Sample records for critical decision processes
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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.
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[Clinical decision making and critical thinking in the nursing diagnostic process].
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".
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Decision making in critically ill patients with hematologic malignancy.
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
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How Critical Thinking Shapes the Military Decision Making Process
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
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[Clinical reasoning in undergraduate nursing education: a scoping review].
Menezes, Sáskia Sampaio Cipriano de; Corrêa, Consuelo Garcia; Silva, Rita de Cássia Gengo E; Cruz, Diná de Almeida Monteiro Lopes da
2015-12-01
This study aimed at analyzing the current state of knowledge on clinical reasoning in undergraduate nursing education. A systematic scoping review through a search strategy applied to the MEDLINE database, and an analysis of the material recovered by extracting data done by two independent reviewers. The extracted data were analyzed and synthesized in a narrative manner. From the 1380 citations retrieved in the search, 23 were kept for review and their contents were summarized into five categories: 1) the experience of developing critical thinking/clinical reasoning/decision-making process; 2) teaching strategies related to the development of critical thinking/clinical reasoning/decision-making process; 3) measurement of variables related to the critical thinking/clinical reasoning/decision-making process; 4) relationship of variables involved in the critical thinking/clinical reasoning/decision-making process; and 5) theoretical development models of critical thinking/clinical reasoning/decision-making process for students. The biggest challenge for developing knowledge on teaching clinical reasoning seems to be finding consistency between theoretical perspectives on the development of clinical reasoning and methodologies, methods, and procedures in research initiatives in this field.
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Bond, Susan; Cooper, Simon
2006-08-01
To review and reflect on the literature on recognition-primed decision (RPD) making and influences on emergency decisions with particular reference to an ophthalmic critical incident involving the sub-arachnoid spread of local anaesthesia following the peribulbar injection. This paper critics the literature on recognition-primed decision making, with particular reference to emergency situations. It illustrates the findings by focussing on an ophthalmic critical incident. Systematic literature review with critical incident reflection. Medline, CINAHL and PsychINFO databases were searched for papers on recognition-primed decision making (1996-2004) followed by the 'snowball method'. Studies were selected in accordance with preset criteria. A total of 12 papers were included identifying the recognition-primed decision making as a good theoretical description of acute emergency decisions. In addition, cognitive resources, situational awareness, stress, team support and task complexity were identified as influences on the decision process. Recognition-primed decision-making theory describes the decision processes of experts in time-bound emergency situations and is the foundation for a model of emergency decision making (Fig. 2). Decision theory and models, in this case related to emergency situations, inform practice and enhance clinical effectiveness. The critical incident described highlights the need for nurses to have a comprehensive and in-depth understanding of anaesthetic techniques as well as an ability to manage and resuscitate patients autonomously. In addition, it illustrates how the critical incidents should influence the audit cycle with improvements in patient safety.
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Critical thinking in clinical nurse education: application of Paul's model of critical thinking.
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.
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Bedside nurse involvement in end-of-life decision making: a brief review of the literature.
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.
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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.
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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.
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The effects of critical thinking instruction on training complex decision making.
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.
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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…
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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…
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Graduate nurses: critical thinkers or better decision makers?
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.
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Plant, Katherine L; Stanton, Neville A
2013-01-01
Aeronautical decision-making is complex as there is not always a clear coupling between the decision made and decision outcome. As such, there is a call for process-orientated decision research in order to understand why a decision made sense at the time it was made. Schema theory explains how we interact with the world using stored mental representations and forms an integral part of the perceptual cycle model (PCM); proposed here as a way to understand the decision-making process. This paper qualitatively analyses data from the critical decision method (CDM) based on the principles of the PCM. It is demonstrated that the approach can be used to understand a decision-making process and highlights how influential schemata can be at informing decision-making. The reliability of this approach is established, the general applicability is discussed and directions for future work are considered. This paper introduces the PCM, and the associated schema theory, as a framework to structure and explain data collected from the CDM. The reliability of both the method and coding scheme is addressed.
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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
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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…
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A qualitative analysis of how advanced practice nurses use clinical decision support systems.
Weber, Scott
2007-12-01
The purpose of this study was to generate a grounded theory that will reflect the experiences of advanced practice nurses (APNs) working as critical care nurse practitioners (NPs) and clinical nurse specialists (CNS) with computer-based decision-making systems. A study design using grounded theory qualitative research methods and convenience sampling was employed in this study. Twenty-three APNs (13 CNS and 10 NPs) were recruited from 16 critical care units located in six large urban medical centers in the U.S. Midwest. Single-structured in-depth interviews with open-ended audio-taped questions were conducted with each APN. Through this process, APNs defined what they consider to be relevant themes and patterns of clinical decision system use in their critical care practices, and they identified the interrelatedness of the conceptual categories that emerged from the results. Data were analyzed using the constant comparative analysis method of qualitative research. APN participants were predominantly female, white/non-Hispanic, had a history of access to the clinical decision system used in their critical care settings for an average of 14 months, and had attended a formal training program to learn how to use clinical decision systems. "Forecasting decision outcomes," which was defined as the voluntary process employed to forecast the outcomes of patient care decisions in critical care prior to actual decision making, was the core variable describing system use that emerged from the responses. This variable consisted of four user constructs or components: (a) users' perceptions of their initial system learning experience, (b) users' sense of how well they understand how system technology works, (c) users' understanding of how system inferences are created or derived, and (d) users' relative trust of system-derived data. Each of these categories was further described through the grounded theory research process, and the relationships between the categories were identified. The findings of this study suggest that the main reason critical care APNs choose to integrate clinical decision systems into their practices is to provide an objective, scientifically derived, technology-based backup for human forecasting of the outcomes of patient care decisions prior to their actual decision making. Implications for nursing, health care, and technology research are presented.
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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.
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Translational Cognition for Decision Support in Critical Care Environments: A Review
Patel, Vimla L.; Zhang, Jiajie; Yoskowitz, Nicole A.; Green, Robert; Sayan, Osman R.
2008-01-01
The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers. PMID:18343731
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Translational cognition for decision support in critical care environments: a review.
Patel, Vimla L; Zhang, Jiajie; Yoskowitz, Nicole A; Green, Robert; Sayan, Osman R
2008-06-01
The dynamic and distributed work environment in critical care requires a high level of collaboration among clinical team members and a sophisticated task coordination system to deliver safe, timely and effective care. A complex cognitive system underlies the decision-making process in such cooperative workplaces. This methodological review paper addresses the issues of translating cognitive research to clinical practice with a specific focus on decision-making in critical care, and the role of information and communication technology to aid in such decisions. Examples are drawn from studies of critical care in our own research laboratories. Critical care, in this paper, includes both intensive (inpatient) and emergency (outpatient) care. We define translational cognition as the research on basic and applied cognitive issues that contribute to our understanding of how information is stored, retrieved and used for problem-solving and decision-making. The methods and findings are discussed in the context of constraints on decision-making in real-world complex environments and implications for supporting the design and evaluation of decision support tools for critical care health providers.
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Critical care nurses' decision making: sedation assessment and management in intensive care.
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.
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[Structural elements of critical thinking of nurses in emergency care].
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.
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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
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Lee as Critical Thinker: The Example of the Gettysburg Campaign
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
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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.
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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…
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[Effects of situational and individual variables on critical thinking expression].
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.
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How Expert Pilots Think Cognitive Processes in Expert Decision Making
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
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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.
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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.
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Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.
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.
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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…
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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.
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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.
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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…
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Recognition Decisions From Visual Working Memory Are Mediated by Continuous Latent Strengths.
Ricker, Timothy J; Thiele, Jonathan E; Swagman, April R; Rouder, Jeffrey N
2017-08-01
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 contents of visual working memory follow a continuous decision process of graded information about the correct choice or a discrete decision process reflecting only knowing and guessing. We find a clear pattern in favor of a continuous latent strength model of visual working memory-based decision making, supporting the notion that visual recognition decision processes are impacted by the degree of matching between the contents of working memory and the choices given. Relation to relevant findings and the implications for human information processing more generally are discussed. Copyright © 2016 Cognitive Science Society, Inc.
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Relevance Judging, Evaluation, and Decision Making in Virtual Libraries: A Descriptive Study.
ERIC Educational Resources Information Center
Fitzgerald, Mary Ann; Galloway, Chad
2001-01-01
Describes a study that investigated the cognitive processes undergraduates used to select information while using a virtual library, GALILEO (Georgia Library Learning Online). Discusses higher order thinking processes, relevance judging, evaluation (critical thinking), decision making, reasoning involving documents, relevance-related reasoning,…
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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.…
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Naval Systems Engineering Guide
2004-10-01
Decision Critical Design Review System Integration Activities IOC FRP Decision Review Production & Deployment Sustainment IOT & FOC Sustainmen...reentered when things change significantly, such as funding, requirements, or schedule. This process must start at the very beginning of a Major...outputs through sub-processes will reveal a number of things : a. Determine the level of process applicability and tailoring required. b. Additional
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Anarchist, Neoliberal, & Democratic Decision-Making: Deepening the Joy in Learning and Teaching
ERIC Educational Resources Information Center
Briscoe, Felecia M.
2012-01-01
Using a critical postmodern framework, this article analyzes the relationship of the decision-making processes of anarchism and neoliberalism to that of deep democracy. Anarchist processes are found to share common core principals with deep democracy; but neoliberal processes are found to be antithetical to deep democracy. To increase the joy in…
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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…
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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…
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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.
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ERIC Educational Resources Information Center
Jazby, Dan
2014-01-01
Research into human decision making (DM) processes from outside of education paint a different picture of DM than current DM models in education. This pilot study assesses the use of critical decision method (CDM)--developed from observations of firefighters' DM -- in the context of primary mathematics teachers' in-class DM. Preliminary results…
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Development of Encoding and Decision Processes in Visual Recognition.
ERIC Educational Resources Information Center
Newcombe, Nora; MacKenzie, Doris L.
This experiment examined two processes which might account for developmental increases in accuracy in visual recognition tasks: age-related increases in efficiency of scanning during inspection, and age-related increases in the ability to make decisions systematically during test. Critical details necessary for recognition were highlighted as…
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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).
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A system of system lenses for leadership decision-making.
Cady, Phil
2016-01-01
The sheer volume and dynamics among system agents in healthcare makes decision-making a daunting task at all levels. Being clear about what leaders mean by "healthcare system" is critical in aligning system strategy and leadership decision-making. This article presents an emerging set of lenses (ideology and beliefs, rational and irrational information processing, interpersonal social dynamics, process and value creation, and context) to help frame leadership decision-making in healthcare systems. © 2015 The Canadian College of Health Leaders.
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Critical thinking: the development of an essential skill for nursing students.
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.
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Critical Thinking: The Development of an Essential Skill for Nursing Students
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
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South African critical care nurses' views on end-of-life decision-making and practices.
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.
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Alastalo, Mika; Salminen, Leena; Lakanmaa, Riitta-Liisa; Leino-Kilpi, Helena
2017-10-01
The aim of this study was to provide a comprehensive description of multiple skills in patient observation in critical care nursing. Data from semi-structured interviews were analysed using thematic analysis. Experienced critical care nurses (n=20) from three intensive care units in two university hospitals in Finland. Patient observation skills consist of: information gaining skills, information processing skills, decision-making skills and co-operation skills. The first three skills are integrated in the patient observation process, in which gaining information is a prerequisite for processing information that precedes making decisions. Co-operation has a special role as it occurs throughout the process. This study provided a comprehensive description of patient observation skills related to the three-phased patient observation process. The findings contribute to clarifying this part of the competence. The description of patient observation skills may be applied in both clinical practice and education as it may serve as a framework for orientation, ensuring clinical skills and designing learning environments. Based on this study, patient observation skills can be recommended to be included in critical care nursing education, orientation and as a part of critical care nurses' competence evaluation. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Refining a brief decision aid in stable CAD: cognitive interviews.
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.
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ERIC Educational Resources Information Center
Gouran, Dennis S.
Although the Attorney General's Commission on Pornography, also known as the Meese Commission, has been criticized excessively at times for threatening freedom of speech and press and individual rights to privacy, an analysis of its "Final Report" reveals numerous deficiencies in the Commission's decision-making process. These…
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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)…
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Conformance Testing: Measurement Decision Rules
NASA Technical Reports Server (NTRS)
Mimbs, Scott M.
2010-01-01
The goal of a Quality Management System (QMS) as specified in ISO 9001 and AS9100 is to provide assurance to the customer that end products meet specifications. Measuring devices, often called measuring and test equipment (MTE), are used to provide the evidence of product conformity to specified requirements. Unfortunately, processes that employ MTE can become a weak link to the overall QMS if proper attention is not given to the measurement process design, capability, and implementation. Documented "decision rules" establish the requirements to ensure measurement processes provide the measurement data that supports the needs of the QMS. Measurement data are used to make the decisions that impact all areas of technology. Whether measurements support research, design, production, or maintenance, ensuring the data supports the decision is crucial. Measurement data quality can be critical to the resulting consequences of measurement-based decisions. Historically, most industries required simplistic, one-size-fits-all decision rules for measurements. One-size-fits-all rules in some cases are not rigorous enough to provide adequate measurement results, while in other cases are overly conservative and too costly to implement. Ideally, decision rules should be rigorous enough to match the criticality of the parameter being measured, while being flexible enough to be cost effective. The goal of a decision rule is to ensure that measurement processes provide data with a sufficient level of quality to support the decisions being made - no more, no less. This paper discusses the basic concepts of providing measurement-based evidence that end products meet specifications. Although relevant to all measurement-based conformance tests, the target audience is the MTE end-user, which is anyone using MTE other than calibration service providers. Topics include measurement fundamentals, the associated decision risks, verifying conformance to specifications, and basic measurement decisions rules.
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An engineering approach to modelling, decision support and control for sustainable systems.
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.
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[Interoception and decision-making].
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.
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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...
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Cognitive continuum theory in interprofessional healthcare: A critical analysis.
Parker-Tomlin, Michelle; Boschen, Mark; Morrissey, Shirley; Glendon, Ian
2017-07-01
Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.
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Dunn, Sandra I; Cragg, Betty; Graham, Ian D; Medves, Jennifer; Gaboury, Isabelle
2018-05-01
Shared decision-making provides an opportunity for the knowledge and skills of care providers to synergistically influence patient care. Little is known about interprofessional shared decision-making processes in critical care settings. The aim of this study was to explore interprofessional team members' perspectives about the nature of interprofessional shared decision-making in a neonatal intensive care unit (NICU) and to determine if there are any differences in perspectives across professional groups. An exploratory qualitative approach was used consisting of semi-structured interviews with 22 members of an interprofessional team working in a tertiary care NICU in Canada. Participants identified four key roles involved in interprofessional shared decision-making: leader, clinical experts, parents, and synthesizer. Participants perceived that interprofessional shared decision-making happens through collaboration, sharing, and weighing the options, the evidence and the credibility of opinions put forward. The process of interprofessional shared decision-making leads to a well-informed decision and participants feeling valued. Findings from this study identified key concepts of interprofessional shared decision-making, increased awareness of differing professional perspectives about this process of shared decision-making, and clarified understanding of the different roles involved in the decision-making process in an NICU.
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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.
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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.
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ERIC Educational Resources Information Center
Thomas, Veronica L.; Magnotta, Sarah R.; Chang, Hua; Steffes, Erin
2018-01-01
Instructors are faced with the challenge of teaching a significant amount of material covering a wide variety of topics in a Principles of Marketing course. In order to present the critical consumer decision-making process concept in a meaningful way while remaining mindful of time constraints, we propose a semi-structured classroom activity that…
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Barnhardt, Terrence M
2005-10-01
Three experiments explored the distinction between identification and production processes (e.g., Gabrieli et al., 1999). A stem decision test was introduced, in which participants were asked to state whether there were any English words that began with the presented three-letter stems. In Experiment 1, stem decision priming was robust for single-solution stems, but much reduced for many-solution stems. In Experiment 2, the solutions effect in stem decision was replicated in a within-subjects design, as was the contrast between the presence of priming in a many-solution stem completion test and the absence of priming in a many-solution stem decision test. In Experiment 3, for each critical many-solution stem in the stem decision test, participants studied three words that began with those three letters. Again, priming was not observed. These results were consistent with the notions that (a) many-solution stem completion relies on production processes, (b) the stem decision test eliminates production processes, and (c) single-solution priming relies on identification processes, regardless of whether the test is stem completion or stem decision.
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IMPROVED SCIENCE AND DECISION SUPPORT FOR MANAGING WATERSHED NUTRIENT LOADS
The proposed research addresses two critical gaps in the TMDL process: (1) the inadequacy of presently existing receiving water models to accurately simulate nutrient-sediment-water interactions and fixed plants; and (2) the lack of decision-oriented optimization f...
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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.
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Kenyan Nurses Involvement in National Policy Development Processes
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
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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.
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Janice K. Wiedenbeck; Philip A. Araman
1995-01-01
We've been telling the wood industry about our process simulation modeling research and development work for several years. We've demonstrated our crosscut-first and rip-first rough mill simulation and animation models. Weâve advised companies on how they could use simulation modeling to help make critically important, pending decisions related to mill layout...
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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.
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Bollich, Kathryn L; Hill, Patrick L; Harms, Peter D; Jackson, Joshua J
2016-01-01
Early adulthood is a developmentally important time period, with many novel life events needing to be traversed for the first time. Despite this important transition period, few studies examine the development of moral decision-making processes during this critical life stage. In the present study, college students completed moral decision-making measures during their freshman and senior years of college. Results indicate that, across four years, moral decision-making demonstrates considerable rank-order stability as well as change, such that people become more likely to help a friend relative to following societal rules. To help understand the mechanisms driving changes in moral decision-making processes, we examined their joint development with personality traits, a known correlate that changes during early adulthood in the direction of greater maturity. We found little evidence that personality and moral decision-making developmental processes are related. In sum, findings indicate that while moral decision-making processes are relatively stable across a four-year period, changes do occur which are likely independent of developmental processes driving personality trait change.
