to provide the final prediction results. Simulation analyses of the proposed method on classification of different US military aircraft databases show the effectiveness of this method.

A Novel Approach to Study Medical Decision Making in the Clinical Setting: The "Own-point-of-view" Perspective.

PubMed

Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard

2017-07-01

Making diagnostic and therapeutic decisions is a critical activity among physicians. It relies on the ability of physicians to use cognitive processes and specific knowledge in the context of a clinical reasoning. This ability is a core competency in physicians, especially in the field of emergency medicine where the rate of diagnostic errors is high. Studies that explore medical decision making in an authentic setting are increasing significantly. They are based on the use of qualitative methods that are applied at two separate times: 1) a video recording of the subject's actual activity in an authentic setting and 2) an interview with the subject, supported by the video recording. Traditionally, activity is recorded from an "external perspective"; i.e., a camera is positioned in the room in which the consultation takes place. This approach has many limits, both technical and with respect to the validity of the data collected. The article aims at 1) describing how decision making is currently being studied, especially from a qualitative standpoint, and the reasons why new methods are needed, and 2) reporting how we used an original, innovative approach to study decision making in the field of emergency medicine and findings from these studies to guide further the use of this method. The method consists in recording the subject's activity from his own point of view, by fixing a microcamera on his temple or the branch of his glasses. An interview is then held on the basis of this recording, so that the subject being interviewed can relive the situation, to facilitate the explanation of his reasoning with respect to his decisions and actions. We describe how this method has been used successfully in investigating medical decision making in emergency medicine. We provide details on how to use it optimally, taking into account the constraints associated with the practice of emergency medicine and the benefits in the study of clinical reasoning. The "own-point-of-view" video technique is a promising method to study clinical decision making in emergency medicine. It is a powerful tool to stimulate recall and help physicians make their reasoning explicit, thanks to a greater psychological immersion. © 2017 by the Society for Academic Emergency Medicine.

Geospatial decision support systems for societal decision making

USGS Publications Warehouse

Bernknopf, R.L.

2005-01-01

While science provides reliable information to describe and understand the earth and its natural processes, it can contribute more. There are many important societal issues in which scientific information can play a critical role. Science can add greatly to policy and management decisions to minimize loss of life and property from natural and man-made disasters, to manage water, biological, energy, and mineral resources, and in general, to enhance and protect our quality of life. However, the link between science and decision-making is often complicated and imperfect. Technical language and methods surround scientific research and the dissemination of its results. Scientific investigations often are conducted under different conditions, with different spatial boundaries, and in different timeframes than those needed to support specific policy and societal decisions. Uncertainty is not uniformly reported in scientific investigations. If society does not know that data exist, what the data mean, where to use the data, or how to include uncertainty when a decision has to be made, then science gets left out -or misused- in a decision making process. This paper is about using Geospatial Decision Support Systems (GDSS) for quantitative policy analysis. Integrated natural -social science methods and tools in a Geographic Information System that respond to decision-making needs can be used to close the gap between science and society. The GDSS has been developed so that nonscientists can pose "what if" scenarios to evaluate hypothetical outcomes of policy and management choices. In this approach decision makers can evaluate the financial and geographic distribution of potential policy options and their societal implications. Actions, based on scientific information, can be taken to mitigate hazards, protect our air and water quality, preserve the planet's biodiversity, promote balanced land use planning, and judiciously exploit natural resources. Applications using the GDSS have demonstrated the benefits of utilizing science for policy decisions. Investment in science reduces decision-making uncertainty and reducing that uncertainty has economic value.

Stakeholders’ Perspectives on Postmastectomy Breast Reconstruction: Recognizing Ways to Improve Shared Decision Making

PubMed Central

Hasak, Jessica M.; Myckatyn, Terence M.; Grabinski, Victoria F.; Philpott, Sydney E.; Parikh, Rajiv P.

2017-01-01

Background: Postmastectomy breast reconstruction (PMBR) is an elective, preference-sensitive decision made during a stressful, time-pressured period after a cancer diagnosis. Shared decision making (SDM) can improve decision quality about preference-sensitive choices. Stakeholders’ perspectives on ways to support PMBR decision-making were explored. Methods: Forty semi-structured interviews with stakeholders (20 postmastectomy patients, 10 PMBR surgeons, 10 PMBR nurses) were conducted. Clinicians were recruited from diverse practices across the United States. Patients were recruited using purposive sampling with varying PMBR experiences, including no reconstruction. The interview guide was based on an implementation research framework. Themes were identified using grounded theory approach, based on frequency and emotive force conveyed. Results: Engagement in SDM was variable. Some patients wanted more information about PMBR from clinicians, particularly about risks. Some clinicians acknowledged highlighting benefits and downplaying risks. Many patients felt pressured to make a choice by their clinicians. Clinicians who successfully engaged patients through decisions often used outside resources to supplement conversations. Conclusions: Patient–clinician trust was critical to high-quality decisions, and many patients expressed decision regret when they were not engaged in PMBR discussions. Patients often perceived a race- or age-related bias in clinician information sharing. Interventions to support SDM may enhance decision quality and reduce decision regret about PMBR, ultimately improving patient-centered care for women with breast cancer. PMID:29263969

Toward a methodology for moral decision making in medicine.

PubMed

Kushner, T; Belliotti, R A; Buckner, D

1991-12-01

The failure of medical codes to provide adequate guidance for physicians' moral dilemmas points to the fact that some rules of analysis, informed by moral theory, are needed to assist in resolving perplexing ethical problems occurring with increasing frequency as medical technology advances. Initially, deontological and teleological theories appear more helpful, but criticisms can be lodged against both, and neither proves to be sufficient in itself. This paper suggests that to elude the limitations of previous approaches, a method of moral decision making must be developed incorporating both coherence methodology and some independently supported theoretical foundations. Wide Reflective Equilibrium is offered, and its process described along with a theory of the person which is used to animate the process. Steps are outlined to be used in the process, leading to the application of the method to an actual case.

Psychiatric service staff perceptions of implementing a shared decision-making tool: a process evaluation study.

PubMed

Schön, Ulla-Karin; Grim, Katarina; Wallin, Lars; Rosenberg, David; Svedberg, Petra

2018-12-01

Shared decision making, SDM, in psychiatric services, supports users to experience a greater sense of involvement in treatment, self-efficacy, autonomy and reduced coercion. Decision tools adapted to the needs of users have the potential to support SDM and restructure how users and staff work together to arrive at shared decisions. The aim of this study was to describe and analyse the implementation process of an SDM intervention for users of psychiatric services in Sweden. The implementation was studied through a process evaluation utilizing both quantitative and qualitative methods. In designing the process evaluation for the intervention, three evaluation components were emphasized: contextual factors, implementation issues and mechanisms of impact. The study addresses critical implementation issues related to decision-making authority, the perceived decision-making ability of users and the readiness of the service to increase influence and participation. It also emphasizes the importance of facilitation, as well as suggesting contextual adaptations that may be relevant for the local organizations. The results indicate that staff perceived the decision support tool as user-friendly and useful in supporting participation in decision-making, and suggest that such concrete supports to participation can be a factor in implementation if adequate attention is paid to organizational contexts and structures.

Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.

PubMed

Mohan, Deepika; Alexander, Stewart C; Garrigues, Sarah K; Arnold, Robert M; Barnato, Amber E

2010-08-01

Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0-6) and at discussing end of life goals (0-16). Twenty-seven hospital-based physicians. Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p = 0.04). It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.

Merger of three modeling approaches to assess potential effects of climate change on trees in the eastern United States

Treesearch

Louis R. Iverson; Anantha M. Prasad; Stephen N. Matthews; Matthew P. Peters

2010-01-01

Climate change will likely cause impacts that are species specific and significant; modeling is critical to better understand potential changes in suitable habitat. We use empirical, abundance-based habitat models utilizing decision tree-based ensemble methods to explore potential changes of 134 tree species habitats in the eastern United States (http://www.nrs.fs.fed....

Hierarchical Deficiencies: Constructed Differences between Adolescent Boys and Girls in a Public School Single-Sex Program in the United States

ERIC Educational Resources Information Center

Glasser, Howard M.

2012-01-01

Although middle school is a critical time in adolescents' development, little is known about how that development is affected by public single-sex classes even though recent federal policy decisions have led more schools to provide these offerings. This case study used ethnographic methods to explore ways teachers, students, and courses in one…

Managing outbreaks of invasive species - a new method to prioritize preemptive quarantine efforts across large geographic regions

Treesearch

J.R. Withrow; E.L. Smith; F.H. Koch; D. Yemshanov

2015-01-01

In pest risk assessment it is frequently necessary to make time-critical decisions regarding management of expanding pest populations. When an invasive pest outbreak is expanding rapidly, preemptive quarantine of areas that are under imminent threat of infestation is one of only a few available management tools that can be implemented quickly to help control the...

An Exploratory Study of a New Educational Method Using Live Animals and Visual Thinking Strategies for Natural Science Teaching in Museums

ERIC Educational Resources Information Center

Genovesi, Jacqueline Sue

2011-01-01

The earth is in an environmental crisis that can only be addressed by changing human conservation attitudes. People must have the scientific knowledge to make informed decisions. Research identifying new promising practices, for the use of live animals that incorporate new theories of learning and factors proven to impact learning, is critical. …

Statistical Methods Applied to Gamma-ray Spectroscopy Algorithms in Nuclear Security Missions

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

Fagan, Deborah K.; Robinson, Sean M.; Runkle, Robert C.

2012-10-01

In a wide range of nuclear security missions, gamma-ray spectroscopy is a critical research and development priority. One particularly relevant challenge is the interdiction of special nuclear material for which gamma-ray spectroscopy supports the goals of detecting and identifying gamma-ray sources. This manuscript examines the existing set of spectroscopy methods, attempts to categorize them by the statistical methods on which they rely, and identifies methods that have yet to be considered. Our examination shows that current methods effectively estimate the effect of counting uncertainty but in many cases do not address larger sources of decision uncertainty—ones that are significantly moremore » complex. We thus explore the premise that significantly improving algorithm performance requires greater coupling between the problem physics that drives data acquisition and statistical methods that analyze such data. Untapped statistical methods, such as Bayes Modeling Averaging and hierarchical and empirical Bayes methods have the potential to reduce decision uncertainty by more rigorously and comprehensively incorporating all sources of uncertainty. We expect that application of such methods will demonstrate progress in meeting the needs of nuclear security missions by improving on the existing numerical infrastructure for which these analyses have not been conducted.« less

EVALUATING HYDROLOGICAL RESPONSE TO FORECASTED LAND-USE CHANGE: SCENARIO TESTING WITH THE AUTOMATED GEOSPATIAL WATERSHED ASSESSMENT (AGWA) TOOL

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions...

Fostering Innovation Through Robotics Exploration

DTIC Science & Technology

2015-06-01

16 Jan 09. 13. SUPPLEMENTARY NOTES 14. ABSTRACT This effort enhanced Robotics STEM activities by incorporating Cognitive tutors at key points to...make important mathematical decision or implement critical calculations. Program utilized Cognitive Tutor Authoring tools for designing problem...activities by incorporating cognitive tutors at key points to make important mathematical decision or implement critical calculations. The program

Applying the Critical Theory of Library Technology to Distance Library Services

ERIC Educational Resources Information Center

Brumfield, Elizabeth Jean

2010-01-01

The re-envisioning of libraries as information leaders in higher education requires an examination of the decisions made in the acquisition and adoption of library technology. The Critical Theory of Library Technology offers a framework for viewing technology decisions through a social, economic and political perspective. This paper uses the…

Scenario Analysis: Evaluating Biodiversity Response to Forecasted Land-Use Change in the San Pedro River Basin (U.S.-Mexico)

EPA Science Inventory

Envisioning and evaluating future scenarios has emerged as a critical component of both science and social decision-making. The ability to assess, report, map, and forecast the life support functions of ecosystems is absolutely critical to our capacity to make informed decisions...

75 FR 23167 - Protection of Stratospheric Ozone: The 2010 Critical Use Exemption From the Phaseout of Methyl...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-03

... seedlings. Nursery stock--fruit, nut, flower. Orchard replant. Ornamentals. Peppers--field. Strawberries--field. Strawberry runners. Tomatoes--field. Sweet potato slips. The agreed U.S. critical use levels for... Table A of Decision XXI/11 for southeast strawberry nurseries. Both Decisions noted that these amounts...

California Policy Options to Accelerate Latino Student Success in Higher Education

ERIC Educational Resources Information Center

Santiago, Deborah A.

2006-01-01

California policy makers and institutional leaders are making critical policy, programmatic, and budgetary decisions affecting segments of the state's population that lack sufficient levels of formal training and education. These decisions are occurring at a time when five critical trends are converging in the state. These trends are: (1)…

Decision making in noisy bistable systems with time-dependent asymmetry

NASA Astrophysics Data System (ADS)

Nené, Nuno R.; Zaikin, Alexey

2013-01-01

Our work draws special attention to the importance of the effects of time-dependent parameters on decision making in bistable systems. Here, we extend previous studies of the mechanism known as speed-dependent cellular decision making in genetic circuits by performing an analytical treatment of the canonical supercritical pitchfork bifurcation problem with an additional time-dependent asymmetry and control parameter. This model has an analogous behavior to the genetic switch. In the presence of transient asymmetries and fluctuations, slow passage through the critical region in both systems increases substantially the probability of specific decision outcomes. We also study the relevance for attractor selection of reaching maximum values for the external asymmetry before and after the critical region. Overall, maximum asymmetries should be reached at an instant where the position of the critical point allows for compensation of the detrimental effects of noise in retaining memory of the transient asymmetries.

Do personal stories make patient decision aids more effective? A critical review of theory and evidence

PubMed Central

2013-01-01

Background Patient decision aids support people to make informed decisions between healthcare options. Personal stories provide illustrative examples of others’ experiences and are seen as a useful way to communicate information about health and illness. Evidence indicates that providing information within personal stories affects the judgments and values people have, and the choices they make, differentially from facts presented in non-narrative prose. It is unclear if including narrative communications within patient decision aids enhances their effectiveness to support people to make informed decisions. Methods A survey of primary empirical research employing a systematic review method investigated the effect of patient decision aids with or without a personal story on people’s healthcare judgements and decisions. Searches were carried out between 2005-2012 of electronic databases (Medline, PsycINFO), and reference lists of identified articles, review articles, and key authors. A narrative analysis described and synthesised findings. Results Of 734 citations identified, 11 were included describing 13 studies. All studies found participants’ judgments and/or decisions differed depending on whether or not their decision aid included a patient story. Knowledge was equally facilitated when the decision aids with and without stories had similar information content. Story-enhanced aids may help people recall information over time and/or their motivation to engage with health information. Personal stories affected both “system 1” (e.g., less counterfactual reasoning, more emotional reactions and perceptions) and “system 2” (e.g., more perceived deliberative decision making, more stable evaluations over time) decision-making strategies. Findings exploring associations with narrative communications, decision quality measures, and different levels of literacy and numeracy were mixed. The pattern of findings was similar for both experimental and real-world studies. Conclusions There is insufficient evidence that adding personal stories to decision aids increases their effectiveness to support people’s informed decision making. More rigorous research is required to elicit evidence about the type of personal story that a) encourages people to make more reasoned decisions, b) discourages people from making choices based on another’s values, and c) motivates people equally to engage with healthcare resources. PMID:24625283

The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment.

PubMed

Venkat, Arvind; Becker, Julianna

2014-01-01

While the ethics and critical care literature is replete with discussion of medical futility and the ethics of end-of-life care decisions in the intensive care unit, little attention is paid to the effect of statutory limitations on the authority of substitute decision makers during the course of treatment of patients in the critical care setting. In many jurisdictions, a clear distinction is made between the authority of a health care power of attorney, who is legally designated by a competent adult to make decisions regarding withholding or withdrawing life-sustaining treatment, and of next-of-kin, who are limited in this regard. However, next-of-kin are often relied upon to consent to necessary procedures to advance a patient's medical care. When conflicts arise between critical care physicians and family members regarding projected patient outcome and functional status, these statutory limitations on decision-making authority by next of kin can cause paralysis in the medical care of severely ill patients, leading to practical and ethical impasses. In this article, we will provide case examples of how statutory limitations on substitute decision making authority for next of kin can impede the care of patients. We will also review the varying jurisdictional limitations on the authority of substitute decision makers and explore their implications for patient care in the critical care setting. Finally, we will review possible ethical and legal solutions to resolve these impasses.

Representing student achievements in science

NASA Astrophysics Data System (ADS)

Fusco, Dana; Calabrese Barton, Angela

2001-03-01

In what follows, we develop a conceptual argument for expanding current visions of performance assessment to include the following three ideals: that performance/assessment addresses the value-laden decisions about what and whose science is learned and assessed and include multiple worldviews, that performance/assessment in science simultaneously emerges in response to local needs, and that the performance/assessment is a method as well as an ongoing search for method. To make this argument, we draw together ideas raised by critical, feminist and multicultural science educators to describe an inclusive science education, one we refer to as critical science education, to raise questions about the nature and purpose of performance assessment in science education. We are particularly interested in how the science of assessment is challenged and transformed within a critical science education perspective and the conditions needed to create an equitable and inclusive practice of science and science assessment across diversity. We present a case study from a youth-led community science project in the inner city to help contextualize our argument.

Explaining why nurses remain in or leave bedside nursing: a critical ethnography.

PubMed

Mahon, Paula; McPherson, Gladys

2014-09-01

To describe the application of critical ethnography to explain nurses' decisions to remain in or leave bedside nursing, and to describe researcher positioning and reflexivity. Enquiry into hospital nurses' decisions to remain in or leave bedside nursing positions has been conducted from a variety of theoretical perspectives by researchers adopting a range of methodological approaches. This research helps to explain how work environments can affect variables such as job satisfaction and turnover, but provides less insight into how personal and professional factors shape decisions to remain in or leave bedside nursing. A critical theoretical perspective was taken to examine the employment decisions made by nurses in a paediatric intensive care unit (PICU). Data was collected from nurses (n=31) through semi-structured interviews and unobtrusive observation. The authors describe critical ethnography as a powerful research framework for enquiry that allowed them to challenge assumptions about why nurses remain in or leave their jobs, and to explore how issues of fairness and equity contribute to these decisions. Critical ethnography offers a powerful methodology for investigations into complex interactions, such as those between nurses in a PICU. In adopting this methodology, researchers should be sensitised to manifestations of power, attend to their stance and location, and reflexion. The greatest challenges from this research included how to make sense of the insider position, how to acknowledge assumptions and allow these to be challenged, and how to ensure that power relationships in the environment and in the research were attended to.

Cultural differences with end-of-life care in the critical care unit.

PubMed

Doolen, Jessica; York, Nancy L

2007-01-01

Critical care nurses are providing healthcare for an increasingly multicultural population. This ever-increasing diversity in cultures and subcultures presents a challenge to nurses who want to provide culturally competent care. It is common for patients and families to face difficult decisions about end-of-life care in critical care units, and minority cultures do not always believe in the Westerner's core values of patient autonomy and self-determination. Knowledge of these cultural differences is fundamental if critical care nurses wish to provide appropriate and culturally competent information regarding end-of-life decisions.

Evolution of Query Optimization Methods

NASA Astrophysics Data System (ADS)

Hameurlain, Abdelkader; Morvan, Franck

Query optimization is the most critical phase in query processing. In this paper, we try to describe synthetically the evolution of query optimization methods from uniprocessor relational database systems to data Grid systems through parallel, distributed and data integration systems. We point out a set of parameters to characterize and compare query optimization methods, mainly: (i) size of the search space, (ii) type of method (static or dynamic), (iii) modification types of execution plans (re-optimization or re-scheduling), (iv) level of modification (intra-operator and/or inter-operator), (v) type of event (estimation errors, delay, user preferences), and (vi) nature of decision-making (centralized or decentralized control).

[Is the critical patient competent for decision taking? Psychological and psychopathological reasons of cognitive impairment].

PubMed

Bernat-Adell, M D; Ballester-Arnal, R; Abizanda-Campos, R

2012-01-01

Emotional factors may lead to cognitive impairment that can adversely affect the capacity of patients to reason, and thereby, limit their participation in decision taking. To analyze critical patient aptitude for decision taking, and to identify variables that may influence competence. An observational descriptive study was carried out. Intensive care unit. Participants were 29 critically ill patients. Social, demographic and psychological variables were analyzed. Functional capacities and psychological reactions during stay in the ICU were assessed. The patients are of the firm opinion that they should have the last word in the taking of decisions; they prefer bad news to be given by the physician; and feel that the presence of a psychologist would make the process easier. Failure on the part of the professional to answer their questions is perceived as the greatest stress factor. Increased depression results in lesser cognitive capacity, and for patients with impaired cognitive capacity, participation in the decision taking process constitutes a burden. The variables anxiety and depression are significantly related to decision taking capacity. Copyright © 2011 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Naturalistic Decision Making for Power System Operators

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

Greitzer, Frank L.; Podmore, Robin; Robinson, Marck

2010-02-01

Motivation – Investigations of large-scale outages in the North American interconnected electric system often attribute the causes to three T’s: Trees, Training and Tools. To document and understand the mental processes used by expert operators when making critical decisions, a naturalistic decision making (NDM) model was developed. Transcripts of conversations were analyzed to reveal and assess NDM-based performance criteria. Findings/Design – An item analysis indicated that the operators’ Situation Awareness Levels, mental models, and mental simulations can be mapped at different points in the training scenario. This may identify improved training methods or analytical/ visualization tools. Originality/Value – This studymore » applies for the first time, the concepts of Recognition Primed Decision Making, Situation Awareness Levels and Cognitive Task Analysis to training of electric power system operators. Take away message – The NDM approach provides a viable framework for systematic training management to accelerate learning in simulator-based training scenarios for power system operators and teams.« less

Safety leadership and systems thinking: application and evaluation of a Risk Management Framework in the mining industry.

PubMed

Donovan, Sarah-Louise; Salmon, Paul M; Lenné, Michael G; Horberry, Tim

2017-10-01

Safety leadership is an important factor in supporting safety in high-risk industries. This article contends that applying systems-thinking methods to examine safety leadership can support improved learning from incidents. A case study analysis was undertaken of a large-scale mining landslide incident in which no injuries or fatalities were incurred. A multi-method approach was adopted, in which the Critical Decision Method, Rasmussen's Risk Management Framework and Accimap method were applied to examine the safety leadership decisions and actions which enabled the safe outcome. The approach enabled Rasmussen's predictions regarding safety and performance to be examined in the safety leadership context, with findings demonstrating the distribution of safety leadership across leader and system levels, and the presence of vertical integration as key to supporting the successful safety outcome. In doing so, the findings also demonstrate the usefulness of applying systems-thinking methods to examine and learn from incidents in terms of what 'went right'. The implications, including future research directions, are discussed. Practitioner Summary: This paper presents a case study analysis, in which systems-thinking methods are applied to the examination of safety leadership decisions and actions during a large-scale mining landslide incident. The findings establish safety leadership as a systems phenomenon, and furthermore, demonstrate the usefulness of applying systems-thinking methods to learn from incidents in terms of what 'went right'. Implications, including future research directions, are discussed.

The cognitive processes underpinning clinical decision in triage assessment: a theoretical conundrum?

PubMed

Noon, Amy J

2014-01-01

High quality clinical decision-making (CDM) has been highlighted as a priority across the nursing profession. Triage nurses, in the Accident and Emergency (A&E) department, work in considerable levels of uncertainty and require essential skills including: critical thinking, evaluation and decision-making. The content of this paper aims to promote awareness of how triage nurses make judgements and decisions in emergency situations. By exploring relevant literature on clinical judgement and decision-making theory, this paper demonstrates the importance of high quality decision-making skills underpinning the triage nurse's role. Having an awareness of how judgements and decisions are made is argued as essential, in a time where traditional nurse boundaries and responsibilities are never more challenged. It is hoped that the paper not only raises this awareness in general but also, in particular, engages the triage nurse to look more critically at how they make their own decisions in their everyday practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

Discontinuing treatment in children with chronic, critical illnesses.

PubMed

Mahon, M M; Deatrick, J A; McKnight, H J; Mohr, W K

2000-03-01

Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

Application of an integrated multi-criteria decision making AHP-TOPSIS methodology for ETL software selection.

PubMed

Hanine, Mohamed; Boutkhoum, Omar; Tikniouine, Abdessadek; Agouti, Tarik

2016-01-01

Actually, a set of ETL software (Extract, Transform and Load) is available to constitute a major investment market. Each ETL uses its own techniques for extracting, transforming and loading data into data warehouse, which makes the task of evaluating ETL software very difficult. However, choosing the right software of ETL is critical to the success or failure of any Business Intelligence project. As there are many impacting factors in the selection of ETL software, the same process is considered as a complex multi-criteria decision making (MCDM) problem. In this study, an application of decision-making methodology that employs the two well-known MCDM techniques, namely Analytic Hierarchy Process (AHP) and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) methods is designed. In this respect, the aim of using AHP is to analyze the structure of the ETL software selection problem and obtain weights of the selected criteria. Then, TOPSIS technique is used to calculate the alternatives' ratings. An example is given to illustrate the proposed methodology. Finally, a software prototype for demonstrating both methods is implemented.

Measuring Road Network Vulnerability with Sensitivity Analysis

PubMed Central

Jun-qiang, Leng; Long-hai, Yang; Liu, Wei-yi; Zhao, Lin

2017-01-01

This paper focuses on the development of a method for road network vulnerability analysis, from the perspective of capacity degradation, which seeks to identify the critical infrastructures in the road network and the operational performance of the whole traffic system. This research involves defining the traffic utility index and modeling vulnerability of road segment, route, OD (Origin Destination) pair and road network. Meanwhile, sensitivity analysis method is utilized to calculate the change of traffic utility index due to capacity degradation. This method, compared to traditional traffic assignment, can improve calculation efficiency and make the application of vulnerability analysis to large actual road network possible. Finally, all the above models and calculation method is applied to actual road network evaluation to verify its efficiency and utility. This approach can be used as a decision-supporting tool for evaluating the performance of road network and identifying critical infrastructures in transportation planning and management, especially in the resource allocation for mitigation and recovery. PMID:28125706

Community-level climate change vulnerability research: trends, progress, and future directions

NASA Astrophysics Data System (ADS)

McDowell, Graham; Ford, James; Jones, Julie

2016-03-01

This study systematically identifies, characterizes, and critically evaluates community-level climate change vulnerability assessments published over the last 25 years (n = 274). We find that while the field has advanced considerably in terms of conceptual framing and methodological approaches, key shortcomings remain in how vulnerability is being studied at the community-level. We argue that vulnerability research needs to more critically engage with the following: methods for evaluating future vulnerability, the relevance of vulnerability research for decision-making, interdependencies between social and ecological systems, attention to researcher / subject power dynamics, critical interpretation of key terms, and consideration of the potentially positive opportunities presented by a changing climate. Addressing these research needs is necessary for generating knowledge that supports climate-affected communities in navigating the challenges and opportunities ahead.

Building capacity for evidence informed decision making in public health: a case study of organizational change

PubMed Central

2012-01-01

Background Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. Methods This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. Results The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. Conclusion With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization. PMID:22348688

Hospital Administration and Nursing Leadership in Disasters: An Exploratory Study Using Concept Mapping.

PubMed

Veenema, Tener Goodwin; Deruggiero, Katherine; Losinski, Sarah; Barnett, Daniel

Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.

A Decision Process for Determining Whether to Conduct Responder Health Research Following Disasters

PubMed Central

Decker, John A.; Kiefer, Max; Reissman, Dori B.; Funk, Renée; Halpin, John; Bernard, Bruce; Ehrenberg, Richard L.; Schuler, Christine R.; Whelan, Elizabeth; Myers, Kyle; Howard, John

2015-01-01

Background Disasters often set the stage for scientific inquiry within the field of occupational safety and health. This is especially true when the long-term consequences of exposures associated with a particular disaster are unclear. However, a responder research study can be costly and difficult to design, and researchers must consider whether the proposed study will produce useful, reliable results and is a prudent public health investment. Methods Senior NIOSH scientists, experienced with disaster response and representing the disciplines of epidemiology, occupational medicine and psychiatry, and industrial hygiene, were convened at the request of the NIOSH Director to develop a decision process to help determine when to conduct responder health research following disasters. Results The decision process can be broken down into various components, including scientific rationale that should be formally recognized as critical to efficiently and effectively determine whether a research study is warranted. The scientific rationale includes certain controlling or “gatekeeper” factors that should be present to proceed with research. Providing the foundation for responder disaster research also requires strategizing before an event occurs, so that critical baseline and comparison data can be collected. Conclusions The recommended framework should ensure that research that is most needed and justified will be identified and prioritized. PMID:23716371

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

Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders.

PubMed

Byun, Tara McAllister; Hitchcock, Elaine R; Ferron, John

2017-06-10

Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects. This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed. Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

Critical Thinking: Discovery of a Misconception

ERIC Educational Resources Information Center

Rohrer, Sandie

2014-01-01

Critical thinking skills in the healthcare field are imperative when making quick-thinking decisions. This descriptive comparative study investigated to what extent completing a critical thinking course improved college students' critical thinking skills. The study further investigated whether the instructors' critical thinking skills were…

Cost-Effectiveness of HBV and HCV Screening Strategies – A Systematic Review of Existing Modelling Techniques

PubMed Central

Geue, Claudia; Wu, Olivia; Xin, Yiqiao; Heggie, Robert; Hutchinson, Sharon; Martin, Natasha K.; Fenwick, Elisabeth; Goldberg, David

2015-01-01

Introduction Studies evaluating the cost-effectiveness of screening for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are generally heterogeneous in terms of risk groups, settings, screening intervention, outcomes and the economic modelling framework. It is therefore difficult to compare cost-effectiveness results between studies. This systematic review aims to summarise and critically assess existing economic models for HBV and HCV in order to identify the main methodological differences in modelling approaches. Methods A structured search strategy was developed and a systematic review carried out. A critical assessment of the decision-analytic models was carried out according to the guidelines and framework developed for assessment of decision-analytic models in Health Technology Assessment of health care interventions. Results The overall approach to analysing the cost-effectiveness of screening strategies was found to be broadly consistent for HBV and HCV. However, modelling parameters and related structure differed between models, producing different results. More recent publications performed better against a performance matrix, evaluating model components and methodology. Conclusion When assessing screening strategies for HBV and HCV infection, the focus should be on more recent studies, which applied the latest treatment regimes, test methods and had better and more complete data on which to base their models. In addition to parameter selection and associated assumptions, careful consideration of dynamic versus static modelling is recommended. Future research may want to focus on these methodological issues. In addition, the ability to evaluate screening strategies for multiple infectious diseases, (HCV and HIV at the same time) might prove important for decision makers. PMID:26689908

Information needs of physicians, care coordinators, and families to support care coordination of children and youth with special health care needs (CYSHCN).

PubMed

Ranade-Kharkar, Pallavi; Weir, Charlene; Norlin, Chuck; Collins, Sarah A; Scarton, Lou Ann; Baker, Gina B; Borbolla, Damian; Taliercio, Vanina; Del Fiol, Guilherme

2017-09-01

Identify and describe information needs and associated goals of physicians, care coordinators, and families related to coordinating care for medically complex children and youth with special health care needs (CYSHCN). We conducted 19 in-depth interviews with physicians, care coordinators, and parents of CYSHCN following the Critical Decision Method technique. We analyzed the interviews for information needs posed as questions using a systematic content analysis approach and categorized the questions into information need goal types and subtypes. The Critical Decision Method interviews resulted in an average of 80 information needs per interview. We categorized them into 6 information need goal types: (1) situation understanding, (2) care networking, (3) planning, (4) tracking/monitoring, (5) navigating the health care system, and (6) learning, and 32 subtypes. Caring for CYSHCN generates a large amount of information needs that require significant effort from physicians, care coordinators, parents, and various other individuals. CYSHCN are often chronically ill and face developmental challenges that translate into intense demands on time, effort, and resources. Care coordination for CYCHSN involves multiple information systems, specialized resources, and complex decision-making. Solutions currently offered by health information technology fall short in providing support to meet the information needs to perform the complex care coordination tasks. Our findings present significant opportunities to improve coordination of care through multifaceted and fully integrated informatics solutions. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Critically Ill Patients and End-of-Life Decision-Making: The Senior Medical Resident Experience

ERIC Educational Resources Information Center

Ahern, Stephane P.; Doyle, Tina K.; Marquis, Francois; Lesk, Corey; Skrobik, Yoanna

2012-01-01

In order to improve the understanding of educational needs among residents caring for the critically ill, narrative accounts of 19 senior physician trainees participating in level of care decision-making were analyzed. In this multicentre qualitative study involving 9 university centers in Canada, in-depth interviews were conducted in either…

Critical Issues for Teacher Educators and Literacy Specialists: A View from Higher Education in New York

ERIC Educational Resources Information Center

Goatley, Virginia

2008-01-01

This article outlines five critical issues for teacher educators and literacy specialists in New York State. Intended to raise issues and share recent policy decisions, the article provides background and conversations about current policy. Readers are encouraged to make decisions about how to participate in the current conversations across the…

Longitudinal Analysis Technique to Assist School Leaders in Making Critical Curriculum and Instruction Decisions for School Improvement

ERIC Educational Resources Information Center

Bigham, Gary D.; Riney, Mark R.

2017-01-01

To meet the constantly changing needs of schools and diverse learners, educators must frequently monitor student learning, revise curricula, and improve instruction. Consequently, it is critical that careful analyses of student performance data are ongoing components of curriculum decision-making processes. The primary purpose of this study is to…

Dorsal Striatal-Midbrain Connectivity in Humans Predicts How Reinforcements Are Used to Guide Decisions

ERIC Educational Resources Information Center

Kahnt, Thorsten; Park, Soyoung Q.; Cohen, Michael X.; Beck, Anne; Heinz, Andreas; Wrase, Jana

2009-01-01

It has been suggested that the target areas of dopaminergic midbrain neurons, the dorsal (DS) and ventral striatum (VS), are differently involved in reinforcement learning especially as actor and critic. Whereas the critic learns to predict rewards, the actor maintains action values to guide future decisions. The different midbrain connections to…

Modeling To Enhance Critical Thinking and Decision Making Skills Development in the Instructional Process: The Social Studies.

ERIC Educational Resources Information Center

Peters, Richard

Students must be actively involved in the process of learning for it to have personal meaning and importance in their lives. Teachers must also become critical thinkers, creative individuals, and decision makers in order to create more challenging learning environments. Teachers need to blend structure and spontaneity into meaningful learning…

Critical Race Parenting in the Trump Era: A Sisyphean Endeavor? A Parable

ERIC Educational Resources Information Center

Montoya, Roberto; Sarcedo, Geneva L.