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Bollich, Kathryn L.; Hill, Patrick L.; Harms, Peter D.; Jackson, Joshua J.
2016-01-01
Early adulthood is a developmentally important time period, with many novel life events needing to be traversed for the first time. Despite this important transition period, few studies examine the development of moral decision-making processes during this critical life stage. In the present study, college students completed moral decision-making measures during their freshman and senior years of college. Results indicate that, across four years, moral decision-making demonstrates considerable rank-order stability as well as change, such that people become more likely to help a friend relative to following societal rules. To help understand the mechanisms driving changes in moral decision-making processes, we examined their joint development with personality traits, a known correlate that changes during early adulthood in the direction of greater maturity. We found little evidence that personality and moral decision-making developmental processes are related. In sum, findings indicate that while moral decision-making processes are relatively stable across a four-year period, changes do occur which are likely independent of developmental processes driving personality trait change. PMID:26751944
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2010-01-01
Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved. PMID:20504357
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McCaughey, Deirdre; Bruning, Nealia S
2010-05-26
Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved.
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Methods for Conducting Cognitive Task Analysis for a Decision Making Task.
1996-01-01
Cognitive task analysis (CTA) improves traditional task analysis procedures by analyzing the thought processes of performers while they complete a...for using these methods to conduct a CTA for domains which involve critical decision making tasks in naturalistic settings. The cognitive task analysis methods
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USDA-ARS?s Scientific Manuscript database
Watershed simulation models are used extensively to investigate hydrologic processes, landuse and climate change impacts, pollutant load assessments and best management practices (BMPs). Developing, calibrating and validating these models require a number of critical decisions that will influence t...
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Palmer, Richard M
2010-06-01
A Novel Decision-Making Process for Tooth Retention or Extraction J Periodontol 2009;80:476-491. Avila G, Galindo-Moreno P, Soehren S, Misch CE, Morelli T, Wang H-L. Richard M. Palmer, PhD, BDS, FDS RCS PURPOSE/QUESTION: Is it possible to devise a system to help in the decision-making process of tooth extraction/retention based on a critical evaluation of the literature? University of Michigan Periodontal Graduate Student Research Fund Comprehensive literature review Level 3: Other evidence Not applicable.
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Pieterse, Arwen H; de Vries, Marieke
2013-09-01
Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference-sensitive health-care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that deliberation is advantageous. Research suggests that simple, fast and frugal heuristic decision strategies sometimes result in better judgments and decisions. Durand et al. have developed two fast and frugal heuristic-based VCMs. To critically analyse the suitability of the 'take the best' (TTB) and 'tallying' fast and frugal heuristics in the context of patient decision making. Analysis of the structural similarities between the environments in which the TTB and tallying heuristics have been proven successful and the context of patient decision making and of the potential of these heuristic decision processes to support patient decision making. The specific nature of patient preference-sensitive decision making does not seem to resemble environments in which the TTB and tallying heuristics have proven successful. Encouraging patients to consider less rather than more relevant information potentially even deteriorates their values clarification process. Values clarification methods promoting the use of more intuitive decision strategies may sometimes be more effective. Nevertheless, we strongly recommend further theoretical thinking about the expected value of such heuristics and of other more intuitive decision strategies in this context, as well as empirical assessments of the mechanisms by which inducing such decision strategies may impact the quality and outcome of values clarification. © 2011 John Wiley & Sons Ltd.
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Pieterse, Arwen H.; de Vries, Marieke
2011-01-01
Abstract Background Increasingly, patient decision aids and values clarification methods (VCMs) are being developed to support patients in making preference‐sensitive health‐care decisions. Many VCMs encourage extensive deliberation about options, without solid theoretical or empirical evidence showing that deliberation is advantageous. Research suggests that simple, fast and frugal heuristic decision strategies sometimes result in better judgments and decisions. Durand et al. have developed two fast and frugal heuristic‐based VCMs. Objective To critically analyse the suitability of the ‘take the best’ (TTB) and ‘tallying’ fast and frugal heuristics in the context of patient decision making. Strategy Analysis of the structural similarities between the environments in which the TTB and tallying heuristics have been proven successful and the context of patient decision making and of the potential of these heuristic decision processes to support patient decision making. Conclusion The specific nature of patient preference‐sensitive decision making does not seem to resemble environments in which the TTB and tallying heuristics have proven successful. Encouraging patients to consider less rather than more relevant information potentially even deteriorates their values clarification process. Values clarification methods promoting the use of more intuitive decision strategies may sometimes be more effective. Nevertheless, we strongly recommend further theoretical thinking about the expected value of such heuristics and of other more intuitive decision strategies in this context, as well as empirical assessments of the mechanisms by which inducing such decision strategies may impact the quality and outcome of values clarification. PMID:21902770
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Clinical decision making by nurses when faced with third-space fluid shift. How well do they fare?
Redden, M; Wotton, K
2001-01-01
Nurses' use of knowledge, the connection of this knowledge to treatment decisions and information actually used to reach such decisions, delineates nurses' level of expertise. Previous research has shown that nurses in their clinical decision-making use the hypothetico-deductive method and intuitive judgment or pattern recognition. This interpretive study explored experienced critical care nurses' (n = 5) and gastrointestinal surgical nurses' (n = 5) clinical decision-making processes through ascertaining their knowledge and understanding of third-space fluid shift in elderly patients undergoing major gastrointestinal surgery. Both groups of nurses, because of their experience with elderly patients undergoing gastrointestinal surgery, were assumed to be experts. Data collection techniques included semi-structured interviews and the use of think aloud protocol for clinical scenario analysis. The findings demonstrated that the gastrointestinal surgical nurses used the hypothetico-deductive method to recognize critical cues and the existence of a problem but could not name the problem. The critical care nurses, on the other hand, used a combination of the hypothetico-deductive method and pattern recognition as a basis for identification of critical cues. The critical care nurses also possessed in depth knowledge of third-space fluid shift and were able to use pivotal cues to identify the actual phenomenon. Ultimately, it would appear that the structure of critical care nurses' work, their increased educational qualifications and the culture of the critical care unit promote a more proactive approach to reasoning in the physiological domain. The findings have implications for the development of practice guidelines and curriculum development in both tertiary and continuing nurse education.
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ERIC Educational Resources Information Center
Buchanan, Gregory S.
2013-01-01
This research study examines the various decision-making processes that superintendents may encounter within the field. The degree to which public school superintendents and public school systems are being held accountable has increased in recent years. The recent unethical decisions made within the last decade in both the public and private…
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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
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Shared decision making in designing new healthcare environments-time to begin improving quality.
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.
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NASA Technical Reports Server (NTRS)
Hale, Joseph P.
2006-01-01
Models and simulations (M&S) are critical resources in the exploration of space. They support program management, systems engineering, integration, analysis, test, and operations and provide critical information and data supporting key analyses and decisions (technical, cost and schedule). Consequently, there is a clear need to establish a solid understanding of M&S strengths and weaknesses, and the bounds within which they can credibly support decision-making. Their usage requires the implementation of a rigorous approach to verification, validation and accreditation (W&A) and establishment of formal process and practices associated with their application. To ensure decision-making is suitably supported by information (data, models, test beds) from activities (studies, exercises) from M&S applications that are understood and characterized, ESMD is establishing formal, tailored W&A processes and practices. In addition, to ensure the successful application of M&S within ESMD, a formal process for the certification of analysts that use M&S is being implemented. This presentation will highlight NASA's Exploration Systems Mission Directorate (ESMD) management approach for M&S W&A to ensure decision-makers receive timely information on the model's fidelity, credibility, and quality.
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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.
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Nurse manager cognitive decision-making amidst stress and work complexity.
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.
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Strategic control in decision-making under uncertainty.
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.
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Strategic Control in Decision Making under Uncertainty
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
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A computerized system for portrayal of landscape alterations
A. E. Stevenson; J. A. Conley; J. B. Carey
1979-01-01
The growing public awareness of and participation in the visual resource decision process has stimulated interest to find improved means of accurately and realistically displaying proposed alterations. The traditional artist renderings often lack the accuracy and objectivity needed for critical decisions. One approach, using computer graphics, led to the MOSAIC system...
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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.
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Health technology funding decision-making processes around the world: the same, yet different.
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.
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Siedlikowski, Sophia; Ells, Carolyn; Bartlett, Gillian
2018-01-01
A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice. To review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women. This study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers. Nine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process. The discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women considering screening, the forms of knowledge that physicians value to guide screening decision-making, and the consent process for population-based screening initiatives. Within the data, there was little attention placed on how physicians coped with uncertainty in practice. Given the dual responsibility of physicians in caring for both individuals and the larger population, further research should probe more deeply into how they balance their duties to individual patients with those to the larger population they serve.
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Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara
2016-10-06
Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.
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Evidence and its uses in health care and research: the role of critical thinking.
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.
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Evidence and its uses in health care and research: The role of critical thinking
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
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Humans Optimize Decision-Making by Delaying Decision Onset
Teichert, Tobias; Ferrera, Vincent P.; Grinband, Jack
2014-01-01
Why do humans make errors on seemingly trivial perceptual decisions? It has been shown that such errors occur in part because the decision process (evidence accumulation) is initiated before selective attention has isolated the relevant sensory information from salient distractors. Nevertheless, it is typically assumed that subjects increase accuracy by prolonging the decision process rather than delaying decision onset. To date it has not been tested whether humans can strategically delay decision onset to increase response accuracy. To address this question we measured the time course of selective attention in a motion interference task using a novel variant of the response signal paradigm. Based on these measurements we estimated time-dependent drift rate and showed that subjects should in principle be able trade speed for accuracy very effectively by delaying decision onset. Using the time-dependent estimate of drift rate we show that subjects indeed delay decision onset in addition to raising response threshold when asked to stress accuracy over speed in a free reaction version of the same motion-interference task. These findings show that decision onset is a critical aspect of the decision process that can be adjusted to effectively improve decision accuracy. PMID:24599295
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What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders
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
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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.
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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.
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The Macro Dynamics of Weapon System Acquisition: Shaping Early Decisions to Get Better Outcomes
2012-05-17
defects and rework •Design tools and processes •Lack of feedback to key design and SE processes •Lack of quantified risk and uncertainty at key... Tools for Rapid Exploration of the Physical Design Space Coupling Operability, Interoperability, and Physical Feasibility Analyses – a Game Changer...Interoperability •Training Quantified Margins and Uncertainties at Each Critical Decision Point M&S RDT&E A Continuum of Tools Underpinned with
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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.
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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
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Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna
2009-01-01
The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.
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ERIC Educational Resources Information Center
Smith, Kathleen N.; Gayles, Joy Gaston
2017-01-01
Using social cognitive career theory and the cognitive information processing model as frameworks, in this constructivist case study we examined the career-related experiences and decisions of 10 women engineering undergraduate seniors who accepted full-time positions. From the data analysis 3 major themes emerged: critical undergraduate…
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Evaluation Utilization by Leaders in Student Affairs Units
ERIC Educational Resources Information Center
Calvert, Jennifer Joy
2011-01-01
While strong evidence exists that the use of data in decision-making is critical for quality improvement and effective student outcomes at the university, institutions of higher education are not using the data from assessments to inform their decision-making processes. The disconnect between what current research describes as the effective use of…
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Factors That Impact Teacher Power in Decision-Making in U.S. Public Schools: A Multilevel Analysis
ERIC Educational Resources Information Center
Wang, Yuling
2015-01-01
The teacher empowerment process emphasizes professional development and participation (i.e., increasing professional status, skills, knowledge and providing the opportunity to participate in decision-making); however, whether these efforts eventually lead to the realization of teacher power remains a critical concern, especially considering that…
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Instructional Design for Advanced Learners: Training Recognition Skills to Hasten Expertise
ERIC Educational Resources Information Center
Fadde, Peter Jae
2009-01-01
Expertise in domains ranging from sports to surgery involves a process of recognition-primed decision-making (RPD) in which experts make rapid, intuitive decisions based on recognizing critical features of dynamic performance situations. While the development of expert RPD is assumed to require years of domain experience, the transition from…
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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…
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Planetary protection, legal ambiguity and the decision making process for Mars sample return
NASA Technical Reports Server (NTRS)
Race, M. S.
1996-01-01
As scientists and mission planners develop planetary protection requirements for future Mars sample return missions, they must recognize the socio-political context in which decisions about the mission will be made and pay careful attention to public concerns about potential back contamination of Earth. To the extent that planetary protection questions are unresolved or unaddressed at the time of an actual mission, they offer convenient footholds for public challenges in both legal and decision making realms, over which NASA will have little direct control. In this paper, two particular non-scientific areas of special concern are discussed in detail: 1) legal issues and 2) the decision making process. Understanding these areas is critical for addressing legitimate public concerns as well as for fulfilling procedural requirements regardless whether sample return evokes public controversy. Legal issues with the potential to complicate future missions include: procedural review under National Environmental Policy Act (NEPA); uncertainty about institutional control and authority; conflicting regulations and overlapping jurisdictions; questions about international treaty obligations and large scale impacts; uncertanities about the nature of the organism; and constitutional and regulatory concerns about quarantine, public health and safety. In light of these important legal issues, it is critical that NASA consider the role and timing of public involvement in the decision making process as a way of anticipating problem areas and preparing for legitimate public questions and challenges to sample return missions.
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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.
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Critical thinking by nurses on ethical issues like the termination of pregnancies.
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.
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NASA Astrophysics Data System (ADS)
Funk, Daniel
2015-04-01
Climate variability poses major challenges for decision-makers in climate-sensitive sectors. Seasonal to decadal (S2D) forecasts provide potential value for management decisions especially in the context of climate change where information from present or past climatology loses significance. However, usable and decision-relevant tailored climate forecasts are still sparse for Europe and successful examples of application require elaborate and individual producer-user interaction. The assessment of sector-specific vulnerabilities to critical climate conditions at specific temporal scale will be a great step forward to increase the usability and efficiency of climate forecasts. A concept for a sector-specific vulnerability assessment (VA) to climate variability is presented. The focus of this VA is on the provision of usable vulnerability information which can be directly incorporated in decision-making processes. This is done by developing sector-specific climate-impact-decision-pathways and the identification of their specific time frames using data from both bottom-up and top-down approaches. The structure of common VA's for climate change related issues is adopted which envisages the determination of exposure, sensitivity and coping capacity. However, the application of the common vulnerability components within the context of climate service application poses some fundamental considerations: Exposure - the effect of climate events on the system of concern may be modified and delayed due to interconnected systems (e.g. catchment). The critical time-frame of a climate event or event sequence is dependent on system-internal thresholds and initial conditions. But also on decision-making processes which require specific lead times of climate information to initiate respective coping measures. Sensitivity - in organizational systems climate may pose only one of many factors relevant for decision making. The scope of "sensitivity" in this concept comprises both the potential physical response of the system of concern as well as the criticality of climate-related decision-making processes. Coping capacity - in an operational context coping capacity can only reduce vulnerability if it can be applied purposeful. With respect to climate vulnerabilities this refers to the availability of suitable, usable and skillful climate information. The focus for this concept is on existing S2D climate service products and their match with user needs. The outputs of the VA are climate-impact-decision-pathways which characterize critical climate conditions, estimate the role of climate in decision-making processes and evaluate the availability and potential usability of S2D climate forecast products. A classification scheme is developed for each component of the impact-pathway to assess its specific significance. The systemic character of these schemes enables a broad application of this VA across sectors where quantitative data is limited. This concept is developed and will be tested within the context of the EU-FP7 project "European Provision Of Regional Impacts Assessments on Seasonal and Decadal Timescales" EUPORIAS.
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Faulkner, Stephen P.
2010-01-01
Landscape patterns and processes reflect both natural ecosystem attributes and the policy and management decisions of individual Federal, State, county, and private organizations. Land-use regulation, water management, and habitat conservation and restoration efforts increasingly rely on landscape-level approaches that incorporate scientific information into the decision-making process. Since management actions are implemented to affect future conditions, decision-support models are necessary to forecast potential future conditions resulting from these decisions. Spatially explicit modeling approaches enable testing of different scenarios and help evaluate potential outcomes of management actions in conjunction with natural processes such as climate change. The ability to forecast the effects of changing land use and climate is critically important to land and resource managers since their work is inherently site specific, yet conservation strategies and practices are expressed at higher spatial and temporal scales that must be considered in the decisionmaking process.
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Predicting species distributions for conservation decisions
Guisan, Antoine; Tingley, Reid; Baumgartner, John B; Naujokaitis-Lewis, Ilona; Sutcliffe, Patricia R; Tulloch, Ayesha I T; Regan, Tracey J; Brotons, Lluis; McDonald-Madden, Eve; Mantyka-Pringle, Chrystal; Martin, Tara G; Rhodes, Jonathan R; Maggini, Ramona; Setterfield, Samantha A; Elith, Jane; Schwartz, Mark W; Wintle, Brendan A; Broennimann, Olivier; Austin, Mike; Ferrier, Simon; Kearney, Michael R; Possingham, Hugh P; Buckley, Yvonne M
2013-01-01
Species distribution models (SDMs) are increasingly proposed to support conservation decision making. However, evidence of SDMs supporting solutions for on-ground conservation problems is still scarce in the scientific literature. Here, we show that successful examples exist but are still largely hidden in the grey literature, and thus less accessible for analysis and learning. Furthermore, the decision framework within which SDMs are used is rarely made explicit. Using case studies from biological invasions, identification of critical habitats, reserve selection and translocation of endangered species, we propose that SDMs may be tailored to suit a range of decision-making contexts when used within a structured and transparent decision-making process. To construct appropriate SDMs to more effectively guide conservation actions, modellers need to better understand the decision process, and decision makers need to provide feedback to modellers regarding the actual use of SDMs to support conservation decisions. This could be facilitated by individuals or institutions playing the role of ‘translators’ between modellers and decision makers. We encourage species distribution modellers to get involved in real decision-making processes that will benefit from their technical input; this strategy has the potential to better bridge theory and practice, and contribute to improve both scientific knowledge and conservation outcomes. PMID:24134332
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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.