2018-01-01

This article examines the complicated decisions parents make when they decide to raise critically conscious children. The article argues that critical parenting in US society is often analogous to the Greek myth of Sisyphus. Using Critical Race Parenting, Critical Race Theory, and Critical Whiteness Studies, this critically interpretive parable…

Challenges of assessing critical thinking and clinical judgment in nurse practitioner students.

PubMed

Gorton, Karen L; Hayes, Janice

2014-03-01

The purpose of this study was to determine whether there was a relationship between critical thinking skills and clinical judgment in nurse practitioner students. The study used a convenience, nonprobability sampling technique, engaging participants from across the United States. Correlational analysis demonstrated no statistically significant relationship between critical thinking skills and examination-style questions, critical thinking skills and scores on the evaluation and reevaluation of consequences subscale of the Clinical Decision Making in Nursing Scale, and critical thinking skills and the preceptor evaluation tool. The study found no statistically significant relationships between critical thinking skills and clinical judgment. Educators and practitioners could consider further research in these areas to gain insight into how critical thinking is and could be measured, to gain insight into the clinical decision making skills of nurse practitioner students, and to gain insight into the development and measurement of critical thinking skills in advanced practice educational programs. Copyright 2014, SLACK Incorporated.

[Quantitative and qualitative research methods, can they coexist yet?].

PubMed

Hunt, Elena; Lavoie, Anne-Marise

2011-06-01

Qualitative design is gaining ground in Nursing research. In spite of a relative progress however, the evidence based practice movement continues to dominate and to underline the exclusive value of quantitative design (particularly that of randomized clinical trials) for clinical decision making. In the actual context convenient to those in power making utilitarian decisions on one hand, and facing nursing criticism of the establishment in favor of qualitative research on the other hand, it is difficult to chose a practical and ethical path that values the nursing role within the health care system, keeping us committed to quality care and maintaining researcher's integrity. Both qualitative and quantitative methods have advantages and disadvantages, and clearly, none of them can, by itself, capture, describe and explain reality adequately. Therefore, a balance between the two methods is needed. Researchers bare responsibility to society and science, and they should opt for the appropriate design susceptible to answering the research question, not promote the design favored by the research funding distributors.

[Effects of situational and individual variables on critical thinking expression].

PubMed

Tanaka, Yuko; Kusumi, Takashi

2016-04-01

The present study examined when people decide to choose an expression that is based on critical thinking, and how situational and individual variables affect such a decision process. Given a conversation scenario including overgeneralization with two friends, participants decided whether to follow the conversation by a critical-thinking expression or not. The authors controlled purpose and topic as situational variables, and measured critical-thinking ability, critical-thinking disposition, and self-monitoring as individual variables. We conducted an experiment in which the situational variables were counterbalanced in a within-subject design with 60 university students. The results of logistic regression analysis showed differences within individuals in the decision process whether to choose a critical-thinking expression, and that some situational factors and some subscales of the individual measurements were related to the differences.

Communication About Chronic Critical Illness

PubMed Central

Nelson, Judith E.; Mercado, Alice F.; Camhi, Sharon L.; Tandon, Nidhi; Wallenstein, Sylvan; August, Gary I.; Morrison, R. Sean

2008-01-01

Background Despite poor outcomes, life-sustaining treatments including mechanical ventilation are continued for a large and growing population of patients with chronic critical illness. This may be owing in part to a lack of understanding resulting from inadequate communication between clinicians and patients and families. Our objective was to investigate the informational needs of patients with chronic critical illness and their families and the extent to which these needs are met. Methods In this prospective observational study conducted at 5 adult intensive care units in a large, university-affiliated hospital in New York, New York, 100 patients with chronic critical illness (within 3–7 days of elective tracheotomy for prolonged mechanical ventilation) or surrogates for incapacitated patients were surveyed using an 18-item questionnaire addressing communication about chronic critical illness. Main outcome measures included ratings of importance and reports of whether information was received about questionnaire items. Results Among 125 consecutive, eligible patients, 100 (80%) were enrolled; questionnaire respondents included 2 patients and 98 surrogates. For all items, more than 78% of respondents rated the information as important for decision making (>98% for 16 of 18 items). Respondents reported receiving no information for a mean (SD) of 9.0 (3.3) of 18 items, with 95% of respondents reporting not receiving information for approximately one-quarter of the items. Of the subjects rating the item as important, 77 of 96 (80%) and 69 of 74 (93%) reported receiving no information about expected functional status at hospital discharge and prognosis for 1-year survival, respectively. Conclusions Many patients and their families may lack important information for decision making about continuation of treatment in the chronic phase of critical illness. Strategies for effective communication in this clinical context should be investigated and implemented. PMID:18071175

LANL Institutional Decision Support By Process Modeling and Analysis Group (AET-2)

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

Booth, Steven Richard

2016-04-04

AET-2 has expertise in process modeling, economics, business case analysis, risk assessment, Lean/Six Sigma tools, and decision analysis to provide timely decision support to LANS leading to continuous improvement. This capability is critical during the current tight budgetary environment as LANS pushes to identify potential areas of cost savings and efficiencies. An important arena is business systems and operations, where processes can impact most or all laboratory employees. Lab-wide efforts are needed to identify and eliminate inefficiencies to accomplish Director McMillan’s charge of “doing more with less.” LANS faces many critical and potentially expensive choices that require sound decision supportmore » to ensure success. AET-2 is available to provide this analysis support to expedite the decisions at hand.« less

A decision tree-based on-line preventive control strategy for power system transient instability prevention

NASA Astrophysics Data System (ADS)

Xu, Yan; Dong, Zhao Yang; Zhang, Rui; Wong, Kit Po

2014-02-01

Maintaining transient stability is a basic requirement for secure power system operations. Preventive control deals with modifying the system operating point to withstand probable contingencies. In this article, a decision tree (DT)-based on-line preventive control strategy is proposed for transient instability prevention of power systems. Given a stability database, a distance-based feature estimation algorithm is first applied to identify the critical generators, which are then used as features to develop a DT. By interpreting the splitting rules of DT, preventive control is realised by formulating the rules in a standard optimal power flow model and solving it. The proposed method is transparent in control mechanism, on-line computation compatible and convenient to deal with multi-contingency. The effectiveness and efficiency of the method has been verified on New England 10-machine 39-bus test system.

Informing urban carbon emissions with atmospheric observations: motivation, methods, and reducing uncertainties.

NASA Astrophysics Data System (ADS)

Kort, E. A.; Ware, J.; Duren, R. M.; Schimel, D.; Miller, C. E.; Decola, P.

2014-12-01

Urban regions play a dominant role in the anthropogenic perturbation to atmospheric carbon dioxide and methane. With increasing urbanization (notably in developing nations) and increasing emissions, quantitative observational information on emissions of CO2 and CH4 becomes critical for improved understanding of the global carbon cycle and for carbon management/policy decisions. In this presentation, we will discuss the impact uncertainty in anthropogenic emissions has on global carbon-climate understanding, providing broad geophysical motivation for urban studies. We will further discuss observations of urban regions at different scales (satellite vs. in-situ), and investigate the information content of these complementary methods for answering targeted questions on both global carbon fluxes and regional management decisions. Finally, we will present new attempts at reducing uncertainty in high-resolution inversions leveraging remotely sensed aerosol profiles to constrain both mixing depths and vertical distributions of trace gases.

Enduring powers of attorney: promoting attorneys' accountability as substitute decision makers.

PubMed

Tilse, Cheryl; Wilson, Jill; White, Ben; Willmott, Lindy; McCawley, Anne-Louise

2014-09-01

The misuse and abuse of Enduring Powers of Attorney (EPAs) by attorneys, particularly in relation to financial decision-making, is a growing concern. This paper explores the opportunities to enhance accountability of attorneys at the time of the execution of the document in Queensland. A four-stage multi-method design comprised a critical reference group; semi-structured interviews with 32 principals or potential principals, attorneys and witnesses; two focus groups with service providers and a state-wide survey of 76 principals, attorneys and witnesses. Across all methods and user groups, understanding the role and obligations of the attorney in an EPA was consistently identified as problematic. Promoting accountability and understanding can be addressed by greater attention to the role of the attorney in the forms/ guidelines and in the structure and witnessing of the forms, increased direction about record keeping and access to appropriate advice and support. © 2013 ACOTA.

Engaging the Public to Identify Opportunities to Improve Critical Care: A Qualitative Analysis of an Open Community Forum

PubMed Central

Potestio, Melissa L.; Boyd, Jamie M.; Bagshaw, Sean M.; Heyland, Daren; Oxland, Peter; Doig, Christopher J.; Zygun, Dave; Stelfox, Henry T.

2015-01-01

Objective To engage the public to understand how to improve the care of critically ill patients. Design A qualitative content analysis of an open community forum (Café Scientifique). Setting Public venue in Calgary, Alberta, Canada. Participants Members of the general public including patients, families of patients, health care providers, and members of the community at large. Methods A panel of researchers, decision-makers, and a family member led a Café Scientifique, an informal dialogue between the populace and experts, over three-hours to engage the public to understand how to improve the care of critically ill patients. Conventional qualitative content analysis was used to analyze the data. The inductive analysis occurred in three phases: coding, categorizing, and developing themes. Results Thirty-eight members of the public (former ICU patients, family members of patients, providers, community members) attended. Participants focused the discussion and provided concrete suggestions for improvement around communication (family as surrogate voice, timing of conversations, decision tools) and provider well-being and engagement, as opposed to medical interventions in critical care. Conclusions Café participants believe patient and family centered care is important to ensure high-quality care in the ICU. A Café Scientifique is a valuable forum to engage the public to contribute to priority setting areas for research in critical care, as well as a platform to share lived experience. Research stakeholders including health care organizations, governments, and funding organizations should provide more opportunities for the public to engage in meaningful conversations about how to best improve healthcare. PMID:26580406

ACL Return to Sport Guidelines and Criteria.

PubMed

Davies, George J; McCarty, Eric; Provencher, Matthew; Manske, Robert C

2017-09-01

Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients that return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10-year follow-ups, and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas is what criteria and clinical decision making should be used to return an athlete back to sports following an ACL-R. This article describes an example of a functional testing algorithm (FTA) as one method for clinical decision making based on quantitative and qualitative testing and assessment utilized to make informed decisions to return an athlete to their sports safely and without compromised performance. The methods were a review of the best current evidence to support a FTA. In order to evaluate all the complicated domains of the clinical decision making for individualizing the return to sports after ACL-R, numerous assessments need to be performed including the biopsychosocial concepts, impairment testing, strength and power testing, functional testing, and patient-reported outcomes (PROs). The optimum criteria to use for individualizing the return to sports after ACL-R remain elusive. However, since this decision needs to be made on a regular basis with the safety and performance factors of the patient involved, this FTA provides one method of quantitatively and qualitatively making the decisions. Admittedly, there is no predictive validity of this system, but it does provide practical guidelines to facilitate the clinical decision making process for return to sports. The clinical decision to return an athlete back into competition has significant implications ranging from the safety of the athlete, to performance factors and actual litigation issues. By using a multifactorial FTA, such as the one described, provides quantitative and qualitatively criteria to make an informed decision in the best interests of the athlete.

Effects of dividing attention during encoding on perceptual priming of unfamiliar visual objects.

PubMed

Soldan, Anja; Mangels, Jennifer A; Cooper, Lynn A

2008-11-01

According to the distractor-selection hypothesis (Mulligan, 2003), dividing attention during encoding reduces perceptual priming when responses to non-critical (i.e., distractor) stimuli are selected frequently and simultaneously with critical stimulus encoding. Because direct support for this hypothesis comes exclusively from studies using familiar word stimuli, the present study tested whether the predictions of the distractor-selection hypothesis extend to perceptual priming of unfamiliar visual objects using the possible/impossible object decision test. Consistent with the distractor-selection hypothesis, Experiments 1 and 2 found no reduction in priming when the non-critical stimuli were presented infrequently and non-synchronously with the critical target stimuli, even though explicit recognition memory was reduced. In Experiment 3, non-critical stimuli were presented frequently and simultaneously during encoding of critical stimuli; however, no decrement in priming was detected, even when encoding time was reduced. These results suggest that priming in the possible/impossible object decision test is relatively immune to reductions in central attention and that not all aspects of the distractor-selection hypothesis generalise to priming of unfamiliar visual objects. Implications for theoretical models of object decision priming are discussed.

Effects of dividing attention during encoding on perceptual priming of unfamiliar visual objects

PubMed Central

Soldan, Anja; Mangels, Jennifer A.; Cooper, Lynn A.

2008-01-01

According to the distractor-selection hypothesis (Mulligan, 2003), dividing attention during encoding reduces perceptual priming when responses to non-critical (i.e., distractor) stimuli are selected frequently and simultaneously with critical stimulus encoding. Because direct support for this hypothesis comes exclusively from studies using familiar word stimuli, the present study tested whether the predictions of the distractor-selection hypothesis extend to perceptual priming of unfamiliar visual objects using the possible/impossible object-decision test. Consistent with the distractor-selection hypothesis, Experiments 1 and 2 found no reduction in priming when the non-critical stimuli were presented infrequently and non-synchronously with the critical target stimuli, even though explicit recognition memory was reduced. In Experiment 3, non-critical stimuli were presented frequently and simultaneously during encoding of critical stimuli; however, no decrement in priming was detected, even when encoding time was reduced. These results suggest that priming in the possible/impossible object-decision test is relatively immune to reductions in central attention and that not all aspects of the distractor-selection hypothesis generalize to priming of unfamiliar visual objects. Implications for theoretical models of object-decision priming are discussed. PMID:18821167

An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol

PubMed Central

Gagnon, Marie-Pierre; Légaré, France; Fortin, Jean-Paul; Lamothe, Lise; Labrecque, Michel; Duplantie, Julie

2008-01-01

Background E-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system. Methods A three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels. Results This study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects. Conclusion These results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must. PMID:18435853

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study.

PubMed

Nuss, Michelle A; Hill, Janette R; Cervero, Ronald M; Gaines, Julie K; Middendorf, Bruce F

2014-01-01

Despite widespread use of mobile technology in medical education, medical students' use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. This year-long (July 2012-June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates(®), PDF Expert(®), VisualDx(®), and Micromedex(®). The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.

Teacher Roles in the Process of Critical Thinking/Decision Making Skills Development among Elementary/Secondary Students in the Social Studies Curriculum.

ERIC Educational Resources Information Center

Peters, Richard

Today's students must be aware of local, regional, national, and international issues, problems, situations, and cultural diversities. This paper presents curriculum ideas for involving elementary and secondary students in classroom inquiry processes and in field-based settings in order to teach them to think critically, make decisions, act, and…

NASA Applications and Lessons Learned in Reliability Engineering

NASA Technical Reports Server (NTRS)

Safie, Fayssal M.; Fuller, Raymond P.

2011-01-01

Since the Shuttle Challenger accident in 1986, communities across NASA have been developing and extensively using quantitative reliability and risk assessment methods in their decision making process. This paper discusses several reliability engineering applications that NASA has used over the year to support the design, development, and operation of critical space flight hardware. Specifically, the paper discusses several reliability engineering applications used by NASA in areas such as risk management, inspection policies, components upgrades, reliability growth, integrated failure analysis, and physics based probabilistic engineering analysis. In each of these areas, the paper provides a brief discussion of a case study to demonstrate the value added and the criticality of reliability engineering in supporting NASA project and program decisions to fly safely. Examples of these case studies discussed are reliability based life limit extension of Shuttle Space Main Engine (SSME) hardware, Reliability based inspection policies for Auxiliary Power Unit (APU) turbine disc, probabilistic structural engineering analysis for reliability prediction of the SSME alternate turbo-pump development, impact of ET foam reliability on the Space Shuttle System risk, and reliability based Space Shuttle upgrade for safety. Special attention is given in this paper to the physics based probabilistic engineering analysis applications and their critical role in evaluating the reliability of NASA development hardware including their potential use in a research and technology development environment.

Identifying critical factors influencing the disposal of dead pigs by farmers in China.

PubMed

Wu, Linhai; Xu, Guoyan; Wang, Xiaoli

2016-01-01

Disposal of dead pigs by pig farmers may have a direct impact on pork safety, public health, and the ecological environment in China. Drawing on the existing literature, this study analyzed and summarized the main factors that could affect the disposal of dead pigs by pig farmers by conducting a survey of 654 pig farmers in Funing County, Jiangsu Province, China. The purpose of this analysis was to investigate the disposal of dead pigs in China and provide useful regulatory strategies for the government. The interrelationships among dimensions and factors that affect the disposal of dead pigs by farmers were analyzed, and critical factors were identified by a hybrid multi-criteria decision-making method, which is a combination of decision-making trial and evaluation laboratory (DEMATEL) and analytic network process (ANP). Our results demonstrated that production characteristics were the most important dimensions and that costs and profits, scale of farming, pattern of farming, knowledge of relevant laws and regulations, and knowledge of pig disease and prevention were the five most critical factors affecting the disposal of dead pigs by farmers in China at this stage. The significance of this study lies in further discussing some management policies for the Chinese government regarding strengthen regulation of disposing dead pigs.

Multi-intelligence critical rating assessment of fusion techniques (MiCRAFT)

NASA Astrophysics Data System (ADS)

Blasch, Erik

2015-06-01

Assessment of multi-intelligence fusion techniques includes credibility of algorithm performance, quality of results against mission needs, and usability in a work-domain context. Situation awareness (SAW) brings together low-level information fusion (tracking and identification), high-level information fusion (threat and scenario-based assessment), and information fusion level 5 user refinement (physical, cognitive, and information tasks). To measure SAW, we discuss the SAGAT (Situational Awareness Global Assessment Technique) technique for a multi-intelligence fusion (MIF) system assessment that focuses on the advantages of MIF against single intelligence sources. Building on the NASA TLX (Task Load Index), SAGAT probes, SART (Situational Awareness Rating Technique) questionnaires, and CDM (Critical Decision Method) decision points; we highlight these tools for use in a Multi-Intelligence Critical Rating Assessment of Fusion Techniques (MiCRAFT). The focus is to measure user refinement of a situation over the information fusion quality of service (QoS) metrics: timeliness, accuracy, confidence, workload (cost), and attention (throughput). A key component of any user analysis includes correlation, association, and summarization of data; so we also seek measures of product quality and QuEST of information. Building a notion of product quality from multi-intelligence tools is typically subjective which needs to be aligned with objective machine metrics.

Physician Approaches to Conflict with Families Surrounding End-of-Life Decision-making in the Intensive Care Unit. A Qualitative Study.

PubMed

Mehter, Hashim M; McCannon, Jessica B; Clark, Jack A; Wiener, Renda Soylemez

2018-02-01

Families of critically ill patients are often asked to make difficult decisions to pursue, withhold, or withdraw aggressive care or resuscitative measures, exercising "substituted judgment" from the imagined standpoint of the patient. Conflict may arise between intensive care unit (ICU) physicians and family members regarding the optimal course of care. To characterize how ICU physicians approach and manage conflict with surrogates regarding end-of-life decision-making. Semistructured interviews were conducted with 18 critical care physicians from four academically affiliated hospitals. Interview transcripts were analyzed using methods of grounded theory. Physicians described strategies for engaging families to resolve conflict about end-of-life decision-making and tending to families' emotional health. Physicians commonly began by gauging family receptiveness to recommendations from the healthcare team. When faced with resistance to recommendations for less aggressive care, approaches ranged from deference to family wishes to various persuasive strategies designed to change families' minds, and some of those strategies may be counterproductive or harmful. The likelihood of deferring to family in the event of conflict was associated with the perceived sincerity of the family's "substituted judgment" and the ability to control patient pain and suffering. Physicians reported concern for the family's emotional needs and made efforts to alleviate the burden on families by assuming decision-making responsibility and expressing nonabandonment and commitment to the patient. Physicians were attentive to repairing damage to their relationship with the family in the aftermath of conflict. Finally, physicians described their own emotional responses to conflict, ranging from frustration and anxiety to satisfaction with successful resolution of conflict. Critical care physicians described a complex and multilayered approach to physician-family conflict. The reported strategies offer insight into pragmatic approaches to achieving resolution of conflict while attending to both family and physician emotional impact, and they also highlight some potentially unhelpful or harmful behaviors that should be avoided. Further research is needed to evaluate how these strategies are perceived by families and other ICU clinicians and how they affect patient, family, and clinician outcomes.

Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy

PubMed

Inauen, Alice; Rettke, Horst; Fridrich, Annemarie; Spirig, Rebecca; Bauer, Georg F

2017-01-01

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study

PubMed Central

Nuss, Michelle A.; Hill, Janette R.; Cervero, Ronald M.; Gaines, Julie K.; Middendorf, Bruce F.

2014-01-01

Purpose Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime. Methods This year-long (July 2012–June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis. Results Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates®, PDF Expert®, VisualDx®, and Micromedex®. The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime. Conclusions This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student's daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions. PMID:25317266

Efficient biprediction decision scheme for fast high efficiency video coding encoding

NASA Astrophysics Data System (ADS)

Park, Sang-hyo; Lee, Seung-ho; Jang, Euee S.; Jun, Dongsan; Kang, Jung-Won

2016-11-01

An efficient biprediction decision scheme of high efficiency video coding (HEVC) is proposed for fast-encoding applications. For low-delay video applications, bidirectional prediction can be used to increase compression performance efficiently with previous reference frames. However, at the same time, the computational complexity of the HEVC encoder is significantly increased due to the additional biprediction search. Although a some research has attempted to reduce this complexity, whether the prediction is strongly related to both motion complexity and prediction modes in a coding unit has not yet been investigated. A method that avoids most compression-inefficient search points is proposed so that the computational complexity of the motion estimation process can be dramatically decreased. To determine if biprediction is critical, the proposed method exploits the stochastic correlation of the context of prediction units (PUs): the direction of a PU and the accuracy of a motion vector. Through experimental results, the proposed method showed that the time complexity of biprediction can be reduced to 30% on average, outperforming existing methods in view of encoding time, number of function calls, and memory access.

The Myth of the Rational Decision Maker: A Framework for Applying and Enhancing Heuristic and Intuitive Decision Making by School Leaders

ERIC Educational Resources Information Center

Davis, Stephen H.

2004-01-01

This article takes a critical look at administrative decision making in schools and the extent to which complex decisions conform to normative models and common expectations of rationality. An alternative framework for administrative decision making is presented that is informed, but not driven, by theories of rationality. The framework assumes…

The Effect of Decision-Making Skill Training Programs on Self-Esteem and Decision-Making Styles

ERIC Educational Resources Information Center

Colakkadioglu, Oguzhan; Celik, D. Billur

2016-01-01

Problem Statement: Decision making is a critical cognitive process in every area of human life. In this process, the individuals play an active role and obtain outputs with their functional use of decision-making skills. Therefore, the decision-making process can affect the course of life, life satisfaction, and the social relations of an…

The role of decision analytic modeling in the health economic assessment of spinal intervention.

PubMed

Edwards, Natalie C; Skelly, Andrea C; Ziewacz, John E; Cahill, Kevin; McGirt, Matthew J

2014-10-15

Narrative review. To review the common tenets, strengths, and weaknesses of decision modeling for health economic assessment and to review the use of decision modeling in the spine literature to date. For the majority of spinal interventions, well-designed prospective, randomized, pragmatic cost-effectiveness studies that address the specific decision-in-need are lacking. Decision analytic modeling allows for the estimation of cost-effectiveness based on data available to date. Given the rising demands for proven value in spine care, the use of decision analytic modeling is rapidly increasing by clinicians and policy makers. This narrative review discusses the general components of decision analytic models, how decision analytic models are populated and the trade-offs entailed, makes recommendations for how users of spine intervention decision models might go about appraising the models, and presents an overview of published spine economic models. A proper, integrated, clinical, and economic critical appraisal is necessary in the evaluation of the strength of evidence provided by a modeling evaluation. As is the case with clinical research, all options for collecting health economic or value data are not without their limitations and flaws. There is substantial heterogeneity across the 20 spine intervention health economic modeling studies summarized with respect to study design, models used, reporting, and general quality. There is sparse evidence for populating spine intervention models. Results mostly showed that interventions were cost-effective based on $100,000/quality-adjusted life-year threshold. Spine care providers, as partners with their health economic colleagues, have unique clinical expertise and perspectives that are critical to interpret the strengths and weaknesses of health economic models. Health economic models must be critically appraised for both clinical validity and economic quality before altering health care policy, payment strategies, or patient care decisions. 4.

Who Am I to Decide Whether This Person Is to Die Today? Physicians' Life-or-Death Decisions for Elderly Critically Ill Patients at the Emergency Department-ICU Interface: A Qualitative Study.

PubMed

Fassier, Thomas; Valour, Elizabeth; Colin, Cyrille; Danet, François

2016-07-01

We explored physicians' perceptions of and attitudes toward triage and end-of-life decisions for elderly critically ill patients at the emergency department (ED)-ICU interface. This was a qualitative study with thematic analysis of data collected through semistructured interviews (15 emergency physicians and 9 ICU physicians) and nonparticipant observations (324 hours, 8 units, in 2 hospitals in France). Six themes emerged: (1) Physicians revealed a representation of elderly patients that comprised both negative and positive stereotypes, and expressed the concept of physiologic age. (2) These age-related factors influenced physicians' decisionmaking in resuscitate/not resuscitate situations. (3) Three main communication patterns framed the decisions: interdisciplinary decisions, decisions by 2 physicians on their own, and unilateral decisions by 1 physician; however, some physicians avoided decisions, facing uncertainty and conflicts. (4) Conflicts and communication gaps occurred at the ED-ICU interface and upstream of the ED-ICU interface. (5) End-of-life decisions were perceived as more complex in the ED, in the absence of family or of information about elderly patients' end-of-life preferences, and when there was conflict with relatives, time pressure, and a lack of training in end-of-life decisionmaking. (6) During decisionmaking, patients' safety and quality of care were potentially compromised by delayed or denied intensive care and lack of palliative care. These qualitative findings highlight the cognitive heuristics and biases, interphysician conflicts, and communication gaps influencing physicians' triage and end-of-life decisions for elderly critically ill patients at the ED-ICU interface and suggest strategies to improve these decisions. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

University education and nuclear criticality safety professionals

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

Wilson, R.E.; Stachowiak, R.V.; Knief, R.A.

1996-12-31

The problem of developing a productive criticality safety specialist at a nuclear fuel facility has long been with us. The normal practice is to hire a recent undergraduate or graduate degree recipient and invest at least a decade in on-the-job training. In the early 1980s, the U.S. Department of Energy (DOE) developed a model intern program in an attempt to speed up the process. The program involved working at assigned projects for extended periods at a working critical mass laboratory, a methods development group, and a fuel cycle facility. This never gained support as it involved extended time away frommore » the job. At the Rocky Flats Environmental Technology Site, the training method is currently the traditional one involving extensive experience. The flaw is that the criticality safety staff turnover has been such that few individuals continue for the decade some consider necessary for maturity in the discipline. To maintain quality evaluations and controls as well as interpretation decisions, extensive group review is used. This has proved costly to the site and professionally unsatisfying to the current staff. The site contractor has proposed a training program to remedy the basic problem.« less

Improved first-order uncertainty method for water-quality modeling

USGS Publications Warehouse

Melching, C.S.; Anmangandla, S.

1992-01-01

Uncertainties are unavoidable in water-quality modeling and subsequent management decisions. Monte Carlo simulation and first-order uncertainty analysis (involving linearization at central values of the uncertain variables) have been frequently used to estimate probability distributions for water-quality model output due to their simplicity. Each method has its drawbacks: Monte Carlo simulation's is mainly computational time; and first-order analysis are mainly questions of accuracy and representativeness, especially for nonlinear systems and extreme conditions. An improved (advanced) first-order method is presented, where the linearization point varies to match the output level whose exceedance probability is sought. The advanced first-order method is tested on the Streeter-Phelps equation to estimate the probability distribution of critical dissolved-oxygen deficit and critical dissolved oxygen using two hypothetical examples from the literature. The advanced first-order method provides a close approximation of the exceedance probability for the Streeter-Phelps model output estimated by Monte Carlo simulation using less computer time - by two orders of magnitude - regardless of the probability distributions assumed for the uncertain model parameters.

Empirical evaluation of decision support systems: Needs, definitions, potential methods, and an example pertaining to waterfowl management

USGS Publications Warehouse

Sojda, R.S.

2007-01-01

Decision support systems are often not empirically evaluated, especially the underlying modelling components. This can be attributed to such systems necessarily being designed to handle complex and poorly structured problems and decision making. Nonetheless, evaluation is critical and should be focused on empirical testing whenever possible. Verification and validation, in combination, comprise such evaluation. Verification is ensuring that the system is internally complete, coherent, and logical from a modelling and programming perspective. Validation is examining whether the system is realistic and useful to the user or decision maker, and should answer the question: “Was the system successful at addressing its intended purpose?” A rich literature exists on verification and validation of expert systems and other artificial intelligence methods; however, no single evaluation methodology has emerged as preeminent. At least five approaches to validation are feasible. First, under some conditions, decision support system performance can be tested against a preselected gold standard. Second, real-time and historic data sets can be used for comparison with simulated output. Third, panels of experts can be judiciously used, but often are not an option in some ecological domains. Fourth, sensitivity analysis of system outputs in relation to inputs can be informative. Fifth, when validation of a complete system is impossible, examining major components can be substituted, recognizing the potential pitfalls. I provide an example of evaluation of a decision support system for trumpeter swan (Cygnus buccinator) management that I developed using interacting intelligent agents, expert systems, and a queuing system. Predicted swan distributions over a 13-year period were assessed against observed numbers. Population survey numbers and banding (ringing) studies may provide long term data useful in empirical evaluation of decision support.

[End-of-life decisions and practices in critically ill patients in the cardiac intensive care unit. A nationwide survey].

PubMed

Schimmer, C; Hamouda, K; Oezkur, M; Sommer, S-P; Leistner, M; Leyh, R

2016-03-01

Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine. The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients. A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237). In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process. In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.

Collaborative decision-making on wind power projects based on AHP method

NASA Astrophysics Data System (ADS)

Badea, A.; Proştean, G.; Tămăşilă, M.; Vârtosu, A.

2017-01-01

The complexity of projects implementation in Renewable Energy Sources (RES) requires finding collaborative alliances between suppliers and project developers in RES. Links activities in supply chain in RES, respectively, transportation of heavy components, processing orders to purchase quality raw materials, storage and materials handling, packaging, and other complex activities requiring a logistics system collaboratively to be permanently dimensioned properly selected and monitored. Requirements imposed by stringency of wind power energy projects implementation inevitably involves constraints in infrastructure, implementation and logistics. Thus, following an extensive research in RES project, to eliminate these constraints were identified alternative collaboration to provide feasible solutions on different levels of performance. The paper presents a critical analysis of different collaboration alternatives in supply chain for RES projects, selecting the ones most suitable for particular situations by using decision-making method Analytic Hierarchy Process (AHP). The role of AHP method was to formulate a decision model by which can be establish the collaboration alternative choice through mathematical calculation to reduce the impact created by constraints encountered. The solution provided through AHP provides a framework for detecting optimal alternative collaboration between suppliers and project developers in RES and avoids some breaks in the chain by resizing safety buffers for leveling orders in RES projects.

Brain-Machine Interface control of a robot arm using actor-critic rainforcement learning.

PubMed

Pohlmeyer, Eric A; Mahmoudi, Babak; Geng, Shijia; Prins, Noeline; Sanchez, Justin C

2012-01-01

Here we demonstrate how a marmoset monkey can use a reinforcement learning (RL) Brain-Machine Interface (BMI) to effectively control the movements of a robot arm for a reaching task. In this work, an actor-critic RL algorithm used neural ensemble activity in the monkey's motor cortext to control the robot movements during a two-target decision task. This novel approach to decoding offers unique advantages for BMI control applications. Compared to supervised learning decoding methods, the actor-critic RL algorithm does not require an explicit set of training data to create a static control model, but rather it incrementally adapts the model parameters according to its current performance, in this case requiring only a very basic feedback signal. We show how this algorithm achieved high performance when mapping the monkey's neural states (94%) to robot actions, and only needed to experience a few trials before obtaining accurate real-time control of the robot arm. Since RL methods responsively adapt and adjust their parameters, they can provide a method to create BMIs that are robust against perturbations caused by changes in either the neural input space or the output actions they generate under different task requirements or goals.

Recognition Decisions from Visual Working Memory Are Mediated by Continuous Latent Strengths

ERIC Educational Resources Information Center

Ricker, Timothy J.; Thiele, Jonathan E.; Swagman, April R.; Rouder, Jeffrey N.

2017-01-01

Making recognition decisions often requires us to reference the contents of working memory, the information available for ongoing cognitive processing. As such, understanding how recognition decisions are made when based on the contents of working memory is of critical importance. In this work we examine whether recognition decisions based on the…

Decision Making for Democratic Leadership in a Guided Internship

ERIC Educational Resources Information Center

Klinker, JoAnn Franklin; Hoover, J. Duane; Valle, Fernando; Hardin, Fred

2014-01-01

Experience in problem-based learning, authentic experiences, on-the-job decision making, and critical reflection on decisions made formed the conceptual framework of an internship to develop democratic leadership as a professional ethic in interns. Interns in an on-the-job guided internship examined decisions over a 13-week period as they…

Toolbox or Adjustable Spanner? A Critical Comparison of Two Metaphors for Adaptive Decision Making

ERIC Educational Resources Information Center

Söllner, Anke; Bröder, Arndt

2016-01-01

For multiattribute decision tasks, different metaphors exist that describe the process of decision making and its adaptation to diverse problems and situations. Multiple strategy models (MSMs) assume that decision makers choose adaptively from a set of different strategies (toolbox metaphor), whereas evidence accumulation models (EAMs) hold that a…

The Influence of Emotion on Fairness-Related Decision Making: A Critical Review of Theories and Evidence.

PubMed

Zheng, Ya; Yang, Zhong; Jin, Chunlan; Qi, Yue; Liu, Xun

2017-01-01

Fairness-related decision making is an important issue in the field of decision making. Traditional theories emphasize the roles of inequity aversion and reciprocity, whereas recent research increasingly shows that emotion plays a critical role in this type of decision making. In this review, we summarize the influences of three types of emotions (i.e., the integral emotion experienced at the time of decision making, the incidental emotion aroused by a task-unrelated dispositional or situational source, and the interaction of emotion and cognition) on fairness-related decision making. Specifically, we first introduce three dominant theories that describe how emotion may influence fairness-related decision making (i.e., the wounded pride/spite model, affect infusion model, and dual-process model). Next, we collect behavioral and neural evidence for and against these theories. Finally, we propose that future research on fairness-related decision making should focus on inducing incidental social emotion, avoiding irrelevant emotion when regulating, exploring the individual differences in emotional dispositions, and strengthening the ecological validity of the paradigm.