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Context is everything or how could I have been that stupid?
Croskerry, Pat
2009-01-01
Dual Process Theory provides a useful working model of decision-making. It broadly divides decision-making into intuitive (System 1) and analytical (System 2) processes. System 1 is especially dependent on contextual cues. There appears to be a universal human tendency to contextualize information, mostly in an effort to imbue meaning but also, perhaps, to conserve cognitive energy. Most decision errors occur in System 1, and this has two major implications. The first is that insufficient account may have been taken out of context when the original decision was made. Secondly, in trying to learn from decision failures, we need the highest fidelity of context reconstruction as possible. It should be appreciated that learning from past events is inevitably an imperfect process. Retrospective investigations, such as root-cause analysis, critical incident review, morbidity and mortality rounds and legal investigations, all suffer the limitation that they cannot faithfully reconstruct the context in which decisions were made and from which actions followed.
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Supporting decision-making processes for evidence-based mental health promotion.
Jané-Llopis, Eva; Katschnig, Heinz; McDaid, David; Wahlbeck, Kristian
2011-12-01
The use of evidence is critical in guiding decision-making, but evidence from effect studies will be only one of a number of factors that will need to be taken into account in the decision-making processes. Equally important for policymakers will be the use of different types of evidence including implementation essentials and other decision-making principles such as social justice, political, ethical, equity issues, reflecting public attitudes and the level of resources available, rather than be based on health outcomes alone. This paper, aimed to support decision-makers, highlights the importance of commissioning high-quality evaluations, the key aspects to assess levels of evidence, the importance of supporting evidence-based implementation and what to look out for before, during and after implementation of mental health promotion and mental disorder prevention programmes.
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Risk-based analysis and decision making in multi-disciplinary environments
NASA Technical Reports Server (NTRS)
Feather, Martin S.; Cornford, Steven L.; Moran, Kelly
2003-01-01
A risk-based decision-making process conceived of and developed at JPL and NASA, has been used to help plan and guide novel technology applications for use on spacecraft. These applications exemplify key challenges inherent in multi-disciplinary design of novel technologies deployed in mission-critical settings. 1) Cross-disciplinary concerns are numerous (e.g., spacecraft involve navigation, propulsion, telecommunications). These concems are cross-coupled and interact in multiple ways (e.g., electromagnetic interference, heat transfer). 2) Time and budget pressures constrain development, operational resources constrain the resulting system (e.g., mass, volume, power). 3) Spacecraft are critical systems that must operate correctly the first time in only partially understood environments, with no chance for repair. 4) Past experience provides only a partial guide: New mission concepts are enhanced and enabled by new technologies, for which past experience is lacking. The decision-making process rests on quantitative assessments of the relationships between three classes of information - objectives (the things the system is to accomplish and constraints on its operation and development), risks (whose occurrence detracts from objectives), and mitigations (options for reducing the likelihood and or severity of risks). The process successfully guides experts to pool their knowledge, using custom-built software to support information gathering and decision-making.
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ERIC Educational Resources Information Center
Frank, Stephen; Trawick-Smith, Joseph
2014-01-01
K-12 education resources are often allocated non-strategically, with schools spending time and money on activities that have little relationship to student outcomes. Most of these decisions take place within districts, rooted in the processes of setting schedules, staffing levels, and assignments, and creating final budgets. Local Education…
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ERIC Educational Resources Information Center
Morris, Adam A.; Miller, Michael T.
2014-01-01
Trustees play an important role in determining the direction, priorities, and future of higher education institutions, and as such, are critical actors in the decision-making and policy formation process. Numerous anecdotal reports have concluded that there are often competing interests in the use and structure of trustees throughout higher…
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Decision Maker Perception of Information Quality: A Case Study of Military Command and Control
ERIC Educational Resources Information Center
Morgan, Grayson B.
2013-01-01
Decision maker perception of information quality cues from an "information system" (IS) and the process which creates such meta cueing, or data about cues, is a critical yet un-modeled component of "situation awareness" (SA). Examples of common information quality meta cueing for quality criteria include custom ring-tones for…
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USDA-ARS?s Scientific Manuscript database
Crop yield estimates have a strong impact on dealing with food shortages and on market demand and supply; these estimates are critical for decision-making processes by the U.S. Government, policy makers, stakeholders, etc. Most of the decision making is based on forecasts provided by the U.S. Depart...
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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…
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An Engineering Educator's Decision Support Tool for Improving Innovation in Student Design Projects
ERIC Educational Resources Information Center
Ozaltin, Nur Ozge; Besterfield-Sacre, Mary; Clark, Renee M.
2015-01-01
Learning how to design innovatively is a critical process skill for undergraduate engineers in the 21st century. To this end, our paper discusses the development and validation of a Bayesian network decision support tool that can be used by engineering educators to make recommendations that positively impact the innovativeness of product designs.…
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Improving serum calcium test ordering according to a decision algorithm.
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.
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Centralized drug review processes: are they fair?
Mitton, Craig R; McMahon, Meghan; Morgan, Steve; Gibson, Jennifer
2006-07-01
Numerous countries have implemented centralized drug review processes to assist in making drug coverage decisions. In addition to examining the final recommendations of these bodies, it is also important to ensure fairness in decision making. Accountability for reasonableness is an ethics-based framework for examining the fairness of priority setting processes. The objective of this study was to assess the fairness of four internationally established centralized drug review processes using accountability for reasonableness. Semi-structured telephone interviews were conducted with stakeholders in Canada, New Zealand, Australia and the UK (n=16). Participants were asked to evaluate their country's centralized drug review process against the four conditions of accountability for reasonableness. Each centralized drug review process satisfied at least one of the four ethical conditions, but none satisfied all four conditions. All participants viewed transparency as critical to both the legitimacy and fairness of centralized drug review processes. Additional strides need to be made in each of the four countries under study to improve the fairness of their centralized drug review processes. Ideally, a fair priority setting process should foster constructive stakeholder engagement and enhance the legitimacy of decisions made in assessing pharmaceutical products for funding. As policy makers are under increasing scrutiny in allocating limited resources, fair process should be seen as a critical component of such activity. This study represents the first attempt to conduct an international comparison of the fairness of centralized drug review agencies in the eyes of participating stakeholders.
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What Critical Ethical Values Guide Strategic Planning Processes in Health Care Organizations?
Kucmanic, Matthew; Sheon, Amy R
2017-11-01
This case explores a fictitious hospital's use of co-creation to make a decision about redesign of inpatient units as a first step in incorporating stakeholder input into creation of governing policies. We apply a "procedural fairness" framework to reveal that conditions required for an ethical decision about space redesign were not met by using clinician and patient focus groups to obtain stakeholder input. In this article, we identify epistemic injustices resulting from this process that could undermine confidence in leadership decisions. Suggestions are offered for incorporating stakeholder input going forward that address prior shortcomings. The result should be conditions that are perceived as procedurally fair and decisions that engender confidence in institutional leadership. © 2017 American Medical Association. All Rights Reserved.
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Cognitive Continuum Theory in nursing decision-making.
Cader, Raffik; Campbell, Steve; Watson, Don
2005-02-01
The purpose of this paper is to analyse and evaluate Cognitive Continuum Theory and to provide evidence for its relevance to nurses' decision-making. It is critical that theories used in nursing are evaluated to provide an understanding of their aims, concepts and usefulness. With the advent of evidence-based care, theories on decision-making have acquired increased significance. The criteria identified by Fawcett's framework has been used to analyse and evaluate Hammond's Cognitive Continuum Theory. Findings. There is empirical evidence to support many of the concepts and propositions of Cognitive Continuum Theory. The theory has been applied to the decision-making process of many professionals, including medical practitioners and nurses. Existing evidence suggests that Cognitive Continuum Theory can provide the framework to explain decision-making in nursing. Cognitive Continuum Theory has the potential to make major contributions towards understanding the decision-making process of nurses in the clinical environment. Knowledge of the theory in nursing practice has become crucial.
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Accrual Budgeting: Experiences of Other Nations and Implications for the United States
2000-02-01
Used as a Tool in Addressing Performance Management Challenges Proponents described accrual budgeting as a useful, if not critical , tool in...accountable in these more decentralized systems. As a result, some proponents view accrual budgeting as critical to establishing more performance-focused...the federal government and thus plays a critical role in the decision-making process. Policymakers, managers, and the American people rely on it to
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Software for rapid prototyping in the pharmaceutical and biotechnology industries.
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.
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Understanding the Role of Numeracy in Health: Proposed Theoretical Framework and Practical Insights
Lipkus, Isaac M.; Peters, Ellen
2009-01-01
Numeracy, that is how facile people are with mathematical concepts and their applications, is gaining importance in medical decision making and risk communication. This paper proposes six critical functions of health numeracy. These functions are integrated into a theoretical framework on health numeracy that has implications for risk-communication and medical-decision-making processes. We examine practical underpinnings for targeted interventions aimed at improving such processes as a function of health numeracy. It is hoped that the proposed functions and theoretical framework will spur more research to determine how an understanding of health numeracy can lead to more effective communication and decision outcomes. PMID:19834054
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Patient's decision making in selecting a hospital for elective orthopaedic surgery.
Moser, Albine; Korstjens, Irene; van der Weijden, Trudy; Tange, Huibert
2010-12-01
The admission to a hospital for elective surgery, like arthroplasty, can be planned ahead. The elective nature of arthroplasty and the increasing stimulus of the public to critically select a hospital raise the issue of how patients actually take such decisions. The aim of this paper is to describe the decision-making process of selecting a hospital as experienced by people who underwent elective joint arthroplasty and to understand what factors influenced the decision-making process. Qualitative descriptive study with 18 participants who had a hip or knee replacement within the last 5 years. Data were gathered from eight individual interviews and four focus group interviews and analysed by content analysis. Three categories that influenced the selection of a hospital were revealed: information sources, criteria in decision making and decision-making styles within the GP- patient relationship. Various contextual aspects influenced the decision-making process. Most participants gave higher priority to the selection of a medical specialist than to the selection of a hospital. Selecting a hospital for arthroplasty is extremely complex. The decision-making process is a highly individualized process because patients have to consider and assimilate a diversity of aspects, which are relevant to their specific situation. Our findings support the model of shared decision making, which indicates that general practitioners should be attuned to the distinct needs of each patient at various moments during the decision making, taking into account personal, medical and contextual factors. © 2010 Blackwell Publishing Ltd.
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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.
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A critical narrative analysis of shared decision-making in acute inpatient mental health care.
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.
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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
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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.
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ERIC Educational Resources Information Center
Amsel, Eric; Klaczynski, Paul A.; Johnston, Adam; Bench, Shane; Close, Jason; Sadler, Eric; Walker, Rick
2008-01-01
Metacognitive knowledge of the dual-processing basis of judgment is critical to resolving conflict between analytic and experiential processing responses [Klaczynski, P. A. (2004). A dual-process model of adolescent development: Implications for decision making, reasoning, and identity. In R. V. Kail (Ed.), "Advances in child development and…
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Engineering the Business of Defense Acquisition: An Analysis of Program Office Processes
2015-04-30
ability to stay focused on the decision outcome rather than procrastinate and wait for a time- dependent resolution. Another critical aspect of...instituted an effective issue resolution process. Conflict, left unmanaged, tended to result in further procrastination and less effective outcomes
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ERIC Educational Resources Information Center
McCready, John W.
2010-01-01
The purpose of this study was to examine use of decision-making tools and feedback in strategic planning in order to develop a rigorous process that would promote the efficiency of strategic planning for acquisitions in the United States Coast Guard (USCG). Strategic planning is critical to agencies such as the USCG in order to be effective…
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ERIC Educational Resources Information Center
Collins, Joshua C.; Rocco, Tonette S.
2015-01-01
Gay men face decisions associated with disclosure, the process of coming out as gay, when and if to disclose, and how much information. These decisions carry more weight in masculinized industries such as law enforcement. The purpose of this phenomenological study was to critically explore gay male law enforcement officers' experiences working in…
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ERIC Educational Resources Information Center
Sambodo, Leonardo A. A. T.; Nuthall, Peter L.
2010-01-01
Purpose: This study traced the origins of subsistence Farmers' technology adoption attitudes and extracted the critical elements in their decision making systems. Design/Methodology/Approach: The analysis was structured using a model based on the Theory of Planned Behaviour (TPB). The role of a "bargaining process" was particularly…
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ERIC Educational Resources Information Center
Coetzer, Alan; Redmond, Janice; Sharafizad, Jalleh
2012-01-01
Purpose: The purpose of this paper is to develop an understanding of factors that impinge on managerial decision-making processes regarding employee access to structured training and development (T&D) opportunities that are at least partially funded by the firm. Design/methodology/approach: Semi-structured interviews incorporating the Critical…
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Scientific literacy for democratic decision-making
NASA Astrophysics Data System (ADS)
Yacoubian, Hagop A.
2018-02-01
Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the ideological underpinnings behind a number of the statements within those documents that have defined the trajectory of scientific literacy and have shaped what ought to be considered as personal and societal benefits. I argue that science curricula and policy documents can truly endorse scientific literacy when they embed principles of democratic education at their core. The latter entails fostering learning experiences where some of the underlying assumptions and political ideologies are brought to the conscious level and future citizens encouraged to reflect upon them critically and explicitly. Such a proposal empowers the future citizens to engage in critical deliberation on science-based social issues without taking the underlying status quo for granted. I end up the paper by situating the preparation of scientifically literate citizens within a framework of democratic education, discuss conditions through which a curriculum for scientific literacy can serve democratic decision-making processes, and provide modest recommendations.
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Performance measurement integrated information framework in e-Manufacturing
NASA Astrophysics Data System (ADS)
Teran, Hilaida; Hernandez, Juan Carlos; Vizán, Antonio; Ríos, José
2014-11-01
The implementation of Internet technologies has led to e-Manufacturing technologies becoming more widely used and to the development of tools for compiling, transforming and synchronising manufacturing data through the Web. In this context, a potential area for development is the extension of virtual manufacturing to performance measurement (PM) processes, a critical area for decision making and implementing improvement actions in manufacturing. This paper proposes a PM information framework to integrate decision support systems in e-Manufacturing. Specifically, the proposed framework offers a homogeneous PM information exchange model that can be applied through decision support in e-Manufacturing environment. Its application improves the necessary interoperability in decision-making data processing tasks. It comprises three sub-systems: a data model, a PM information platform and PM-Web services architecture. A practical example of data exchange for measurement processes in the area of equipment maintenance is shown to demonstrate the utility of the model.
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ERIC Educational Resources Information Center
Kurubacak, Gulsun
2006-01-01
The main purpose of this article is to generate a functional model of evaluation that EMSs can be able to empower online communications characterized by imperative decision making task. The evaluation process of EMSs must merge the multicultural strategies of the theory of Media Richness, and the ethical concerns of the critical approach. Media…
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ERIC Educational Resources Information Center
Kurubacak, Gulsun
2006-01-01
The main purpose of this article is to generate a functional model of evaluation that EMSs can be able to empower online communications characterized by imperative decision making task. The evaluation process of EMSs must merge the multicultural strategies of the theory of "Media Richness," and the ethical concerns of the critical approach. "Media…
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NASA Astrophysics Data System (ADS)
Turalska, M.; West, B. J.
2014-11-01
We consider a dual model of decision making, in which an individual forms its opinion based on contrasting mechanisms of imitation and rational calculation. The decision-making model (DMM) implements imitating behavior by means of a network of coupled two-state master equations that undergoes a phase transition at a critical value of a control parameter. The evolutionary spatial game, being a generalization of the prisoner's dilemma game, is used to determine in objective fashion the cooperative or anticooperative strategy adopted by individuals. Interactions between two sources of dynamics increases the domain of initial states attracted to phase transition dynamics beyond that of the DMM network in isolation. Additionally, on average the influence of the DMM on the game increases the final observed fraction of cooperators in the system.
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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.
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Kim, Ho-Joong; Park, Jae-Young; Kang, Kyoung-Tak; Chang, Bong-Soon; Lee, Choon-Ki; Yeom, Jin S
2015-02-01
In a preference-based shared decision-making system, several subjective and/or objective factors such as pain severity, degree of disability, and the radiological severity of canal stenosis may influence the final surgical decision for the treatment of lumbar spinal stenosis (LSS). However, our understanding of the shared decision-making process and the significance of each factor remain primitive. In the present study, we aimed to investigate which factors influence the surgical decision for the treatment of LSS when using a preference-based, shared decision-making process. We included 555 patients, aged 45-80 years, who used a preference-based shared decision-making process and were treated conservatively or surgically for chronic leg and/or back pain caused by LSS from April 2012 to December 2012. Univariate and multivariable-adjusted logistic regression analyses were used to assess the association of surgical decision making with age, sex, body mass index, symptom duration, radiologic stenotic grade, Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back and leg pain, Short Form-36 (SF-36) subscales, and motor weakness. In univariate analysis, the following variables were associated with a higher odds of a surgical decision for LSS: male sex; the VAS score for leg pain; ODI; morphological stenotic grades B, C, and D; motor weakness; and the physical function, physical role, bodily pain, social function, and emotional role of the SF-36 subscales. Multivariate analysis revealed that male sex, ODI, morphological stenotic grades C and D, and motor weakness were significantly associated with a higher possibility of a surgical decision. Motor weakness, male sex, morphological stenotic grade, and the amount of disability are critical factors leading to a surgical decision for LSS when using a preference-based shared decision-making process.