The Influence of Emotion on Fairness-Related Decision Making: A Critical Review of Theories and Evidence

PubMed Central

Zheng, Ya; Yang, Zhong; Jin, Chunlan; Qi, Yue; Liu, Xun

2017-01-01

Fairness-related decision making is an important issue in the field of decision making. Traditional theories emphasize the roles of inequity aversion and reciprocity, whereas recent research increasingly shows that emotion plays a critical role in this type of decision making. In this review, we summarize the influences of three types of emotions (i.e., the integral emotion experienced at the time of decision making, the incidental emotion aroused by a task-unrelated dispositional or situational source, and the interaction of emotion and cognition) on fairness-related decision making. Specifically, we first introduce three dominant theories that describe how emotion may influence fairness-related decision making (i.e., the wounded pride/spite model, affect infusion model, and dual-process model). Next, we collect behavioral and neural evidence for and against these theories. Finally, we propose that future research on fairness-related decision making should focus on inducing incidental social emotion, avoiding irrelevant emotion when regulating, exploring the individual differences in emotional dispositions, and strengthening the ecological validity of the paradigm. PMID:28974937

Critical reading and critical thinking--study design and methodology: a personal approach on how to read the clinical literature.

PubMed

Lipman, Timothy O

2013-04-01

The volume of medical literature grows exponentially. Yet we are faced with the necessity to make clinical decisions based on the availability and quality of scientific information. The general strength (reliability, robustness) of any interpretation that guides us in clinical decision making is dependent on how information was obtained. All information and medical studies and, consequently, all conclusions are not created equal. It is incumbent upon us to be able to assess the quality of the information that guides us in the care of our patients. Being able to assess medical literature critically requires use of critical reading and critical thinking skills. To achieve these skills, to be able to analyze medical literature critically, takes a combination of education and practice, practice, and more practice.

Assessing precision, bias and sigma-metrics of 53 measurands of the Alinity ci system.

PubMed

Westgard, Sten; Petrides, Victoria; Schneider, Sharon; Berman, Marvin; Herzogenrath, Jörg; Orzechowski, Anthony

2017-12-01

Assay performance is dependent on the accuracy and precision of a given method. These attributes can be combined into an analytical Sigma-metric, providing a simple value for laboratorians to use in evaluating a test method's capability to meet its analytical quality requirements. Sigma-metrics were determined for 37 clinical chemistry assays, 13 immunoassays, and 3 ICT methods on the Alinity ci system. Analytical Performance Specifications were defined for the assays, following a rationale of using CLIA goals first, then Ricos Desirable goals when CLIA did not regulate the method, and then other sources if the Ricos Desirable goal was unrealistic. A precision study was conducted at Abbott on each assay using the Alinity ci system following the CLSI EP05-A2 protocol. Bias was estimated following the CLSI EP09-A3 protocol using samples with concentrations spanning the assay's measuring interval tested in duplicate on the Alinity ci system and ARCHITECT c8000 and i2000 SR systems, where testing was also performed at Abbott. Using the regression model, the %bias was estimated at an important medical decisions point. Then the Sigma-metric was estimated for each assay and was plotted on a method decision chart. The Sigma-metric was calculated using the equation: Sigma-metric=(%TEa-|%bias|)/%CV. The Sigma-metrics and Normalized Method Decision charts demonstrate that a majority of the Alinity assays perform at least at five Sigma or higher, at or near critical medical decision levels. More than 90% of the assays performed at Five and Six Sigma. None performed below Three Sigma. Sigma-metrics plotted on Normalized Method Decision charts provide useful evaluations of performance. The majority of Alinity ci system assays had sigma values >5 and thus laboratories can expect excellent or world class performance. Laboratorians can use these tools as aids in choosing high-quality products, further contributing to the delivery of excellent quality healthcare for patients. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Tools to support evidence-informed public health decision making

PubMed Central

2014-01-01

Background Public health professionals are increasingly expected to engage in evidence-informed decision making to inform practice and policy decisions. Evidence-informed decision making involves the use of research evidence along with expertise, existing public health resources, knowledge about community health issues, the local context and community, and the political climate. The National Collaborating Centre for Methods and Tools has identified a seven step process for evidence-informed decision making. Tools have been developed to support public health professionals as they work through each of these steps. This paper provides an overview of tools used in three Canadian public health departments involved in a study to develop capacity for evidence-informed decision making. Methods As part of a knowledge translation and exchange intervention, a Knowledge Broker worked with public health professionals to identify and apply tools for use with each of the steps of evidence-informed decision making. The Knowledge Broker maintained a reflective journal and interviews were conducted with a purposive sample of decision makers and public health professionals. This paper presents qualitative analysis of the perceived usefulness and usability of the tools. Results Tools were used in the health departments to assist in: question identification and clarification; searching for the best available research evidence; assessing the research evidence for quality through critical appraisal; deciphering the ‘actionable message(s)’ from the research evidence; tailoring messages to the local context to ensure their relevance and suitability; deciding whether and planning how to implement research evidence in the local context; and evaluating the effectiveness of implementation efforts. Decision makers provided descriptions of how the tools were used within the health departments and made suggestions for improvement. Overall, the tools were perceived as valuable for advancing and sustaining evidence-informed decision making. Conclusion Tools are available to support the process of evidence-informed decision making among public health professionals. The usability and usefulness of these tools for advancing and sustaining evidence-informed decision making are discussed, including recommendations for the tools’ application in other public health settings beyond this study. Knowledge and awareness of these tools may assist other health professionals in their efforts to implement evidence-informed practice. PMID:25034534

Metrology in Medicine: From Measurements to Decision, with Specific Reference to Anesthesia and Intensive Care

PubMed Central

Imhoff, Michael; Cecconi, Maurizio

2015-01-01

Metrology is the science of measurements. Although of critical importance in medicine and especially in critical care, frequent confusion in terms and definitions impact either interphysician communications or understanding of manufacturers’ and engineers’ instructions and limitations when using devices. In this review, we first list the terms defined by the International Bureau of Weights and Measures regarding quantities and units, measurements, devices for measurement, properties of measuring devices, and measurement standards. The traditional tools for assessing the most important measurement quality criteria are also reviewed with clinical examples for diagnosis, alarm, and titration purposes, as well as for assessing the uncertainty of reference methods. PMID:25625255

Does Robotic Telerounding Enhance Nurse-Physician Collaboration Satisfaction About Care Decisions?

PubMed

Bettinelli, Michele; Lei, Yuxiu; Beane, Matt; Mackey, Caleb; Liesching, Timothy N

2015-08-01

Delivering healthcare using remote robotic telepresence is an evolving practice in medical and surgical intensive critical care units and will likely have varied implications for work practices and working relationships in intensive care units. Our study assessed the nurse-physician collaboration satisfaction about care decisions from surgical intensive critical care nurses during remote robotic telepresence night rounds in comparison with conventional telephone night rounds. This study used a randomized trial to test whether robotic telerounding enhances the nurse-physician collaboration satisfaction about care decisions. A physician randomly used either the conventional telephone or the RP-7 robot (InTouch(®) Health, Santa Barbara, CA) to perform nighttime rounding in a surgical intensive care unit. The Collaboration and Satisfaction About Care Decisions (CSACD) survey instrument was used to measure the nurse-physician collaboration. The CSACD scores were compared using the signed-rank test with a significant p value of ≤0.05. From December 1, 2011 to December 13, 2012, 20 off-shift nurses submitted 106 surveys during telephone rounds and 108 surveys during robot rounds. The median score of surveys during robot rounds was slightly but not significantly higher than telephone rounds (51.3 versus 50.5; p=0.3). However, the CSACD score was significantly increased from baseline with robot rounds (51.3 versus 43.0; p=0.01), in comparison with telephone rounds (50.5 versus 43.0; p=0.09). The mediators, including age, working experience, and robot acceptance, were not significantly (p>0.1) correlated with the CSACD score difference (robot versus telephone). Robot rounding in the intensive care unit was comparable but not superior to the telephone in regard to the nurse-physician collaboration and satisfaction about care decision. The working experience and technology acceptance of intensive care nurses did not contribute to the preference of night shift rounding method from the aspect of collaboration with the physician about care decision-making.

Legal decision-making by people with aphasia: critical incidents for speech pathologists.

PubMed

Ferguson, Alison; Duffield, Gemma; Worrall, Linda

2010-01-01

The assessment and management of a person with aphasia for whom decision-making capacity is queried represents a highly complex clinical issue. In addition, there are few published guidelines and even fewer published accounts of empirical research to assist. The research presented in this paper aimed to identify the main issues for speech pathologists when decision-making capacity for legal and related matters arose for their clients with aphasia, and to describe qualitatively the nature of these issues and the practices of the speech pathologists in these situations. The methodology was informed by the qualitative research paradigm and made use of the semi-structured interview methods developed for the Critical Incident Technique. Nine speech pathologists, with a range of clinical experience between three and 27 years, were interviewed by telephone, with verbatim notes being taken on-line by the interviewer. The speech pathologists described a total of 21 clients (15 male, six female) with acquired neurological communication disorders (including cerebral vascular accident, traumatic brain injury, and tumour) whose care had raised critical incidents for the speech pathologist in relation to legal and related matters. These verbatim notes were qualitatively analysed using NVivo qualitative analysis software. The main incidents related to legal decisions (for example, power of attorney, will-making), as well as decisions involving consent for medical treatment, discharge, accommodation, and business/financial decisions. In all but one of the incidents recounted, the issues centred on a situation of conflict between the person with aphasia and their family, friends or with the multidisciplinary team. The roles taken by the speech pathologists ranged from those expected within a speech pathology scope of practice, such as that of assessor and consultant, to those which arguably present dilemmas and conflict of interest, for example, interpreter, advocate. The assessment practices involved some standardized testing, but this was stressed by all participants to be of lesser importance than informal observations of function. Speech pathologists emphasized the importance of multiple observations, and multimodal means of communication. The findings indicate that speech pathologists are currently playing an active role when questions arise regarding capacity for legal and related decision-making by people with aphasia. At the same time, the findings support the need for further research to develop guidelines for practice and to build educational experiences for students and novice clinicians to assist them when they engage with the complex case management issues in this area. 2010 Royal College of Speech & Language Therapists.

Variation in choice of study design: findings from the Epidemiology Design Decision Inventory and Evaluation (EDDIE) survey.

PubMed

Stang, Paul E; Ryan, Patrick B; Overhage, J Marc; Schuemie, Martijn J; Hartzema, Abraham G; Welebob, Emily

2013-10-01

Researchers using observational data to understand drug effects must make a number of analytic design choices that suit the characteristics of the data and the subject of the study. Review of the published literature suggests that there is a lack of consistency even when addressing the same research question in the same database. To characterize the degree of similarity or difference in the method and analysis choices made by observational database research experts when presented with research study scenarios. On-line survey using research scenarios on drug-effect studies to capture method selection and analysis choices that follow a dependency branching based on response to key questions. Voluntary participants experienced in epidemiological study design solicited for participation through registration on the Observational Medical Outcomes Partnership website, membership in particular professional organizations, or links in relevant newsletters. Description (proportion) of respondents selecting particular methods and making specific analysis choices based on individual drug-outcome scenario pairs. The number of questions/decisions differed based on stem questions of study design, time-at-risk, outcome definition, and comparator. There is little consistency across scenarios, by drug or by outcome of interest, in the decisions made for design and analyses in scenarios using large healthcare databases. The most consistent choice was the cohort study design but variability in the other critical decisions was common. There is great variation among epidemiologists in the design and analytical choices that they make when implementing analyses in observational healthcare databases. These findings confirm that it will be important to generate empiric evidence to inform these decisions and to promote a better understanding of the impact of standardization on research implementation.

Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

PubMed

Han, Kyung-Ja; Kim, Hesook Suzie; Kim, Mae-Ja; Hong, Kyung-Ja; Park, Sungae; Yun, Soon-Nyoung; Song, Misoon; Jung, Yoenyi; Kim, Haewon; Kim, Dong-Oak Debbie; Choi, Heejung; Kim, Kyungae

2007-06-01

The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

Socializing the human factors analysis and classification system: incorporating social psychological phenomena into a human factors error classification system.

PubMed

Paletz, Susannah B F; Bearman, Christopher; Orasanu, Judith; Holbrook, Jon

2009-08-01

The presence of social psychological pressures on pilot decision making was assessed using qualitative analyses of critical incident interviews. Social psychological phenomena have long been known to influence attitudes and behavior but have not been highlighted in accident investigation models. Using a critical incident method, 28 pilots who flew in Alaska were interviewed. The participants were asked to describe a situation involving weather when they were pilot in command and found their skills challenged. They were asked to describe the incident in detail but were not explicitly asked to identify social pressures. Pressures were extracted from transcripts in a bottom-up manner and then clustered into themes. Of the 28 pilots, 16 described social psychological pressures on their decision making, specifically, informational social influence, the foot-in-the-door persuasion technique, normalization of deviance, and impression management and self-consistency motives. We believe accident and incident investigations can benefit from explicit inclusion of common social psychological pressures. We recommend specific ways of incorporating these pressures into theHuman Factors Analysis and Classification System.

An investigation into pilot and system response to critical in-flight events. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Rockwell, T. H.; Griffin, W. C.

1981-01-01

Critical in-flight events (CIFE) that threaten the aircraft were studied. The scope of the CIFE was described and defined with emphasis on characterizing event development, detection and assessment; pilot information requirements, sources, acquisition, and interpretation, pilot response options, decision processed, and decision implementation and event outcome. Detailed scenarios were developed for use in simulators and paper and pencil testing for developing relationships between pilot performance and background information as well as for an analysis of pilot reaction decision and feedback processes. Statistical relationships among pilot characteristics and observed responses to CIFE's were developed.

Why people drink and drive : the bases of drinking-and-driving decisions.

DOT National Transportation Integrated Search

1995-03-01

Using a Critical Incidents approach, 600 drivers were called upon to identify the bases of decisions to drink : and drive. In an unstructured interview, each driver descnbed the bases for decisions leading to specific instances : of impaired driving,...

Decisions, Decisions....

ERIC Educational Resources Information Center

White, Owen Roberts

1985-01-01

The author reviews systems providing objective guidelines to facilitate ongoing, daily instructional decisions, focusing on those which utilize the sensitive datum and uniform charting procedures of precision teaching. Potential users are warned that the special education teacher must remain a critical and vigilant analyst of the learning process.…

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.

Self-Stigma and Consumer Participation in Shared Decision Making in Mental Health Services.

PubMed

Hamann, Johannes; Bühner, Markus; Rüsch, Nicolas

2017-08-01

People with mental illness struggle with symptoms and with public stigma. Some accept common prejudices and lose self-esteem, resulting in shame and self-stigma, which may affect their interactions with mental health professionals. This study explored whether self-stigma and shame are associated with consumers' preferences for participation in medical decision making and their behavior in psychiatric consultations. In a cross-sectional study conducted in Germany, 329 individuals with a diagnosis of a schizophrenia spectrum disorder or an affective disorder and their psychiatrists provided sociodemographic and illness-related information. Self-stigma, shame, locus of control, and views about clinical decision making were assessed by self-report. Psychiatrists rated their impression of the decision-making behavior of consumers. Regression analyses and structural equation modeling were used to determine the association of self-stigma and shame with clinical decision making. Self-stigma was not related to consumers' participation preferences, but it was associated with some aspects of communicative behavior. Active and critical behavior (for example, expressing views, daring to challenge the doctor's opinion, and openly speaking out about disagreements with the doctor) was associated with less shame, less self-stigma, more self-responsibility, less attribution of external control to powerful others, and more years of education. Self-stigma and shame were associated with less participative and critical behavior, which probably leads to clinical encounters that involve less shared decision making and more paternalistic decision making. Paternalistic decision making may reinforce self-stigma and lead to poorer health outcomes. Therefore, interventions that reduce self-stigma and increase consumers' critical and participative communication may improve health outcomes.

Critical thinking: the development of an essential skill for nursing students.

PubMed

Papathanasiou, Ioanna V; Kleisiaris, Christos F; Fradelos, Evangelos C; Kakou, Katerina; Kourkouta, Lambrini

2014-08-01

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning.

Critical Thinking: The Development of an Essential Skill for Nursing Students

PubMed Central

Papathanasiou, Ioanna V.; Kleisiaris, Christos F.; Fradelos, Evangelos C.; Kakou, Katerina; Kourkouta, Lambrini

2014-01-01

Critical thinking is defined as the mental process of actively and skillfully perception, analysis, synthesis and evaluation of collected information through observation, experience and communication that leads to a decision for action. In nursing education there is frequent reference to critical thinking and to the significance that it has in daily clinical nursing practice. Nursing clinical instructors know that students face difficulties in making decisions related to clinical practice. The main critical thinking skills in which nursing students should be exercised during their studies are critical analysis, introductory and concluding justification, valid conclusion, distinguish of facts and opinions, evaluation the credibility of information sources, clarification of concepts and recognition of conditions. Specific behaviors are essentials for enhancing critical thinking. Nursing students in order to learn and apply critical thinking should develop independence of thought, fairness, perspicacity in personal and social level, humility, spiritual courage, integrity, perseverance, self-confidence, interest for research and curiosity. Critical thinking is an essential process for the safe, efficient and skillful nursing practice. The nursing education programs should adopt attitudes that promote critical thinking and mobilize the skills of critical reasoning. PMID:25395733

Recommendations for Modeling Disaster Responses in Public Health and Medicine: A Position Paper of The Society for Medical Decision Making

PubMed Central

Brandeau, Margaret L.; McCoy, Jessica H.; Hupert, Nathaniel; Holty, Jon-Erik; Bravata, Dena M.

2013-01-01

Purpose Mathematical and simulation models are increasingly used to plan for and evaluate health sector responses to disasters, yet no clear consensus exists regarding best practices for the design, conduct, and reporting of such models. We examined a large selection of published health sector disaster response models to generate a set of best practice guidelines for such models. Methods We reviewed a spectrum of published disaster response models addressing public health or healthcare delivery, focusing in particular on the type of disaster and response decisions considered, decision makers targeted, choice of outcomes evaluated, modeling methodology, and reporting format. We developed initial recommendations for best practices for creating and reporting such models and refined these guidelines after soliciting feedback from response modeling experts and from members of the Society for Medical Decision Making. Results We propose six recommendations for model construction and reporting, inspired by the most exemplary models: Health sector disaster response models should address real-world problems; be designed for maximum usability by response planners; strike the appropriate balance between simplicity and complexity; include appropriate outcomes, which extend beyond those considered in traditional cost-effectiveness analyses; and be designed to evaluate the many uncertainties inherent in disaster response. Finally, good model reporting is particularly critical for disaster response models. Conclusions Quantitative models are critical tools for planning effective health sector responses to disasters. The recommendations we propose can increase the applicability and interpretability of future models, thereby improving strategic, tactical, and operational aspects of preparedness planning and response. PMID:19605887

Transforming Patient-Centered Care: Development of the Evidence Informed Decision Making through Engagement Model.

PubMed

Moore, Jennifer E; Titler, Marita G; Kane Low, Lisa; Dalton, Vanessa K; Sampselle, Carolyn M

2015-01-01

In response to the passage of the Affordable Care Act in the United States, clinicians and researchers are critically evaluating methods to engage patients in implementing evidence-based care to improve health outcomes. However, most models on implementation only target clinicians or health systems as the adopters of evidence. Patients are largely ignored in these models. A new implementation model that captures the complex but important role of patients in the uptake of evidence may be a critical missing link. Through a process of theory evaluation and development, we explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model's ability to capture these key concepts. The process demonstrated that a new, patient-centered model for implementation is needed. In response, the Evidence Informed Decision Making through Engagement Model is presented. We conclude that, by fully integrating women into an implementation model, outcomes that are important to both the clinician and patient will improve. In the interest of providing evidence-based care to women during pregnancy and childbirth, it is essential that care is patient centered. The inclusion of concepts discussed in this article has the potential to extend beyond maternity care and influence other clinical areas. Utilizing the newly developed Evidence Informed Decision Making through Engagement Model provides a framework for utilizing evidence and translating it into practice while acknowledging the important role that women have in the process. Published by Elsevier Inc.

Decisions, Decisions: The Countless Times Instructional Practice and Reality Meet

ERIC Educational Resources Information Center

Miranda, Martina L.

2014-01-01

This article examines critical issues related to teacher decision-making in early childhood music classrooms. Through the story of one teacher's experience, we take a closer look at specific criteria to guide decision-making, and strategies to deepen awareness of young children's needs in the music classroom and guide instructional…

From data to evidence: evaluative methods in evidence-based medicine.

PubMed

Landry, M D; Sibbald, W J

2001-11-01

The amount of published information is increasing exponentially, and recent technologic advances have created systems whereby mass distribution of this information can occur at an infinite rate. This is particularly true in the broad field of medicine, as the absolute volume of data available to the practicing clinician is creating new challenges in the management of relevant information flow. Evidence-based medicine (EBM) is an information management and learning strategy that seeks to integrate clinical expertise with the best evidence available in order to make effective clinical decisions that will ultimately improve patient care. The systematic approach underlying EBM encourages the clinician to formulate specific and relevant questions, which are answered in an iterative manner through accessing the best available published evidence. The arguments against EBM stem from the idea that there are inherent weaknesses in research methodologies and that emphasis placed on published research may ignore clinical skills and individual patient needs. Despite these arguments, EBM is gaining momentum and is consistently used as a method of learning and improving health care delivery. However, if EBM is to be effective, the clinician needs to have a critical understanding of research methodology in order to judge the value and level of a particular data source. Without critical analysis of research methodology, there is an inherent risk of drawing incorrect conclusions that may affect clinical decision-making. Currently, there is a trend toward using secondary pre-appraised data rather than primary sources as best evidence. We review the qualitative and quantitative methodology commonly used in EBM and argue that it is necessary for the clinician to preferentially use primary rather than secondary sources in making clinically relevant decisions.

A service life extension (SLEP) approach to operating aging aircraft beyond their original design lives

NASA Astrophysics Data System (ADS)

Pentz, Alan Carter

With today's uncertain funding climate (including sequestration and continuing budget resolutions), decision makers face severe budgetary challenges to maintain dominance through all aspects of the Department of Defense (DoD). To meet war-fighting capabilities, the DoD continues to extend aircraft programs beyond their design service lives by up to ten years, and occasionally much more. The budget requires a new approach to traditional extension strategies (i.e., reuse, reset, and reclamation) for structural hardware. While extending service life without careful controls can present a safety concern, future operations planning does not consider how much risk is present when operating within sound structural principles. Traditional structural hardware extension methods drive increased costs. Decision makers often overlook the inherent damage tolerance and fatigue capability of structural components and rely on simple time- and flight-based cycle accumulation when determining aircraft retirement lives. This study demonstrates that decision makers should consider risk in addition to the current extension strategies. Through an evaluation of eight military aircraft programs and the application and simulation of F-18 turbine engine usage data, this dissertation shows that insight into actual aircraft mission data, consideration of fatigue capability, and service extension length are key factors to consider. Aircraft structural components, as well as many critical safety components and system designs, have a predefined level of conservatism and inherent damage tolerance. The methods applied in this study would apply to extensions of other critical structures such as bridges. Understanding how much damage tolerance is built into the design compared to the original design usage requirements presents the opportunity to manage systems based on risk. The study presents the sensitivity of these factors and recommends avenues for further research.

Selective primary health care: a critical review of methods and results.

PubMed

Unger, J P; Killingsworth, J R

1986-01-01

In the aftermath of the Alma Ata conference, three types of Primary Health Care (PHC), have been identified. Comprehensive PHC (CPHC) and Basic PHC (BPHC) both have a wide scope of activities, BPHC however does not include water and sanitation activities. Only one year after the Alma Ata conference, CPHC was attacked as not 'feasible' and selective PHC (SPHC) was offered as an interim alternative. SPHC only addresses 5 to 8 diseases, almost all of them falling within the realm of pediatrics. Our article critically analyses the methods and results of SPHC. It contrasts the lack of supportive data for SPHC and its methodological deficiencies with the extent of its adoption by bilateral cooperation agencies, foundations, academic and research institutions, and international agencies. We suggest that rather than health factors, the major determinants of this adoption have been political and economical constraints acting upon decision makers exposed to a similar training in public health.

[Structural elements of critical thinking of nurses in emergency care].

PubMed

Crossetti, Maria da Graça Oliveira; Bittencourt, Greicy Kelly Gouveia Dias; Lima, Ana Amélia Antunes; de Góes, Marta Georgina Oliveira; Saurin, Gislaine

2014-09-01

The objective of this study was to analyze the structural elements of critical thinking (CT) of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.

Decision Support Tool for Early Differential Diagnosis of Acute Lung Injury and Cardiogenic Pulmonary Edema in Medical Critically Ill Patients

PubMed Central

Shahjehan, Khurram; Li, Guangxi; Dhokarh, Rajanigandha; Kashyap, Rahul; Janish, Christopher; Alsara, Anas; Jaffe, Allan S.; Hubmayr, Rolf D.; Gajic, Ognjen

2012-01-01

Background: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. Methods: In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. Results: Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio2 ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). Conclusions: A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use. PMID:22030803

Addressing sexual health behaviour during emerging adulthood: a critical review of the literature

PubMed Central

Alexander, Kamila A; Jemmott1, Loretta S; Teitelman, Anne M; D’Antonio, Patricia

2016-01-01

Aims and objectives In this critical literature review, we examine evidence-based interventions that target sexual behaviours of 18- to 25-year-old emerging adult women. Background Nurses and clinicians implement theory-driven research programmes for young women with increased risk of HIV/AIDS and sexually transmitted infections. Strategies to decrease transmission of HIV and sexually transmitted infections are rigorously evaluated and promoted by public health agencies such as the United States Centers for Disease Control and Prevention. While many interventions demonstrate episodic reductions in sexual risk behaviours and infection transmission, there is little evidence they build sustainable skills and behaviours. Programmes may not attend to contextual and affective influences on sexual behaviour change. Design Discursive paper. Methods We conducted a conceptually based literature review and critical analysis of the Centers for Disease Control and Prevention’s best-evidence and good-evidence HIV behavioural interventions. In this review, we examined three contextual and affective influences on the sexual health of emerging adult women: (1) developmental age, (2) reproduction and pregnancy desires and (3) sexual security or emotional responses accompanying relationship experiences. Results Our analyses revealed intervention programmes paid little attention to ways age, desires for pregnancy or emotional factors influence sexual decisions. Some programmes included 18- to 25-year-olds, but they made up small percentages of the sample and did not attend to unique emerging adult experiences. Second, primary focus on infection prevention overshadowed participant desires for pregnancy. Third, few interventions considered emotional mechanisms derived from relationship experiences involved in sexual decision-making. Conclusions Growing evidence demonstrates sexual health interventions may be more effective if augmented to attend to contextual and affective influences on relationship risks and decision-making. Modifying currently accepted strategies may enhance sustainability of sexual health-promoting behaviours. PMID:24988875

Challenges in Building Disease-Based National Health Accounts

PubMed Central

Rosen, Allison B.; Cutler, David M.

2012-01-01

Background Measuring spending on diseases is critical to assessing the value of medical care. Objective To review the current state of cost of illness (COI) estimation methods, identifying their strengths, limitations and uses. We briefly describe the current National Health Expenditure Accounts (NHEA), and then go on to discuss the addition of COI estimation to the NHEA. Conclusion Recommendations are made for future research aimed at identifying the best methods for developing and using disease-based national health accounts to optimize the information available to policymakers as they struggle with difficult resource allocation decisions. PMID:19536017

Evidence and its uses in health care and research: the role of critical thinking.

PubMed

Jenicek, Milos; Croskerry, Pat; Hitchcock, David L

2011-01-01

Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician's expertise, the patient's individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum.

Evidence and its uses in health care and research: The role of critical thinking

PubMed Central

Jenicek, Milos; Croskerry, Pat; Hitchcock, David L.

2011-01-01

Summary Obtaining and critically appraising evidence is clearly not enough to make better decisions in clinical care. The evidence should be linked to the clinician’s expertise, the patient’s individual circumstances (including values and preferences), and clinical context and settings. We propose critical thinking and decision-making as the tools for making that link. Critical thinking is also called for in medical research and medical writing, especially where pre-canned methodologies are not enough. It is also involved in our exchanges of ideas at floor rounds, grand rounds and case discussions; our communications with patients and lay stakeholders in health care; and our writing of research papers, grant applications and grant reviews. Critical thinking is a learned process which benefits from teaching and guided practice like any discipline in health sciences. Training in critical thinking should be a part or a pre-requisite of the medical curriculum. PMID:21169920

Critical Factors Influencing Decision to Adopt Human Resource Information System (HRIS) in Hospitals

PubMed Central

Alam, Md Golam Rabiul; Masum, Abdul Kadar Muhammad; Beh, Loo-See; Hong, Choong Seon

2016-01-01

The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh—an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories—Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries. PMID:27494334

Critical Factors Influencing Decision to Adopt Human Resource Information System (HRIS) in Hospitals.

PubMed

Alam, Md Golam Rabiul; Masum, Abdul Kadar Muhammad; Beh, Loo-See; Hong, Choong Seon

2016-01-01

The aim of this research is to explore factors influencing the management decisions to adopt human resource information system (HRIS) in the hospital industry of Bangladesh-an emerging developing country. To understand this issue, this paper integrates two prominent adoption theories-Human-Organization-Technology fit (HOT-fit) model and Technology-Organization-Environment (TOE) framework. Thirteen factors under four dimensions were investigated to explore their influence on HRIS adoption decisions in hospitals. Employing non-probability sampling method, a total of 550 copies of structured questionnaires were distributed among HR executives of 92 private hospitals in Bangladesh. Among the respondents, usable questionnaires were 383 that suggesting a valid response rate of 69.63%. We classify the sample into 3 core groups based on the HRIS initial implementation, namely adopters, prospectors, and laggards. The obtained results specify 5 most critical factors i.e. IT infrastructure, top management support, IT capabilities of staff, perceived cost, and competitive pressure. Moreover, the most significant dimension is technological dimension followed by organisational, human, and environmental among the proposed 4 dimensions. Lastly, the study found existence of significant differences in all factors across different adopting groups. The study results also expose constructive proposals to researchers, hospitals, and the government to enhance the likelihood of adopting HRIS. The present study has important implications in understanding HRIS implementation in developing countries.

Faults Discovery By Using Mined Data

NASA Technical Reports Server (NTRS)

Lee, Charles

2005-01-01

Fault discovery in the complex systems consist of model based reasoning, fault tree analysis, rule based inference methods, and other approaches. Model based reasoning builds models for the systems either by mathematic formulations or by experiment model. Fault Tree Analysis shows the possible causes of a system malfunction by enumerating the suspect components and their respective failure modes that may have induced the problem. The rule based inference build the model based on the expert knowledge. Those models and methods have one thing in common; they have presumed some prior-conditions. Complex systems often use fault trees to analyze the faults. Fault diagnosis, when error occurs, is performed by engineers and analysts performing extensive examination of all data gathered during the mission. International Space Station (ISS) control center operates on the data feedback from the system and decisions are made based on threshold values by using fault trees. Since those decision-making tasks are safety critical and must be done promptly, the engineers who manually analyze the data are facing time challenge. To automate this process, this paper present an approach that uses decision trees to discover fault from data in real-time and capture the contents of fault trees as the initial state of the trees.

Improving Health Care Provider Communication in End-of-Life Decision-Making.

PubMed

Wilson, Tracey; Haut, Cathy; Akintade, Bimbola

2017-01-01

Critical care providers are responsible for many aspects of patient care, primarily focusing on preserving life. However, nearly 40% of patients who are admitted to an adult critical care unit will not survive. Initiating a conversation about end-of-life decision-making is a daunting task. Often, health care providers are not trained, experienced, or comfortable facilitating these conversations. This article describes a quality improvement project that identified current views on end-of-life communication in the intensive care unit and potential barriers that obstruct open discussion, and offering strategies for improvement. ©2017 American Association of Critical-Care Nurses.

Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients

PubMed Central

2013-01-01

Introduction Close monitoring and repeated risk assessment of sepsis patients in the intensive care unit (ICU) is important for decisions regarding care intensification or early discharge to the ward. We studied whether considering plasma kinetics of procalcitonin, a biomarker of systemic bacterial infection, over the first 72 critical care hours improved mortality prognostication of septic patients from two US settings. Methods This retrospective analysis included consecutively treated eligible adults with a diagnosis of sepsis from critical care units in two independent institutions in Clearwater, FL and Chicago, IL. Cohorts were used for derivation or validation to study the association between procalcitonin change over the first 72 critical care hours and mortality. Results ICU/in-hospital mortality rates were 29.2%/31.8% in the derivation cohort (n = 154) and 17.6%/29.4% in the validation cohort (n = 102). In logistic regression analysis of both cohorts, procalcitonin change was strongly associated with ICU and in-hospital mortality independent of clinical risk scores (Acute Physiology, Age and Chronic Health Evaluation IV or Simplified Acute Physiology Score II), with area under the curve (AUC) from 0.67 to 0.71. When procalcitonin decreased by at least 80%, the negative predictive value for ICU/in-hospital mortality was 90%/90% in the derivation cohort, and 91%/79% in the validation cohort. When procalcitonin showed no decrease or increased, the respective positive predictive values were 48%/48% and 36%/52%. Discussion In septic patients, procalcitonin kinetics over the first 72 critical care hours provide prognostic information beyond that available from clinical risk scores. If these observations are confirmed, procalcitonin monitoring may assist physician decision-making regarding care intensification or early transfer from the ICU to the floor. PMID:23787145

Proceedings of the Sixth NASA Langley Formal Methods (LFM) Workshop

NASA Technical Reports Server (NTRS)

Rozier, Kristin Yvonne (Editor)

2008-01-01

Today's verification techniques are hard-pressed to scale with the ever-increasing complexity of safety critical systems. Within the field of aeronautics alone, we find the need for verification of algorithms for separation assurance, air traffic control, auto-pilot, Unmanned Aerial Vehicles (UAVs), adaptive avionics, automated decision authority, and much more. Recent advances in formal methods have made verifying more of these problems realistic. Thus we need to continually re-assess what we can solve now and identify the next barriers to overcome. Only through an exchange of ideas between theoreticians and practitioners from academia to industry can we extend formal methods for the verification of ever more challenging problem domains. This volume contains the extended abstracts of the talks presented at LFM 2008: The Sixth NASA Langley Formal Methods Workshop held on April 30 - May 2, 2008 in Newport News, Virginia, USA. The topics of interest that were listed in the call for abstracts were: advances in formal verification techniques; formal models of distributed computing; planning and scheduling; automated air traffic management; fault tolerance; hybrid systems/hybrid automata; embedded systems; safety critical applications; safety cases; accident/safety analysis.