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Innovation, Technology and Decision Making: A Perspective for Strategic Action in Firms
NASA Technical Reports Server (NTRS)
Mulenburg, Gerald M.
2002-01-01
Innovation, technology, and the making of decisions are tightly intertwined in what can generally be called, strategic decision making. Although true for all firms, it is especially true in innovative, high technology firms that operate in a turbulent, fast moving environment where strategic decisions must be made accurately and quickly to survive. This paper looks at some factors reported in the literature that affect how and why the strategic decision process is so important, especially in companies in fast-moving, competitive environments. The work of several prominent authors who looked critically at past theory and research, and the current state of knowledge and practice, provides a perspective of how firms make strategic decisions.
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The functional neuroanatomy of decision-making.
Rosenbloom, Michael H; Schmahmann, Jeremy D; Price, Bruce H
2012-01-01
Decision-making is a complex executive function that draws on past experience, present goals, and anticipation of outcome, and which is influenced by prevailing and predicted emotional tone and cultural context. Functional imaging investigations and focal lesion studies identify the orbitofrontal, anterior cingulate, and dorsolateral prefrontal cortices as critical to decision-making. The authors review the connections of these prefrontal regions with the neocortex, limbic system, basal ganglia, and cerebellum, highlight current ideas regarding the cognitive processes of decision-making that these networks subserve, and present a novel integrated neuroanatomical model for decision-making. Finally, clinical relevance of this circuitry is illustrated through a discussion of frontotemporal dementia, traumatic brain injury, and sociopathy.
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Marraccini, Marisa E.; Weyandt, Lisa L.; Rossi, Joseph S.; Gudmundsdottir, Bergljot Gyda
2016-01-01
Increasing numbers of adults, particularly college students, are misusing prescription stimulants primarily for cognitive/academic enhancement, so it is critical to explore whether empirical findings support neurocognitive benefits of prescription stimulants. Previous meta-analytic studies have supported small benefits from prescription stimulants for the cognitive domains of inhibitory control and memory; however, no meta-analytic studies have examined the effects on processing speed or the potential impairment on other domains of cognition, including planning, decision-making, and cognitive perseveration. Therefore, the present study conducted a meta-analysis of the available literature examining the effects of prescription stimulants on specific measures of processing speed, planning, decision-making, and cognitive perseveration among healthy adult populations. The meta-analysis results indicated a positive influence of prescription stimulant medication on processing speed accuracy, with an overall mean effect size of g = 0.282 (95% CI 0.077, 0.488; n = 345). Neither improvements nor impairments were revealed for planning time, planning accuracy, advantageous decision-making, or cognitive perseveration; however findings are limited by the small number of studies examining these outcomes. Findings support that prescription stimulant medication may indeed act as a neurocognitive enhancer for accuracy measures of processing speed without impeding other areas of cognition. Considering that adults are already engaging in illegal use of prescription stimulants for academic enhancement, as well as the potential for stimulant misuse to have serious side effects, the establishment of public policies informed by interdisciplinary research surrounding this issue, whether restrictive or liberal, is of critical importance. PMID:27454675
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A gaze through the lens of decision theory toward knowledge translation science.
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.
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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.
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Human Decision Processes: Implications for SSA Support Tools
NASA Astrophysics Data System (ADS)
Picciano, P.
2013-09-01
Despite significant advances in computing power and artificial intelligence (AI), few critical decisions are made without a human decision maker in the loop. Space Situational Awareness (SSA) missions are both critical and complex, typically adhering to the human-in-the-loop (HITL) model. The collection of human operators injects a needed diversity of expert knowledge, experience, and authority required to successfully fulfill SSA tasking. A wealth of literature on human decision making exists citing myriad empirical studies and offering a varied set of prescriptive and descriptive models of judgment and decision making (Hastie & Dawes, 2001; Baron, 2000). Many findings have been proven sufficiently robust to allow information architects or system/interface designers to take action to improve decision processes. For the purpose of discussion, these concepts are bifurcated in two groups: 1) vulnerabilities to mitigate, and 2) capabilities to augment. These vulnerabilities and capabilities refer specifically to the decision process and should not be confused with a shortcoming or skill of a specific human operator. Thus the framing of questions and orders, the automated tools with which to collaborate, priming and contextual data, and the delivery of information all play a critical role in human judgment and choice. Evaluating the merits of any decision can be elusive; in order to constrain this discussion, ‘rational choice' will tend toward the economic model characteristics such as maximizing utility and selection consistency (e.g., if A preferred to B, and B preferred to C, than A should be preferred to C). Simple decision models often encourage one to list the pros and cons of a decision, perhaps use a weighting schema, but one way or another weigh the future benefit (or harm) of making a selection. The result (sought by the rationalist models) should drive toward higher utility. Despite notable differences in researchers' theses (to be discussed in the full paper), one opinion shared is that the rational, economic, deliberate listing/evaluation of all options is NOT representative of how many decision are made. A framework gaining interest lately describes two systems predominantly at work: intuition and reasoning (Kahneman, 2003). Intuition is fast, automatic, and parallel contrasted with the more effortful, deliberative, and sequential reasoning. One of the issues of contention is that considerable research is stacked supporting both sides claiming that intuition is: • A hallmark of expertise responsible for rapid, optimal decisions in the face of adversity • A vulnerability where biases serve as decision traps leading to wrong choices Using seminal studies from a range of domains and tasking, potential solutions for SSA decision support will be offered. Important issues such as managing uncertainty, framing inquiries, and information architecture, and contextual cues will be discussed. The purpose is to provide awareness of the human limitations and capabilities in complex decision making so engineers and designers can consider such factors in their development of SSA tools.
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Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M
2014-06-01
Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.
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Preliminary Evidence for an Automatic Link between Sex and Power among Men Who Molest Children
ERIC Educational Resources Information Center
Kamphuis, Jan H.; De Ruiter, Corine; Janssen, Bas; Spiering, Mark
2005-01-01
Understanding critical motivational processes of sexual offenders may ultimately provide important clues to more effective treatments. Implicit, automatic cognitive processes have received minimal attention; however, a lexical decision experiment revealed automatic links between the concepts of power and sex among participants who self-reported…
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A Systems Dynamics Model of Implementation of an Innovation.
ERIC Educational Resources Information Center
Gaynor, Alan K.; And Others
The research presented in this report investigated the critical factors that affected the decision to abandon or replace a curricular innovation in one elementary school. The specific innovation examined in this research is called developing mathematical processes, which emphasizes process and induction rather than computational skills. Although…
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Teaching Students to Think Critically about Fitness and Wellness Choices
ERIC Educational Resources Information Center
Block, Betty A.; Russell, William
2012-01-01
Students in fitness and wellness classes who understand how to implement intellectual thought processes will be better prepared to make good decisions regarding their own fitness and wellness. Teachers are encouraged to teach students to recognize when they are employing intellectual thought processes or whether they are using psychological…
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Yan, Fang; Liu, Haihong; Liu, Zengrong
2014-01-01
P53 and E2F1 are critical transcription factors involved in the choices between different cell fates including cell differentiation, cell cycle arrest or apoptosis. Recent experiments have shown that two families of microRNAs (miRNAs), p53-responsive miR34 (miRNA-34 a, b and c) and E2F1-inducible miR449 (miRNA-449 a, b and c) are potent inducers of these different fates and might have an important role in sensitizing cancer cells to drug treatment and tumor suppression. Identifying the mechanisms responsible for the combinatorial regulatory roles of these two transcription factors and two miRNAs is an important and challenging problem. Here, based in part on the model proposed in Tongli Zhang et al. (2007), we developed a mathematical model of the decision process and explored the combinatorial regulation between these two transcription factors and two miRNAs in response to DNA damage. By analyzing nonlinear dynamic behaviors of the model, we found that p53 exhibits pulsatile behavior. Moreover, a comparison is given to reveal the subtle differences of the cell fate decision process between regulation and deregulation of miR34 on E2F1. It predicts that miR34 plays a critical role in promoting cell cycle arrest. In addition, a computer simulation result also predicts that the miR449 is necessary for apoptosis in response to sustained DNA damage. In agreement with experimental observations, our model can account for the intricate regulatory relationship between these two transcription factors and two miRNAs in the cell fate decision process after DNA damage. These theoretical results indicate that miR34 and miR449 are effective tumor suppressors and play critical roles in cell fate decisions. The work provides a dynamic mechanism that shows how cell fate decisions are coordinated by two transcription factors and two miRNAs. This article is part of a Special Issue entitled: Computational Proteomics, Systems Biology and Clinical Implications. Guest Editor: Yudong Cai. Crown Copyright © 2013. All rights reserved.
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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
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NASA Astrophysics Data System (ADS)
Gessesse, Berhan; Bewket, Woldeamlak; Bräuning, Achim
2016-04-01
Land degradation due to lack of sustainable land management practices is one of the critical challenges in many developing countries including Ethiopia. This study explored the major determinants of farm-level tree-planting decisions as a land management strategy in a typical farming and degraded landscape of the Modjo watershed, Ethiopia. The main data were generated from household surveys and analysed using descriptive statistics and a binary logistic regression model. The model significantly predicted farmers' tree-planting decisions (χ2 = 37.29, df = 15, P < 0.001). Besides, the computed significant value of the model revealed that all the considered predictor variables jointly influenced the farmers' decisions to plant trees as a land management strategy. The findings of the study demonstrated that the adoption of tree-growing decisions by local land users was a function of a wide range of biophysical, institutional, socioeconomic and household-level factors. In this regard, the likelihood of household size, productive labour force availability, the disparity of schooling age, level of perception of the process of deforestation and the current land tenure system had a critical influence on tree-growing investment decisions in the study watershed. Eventually, the processes of land-use conversion and land degradation were serious, which in turn have had adverse effects on agricultural productivity, local food security and poverty trap nexus. Hence, the study recommended that devising and implementing sustainable land management policy options would enhance ecological restoration and livelihood sustainability in the study watershed.
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Pharmacy student decision making in over-the-counter medicine supply: A critical incident study.
McMillan, Sara S; Thangarajah, Thachaayini; Anderson, Claire; Kelly, Fiona
2017-09-28
Various factors influence decision making in over-the-counter (OTC) medicine consultations, yet limited studies have focused, in-depth, on the thought process of pharmacy staff. This includes pharmacy students as pharmacists-in-training. To explore the factors that influence pharmacy students' decisions in relation to OTC consultations and choice of OTC medicine/s. Semi-structured interviews using the critical incident technique were undertaken with ten pharmacy students in Australia, who also worked as part-time pharmacy staff. Nine key themes were identified to influence pharmacy student decision making in OTC consultations, including customer response, confidence and scope of practice. Product requests were reported as more challenging due to customer expectations and experiences in other pharmacies, states or countries. Although negative customer response influenced some students to supply medicines in contradiction of evidence, an overarching concern for safety meant that a medicine was only supplied if unlikely to cause harm. Students reported developing confidence in OTC decision making more from real-life practice than university training; greater confidence was identified for inquiries more frequently experienced in the pharmacy. Students perceived that customers had assumptions around support staff, and were happier to talk to students than assistants. This study further identified that OTC decision making is a complex process for pharmacy students. Additional opportunities for experiential learning within this area are suggested, such as work-based placements or in-class activities such as role-plays with simulated patients. Copyright © 2017 Elsevier Inc. All rights reserved.
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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
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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.
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Incorporating affective bias in models of human decision making
NASA Technical Reports Server (NTRS)
Nygren, Thomas E.
1991-01-01
Research on human decision making has traditionally focused on how people actually make decisions, how good their decisions are, and how their decisions can be improved. Recent research suggests that this model is inadequate. Affective as well as cognitive components drive the way information about relevant outcomes and events is perceived, integrated, and used in the decision making process. The affective components include how the individual frames outcomes as good or bad, whether the individual anticipates regret in a decision situation, the affective mood state of the individual, and the psychological stress level anticipated or experienced in the decision situation. A focus of the current work has been to propose empirical studies that will attempt to examine in more detail the relationships between the latter two critical affective influences (mood state and stress) on decision making behavior.
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Critical care physician cognitive task analysis: an exploratory study
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
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Critical care physician cognitive task analysis: an exploratory study.
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.
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Goh, Joshua O S; Su, Yu-Shiang; Tang, Yong-Jheng; McCarrey, Anna C; Tereshchenko, Alexander; Elkins, Wendy; Resnick, Susan M
2016-12-07
Aging compromises the frontal, striatal, and medial temporal areas of the reward system, impeding accurate value representation and feedback processing critical for decision making. However, substantial variability characterizes age-related effects on the brain so that some older individuals evince clear neurocognitive declines whereas others are spared. Moreover, the functional correlates of normative individual differences in older-adult value-based decision making remain unclear. We performed a functional magnetic resonance imaging study in 173 human older adults during a lottery choice task in which costly to more desirable stakes were depicted using low to high expected values (EVs) of points. Across trials that varied in EVs, participants decided to accept or decline the offered stakes to maximize total accumulated points. We found that greater age was associated with less optimal decisions, accepting stakes when losses were likely and declining stakes when gains were likely, and was associated with increased frontal activity for costlier stakes. Critically, risk preferences varied substantially across older adults and neural sensitivity to EVs in the frontal, striatal, and medial temporal areas dissociated risk-aversive from risk-taking individuals. Specifically, risk-averters increased neural responses to increasing EVs as stakes became more desirable, whereas risk-takers increased neural responses with decreasing EV as stakes became more costly. Risk preference also modulated striatal responses during feedback with risk-takers showing more positive responses to gains compared with risk-averters. Our findings highlight the frontal, striatal, and medial temporal areas as key neural loci in which individual differences differentially affect value-based decision-making ability in older adults. Frontal, striatal, and medial temporal functions implicated in value-based decision processing of rewards and costs undergo substantial age-related changes. However, age effects on brain function and cognition differ across individuals. How this normative variation relates to older-adult value-based decision making is unclear. We found that although the ability make optimal decisions declines with age, there is still much individual variability in how this deterioration occurs. Critically, whereas risk-averters showed increased neural activity to increasingly valuable stakes in frontal, striatal, and medial temporal areas, risk-takers instead increased activity as stakes became more costly. Such distinct functional decision-making processing in these brain regions across normative older adults may reflect individual differences in susceptibility to age-related brain changes associated with incipient cognitive impairment. Copyright © 2016 the authors 0270-6474/16/3612498-12$15.00/0.
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Risk factors for invasive fungal disease in critically ill adult patients: a systematic review.
Muskett, Hannah; Shahin, Jason; Eyres, Gavin; Harvey, Sheila; Rowan, Kathy; Harrison, David
2011-01-01
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. 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. 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. 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.
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Risk factors for invasive fungal disease in critically ill adult patients: a systematic review
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
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Understanding HIV disclosure: A review and application of the Disclosure Processes Model
Chaudoir, Stephenie R.; Fisher, Jeffrey D.; Simoni, Jane M.
2014-01-01
HIV disclosure is a critical component of HIV/AIDS prevention and treatment efforts, yet the field lacks a comprehensive theoretical framework with which to study how HIV-positive individuals make decisions about disclosing their serostatus and how these decisions affect them. Recent theorizing in the context of the Disclosure Processes Model has suggested that the disclosure process consists of antecedent goals, the disclosure event itself, mediating processes and outcomes, and a feedback loop. In this paper, we apply this new theoretical framework to HIV disclosure in order to review the current state of the literature, identify gaps in existing research, and highlight the implications of the framework for future work in this area. PMID:21514708
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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.
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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.
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How shrinks think: decision making in psychiatry.
Bhugra, Dinesh; Malliaris, Yanni; Gupta, Susham
2010-10-01
Psychiatrists use biopsychosocial models in identifying aetiological factors in assessing their patients and similar approaches in planning management. Models in decision making will be influenced by previous experience, training, age and gender, among other factors. Critical thinking and evidence base are both important components in the process of reaching clinical decisions. Expected outcome of treatment may be another factor. The way we think influences our decision making, clinical or otherwise. With patients expecting and taking larger roles in their own management, there needs to be a shift towards patient-centred care in decision making. Further exploration in how clinical decisions are made by psychiatrists is necessary. An understanding of the manner in which therapeutic alliances are formed between the clinician and the patient is necessary to understand decision making.
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The enactment stage of end-of-life decision-making for children.
Sullivan, Jane Elizabeth; Gillam, Lynn Heather; Monagle, Paul Terence
2018-01-11
Typically pediatric end-of-life decision-making studies have examined the decision-making process, factors, and doctors' and parents' roles. Less attention has focussed on what happens after an end-of-life decision is made; that is, decision enactment and its outcome. This study explored the views and experiences of bereaved parents in end-of-life decision-making for their child. Findings reported relate to parents' experiences of acting on their decision. It is argued that this is one significant stage of the decision-making process. A qualitative methodology was used. Semi-structured interviews were conducted with bereaved parents, who had discussed end-of-life decisions for their child who had a life-limiting condition and who had died. Data were thematically analysed. Twenty-five bereaved parents participated. Findings indicate that, despite differences in context, including the child's condition and age, end-of-life decision-making did not end when an end-of-life decision was made. Enacting the decision was the next stage in a process. Time intervals between stages and enactment pathways varied, but the enactment was always distinguishable as a separate stage. Decision enactment involved making further decisions - parents needed to discern the appropriate time to implement their decision to withdraw or withhold life-sustaining medical treatment. Unexpected events, including other people's actions, impacted on parents enacting their decision in the way they had planned. Several parents had to re-implement decisions when their child recovered from serious health issues without medical intervention. Significance of results A novel, critical finding was that parents experienced end-of-life decision-making as a sequence of interconnected stages, the final stage being enactment. The enactment stage involved further decision-making. End-of-life decision-making is better understood as a process rather than a discrete once-off event. The enactment stage has particular emotional and practical implications for parents. Greater understanding of this stage can improve clinician's support for parents as they care for their child.
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A decision modeling for phasor measurement unit location selection in smart grid systems
NASA Astrophysics Data System (ADS)
Lee, Seung Yup
As a key technology for enhancing the smart grid system, Phasor Measurement Unit (PMU) provides synchronized phasor measurements of voltages and currents of wide-area electric power grid. With various benefits from its application, one of the critical issues in utilizing PMUs is the optimal site selection of units. The main aim of this research is to develop a decision support system, which can be used in resource allocation task for smart grid system analysis. As an effort to suggest a robust decision model and standardize the decision modeling process, a harmonized modeling framework, which considers operational circumstances of component, is proposed in connection with a deterministic approach utilizing integer programming. With the results obtained from the optimal PMU placement problem, the advantages and potential that the harmonized modeling process possesses are assessed and discussed.
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E-DECIDER Disaster Response and Decision Support Cyberinfrastructure: Technology and Challenges
NASA Astrophysics Data System (ADS)
Glasscoe, M. T.; Parker, J. W.; Pierce, M. E.; Wang, J.; Eguchi, R. T.; Huyck, C. K.; Hu, Z.; Chen, Z.; Yoder, M. R.; Rundle, J. B.; Rosinski, A.
2014-12-01
Timely delivery of critical information to decision makers during a disaster is essential to response and damage assessment. Key issues to an efficient emergency response after a natural disaster include rapidly processing and delivering this critical information to emergency responders and reducing human intervention as much as possible. Essential elements of information necessary to achieve situational awareness are often generated by a wide array of organizations and disciplines, using any number of geospatial and non-geospatial technologies. A key challenge is the current state of practice does not easily support information sharing and technology interoperability. NASA E-DECIDER (Emergency Data Enhanced Cyber-Infrastructure for Disaster Evaluation and Response) has worked with the California Earthquake Clearinghouse and its partners to address these issues and challenges by adopting the XChangeCore Web Service Data Orchestration technology and participating in several earthquake response exercises. The E-DECIDER decision support system provides rapid delivery of advanced situational awareness data products to operations centers and emergency responders in the field. Remote sensing and hazard data, model-based map products, information from simulations, damage detection, and crowdsourcing is integrated into a single geospatial view and delivered through a service oriented architecture for improved decision-making and then directly to mobile devices of responders. By adopting a Service Oriented Architecture based on Open Geospatial Consortium standards, the system provides an extensible, comprehensive framework for geospatial data processing and distribution on Cloud platforms and other distributed environments. While the Clearinghouse and its partners are not first responders, they do support the emergency response community by providing information about the damaging effects earthquakes. It is critical for decision makers to maintain a situational awareness that is knowledgeable of potential and current conditions, possible impacts on populations and infrastructure, and other key information. E-DECIDER and the Clearinghouse have worked together to address many of these issues and challenges to deliver interoperable, authoritative decision support products.
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A Common Mechanism Underlying Food Choice and Social Decisions.
Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst
2015-10-01
People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others' benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making.
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A Common Mechanism Underlying Food Choice and Social Decisions
Krajbich, Ian; Hare, Todd; Bartling, Björn; Morishima, Yosuke; Fehr, Ernst
2015-01-01
People make numerous decisions every day including perceptual decisions such as walking through a crowd, decisions over primary rewards such as what to eat, and social decisions that require balancing own and others’ benefits. The unifying principles behind choices in various domains are, however, still not well understood. Mathematical models that describe choice behavior in specific contexts have provided important insights into the computations that may underlie decision making in the brain. However, a critical and largely unanswered question is whether these models generalize from one choice context to another. Here we show that a model adapted from the perceptual decision-making domain and estimated on choices over food rewards accurately predicts choices and reaction times in four independent sets of subjects making social decisions. The robustness of the model across domains provides behavioral evidence for a common decision-making process in perceptual, primary reward, and social decision making. PMID:26460812
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Walton, Mark E; Chau, Bolton K H; Kennerley, Steven W
2015-02-01
Our environment and internal states are frequently complex, ambiguous and dynamic, meaning we need to have selection mechanisms to ensure we are basing our decisions on currently relevant information. Here, we review evidence that orbitofrontal (OFC) and ventromedial prefrontal cortex (VMPFC) play conserved, critical but distinct roles in this process. While OFC may use specific sensory associations to enhance task-relevant information, particularly in the context of learning, VMPFC plays a role in ensuring irrelevant information does not impinge on the decision in hand.
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Sànchez-Marrè, Miquel; Gilbert, Karina; Sojda, Rick S.; Steyer, Jean Philippe; Struss, Peter; Rodríguez-Roda, Ignasi; Voinov, A.A.; Jakeman, A.J.; Rizzoli, A.E.
2006-01-01
There are inherent open problems arising when developing and running Intelligent Environmental Decision Support Systems (IEDSS). During daily operation of IEDSS several open challenge problems appear. The uncertainty of data being processed is intrinsic to the environmental system, which is being monitored by several on-line sensors and off-line data. Thus, anomalous data values at data gathering level or even uncertain reasoning process at later levels such as in diagnosis or decision support or planning can lead the environmental process to unsafe critical operation states. At diagnosis level or even at decision support level or planning level, spatial reasoning or temporal reasoning or both aspects can influence the reasoning processes undertaken by the IEDSS. Most of Environmental systems must take into account the spatial relationships between the environmental goal area and the nearby environmental areas and the temporal relationships between the current state and the past states of the environmental system to state accurate and reliable assertions to be used within the diagnosis process or decision support process or planning process. Finally, a related issue is a crucial point: are really reliable and safe the decisions proposed by the IEDSS? Are we sure about the goodness and performance of proposed solutions? How can we ensure a correct evaluation of the IEDSS? Main goal of this paper is to analyse these four issues, review some possible approaches and techniques to cope with them, and study new trends for future research within the IEDSS field.
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A Framework to Determine New System Requirements Under Design Parameter and Demand Uncertainties
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
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Gagnon, C.; Hirsch, P.; Howitt, R.
1993-07-01
Public participation in social impact assessment (SIA) has been identified as a source of improved decision-making about resource development in several countries, with an implicit assumption that this sort of participation provides an avenue for empowerment of affected communities in these decision-making processes. This paper provides a critical discussion of the effectiveness of SIA as a means of local empowerment through case studies of resource projects in Australia, Canada, and Southeast Asia.
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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.
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Assessment Methodology for Process Validation Lifecycle Stage 3A.
Sayeed-Desta, Naheed; Pazhayattil, Ajay Babu; Collins, Jordan; Chen, Shu; Ingram, Marzena; Spes, Jana
2017-07-01
The paper introduces evaluation methodologies and associated statistical approaches for process validation lifecycle Stage 3A. The assessment tools proposed can be applied to newly developed and launched small molecule as well as bio-pharma products, where substantial process and product knowledge has been gathered. The following elements may be included in Stage 3A: number of 3A batch determination; evaluation of critical material attributes, critical process parameters, critical quality attributes; in vivo in vitro correlation; estimation of inherent process variability (IPV) and PaCS index; process capability and quality dashboard (PCQd); and enhanced control strategy. US FDA guidance on Process Validation: General Principles and Practices, January 2011 encourages applying previous credible experience with suitably similar products and processes. A complete Stage 3A evaluation is a valuable resource for product development and future risk mitigation of similar products and processes. Elements of 3A assessment were developed to address industry and regulatory guidance requirements. The conclusions made provide sufficient information to make a scientific and risk-based decision on product robustness.
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Marraccini, Marisa E; Weyandt, Lisa L; Rossi, Joseph S; Gudmundsdottir, Bergljot Gyda
2016-08-01
Increasing numbers of adults, particularly college students, are misusing prescription stimulants primarily for cognitive/academic enhancement, so it is critical to explore whether empirical findings support neurocognitive benefits of prescription stimulants. Previous meta-analytic studies have supported small benefits from prescription stimulants for the cognitive domains of inhibitory control and memory; however, no meta-analytic studies have examined the effects on processing speed or the potential impairment on other domains of cognition, including planning, decision-making, and cognitive perseveration. Therefore, the present study conducted a meta-analysis of the available literature examining the effects of prescription stimulants on specific measures of processing speed, planning, decision-making, and cognitive perseveration among healthy adult populations. The meta-analysis results indicated a positive influence of prescription stimulant medication on processing speed accuracy, with an overall mean effect size of g = 0.282 (95% CI [0.077, 0.488]; n = 345). Neither improvements nor impairments were revealed for planning time, planning accuracy, advantageous decision-making, or cognitive perseveration; however, findings are limited by the small number of studies examining these outcomes. Findings support that prescription stimulant medication may indeed act as a neurocognitive enhancer for accuracy measures of processing speed without impeding other areas of cognition. Considering that adults are already engaging in illegal use of prescription stimulants for academic enhancement, as well as the potential for stimulant misuse to have serious side effects, the establishment of public policies informed by interdisciplinary research surrounding this issue, whether restrictive or liberal, is of critical importance. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
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Human Dignity Through the American Experience. (Government). Grade 12.
ERIC Educational Resources Information Center
Vallejo Unified School District, CA.
The curriculum guide for twelfth grade pupils aims at helping students to understand and accept people who are different, develop a satisfactory self image, learn to think critically in the decision making process, and become familiar with the valuing process. Information on foundations in American government serves as a base for human rights and…
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Using Triage Figuratively to Describe Effective Teaching in Physical Education
ERIC Educational Resources Information Center
Henkel, Steven A.
2016-01-01
This article presents critical outcomes for physical education in a "triage" framework by comparing the process of determining the severity of injuries at the scene of an accident to the process of prioritizing decisions in the classroom. The intent is to reduce all possible outcomes of effective teaching to six nonnegotiable outcomes…
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Socratic Problem-Solving in the Business World
ERIC Educational Resources Information Center
Peterson, Evan
2009-01-01
Accurate and effective decision-making is one of the most essential skills necessary for organizational success. The problem-solving process provides a systematic means of effectively recognizing, analyzing, and solving a dilemma. The key element in this process is critical analysis of the situation, which can be executed by a taking a Socratic…
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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.
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NASA Astrophysics Data System (ADS)
Holmes, Philip; Eckhoff, Philip; Wong-Lin, K. F.; Bogacz, Rafal; Zacksenhouse, Miriam; Cohen, Jonathan D.
2010-03-01
We describe how drift-diffusion (DD) processes - systems familiar in physics - can be used to model evidence accumulation and decision-making in two-alternative, forced choice tasks. We sketch the derivation of these stochastic differential equations from biophysically-detailed models of spiking neurons. DD processes are also continuum limits of the sequential probability ratio test and are therefore optimal in the sense that they deliver decisions of specified accuracy in the shortest possible time. This leaves open the critical balance of accuracy and speed. Using the DD model, we derive a speed-accuracy tradeoff that optimizes reward rate for a simple perceptual decision task, compare human performance with this benchmark, and discuss possible reasons for prevalent sub-optimality, focussing on the question of uncertain estimates of key parameters. We present an alternative theory of robust decisions that allows for uncertainty, and show that its predictions provide better fits to experimental data than a more prevalent account that emphasises a commitment to accuracy. The article illustrates how mathematical models can illuminate the neural basis of cognitive processes.
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Marshall, Teresa A; Marchini, Leonardo; Cowen, Howard; Hartshorn, Jennifer E; Holloway, Julie A; Straub-Morarend, Cheryl L; Gratton, David; Solow, Catherine M; Colangelo, Nicholas; Johnsen, David C
2017-08-01
Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.
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Coalbed-methane pilots - timing, design, and analysis
DOE Office of Scientific and Technical Information (OSTI.GOV)
Roadifer, R.D.; Moore, T.R.
2009-10-15
Four distinct sequential phases form a recommended process for coalbed-methane (CBM)-prospect assessment: initial screening reconnaissance, pilot testing, and final appraisal. Stepping through these four phases provides a program of progressively ramping work and cost, while creating a series of discrete decision points at which analysis of results and risks can be assessed. While discussing each of these phases in some degree, this paper focuses on the third, the critically important pilot-testing phase. This paper contains roughly 30 specific recommendations and the fundamental rationale behind each recommendation to help ensure that a CBM pilot will fulfill its primary objectives of (1)more » demonstrating whether the subject coal reservoir will desorb and produce consequential gas and (2) gathering the data critical to evaluate and risk the prospect at the next-often most critical-decision point.« less
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Yohn, Samantha E.; López-Cruz, Laura; San Miguel, Noemí; Correa, Mercè
2016-01-01
Abstract Motivation has been defined as the process that allows organisms to regulate their internal and external environment, and control the probability, proximity and availability of stimuli. As such, motivation is a complex process that is critical for survival, which involves multiple behavioural functions mediated by a number of interacting neural circuits. Classical theories of motivation suggest that there are both directional and activational aspects of motivation, and activational aspects (i.e. speed and vigour of both the instigation and persistence of behaviour) are critical for enabling organisms to overcome work-related obstacles or constraints that separate them from significant stimuli. The present review discusses the role of brain dopamine and related circuits in behavioural activation, exertion of effort in instrumental behaviour, and effort-related decision-making, based upon both animal and human studies. Impairments in behavioural activation and effort-related aspects of motivation are associated with psychiatric symptoms such as anergia, fatigue, lassitude and psychomotor retardation, which cross multiple pathologies, including depression, schizophrenia, and Parkinson’s disease. Therefore, this review also attempts to provide an interdisciplinary approach that integrates findings from basic behavioural neuroscience, behavioural economics, clinical neuropsychology, psychiatry, and neurology, to provide a coherent framework for future research and theory in this critical field. Although dopamine systems are a critical part of the brain circuitry regulating behavioural activation, exertion of effort, and effort-related decision-making, mesolimbic dopamine is only one part of a distributed circuitry that includes multiple neurotransmitters and brain areas. Overall, there is a striking similarity between the brain areas involved in behavioural activation and effort-related processes in rodents and in humans. Animal models of effort-related decision-making are highly translatable to humans, and an emerging body of evidence indicates that alterations in effort-based decision-making are evident in several psychiatric and neurological disorders. People with major depression, schizophrenia, and Parkinson’s disease show evidence of decision-making biases towards a lower exertion of effort. Translational studies linking research with animal models, human volunteers, and clinical populations are greatly expanding our knowledge about the neural basis of effort-related motivational dysfunction, and it is hoped that this research will ultimately lead to improved treatment for motivational and psychomotor symptoms in psychiatry and neurology. PMID:27189581
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Improving Leadership Through Better Decision Making: Fostering Critical Thinking
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
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Marine Air Ground Task Force Distribution In The Battlespace
2016-09-01
benefit of this research is a proposed systemic structure with an associated web application that provides the MAGTF commander with critical...associated web application that provides the MAGTF commander with critical information for supporting operations. vi THIS PAGE INTENTIONALLY LEFT BLANK... web analytics in order to support the decision making process. The potential benefit of this research is a methodology with associated application
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Hall, William
2017-01-14
As healthcare resources become increasingly scarce due to growing demand and stagnating budgets, the need for effective priority setting and resource allocation will become ever more critical to providing sustainable care to patients. While societal values should certainly play a part in guiding these processes, the methodology used to capture these values need not necessarily be limited to multi-criterion decision analysis (MCDA)-based processes including 'evidence-informed deliberative processes.' However, if decision-makers intend to not only incorporates the values of the public they serve into decisions but have the decisions enacted as well, consideration should be given to more direct involvement of stakeholders. Based on the examples provided by Baltussen et al, MCDA-based processes like 'evidence-informed deliberative processes' could be one way of achieving this laudable goal. © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Banks, Victoria A; Stanton, Neville A
2015-01-01
Automated assistance in driving emergencies aims to improve the safety of our roads by avoiding or mitigating the effects of accidents. However, the behavioural implications of such systems remain unknown. This paper introduces the driver decision-making in emergencies (DDMiEs) framework to investigate how the level and type of automation may affect driver decision-making and subsequent responses to critical braking events using network analysis to interrogate retrospective verbalisations. Four DDMiE models were constructed to represent different levels of automation within the driving task and its effects on driver decision-making. Findings suggest that whilst automation does not alter the decision-making pathway (e.g. the processes between hazard detection and response remain similar), it does appear to significantly weaken the links between information-processing nodes. This reflects an unintended yet emergent property within the task network that could mean that we may not be improving safety in the way we expect. This paper contrasts models of driver decision-making in emergencies at varying levels of automation using the Southampton University Driving Simulator. Network analysis of retrospective verbalisations indicates that increasing the level of automation in driving emergencies weakens the link between information-processing nodes essential for effective decision-making.
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Evidence development and publication planning: strategic process.
Wittek, Michael R; Jo Williams, Mary; Carlson, Angeline M
2009-11-01
A number of decisions in the health care field rely heavily on published clinical evidence. A systematic approach to evidence development and publication planning is required to develop a portfolio of evidence that includes at minimum information on efficacy, safety, durability of effect, quality of life, and economic outcomes. The approach requires a critical assessment of available literature, identification of gaps in the literature, and a strategic plan to fill the gaps to ensure the availability of evidence demanded for clinical decisions, coverage/payment decisions and health technology assessments. The purpose of this manuscript is to offer a six-step strategic process leading to a portfolio of evidence that meets the informational needs of providers, payers, and governmental agencies concerning patient access to a therapy.