Critical appraisal of assumptions in chains of model calculations used to project local climate impacts for adaptation decision support—the case of Baakse Beek

NASA Astrophysics Data System (ADS)

van der Sluijs, Jeroen P.; Arjan Wardekker, J.

2015-04-01

In order to enable anticipation and proactive adaptation, local decision makers increasingly seek detailed foresight about regional and local impacts of climate change. To this end, the Netherlands Models and Data-Centre implemented a pilot chain of sequentially linked models to project local climate impacts on hydrology, agriculture and nature under different national climate scenarios for a small region in the east of the Netherlands named Baakse Beek. The chain of models sequentially linked in that pilot includes a (future) weather generator and models of respectively subsurface hydrogeology, ground water stocks and flows, soil chemistry, vegetation development, crop yield and nature quality. These models typically have mismatching time step sizes and grid cell sizes. The linking of these models unavoidably involves the making of model assumptions that can hardly be validated, such as those needed to bridge the mismatches in spatial and temporal scales. Here we present and apply a method for the systematic critical appraisal of model assumptions that seeks to identify and characterize the weakest assumptions in a model chain. The critical appraisal of assumptions presented in this paper has been carried out ex-post. For the case of the climate impact model chain for Baakse Beek, the three most problematic assumptions were found to be: land use and land management kept constant over time; model linking of (daily) ground water model output to the (yearly) vegetation model around the root zone; and aggregation of daily output of the soil hydrology model into yearly input of a so called ‘mineralization reduction factor’ (calculated from annual average soil pH and daily soil hydrology) in the soil chemistry model. Overall, the method for critical appraisal of model assumptions presented and tested in this paper yields a rich qualitative insight in model uncertainty and model quality. It promotes reflectivity and learning in the modelling community, and leads to well informed recommendations for model improvement.

Physician Reimbursement for Critical Care Services Integrating Palliative Care for Patients Who Are Critically Ill

PubMed Central

Nelson, Judith E.; Weissman, David E.; Hays, Ross M.; Mosenthal, Anne C.; Mulkerin, Colleen; Puntillo, Kathleen A.; Ray, Daniel E.; Bassett, Rick; Boss, Renee D.; Brasel, Karen J.; Campbell, Margaret L.; Cortez, Therese B.; Curtis, J. Randall

2012-01-01

Patients with advanced illness often spend time in an ICU, while nearly one-third of patients with advanced cancer who receive Medicare die in hospitals, often with failed ICU care. For most, death occurs following the withdrawal or withholding of life-sustaining treatments. The integration of palliative care is essential for high-quality critical care. Although palliative care specialists are becoming increasingly available, intensivists and other physicians are also expected to provide basic palliative care, including symptom treatment and communication about goals of care. Patients who are critically ill are often unable to make decisions about their care. In these situations, physicians must meet with family members or other surrogates to determine appropriate medical treatments. These meetings require clinical expertise to ensure that patient values are explored for medical decision making about therapeutic options, including palliative care. Meetings with families take time. Issues related to the disease process, prognosis, and treatment plan are complex, and decisions about the use or limitation of intensive care therapies have life-or-death implications. Inadequate reimbursement for physician services may be a barrier to the optimal delivery of high-quality palliative care, including effective communication. Appropriate documentation of time spent integrating palliative and critical care for patients who are critically ill can be consistent with the Current Procedural Terminology codes (99291 and 99292) for critical care services. The purpose of this article is to help intensivists and other providers understand the circumstances in which integration of palliative and critical care meets the definition of critical care services for billing purposes. PMID:22396564

Challenges faced by nurses in managing pain in a critical care setting.

PubMed

Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith

2012-05-01

To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.

Evidence-based decision-making for vaccine introductions: Overview of the ProVac International Working Group’s experience

PubMed Central

Jauregui, Barbara; Garcia, Ana Gabriela Felix; Janusz, Cara Bess; Blau, Julia; Munier, Aline; Atherly, Deborah; Mvundura, Mercy; Hajjeh, Rana; Lopman, Benjamin; Clark, Andrew David; Baxter, Louise; Hutubessy, Raymond; de Quadros, Ciro; Andrus, Jon Kim

2015-01-01

Introduction Pan American Health Organization’s (PAHO) ProVac Initiative aims to strengthen countries’ technical capacity to make evidence-based immunization policy. With financial support from the Bill and Melinda Gates Foundation, PAHO established the ProVac International Working Group (IWG), a platform created for two years to transfer the ProVac Initiative’s tools and methods to support decisions in non-PAHO regions. Methods In 2011, WHO Regional Offices and partner agencies established the IWG to transfer the ProVac framework for new vaccine decision support, including tools and trainings to other regions of the world. During the two year period, PAHO served as the coordinating secretariat and partner agencies played implementing or advisory roles. Results Fifty nine national professionals from 17 countries received training on the use of economic evaluations to aid vaccine policy making through regional workshops. The IWG provided direct technical support to nine countries to develop cost-effectiveness analyses to inform decisions. All nine countries introduced the new vaccine evaluated or their NITAGs have made a recommendation to the Ministry of Health to introduce the new vaccine. Discussion Developing countries around the world are increasingly interested in weighing the potential health impact due to new vaccine introduction against the investments required. During the two years, the ProVac approach proved valuable and timely to aid the national decision making processes, even despite the different challenges and idiosyncrasies encountered in each region. The results of this work suggest that: (1) there is great need and demand for technical support and for capacity building around economic evaluations; and (2) the ProVac method of supporting country-owned analyses is as effective in other regions as it has been in the PAHO region. Conclusion Decision support for new vaccine introduction in low- and middle-income countries is critical to guiding the efficient use of resources and prioritizing high impact vaccination programs. PMID:25919170

Improving decision making in crisis.

PubMed

Higgins, Guy; Freedman, Jennifer

2013-01-01

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

Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra.

PubMed

Claxton, Karl; Sculpher, Mark; McCabe, Chris; Briggs, Andrew; Akehurst, Ron; Buxton, Martin; Brazier, John; O'Hagan, Tony

2005-04-01

Recently the National Institute for Clinical Excellence (NICE) updated its methods guidance for technology assessment. One aspect of the new guidance is to require the use of probabilistic sensitivity analysis with all cost-effectiveness models submitted to the Institute. The purpose of this paper is to place the NICE guidance on dealing with uncertainty into a broader context of the requirements for decision making; to explain the general approach that was taken in its development; and to address each of the issues which have been raised in the debate about the role of probabilistic sensitivity analysis in general. The most appropriate starting point for developing guidance is to establish what is required for decision making. On the basis of these requirements, the methods and framework of analysis which can best meet these needs can then be identified. It will be argued that the guidance on dealing with uncertainty and, in particular, the requirement for probabilistic sensitivity analysis, is justified by the requirements of the type of decisions that NICE is asked to make. Given this foundation, the main issues and criticisms raised during and after the consultation process are reviewed. Finally, some of the methodological challenges posed by the need fully to characterise decision uncertainty and to inform the research agenda will be identified and discussed. Copyright (c) 2005 John Wiley & Sons, Ltd.

Saving the Lost Boys: Narratives of Discipline Disproportionality

ERIC Educational Resources Information Center

Gray, Mariama Smith

2016-01-01

In this article, I explore how discriminatory adult practices disproportionately involve Latino boys in the juvenile justice system. I use the critical methodologies of critical ethnography, critical discourse analysis and Critical Race Theory (CRT) to provide a race-centered analysis of decision-making in student discipline. My findings reveal…

How to translate therapeutic recommendations in clinical practice guidelines into rules for critiquing physician prescriptions? Methods and application to five guidelines

PubMed Central

2010-01-01

Background Clinical practice guidelines give recommendations about what to do in various medical situations, including therapeutical recommendations for drug prescription. An effective way to computerize these recommendations is to design critiquing decision support systems, i.e. systems that criticize the physician's prescription when it does not conform to the guidelines. These systems are commonly based on a list of "if conditions then criticism" rules. However, writing these rules from the guidelines is not a trivial task. The objective of this article is to propose methods that (1) simplify the implementation of guidelines' therapeutical recommendations in critiquing systems by automatically translating structured therapeutical recommendations into a list of "if conditions then criticize" rules, and (2) can generate an appropriate textual label to explain to the physician why his/her prescription is not recommended. Methods We worked on the therapeutic recommendations in five clinical practice guidelines concerning chronic diseases related to the management of cardiovascular risk. We evaluated the system using a test base of more than 2000 cases. Results Algorithms for automatically translating therapeutical recommendations into "if conditions then criticize" rules are presented. Eight generic recommendations are also proposed; they are guideline-independent, and can be used as default behaviour for handling various situations that are usually implicit in the guidelines, such as decreasing the dose of a poorly tolerated drug. Finally, we provide models and methods for generating a human-readable textual critique. The system was successfully evaluated on the test base. Conclusion We show that it is possible to criticize physicians' prescriptions starting from a structured clinical guideline, and to provide clear explanations. We are now planning a randomized clinical trial to evaluate the impact of the system on practices. PMID:20509903

A critical narrative analysis of shared decision-making in acute inpatient mental health care.

PubMed

Stacey, Gemma; Felton, Anne; Morgan, Alastair; Stickley, Theo; Willis, Martin; Diamond, Bob; Houghton, Philip; Johnson, Beverley; Dumenya, John

2016-01-01

Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients' care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

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

PubMed

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

2015-01-01

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

Review of ecological-based risk management approaches used at five Army Superfund sites.

PubMed

Poucher, Sherri L; Tracey, Gregory A; Johnson, Mark S; Haines, Laurie B

2012-04-01

Factors used in environmental remedial decision making concerning ecological risk are not well understood or necessarily consistent. Recent Records of Decision (RODs) for Army CERCLA sites were reviewed to select case studies where remedial management occurred in response to ecological risks. Thirty-four Army RODs were evaluated representing decisions promulgated between 1996 and 2004. Five were selected based on assessments that remedial actions were clearly linked to concern for ecological receptors. The Ecological Risk Assessment (ERA) approach and the subsequent risk management process were reviewed for each site. The case studies demonstrated that the ERA findings, as well as critical management decisions regarding interpretation of identified ecological risks, were determinants of remedial action objectives. Decisions regarding the selection of remedial alternatives were based on a set of criteria prescribed by Superfund requirements and guidance. Remedial alternative evaluations require protection of human health and the environment, but protective conditions were determined using different methods at each site. Examining the remedial management process for the 5 case study sites revealed that uncertainty in the risk assessment and decisions regarding appropriate spatial scales for both risk assessment and remediation were important factors influencing remedial action decisions. The case reviews also revealed that levels of documentation were variable from site to site. In the future, more detailed documentation of decision criteria and the development of criteria that consider the resilience of the site will result in more technically defensible ecological risk management. Copyright © 2011 SETAC.

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

PubMed Central

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

2016-01-01

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

The Parent Perspective: “Being a Good Parent” When Making Critical Decisions in the PICU

PubMed Central

October, Tessie W.; Fisher, Kiondra R.; Feudtner, Chris; Hinds, Pamela S.

2015-01-01

Objective To identify factors important to parents making decisions for their critically ill child. Design Prospective cross-sectional study. Setting Single center, tertiary care PICU. Subjects Parents making critical treatment decisions for their child. Intervention One-on-one interviews that used the Good Parent Tool-2 open-ended question that asks parents to describe factors important for parenting their ill child and how clinicians could help them achieve their definition of “being a good parent” to their child. Parent responses were analyzed thematically. Parents also ranked themes in order of importance to them using the Good Parent Ranking Exercise. Measurement and Main Results Of 53 eligible parents, 43 (81%) participated. We identified nine themes through content analysis of the parent’s narrative statements from the Good Parent Tool. Most commonly (60% of quotes) components of being a good parent described by parents included focusing on their child’s quality of life, advocating for their child with the medical team, and putting their child’s needs above their own. Themes key to parental decision making were similar regardless of parent race and socioeconomic status or child’s clinical status. We identified nine clinician strategies identified by parents as helping them fulfill their parenting role, most commonly, parents wanted to be kept informed (32% of quotes). Using the Good Parent Ranking Exercise, fathers ranked making informed medical decisions as most important, whereas mothers ranked focusing on the child’s health and putting their child’s needs above their own as most important. However, mothers who were not part of a couple ranked making informed medical decisions as most important. Conclusion These findings suggest a range of themes important for parents to “be a good parent” to their child while making critical decisions. Further studies need to explore whether clinician’s knowledge of the parent’s most valued factor can improve family-centered care. PMID:24583502

Improving serum calcium test ordering according to a decision algorithm.

PubMed

Faria, Daniel K; Taniguchi, Leandro U; Fonseca, Luiz A M; Ferreira-Junior, Mario; Aguiar, Francisco J B; Lichtenstein, Arnaldo; Sumita, Nairo M; Duarte, Alberto J S; Sales, Maria M

2018-05-18

To detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm. We studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014. Total and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions. A decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Gating the holes in the Swiss cheese (part I): Expanding professor Reason's model for patient safety

PubMed Central

Bryan Young, G.; Makhinson, Michael; Smith, Preston A.; Stobart, Kent; Croskerry, Pat

2017-01-01

Abstract Introduction Although patient safety has improved steadily, harm remains a substantial global challenge. Additionally, safety needs to be ensured not only in hospitals but also across the continuum of care. Better understanding of the complex cognitive factors influencing health care–related decisions and organizational cultures could lead to more rational approaches, and thereby to further improvement. Hypothesis A model integrating the concepts underlying Reason's Swiss cheese theory and the cognitive‐affective biases plus cascade could advance the understanding of cognitive‐affective processes that underlie decisions and organizational cultures across the continuum of care. Methods Thematic analysis, qualitative information from several sources being used to support argumentation. Discussion Complex covert cognitive phenomena underlie decisions influencing health care. In the integrated model, the Swiss cheese slices represent dynamic cognitive‐affective (mental) gates: Reason's successive layers of defence. Like firewalls and antivirus programs, cognitive‐affective gates normally allow the passage of rational decisions but block or counter unsounds ones. Gates can be breached (ie, holes created) at one or more levels of organizations, teams, and individuals, by (1) any element of cognitive‐affective biases plus (conflicts of interest and cognitive biases being the best studied) and (2) other potential error‐provoking factors. Conversely, flawed decisions can be blocked and consequences minimized; for example, by addressing cognitive biases plus and error‐provoking factors, and being constantly mindful. Informed shared decision making is a neglected but critical layer of defence (cognitive‐affective gate). The integrated model can be custom tailored to specific situations, and the underlying principles applied to all methods for improving safety. The model may also provide a framework for developing and evaluating strategies to optimize organizational cultures and decisions. Limitations The concept is abstract, the model is virtual, and the best supportive evidence is qualitative and indirect. Conclusions The proposed model may help enhance rational decision making across the continuum of care, thereby improving patient safety globally. PMID:29168290

Presenting evidence and summary measures to best inform societal decisions when comparing multiple strategies.

PubMed

Eckermann, Simon; Willan, Andrew R

2011-07-01

Multiple strategy comparisons in health technology assessment (HTA) are becoming increasingly important, with multiple alternative therapeutic actions, combinations of therapies and diagnostic and genetic testing alternatives. Comparison under uncertainty of incremental cost, effects and cost effectiveness across more than two strategies is conceptually and practically very different from that for two strategies, where all evidence can be summarized in a single bivariate distribution on the incremental cost-effectiveness plane. Alternative methods for comparing multiple strategies in HTA have been developed in (i) presenting cost and effects on the cost-disutility plane and (ii) summarizing evidence with multiple strategy cost-effectiveness acceptability (CEA) and expected net loss (ENL) curves and frontiers. However, critical questions remain for the analyst and decision maker of how these techniques can be best employed across multiple strategies to (i) inform clinical and cost inference in presenting evidence, and (ii) summarize evidence of cost effectiveness to inform societal reimbursement decisions where preferences may be risk neutral or somewhat risk averse under the Arrow-Lind theorem. We critically consider how evidence across multiple strategies can be best presented and summarized to inform inference and societal reimbursement decisions, given currently available methods. In the process, we make a number of important original findings. First, in presenting evidence for multiple strategies, the joint distribution of costs and effects on the cost-disutility plane with associated flexible comparators varying across replicates for cost and effect axes ensure full cost and effect inference. Such inference is usually confounded on the cost-effectiveness plane with comparison relative to a fixed origin and axes. Second, in summarizing evidence for risk-neutral societal decision making, ENL curves and frontiers are shown to have advantages over the CEA frontier in directly presenting differences in expected net benefit (ENB). The CEA frontier, while identifying strategies that maximize ENB, only presents their probability of maximizing net benefit (NB) and, hence, fails to explain why strategies maximize ENB at any given threshold value. Third, in summarizing evidence for somewhat risk-averse societal decision making, trade-offs between the strategy maximizing ENB and other potentially optimal strategies with higher probability of maximizing NB should be presented over discrete threshold values where they arise. However, the probabilities informing these trade-offs and associated discrete threshold value regions should be derived from bilateral CEA curves to prevent confounding by other strategies inherent in multiple strategy CEA curves. Based on these findings, a series of recommendations are made for best presenting and summarizing cost-effectiveness evidence for reimbursement decisions when comparing multiple strategies, which are contrasted with advice for comparing two strategies. Implications for joint research and reimbursement decisions are also discussed.

Network information attacks on the control systems of power facilities belonging to the critical infrastructure

NASA Astrophysics Data System (ADS)

Loginov, E. L.; Raikov, A. N.

2015-04-01

The most large-scale accidents occurred as a consequence of network information attacks on the control systems of power facilities belonging to the United States' critical infrastructure are analyzed in the context of possibilities available in modern decision support systems. Trends in the development of technologies for inflicting damage to smart grids are formulated. A volume matrix of parameters characterizing attacks on facilities is constructed. A model describing the performance of a critical infrastructure's control system after an attack is developed. The recently adopted measures and legislation acts aimed at achieving more efficient protection of critical infrastructure are considered. Approaches to cognitive modeling and networked expertise of intricate situations for supporting the decision-making process, and to setting up a system of indicators for anticipatory monitoring of critical infrastructure are proposed.

An introduction to behavioural decision-making theories for paediatricians.

PubMed

Haward, Marlyse F; Janvier, Annie

2015-04-01

Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Assessing Critical Thinking Outcomes of Dental Hygiene Students Utilizing Virtual Patient Simulation: A Mixed Methods Study.

PubMed

Allaire, Joanna L

2015-09-01

Dental hygiene educators must determine which educational practices best promote critical thinking, a quality necessary to translate knowledge into sound clinical decision making. The aim of this small pilot study was to determine whether virtual patient simulation had an effect on the critical thinking of dental hygiene students. A pretest-posttest design using the Health Science Reasoning Test was used to evaluate the critical thinking skills of senior dental hygiene students at The University of Texas School of Dentistry at Houston Dental Hygiene Program before and after their experience with computer-based patient simulation cases. Additional survey questions sought to identify the students' perceptions of whether the experience had helped develop their critical thinking skills and improved their ability to provide competent patient care. A convenience sample of 31 senior dental hygiene students completed both the pretest and posttest (81.5% of total students in that class); 30 senior dental hygiene students completed the survey on perceptions of the simulation (78.9% response rate). Although the results did not show a significant increase in mean scores, the students reported feeling that the use of virtual patients was an effective teaching method to promote critical thinking, problem-solving, and confidence in the clinical realm. The results of this pilot study may have implications to support the use of virtual patient simulations in dental hygiene education. Future research could include a larger controlled study to validate findings from this study.

Life cycle tools combined with multi-criteria and participatory methods for agricultural sustainability: Insights from a systematic and critical review.

PubMed

De Luca, Anna Irene; Iofrida, Nathalie; Leskinen, Pekka; Stillitano, Teodora; Falcone, Giacomo; Strano, Alfio; Gulisano, Giovanni

2017-10-01

Life cycle (LC) methodologies have attracted a great interest in agricultural sustainability assessments, even if, at the same time, they have sometimes been criticized for making unrealistic assumptions and subjective choices. To cope with these weaknesses, Multi-Criteria Decision Analysis (MCDA) and/or participatory methods can be used to balance and integrate different sustainability dimensions. The purpose of this study is to highlight how life cycle approaches were combined with MCDA and participatory methods to address agricultural sustainability in the published scientific literature. A systematic and critical review was developed, highlighting the following features: which multi-criterial and/or participatory methods have been associated with LC tools; how they have been integrated or complemented (methodological relationships); the intensity of the involvement of stakeholders (degree of participation); and which synergies have been achieved by combining the methods. The main typology of integration was represented by multi-criterial frameworks integrating LC evaluations. LC tools can provide MCDA studies with local and global information on how to reduce negative impacts and avoid burden shifts, while MCDA methods can help LC practitioners deal with subjective assumptions in an objective way, to take into consideration actors' values and to overcome trade-offs among the different dimensions of sustainability. Considerations concerning the further development of Life Cycle Sustainability Assessment (LCSA) have been identified as well. Copyright © 2017 Elsevier B.V. All rights reserved.

System Dynamics Approach for Critical Infrastructure and Decision Support. A Model for a Potable Water System.

NASA Astrophysics Data System (ADS)

Pasqualini, D.; Witkowski, M.

2005-12-01

The Critical Infrastructure Protection / Decision Support System (CIP/DSS) project, supported by the Science and Technology Office, has been developing a risk-informed Decision Support System that provides insights for making critical infrastructure protection decisions. The system considers seventeen different Department of Homeland Security defined Critical Infrastructures (potable water system, telecommunications, public health, economics, etc.) and their primary interdependencies. These infrastructures have been modeling in one model called CIP/DSS Metropolitan Model. The modeling approach used is a system dynamics modeling approach. System dynamics modeling combines control theory and the nonlinear dynamics theory, which is defined by a set of coupled differential equations, which seeks to explain how the structure of a given system determines its behavior. In this poster we present a system dynamics model for one of the seventeen critical infrastructures, a generic metropolitan potable water system (MPWS). Three are the goals: 1) to gain a better understanding of the MPWS infrastructure; 2) to identify improvements that would help protect MPWS; and 3) to understand the consequences, interdependencies, and impacts, when perturbations occur to the system. The model represents raw water sources, the metropolitan water treatment process, storage of treated water, damage and repair to the MPWS, distribution of water, and end user demand, but does not explicitly represent the detailed network topology of an actual MPWS. The MPWS model is dependent upon inputs from the metropolitan population, energy, telecommunication, public health, and transportation models as well as the national water and transportation models. We present modeling results and sensitivity analysis indicating critical choke points, negative and positive feedback loops in the system. A general scenario is also analyzed where the potable water system responds to a generic disruption.

Decision Analysis Techniques for Adult Learners: Application to Leadership

ERIC Educational Resources Information Center

Toosi, Farah

2017-01-01

Most decision analysis techniques are not taught at higher education institutions. Leaders, project managers and procurement agents in industry have strong technical knowledge, and it is crucial for them to apply this knowledge at the right time to make critical decisions. There are uncertainties, problems, and risks involved in business…

The Critical Importance of Costs for Education Decisions. REL 2017-274

ERIC Educational Resources Information Center

Hollands, Fiona M.; Levin, Henry M.

2017-01-01

This brief provides guidance to decision makers in schools, districts, state education departments, and intermediary organizations about ways that cost analyses can help inform their decisions about program choices, budgets, and strategies. It addresses questions about: (1) why cost information matters in education; (2) what cost metrics are…

Decision Making: New Paradigm for Education.

ERIC Educational Resources Information Center

Wales, Charles E.; And Others

1986-01-01

Defines education's new paradigm as schooling based on decision making, the critical thinking skills serving it, and the knowledge base supporting it. Outlines a model decision-making process using a hypothetical breakfast problem; a late riser chooses goals, generates ideas, develops an action plan, and implements and evaluates it. (4 references)…

The Wisdom of Tacit Knowing-in-Action and Mission Command

ERIC Educational Resources Information Center

Moilanen, Jon H.

2015-01-01

Adult learners regularly confront complex and dynamic challenges in moments of crisis that require self-efficacy of intuition and immediate decision. Such "snap decision-making" requires highly developed critical thinking skills to effectively operate in the midst of chaos. This decisiveness is particularly challenging in the military…

An Ethical Decision-Making Framework for Community College Administrators

ERIC Educational Resources Information Center

Oliver, Diane E.; Hioco, Barbara

2012-01-01

The purpose of this article is to describe a decision-making framework developed for use by community college administrators and higher education faculty members who teach graduate courses in community college administration or leadership. The rationale for developing a decision-making approach that integrates ethics and critical thinking was…

Accepting the challenge: what academic health sciences library directors do to become effective leaders

PubMed Central

Fought, Rick L.; Misawa, Mitsunori

2018-01-01

Objective This study sought to better understand effective leadership through the lived experiences of academic health sciences library directors. Methods Phenomenological interviews were conducted with eight academic health sciences library directors to capture the essence of their shared leadership experiences. The research question that guided the study was: How do academic health sciences library directors understand their leadership effectiveness? The interviews were transcribed and coded, and the data were analyzed thematically. Results Three main themes emerged from data after analysis: assessment of the environment, strategies and decisions, and critical skills. Assessment of the environment includes awareness not only of trends in libraries and technology, but also the trends in health information, higher education, and current events and politics of their institutions and states. The strategies and decisions theme is about the ability to think both in the long-term and short-term when leading the library. Finally, critical skills are those leadership skills that the research participants identified as most important to their leadership effectiveness. Conclusions The study identified three main themes capturing the essence of the research participants’ leadership experiences. The three themes constitute a wide array of leadership skills that are important to learn, understand, and develop to increase leadership effectiveness. Effective leadership is fundamental to obtaining long-term strategic goals and is critical to the long-term future of the libraries. PMID:29632444

Nurses' decision-making process in cases of physical restraint in acute elderly care: a qualitative study.

PubMed

Goethals, S; Dierckx de Casterlé, B; Gastmans, C

2013-05-01

The increasing vulnerability of patients in acute elderly care requires constant critical reflection in ethically charged situations such as when employing physical restraint. Qualitative evidence concerning nurses' decision making in cases of physical restraint is limited and fragmented. A thorough understanding of nurses' decision-making process could be useful to understand how nurses reason and make decisions in ethically laden situations. The aims of this study were to explore and describe nurses' decision-making process in cases of physical restraint. We used a qualitative interview design inspired by the Grounded Theory approach. Data analysis was guided by the Qualitative Analysis Guide of Leuven. Twelve hospitals geographically spread throughout the five provinces of Flanders, Belgium. Twenty-one acute geriatric nurses interviewed between October 2009 and April 2011 were purposively and theoretically selected, with the aim of including nurses having a variety of characteristics and experiences concerning decisions on using physical restraint. In cases of physical restraint in acute elderly care, nurses' decision making was never experienced as a fixed decision but rather as a series of decisions. Decision making was mostly reasoned upon and based on rational arguments; however, decisions were also made routinely and intuitively. Some nurses felt very certain about their decisions, while others experienced feelings of uncertainty regarding their decisions. Nurses' decision making is an independent process that requires nurses to obtain a good picture of the patient, to be constantly observant, and to assess and reassess the patient's situation. Coming to thoughtful and individualized decisions requires major commitment and constant critical reflection. Copyright © 2012 Elsevier Ltd. All rights reserved.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers.

PubMed

Petrinec, Amy B; Mazanec, Polly M; Burant, Christopher J; Hoffer, Alan; Daly, Barbara J

2015-06-01

To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. A single-group descriptive longitudinal correlational study. Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. None. Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p=0.01) and emotion-focused (p<0.01) coping decreased over time while avoidant coping (p=0.20) use remained stable. Coping strategies 30 days after hospitalization (R2=0.50, p<0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2=0.30, p=0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

Influences on Decision Making Identified by Parents of Children Receiving Pediatric Palliative Care.

PubMed

Carroll, Karen W; Mollen, Cynthia J; Aldridge, Sarah; Hexem, Kari R; Feudtner, Chris

2012-01-01

Parental decision making is a critical component in the provision of palliative and end-of-life care, yet factors that parents perceive as influencing this process, when they are making decisions for their children, have not been well characterized. As part of a mixed-methods cohort study, we interviewed 73 parents of 50 pediatric patients who were referred to the hospital's pediatric palliative care service. The semistructured interviews focused on "decision making for your child"; the interviews were recorded and transcribed. A random sample (n = 13) was first coded and analyzed for core themes, and these themes were then cross-validated with a second random sample (n = 3) of interviews. Four dominant interrelated themes permeated parents' discussions about the decisions they were making for their children and the process of decision making. First, Orientation and Direction (including the subthemes of Goals and Hopes, Spirituality and Meaning, and Purposeful Effort) connotes the parents' effort to establish and clarify the broad context of decision making. Second, Defining What Is Good for the Child (including the subthemes of Quality of Life and Suffering, and Normalcy and Normalization) conveys how the parents posed questions and pondered what decisions would be in the child's best interests. Third, the entwined theme of Relationships, Communication, and Support reflects how parents reported the social and interactive nature of decision making. Fourth, the theme of Feelings and Personal Accountability focuses inward as parents report efforts to deal with their emotional responses and self-judgments. Parents report grappling with several influences upon their decision-making processes that extend well beyond the standard discussions of medical information exchanges and the evaluation of risks and benefits. Decision support for these parents should account for these diverse influences.

Development and validation of a liquid chromatography-tandem mass spectrometry method for the separation of conjugated and unconjugated 17alpha- and 17beta-boldenone in urine sample.

PubMed

Gasparini, Mara; Assini, Walter; Bozzoni, Eros; Tognoli, Nadia; Dusi, Guglielmo

2007-03-14

Natural occurrence or illegal treatment of boldenone (BOLD) presence in cattle urine is under debate within the European Union. Separation of conjugated and unconjugated forms of 17alpha-boldenone (alpha-BOLD) and 17beta-boldenone (beta-BOLD) and presence of related molecules as androsta-1,4-diene-3,17-dione (ADD) appear critical points for the decision of an illegal use. The aim of this study is a new analytical approach of BOLD and ADD confirmation in cattle urine. The separation between conjugated and unconjugated forms of BOLD was obtained by a preliminary urine liquid-liquid extraction step with ethyl acetate. In this step the organic phase extracts only unconjugated BOLD and ADD, while BOLD in conjugated form remain in urine phase. Afterwards the urine phase, contains conjugated BOLD, was subjected to an enzymatic deconjugation. Solid-phase extraction (OASIS-HLB Waters) was used for the purification and concentration of analytes in organic and urine phases and liquid chromatography ion electrospray tandem mass spectrometry (LC-MS-MS) was applied for the confirmation of BOLD and ADD, using deuterium-labelled 17beta-boldenone (BOLD-d3) as internal standard. The method was validated as a quantitative confirmatory method according to the Commission Decision 2002/657/CE. The results obtained demonstrate that the developed method show very high specificity, precision, trueness and ruggedness. Decision limits (CCalpha) smaller than 0.5 ng mL(-1) were obtained for each analyte.

Alternative Test Methods for Developmental Neurotoxicity: A ...

EPA Pesticide Factsheets

Exposure to environmental contaminants is well documented to adversely impact the development of the nervous system. However, the time, animal and resource intensive EPA and OECD testing guideline methods for developmental neurotoxicity (DNT) are not a viable solution to characterizing potential chemical hazards for the thousands of untested chemicals currently in commerce. Thus, research efforts over the past decade have endeavored to develop cost-effective alternative DNT testing methods. These efforts have begun to generate data that can inform regulatory decisions. Yet there are major challenges to both the acceptance and use of this data. Major scientific challenges for DNT include development of new methods and models that are “fit for purpose”, development of a decision-use framework, and regulatory acceptance of the methods. It is critical to understand that use of data from these methods will be driven mainly by the regulatory problems being addressed. Some problems may be addressed with limited datasets, while others may require data for large numbers of chemicals, or require the development and use of new biological and computational models. For example mechanistic information derived from in vitro DNT assays can be used to inform weight of evidence (WoE) or integrated approaches to testing and assessment (IATA) approaches for chemical-specific assessments. Alternatively, in vitro data can be used to prioritize (for further testing) the thousands

Prostate cancer screening and shared decision-making preferences among African-American members of the Prince Hall Masons.

PubMed

Williams, Randi M; Zincke, Nicole L; Turner, Ralph O; Davis, Jackson L; Davis, Kimberly M; Schwartz, Marc D; Johnson, Lenora; Kerner, Jon F; Taylor, Kathryn L

2008-10-01

Shared decision making (SDM) is recommended as one method to assist men in making an informed decision about prostate cancer screening (PCS). SDM preferences for PCS have not been evaluated among African-American (AA) men. Given AA men's increased risk and the uncertainty surrounding screening, it is critical to determine how to assist AA men in making an informed decision. We assessed the extent to which a sample of AA men wished to engage in SDM regarding PCS and the demographic and psychological characteristics associated with SDM preferences. Participants completed a telephone interview that covered demographic and medical information, SDM preferences, PCS knowledge, decisional conflict, and satisfaction with previous screening decisions. Subjects included 286 AA men aged 40-70, who were members of a Masonic organization. Fifty-seven percent preferred SDM, 36% preferred to make their own decision, and 7% wanted their doctor to decide. A higher level of education and older age were associated with preferring SDM (p<0.05), while men with greater PCS knowledge were more likely to prefer to make the decision independently (p<0.05). Results suggest that physicians need to be prepared to discuss PCS with their patients. Further, more attention may be needed to engage younger, less educated, and less knowledgeable men as they may be less likely to discuss PCS. This understanding of AA men's preferences for PCS decisions helps to clarify the issues that health professionals need to consider when attempting to assist AA men in making a PCS decision. Copyright (c) 2008 John Wiley & Sons, Ltd.

I don't want to be the one saying 'we should just let him die': intrapersonal tensions experienced by surrogate decision makers in the ICU.