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Integrating Climate and Risk-Informed Science to Support Critical Decisions
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.
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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.
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Emotion, Decision-Making and Substance Dependence: A Somatic-Marker Model of Addiction
Verdejo-García, A; Pérez-García, M; Bechara, A
2006-01-01
Similar to patients with orbitofrontal cortex lesions, substance dependent individuals (SDI) show signs of impairments in decision-making, characterised by a tendency to choose the immediate reward at the expense of severe negative future consequences. The somatic-marker hypothesis proposes that decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion and feeling. According to this model, there should be a link between abnormalities in experiencing emotions in SDI, and their severe impairments in decision-making in real-life. Growing evidence from neuroscientific studies suggests that core aspects of substance addiction may be explained in terms of abnormal emotional guidance of decision-making. Behavioural studies have revealed emotional processing and decision-making deficits in SDI. Combined neuropsychological and physiological assessment has demonstrated that the poorer decision-making of SDI is associated with altered reactions to reward and punishing events. Imaging studies have shown that impaired decision-making in addiction is associated with abnormal functioning of a distributed neural network critical for the processing of emotional information, including the ventromedial cortex, the amygdala, the striatum, the anterior cingulate cortex, and the insular/somato-sensory cortices, as well as non-specific neurotransmitter systems that modulate activities of neural processes involved in decision-making. The aim of this paper is to review this growing evidence, and to examine the extent of which these studies support a somatic-marker model of addiction. PMID:18615136
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A Decision Process for Determining Whether to Conduct Responder Health Research Following Disasters
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
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Training conservation practitioners to be better decision makers
Johnson, Fred A.; Eaton, Mitchell J.; Williams, James H.; Jensen, Gitte H.; Madsen, Jesper
2015-01-01
Traditional conservation curricula and training typically emphasizes only one part of systematic decision making (i.e., the science), at the expense of preparing conservation practitioners with critical skills in values-setting, working with decision makers and stakeholders, and effective problem framing. In this article we describe how the application of decision science is relevant to conservation problems and suggest how current and future conservation practitioners can be trained to be better decision makers. Though decision-analytic approaches vary considerably, they all involve: (1) properly formulating the decision problem; (2) specifying feasible alternative actions; and (3) selecting criteria for evaluating potential outcomes. Two approaches are available for providing training in decision science, with each serving different needs. Formal education is useful for providing simple, well-defined problems that allow demonstrations of the structure, axioms and general characteristics of a decision-analytic approach. In contrast, practical training can offer complex, realistic decision problems requiring more careful structuring and analysis than those used for formal training purposes. Ultimately, the kinds and degree of training necessary depend on the role conservation practitioners play in a decision-making process. Those attempting to facilitate decision-making processes will need advanced training in both technical aspects of decision science and in facilitation techniques, as well as opportunities to apprentice under decision analysts/consultants. Our primary goal should be an attempt to ingrain a discipline for applying clarity of thought to all decisions.
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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.
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Clinical decision making: how surgeons do it.
Crebbin, Wendy; Beasley, Spencer W; Watters, David A K
2013-06-01
Clinical decision making is a core competency of surgical practice. It involves two distinct types of mental process best considered as the ends of a continuum, ranging from intuitive and subconscious to analytical and conscious. In practice, individual decisions are usually reached by a combination of each, according to the complexity of the situation and the experience/expertise of the surgeon. An expert moves effortlessly along this continuum, according to need, able to apply learned rules or algorithms to specific presentations, choosing these as a result of either pattern recognition or analytical thinking. The expert recognizes and responds quickly to any mismatch between what is observed and what was expected, coping with gaps in information and making decisions even where critical data may be uncertain or unknown. Even for experts, the cognitive processes involved are difficult to articulate as they tend to be very complex. However, if surgeons are to assist trainees in developing their decision-making skills, the processes need to be identified and defined, and the competency needs to be measurable. This paper examines the processes of clinical decision making in three contexts: making a decision about how to manage a patient; preparing for an operative procedure; and reviewing progress during an operative procedure. The models represented here are an exploration of the complexity of the processes, designed to assist surgeons understand how expert clinical decision making occurs and to highlight the challenge of teaching these skills to surgical trainees. © 2013 The Authors. ANZ Journal of Surgery © 2013 Royal Australasian College of Surgeons.
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PRO-Elicere: A Study for Create a New Process of Dependability Analysis of Space Computer Systems
NASA Astrophysics Data System (ADS)
da Silva, Glauco; Netto Lahoz, Carlos Henrique
2013-09-01
This paper presents the new approach to the computer system dependability analysis, called PRO-ELICERE, which introduces data mining concepts and intelligent mechanisms to decision support to analyze the potential hazards and failures of a critical computer system. Also, are presented some techniques and tools that support the traditional dependability analysis and briefly discusses the concept of knowledge discovery and intelligent databases for critical computer systems. After that, introduces the PRO-ELICERE process, an intelligent approach to automate the ELICERE, a process created to extract non-functional requirements for critical computer systems. The PRO-ELICERE can be used in the V&V activities in the projects of Institute of Aeronautics and Space, such as the Brazilian Satellite Launcher (VLS-1).
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Cognitive influences on self-care decision making in persons with heart failure.
Dickson, Victoria V; Tkacs, Nancy; Riegel, Barbara
2007-09-01
Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation. There is compelling evidence that the neural processes critical to decision making are located in the same structures that are affected by heart failure. Because self-care requires the cognitive ability to learn, perceive, interpret, and respond, research is needed to discern how neural deficits affects these abilities, decision-making, and self-care behaviors.
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Normalization is a general neural mechanism for context-dependent decision making
Louie, Kenway; Khaw, Mel W.; Glimcher, Paul W.
2013-01-01
Understanding the neural code is critical to linking brain and behavior. In sensory systems, divisive normalization seems to be a canonical neural computation, observed in areas ranging from retina to cortex and mediating processes including contrast adaptation, surround suppression, visual attention, and multisensory integration. Recent electrophysiological studies have extended these insights beyond the sensory domain, demonstrating an analogous algorithm for the value signals that guide decision making, but the effects of normalization on choice behavior are unknown. Here, we show that choice models using normalization generate significant (and classically irrational) choice phenomena driven by either the value or number of alternative options. In value-guided choice experiments, both monkey and human choosers show novel context-dependent behavior consistent with normalization. These findings suggest that the neural mechanism of value coding critically influences stochastic choice behavior and provide a generalizable quantitative framework for examining context effects in decision making. PMID:23530203
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User-Centered Design (UCD) Process Description
2014-12-01
where critical tasks and decision points are identified. From here, paper wireframe storyboards are sketched and then validated with cognitive...paper wireframe storyboards are sketched and then validated with cognitive walk-throughs. Low-fidelity prototypes are then created and checked
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What you don't know about making decisions.
Garvin, D A; Roberto, M A
2001-09-01
Most executives think of decision making as a singular event that occurs at a particular point in time. In reality, though, decision making is a process fraught with power plays, politics, personal nuances, and institutional history. Leaders who recognize this make far better decisions than those who persevere in the fantasy that decisions are events they alone control. That said, some decision-making processes are far more effective than others. Most often, participants use an advocacy process, possibly the least productive way to get things done. They view decision making as a contest, arguing passionately for their preferred solutions, presenting information selectively, withholding relevant conflicting data so they can make a convincing case, and standing firm against opposition. Much more powerful is an inquiry process, in which people consider a variety of options and work together to discover the best solution. Moving from advocacy to inquiry requires careful attention to three critical factors: fostering constructive, rather than personal, conflict; making sure everyone knows that their viewpoints are given serious consideration even if they are not ultimately accepted; and knowing when to bring deliberations to a close. The authors discuss in detail strategies for moving from an advocacy to an inquiry process, as well as for fostering productive conflict, true consideration, and timely closure. And they offer a framework for assessing the effectiveness of your process while you're still in the middle of it. Decision making is a job that lies at the very heart of leadership and one that requires a genius for balance: the ability to embrace the divergence that may characterize early discussions and to forge the unity needed for effective implementation.
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The Application of V&V within Reuse-Based Software Engineering
NASA Technical Reports Server (NTRS)
Addy, Edward
1996-01-01
Verification and Validation (V&V) is performed during application development for many systems, especially safety-critical and mission-critical systems. The V&V process is intended to discover errors as early as possible during the development process. Early discovery is important in order to minimize the cost and other impacts of correcting these errors. In reuse-based software engineering, decisions on the requirements, design and even implementation of domain assets can can be made prior to beginning development of a specific system. in order to bring the effectiveness of V&V to bear within reuse-based software engineering. V&V must be incorporated within the domain engineering process.
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Towards evidence-based critical thinking medicine? Uses of best evidence in flawless argumentations.
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.
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NASA Technical Reports Server (NTRS)
2002-01-01
Under a Phase II SBIR contract, Kennedy and Lumina Decision Systems, Inc., jointly developed the Schedule and Cost Risk Analysis Modeling (SCRAM) system, based on a version of Lumina's flagship software product, Analytica(R). Acclaimed as "the best single decision-analysis program yet produced" by MacWorld magazine, Analytica is a "visual" tool used in decision-making environments worldwide to build, revise, and present business models, minus the time-consuming difficulty commonly associated with spreadsheets. With Analytica as their platform, Kennedy and Lumina created the SCRAM system in response to NASA's need to identify the importance of major delays in Shuttle ground processing, a critical function in project management and process improvement. As part of the SCRAM development project, Lumina designed a version of Analytica called the Analytica Design Engine (ADE) that can be easily incorporated into larger software systems. ADE was commercialized and utilized in many other developments, including web-based decision support.
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Lean Keng, Soon; AlQudah, Hani Nawaf Ibrahim
2017-02-01
To raise awareness of critical care nurses' cognitive bias in decision-making, its relationship with leadership styles and its impact on care delivery. The relationship between critical care nurses' decision-making and leadership styles in hospitals has been widely studied, but the influence of cognitive bias on decision-making and leadership styles in critical care environments remains poorly understood, particularly in Jordan. Two-phase mixed methods sequential explanatory design and grounded theory. critical care unit, Prince Hamza Hospital, Jordan. Participant sampling: convenience sampling Phase 1 (quantitative, n = 96), purposive sampling Phase 2 (qualitative, n = 20). Pilot tested quantitative survey of 96 critical care nurses in 2012. Qualitative in-depth interviews, informed by quantitative results, with 20 critical care nurses in 2013. Descriptive and simple linear regression quantitative data analyses. Thematic (constant comparative) qualitative data analysis. Quantitative - correlations found between rationality and cognitive bias, rationality and task-oriented leadership styles, cognitive bias and democratic communication styles and cognitive bias and task-oriented leadership styles. Qualitative - 'being competent', 'organizational structures', 'feeling self-confident' and 'being supported' in the work environment identified as key factors influencing critical care nurses' cognitive bias in decision-making and leadership styles. Two-way impact (strengthening and weakening) of cognitive bias in decision-making and leadership styles on critical care nurses' practice performance. There is a need to heighten critical care nurses' consciousness of cognitive bias in decision-making and leadership styles and its impact and to develop organization-level strategies to increase non-biased decision-making. © 2016 John Wiley & Sons Ltd.
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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.
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The attentional drift-diffusion model extends to simple purchasing decisions.
Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio
2012-01-01
How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions.
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The Attentional Drift-Diffusion Model Extends to Simple Purchasing Decisions
Krajbich, Ian; Lu, Dingchao; Camerer, Colin; Rangel, Antonio
2012-01-01
How do we make simple purchasing decisions (e.g., whether or not to buy a product at a given price)? Previous work has shown that the attentional drift-diffusion model (aDDM) can provide accurate quantitative descriptions of the psychometric data for binary and trinary value-based choices, and of how the choice process is guided by visual attention. Here we extend the aDDM to the case of purchasing decisions, and test it using an eye-tracking experiment. We find that the model also provides a reasonably accurate quantitative description of the relationship between choice, reaction time, and visual fixations using parameters that are very similar to those that best fit the previous data. The only critical difference is that the choice biases induced by the fixations are about half as big in purchasing decisions as in binary choices. This suggests that a similar computational process is used to make binary choices, trinary choices, and simple purchasing decisions. PMID:22707945
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An Overview of NASA's Program of Future M&S VV&A Outreach and Training Activities
NASA Technical Reports Server (NTRS)
Caine, Lisa; Hale, Joseph P.
2006-01-01
NASA's Exploration Systems Mission Directorate (ESMD) is implementing a management approach for modeling and simulation (M&S) that will provide decision-makers information on the model s fidelity, credibility, and quality. The Integrated Modeling & Simulation Verification, Validation and Accreditation (IM&S W&A) process will allow the decision-maker to understand the risks involved in using a model s results for mission-critical decisions. The W&A Technical Working Group (W&A TWG) has been identified to communicate this process throughout the agency. As the W&A experts, the W&A NVG will be the central resource for support of W&A policy, procedures, training and templates for documentation. This presentation will discuss the W&A Technical Working Group s outreach approach aimed at educating M&S program managers, developers, users and proponents on the W&A process, beginning at MSFC with the CLV program.
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Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S
2012-05-01
The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.
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Comparison as a Universal Learning Action
ERIC Educational Resources Information Center
Merkulova, T. V.
2016-01-01
This article explores "comparison" as a universal metasubject learning action, a key curricular element envisaged by the Russian Federal State Educational Standards. Representing the modern learner's fundamental pragmatic skill embedding such core capacities as information processing, critical thinking, robust decision-making, and…
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NASA Astrophysics Data System (ADS)
Funk, Daniel
2016-04-01
The successful provision of from seasonal to decadal (S2D) climate service products to sector-specific users is dependent on specific problem characteristics and individual user needs and decision-making processes. Climate information requires an impact on decision making to have any value (Rodwell and Doblas-Reyes, 2006). For that reason the knowledge of sector-specific vulnerabilities to S2D climate variability is very valuable information for both, climate service producers and users. In this context a concept for a vulnerability assessment framework was developed to (i) identify climate events (and especially their temporal scales) critical for sector-specific problems to assess the basic requirements for an appropriate climate-service product development; and to (ii) assess the potential impact or value of related climate information for decision-makers. The concept was developed within the EUPORIAS project (European Provision of Regional Impacts Assessments on Seasonal and Decadal Timescales) based on ten project-related case-studies from different sectors all over Europe. In the prevalent stage the framework may be useful as preliminary assessment or 'quick-scan' of the vulnerability of specific systems to climate variability in the context of S2D climate service provision. The assessment strategy of the framework is user-focused, using predominantly a bottom-up approach (vulnerability as state) but also a top-down approach (vulnerability as outcome) generally based on qualitative data (surveys, interviews, etc.) and literature research for system understanding. The starting point of analysis is a climate-sensitive 'critical situation' of the considered system which requires a decision and is defined by the user. From this basis the related 'critical climate conditions' are assessed and 'climate information needs' are derived. This mainly refers to the critical period of time of the climate event or sequence of events. The relevant period of time of problem-specific critical climate conditions may be assessed by the resilience of the system of concern, the response time of an interconnected system (i.e. top-down approach using a bottom-up methodology) or alternatively, by the critical time-frame of decision-making processes (bottom-up approach). This approach counters the challenges for a vulnerability assessment of economic sectors to S2D climate events which originate from the inherent role of climate for economic sectors: climate may affect economic sectors as hazard, resource, production- or regulation factor. This implies, that climate dependencies are often indirect and nonlinear. Consequently, climate events which are critical for affected systems do not necessarily correlate with common climatological extremes. One important output of the framework is a classification system of 'climate-impact types' which classifies sector-specific problems in a systemic way. This system proves to be promising because (i) it reflects and thus differentiates the cause for the climate relevance of a specific problem (compositions of buffer factors); (ii) it integrates decision-making processes which proved to be a significant factor; (iii) it indicates a potential usability of S2D climate service products and thus integrates coping options, and (vi) it is a systemic approach which goes beyond the established 'snap-shot' of vulnerability assessments.
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Decision sidestepping: How the motivation for closure prompts individuals to bypass decision making.
Otto, Ashley S; Clarkson, Joshua J; Kardes, Frank R
2016-07-01
We all too often have to make decisions-from the mundane (e.g., what to eat for breakfast) to the complex (e.g., what to buy a loved one)-and yet there exists a multitude of strategies that allows us to make a decision. This work focuses on a subset of decision strategies that allows individuals to make decisions by bypassing the decision-making process-a phenomenon we term decision sidestepping. Critical to the present manuscript, however, we contend that decision sidestepping stems from the motivation to achieve closure. We link this proposition back to the fundamental nature of closure and how those seeking closure are highly bothered by decision making. As such, we argue that the motivation to achieve closure prompts a reliance on sidestepping strategies (e.g., default bias, choice delegation, status quo bias, inaction inertia, option fixation) to reduce the bothersome nature of decision making. In support of this framework, five experiments demonstrate that (a) those seeking closure are more likely to engage in decision sidestepping, (b) the effect of closure on sidestepping stems from the bothersome nature of decision making, and (c) the reliance on sidestepping results in downstream consequences for subsequent choice. Taken together, these findings offer unique insight into the cognitive motivations stimulating a reliance on decision sidestepping and thus a novel framework by which to understand how individuals make decisions while bypassing the decision-making process. (PsycINFO Database Record (c) 2016 APA, all rights reserved).
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Delayed clarification: information, clarification and ethical decisions in critical care in Norway.
Bunch, E H
2000-12-01
Following the analysis of about 150 hours of field observation on a critical care unit in Norway a theory was generated to explain the actual ethical decision-making process. This was grounded in the empirical reality of physicians, nurses and family. The core theme in this study was a delayed clarification in assessing the prognosis of accident victims with neurosurgical traumas. The physicians, nurses and family had to wait for the clinical picture to clarify, during which time there was an exchange and emergence of information. Exchanging information, a subprocess to delayed clarification, involved a continuous flow of collecting and dispersing information about the clinical status of the patient. The nurses engaged in two useful strategies: grading information to family when the patient prognosis was poor, and providing grieving strategies for themselves, colleagues and family members. The core variable, delayed clarification has three dimensions: clinical, psychological and ethical. The nurses participated in the decision-making process to discontinue treatment as passive participants, they did not engage in collegial deliberations with the physicians. Ethical dilemmas were end of life questions, resource allocations, and questions of justice and organ transplants.
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Breaking down hierarchies of decision-making in primates
Hyafil, Alexandre; Moreno-Bote, Rubén
2017-01-01
Possible options in a decision often organize as a hierarchy of subdecisions. A recent study concluded that perceptual processes in primates mimic this hierarchical structure and perform subdecisions in parallel. We argue that a flat model that directly selects between final choices accounts more parsimoniously for the reported behavioral and neural data. Critically, a flat model is characterized by decision signals integrating evidence at different hierarchical levels, in agreement with neural recordings showing this integration in localized neural populations. Our results point to the role of experience for building integrated perceptual categories where sensory evidence is merged prior to decision. DOI: http://dx.doi.org/10.7554/eLife.16650.001 PMID:28648171
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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...
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Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet
2018-03-24
To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Lee, K. David; Colony, Mike
2011-06-01
Modeling and simulation has been established as a cost-effective means of supporting the development of requirements, exploring doctrinal alternatives, assessing system performance, and performing design trade-off analysis. The Army's constructive simulation for the evaluation of equipment effectiveness in small combat unit operations is currently limited to representation of situation awareness without inclusion of the many uncertainties associated with real world combat environments. The goal of this research is to provide an ability to model situation awareness and decision process uncertainties in order to improve evaluation of the impact of battlefield equipment on ground soldier and small combat unit decision processes. Our Army Probabilistic Inference and Decision Engine (Army-PRIDE) system provides this required uncertainty modeling through the application of two critical techniques that allow Bayesian network technology to be applied to real-time applications. (Object-Oriented Bayesian Network methodology and Object-Oriented Inference technique). In this research, we implement decision process and situation awareness models for a reference scenario using Army-PRIDE and demonstrate its ability to model a variety of uncertainty elements, including: confidence of source, information completeness, and information loss. We also demonstrate that Army-PRIDE improves the realism of the current constructive simulation's decision processes through Monte Carlo simulation.
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Estimating Supply-Chain Burdens in Support of Acquisition Decisions
2013-03-20
Çì~íÉ=pÅÜççä= Abstract Acquisition decisions drive supply-chain requirements that incur financial costs and other critical impacts. To account ...their rates are fully burdened with respect to the cost of transport assets and any force protection, if necessary. However, DoD accounting systems and...Board (DSB) report (2008) highlighted the failure of DoD management processes to properly account for the enterprise- wide costs of fuel. Before 2009
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The use of decision analysis to examine ethical decision making by critical care nurses.
Hughes, K K; Dvorak, E M
1997-01-01
To examine the extent to which critical care staff nurses make ethical decisions that coincide with those recommended by a decision analytic model. Nonexperimental, ex post facto. Midwestern university-affiliated 500 bed tertiary care medical center. One hundred critical care staff nurses randomly selected from seven critical care units. Complete responses were obtained from 82 nurses (for a final response rate of 82%). The dependent variable--consistent decision making--was measured as staff nurses' abilities to make ethical decisions that coincided with those prescribed by the decision model. Subjects completed two instruments, the Ethical Decision Analytic Model, a computer-administered instrument designed to measure staff nurses' abilities to make consistent decisions about a chemically-impaired colleague; and a Background Inventory. The results indicate marked consensus among nurses when informal methods were used. However, there was little consistency between the nurses' informal decisions and those recommended by the decision analytic model. Although 50% (n = 41) of all nurses chose a course of action that coincided with the model's least optimal alternative, few nurses agreed with the model as to the most optimal course of action. The findings also suggest that consistency was unrelated (p > 0.05) to the nurses' educational background or years of clinical experience; that most subjects reported receiving little or no education in decision making during their basic nursing education programs; but that exposure to decision-making strategies was related to years of nursing experience (p < 0.05). The findings differ from related studies that have found a moderate degree of consistency between nurses and decision analytic models for strictly clinical decision tasks, especially when those tasks were less complex. However, the findings partially coincide with other findings that decision analysis may not be particularly well-suited to the critical care environment. Additional research is needed to determine whether critical care nurses use the same decision-making methods as do other nurses; and to clarify the effects of decision task (clinical versus ethical) on nurses' decision making. It should not be assumed that methods used to study nurses' clinical decision making are applicable for all nurses or all types of decisions, including ethical decisions.
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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.
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Wong, Carlos King Ho; Wu, Olivia; Cheung, Bernard M Y
2018-02-01
The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms.
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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.
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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.
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Application of Domain Knowledge to Software Quality Assurance
NASA Technical Reports Server (NTRS)
Wild, Christian W.
1997-01-01
This work focused on capturing, using, and evolving a qualitative decision support structure across the life cycle of a project. The particular application of this study was towards business process reengineering and the representation of the business process in a set of Business Rules (BR). In this work, we defined a decision model which captured the qualitative decision deliberation process. It represented arguments both for and against proposed alternatives to a problem. It was felt that the subjective nature of many critical business policy decisions required a qualitative modeling approach similar to that of Lee and Mylopoulos. While previous work was limited almost exclusively to the decision capture phase, which occurs early in the project life cycle, we investigated the use of such a model during the later stages as well. One of our significant developments was the use of the decision model during the operational phase of a project. By operational phase, we mean the phase in which the system or set of policies which were earlier decided are deployed and put into practice. By making the decision model available to operational decision makers, they would have access to the arguments pro and con for a variety of actions and can thus make a more informed decision which balances the often conflicting criteria by which the value of action is measured. We also developed the concept of a 'monitored decision' in which metrics of performance were identified during the decision making process and used to evaluate the quality of that decision. It is important to monitor those decision which seem at highest risk of not meeting their stated objectives. Operational decisions are also potentially high risk decisions. Finally, we investigated the use of performance metrics for monitored decisions and audit logs of operational decisions in order to feed an evolutionary phase of the the life cycle. During evolution, decisions are revisisted, assumptions verified or refuted, and possible reassessments resulting in new policy are made. In this regard we implemented a machine learning algorithm which automatically defined business rules based on expert assessment of the quality of operational decisions as recorded during deployment.
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Scott A. Enebak
2012-01-01
This article gives a brief history of the importance of methyl bromide in the production of forest tree seedlings in the southern United States and the timeline for the Montreal Protocol and Clean Air Act to phase out ozone depleting compounds. In addition, the process, steps used, and current status under the Critical Use Exemption and Quarantine Pre-shipment articles...
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Developing an Advanced Environment for Collaborative Computing
NASA Technical Reports Server (NTRS)
Becerra-Fernandez, Irma; Stewart, Helen; DelAlto, Martha; DelAlto, Martha; Knight, Chris
1999-01-01
Knowledge management in general tries to organize and make available important know-how, whenever and where ever is needed. Today, organizations rely on decision-makers to produce "mission critical" decisions that am based on inputs from multiple domains. The ideal decision-maker has a profound understanding of specific domains that influence the decision-making process coupled with the experience that allows them to act quickly and decisively on the information. In addition, learning companies benefit by not repeating costly mistakes, and by reducing time-to-market in Research & Development projects. Group-decision making tools can help companies make better decisions by capturing the knowledge from groups of experts. Furthermore, companies that capture their customers preferences can improve their customer service, which translates to larger profits. Therefore collaborative computing provides a common communication space, improves sharing of knowledge, provides a mechanism for real-time feedback on the tasks being performed, helps to optimize processes, and results in a centralized knowledge warehouse. This paper presents the research directions. of a project which seeks to augment an advanced collaborative web-based environment called Postdoc, with workflow capabilities. Postdoc is a "government-off-the-shelf" document management software developed at NASA-Ames Research Center (ARC).
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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.
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Heidari, Mohammad; Ebrahimi, Parvin
2016-01-01
Background and Aims: 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. Materials and Methods: 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. Results: 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). Conclusions: 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. PMID:27829713
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ERIC Educational Resources Information Center
Chaudoir, Stephenie R.; Fisher, Jeffrey D.
2010-01-01
Disclosure is a critical aspect of the experience of people who live with concealable stigmatized identities. This article presents the disclosure processes model (DPM)--a framework with which to examine when and why interpersonal disclosure may be beneficial. The DPM suggests that antecedent goals representing approach and avoidance motivational…
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Using the Analytic Hierarchy Process for Decision-Making in Ecosystem Management
Daniel L. Schmoldt; David L. Peterson
1997-01-01
Land management activities on public lands combine multiple objectives in order to create a plan of action over a finite time horizon. Because management activities are constrained by time and money, it is critical to make the best use of available agency resources. The Analytic Hierarchy Process (AHP) offers a structure for multi-objective decisionmaking so that...
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ERIC Educational Resources Information Center
Mercier, Celine; Crocker, Anne G.
2011-01-01
This paper deals with the initial steps of the judicial process for persons with intellectual disabilities who are suspected of a minor offense; a stage where plaintiffs, police officers, and crown attorneys make a series of decisions that will have a significant impact on the course of the judicial process. The objective of this study was…
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Cognitive debiasing 1: origins of bias and theory of debiasing.
Croskerry, Pat; Singhal, Geeta; Mamede, Sílvia
2013-10-01
Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of development and within our working environments. Both are associated with abbreviated decision making in the form of heuristics. Other work suggests that ambient and contextual factors may create high risk situations that dispose decision makers to particular biases. Fatigue, sleep deprivation and cognitive overload appear to be important determinants. The theoretical basis of several approaches towards debiasing is then discussed. All share a common feature that involves a deliberate decoupling from Type 1 intuitive processing and moving to Type 2 analytical processing so that eventually unexamined intuitive judgments can be submitted to verification. This decoupling step appears to be the critical feature of cognitive and affective debiasing.
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Decision-Making in Agent-Based Models of Migration: State of the Art and Challenges.
Klabunde, Anna; Willekens, Frans
We review agent-based models (ABM) of human migration with respect to their decision-making rules. The most prominent behavioural theories used as decision rules are the random utility theory, as implemented in the discrete choice model, and the theory of planned behaviour. We identify the critical choices that must be made in developing an ABM, namely the modelling of decision processes and social networks. We also discuss two challenges that hamper the widespread use of ABM in the study of migration and, more broadly, demography and the social sciences: (a) the choice and the operationalisation of a behavioural theory (decision-making and social interaction) and (b) the selection of empirical evidence to validate the model. We offer advice on how these challenges might be overcome.
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NASA Astrophysics Data System (ADS)
Murtinho, Felipe; Hayes, Tanya
2017-06-01
Payment for Environmental Service programs are increasingly applied in communal settings where resource users collectively join the program and agree to limit their shared use of a common-property resource. Who decides to join PES and the degree to which community members agree with the collective decision is critical for the success of said programs. Yet, we have limited understanding of the factors that influence communal participation and the collective decision process. This paper examines communal participation in a national payment for conservation program in Ecuador. We use quantitative and qualitative analysis to (i) identify the attributes of the communities that participate (or not), and factors that facilitate participation ( n = 67), and (ii) assess household preference and alignment with the collective decision to participate ( n = 212). Household participation preferences indicate varying degrees of consensus with the collective decision to participate, with those using the resource less likely to support participation. At the communal level, however, our results indicate that over time, those communities that depend more heavily on their resource systems may ultimately choose to participate. Our findings suggest that communal governance structures and outside organizations may be instrumental in gaining participation in resource-dependent communities and building consensus. Findings also point to the need for further research on communal decision-processes to ensure that the collective decision is based on an informed and democratic process.
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A review of costing methodologies in critical care studies.
Pines, Jesse M; Fager, Samuel S; Milzman, David P
2002-09-01
Clinical decision making in critical care has traditionally been based on clinical outcome measures such as mortality and morbidity. Over the past few decades, however, increasing competition in the health care marketplace has made it necessary to consider costs when making clinical and managerial decisions in critical care. Sophisticated costing methodologies have been developed to aid this decision-making process. We performed a narrative review of published costing studies in critical care during the past 6 years. A total of 282 articles were found, of which 68 met our search criteria. They involved a mean of 508 patients (range, 20-13,907). A total of 92.6% of the studies (63 of 68) used traditional cost analysis, whereas the remaining 7.4% (5 of 68) used cost-effectiveness analysis. None (0 of 68) used cost-benefit analysis or cost-utility analysis. A total of 36.7% (25 of 68) used hospital charges as a surrogate for actual costs. Of the 43 articles that actually counted costs, 37.2% (16 of 43) counted physician costs, 27.9% (12 of 43) counted facility costs, 34.9% (15 of 43) counted nursing costs, 9.3% (4 of 43) counted societal costs, and 90.7% (39 of 43) counted laboratory, equipment, and pharmacy costs. Our conclusion is that despite considerable progress in costing methodologies, critical care studies have not adequately implemented these techniques. Given the importance of financial implications in medicine, it would be prudent for critical care studies to use these more advanced techniques. Copyright 2002, Elsevier Science (USA). All rights reserved.
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Engaging stakeholders for adaptive management using structured decision analysis
Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett
2009-01-01
Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.
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Salamone, John D; Yohn, Samantha E; López-Cruz, Laura; San Miguel, Noemí; Correa, Mercè
2016-05-01
Motivation has been defined as the process that allows organisms to regulate their internal and external environment, and control the probability, proximity and availability of stimuli. As such, motivation is a complex process that is critical for survival, which involves multiple behavioural functions mediated by a number of interacting neural circuits. Classical theories of motivation suggest that there are both directional and activational aspects of motivation, and activational aspects (i.e. speed and vigour of both the instigation and persistence of behaviour) are critical for enabling organisms to overcome work-related obstacles or constraints that separate them from significant stimuli. The present review discusses the role of brain dopamine and related circuits in behavioural activation, exertion of effort in instrumental behaviour, and effort-related decision-making, based upon both animal and human studies. Impairments in behavioural activation and effort-related aspects of motivation are associated with psychiatric symptoms such as anergia, fatigue, lassitude and psychomotor retardation, which cross multiple pathologies, including depression, schizophrenia, and Parkinson's disease. Therefore, this review also attempts to provide an interdisciplinary approach that integrates findings from basic behavioural neuroscience, behavioural economics, clinical neuropsychology, psychiatry, and neurology, to provide a coherent framework for future research and theory in this critical field. Although dopamine systems are a critical part of the brain circuitry regulating behavioural activation, exertion of effort, and effort-related decision-making, mesolimbic dopamine is only one part of a distributed circuitry that includes multiple neurotransmitters and brain areas. Overall, there is a striking similarity between the brain areas involved in behavioural activation and effort-related processes in rodents and in humans. Animal models of effort-related decision-making are highly translatable to humans, and an emerging body of evidence indicates that alterations in effort-based decision-making are evident in several psychiatric and neurological disorders. People with major depression, schizophrenia, and Parkinson's disease show evidence of decision-making biases towards a lower exertion of effort. Translational studies linking research with animal models, human volunteers, and clinical populations are greatly expanding our knowledge about the neural basis of effort-related motivational dysfunction, and it is hoped that this research will ultimately lead to improved treatment for motivational and psychomotor symptoms in psychiatry and neurology. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-12-16
... sensor network and provide extended sensor network and components to fill critical situational awareness... different agencies), and share resources. The IOCs will improve tactical decision-making, situational awareness, operations monitoring/ interoperability, rules-based processing, and joint planning in a...
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Team Leadership: It's Not for the Faint of Heart
ERIC Educational Resources Information Center
Curry, Katherine A.
2014-01-01
Group decision-making can result in important benefits for organizational effectiveness. However, collaborative environments do not emerge organically. Effective leadership is critical for group success. Educational leaders must understand group processes and the importance of creating a culture that supports collaboration. Student discipline for…
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Multi-criteria development and incorporation into decision tools for health technology adoption.
Poulin, Paule; Austen, Lea; Scott, Catherine M; Waddell, Cameron D; Dixon, Elijah; Poulin, Michelle; Lafrenière, René
2013-01-01
When introducing new health technologies, decision makers must integrate research evidence with local operational management information to guide decisions about whether and under what conditions the technology will be used. Multi-criteria decision analysis can support the adoption or prioritization of health interventions by using criteria to explicitly articulate the health organization's needs, limitations, and values in addition to evaluating evidence for safety and effectiveness. This paper seeks to describe the development of a framework to create agreed-upon criteria and decision tools to enhance a pre-existing local health technology assessment (HTA) decision support program. The authors compiled a list of published criteria from the literature, consulted with experts to refine the criteria list, and used a modified Delphi process with a group of key stakeholders to review, modify, and validate each criterion. In a workshop setting, the criteria were used to create decision tools. A set of user-validated criteria for new health technology evaluation and adoption was developed and integrated into the local HTA decision support program. Technology evaluation and decision guideline tools were created using these criteria to ensure that the decision process is systematic, consistent, and transparent. This framework can be used by others to develop decision-making criteria and tools to enhance similar technology adoption programs. The development of clear, user-validated criteria for evaluating new technologies adds a critical element to improve decision-making on technology adoption, and the decision tools ensure consistency, transparency, and real-world relevance.