PubMed

Schenker, Yael; Crowley-Matoka, Megan; Dohan, Daniel; Tiver, Greer A; Arnold, Robert M; White, Douglas B

2012-12-01

Although numerous studies have addressed external factors associated with difficulty in surrogate decision making, intrapersonal sources of tension are an important element of decision making that have received little attention. To characterize key intrapersonal tensions experienced by surrogate decision makers in the intensive care unit (ICU), and explore associated coping strategies. Qualitative interview study. Thirty surrogates from five ICUs at two hospitals in Pittsburgh, Pennsylvania, who were actively involved in making life-sustaining treatment decisions for a critically ill loved one. We conducted in-depth, semi-structured interviews with surrogates, focused on intrapersonal tensions, role challenges, and coping strategies. We analyzed transcripts using constant comparative methods. Surrogates experience significant emotional conflict between the desire to act in accordance with their loved one's values and 1) not wanting to feel responsible for a loved one's death, 2) a desire to pursue any chance of recovery, and 3) the need to preserve family well-being. Associated coping strategies included 1) recalling previous discussions with a loved one, 2) sharing decisions with family members, 3) delaying or deferring decision making, 4) spiritual/religious practices, and 5) story-telling. Surrogates' struggle to reconcile personal and family emotional needs with their loved ones' wishes, and utilize common coping strategies to combat intrapersonal tensions. These data suggest reasons surrogates may struggle to follow a strict substituted judgment standard. They also suggest ways clinicians may improve decision making, including attending to surrogates' emotions, facilitating family decision making, and eliciting potential emotional conflicts and spiritual needs.

The Relationship of Critical-Thinking Skills and the Clinical-Judgment Skills of Baccalaureate Nursing Students.

ERIC Educational Resources Information Center

Bowles, Kathleen

2000-01-01

Nursing graduates (n=65) completed a critical thinking instrument and clinical decision-making scale. The critical thinking subscales of inference and inductive reasoning were positively correlated to clinical judgment. A significant relationship was found between critical thinking score and grade point average in nursing. (SK)

Congruency in Defining Critical Thinking by Nurse Educators and Non-nurse Scholars.

ERIC Educational Resources Information Center

Gordon, Joanne M.

2000-01-01

Nurse educators (n=201) identified their concept of critical thinking and agreement with nonnurse experts (a Delphi panel of academic scholars) on critical thinking items. They agreed on skills and dispositions, but nurse educators were more likely to consider research, problem solving, decision making, and planning as critical thinking…

Accounting for no net loss: A critical assessment of biodiversity offsetting metrics and methods.

PubMed

Carreras Gamarra, Maria Jose; Lassoie, James Philip; Milder, Jeffrey

2018-08-15

Biodiversity offset strategies are based on the explicit calculation of both losses and gains necessary to establish ecological equivalence between impact and offset areas. Given the importance of quantifying biodiversity values, various accounting methods and metrics are continuously being developed and tested for this purpose. Considering the wide array of alternatives, selecting an appropriate one for a specific project can be not only challenging, but also crucial; accounting methods can strongly influence the biodiversity outcomes of an offsetting strategy, and if not well-suited to the context and values being offset, a no net loss outcome might not be delivered. To date there has been no systematic review or comparative classification of the available biodiversity accounting alternatives that aim at facilitating metric selection, and no tools that guide decision-makers throughout such a complex process. We fill this gap by developing a set of analyses to support (i) identifying the spectrum of available alternatives, (ii) understanding the characteristics of each and, ultimately (iii) making the most sensible and sound decision about which one to implement. The metric menu, scoring matrix, and decision tree developed can be used by biodiversity offsetting practitioners to help select an existing metric, and thus achieve successful outcomes that advance the goal of no net loss of biodiversity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Problem and Dilemma Identification and Formulation As the Most Critical Element of the Decision-Making Process: Behavioral Biases and Characteristics.

ERIC Educational Resources Information Center

Pashiardis, Petros

This paper presents an overview of research in the field of decision theory, with a focus on problem and identification. The goal is to make the decision-making process as rational as possible in order to maximize the rational administration of the organization. The decisions associated with educational administration can be categorized as…

Design and implementation of intelligent electronic warfare decision making algorithm

NASA Astrophysics Data System (ADS)

Peng, Hsin-Hsien; Chen, Chang-Kuo; Hsueh, Chi-Shun

2017-05-01

Electromagnetic signals and the requirements of timely response have been a rapid growth in modern electronic warfare. Although jammers are limited resources, it is possible to achieve the best electronic warfare efficiency by tactical decisions. This paper proposes the intelligent electronic warfare decision support system. In this work, we develop a novel hybrid algorithm, Digital Pheromone Particle Swarm Optimization, based on Particle Swarm Optimization (PSO), Ant Colony Optimization (ACO) and Shuffled Frog Leaping Algorithm (SFLA). We use PSO to solve the problem and combine the concept of pheromones in ACO to accumulate more useful information in spatial solving process and speed up finding the optimal solution. The proposed algorithm finds the optimal solution in reasonable computation time by using the method of matrix conversion in SFLA. The results indicated that jammer allocation was more effective. The system based on the hybrid algorithm provides electronic warfare commanders with critical information to assist commanders in effectively managing the complex electromagnetic battlefield.

Walking the line: Understanding pedestrian behaviour and risk at rail level crossings with cognitive work analysis.

PubMed

Read, Gemma J M; Salmon, Paul M; Lenné, Michael G; Stanton, Neville A

2016-03-01

Pedestrian fatalities at rail level crossings (RLXs) are a public safety concern for governments worldwide. There is little literature examining pedestrian behaviour at RLXs and no previous studies have adopted a formative approach to understanding behaviour in this context. In this article, cognitive work analysis is applied to understand the constraints that shape pedestrian behaviour at RLXs in Melbourne, Australia. The five phases of cognitive work analysis were developed using data gathered via document analysis, behavioural observation, walk-throughs and critical decision method interviews. The analysis demonstrates the complex nature of pedestrian decision making at RLXs and the findings are synthesised to provide a model illustrating the influences on pedestrian decision making in this context (i.e. time, effort and social pressures). Further, the CWA outputs are used to inform an analysis of the risks to safety associated with pedestrian behaviour at RLXs and the identification of potential interventions to reduce risk. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Prediction of Sybil attack on WSN using Bayesian network and swarm intelligence

NASA Astrophysics Data System (ADS)

Muraleedharan, Rajani; Ye, Xiang; Osadciw, Lisa Ann

2008-04-01

Security in wireless sensor networks is typically sacrificed or kept minimal due to limited resources such as memory and battery power. Hence, the sensor nodes are prone to Denial-of-service attacks and detecting the threats is crucial in any application. In this paper, the Sybil attack is analyzed and a novel prediction method, combining Bayesian algorithm and Swarm Intelligence (SI) is proposed. Bayesian Networks (BN) is used in representing and reasoning problems, by modeling the elements of uncertainty. The decision from the BN is applied to SI forming an Hybrid Intelligence Scheme (HIS) to re-route the information and disconnecting the malicious nodes in future routes. A performance comparison based on the prediction using HIS vs. Ant System (AS) helps in prioritizing applications where decisions are time-critical.

Monte Carlo simulation: Its status and future

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

Murtha, J.A.

1997-04-01

Monte Carlo simulation is a statistics-based analysis tool that yields probability-vs.-value relationships for key parameters, including oil and gas reserves, capital exposure, and various economic yardsticks, such as net present value (NPV) and return on investment (ROI). Monte Carlo simulation is a part of risk analysis and is sometimes performed in conjunction with or as an alternative to decision [tree] analysis. The objectives are (1) to define Monte Carlo simulation in a more general context of risk and decision analysis; (2) to provide some specific applications, which can be interrelated; (3) to respond to some of the criticisms; (4) tomore » offer some cautions about abuses of the method and recommend how to avoid the pitfalls; and (5) to predict what the future has in store.« less

'Heads you win, tails I lose': a critical incident study of GPs' decisions about emergency admission referrals.

PubMed

Dempsey, Owen P; Bekker, Hilary L

2002-12-01

Acute hospital Trusts' inability to cope with the numbers of emergency admissions has led to the production of guidelines by the Department of Health aimed at reducing inappropriate admissions by GPs. There is a paucity of research describing GPs' decisions to (not) admit patients and it is unclear how effective these guidelines are in changing these practices. To describe GPs' decision-making about referrals for emergency hospital admissions. Observational design using the critical incident technique to elicit data. Eight GPs in West Yorkshire recorded details of memorable emergency admission decisions, both prospective and retrospective consultations. The transcript data were classified by theme using NUD*IST. Forty prospective and 8 retrospective consultations were analysed. Factors affecting GPs' decisions were:Identification of all consequences for all stakeholders in the decision. Emotional impact on the GP of managing these conflicting needs. 'Peer review' of the GP's professionalism about the decision. Contextual pressures limiting effectiveness of GPs' decision-making. Referral decisions require the evaluation of several conflicting consequences for many stakeholders in time-pressured and peer-reviewed situations. These factors encourage the use of heuristics, i.e. GPs' judgements will be influenced more by the social context of the choice than information about the patient's condition. Emergency referral guidelines provide more information to evaluate from another stakeholder; introducing guidelines is likely to increase GPs' use of heuristics and the making of less optimal decisions.

Visualization-based decision support for value-driven system design

NASA Astrophysics Data System (ADS)

Tibor, Elliott

In the past 50 years, the military, communication, and transportation systems that permeate our world, have grown exponentially in size and complexity. The development and production of these systems has seen ballooning costs and increased risk. This is particularly critical for the aerospace industry. The inability to deal with growing system complexity is a crippling force in the advancement of engineered systems. Value-Driven Design represents a paradigm shift in the field of design engineering that has potential to help counteract this trend. The philosophy of Value-Driven Design places the desires of the stakeholder at the forefront of the design process to capture true preferences and reveal system alternatives that were never previously thought possible. Modern aerospace engineering design problems are large, complex, and involve multiple levels of decision-making. To find the best design, the decision-maker is often required to analyze hundreds or thousands of combinations of design variables and attributes. Visualization can be used to support these decisions, by communicating large amounts of data in a meaningful way. Understanding the design space, the subsystem relationships, and the design uncertainties is vital to the advancement of Value-Driven Design as an accepted process for the development of more effective, efficient, robust, and elegant aerospace systems. This research investigates the use of multi-dimensional data visualization tools to support decision-making under uncertainty during the Value-Driven Design process. A satellite design system comprising a satellite, ground station, and launch vehicle is used to demonstrate effectiveness of new visualization methods to aid in decision support during complex aerospace system design. These methods are used to facilitate the exploration of the feasible design space by representing the value impact of system attribute changes and comparing the results of multi-objective optimization formulations with a Value-Driven Design formulation. The visualization methods are also used to assist in the decomposition of a value function, by representing attribute sensitivities to aid with trade-off studies. Lastly, visualization is used to enable greater understanding of the subsystem relationships, by displaying derivative-based couplings, and the design uncertainties, through implementation of utility theory. The use of these visualization methods is shown to enhance the decision-making capabilities of the designer by granting them a more holistic view of the complex design space.

Risk Analysis: Its Application to Argumentation and Decision-Making.

ERIC Educational Resources Information Center

Follert, Vincent

1981-01-01

Notes that utility theory has enjoyed renewed interest among debate critics and other decision makers. Some of the problems with its application are identified and guidelines for debaters are suggested. (PD)

Implementing Article 12 of the United Nations Convention on the Rights of the Child in Child Protection Decision-Making: A Critical Analysis of the Challenges and Opportunities for Social Work

ERIC Educational Resources Information Center

McCafferty, Paul

2017-01-01

One of the most frequently cited principles in the 1989 United Nations Convention on the Rights of the Child is Article 12. This article provides a critical analysis of the challenges that child protection social work faces when implementing Article 12 in social work decision-making whilst simultaneously keeping children safe. The article begins…

Critical care physician cognitive task analysis: an exploratory study.

PubMed

Fackler, James C; Watts, Charles; Grome, Anna; Miller, Thomas; Crandall, Beth; Pronovost, Peter

2009-01-01

For better or worse, the imposition of work-hour limitations on house-staff has imperiled continuity and/or improved decision-making. Regardless, the workflow of every physician team in every academic medical centre has been irrevocably altered. We explored the use of cognitive task analysis (CTA) techniques, most commonly used in other high-stress and time-sensitive environments, to analyse key cognitive activities in critical care medicine. The study objective was to assess the usefulness of CTA as an analytical tool in order that physician cognitive tasks may be understood and redistributed within the work-hour limited medical decision-making teams. After approval from each Institutional Review Board, two intensive care units (ICUs) within major university teaching hospitals served as data collection sites for CTA observations and interviews of critical care providers. Five broad categories of cognitive activities were identified: pattern recognition; uncertainty management; strategic vs. tactical thinking; team coordination and maintenance of common ground; and creation and transfer of meaning through stories. CTA within the framework of Naturalistic Decision Making is a useful tool to understand the critical care process of decision-making and communication. The separation of strategic and tactical thinking has implications for workflow redesign. Given the global push for work-hour limitations, such workflow redesign is occurring. Further work with CTA techniques will provide important insights toward rational, rather than random, workflow changes.

Cost effectiveness of pediatric pneumococcal conjugate vaccines: a comparative assessment of decision-making tools.

PubMed

Chaiyakunapruk, Nathorn; Somkrua, Ratchadaporn; Hutubessy, Raymond; Henao, Ana Maria; Hombach, Joachim; Melegaro, Alessia; Edmunds, John W; Beutels, Philippe

2011-05-12

Several decision support tools have been developed to aid policymaking regarding the adoption of pneumococcal conjugate vaccine (PCV) into national pediatric immunization programs. The lack of critical appraisal of these tools makes it difficult for decision makers to understand and choose between them. With the aim to guide policymakers on their optimal use, we compared publicly available decision-making tools in relation to their methods, influential parameters and results. The World Health Organization (WHO) requested access to several publicly available cost-effectiveness (CE) tools for PCV from both public and private provenance. All tools were critically assessed according to the WHO's guide for economic evaluations of immunization programs. Key attributes and characteristics were compared and a series of sensitivity analyses was performed to determine the main drivers of the results. The results were compared based on a standardized set of input parameters and assumptions. Three cost-effectiveness modeling tools were provided, including two cohort-based (Pan-American Health Organization (PAHO) ProVac Initiative TriVac, and PneumoADIP) and one population-based model (GlaxoSmithKline's SUPREMES). They all compared the introduction of PCV into national pediatric immunization program with no PCV use. The models were different in terms of model attributes, structure, and data requirement, but captured a similar range of diseases. Herd effects were estimated using different approaches in each model. The main driving parameters were vaccine efficacy against pneumococcal pneumonia, vaccine price, vaccine coverage, serotype coverage and disease burden. With a standardized set of input parameters developed for cohort modeling, TriVac and PneumoADIP produced similar incremental costs and health outcomes, and incremental cost-effectiveness ratios. Vaccine cost (dose price and number of doses), vaccine efficacy and epidemiology of critical endpoint (for example, incidence of pneumonia, distribution of serotypes causing pneumonia) were influential parameters in the models we compared. Understanding the differences and similarities of such CE tools through regular comparisons could render decision-making processes in different countries more efficient, as well as providing guiding information for further clinical and epidemiological research. A tool comparison exercise using standardized data sets can help model developers to be more transparent about their model structure and assumptions and provide analysts and decision makers with a more in-depth view behind the disease dynamics. Adherence to the WHO guide of economic evaluations of immunization programs may also facilitate this process. Please see related article: http://www.biomedcentral.com/1741-7007/9/55.

Reducing Work Content in Early Stage Naval Ship Designs (Briefing Charts)

DTIC Science & Technology

2014-05-14

criticizes US naval ships for: • early design decisions that lock in density • poor arrangements of piping and ventilation 8 An overly dense ship with...Thresholds Update Save As Exit T45 #1 T45 #2 T45 #3 HPC Enables Exhaustive Exploration by: and Visualization Exploring The Space Evaluating The Space From...design points such as traditional design spiral method 30 SHIP AVG Weighted Qty (Qty) by Cost 1980s Reagan Build-up 14 10% 1% 1990/2000s Low Rate

Problem solving and decisionmaking: An integration

NASA Technical Reports Server (NTRS)

Dieterly, D. L.

1980-01-01

An attempt was made to redress a critical fault of decisionmaking and problem solving research-a lack of a standard method to classify problem or decision states or conditions. A basic model was identified and expanded to indicate a possible taxonomy of conditions which may be used in reviewing previous research or for systematically pursuing new research designs. A generalization of the basic conditions was then made to indicate that the conditions are essentially the same for both concepts, problem solving and decisionmaking.

Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland

PubMed Central

Pianosi, Kiersten; Bethune, Cheri; Hurley, Katrina F.

2016-01-01

Background: Specialty career choice is a critical decision for medical students, and research has examined factors influencing particular specialties or assessed it from a demographic perspective. The purpose of this study was to explore and describe influential factors in students' decision-making, irrespective of their particular specialty in a Canadian medical school. Methods: Study participants were recruited from fourth-year medical classes at the Memorial University of Newfoundland in 2003, 2006, 2007 and 2008. Sixteen focus groups (n = 70) were led by a nonfaculty facilitator to uncover factors affecting medical student career choice. The analysis was guided by principles of grounded theory methodology. The focus group transcripts were sequentially coded based on recurring topics and themes that arose in the students' discussions. A set of key themes emerged and representative quotations for each theme were tracked. Results: Twenty themes were identified from the focus group discussions: 7 major, 3 intermediate and 10 minor themes. The major themes were undergraduate experience, exposure, public perception and recruitment, teacher influence, family/outside influences, residency issues and personal philosophy. Intermediate themes included lifestyle, bad-mouthing/negative perceptions and context. Minor themes included critical incidents/experiences, information gaps, uncertainty, nature of the work, extracurricular programs, timing of decision-making, financial issues, prestige, fit with colleagues and gender issues. Interpretation: Exposure to specialties and the timing of this exposure appears to be crucial to career choice, as does the context (who, what, when, where) of any particular rotation. Given the influence of personal philosophy, future research examining students' level of self-assessment and self-reflection in their decision-making processes and level of certainty about their selected specialty would be useful. PMID:27398357

A study to enhance medical students' professional decision-making, using teaching interventions on common medications.

PubMed

Wilcock, Jane; Strivens, Janet

2015-01-01

Aim To create sustained improvements in medical students' critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training.

A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

PubMed Central

Wilcock, Jane; Strivens, Janet

2015-01-01

Aim To create sustained improvements in medical students’ critical thinking skills through short teaching interventions in pharmacology. Method The ability to make professional decisions was assessed by providing year-4 medical students at a UK medical school with a novel medical scenario (antenatal pertussis vaccination). Forty-seven students in the 2012 cohort acted as a pretest group, answering a questionnaire on this novel scenario. To improve professional decision-making skills, 48 students from the 2013 cohort were introduced to three commonly used medications, through tutor-led 40-min teaching interventions, among six small groups using a structured presentation of evidence-based medicine and ethical considerations. Student members then volunteered to peer-teach on a further three medications. After a gap of 8 weeks, this cohort (post-test group) was assessed for professional decision-making skills using the pretest questionnaire, and differences in the 2-year groups analysed. Results Students enjoyed presenting on medications to their peers but had difficulty interpreting studies and discussing ethical dimensions; this was improved by contextualising information via patient scenarios. After 8 weeks, most students did not show enhanced clinical curiosity, a desire to understand evidence, or ethical questioning when presented with a novel medical scenario compared to the previous year group who had not had the intervention. Students expressed a high degree of trust in guidelines and expert tutors and felt that responsibility for their own actions lay with these bodies. Conclusion Short teaching interventions in pharmacology did not lead to sustained improvements in their critical thinking skills in enhancing professional practice. It appears that students require earlier and more frequent exposure to these skills in their medical training. PMID:26051556

Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy.

PubMed

Madani, Amin; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C; Barkun, Jeffrey S; Fried, Gerald M; Aggarwal, Rajesh

2015-11-01

Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

“Do your homework…and then hope for the best”: the challenges that medical tourism poses to Canadian family physicians’ support of patients’ informed decision-making

PubMed Central

2013-01-01

Background Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism. Methods Focus groups were held with family physicians practicing in British Columbia, Canada. After receiving ethics approval, letters of invitation were faxed to family physicians in six cities. 22 physicians agreed to participate and focus groups ranged from two to six participants. Questions explored participants’ perceptions of and experiences with medical tourism. A coding scheme was created using inductive and deductive codes that captured issues central to analytic themes identified by the investigators. Extracts of the coded data that dealt with informed decision-making were shared among the investigators in order to identify themes. Four themes were identified, all of which dealt with the challenges that medical tourism poses to family physicians’ abilities to support medical tourists’ informed decision-making. Findings relevant to each theme were contrasted against the existing medical tourism literature so as to assist in understanding their significance. Results Four key challenges were identified: 1) confusion and tensions related to the regular domestic physician’s role in decision-making; 2) tendency to shift responsibility related to healthcare outcomes onto the patient because of the regular domestic physician’s reduced role in shared decision-making; 3) strains on the patient-physician relationship and corresponding concern around the responsibility of the foreign physician; and 4) regular domestic physicians’ concerns that treatments sought abroad may not be based on the best available medical evidence on treatment efficacy. Conclusions Medical tourism is creating new challenges for Canadian family physicians who now find themselves needing to carefully negotiate their roles and responsibilities in the informed decision-making process of their patients who decide to seek private treatment abroad as medical tourists. These physicians can and should be educated to enable their patients to look critically at the information available about medical tourism providers and to ask critical questions of patients deciding to access care abroad. PMID:24053385

"Pre-Semantic" Cognition Revisited: Critical Differences between Semantic Aphasia and Semantic Dementia

ERIC Educational Resources Information Center

Jefferies, Elizabeth; Rogers, Timothy T.; Hopper, Samantha; Lambon Ralph, Matthew A.

2010-01-01

Patients with semantic dementia show a specific pattern of impairment on both verbal and non-verbal "pre-semantic" tasks, e.g., reading aloud, past tense generation, spelling to dictation, lexical decision, object decision, colour decision and delayed picture copying. All seven tasks are characterised by poorer performance for items that are…

Despite Best Intentions: A Critical Analysis of Social Justice Leadership and Decision Making

ERIC Educational Resources Information Center

DeMatthews, David E.; Mungal, Angus Shiva; Carrola, Paul A.

2015-01-01

The purpose of this article is to explore the relationship between social justice leadership and organizational decision making in order to make recommendations for how principals can make more socially just decisions in difficult school contexts. This article begins with a discussion of social justice leadership, facets and theories associated…

An Integrated Understanding of Confidence and User Calibration in Information Systems Use

ERIC Educational Resources Information Center

Tang, Fengchun

2012-01-01

Dealing with uncertainty is a critical part of human decision-making and confidence reflects one's belief about the relative likelihood that various outcomes occur when making decision under uncertainty. Unfortunately, confidence often deviates from the actual quality of the decision, leading to under- or over-confidence. Calibration, the…

Teaching Decision Making to Adolescents: A Critical Review.

ERIC Educational Resources Information Center

Beyth-Marom, Ruth; And Others

A conceptual framework derived from formal and behavioral theories was used to describe and evaluate a sample of the best developed programs for teaching decision making to adolescents. The internal validity of the programs was evaluated in terms of the adequacy of their coverage of the normatively prescribed steps to good decision making. The…

A quantitative risk model for early lifecycle decision making

NASA Technical Reports Server (NTRS)

Feather, M. S.; Cornford, S. L.; Dunphy, J.; Hicks, K.

2002-01-01

Decisions made in the earliest phases of system development have the most leverage to influence the success of the entire development effort, and yet must be made when information is incomplete and uncertain. We have developed a scalable cost-benefit model to support this critical phase of early-lifecycle decision-making.

The Development and Validation of a Novice Nurse Decision-Making Skills Education Curriculum

ERIC Educational Resources Information Center

Simmons, Joanne

2017-01-01

Novice nurses (NNs) are entering critical care environments with limited knowledge, skills, and decision-making expertise. They are expected to care for complex patients in a dynamic healthcare setting. The research question for this project examined whether NNs improve their knowledge and skills by participating in a nursing decision-making…

Integrating Socio-Scientific Issues to Enhance the Bioethical Decision-Making Skills of High School Students

ERIC Educational Resources Information Center

Gutierez, Sally B.

2015-01-01

Scientific literacy has been focused on the construction of students' knowledge to use appropriate and meaningful concepts, critically think, and make balanced, well-informed decisions relevant to their lives. This study presents the effects of integrating socio-scientific issues to enhance the bioethical decision-making skills of biology…

The impact of ecolabel knowledge to purchase decision of green producton biology students

NASA Astrophysics Data System (ADS)

Sigit, Diana Vivanti; Fauziah, Rizky; Heryanti, Erna

2017-08-01

The world needs real solutions to reduce the impact of environmental damages. Students as agents of changes have a role to overcome these problems. One of the important solution is to be a critical consumer who has purchase decisions in a green product. To show the quality of an environmental friendly product, it is then required an ecolabel on the green product which indicates that the product has been through the production processed and come from environmental friendly substances. The research aimed at finding out whether there was an impact of ecolabel knowledge with purchase decision of green product on biology students. This research was conducted in Biology Department. This research used a survey descriptive method. The population used was biology students of Universitas Negeri Jakarta while the sampling technique was done through simple random sampling technique with 147 respondents. Instrument used were ecolabel knowledge test and a questionnaire of green product purchase decision. The result of prerequisite test showed that the data was normally distributed and homogenous variance. The regression model obtained was Ŷ=77.083+ 0.370X. Meanwhile, the determinant coefficient (r2) obtained was 0.047 or 4.7% that mean ecolabel knowledge just contributed 4,71% to the green product purchase decision. These implied that many factors contributed in the purchase decision of green product instead of ecolabel knowledge.

A gaze through the lens of decision theory toward knowledge translation science.

PubMed

Bucknall, Tracey

2007-01-01

Research findings become evidence when an individual decides that the information is relevant and useful to a particular circumstance. Prior to that point, they are unrelated facts. For research translation to occur, research evidence needs filtering, interpretation, and application by individuals to the specific situation. For this reason, decision science is complementary to knowledge translation science. Both aim to support the individual in deciding the most appropriate action in a dynamic environment where there are masses of uncensored and nonprioritized information readily available. Decision science employs research theories to study the cognitive processes underpinning the filtering and integration of current scientific information into changing contexts. Two meta-theories, coherence and correspondence theories, have been used to provide alternative views and prompt significant debate to advance the science. The aim of this article is to stimulate debate about the relationship between decision theory and knowledge translation. Discussed is the critical role of cognition in clinical decision making, with a focus on knowledge translation. A critical commentary of the knowledge utilization modeling papers is presented from a decision science perspective. The article concludes with a discussion on the implications for knowledge translation when viewed through the lens of decision science.

Vista goes online: Decision-analytic systems for real-time decision-making in mission control

NASA Technical Reports Server (NTRS)

Barry, Matthew; Horvitz, Eric; Ruokangas, Corinne; Srinivas, Sampath

1994-01-01

The Vista project has centered on the use of decision-theoretic approaches for managing the display of critical information relevant to real-time operations decisions. The Vista-I project originally developed a prototype of these approaches for managing flight control displays in the Space Shuttle Mission Control Center (MCC). The follow-on Vista-II project integrated these approaches in a workstation program which currently is being certified for use in the MCC. To our knowledge, this will be the first application of automated decision-theoretic reasoning techniques for real-time spacecraft operations. We shall describe the development and capabilities of the Vista-II system, and provide an overview of the use of decision-theoretic reasoning techniques to the problems of managing the complexity of flight controller displays. We discuss the relevance of the Vista techniques within the MCC decision-making environment, focusing on the problems of detecting and diagnosing spacecraft electromechanical subsystems component failures with limited information, and the problem of determining what control actions should be taken in high-stakes, time-critical situations in response to a diagnosis performed under uncertainty. Finally, we shall outline our current research directions for follow-on projects.

Using the decision ladder to understand road user decision making at actively controlled rail level crossings.

PubMed

Mulvihill, Christine M; Salmon, Paul M; Beanland, Vanessa; Lenné, Michael G; Read, Gemma J M; Walker, Guy H; Stanton, Neville A

2016-09-01

Rail level crossings (RLXs) represent a key strategic risk for railways worldwide. Despite enforcement and engineering countermeasures, user behaviour at RLXs can often confound expectations and erode safety. Research in this area is limited by a relative absence of insights into actual decision making processes and a focus on only a subset of road user types. One-hundred and sixty-six road users (drivers, motorcyclists, cyclists and pedestrians) completed a diary entry for each of 457 naturalistic encounters with RLXs when a train was approaching. The final eligible sample comprised 94 participants and 248 encounters at actively controlled crossings where a violation of the active warnings was possible. The diary incorporated Critical Decision Method probe questions, which enabled user responses to be mapped onto Rasmussen's decision ladder. Twelve percent of crossing events were non-compliant. The underlying decision making was compared to compliant events and a reference decision model to reveal important differences in the structure and type of decision making within and between road user groups. The findings show that engineering countermeasures intended to improve decision making (e.g. flashing lights), may have the opposite effect for some users because the system permits a high level of flexibility for circumvention. Non-motorised users were more likely to access information outside of the warning signals because of their ability to achieve greater proximity to the train tracks and the train itself. The major conundrum in resolving these issues is whether to restrict the amount of time and information available to users so that it cannot be used for circumventing the system or provide more information to help users make safe decisions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Decision theory for computing variable and value ordering decisions for scheduling problems

NASA Technical Reports Server (NTRS)

Linden, Theodore A.

1993-01-01

Heuristics that guide search are critical when solving large planning and scheduling problems, but most variable and value ordering heuristics are sensitive to only one feature of the search state. One wants to combine evidence from all features of the search state into a subjective probability that a value choice is best, but there has been no solid semantics for merging evidence when it is conceived in these terms. Instead, variable and value ordering decisions should be viewed as problems in decision theory. This led to two key insights: (1) The fundamental concept that allows heuristic evidence to be merged is the net incremental utility that will be achieved by assigning a value to a variable. Probability distributions about net incremental utility can merge evidence from the utility function, binary constraints, resource constraints, and other problem features. The subjective probability that a value is the best choice is then derived from probability distributions about net incremental utility. (2) The methods used for rumor control in Bayesian Networks are the primary way to prevent cycling in the computation of probable net incremental utility. These insights lead to semantically justifiable ways to compute heuristic variable and value ordering decisions that merge evidence from all available features of the search state.

Choosing Psychiatry as a Career: Motivators and Deterrents at a Critical Decision-Making Juncture

PubMed Central

Wiesenfeld, Lesley; Abbey, Susan; Takahashi, Sue Glover; Abrahams, Caroline

2014-01-01

Objective To examine factors influencing the choice of psychiatry as a career between residency program application and ranking decision making. Methods: Using an online questionnaire, applicants to the largest Canadian psychiatry residency program were surveyed about the impact of various factors on their ultimate decision to enter psychiatry residency training. Results: Applicants reported that patient-related stigma was a motivator in considering psychiatry as a career, but that negative comments from colleagues, friends, and family about choosing psychiatry was a deterrent. Training program length, limited treatments, and insufficient clerkship exposure were noted as deterrents to choosing psychiatry, though future job prospects, the growing role of neuroscience, and diagnostic complexity positively influenced choosing psychiatry as a specialty. Research and elective time away opportunities were deemed relatively unimportant to ranking decisions, compared with more highly weighted factors, such as program flexibility, emphasis on psychotherapy, service– training balance, and training program location. Most applicants also reported continuing to fine tune ranking decisions between the application and ranking submission deadline. Conclusions: Stigma, exposure to psychiatry, diagnostic complexity, and an encouraging job market were highlighted as positive influences on the choice to enter psychiatry residency. Interview and information days represent opportunities for continued targeted recruitment activity for psychiatry residency programs. PMID:25161070

CDC Grand Rounds: Modeling and Public Health Decision-Making.

PubMed

Fischer, Leah S; Santibanez, Scott; Hatchett, Richard J; Jernigan, Daniel B; Meyers, Lauren Ancel; Thorpe, Phoebe G; Meltzer, Martin I

2016-12-09

Mathematical models incorporate various data sources and advanced computational techniques to portray real-world disease transmission and translate the basic science of infectious diseases into decision-support tools for public health. Unlike standard epidemiologic methods that rely on complete data, modeling is needed when there are gaps in data. By combining diverse data sources, models can fill gaps when critical decisions must be made using incomplete or limited information. They can be used to assess the effect and feasibility of different scenarios and provide insight into the emergence, spread, and control of disease. During the past decade, models have been used to predict the likelihood and magnitude of infectious disease outbreaks, inform emergency response activities in real time (1), and develop plans and preparedness strategies for future events, the latter of which proved invaluable during outbreaks such as severe acute respiratory syndrome and pandemic influenza (2-6). Ideally, modeling is a multistep process that involves communication between modelers and decision-makers, allowing them to gain a mutual understanding of the problem to be addressed, the type of estimates that can be reliably generated, and the limitations of the data. As models become more detailed and relevant to real-time threats, the importance of modeling in public health decision-making continues to grow.

Financial Forecasting and Stochastic Modeling: Predicting the Impact of Business Decisions.

PubMed

Rubin, Geoffrey D; Patel, Bhavik N

2017-05-01

In health care organizations, effective investment of precious resources is critical to assure that the organization delivers high-quality and sustainable patient care within a supportive environment for patients, their families, and the health care providers. This holds true for organizations independent of size, from small practices to large health systems. For radiologists whose role is to oversee the delivery of imaging services and the interpretation, communication, and curation of imaging-informed information, business decisions influence where and how they practice, the tools available for image acquisition and interpretation, and ultimately their professional satisfaction. With so much at stake, physicians must understand and embrace the methods necessary to develop and interpret robust financial analyses so they effectively participate in and better understand decision making. This review discusses the financial drivers upon which health care organizations base investment decisions and the central role that stochastic financial modeling should play in support of strategically aligned capital investments. Given a health care industry that has been slow to embrace advanced financial analytics, a fundamental message of this review is that the skills and analytical tools are readily attainable and well worth the effort to implement in the interest of informed decision making. © RSNA, 2017 Online supplemental material is available for this article.

Measuring the Impact of Online Evidence Retrieval Systems using Critical Incidents & Journey Mapping.

PubMed

Westbrook, Johanna I; Coiera, Enrico W; Braithwaite, Jeffrey

2005-01-01

Online evidence retrieval systems are one potential tool in supporting evidence-based practice. We have undertaken a program of research to investigate how hospital-based clinicians (doctors, nurses and allied health professionals) use these systems, factors influencing use and their impact on decision-making and health care delivery. A central component of this work has been the development and testing of a broad range of evaluation techniques. This paper provides an overview of the results obtained from three stages of this evaluation and details the results derived from the final stage which sought to test two methods for assessing the integration of an online evidence system and its impact on decision making and patient care. The critical incident and journey mapping techniques were applied. Semi-structured interviews were conducted with 29 clinicians who were experienced users of the online evidence system. Clinicians were asked to described recent instances in which the information obtained using the online evidence system was especially helpful with their work. A grounded approach to data analysis was taken producing three categories of impact. The journey mapping technique was adapted as a method to describe and quantify clinicians' integration of CIAP into their practice and the impact of this on patient care. The analogy of a journey is used to capture the many stages in this integration process, from introduction to the system to full integration into everyday clinical practice with measurable outcomes. Transcribed interview accounts of system use were mapped against the journey stages and scored. Clinicians generated 85 critical incidents and one quarter of these provided specific examples of system use leading to improvements in patient care. The journey mapping technique proved to be a useful method for providing a quantification of the ways and extent to which clincians had integrated system use into practice, and insights into how information systems can influence organisational culture. Further work is required on this technique to assess its value as an evaluation method. The study demonstrates the strength of a triangulated evidence approach to assessing the use and impact of online clinical evidence systems.

TU-FG-201-11: Evaluating the Validity of Prospective Risk Analysis Methods: A Comparison of Traditional FMEA and Modified Healthcare FMEA

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

Lah, J; Manger, R; Kim, G

Purpose: To examine the ability of traditional Failure mode and effects analysis (FMEA) and a light version of Healthcare FMEA (HFMEA), called Scenario analysis of FMEA (SAFER) by comparing their outputs in terms of the risks identified and their severity rankings. Methods: We applied two prospective methods of the quality management to surface image guided, linac-based radiosurgery (SIG-RS). For the traditional FMEA, decisions on how to improve an operation are based on risk priority number (RPN). RPN is a product of three indices: occurrence, severity and detectability. The SAFER approach; utilized two indices-frequency and severity-which were defined by a multidisciplinarymore » team. A criticality matrix was divided into 4 categories; very low, low, high and very high. For high risk events, an additional evaluation was performed. Based upon the criticality of the process, it was decided if additional safety measures were needed and what they comprise. Results: Two methods were independently compared to determine if the results and rated risks were matching or not. Our results showed an agreement of 67% between FMEA and SAFER approaches for the 15 riskiest SIG-specific failure modes. The main differences between the two approaches were the distribution of the values and the failure modes (No.52, 54, 154) that have high SAFER scores do not necessarily have high FMEA RPN scores. In our results, there were additional risks identified by both methods with little correspondence. In the SAFER, when the risk score is determined, the basis of the established decision tree or the failure mode should be more investigated. Conclusion: The FMEA method takes into account the probability that an error passes without being detected. SAFER is inductive because it requires the identification of the consequences from causes, and semi-quantitative since it allow the prioritization of risks and mitigation measures, and thus is perfectly applicable to clinical parts of radiotherapy.« less

Decision Analysis Methods Used to Make Appropriate Investments in Human Exploration Capabilities and Technologies

NASA Technical Reports Server (NTRS)

Williams-Byrd, Julie; Arney, Dale C.; Hay, Jason; Reeves, John D.; Craig, Douglas

2016-01-01

NASA is transforming human spaceflight. The Agency is shifting from an exploration-based program with human activities in low Earth orbit (LEO) and targeted robotic missions in deep space to a more sustainable and integrated pioneering approach. Through pioneering, NASA seeks to address national goals to develop the capacity for people to work, learn, operate, live, and thrive safely beyond Earth for extended periods of time. However, pioneering space involves daunting technical challenges of transportation, maintaining health, and enabling crew productivity for long durations in remote, hostile, and alien environments. Prudent investments in capability and technology developments, based on mission need, are critical for enabling a campaign of human exploration missions. There are a wide variety of capabilities and technologies that could enable these missions, so it is a major challenge for NASA's Human Exploration and Operations Mission Directorate (HEOMD) to make knowledgeable portfolio decisions. It is critical for this pioneering initiative that these investment decisions are informed with a prioritization process that is robust and defensible. It is NASA's role to invest in targeted technologies and capabilities that would enable exploration missions even though specific requirements have not been identified. To inform these investments decisions, NASA's HEOMD has supported a variety of analysis activities that prioritize capabilities and technologies. These activities are often based on input from subject matter experts within the NASA community who understand the technical challenges of enabling human exploration missions. This paper will review a variety of processes and methods that NASA has used to prioritize and rank capabilities and technologies applicable to human space exploration. The paper will show the similarities in the various processes and showcase instances were customer specified priorities force modifications to the process. Specifically, this paper will describe the processes that the NASA Langley Research Center (LaRC) Technology Assessment and Integration Team (TAIT) has used for several years and how those processes have been customized to meet customer needs while staying robust and defensible. This paper will show how HEOMD uses these analyses results to assist with making informed portfolio investment decisions. The paper will also highlight which human exploration capabilities and technologies typically rank high regardless of the specific design reference mission. The paper will conclude by describing future capability and technology ranking activities that will continue o leverage subject matter experts (SME) input while also incorporating more model-based analysis.

Selecting an Architecture for a Safety-Critical Distributed Computer System with Power, Weight and Cost Considerations

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2014-01-01

This report presents an example of the application of multi-criteria decision analysis to the selection of an architecture for a safety-critical distributed computer system. The design problem includes constraints on minimum system availability and integrity, and the decision is based on the optimal balance of power, weight and cost. The analysis process includes the generation of alternative architectures, evaluation of individual decision criteria, and the selection of an alternative based on overall value. In this example presented here, iterative application of the quantitative evaluation process made it possible to deliberately generate an alternative architecture that is superior to all others regardless of the relative importance of cost.

The Experience of Decision Making in the Care of Children with Palliative Care Needs: The Experiences of Jordanian Mothers.

PubMed

Atout, Maha; Hemingway, Pippa; Seymour, Jane

2017-12-01

The purpose of this study was to explore the experience of decision making in the care of children with palliative care needs in Jordan, from the perspective of their mothers. This study employed a collective qualitative case study approach. Data were collected in 3 pediatric wards in a Jordanian hospital. The study used 2 data collection methods: participant observation (197 observational hours) and 56 semi-structured interviews with 24 mothers, 12 physicians and 20 nurses. The findings show how Jordanian mothers seek to transfer the role of decision making to physicians, as they perceive themselves to be unable to make decisions about critical issues related to the treatment of their children. Mothers had a widespread apprehension of "future guilt," especially when they feared that any decisions they might make could have an adverse impact on their children. Contrary to the predominant pattern, some mothers took a proactive approach towards decision making about their children's treatment. These mothers requested detailed information from primary physicians and sought different sources of knowledge such as second opinions, reading online resources, or talking to other parents who had a child with similar circumstances. The study concludes that mothers prefer to involve physicians in decisions about their children's healthcare and treatment to eliminate their fear of probable future guilt; this modifies any tendency to autonomously decide for their children. These findings are underpinned by the Jordanian culture in which doctors' opinions are highly regarded.

The Colorectal Surgeon's personality may influence the rectal anastomotic decision.

PubMed

Moug, S J; Henderson, N; Tiernan, J; Bisset, C N; Ferguson, E; Harji, D; Maxwell-Armstrong, C; MacDermid, E; Acheson, A G; Steele, R J C; Fearnhead, N S

2018-06-14

Colorectal surgeons regularly make the decision to anastomose, defunction or form an end colostomy when performing rectal surgery. This study aimed to define personality traits of colorectal surgeons and explore any influence of such traits on the decision to perform a rectal anastomosis. 50 attendees of The Association of Coloproctology of Great Britain and Ireland 2016 conference participated. After written consent, all underwent personality testing: alexithymia (inability to understand emotions); type of thinking process (intuitive versus rational) and personality traits (extraversion; agreeableness; openness; emotional stability; conscientiousness). Questions were answered regarding anastomotic decisions in various clinical scenarios and results analysed to reveal any influence of the surgeon's personality on anastomotic decision. Participants were: male (86%); consultants (84%); England based (68%). Alexithymia was low (4%) with 81% displaying intuitive thinking (reflex, fast). Participants scored higher in emotional stability (ability to remain calm) and conscientiousness (organised, methodical) compared to population norms. Personality traits influenced the next anastomotic decision if: surgeons had recently received criticism at a departmental audit meeting; operating with an anaesthetist that is not your regular one; or there had been no anastomotic leaks in their patients for >1 year. Colorectal surgeons have speciality relevant personalities that potentially influence the important decision to anastomose and could explain the variation in surgical practice across the U.K. Future work should explore these findings in other countries and any link of personality traits to patient related outcomes. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Decomposition-Based Decision Making for Aerospace Vehicle Design

NASA Technical Reports Server (NTRS)

Borer, Nicholas K.; Mavris, DImitri N.

2005-01-01

Most practical engineering systems design problems have multiple and conflicting objectives. Furthermore, the satisfactory attainment level for each objective ( requirement ) is likely uncertain early in the design process. Systems with long design cycle times will exhibit more of this uncertainty throughout the design process. This is further complicated if the system is expected to perform for a relatively long period of time, as now it will need to grow as new requirements are identified and new technologies are introduced. These points identify a need for a systems design technique that enables decision making amongst multiple objectives in the presence of uncertainty. Traditional design techniques deal with a single objective or a small number of objectives that are often aggregates of the overarching goals sought through the generation of a new system. Other requirements, although uncertain, are viewed as static constraints to this single or multiple objective optimization problem. With either of these formulations, enabling tradeoffs between the requirements, objectives, or combinations thereof is a slow, serial process that becomes increasingly complex as more criteria are added. This research proposal outlines a technique that attempts to address these and other idiosyncrasies associated with modern aerospace systems design. The proposed formulation first recasts systems design into a multiple criteria decision making problem. The now multiple objectives are decomposed to discover the critical characteristics of the objective space. Tradeoffs between the objectives are considered amongst these critical characteristics by comparison to a probabilistic ideal tradeoff solution. The proposed formulation represents a radical departure from traditional methods. A pitfall of this technique is in the validation of the solution: in a multi-objective sense, how can a decision maker justify a choice between non-dominated alternatives? A series of examples help the reader to observe how this technique can be applied to aerospace systems design and compare the results of this so-called Decomposition-Based Decision Making to more traditional design approaches.

Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.

PubMed

Choi, Soki; Brommels, Mats

2009-01-01

The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.

The clinical utility index as a practical multiattribute approach to drug development decisions.

PubMed

Poland, B; Hodge, F L; Khan, A; Clemen, R T; Wagner, J A; Dykstra, K; Krishna, R

2009-07-01

We identify some innovative approaches to predicting overall patient benefit from investigational drugs to support development decisions. We then illustrate calculation of a probabilistic clinical utility index (CUI), an implementation of multiattribute utility that focuses on clinical attributes. We recommend use of the CUI for the support of early drug development decisions because of its practicality, reasonable accuracy, and transparency to decision makers, at stages in which financial factors that may dominate later-phase decisions are less critical.

A bi-objective model for optimizing replacement time of age and block policies with consideration of spare parts’ availability

NASA Astrophysics Data System (ADS)

Alsyouf, Imad

2018-05-01

Reliability and availability of critical systems play an important role in achieving the stated objectives of engineering assets. Preventive replacement time affects the reliability of the components, thus the number of system failures encountered and its downtime expenses. On the other hand, spare parts inventory level is a very critical factor that affects the availability of the system. Usually, the decision maker has many conflicting objectives that should be considered simultaneously for the selection of the optimal maintenance policy. The purpose of this research was to develop a bi-objective model that will be used to determine the preventive replacement time for three maintenance policies (age, block good as new, block bad as old) with consideration of spare parts’ availability. It was suggested to use a weighted comprehensive criterion method with two objectives, i.e. cost and availability. The model was tested with a typical numerical example. The results of the model demonstrated its effectiveness in enabling the decision maker to select the optimal maintenance policy under different scenarios and taking into account preferences with respect to contradicting objectives such as cost and availability.

Decision support for mitigating the risk of tree induced transmission line failure in utility rights-of-way.

PubMed

Poulos, H M; Camp, A E

2010-02-01

Vegetation management is a critical component of rights-of-way (ROW) maintenance for preventing electrical outages and safety hazards resulting from tree contact with conductors during storms. Northeast Utility's (NU) transmission lines are a critical element of the nation's power grid; NU is therefore under scrutiny from federal agencies charged with protecting the electrical transmission infrastructure of the United States. We developed a decision support system to focus right-of-way maintenance and minimize the potential for a tree fall episode that disables transmission capacity across the state of Connecticut. We used field data on tree characteristics to develop a system for identifying hazard trees (HTs) in the field using limited equipment to manage Connecticut power line ROW. Results from this study indicated that the tree height-to-diameter ratio, total tree height, and live crown ratio were the key characteristics that differentiated potential risk trees (danger trees) from trees with a high probability of tree fall (HTs). Products from this research can be transferred to adaptive right-of-way management, and the methods we used have great potential for future application to other regions of the United States and elsewhere where tree failure can disrupt electrical power.

Principles of shared decision-making within teams.

PubMed

Jacobs, Jeffrey P; Wernovsky, Gil; Cooper, David S; Karl, Tom R

2015-12-01

In the domain of paediatric and congenital cardiac care, the stakes are huge. Likewise, the care of these children assembles a group of "A+ personality" individuals from the domains of cardiac surgery, cardiology, anaesthesiology, critical care, and nursing. This results in an environment that has opportunity for both powerful collaboration and powerful conflict. Providers of healthcare should avoid conflict when it has no bearing on outcome, as it is clearly a squandering of individual and collective political capital. Outcomes after cardiac surgery are now being reported transparently and publicly. In the present era of transparency, one may wonder how to balance the following potentially competing demands: quality healthcare, transparency and accountability, and teamwork and shared decision-making. An understanding of transparency and public reporting in the domain of paediatric cardiac surgery facilitates the implementation of a strategy for teamwork and shared decision-making. In January, 2015, the Society of Thoracic Surgeons (STS) began to publicly report outcomes of paediatric and congenital cardiac surgery using the 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) Mortality Risk Model. The 2014 STS-CHSD Mortality Risk Model facilitates description of Operative Mortality adjusted for procedural and patient-level factors. The need for transparency in reporting of outcomes can create pressure on healthcare providers to implement strategies of teamwork and shared decision-making to assure outstanding results. A simple strategy of shared decision-making was described by Tom Karl and was implemented in multiple domains by Jeff Jacobs and David Cooper. In a critical-care environment, it is not unusual for healthcare providers to disagree about strategies of management of patients. When two healthcare providers disagree, each provider can classify the disagreement into three levels: • SDM Level 1 Decision: "We disagree but it really does not matter, so do whatever you desire!" • SDM Level 2 Decision: "We disagree and I believe it matters, but I am OK if you do whatever you desire!!" • SDM Level 3 Decision: "We disagree and I must insist (diplomatically and politely) that we follow the strategy that I am proposing!!!!!!" SDM Level 1 Decisions and SDM Level 2 Decisions typically do not create stress on the team, especially when there is mutual purpose and respect among the members of the team. SDM Level 3 Decisions are the real challenge. Periodically, the healthcare team is faced with such Level 3 Decisions, and teamwork and shared decision-making may be challenged. Teamwork is a learned behaviour, and mentorship is critical to achieve a properly balanced approach. If we agree to leave our egos at the door, then, in the final analysis, the team will benefit and we will set the stage for optimal patient care. In the environment of strong disagreement, true teamwork and shared decision-making are critical to preserve the unity and strength of the multi-disciplinary team and simultaneously provide excellent healthcare.

Linking decision-making research and cancer prevention and control: important themes.

PubMed

McCaul, Kevin D; Peters, Ellen; Nelson, Wendy; Stefanek, Michael

2005-07-01

This article describes 6 themes underlying the multiple presentations from the Basic and Applied Decision Making in Cancer Control meeting, held February 19-20, 2004. The following themes have important implications for research and practice linking basic decision-making research to cancer prevention and control: (a) Traditional decision-making theories fail to capture real-world decision making, (b) decision makers are often unable to predict future preferences, (c) preferences are often constructed on the spot and thus are influenced by situational cues, (d) decision makers often rely on feelings rather than beliefs when making a decision, (e) the perspective of the decision maker is critical in determining preferences, and (f) informed decision making may--or may not--yield the best decisions.

An islanding detection methodology combining decision trees and Sandia frequency shift for inverter-based distributed generations

DOE PAGES

Azim, Riyasat; Li, Fangxing; Xue, Yaosuo; ...

2017-07-14

Distributed generations (DGs) for grid-connected applications require an accurate and reliable islanding detection methodology (IDM) for secure system operation. This paper presents an IDM for grid-connected inverter-based DGs. The proposed method is a combination of passive and active islanding detection techniques for aggregation of their advantages and elimination/minimisation of the drawbacks. In the proposed IDM, the passive method utilises critical system attributes extracted from local voltage measurements at target DG locations as well as employs decision tree-based classifiers for characterisation and detection of islanding events. The active method is based on Sandia frequency shift technique and is initiated only whenmore » the passive method is unable to differentiate islanding events from other system events. Thus, the power quality degradation introduced into the system by active islanding detection techniques can be minimised. Furthermore, a combination of active and passive techniques allows detection of islanding events under low power mismatch scenarios eliminating the disadvantage associated with the use of passive techniques alone. Finally, detailed case study results demonstrate the effectiveness of the proposed method in detection of islanding events under various power mismatch scenarios, load quality factors and in the presence of single or multiple grid-connected inverter-based DG units.« less

An islanding detection methodology combining decision trees and Sandia frequency shift for inverter-based distributed generations

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

Azim, Riyasat; Li, Fangxing; Xue, Yaosuo

Distributed generations (DGs) for grid-connected applications require an accurate and reliable islanding detection methodology (IDM) for secure system operation. This paper presents an IDM for grid-connected inverter-based DGs. The proposed method is a combination of passive and active islanding detection techniques for aggregation of their advantages and elimination/minimisation of the drawbacks. In the proposed IDM, the passive method utilises critical system attributes extracted from local voltage measurements at target DG locations as well as employs decision tree-based classifiers for characterisation and detection of islanding events. The active method is based on Sandia frequency shift technique and is initiated only whenmore » the passive method is unable to differentiate islanding events from other system events. Thus, the power quality degradation introduced into the system by active islanding detection techniques can be minimised. Furthermore, a combination of active and passive techniques allows detection of islanding events under low power mismatch scenarios eliminating the disadvantage associated with the use of passive techniques alone. Finally, detailed case study results demonstrate the effectiveness of the proposed method in detection of islanding events under various power mismatch scenarios, load quality factors and in the presence of single or multiple grid-connected inverter-based DG units.« less

Teaching critical thinking.

PubMed

Holmes, N G; Wieman, Carl E; Bonn, D A

2015-09-08

The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year.

Teaching critical thinking

PubMed Central

Holmes, N. G.; Wieman, Carl E.; Bonn, D. A.

2015-01-01

The ability to make decisions based on data, with its inherent uncertainties and variability, is a complex and vital skill in the modern world. The need for such quantitative critical thinking occurs in many different contexts, and although it is an important goal of education, that goal is seldom being achieved. We argue that the key element for developing this ability is repeated practice in making decisions based on data, with feedback on those decisions. We demonstrate a structure for providing suitable practice that can be applied in any instructional setting that involves the acquisition of data and relating that data to scientific models. This study reports the results of applying that structure in an introductory physics laboratory course. Students in an experimental condition were repeatedly instructed to make and act on quantitative comparisons between datasets, and between data and models, an approach that is common to all science disciplines. These instructions were slowly faded across the course. After the instructions had been removed, students in the experimental condition were 12 times more likely to spontaneously propose or make changes to improve their experimental methods than a control group, who performed traditional experimental activities. The students in the experimental condition were also four times more likely to identify and explain a limitation of a physical model using their data. Students in the experimental condition also showed much more sophisticated reasoning about their data. These differences between the groups were seen to persist into a subsequent course taken the following year. PMID:26283351

Fostering Critical Thinking in Physical Education Students

ERIC Educational Resources Information Center

Lodewyk, Ken R.

2009-01-01

Critical thinking is essentially "better thinking." When students think critically they consider complex information from numerous sources and perspectives in order to make a reasonable judgment that they can justify. It has been associated with academic qualities such as decision-making, creativity, reasoning, problem-solving, debating,…

Reflections on a vision for integrated research and monitoring after 15 years

USGS Publications Warehouse

Murdoch, Peter S.; McHale, Michael; Baron, Jill S.

2014-01-01

In May of 1998, Owen Bricker and his co-author Michael Ruggiero introduced a conceptual design for integrating the Nation’s environmental research and monitoring programs. The Framework for Integrated Monitoring and Related Research was an organizing strategy for relating data collected by various programs, at multiple spatial and temporal scales, and by multiple science disciplines to solve complex ecological issues that individual research or monitoring programs were not designed to address. The concept nested existing intensive monitoring and research stations within national and regional surveys, remotely sensed data, and inventories to produce a collaborative program for multi-scale, multi-network integrated environmental monitoring and research. Analyses of gaps in data needed for specific issues would drive decisions on network improvements or enhancements. Data contributions to the Framework from existing networks would help indicate critical research and monitoring programs to protect during budget reductions. Significant progress has been made since 1998 on refining the Framework strategy. Methods and models for projecting scientific information across spatial and temporal scales have been improved, and a few regional pilots of multi-scale data-integration concepts have been attempted. The links between science and decision-making are also slowly improving and being incorporated into science practice. Experiments with the Framework strategy since 1998 have revealed the foundational elements essential to its successful implementation, such as defining core measurements, establishing standards of data collection and management, integrating research and long-term monitoring, and describing baseline ecological conditions. They have also shown us the remaining challenges to establishing the Framework concept: protecting and enhancing critical long-term monitoring, filling gaps in measurement methods, improving science for decision support, and integrating the disparate integrated science efforts now underway. In the 15 years since the Bricker and Ruggiero (Ecol Appl 8(2):326–329, 1998) paper challenged us with a new paradigm for bringing sound and comprehensive science to environmental decisions, the scientific community can take pride in the progress that has been made, while also taking stock of the challenges ahead for completing the Framework vision.

Influencing health policy through public deliberation: Lessons learned from two decades of Citizens'/community juries.

PubMed

Degeling, Chris; Rychetnik, Lucie; Street, Jackie; Thomas, Rae; Carter, Stacy M

2017-04-01

Citizens'/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process. Copyright © 2017 Elsevier Ltd. All rights reserved.

RESEARCH: Theory in Practice: Applying Participatory Democracy Theory to Public Land Planning

PubMed

Moote; Mcclaran; Chickering

1997-11-01

/ Application of participatory democracy theory to public participation in public land planning, while widely advocated, has not been closely examined. A case study is used here to explicate the application of participatory democracy concepts to public participation in public land planning and decision making. In this case, a Bureau of Land Management resource area manager decided to make a significant shift from the traditional public involvement process to a more participatory method-coordinated resource management (CRM). This case was assessed using document analysis, direct observation of CRM meetings, questionnaires, and interviews of key participants. These sources were used to examine the CRM case using participatory democracy concepts of efficacy, access and representation, continuous participation throughout planning, information exchange and learning, and decision-making authority. The case study suggests that social deliberation in itself does not ensure successful collaboration and that establishing rules of operation and decision making within the group is critical. Furthermore, conflicts between the concept of shared decision-making authority and the public land management agencies' accountability to Congress, the President, and the courts need further consideration.KEY WORDS: Case study; Coordinated resource management; Public participation; Administrative discretion; Representation; Consensus; Collaboration

Decision support for redesigning wastewater treatment technologies.

PubMed

McConville, Jennifer R; Künzle, Rahel; Messmer, Ulrike; Udert, Kai M; Larsen, Tove A

2014-10-21

This paper offers a methodology for structuring the design space for innovative process engineering technology development. The methodology is exemplified in the evaluation of a wide variety of treatment technologies for source-separated domestic wastewater within the scope of the Reinvent the Toilet Challenge. It offers a methodology for narrowing down the decision-making field based on a strict interpretation of treatment objectives for undiluted urine and dry feces and macroenvironmental factors (STEEPLED analysis) which influence decision criteria. Such an evaluation identifies promising paths for technology development such as focusing on space-saving processes or the need for more innovation in low-cost, energy-efficient urine treatment methods. Critical macroenvironmental factors, such as housing density, transportation infrastructure, and climate conditions were found to affect technology decisions regarding reactor volume, weight of outputs, energy consumption, atmospheric emissions, investment cost, and net revenue. The analysis also identified a number of qualitative factors that should be carefully weighed when pursuing technology development; such as availability of O&M resources, health and safety goals, and other ethical issues. Use of this methodology allows for coevolution of innovative technology within context constraints; however, for full-scale technology choices in the field, only very mature technologies can be evaluated.

Development and validation of a risk model for identification of non-neutropenic, critically ill adult patients at high risk of invasive Candida infection: the Fungal Infection Risk Evaluation (FIRE) Study.

PubMed

Harrison, D; Muskett, H; Harvey, S; Grieve, R; Shahin, J; Patel, K; Sadique, Z; Allen, E; Dybowski, R; Jit, M; Edgeworth, J; Kibbler, C; Barnes, R; Soni, N; Rowan, K

2013-02-01

There is increasing evidence that invasive fungal disease (IFD) is more likely to occur in non-neutropenic patients in critical care units. A number of randomised controlled trials (RCTs) have evaluated antifungal prophylaxis in non-neutropenic, critically ill patients, demonstrating a reduction in the risk of proven IFD and suggesting a reduction in mortality. It is necessary to establish a method to identify and target antifungal prophylaxis at those patients at highest risk of IFD, who stand to benefit most from any antifungal prophylaxis strategy. To develop and validate risk models to identify non-neutropenic, critically ill adult patients at high risk of invasive Candida infection, who would benefit from antifungal prophylaxis, and to assess the cost-effectiveness of targeting antifungal prophylaxis to high-risk patients based on these models. Systematic review, prospective data collection, statistical modelling, economic decision modelling and value of information analysis. Ninety-six UK adult general critical care units. Consecutive admissions to participating critical care units. None. Invasive fungal disease, defined as a blood culture or sample from a normally sterile site showing yeast/mould cells in a microbiological or histopathological report. For statistical and economic modelling, the primary outcome was invasive Candida infection, defined as IFD-positive for Candida species. Systematic review: Thirteen articles exploring risk factors, risk models or clinical decision rules for IFD in critically ill adult patients were identified. Risk factors reported to be significantly associated with IFD were included in the final data set for the prospective data collection. Data were collected on 60,778 admissions between July 2009 and March 2011. Overall, 383 patients (0.6%) were admitted with or developed IFD. The majority of IFD patients (94%) were positive for Candida species. The most common site of infection was blood (55%). The incidence of IFD identified in unit was 4.7 cases per 1000 admissions, and for unit-acquired IFD was 3.2 cases per 1000 admissions. Statistical modelling: Risk models were developed at admission to the critical care unit, 24 hours and the end of calendar day 3. The risk model at admission had fair discrimination (c-index 0.705). Discrimination improved at 24 hours (c-index 0.823) and this was maintained at the end of calendar day 3 (c-index 0.835). There was a drop in model performance in the validation sample. Economic decision model: Irrespective of risk threshold, incremental quality-adjusted life-years of prophylaxis strategies compared with current practice were positive but small compared with the incremental costs. Incremental net benefits of each prophylaxis strategy compared with current practice were all negative. Cost-effectiveness acceptability curves showed that current practice was the strategy most likely to be cost-effective. Across all parameters in the decision model, results indicated that the value of further research for the whole population of interest might be high relative to the research costs. The results of the Fungal Infection Risk Evaluation (FIRE) Study, derived from a highly representative sample of adult general critical care units across the UK, indicated a low incidence of IFD among non-neutropenic, critically ill adult patients. IFD was associated with substantially higher mortality, more intensive organ support and longer length of stay. Risk modelling produced simple risk models that provided acceptable discrimination for identifying patients at 'high risk' of invasive Candida infection. Results of the economic model suggested that the current most cost-effective treatment strategy for prophylactic use of systemic antifungal agents among non-neutropenic, critically ill adult patients admitted to NHS adult general critical care units is a strategy of no risk assessment and no antifungal prophylaxis. Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research.

Enhancing the informed consent process for critical care research: strategies from a thromboprophylaxis trial.

PubMed

Smith, Orla M; McDonald, Ellen; Zytaruk, Nicole; Foster, Denise; Matte, Andrea; Clarke, France; Fleury, Suzie; Krause, Katie; McArdle, Tracey; Skrobik, Yoanna; Cook, Deborah J

2013-12-01

Critically ill patients lack capacity for decisions about research participation. Consent to enrol these patients in studies is typically obtained from substitute decision-makers. To present strategies that may optimise the process of obtaining informed consent from substitute decision-makers for participation of critically ill patients in trials. We use examples from a randomised trial of heparin thromboprophylaxis in the intensive care unit (PROTECT, clinicaltrials.gov NCT00182143). 3764 patients were randomised, with an informed consent rate of 82%; 90% of consents were obtained from substitute decision-makers. North American PROTECT research coordinators attended three meetings to discuss enrolment: (1) Trial start-up (January 2006); (2) Near trial closure (January 2010); and (3) Post-publication (April 2011). Data were derived from slide presentations, field notes from break-out groups and plenary discussions, then analysed inductively. We derived three phases for the informed consent process: (1) Preparation for the Consent Encounter; (2) The Consent Encounter; and (3) Follow-up to the Consent Encounter. Specific strategies emerged for each phase: Phase 1 (four strategies); Phase 2 (six strategies); and Phase 3 (three strategies). We identified 13 strategies that may improve the process of obtaining informed consent from substitute decision-makers and be generalisable to other settings and studies. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

Navigating the boundary of science for decision making at the state and local level

NASA Astrophysics Data System (ADS)

Gonzales, L. M.; Wood, C.; Boland, M. A.; Rose, C. A.

2015-12-01

Scientific information should play a vital role in many decision making processes, yet issues incorporating geoscience information often arise due to inherent differences between how scientists and decision makers operate. Decision makers and scientists have different priorities, produce work at different rates, and often lack an understanding of each others' institutional constraints. Boundary organizations, entities that facilitate collaboration and information flow across traditional boundaries such as that between scientists and decision makers, are in a unique position to improve the dialogue between disparate groups. The American Geosciences Institute (AGI), a nonprofit federation of 50 geoscience societies and organizations, is linking the geoscience and decision-making communities through its Critical Issues Program. AGI's Critical Issues program has first-hand experience in improving the transfer of information across the science-decision making boundary, particularly in areas pertaining to water resources and hazards. This presentation will focus on how, by collaborating with organizations representing the decision making and geoscience communities to inform our program development, we have created our three main content types - website, webinar series, and research database - to better meet the needs of the decision-making process. The program presents existing geoscience information in a way that makes the interconnected nature of geoscience topics more easily understood, encourages discussion between the scientific and decision-making communities, and has established a trusted source of impartial geoscience information. These efforts have focused on state and local decision makers—groups that increasingly influence climate and risk-related decisions, yet often lack the resources to access and understand geoscience information.

Clinical Intuition in Family Medicine: More Than First Impressions

PubMed Central

Woolley, Amanda; Kostopoulou, Olga

2013-01-01

PURPOSE The clinical literature advises physicians not to trust their intuition. Studies of clinical intuition, however, equate it to early impressions, the first thing that comes to the physician’s mind. This study aimed to investigate the validity of this perspective by examining real cases of intuition in family medicine. METHODS Eighteen family physicians were interviewed about patient cases in which they believed that they had experienced an intuition. Cases were included if (1) participants were unaware of the basis of their judgment, or (2) participants talked about the basis of their judgment but believed that it was irrational or unsubstantiated. During the interview, case descriptions were systematically probed following the Critical Decision Method. Transcripts were coded for judgments, informational cues, expectancies, goals, and actions and were reordered into chronological accounts of the decision process. The 2 authors independently categorized cases into 3 emerging decision process types. RESULTS Participants reported 31 cases, 24 of which met inclusion criteria. Three types of decision process emerged: gut feelings, recognitions, and insights (κ = 0.78). In all cases, participants thought that their intuitive judgment was in conflict with a more rational explanation or what other colleagues would do. CONCLUSIONS Automatic, nonanalytical processes in clinical judgment extend beyond first impressions. Rather than admonishing clinicians not to trust their intuition, it should be acknowledged that little is currently known about the different types of intuitive processes and what determines their success or failure. Research on the conditions for accurate clinical intuitions is needed. PMID:23319507

Poor Decision Making Is a Consequence of Cognitive Decline among Older Persons without Alzheimer’s Disease or Mild Cognitive Impairment

PubMed Central

Boyle, Patricia A.; Yu, Lei; Wilson, Robert S.; Gamble, Keith; Buchman, Aron S.; Bennett, David A.

2012-01-01

Objective Decision making is an important determinant of health and well-being across the lifespan but is critical in aging, when many influential decisions are made just as cognitive function declines. Increasing evidence suggests that older adults, even those without dementia, often make poor decisions and are selectively vulnerable to scams. To date, however, the factors associated with poor decision making in old age are unknown. The objective of this study was to test the hypothesis that poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment. Methods Participants were 420 non-demented persons from the Memory and Aging Project, a longitudinal, clinical-pathologic cohort study of aging in the Chicago metropolitan area. All underwent repeated cognitive evaluations and subsequently completed assessments of decision making and susceptibility to scams. Decision making was measured using 12 items from a previously established performance-based measure and a self-report measure of susceptibility to scams. Results Cognitive function data were collected over an average of 5.5 years prior to the decision making assessment. Regression analyses were used to examine whether the prior rate of cognitive decline predicted the level of decision making and susceptibility to scams; analyses controlled for age, sex, education, and starting level of cognition. Among 420 persons without dementia, more rapid cognitive decline predicted poorer decision making and increased susceptibility to scams (p’s<0.001). Further, the relations between cognitive decline, decision making and scams persisted in analyses restricted to persons without any cognitive impairment (i.e., no dementia or even mild cognitive impairment). Conclusions Poor decision making is a consequence of cognitive decline among older persons without Alzheimer’s disease or mild cognitive impairment, those widely considered “cognitively healthy.” These findings suggest that even very subtle age-related changes in cognition have detrimental effects on judgment. PMID:22916287

Understanding nurses' decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

PubMed

Kydonaki, Kalliopi; Huby, Guro; Tocher, Jennifer; Aitken, Leanne M

2016-02-01

To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation. © 2016 John Wiley & Sons Ltd.

Identifying core competencies for public health epidemiologists.

PubMed

Bondy, Susan J; Johnson, Ian; Cole, Donald C; Bercovitz, Kim

2008-01-01

Public health authorities have prioritized the identification of competencies, yet little empirical data exist to support decisions on competency selection among particular disciplines. We sought perspectives on important competencies among epidemiologists familiar with or practicing in public health settings (local to national). Using a sequential, qualitative-quantitative mixed method design, we conducted key informant interviews with 12 public health practitioners familiar with front-line epidemiologists' practice, followed by a web-based survey of members of a provincial association of public health epidemiologists (90 respondents of 155 eligible) and a consensus workshop. Competency statements were drawn from existing core competency lists and those identified by key informants, and ranked by extent of agreement in importance for entry-level practitioners. Competencies in quantitative methods and analysis, critical appraisal of scientific evidence and knowledge transfer of scientific data to other members of the public health team were all regarded as very important for public health epidemiologists. Epidemiologist competencies focused on the provision, interpretation and 'translation' of evidence to inform decision-making by other public health professionals. Considerable tension existed around some potential competency items, particularly in the areas of more advanced database and data-analytic skills. Empirical data can inform discussions of discipline-specific competencies as one input to decisions about competencies appropriate for epidemiologists in the public health workforce.

Stakeholder Assessment of the Evidence for Cancer Genomic Tests: Insights from Three Case Studies

PubMed Central

Deverka, Patricia A.; Schully, Sheri D.; Ishibe, Naoko; Carlson, Josh J.; Freedman, Andrew; Goddard, Katrina A.B.; Khoury, Muin J.; Ramsey, Scott D.

2015-01-01

Insufficient evidence on the net benefits and harms of genomic tests in real-world settings is a translational barrier for genomic medicine. Purpose Understanding stakeholders’ assessment of the current evidence base for clinical practice and coverage decisions should be a critical step to influence research, policy, and practice. Methods Twenty-two stakeholders participated in a workshop exploring the evidence of genomic tests for clinical and coverage decision-making. Stakeholders completed a survey prior to and during the meeting. They also discussed if they would recommend for or against current clinical use of each test. Results At baseline, the level of confidence on the clinical validity and clinical utility of each test varied, although the group expressed greater confidence for EGFR mutation and Lynch Syndrome (LS) testing than for Oncotype DX. Following the discussion, survey results reflected even less confidence for Oncotype DX and EGFR testing, but not LS. The majority of stakeholders would consider clinical use for all three tests, but under the conditions of additional research or a shared clinical decision-making approach. Conclusion Stakeholder engagement in unbiased settings is necessary to understand various perspectives about evidentiary thresholds in genomic medicine. Participants recommended the use of various methods for evidence generation and synthesis. PMID:22481130

Playing with a "Full DECK": A Creative Application of the Integrative Decision-Making Framework of Ethical Behavior

ERIC Educational Resources Information Center

Case, Jan C.; Plaisance, Pamela M.; Renfrow, Jennifer J.; Olivier, Brandi N.

2008-01-01

Rehabilitation practitioners are faced with a variety of complex ethical decisions in a dynamic, changing world. Attention to principle ethics, virtue ethics, critical thinking, and creativity are essential for best practice. This article presents one tool (DECK--Decision-Making that Enhances Counselor Know-How) to facilitate such ethical…

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.

Testing the efficiency of rover science protocols for robotic sample selection: A GeoHeuristic Operational Strategies Test

NASA Astrophysics Data System (ADS)

Yingst, R. A.; Bartley, J. K.; Chidsey, T. C.; Cohen, B. A.; Gilleaudeau, G. J.; Hynek, B. M.; Kah, L. C.; Minitti, M. E.; Williams, R. M. E.; Black, S.; Gemperline, J.; Schaufler, R.; Thomas, R. J.

2018-05-01

The GHOST field tests are designed to isolate and test science-driven rover operations protocols, to determine best practices. During a recent field test at a potential Mars 2020 landing site analog, we tested two Mars Science Laboratory data-acquisition and decision-making methods to assess resulting science return and sample quality: a linear method, where sites of interest are studied in the order encountered, and a "walkabout-first" method, where sites of interest are examined remotely before down-selecting to a subset of sites that are interrogated with more resource-intensive instruments. The walkabout method cost less time and fewer resources, while increasing confidence in interpretations. Contextual data critical to evaluating site geology was acquired earlier than for the linear method, and given a higher priority, which resulted in development of more mature hypotheses earlier in the analysis process. Combined, this saved time and energy in the collection of data with more limited spatial coverage. Based on these results, we suggest that the walkabout method be used where doing so would provide early context and time for the science team to develop hypotheses-critical tests; and that in gathering context, coverage may be more important than higher resolution.

Critical Thinking Skills of United States Dental Hygiene Students

ERIC Educational Resources Information Center

Notgarnie, Howard M.

2011-01-01

The complexity of decision-making in dental hygienists' practice requires critical thinking skills. Interest in raising educational standards for entry into the dental hygiene profession is a response to the demand for enhanced professional skills, including critical thinking skills. No studies found in the course of literature review compared…

Why bother with the brain? A role for decision neuroscience in understanding strategic variability.

PubMed

Venkatraman, Vinod

2013-01-01

Neuroscience, by its nature, seems to hold considerable promise for understanding the fundamental mechanisms of decision making. In recent years, several studies in the domain of "neuroeconomics" or "decision neuroscience" have provided important insights into brain function. Yet, the apparent success and value of each of these domains are frequently called into question by researchers in economics and behavioral decision making. Critics often charge that knowledge about the brain is unnecessary for understanding decision preferences. In this chapter, I contend that knowledge about underlying brain mechanisms helps in the development of biologically plausible models of behavior, which can then help elucidate the mechanisms underlying individual choice biases and strategic preferences. Using a novel risky choice paradigm, I will demonstrate that people vary in whether they adopt compensatory or noncompensatory rules in economic decision making. Importantly, neuroimaging studies using functional magnetic resonance imaging reveal that distinct neural mechanisms support variability in choices and variability in strategic preferences. Converging evidence from a study involving decisions between hypothetical stocks illustrates how knowledge about the underlying mechanisms can help inform neuroanatomical models of cognitive control. Last, I will demonstrate how knowledge about these underlying neural mechanisms can provide novel insights into the effects of decision states like sleep deprivation on decision preferences. Together, these findings suggest that neuroscience can play a critical role in creating robust and flexible models of real-world decision behavior. Copyright © 2013 Elsevier B.V. All rights reserved.

Integration of Mahalanobis-Taguchi system and traditional cost accounting for remanufacturing crankshaft

NASA Astrophysics Data System (ADS)

Abu, M. Y.; Norizan, N. S.; Rahman, M. S. Abd

2018-04-01

Remanufacturing is a sustainability strategic planning which transforming the end of life product to as new performance with their warranty is same or better than the original product. In order to quantify the advantages of this strategy, all the processes must implement the optimization to reach the ultimate goal and reduce the waste generated. The aim of this work is to evaluate the criticality of parameters on the end of life crankshaft based on Taguchi’s orthogonal array. Then, estimate the cost using traditional cost accounting by considering the critical parameters. By implementing the optimization, the remanufacturer obviously produced lower cost and waste during production with higher potential to gain the profit. Mahalanobis-Taguchi System was proven as a powerful method of optimization that revealed the criticality of parameters. When subjected the method to the MAN engine model, there was 5 out of 6 crankpins were critical which need for grinding process while no changes happened to the Caterpillar engine model. Meanwhile, the cost per unit for MAN engine model was changed from MYR1401.29 to RM1251.29 while for Caterpillar engine model have no changes due to the no changes on criticality of parameters consideration. Therefore, by integrating the optimization and costing through remanufacturing process, a better decision can be achieved after observing the potential profit will be gained. The significant of output demonstrated through promoting sustainability by reducing re-melting process of damaged parts to ensure consistent benefit of return cores.

The Role of Time-Limited Trials in Dialysis Decision Making in Critically Ill Patients.

PubMed

Scherer, Jennifer S; Holley, Jean L

2016-02-05

Technologic advances, such as continuous RRT, provide lifesaving therapy for many patients. AKI in the critically ill patient, a fatal diagnosis in the past, is now often a survivable condition. Dialysis decision making for the critically ill patient with AKI is complex. What was once a question solely of survival now is nuanced by an individual's definition of quality of life, personal values, and short- and long-term prognoses. Clinical evaluation of AKI in the critically ill is multifaceted. Treatment decision making requires consideration of the natural evolution of the patient's AKI within the context of the global prognosis. Situations are often marked by prognostic uncertainty and clinical unknowns. In the face of these uncertainties, establishment of patient-directed therapies is imperative. A time-limited trial of continuous RRT in this setting is often appropriate but difficult to execute. Using patient preferences as a clinical guide, a proper time-limited trial requires assessment of prognosis, elicitation of patient values, strong communication skills, clear documentation, and often, appropriate integration of palliative care services. A well conducted time-limited trial can avoid interprofessional conflict and provide support for the patient, family, and staff. Copyright © 2016 by the American Society of Nephrology.

Towards evidence-based critical thinking medicine? Uses of best evidence in flawless argumentations.

PubMed

Jenicek, Milos

2006-08-01

Uses of informal logic and critical thinking methodology are increasingly taught, learnt and advantageously applied in such diverse domains as law, the military, business, and education. Health sciences are also following this trend. However, production and critical appraisal of evidence as already practiced in Evidence-Based Medicine must be coupled with equally rigorous uses in order to ensure appropriate health problem understanding and decision-making. Making most proposals and decisions in medicine is the conclusion of an argumentation process that lies behind any communication between health professionals working with patients, performing research or sharing ideas about health problems, their interpretations and solutions with numerous stakeholders in public life. Modern critical thinking and decision making in medicine is not instantly mastered, but is instead a learnt experience as anything else in professional and social interactions. The modern argument as outlined, illustrated and applied to health problems in this essay is an extension of a previously established way of thinking in Evidence-Based Medicine. Ideally, health professionals, their patients and all other stakeholders should speak the same language and it is up to us to make this possible. Evidence and critical thinking - based medicine might be a solution. As modern critical thinkers, we are at the forefront and we must see to it that patients and professional and general communities benefit from this more so even than from other remarkable historical and current contributions to the well-being of those under our care.

An Analytic Hierarchy Process-based Method to Rank the Critical Success Factors of Implementing a Pharmacy Barcode System.

PubMed

Alharthi, Hana; Sultana, Nahid; Al-Amoudi, Amjaad; Basudan, Afrah

2015-01-01

Pharmacy barcode scanning is used to reduce errors during the medication dispensing process. However, this technology has rarely been used in hospital pharmacies in Saudi Arabia. This article describes the barriers to successful implementation of a barcode scanning system in Saudi Arabia. A literature review was conducted to identify the relevant critical success factors (CSFs) for a successful dispensing barcode system implementation. Twenty-eight pharmacists from a local hospital in Saudi Arabia were interviewed to obtain their perception of these CSFs. In this study, planning (process flow issues and training requirements), resistance (fear of change, communication issues, and negative perceptions about technology), and technology (software, hardware, and vendor support) were identified as the main barriers. The analytic hierarchy process (AHP), one of the most widely used tools for decision making in the presence of multiple criteria, was used to compare and rank these identified CSFs. The results of this study suggest that resistance barriers have a greater impact than planning and technology barriers. In particular, fear of change is the most critical factor, and training is the least critical factor.

Development of instrument for assessing students’ critical and creative thinking ability

NASA Astrophysics Data System (ADS)

Herpiana, R.; Rosidin, U.

2018-01-01

The purpose of this study was to develop instruments to measure critical thinking ability and creative students in the topics of physics simple harmonic motion. The research method used was research development with application of procedures including research and data collection, planning, and initial product development. The participants of the study were thirty-four tenth grade students and five physics teachers of physics who were selected randomly from schools in the province of Lampung. The data collected by using test and analyzed in quantitative descriptive. Initial data showed that students’ critical and creative thinking ability were still low and instruments to assess students’ critical thinking skills and creative students was not yet available. Most of assessment conducted focused on memorization. Thus, the researchers developed a draft of instrument in the form of the test description based on criteria that encouraged students’ activity in understanding the concepts, strategies and decision/solution in dealing with problems. The development of the instrument was conducted considering real-world phenomena in the form of pictures and stories, description of the situation, and verbal presentation.

Expert nurses' clinical reasoning under uncertainty: representation, structure, and process.

PubMed Central

Fonteyn, M. E.; Grobe, S. J.

1992-01-01

How do expert nurses reason when planning care and making clinical decisions for a patient who is at risk, and whose outcome is uncertain? In this study, a case study involving a critically ill elderly woman whose condition deteriorated over time, was presented in segments to ten expert critical care nurses. Think aloud method was used to elicit knowledge from these experts to provide conceptual information about their knowledge and to reveal their reasoning processes and problem-solving strategies. The verbatim transcripts were then analyzed using a systematic three-step method that makes analysis easier and adds creditability to study findings by providing a means of retracing and explaining analysis results. Findings revealed information about how patient problems were represented during reasoning, the manner in which experts subjects structured their plan of care, and the reasoning processes and heuristics they used to formulate solutions for resolving the patient's problems and preventing deterioration in the patient's condition. PMID:1482907

Ideology and Palliative Care: Moral Hazards at the Bedside.

PubMed

Rhodes, Rosamond; Strain, James J

2018-01-01

Palliative care has had a long-standing commitment to teaching medical students and other medical professionals about pain management, communication, supporting patients in their decisions, and providing compassionate end-of-life care. Palliative care programs also have a critical role in helping patients understand medical conditions, and in supporting them in dealing with pain, fear of dying, and the experiences of the terminal phase of their lives. We applaud their efforts to provide that critical training and fully support their continued important work in meeting the needs of patients and families. Although we appreciate the contributions of palliative care services, we have noted a problem involving some palliative care professionals' attitudes, methods of decisionmaking, and use of language. In this article we explain these problems by discussing two cases that we encountered.

Considering Risk and Resilience in Decision-Making

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2015-01-01

This paper examines the concepts of decision-making, risk analysis, uncertainty and resilience analysis. The relation between risk, vulnerability, and resilience is analyzed. The paper describes how complexity, uncertainty, and ambiguity are the most critical factors in the definition of the approach and criteria for decision-making. Uncertainty in its various forms is what limits our ability to offer definitive answers to questions about the outcomes of alternatives in a decision-making process. It is shown that, although resilience-informed decision-making would seem fundamentally different from risk-informed decision-making, this is not the case as resilience-analysis can be easily incorporated within existing analytic-deliberative decision-making frameworks.

A decision-theoretic approach to the display of information for time-critical decisions: The Vista project

NASA Technical Reports Server (NTRS)

Horvitz, Eric; Ruokangas, Corinne; Srinivas, Sampath; Barry, Matthew

1993-01-01

We describe a collaborative research and development effort between the Palo Alto Laboratory of the Rockwell Science Center, Rockwell Space Operations Company, and the Propulsion Systems Section of NASA JSC to design computational tools that can manage the complexity of information displayed to human operators in high-stakes, time-critical decision contexts. We shall review an application from NASA Mission Control and describe how we integrated a probabilistic diagnostic model and a time-dependent utility model, with techniques for managing the complexity of computer displays. Then, we shall describe the behavior of VPROP, a system constructed to demonstrate promising display-management techniques. Finally, we shall describe our current research directions on the Vista 2 follow-on project.

Benefit cost models to support pavement management decisions.

DOT National Transportation Integrated Search

2012-06-01

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

Benefit cost models to support pavement management decisions : executive summary report.

DOT National Transportation Integrated Search

2012-01-01

A critical role of pavement management is to : provide decision makers with estimates of the : required budget level to achieve specific steadystate : network conditions, and to recommend the : best allocation of available budget among : competing ne...

Air Traffic Control: Improved Cost Information Needed to Make Billion Dollar Modernization Investment Decisions

DOT National Transportation Integrated Search

1997-01-01

This Government Accounting Office report addresses the reliability of the cost information critical to capital investment decision-making on air traffic control projects. Specifically, the GAO evaluated the Federal Aviation Administration's processes...

End-of-Life Care in the Intensive Care Unit

PubMed Central

Engelberg, Ruth A.; Bensink, Mark E.; Ramsey, Scott D.

2012-01-01

The incidence and costs of critical illness are increasing in the United States at a time when there is a focus both on limiting the rising costs of healthcare and improving the quality of end-of-life care. More than 25% of healthcare costs are spent in the last year of life, and approximately 20% of deaths occur in the intensive care unit (ICU). Consequently, there has been speculation that end-of-life care in the ICU represents an important target for cost savings. It is unclear whether efforts to improve end-of-life care in the ICU could significantly reduce healthcare costs. Here, we summarize recent studies suggesting that important opportunities may exist to improve quality and reduce costs through two mechanisms: advance care planning for patients with life-limiting illness and use of time-limited trials of ICU care for critically ill patients. The goal of these approaches is to ensure patients receive the intensity of care that they would choose at the end of life, given the opportunity to make an informed decision. Although these mechanisms hold promise for increasing quality and reducing costs, there are few clearly described, effective methods to implement these mechanisms in routine clinical practice. We believe basic science in communication and decision making, implementation research, and demonstration projects are critically important if we are to translate these approaches into practice and, in so doing, provide high-quality and patient-centered care while limiting rising healthcare costs. PMID:22859524

Bridging technology and clinical practice: innovating inpatient hyperglycaemia management in non-critical care settings.

PubMed

Thabit, H; Hovorka, R

2018-04-01

Emerging evidence shows that suboptimal glycaemic control is associated with increased morbidity and length of stay in hospital. Various guidelines for safe and effective inpatient glycaemic control in the non-critical care setting have been published. In spite of this, implementation in practice remains limited because of the increasing number of people with diabetes admitted to hospital and staff work burden. The use of technology in the outpatient setting has led to improved glycaemic outcomes and quality of life for people with diabetes. There remains an unmet need for technology utilisation in inpatient hyperglycaemia management in the non-critical care setting. Novel technologies have the potential to provide benefits in diabetes care in hospital by improving efficacy, safety and efficiency. Rapid analysis of glucose measurements by point-of-care devices help facilitate clinical decision-making and therapy adjustment in the hospital setting. Glucose treatment data integration with computerized glucose management systems underpins the effective use of decision support systems and may streamline clinical staff workflow. Continuous glucose monitoring and automation of insulin delivery through closed-loop systems may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia whilst reducing staff workload. This review summarizes the evidence with regard to technological methods to manage inpatient glycaemic control, their limitations and the future outlook, as well as potential strategies by healthcare organizations such as the National Health Service to mediate the adoption, procurement and use of diabetes technologies in the hospital setting. © 2017 Diabetes UK.

User experience of transtibial prosthetic liners: A systematic review.

PubMed

Richardson, Amy; Dillon, Michael P

2017-02-01

The liner is an integral part of a transtibial prosthesis designed to protect the residual limb, enhance comfort and provide suspension. Literature is difficult to interpret and use given the variety of interventions, outcome measures and method designs. Critical appraisal and synthesis of the evidence is needed to help inform decisions about liner prescription based on the user experience. To critically appraise and synthesise research describing the user experience of transtibial prosthetic liners. Systematic review. A comprehensive suite of databases were searched using terms related to amputation level, liner type and user experience. Included studies were in English and measured the first-person experience of using a transtibial liner. Studies were appraised using the McMaster University Critical Review Forms. A total of 18 articles met the inclusion criteria. While the quality of the evidence has improved over time, a number of common issues (e.g. sampling bias, validity of outcome measures, incorrect inferential analysis) reduce our ability to differentiate between the user experience of different transtibial liners. There is insufficient research to differentiate between the user experience of different transtibial liners. High-quality research is needed to inform decisions about liner prescription based on the user experience. Clinical relevance The available evidence suggests that the user experience of commonly reported problems (e.g. sweating) may be very similar between different liners. Aspects of the user experience that differ most between liners (e.g. unwanted noises, rotation within the socket) can help focus attention on what matters most when discussing prescription.

Critical review of complementary and alternative medicine use in menopause: focus on prevalence, motivation, decision-making, and communication.

PubMed

Peng, Wenbo; Adams, Jon; Sibbritt, David W; Frawley, Jane E

2014-05-01

This study aims to undertake the first critical review of complementary and alternative medicine (CAM) use among menopausal women (a term here used to include premenopausal, perimenopausal and postmenopausal women) by focusing on the prevalence of CAM use and CAM users' characteristics, motivation, decision-making, and communication with healthcare providers. A comprehensive search of 2002-2012 international literature in the Medline, CINAHL, AMED, and SCOPUS databases was conducted. The search was confined to peer-reviewed articles published in English with abstracts and reporting new empirical research findings regarding CAM use and menopause. A considerable level of CAM use was observed among women in menopause. Many menopausal women use CAM concurrently with their conventional medicine. However, communication regarding CAM between menopausal women and healthcare providers seems less than optimal, with a demand for further information on the safety and efficacy of medicines. Existing literature is of variable methodological rigor, often presenting small sample sizes and low-quality data collection. Further rigorous research on this topic-including quantitative and qualitative methods using large national samples, where relevant-is required. The findings of this critical review provide insights for those practicing and managing health care in this area of women's health. Healthcare providers should prepare to inform menopausal women about all treatment options, including CAM, and should be aware of the possible adverse effects of CAM and potential interactions between CAM and conventional medicine among women in menopause who are under their care.

Contracting by managed care systems for pharmaceutical products and services.

PubMed

Sharp, W T; Strandberg, L R

1990-11-01

The health care delivery system has received criticism because of its rapidly increasing costs. In an attempt to control costs, the administrators of managed care organizations are searching for cost control mechanisms. Thus, the administrators of managed care organizations appear to be searching carefully for any alternative method to lower the cost of delivering medical care to plan members. In this environment pharmacists must be extremely careful to study the cost of providing prescription services to managed care organizations, because they will be constrained by the obligations indicated in the contractual relationship. Any decisions to provide pharmaceutical services should be studied in detail after careful discussion with administrators of a managed care organization. Only after a careful analysis should a pharmacist make a decision to offer or not offer pharmaceutical services to a managed care organization.

Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan

PubMed Central

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

2005-01-01

Clinical decision support (CDS) in electronic prescribing (eRx) systems can improve the safety, quality, efficiency, and cost-effectiveness of care. However, at present, these potential benefits have not been fully realized. In this consensus white paper, we set forth recommendations and action plans in three critical domains: (1) advances in system capabilities, including basic and advanced sets of CDS interventions and knowledge, supporting database elements, operational features to improve usability and measure performance, and management and governance structures; (2) uniform standards, vocabularies, and centralized knowledge structures and services that could reduce rework by vendors and care providers, improve dissemination of well-constructed CDS interventions, promote generally applicable research in CDS methods, and accelerate the movement of new medical knowledge from research to practice; and (3) appropriate financial and legal incentives to promote adoption. PMID:15802474

A study of an arbiter function in the structures of a shared bus

NASA Astrophysics Data System (ADS)

Seck, J.-P.

The results of a comparative study of synchronous and asynchronous arbiters for managing user access to a shared bus is presented. The best available method is determined to be modular arbiter structures attached only to the decision module. Linear and circular arbitration strategies are examined for suitability for automatic decision-making. A multiple strategies arbiter scheme is devised, involving the superposition of various strategies of one sequential machine into another. It is then possible to modify the strategy on-line if the current strategy is ineffective. The utilization of a multiple structure of cascading arbiter devices is noted to be effective if response time is not a critical matter. Finally, attention is given to automatic circuit testing and fault detection. An example is furnished in terms of a management system for a shared memory in a multimicroprocessor structure.

"Side effects affected my daily activities a lot": a qualitative exploration of the impact of contraceptive side effects in Bangladesh.

PubMed

Jain, Aparna; Reichenbach, Laura; Ehsan, Iqbal; Rob, Ubaidur

2017-01-01

In a country like Bangladesh that has made great progress in contraceptive use with one of the lowest levels of fertility and highest levels of contraceptive use, understanding what factors influence women's decisions to discontinue a contraceptive method and not switch to a new method is critical in designing interventions and programs that will help enable Bangladesh to reach its FP2020 goals. Research on side effects has focused on physical manifestations like headaches, moodiness, abdominal pain, and menstrual irregularities. While physical effects alone may stop women from continuing a contraceptive method, less is known about how side effects influence women's daily activities and lives. The purpose of this study is to understand the ways that side effects affect Bangladeshi women's participation in different social settings. Thirty-five in-depth interviews with married women who recently discontinued or switched to a different contraceptive method were conducted in Sylhet and Khulna Divisions. Interviews explored reasons for discontinuation including experience of side effects and impact of side effects on women's lives. Key themes emerged including that side effects are not only experienced physically but are barriers to women's participation in many aspects of their lives. The spheres of life that most commonly appeared to be influenced by side effects include religion, household, and sexual intimacy irrespective of method used or residence. Family planning providers need to be aware of these additional consequences associated with contraceptive side effects to provide tailored counseling that recognizes these issues and helps women to mitigate them. For Bangladesh to achieve its FP2020 goals, understanding the broader context in which family planning decisions are made vis-à-vis side effects is critical to design programs and interventions that meet all the needs of women beyond just their fertility intentions.

Decision support system for triage management: A hybrid approach using rule-based reasoning and fuzzy logic.

PubMed

Dehghani Soufi, Mahsa; Samad-Soltani, Taha; Shams Vahdati, Samad; Rezaei-Hachesu, Peyman

2018-06-01

Fast and accurate patient triage for the response process is a critical first step in emergency situations. This process is often performed using a paper-based mode, which intensifies workload and difficulty, wastes time, and is at risk of human errors. This study aims to design and evaluate a decision support system (DSS) to determine the triage level. A combination of the Rule-Based Reasoning (RBR) and Fuzzy Logic Classifier (FLC) approaches were used to predict the triage level of patients according to the triage specialist's opinions and Emergency Severity Index (ESI) guidelines. RBR was applied for modeling the first to fourth decision points of the ESI algorithm. The data relating to vital signs were used as input variables and modeled using fuzzy logic. Narrative knowledge was converted to If-Then rules using XML. The extracted rules were then used to create the rule-based engine and predict the triage levels. Fourteen RBR and 27 fuzzy rules were extracted and used in the rule-based engine. The performance of the system was evaluated using three methods with real triage data. The accuracy of the clinical decision support systems (CDSSs; in the test data) was 99.44%. The evaluation of the error rate revealed that, when using the traditional method, 13.4% of the patients were miss-triaged, which is statically significant. The completeness of the documentation also improved from 76.72% to 98.5%. Designed system was effective in determining the triage level of patients and it proved helpful for nurses as they made decisions, generated nursing diagnoses based on triage guidelines. The hybrid approach can reduce triage misdiagnosis in a highly accurate manner and improve the triage outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

Fuzzy Multicriteria Decision Analysis for Adaptive Watershed Management

NASA Astrophysics Data System (ADS)

Chang, N.

2006-12-01

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

A preliminary psychometric evaluation of the eight-item cognitive load scale.

PubMed

Pignatiello, Grant A; Tsivitse, Emily; Hickman, Ronald L

2018-04-01

The aim of this article is to report the psychometric properties of the eight-item cognitive load scale. According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions. To date, no psychometric analyses of instruments evaluating cognitive load have been reported within healthcare settings. A convenience sample of 62 surrogate decision makers for critically ill patients were exposed to one of two healthcare decision support interventions were recruited from four intensive care units at a tertiary medical center in Northeast Ohio. Participants were administered a battery of psychosocial instruments and the eight-item cognitive load scale (CLS). The CLS demonstrated a bidimensional factor structure with acceptable discriminant validity and internal consistency reliability (Cronbach's α = 0.75 and 0.89). The CLS is a psychometrically sound instrument that may be used in the evaluation of decision support among surrogate decision makers of the critically ill. The authors recommend application of the cognitive load scale in the evaluation and development of healthcare education and interventions. Copyright © 2018 Elsevier Inc. All rights reserved.

Providing English Language Development Services to English Learners with Disabilities: Approaches to Making Exit Decisions. NCEO Report 404

ERIC Educational Resources Information Center

Thurlow, Martha L.; Shyyan, Vitaliy V.; Lazarus, Sheryl S.; Christensen, Laurene L.

2016-01-01

Instructional and decision-making practices for English learners (ELs) with disabilities are garnering increased attention as the number of these students increases across the U.S. Although many critical educational decisions are made for these students, the determination that an EL with disabilities should be reclassified and exited from services…

Is It Rational or Intuitive? Factors and Processes Affecting School Superintendents' Decisions When Facing Professional Dilemmas

ERIC Educational Resources Information Center

Hart, Walter H.

2018-01-01

Given the critical impact of their decisions and of the community's perception of their performance, it is reasonable that school superintendents would seek to understand the factors that influence their decisions and the processes used to make them. The researcher in this study used a qualitative approach, interviewing 13 school superintendents…

A review of challenges to determining and demonstrating efficiency of large fire management

Treesearch

Matthew P. Thompson; Francisco Rodriguez y Silva; David E. Calkin; Michael S. Hand

2017-01-01

Characterising the impacts of wildland fire and fire suppression is critical information for fire management decision-making. Here, we focus on decisions related to the rare larger and longer-duration fire events, where the scope and scale of decision-making can be far broader than initial response efforts, and where determining and demonstrating efficiency of...

Refining a brief decision aid in stable CAD: cognitive interviews.

PubMed

Kelly-Blake, Karen; Clark, Stacie; Dontje, Katherine; Olomu, Adesuwa; Henry, Rebecca C; Rovner, David R; Rothert, Marilyn L; Holmes-Rovner, Margaret

2014-02-13

We describe the results of cognitive interviews to refine the "Making Choices©" Decision Aid (DA) for shared decision-making (SDM) about stress testing in patients with stable coronary artery disease (CAD). We conducted a systematic development process to design a DA consistent with International Patient Decision Aid Standards (IPDAS) focused on Alpha testing criteria. Cognitive interviews were conducted with ten stable CAD patients using the "think aloud" interview technique to assess the clarity, usefulness, and design of each page of the DA. Participants identified three main messages: 1) patients have multiple options based on stress tests and they should be discussed with a physician, 2) take care of yourself, 3) the stress test is the gold standard for determining the severity of your heart disease. Revisions corrected the inaccurate assumption of item number three. Cognitive interviews proved critical for engaging patients in the development process and highlighted the necessity of clear message development and use of design principles that make decision materials easy to read and easy to use. Cognitive interviews appear to contribute critical information from the patient perspective to the overall systematic development process for designing decision aids.

Decision analysis in clinical cardiology: When is coronary angiography required in aortic stenosis

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

Georgeson, S.; Meyer, K.B.; Pauker, S.G.

1990-03-15

Decision analysis offers a reproducible, explicit approach to complex clinical decisions. It consists of developing a model, typically a decision tree, that separates choices from chances and that specifies and assigns relative values to outcomes. Sensitivity analysis allows exploration of alternative assumptions. Cost-effectiveness analysis shows the relation between dollars spent and improved health outcomes achieved. In a tutorial format, this approach is applied to the decision whether to perform coronary angiography in a patient who requires aortic valve replacement for critical aortic stenosis.

Expert decision-making strategies

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.

1991-01-01

A recognition-primed decisions (RPD) model is employed as a framework to investigate crew decision-making processes. The quality of information transfer, a critical component of the team RPD model and an indicator of the team's 'collective consciouness', is measured and analyzed with repect to crew performance. As indicated by the RPD model, timing and patterns of information search transfer were expected to reflect extensive and continual situation assessment, and serial evaluation of alternative states of the world or decision response options.

Iterative near-term ecological forecasting: Needs, opportunities, and challenges

USGS Publications Warehouse

Dietze, Michael C.; Fox, Andrew; Beck-Johnson, Lindsay; Betancourt, Julio L.; Hooten, Mevin B.; Jarnevich, Catherine S.; Keitt, Timothy H.; Kenney, Melissa A.; Laney, Christine M.; Larsen, Laurel G.; Loescher, Henry W.; Lunch, Claire K.; Pijanowski, Bryan; Randerson, James T.; Read, Emily; Tredennick, Andrew T.; Vargas, Rodrigo; Weathers, Kathleen C.; White, Ethan P.

2018-01-01

Two foundational questions about sustainability are “How are ecosystems and the services they provide going to change in the future?” and “How do human decisions affect these trajectories?” Answering these questions requires an ability to forecast ecological processes. Unfortunately, most ecological forecasts focus on centennial-scale climate responses, therefore neither meeting the needs of near-term (daily to decadal) environmental decision-making nor allowing comparison of specific, quantitative predictions to new observational data, one of the strongest tests of scientific theory. Near-term forecasts provide the opportunity to iteratively cycle between performing analyses and updating predictions in light of new evidence. This iterative process of gaining feedback, building experience, and correcting models and methods is critical for improving forecasts. Iterative, near-term forecasting will accelerate ecological research, make it more relevant to society, and inform sustainable decision-making under high uncertainty and adaptive management. Here, we identify the immediate scientific and societal needs, opportunities, and challenges for iterative near-term ecological forecasting. Over the past decade, data volume, variety, and accessibility have greatly increased, but challenges remain in interoperability, latency, and uncertainty quantification. Similarly, ecologists have made considerable advances in applying computational, informatic, and statistical methods, but opportunities exist for improving forecast-specific theory, methods, and cyberinfrastructure. Effective forecasting will also require changes in scientific training, culture, and institutions. The need to start forecasting is now; the time for making ecology more predictive is here, and learning by doing is the fastest route to drive the science forward.

Iterative near-term ecological forecasting: Needs, opportunities, and challenges.

PubMed

Dietze, Michael C; Fox, Andrew; Beck-Johnson, Lindsay M; Betancourt, Julio L; Hooten, Mevin B; Jarnevich, Catherine S; Keitt, Timothy H; Kenney, Melissa A; Laney, Christine M; Larsen, Laurel G; Loescher, Henry W; Lunch, Claire K; Pijanowski, Bryan C; Randerson, James T; Read, Emily K; Tredennick, Andrew T; Vargas, Rodrigo; Weathers, Kathleen C; White, Ethan P

2018-02-13

Two foundational questions about sustainability are "How are ecosystems and the services they provide going to change in the future?" and "How do human decisions affect these trajectories?" Answering these questions requires an ability to forecast ecological processes. Unfortunately, most ecological forecasts focus on centennial-scale climate responses, therefore neither meeting the needs of near-term (daily to decadal) environmental decision-making nor allowing comparison of specific, quantitative predictions to new observational data, one of the strongest tests of scientific theory. Near-term forecasts provide the opportunity to iteratively cycle between performing analyses and updating predictions in light of new evidence. This iterative process of gaining feedback, building experience, and correcting models and methods is critical for improving forecasts. Iterative, near-term forecasting will accelerate ecological research, make it more relevant to society, and inform sustainable decision-making under high uncertainty and adaptive management. Here, we identify the immediate scientific and societal needs, opportunities, and challenges for iterative near-term ecological forecasting. Over the past decade, data volume, variety, and accessibility have greatly increased, but challenges remain in interoperability, latency, and uncertainty quantification. Similarly, ecologists have made considerable advances in applying computational, informatic, and statistical methods, but opportunities exist for improving forecast-specific theory, methods, and cyberinfrastructure. Effective forecasting will also require changes in scientific training, culture, and institutions. The need to start forecasting is now; the time for making ecology more predictive is here, and learning by doing is the fastest route to drive the science forward.

Adapting Cognitive Task Analysis to Investigate Clinical Decision Making and Medication Safety Incidents.

PubMed

Russ, Alissa L; Militello, Laura G; Glassman, Peter A; Arthur, Karen J; Zillich, Alan J; Weiner, Michael

2017-05-03

Cognitive task analysis (CTA) can yield valuable insights into healthcare professionals' cognition and inform system design to promote safe, quality care. Our objective was to adapt CTA-the critical decision method, specifically-to investigate patient safety incidents, overcome barriers to implementing this method, and facilitate more widespread use of cognitive task analysis in healthcare. We adapted CTA to facilitate recruitment of healthcare professionals and developed a data collection tool to capture incidents as they occurred. We also leveraged the electronic health record (EHR) to expand data capture and used EHR-stimulated recall to aid reconstruction of safety incidents. We investigated 3 categories of medication-related incidents: adverse drug reactions, drug-drug interactions, and drug-disease interactions. Healthcare professionals submitted incidents, and a subset of incidents was selected for CTA. We analyzed several outcomes to characterize incident capture and completed CTA interviews. We captured 101 incidents. Eighty incidents (79%) met eligibility criteria. We completed 60 CTA interviews, 20 for each incident category. Capturing incidents before interviews allowed us to shorten the interview duration and reduced reliance on healthcare professionals' recall. Incorporating the EHR into CTA enriched data collection. The adapted CTA technique was successful in capturing specific categories of safety incidents. Our approach may be especially useful for investigating safety incidents that healthcare professionals "fix and forget." Our innovations to CTA are expected to expand the application of this method in healthcare and inform a wide range of studies on clinical decision making and patient safety.

Application of ANP and DEMATEL to evaluate the decision-making of municipal solid waste management in Metro Manila.

PubMed

Tseng, Ming-Lang

2009-09-01

A municipal solid waste management (MSW) expert group was consulted in order to mirror how government officials might reach an effective solution regarding municipal solid waste management in Metro Manila. A critical issue regarding this is how the expert group can better evaluate and select a favorable MSW management solution using a series of criteria. MSW management solution selection is a multiple criteria decision-making (MCDM) problem, which requires the consideration of a large number of complex criteria. A robust MCDM method should consider the interactions among these criteria. The analytic network process (ANP) is a relatively new MCDM method which can deal with all kinds of interactions systematically. The Decision Making Trial and Evaluation Laboratory (DEMATEL) not only can convert the relations between cause and effect of criteria into a structural model, but also can be used as a way to handle the inner dependences within a set of criteria. Hence, this paper applies an effective solution based on a combined ANP and DEMATEL method to assist the expert group evaluating different MSW management solutions. According to the results, the best solution is for each city to have its own type of thermal process technology and resource recovery facility before landfill rather than entering a joint venture with enterprises or going into build-operate-transfer projects in order to be able to construct thermal process technologies and resource recovery facilities.

Strategic control in decision-making under uncertainty.

PubMed

Venkatraman, Vinod; Huettel, Scott A

2012-04-01

Complex economic decisions - whether investing money for retirement or purchasing some new electronic gadget - often involve uncertainty about the likely consequences of our choices. Critical for resolving that uncertainty are strategic meta-decision processes, which allow people to simplify complex decision problems, evaluate outcomes against a variety of contexts, and flexibly match behavior to changes in the environment. In recent years, substantial research has implicated the dorsomedial prefrontal cortex (dmPFC) in the flexible control of behavior. However, nearly all such evidence comes from paradigms involving executive function or response selection, not complex decision-making. Here, we review evidence that demonstrates that the dmPFC contributes to strategic control in complex decision-making. This region contains a functional topography such that the posterior dmPFC supports response-related control, whereas the anterior dmPFC supports strategic control. Activation in the anterior dmPFC signals changes in how a decision problem is represented, which in turn can shape computational processes elsewhere in the brain. Based on these findings, we argue for both generalized contributions of the dmPFC to cognitive control, and specific computational roles for its subregions depending upon the task demands and context. We also contend that these strategic considerations are likely to be critical for decision-making in other domains, including interpersonal interactions in social settings. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Strategic Control in Decision Making under Uncertainty

PubMed Central

Venkatraman, Vinod; Huettel, Scott

2012-01-01

Complex economic decisions – whether investing money for retirement or purchasing some new electronic gadget – often involve uncertainty about the likely consequences of our choices. Critical for resolving that uncertainty are strategic meta-decision processes, which allow people to simplify complex decision problems, to evaluate outcomes against a variety of contexts, and to flexibly match behavior to changes in the environment. In recent years, substantial research implicates the dorsomedial prefrontal cortex (dmPFC) in the flexible control of behavior. However, nearly all such evidence comes from paradigms involving executive function or response selection, not complex decision making. Here, we review evidence that demonstrates that the dmPFC contributes to strategic control in complex decision making. This region contains a functional topography such that the posterior dmPFC supports response-related control while the anterior dmPFC supports strategic control. Activation in the anterior dmPFC signals changes in how a decision problem is represented, which in turn can shape computational processes elsewhere in the brain. Based on these findings, we argue both for generalized contributions of the dmPFC to cognitive control, and for specific computational roles for its subregions depending upon the task demands and context. We also contend that these strategic considerations are also likely to be critical for decision making in other domains, including interpersonal interactions in social settings. PMID:22487037

Instruments to assess the perception of physicians in the decision-making process of specific clinical encounters: a systematic review

PubMed Central

Légaré, France; Moher, David; Elwyn, Glyn; LeBlanc, Annie; Gravel, Karine

2007-01-01

Background The measurement of processes and outcomes that reflect the complexity of the decision-making process within specific clinical encounters is an important area of research to pursue. A systematic review was conducted to identify instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. Methods For every year available up until April 2007, PubMed, PsycINFO, Current Contents, Dissertation Abstracts and Sociological Abstracts were searched for original studies in English or French. Reference lists from retrieved studies were also consulted. Studies were included if they reported a self-administered instrument evaluating physicians' perceptions of the decision-making process within specific clinical encounters, contained sufficient description to permit critical appraisal and presented quantitative results based on administering the instrument. Two individuals independently assessed the eligibility of the instruments and abstracted information on their conceptual underpinnings, main evaluation domain, development, format, reliability, validity and responsiveness. They also assessed the quality of the studies that reported on the development of the instruments with a modified version of STARD. Results Out of 3431 records identified and screened for evaluation, 26 potentially relevant instruments were assessed; 11 met the inclusion criteria. Five instruments were published before 1995. Among those published after 1995, five offered a corresponding patient version. Overall, the main evaluation domains were: satisfaction with the clinical encounter (n = 2), mutual understanding between health professional and patient (n = 2), mental workload (n = 1), frustration with the clinical encounter (n = 1), nurse-physician collaboration (n = 1), perceptions of communication competence (n = 2), degree of comfort with a decision (n = 1) and information on medication (n = 1). For most instruments (n = 10), some reliability and validity criteria were reported in French or English. Overall, the mean number of items on the modified version of STARD was 12.4 (range: 2 to 18). Conclusion This systematic review provides a critical appraisal and repository of instruments that assess the perception physicians have of the decision-making process within specific clinical encounters. More research is needed to pursue the validation of the existing instruments and the development of patient versions. This will help researchers capture the complexity of the decision-making process within specific clinical encounters. PMID:17937801

A multiscale forecasting method for power plant fleet management

NASA Astrophysics Data System (ADS)

Chen, Hongmei

In recent years the electric power industry has been challenged by a high level of uncertainty and volatility brought on by deregulation and globalization. A power producer must minimize the life cycle cost while meeting stringent safety and regulatory requirements and fulfilling customer demand for high reliability. Therefore, to achieve true system excellence, a more sophisticated system-level decision-making process with a more accurate forecasting support system to manage diverse and often widely dispersed generation units as a single, easily scaled and deployed fleet system in order to fully utilize the critical assets of a power producer has been created as a response. The process takes into account the time horizon for each of the major decision actions taken in a power plant and develops methods for information sharing between them. These decisions are highly interrelated and no optimal operation can be achieved without sharing information in the overall process. The process includes a forecasting system to provide information for planning for uncertainty. A new forecasting method is proposed, which utilizes a synergy of several modeling techniques properly combined at different time-scales of the forecasting objects. It can not only take advantages of the abundant historical data but also take into account the impact of pertinent driving forces from the external business environment to achieve more accurate forecasting results. Then block bootstrap is utilized to measure the bias in the estimate of the expected life cycle cost which will actually be needed to drive the business for a power plant in the long run. Finally, scenario analysis is used to provide a composite picture of future developments for decision making or strategic planning. The decision-making process is applied to a typical power producer chosen to represent challenging customer demand during high-demand periods. The process enhances system excellence by providing more accurate market information, evaluating the impact of external business environment, and considering cross-scale interactions between decision actions. Along with this process, system operation strategies, maintenance schedules, and capacity expansion plans that guide the operation of the power plant are optimally identified, and the total life cycle costs are estimated.

On Nonlinear Combustion Instability in Liquid Propellant Rocket Motors

NASA Technical Reports Server (NTRS)

Sims, J. D. (Technical Monitor); Flandro, Gary A.; Majdalani, Joseph; Sims, Joseph D.

2004-01-01

All liquid propellant rocket instability calculations in current use have limited value in the predictive sense and serve mainly as a correlating framework for the available data sets. The well-known n-t model first introduced by Crocco and Cheng in 1956 is still used as the primary analytical tool of this type. A multitude of attempts to establish practical analytical methods have achieved only limited success. These methods usually produce only stability boundary maps that are of little use in making critical design decisions in new motor development programs. Recent progress in understanding the mechanisms of combustion instability in solid propellant rockets"' provides a firm foundation for a new approach to prediction, diagnosis, and correction of the closely related problems in liquid motor instability. For predictive tools to be useful in the motor design process, they must have the capability to accurately determine: 1) time evolution of the pressure oscillations and limit amplitude, 2) critical triggering pulse amplitude, and 3) unsteady heat transfer rates at injector surfaces and chamber walls. The method described in this paper relates these critical motor characteristics directly to system design parameters. Inclusion of mechanisms such as wave steepening, vorticity production and transport, and unsteady detonation wave phenomena greatly enhance the representation of key features of motor chamber oscillatory behavior. The basic theoretical model is described and preliminary computations are compared to experimental data. A plan to develop the new predictive method into a comprehensive analysis tool is also described.

Claimed effects, outcome variables and methods of measurement for health claims proposed under European Community Regulation 1924/2006 in the area of blood glucose and insulin concentrations.

PubMed

Martini, Daniela; Biasini, Beatrice; Zavaroni, Ivana; Bedogni, Giorgio; Musci, Marilena; Pruneti, Carlo; Passeri, Giovanni; Ventura, Marco; Galli, Daniela; Mirandola, Prisco; Vitale, Marco; Dei Cas, Alessandra; Bonadonna, Riccardo C; Del Rio, Daniele

2018-04-01

Most requests for authorization to bear health claims under Articles 13(5) and 14 related to blood glucose and insulin concentration/regulation presented to the European Food Safety Authority (EFSA) receive a negative opinion. Reasons for such decisions are mainly ascribable to poor substantiation of the claimed effects. In this scenario, a project was carried out aiming at critically analysing the outcome variables (OVs) and methods of measurement (MMs) to be used to substantiate health claims, with the final purpose to improve the quality of applications provided by stakeholders to EFSA. This manuscript provides a position statement of the experts involved in the project, reporting the results of an investigation aimed to collect, collate and critically analyse the information relevant to claimed effects (CEs), OVs and MMs related to blood glucose and insulin levels and homoeostasis compliant with Regulation 1924/2006. The critical analysis of OVs and MMs was performed with the aid of the pertinent scientific literature and was aimed at defining their appropriateness (alone or in combination with others) to support a specific CE. The results can be used to properly select OVs and MMs in a randomized controlled trial, for an effective substantiation of the claims, using the reference method(s) whenever available. Moreover, results can help EFSA in updating the guidance for the scientific requirements of health claims.

Lee as Critical Thinker: The Example of the Gettysburg Campaign

DTIC Science & Technology

2012-05-04

well as what should have been done if the critical thinking process had been conducted appropriately. Conclusion: Several human and military...of reasoning that make up the cognitive decision making process .6 The critical thinking elements of the model (Clarify Concern, Point of View...Finally, there are three remaining biases, traps, and errors that can negatively affect the critical thinking process . A confirmation trap describes

Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

PubMed Central

Smith, Neale; Mitton, Craig; Peacock, Stuart; Cornelissen, Evelyn; MacLeod, Stuart

2009-01-01

Background To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation. Methods The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes. Results Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation. Conclusion We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is likely that the results are broadly applicable to other healthcare contexts. The implementation of this research agenda in British Columbia will depend upon the ability of the researchers and decision-makers to develop particular projects that fit within the constraints of existing funding opportunities. The process of engagement itself had benefits in terms of connecting decision-makers with their peers and sparking increased interest in the use and refinement of priority setting frameworks. PMID:19754969

Reflection: A Key Component to Thinking Critically

ERIC Educational Resources Information Center

Colley, Binta M.; Bilics, Andrea R.; Lerch, Carol M.

2012-01-01

The ability to think critically is an important trait of all members of society. With today's multinational, multicultural, complex issues, citizens must be able to sift through large amounts of various data to make intelligent decisions. Thinking critically must be a focus of higher education in order to provide the intellectual training for its…

Critical thinking in patient centered care.

PubMed

Mitchell, Shannon H; Overman, Pamela; Forrest, Jane L

2014-06-01

Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

The effects of an editor serving as one of the reviewers during the peer-review process.

PubMed

Giordan, Marco; Csikasz-Nagy, Attila; Collings, Andrew M; Vaggi, Federico

2016-01-01

Background Publishing in scientific journals is one of the most important ways in which scientists disseminate research to their peers and to the wider public. Pre-publication peer review underpins this process, but peer review is subject to various criticisms and is under pressure from growth in the number of scientific publications. Methods Here we examine an element of the editorial process at eLife , in which the Reviewing Editor usually serves as one of the referees, to see what effect this has on decision times, decision type, and the number of citations. We analysed a dataset of 8,905 research submissions to eLife since June 2012, of which 2,747 were sent for peer review. This subset of 2747 papers was then analysed in detail.   Results The Reviewing Editor serving as one of the peer reviewers results in faster decision times on average, with the time to final decision ten days faster for accepted submissions (n=1,405) and five days faster for papers that were rejected after peer review (n=1,099). Moreover, editors acting as reviewers had no effect on whether submissions were accepted or rejected, and a very small (but significant) effect on citation rates. Conclusions An important aspect of eLife 's peer-review process is shown to be effective, given that decision times are faster when the Reviewing Editor serves as a reviewer. Other journals hoping to improve decision times could consider adopting a similar approach.

Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature

PubMed Central

2014-01-01

Background Patients are increasingly expected and asked to be involved in health care decisions. In this decision-making process, preferences for participation are important. In this systematic review we aim to provide an overview the literature related to the congruence between patients’ preferences and their perceived participation in medical decision-making. We also explore the direction of mismatched and outline factors associated with congruence. Methods A systematic review was performed on patient participation in medical decision-making. Medline, PsycINFO, CINAHL, EMBASE and the Cochrane Library databases up to September 2012, were searched and all studies were rigorously critically appraised. In total 44 papers were included, they sampled contained 52 different patient samples. Results Mean of congruence between preference for and perceived participation in decision-making was 60% (49 and 70 representing 25th and 75th percentiles). If no congruence was found, of 36 patient samples most patients preferred more involvement and of 9 patient samples most patients preferred less involvement. Factors associated with preferences the most investigated were age and educational level. Younger patients preferred more often an active or shared role as did higher educated patients. Conclusion This review suggests that a similar approach to all patients is not likely to meet patients’ wishes, since preferences for participation vary among patients. Health care professionals should be sensitive to patients individual preferences and communicate about patients’ participation wishes on a regular basis during their illness trajectory. PMID:24708833

Germline stem cells are critical for sexual fate decision of germ cells

PubMed Central

2016-01-01

Egg or sperm? The mechanism of sexual fate decision in germ cells has been a long‐standing issue in biology. A recent analysis identified foxl3 as a gene that determines the sexual fate decision of germ cells in the teleost fish, medaka. foxl3/Foxl3 acts in female germline stem cells to repress commitment into male fate (spermatogenesis), indicating that the presence of mitotic germ cells in the female is critical for continuous sexual fate decision of germ cells in medaka gonads. Interestingly, foxl3 is found in most vertebrate genomes except for mammals. This provides the interesting possibility that the sexual fate of germ cells in mammals is determined in a different way compared to foxl3‐possessing vertebrates. Considering the fact that germline stem cells are the cells where foxl3 begins to express and sexual fate decision initiates and mammalian ovary does not have typical germline stem cells, the mechanism in mammals may have been co‐evolved with germline stem cell loss in mammalian ovary. PMID:27699806

Communication and Decision-Making About End-of-Life Care in the Intensive Care Unit.

PubMed

Brooks, Laura Anne; Manias, Elizabeth; Nicholson, Patricia

2017-07-01

Clinicians in the intensive care unit commonly face decisions involving withholding or withdrawing life-sustaining therapy, which present many clinical and ethical challenges. Communication and shared decision-making are key aspects relating to the transition from active treatment to end-of-life care. To explore the experiences and perspectives of nurses and physicians when initiating end-of-life care in the intensive care unit. The study was conducted in a 24-bed intensive care unit in Melbourne, Australia. An interpretative, qualitative inquiry was used, with focus groups as the data collection method. Intensive care nurses and physicians were recruited to participate in a discipline-specific focus group. Focus group discussions were audio-recorded, transcribed, and subjected to thematic data analysis. Five focus groups were conducted; 17 nurses and 11 physicians participated. The key aspects discussed included communication and shared decision-making. Themes related to communication included the timing of end-of-life care discussions and conducting difficult conversations. Implementation and multidisciplinary acceptance of end-of-life care plans and collaborative decisions involving patients and families were themes related to shared decision-making. Effective communication and decision-making practices regarding initiating end-of-life care in the intensive care unit are important. Multidisciplinary implementation and acceptance of end-of-life care plans in the intensive care unit need improvement. Clear organizational processes that support the introduction of nurse and physician end-of-life care leaders are essential to optimize outcomes for patients, family members, and clinicians. ©2017 American Association of Critical-Care Nurses.

Meeting the nutritional needs of patients with severe dysphagia following a stroke: an interdisciplinary approach.

PubMed

Rodrigue, Nathalie; Côté, Robert; Kirsch, Connie; Germain, Chantal; Couturier, Céline; Fraser, Roxanne

2002-03-01

Dysphagia is a common problem with individuals who have experienced a stroke. The interdisciplinary stroke team noted delays in clinical decision-making, or in implementing plans for patients with severe dysphagia requiring an alternative method to oral feeding, such as enteral feeding via Dobhoff (naso-jejunum) or PEG (percutaneous endoscopic gastrostomy) tubes, occurred because protocols had not been established. This resulted in undernourishment, which in turn contributed to clinical problems, such as infections and confusion, which delayed rehabilitation and contributed to excess disability. The goal of the project was to improve quality of care and quality of life for stroke patients experiencing swallowing problems by creating a dysphagia management decision-making process. The project began with a retrospective chart review of 91 cases over a period of six months to describe the population characteristics, dysphagia frequency, stroke and dysphagia severity, and delays encountered with decision-making regarding dysphagia management. A literature search was conducted, and experts in the field were consulted to provide current knowledge prior to beginning the project. Using descriptive statistics, dysphagia was present in 44% of the stroke population and 69% had mild to moderate stroke severity deficit. Delays were found in the decision to insert a PEG (mean 10 days) and the time between decision and PEG insertion (mean 12 days). Critical periods were examined in order to speed up the process of decision-making and intervention. This resulted in the creation of a decision-making algorithm based on stroke and dysphagia severity that will be tested during winter 2002.

Development and evaluation of learning module on clinical decision-making in Prosthodontics.

PubMed

Deshpande, Saee; Lambade, Dipti; Chahande, Jayashree

2015-01-01

Best practice strategies for helping students learn the reasoning skills of problem solving and critical thinking (CT) remain a source of conjecture, particularly with regard to CT. The dental education literature is fundamentally devoid of research on the cognitive components of clinical decision-making. This study was aimed to develop and evaluate the impact of blended learning module on clinical decision-making skills of dental graduates for planning prosthodontics rehabilitation. An interactive teaching module consisting of didactic lectures on clinical decision-making and a computer-assisted case-based treatment planning software was developed Its impact on cognitive knowledge gain in clinical decision-making was evaluated using an assessment involving problem-based multiple choice questions and paper-based case scenarios. Mean test scores were: Pretest (17 ± 1), posttest 1 (21 ± 2) and posttest 2 (43 ± 3). Comparison of mean scores was done with one-way ANOVA test. There was overall significant difference in between mean scores at all the three points (P < 0.001). A pair-wise comparison of mean scores was done with Bonferroni test. The mean difference is significant at the 0.05 level. The pair-wise comparison shows that posttest 2 score is significantly higher than posttest 1 and posttest 1 is significantly higher than pretest that is, pretest 2 > posttest 1 > pretest. Blended teaching methods employing didactic lectures on the clinical decision-making as well as computer assisted case-based learning can be used to improve quality of clinical decision-making in prosthodontic rehabilitation for dental graduates.

Considerations in the construction of an instrument to assess attitudes regarding critical illness gene variation research.

PubMed

Freeman, Bradley D; Kennedy, Carie R; Bolcic-Jankovic, Dragana; Eastman, Alexander; Iverson, Ellen; Shehane, Erica; Celious, Aaron; Barillas, Jennifer; Clarridge, Brian

2012-02-01

Clinical studies conducted in intensive care units are associated with logistical and ethical challenges. Diseases investigated are precipitous and life-threatening, care is highly technological, and patients are often incapacitated and decision-making is provided by surrogates. These investigations increasingly involve collection of genetic data. The manner in which the exigencies of critical illness impact attitudes regarding genetic data collection is unstudied. Given interest in understanding stakeholder preferences as a foundation for the ethical conduct of research, filling this knowledge gap is timely. The conduct of opinion research in the critical care arena is novel. This brief report describes the development of parallel patient/surrogate decision-maker quantitative survey instruments for use in this environment. Future research employing this instrument or a variant of it with diverse populations promises to inform research practices in critical illness gene variation research.

Considerations in the Construction of an Instrument to Assess Attitudes Regarding Critical Illness Gene Variation Research

PubMed Central

Freeman, Bradley D.; Kennedy, Carie R.; Bolcic-Jankovic, Dragana; Eastman, Alexander; Iverson, Ellen; Shehane, Erica; Celious, Aaron; Barillas, Jennifer; Clarridge, Brian

2012-01-01

Clinical studies conducted in intensive care units are associated with logistical and ethical challenges. Diseases investigated are precipitous and life-threatening, care is highly technological, and patients are often incapacitated and decision-making is provided by surrogates. These investigations increasingly involve collection of genetic data. The manner in which the exigencies of critical illness impact attitudes regarding genetic data collection is unstudied. Given interest in understanding stakeholder preferences as a foundation for the ethical conduct of research, filling this knowledge gap is timely. The conduct of opinion research in the critical care arena is novel. This brief report describes the development of parallel patient/surrogate decision-maker quantitative survey instruments for use in this environment. Future research employing this instrument or a variant of it with diverse populations promises to inform research practices in critical illness gene variation research. PMID:22378135

Information Technology and Community Restoration Studies/Task 1: Information Technology

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

Upton, Jaki F.; Lesperance, Ann M.; Stein, Steven L.

2009-11-19

Executive Summary The Interagency Biological Restoration Demonstration—a program jointly funded by the Department of Defense's Defense Threat Reduction Agency and the Department of Homeland Security's (DHS's) Science and Technology Directorate—is developing policies, methods, plans, and applied technologies to restore large urban areas, critical infrastructures, and Department of Defense installations following the intentional release of a biological agent (anthrax) by terrorists. There is a perception that there should be a common system that can share information both vertically and horizontally amongst participating organizations as well as support analyses. A key question is: "How far away from this are we?" As partmore » of this program, Pacific Northwest National Laboratory conducted research to identify the current information technology tools that would be used by organizations in the greater Seattle urban area in such a scenario, to define criteria for use in evaluating information technology tools, and to identify current gaps. Researchers interviewed 28 individuals representing 25 agencies in civilian and military organizations to identify the tools they currently use to capture data needed to support operations and decision making. The organizations can be grouped into five broad categories: defense (Department of Defense), environmental/ecological (Environmental Protection Agency/Ecology), public health and medical services, emergency management, and critical infrastructure. The types of information that would be communicated in a biological terrorism incident include critical infrastructure and resource status, safety and protection information, laboratory test results, and general emergency information. The most commonly used tools are WebEOC (web-enabled crisis information management systems with real-time information sharing), mass notification software, resource tracking software, and NW WARN (web-based information to protect critical infrastructure systems). It appears that the current information management tools are used primarily for information gathering and sharing—not decision making. Respondents identified the following criteria for a future software system. It is easy to learn, updates information in real time, works with all agencies, is secure, uses a visualization or geographic information system feature, enables varying permission levels, flows information from one stage to another, works with other databases, feeds decision support tools, is compliant with appropriate standards, and is reasonably priced. Current tools have security issues, lack visual/mapping functions and critical infrastructure status, and do not integrate with other tools. It is clear that there is a need for an integrated, common operating system. The system would need to be accessible by all the organizations that would have a role in managing an anthrax incident to enable regional decision making. The most useful tool would feature a GIS visualization that would allow for a common operating picture that is updated in real time. To capitalize on information gained from the interviews, the following activities are recommended: • Rate emergency management decision tools against the criteria specified by the interviewees. • Identify and analyze other current activities focused on information sharing in the greater Seattle urban area. • Identify and analyze information sharing systems/tools used in other regions.« less

Graph-based structural change detection for rotating machinery monitoring

NASA Astrophysics Data System (ADS)

Lu, Guoliang; Liu, Jie; Yan, Peng

2018-01-01

Detection of structural changes is critically important in operational monitoring of a rotating machine. This paper presents a novel framework for this purpose, where a graph model for data modeling is adopted to represent/capture statistical dynamics in machine operations. Meanwhile we develop a numerical method for computing temporal anomalies in the constructed graphs. The martingale-test method is employed for the change detection when making decisions on possible structural changes, where excellent performance is demonstrated outperforming exciting results such as the autoregressive-integrated-moving average (ARIMA) model. Comprehensive experimental results indicate good potentials of the proposed algorithm in various engineering applications. This work is an extension of a recent result (Lu et al., 2017).

Desperately seeking donors: the 'saviour sibling' decision in Quintavalle v Human Fertilisation and Embryology Authority (UK).

PubMed

Hocking, Barbara Ann; Guy, Scott

2005-08-01

The recent House of Lords decision in Quintavalle v Human Fertilisation and Embryology Authority has raised difficult and complex issues regarding the extent to which embryo selection and reproductive technology can be used as a means of rectifying genetic disorders and treating critically ill children. This comment outlines the facts of Quintavalle and explores how the House of Lords approached the legal, ethical and policy issues that arose out of the Human Fertilisation and Embryology Authority's (UK) decision to allow reproductive and embryo technology to be used to produce a 'saviour sibling' whose tissue could be used to save the life of a critically ill child. Particular attention will be given to the implications of the decision in Quintavalle for Australian family and medical law and policy. As part of this focus, the comment explores the current Australian legislative and policy framework regarding the use of genetic and reproductive technology as a mechanism through which to assist critically ill siblings. It is argued that the present Australian framework would appear to impose significant limits on the medical uses of genetic technology and, in this context, would seem to reflect many of the principles that were articulated by the House of Lords in Quintavalle.

3rd Circuit hints it may reconsider McNemar reasoning.

PubMed

1997-10-17

The [name removed] v. The Disney Store ruling is under criticism and the 3rd U.S. Circuit Court of Appeals may reconsider its 1996 decision to not allow employees who receive disability benefits to sue under the Americans with Disabilities Act (ADA). A panel of 3rd Circuit judges, working on [name removed] v. American Sterilizer Co., asserts that the [name removed] decision should not be used to assume that an individual's ADA claims are barred because of prior representations of disability. [Name removed] is suing American Sterilizer under the retaliation provisions of the ADA. Other courts are criticizing the [name removed] decision, including the District of Columbia Court in [name removed] v. Washington Metropolitan Area Transit Authority. The [name removed] court assets that a statement made in the context of a disability application does not preclude an ADA claim brought by a worker for illegal discrimination because the ADA and the Social Security Act differ in their statutory intent. AIDS advocates state that the [name removed] decision places a plaintiff in the position of having to choose between asserting a legal right or maintaining an income. Alan Epstein, who represented [name removed], is pleased by the criticism but explains that [name removed], who died this summer, will not be vindicated.

Drivers' decision-making when attempting to cross an intersection results from choice between affordances

PubMed Central

Marti, Geoffrey; Morice, Antoine H. P.; Montagne, Gilles

2015-01-01

In theory, a safe approach to an intersection implies that drivers can simultaneously manage two scenarios: they either choose to cross or to give way to an oncoming vehicle. In this article we formalize the critical time for safe crossing (CTcross) and the critical time for safe stopping (CTstop) to represent crossing and stopping possibilities, respectively. We describe these critical times in terms of affordances and empirically test their respective contribution to the driver's decision-making process. Using a driving simulator, three groups of participants drove cars with identical acceleration capabilities and different braking capabilities. They were asked to try to cross an intersection where there was an oncoming vehicle, if they deemed the maneuver to be safe. If not, they could decide to stop or, as a last resort, make an emergency exit. The intersections were identical among groups. Results showed that although the crossing possibilities (CTcross) were the same for all groups, there were between-group differences in crossing frequency. This suggests that stopping possibilities (CTstop) play a role in the driver's decision-making process, in addition to the crossing possibilities. These results can be accounted for by a behavioral model of decision making, and provide support for the hypothesis of choice between affordances. PMID:25620922

Treatment limitation decisions under uncertainty: the value of subsequent euthanasia.

PubMed

Savulescu, Julian

1994-01-01

This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.

Parental decision-making for medically complex infants and children: an integrated literature review.

PubMed

Allen, Kimberly A

2014-09-01

Many children with life-threatening conditions who would have died at birth are now surviving months to years longer than previously expected. Understanding how parents make decisions is necessary to prevent parental regret about decision-making, which can lead to psychological distress, decreased physical health, and decreased quality of life for the parents. The aim of this integrated literature review was to describe possible factors that affect parental decision-making for medically complex children. The critical decisions included continuation or termination of a high-risk pregnancy, initiation of life-sustaining treatments such as resuscitation, complex cardiothoracic surgery, use of experimental treatments, end-of-life care, and limitation of care or withdrawal of support. PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO were searched using the combined key terms 'parents and decision-making' to obtain English language publications from 2000 to June 2013. The findings from each of the 31 articles retained were recorded. The strengths of the empirical research reviewed are that decisions about initiating life support and withdrawing life support have received significant attention. Researchers have explored how many different factors impact decision-making and have used multiple different research designs and data collection methods to explore the decision-making process. These initial studies lay the foundation for future research and have provided insight into parental decision-making during times of crisis. Studies must begin to include both parents and providers so that researchers can evaluate how decisions are made for individual children with complex chronic conditions to understand the dynamics between parents and parent-provider relationships. The majority of studies focused on one homogenous diagnostic group of premature infants and children with complex congenital heart disease. Thus comparisons across other child illness categories cannot be made. Most studies also used cross-sectional and/or retrospective research designs, which led to researchers and clinicians having limited understanding of how factors change over time for parents. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decision-Making on Medical Innovations in a Changing Healthcare Environment: Insights from Accountable Care Organizations and Payers on Personalized Medicine and Other Technologies

PubMed Central

Trosman, Julia R.; Weldon, Christine B.; Douglas, Michael P.; Deverka, Patricia A.; Watkins, John; Phillips, Kathryn A.

2016-01-01

Background New payment and care organization approaches, such as the Accountable Care Organization (ACO), are reshaping accountability and shifting risk, as well as decision-making, from payers to providers, under the Triple Aim of health reform. The Triple Aim calls for improving experience of care, improving health of populations and reducing healthcare costs. In the era of accelerating scientific advancement of personalized medicine and other innovations, it is critical to understand how the transition to the ACO model impacts decision-making on adoption and utilization of innovative technologies. Methods We interviewed representatives from ten private payers and six provider institutions involved in implementing the ACO model (i.e. ACOs) to understand changes, challenges and facilitators of decision-making on medical innovations, including personalized medicine. We used the framework approach of qualitative research for study design and thematic analysis. Results We found that representatives from the participating payer companies and ACOs perceive similar challenges to ACOs’ decision-making in terms of achieving a balance between the components of the Triple Aim – improving care experience, improving population health and reducing costs. The challenges include the prevalence of cost over care quality considerations in ACOs’ decisions and ACOs’ insufficient analytical and technology assessment capacity to evaluate complex innovations such as personalized medicine. Decision-making facilitators included increased competition across ACOs and patients’ interest in personalized medicine. Conclusions As new payment models evolve, payers, ACOs and other stakeholders should address challenges and leverage opportunities to arm ACOs with robust, consistent, rigorous and transparent approaches to decision-making on medical innovations. PMID:28212967

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

PubMed

Cabrera, V E

2018-01-01

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

Identification, assessment and management of "endocrine disruptors" in wildlife in the EU substance legislation--discussion paper from the German Federal Environment Agency (UBA).

PubMed

Frische, Tobias; Bachmann, Jean; Frein, Daniel; Juffernholz, Tanja; Kehrer, Anja; Klein, Anita; Maack, Gerd; Stock, Frauke; Stolzenberg, Hans-Christian; Thierbach, Claudia; Walter-Rohde, Susanne

2013-12-16

A discussion paper was developed by a panel of experts of the German Federal Environment Agency (UBA) contributing to the on-going debate on the identification, assessment and management of endocrine disruptors with a view to protect wildlife according to the EU substance legislation (plant protection products, biocides, industrial chemicals). Based on a critical synthesis of the state-of-the-art regarding regulatory requirements, testing methods, assessment schemes, decision-making criteria and risk management options, we advise an appropriate and consistent implementation of this important subject into existing chemicals legislation in Europe. Our proposal for a balanced risk management of endocrine disruptors essentially advocates transparent regulatory decision making based on a scientifically robust weight of evidence approach and an adequate risk management consistent across different legislations. With respect to the latter, a more explicit consideration of the principle of proportionality of regulatory decision making and socio-economic benefits in the on-going debate is further encouraged. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.