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A rule-based system for real-time analysis of control systems
NASA Astrophysics Data System (ADS)
Larson, Richard R.; Millard, D. Edward
1992-10-01
An approach to automate the real-time analysis of flight critical health monitoring and system status is being developed and evaluated at the NASA Dryden Flight Research Facility. A software package was developed in-house and installed as part of the extended aircraft interrogation and display system. This design features a knowledge-base structure in the form of rules to formulate interpretation and decision logic of real-time data. This technique has been applied for ground verification and validation testing and flight testing monitoring where quick, real-time, safety-of-flight decisions can be very critical. In many cases post processing and manual analysis of flight system data are not required. The processing is described of real-time data for analysis along with the output format which features a message stack display. The development, construction, and testing of the rule-driven knowledge base, along with an application using the X-31A flight test program, are presented.
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If You See Something, Say Something…More
NASA Astrophysics Data System (ADS)
Mann, M. E.; Peacock, K.
2015-12-01
Scientists have a collective ethical obligation to communicate the implications of their science and to communicate it as accurately and fully as possible. Nowhere is that obligation more profound than in areas of research, like climate change, where the stakes are so great, and where societal decision-making demands the most accurate assessments of risk. If scientists remain on the sidelines, they insure that others with an axe to grind will fill the void, game the process of risk assessment, and insure sub-optimal policy decision-making. But simple participation is not adequate either. Scientists, when they communicate climate change risk, must resist the temptation to downplay high-risk and high-cost scenarios in an effort simply to avoid criticism by contrarians. Otherwise, the net affect is the same, with bad faith actors achieving their goal of minimizing the emphasis placed on mitigation efforts in the policymaking process. We will discuss some examples including the critically important case of ice sheet collapse and sea level rise.
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A rule-based system for real-time analysis of control systems
NASA Technical Reports Server (NTRS)
Larson, Richard R.; Millard, D. Edward
1992-01-01
An approach to automate the real-time analysis of flight critical health monitoring and system status is being developed and evaluated at the NASA Dryden Flight Research Facility. A software package was developed in-house and installed as part of the extended aircraft interrogation and display system. This design features a knowledge-base structure in the form of rules to formulate interpretation and decision logic of real-time data. This technique has been applied for ground verification and validation testing and flight testing monitoring where quick, real-time, safety-of-flight decisions can be very critical. In many cases post processing and manual analysis of flight system data are not required. The processing is described of real-time data for analysis along with the output format which features a message stack display. The development, construction, and testing of the rule-driven knowledge base, along with an application using the X-31A flight test program, are presented.
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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…
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Weaning from mechanical ventilation: factors that influence intensive care nurses' decision-making.
Tingsvik, Catarina; Johansson, Karin; Mårtensson, Jan
2015-01-01
The aim of the study was to describe the factors that influence intensive care nurses' decision-making when weaning patients from mechanical ventilation. Patients with failing vital function may require respiratory support. Weaning from mechanical ventilation is a process in which the intensive care nurse participates in both planning and implementation. A qualitative approach was used. The data were collected by means of semi-structured interviews with 22 intensive care nurses. The interviews were transcribed and analysed using qualitative content analysis. One theme emerged: 'A complex nursing situation where the patient receives attention and which is influenced by the current care culture'. There was consensus that the overall assessment of the patient made by the intensive care nurse was the main factor that influenced the decision-making process. This assessment was a continuous process consisting of three factors: the patient's perspective as well as her/his physical and mental state. On the other hand, there was a lack of consensus about what other factors influenced the decision-making process. These factors included the care culture constituted by the characteristics of the team, the intensive care nurses' professional skills, personalities and ability to be present. The individual overall assessment of the patient enabled nursing care from a holistic perspective. Furthermore, the weaning process can be more effective and potential suffering reduced by creating awareness of the care culture's impact on the decision-making process. © 2014 British Association of Critical Care Nurses.
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[Chakrabarty today: 30 years after the United States Supreme Court Resolution].
Bergel, Salvador Darío
2010-01-01
The decision of the United States Supreme Court in the Chakrabarty case marked the beginning of a far reaching process, the development of which considerably extended the field of patentabiltiy of humans, their body parts and genetic information. The author believes that a period of three decades is sufficient to draw conclusions. A critical point has been reached from a debatable decision, which had more economic support than legal, which requires serious recapitulation of the scope and the purpose of industrial property rights.
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11 critical questions to ask when buying a physician practice.
Jessee, William F
2012-07-01
Answering probing questions in advance of a practice purchase can help hospital and health system leaders make informed decisions. The questions are intended to stimulate careful consideration before entering into a practice acquisition; no single piece of information or answer should be considered definitive in the final decision-making process. Success depends on having a clear game plan and spending time ensuring that all players-board, management, physician leaders, and the physicians who will be employees--understand and support the plan.
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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.)
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[Factors influencing nurses' clinical decision making--focusing on critical thinking disposition].
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.
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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.
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Johnson, Fred A.; Williams, Byron K.; Nichols, James D.
2013-01-01
There has been some tendency to view decision science and resilience theory as opposing approaches, or at least as contending perspectives, for natural resource management. Resilience proponents have been especially critical of optimization in decision science, at least for those cases where it is focused on the aggressive pursuit of efficiency. In general, optimization of resource systems is held to reduce spatial, temporal, or organizational heterogeneity that would otherwise limit efficiency, leading to homogenization of a system and making it less able to cope with unexpected changes or disturbances. For their part, decision analysts have been critical of resilience proponents for not providing much practical advice to decision makers. We believe a key source of tension between resilience thinking and application of decision science is the pursuit of efficiency in the latter (i.e., choosing the “best” management action or strategy option to maximize productivity of one or few resource components), vs. a desire in the former to keep options open (i.e., maintaining and enhancing diversity). It seems obvious, however, that with managed natural systems, there must be a principle by which to guide decision making, which at a minimumallows for a comparison of projected outcomes associated with decision alternatives. This is true even if the primary concern of decision making is the preservation of system resilience. We describe how a careful framing of conservation problems, especially in terms of management objectives and predictive models, can help reduce the purported tension between resiliencethinking and decision analysis. In particular, objective setting in conservation problems needs to be more attuned to the dynamics of ecological systems and to the possibility of deep uncertainties that underlie the risk of unintended, if not irreversible, outcomes. Resilience thinking also leads to the suggestion that model development should focus more on process rather than pattern, on multiple scales of influence, and on phenomena that can create alternative stability regimes. Although we acknowledge the inherent difficulties in modeling ecological processes, we stress that formulation of useful models need not depend on a thorough mechanistic understanding or precise parameterization, assuming that uncertainty is acknowledged and treated in a systematic manner.
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Disaster Response Modeling Through Discrete-Event Simulation
NASA Technical Reports Server (NTRS)
Wang, Jeffrey; Gilmer, Graham
2012-01-01
Organizations today are required to plan against a rapidly changing, high-cost environment. This is especially true for first responders to disasters and other incidents, where critical decisions must be made in a timely manner to save lives and resources. Discrete-event simulations enable organizations to make better decisions by visualizing complex processes and the impact of proposed changes before they are implemented. A discrete-event simulation using Simio software has been developed to effectively analyze and quantify the imagery capabilities of domestic aviation resources conducting relief missions. This approach has helped synthesize large amounts of data to better visualize process flows, manage resources, and pinpoint capability gaps and shortfalls in disaster response scenarios. Simulation outputs and results have supported decision makers in the understanding of high risk locations, key resource placement, and the effectiveness of proposed improvements.
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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.
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Huang, Kevin B; Weber, Urs; Johnson, Jennifer; Anderson, Nathanial; Knies, Andrea K; Nhundu, Belinda; Bautista, Cynthia; Poskus, Kelly; Sheth, Kevin N; Hwang, David Y
2018-01-01
An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not. Between March 2013 and December 2015, we administered the Family Satisfaction in the ICU 24 survey to family members of adult neuroscience ICU patients. We compared the mean score for the survey subsection regarding shared decision making (graded on a 100-point scale), as well as individual survey items, between those who reported the patient's PCP involvement in any medical decision making versus those who did not. Among 263 respondents, there was no difference in mean overall decision-making satisfaction scores for those who reported involvement (81.1; SD = 15.2) versus those who did not (80.1; SD = 12.8; P = .16). However, a higher proportion reporting involvement felt completely satisfied with their 1) inclusion in the ICU decision making process (75.9% vs 61.4%; P = .055), and 2) control over the care of the patient (73.6% vs 55.6%; P = .02), with no difference regarding consistency of clinical information provided by the medical team (64.8% vs 63.5%; P = 1.00). Families who report involvement of a patient's PCP in medical decision making for critically ill patients may be more satisfied than those who do not with regard to specific aspects of ICU decision making. Further research would help understand how best to engage PCPs in shared decisions. © Copyright 2018 by the American Board of Family Medicine.
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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.
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Rogalewicz, Vladimír; Barták, Miroslav
The paper summarizes the criticisms of the QALY concept utilization in health-economic evaluations that has been growing stronger in the last years. Despite of its limitations, the QALY concept has been routinely used in many countries incl. the Czech Republic. However, some states disapproved QALYs as an optimizing criterion at the level of their political decisions. The critical reflection concerns both the theoretical and the experimental issues. Based on a literary review, fundamental arguments against the concept are summarized, and a synthesis of material objections is presented. The critical arguments focus on the foundations of the QALY concept in the economic theory, some ethical principles, inconsistencies and technical imperfections of the quality-of-life measurement tools used in QALY calculations, the substitution rule, differences between various diagnoses, and disregarding some other important parameters. As a whole, the critics´ arguments can be judged as quite strong. The future will show whether the critical arguments summarized in this paper will lead to a development of alternative tools that have a potential of eliminating imperfections in QALYs, and consequently provide more complex data for the decision process.Key words: cost-effectiveness - health technology assessment - HTA - QALY - utility measure for medical interventions.
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Self-Organized Percolation and Critical Sales Fluctuations
NASA Astrophysics Data System (ADS)
Weisbuch, Gérard; Solomon, Sorin
There is a discrepancy between the standard view of equilibrium through price adjustment in economics and the observation of large fluctuations in stock markets. We study here a simple model where agents decisions not only depend upon their individual preferences but also upon information obtained from their neighbors in a social network. The model shows that information diffusion coupled to the adjustment process drives the system to criticality with large fluctuations rather than converging smoothly to equilibrium.
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Public attitudes and values in priority setting.
Peacock, Stuart J
2015-01-01
There is growing recognition that critical decisions concerning investments in new health care technologies and services should incorporate society's values along with the scientific evidence. From a normative perspective, public engagement can help realize the democratic ideals of legitimacy, transparency, and accountability. On a more pragmatic level, public engagement can help stakeholders understand the degree of popular support for policy options, and may enhance public trust in decision-making processes. To better understand public attitudes and values relating to priority setting in health care, researchers and decision-makers will have to employ a range of quantitative and qualitative approaches, drawing on different disciplines and methodological traditions.
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Bornstein, Aaron M.; Daw, Nathaniel D.
2013-01-01
How do we use our memories of the past to guide decisions we've never had to make before? Although extensive work describes how the brain learns to repeat rewarded actions, decisions can also be influenced by associations between stimuli or events not directly involving reward — such as when planning routes using a cognitive map or chess moves using predicted countermoves — and these sorts of associations are critical when deciding among novel options. This process is known as model-based decision making. While the learning of environmental relations that might support model-based decisions is well studied, and separately this sort of information has been inferred to impact decisions, there is little evidence concerning the full cycle by which such associations are acquired and drive choices. Of particular interest is whether decisions are directly supported by the same mnemonic systems characterized for relational learning more generally, or instead rely on other, specialized representations. Here, building on our previous work, which isolated dual representations underlying sequential predictive learning, we directly demonstrate that one such representation, encoded by the hippocampal memory system and adjacent cortical structures, supports goal-directed decisions. Using interleaved learning and decision tasks, we monitor predictive learning directly and also trace its influence on decisions for reward. We quantitatively compare the learning processes underlying multiple behavioral and fMRI observables using computational model fits. Across both tasks, a quantitatively consistent learning process explains reaction times, choices, and both expectation- and surprise-related neural activity. The same hippocampal and ventral stream regions engaged in anticipating stimuli during learning are also engaged in proportion to the difficulty of decisions. These results support a role for predictive associations learned by the hippocampal memory system to be recalled during choice formation. PMID:24339770
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Influences on Decision Making Identified by Parents of Children Receiving Pediatric Palliative Care.
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.
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Schroeder, Susan A.; Fulton, David C.
2017-01-01
Although researchers agree that public participation in natural resource decision making is critical to institutional acceptance by stakeholders and the general public, the processes to gain public perceptions of fairness, agency trust, and acceptance of management decisions are not clear. Using results from a mail survey of Minnesota resident anglers, we used structural equation modeling to examine how instrumental versus symbolic motives related to anglers’ perceptions of agency fairness, trustworthiness, and ultimately acceptance of fisheries management decisions. We applied laboratory research on relationships among procedural fairness, trust, and management acceptance, and then tested models incorporating anglers’ perceptions of voice for anglers and nonanglers in management decisions. Results suggested that trust fully mediated the relationship between procedural fairness and management acceptance. Angler perceptions of angler and nonangler voice both related to views of procedural fairness, but angler voice was more strongly related and was also significantly related to acceptance of management decisions.
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Shared Decision-Making and Patient Empowerment in Preventive Cardiology.
Kambhampati, Swetha; Ashvetiya, Tamara; Stone, Neil J; Blumenthal, Roger S; Martin, Seth S
2016-05-01
Shared decision-making, central to evidence-based medicine and good patient care, begins and ends with the patient. It is the process by which a clinician and a patient jointly make a health decision after discussing options, potential benefits and harms, and considering the patient's values and preferences. Patient empowerment is crucial to shared decision-making and occurs when a patient accepts responsibility for his or her health. They can then learn to solve their own problems with information and support from professionals. Patient empowerment begins with the provider acknowledging that patients are ultimately in control of their care and aims to increase a patient's capacity to think critically and make autonomous, informed decisions about their health. This article explores the various components of shared decision-making in scenarios such as hypertension and hyperlipidemia, heart failure, and diabetes. It explores barriers and the potential for improving medication adherence, disease awareness, and self-management of chronic disease.
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Unregulated drinking water initiative for environmental surveillance and public health.
Backer, Lorraine C; Tosta, Nancy
2011-03-01
The critical public health need to assess and protect the drinking water used by 37 million Americans requires attention and resources. NCEH, in partnership with states, has begun the process to identify information available on unregulated drinking water sources to improve the availability of data to support decisive public health actions and resource allocation. Far more attention and resources are needed to complete this process.
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DOT National Transportation Integrated Search
2007-12-01
Households and firms are key drivers of urban growth, yet models for forecasting travel demand often : ignore their dynamic evolution and several key decision processes. An understanding of household and : firm behavior over time is critical in antic...
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The effects of an editor serving as one of the reviewers during the peer-review process.
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.
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A SOMATIC-MARKER THEORY OF ADDICTION
Verdejo-García, Antonio; Bechara, Antoine
2009-01-01
Similar to patients with ventromedial prefrontal cortex (VMPC) lesions, substance abusers show altered decision-making, characterized by a tendency to choose the immediate reward, at the expense of negative future consequences. The somatic-marker model proposes that decision-making depends on neural substrates that regulate homeostasis, emotion and feeling. According to this model, there should be a link between alterations in processing emotions in substance abusers, and their impairments in decision-making. A growing evidence from neuroscientific studies indicate that core aspects of addiction may be explained in terms of abnormal emotional/homeostatic guidance of decision-making. Behavioural studies have revealed emotional processing and decision-making deficits in substance abusers. Neuroimaging studies have shown that altered decision-making in addiction is associated with abnormal functioning of a distributed neural network critical for the processing of emotional information, and the experience of “craving”, including the VMPC, the amygdala, the striatum, the anterior cingulate cortex, and the insular/somato-sensory cortices, as well as non-specific neurotransmitter systems that modulate activities of neural processes involved in decision-making. The aim of this paper is to review this growing evidence, and to examine the extent of which these studies support a somatic-marker theory of addiction. We conclude that there are at least two underlying types of dysfunctions where emotional signals (somatic-markers) turns in favor of immediate outcomes in addiction: (1) a hyperactivity in the amygdala or impulsive system, which exaggerates the rewarding impact of available incentives, and (2) hypoactivity in the prefrontal cortex or reflective system, which forecasts the long-term consequences of a given action. PMID:18722390
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Palese, Alvisa; Cassone, Andrea; Kulla, Annamaria; Dorigo, Sabrina; Magee, Jesse; Artico, Marco; Camero, Francesco; Cassin, Catia; Cialdella, Sandra; Floridia, Giuseppe; Nadlišek, Boris; Palcic, Annamaria; Valle, Giulia; Sclauzero, Paola
2011-01-01
The clinical and research debate on the peripheral intravascular (PIV) catheter length of stay in situ is ongoing. The principal aim of this study was to explore the factors behind a nurse's decision to leave a PIV in place for more than 96 hours. The study focused on 7 northern Italian hospitals in 2009. A consequent sample of 269 PIV catheters was included. Direct observation and interviews were adopted. The time of the expected PIV replacement was fixed at 96 hours after its positioning, in accordance with the international guideline. Several factors were taken into account in regard to replacement of the PIV catheters by nurses, ranging from analysis based on their own clinical experience with PIV complications and analysis of the patient's clinical situation to the critical analysis of their own work situation. This clinical decision-making process is valuable: leaving the PIV in place for more than 96 hours is a complex decision and not simply a guideline violation.
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NASA Astrophysics Data System (ADS)
Rodriguez Lucatero, C.; Schaum, A.; Alarcon Ramos, L.; Bernal-Jaquez, R.
2014-07-01
In this study, the dynamics of decisions in complex networks subject to external fields are studied within a Markov process framework using nonlinear dynamical systems theory. A mathematical discrete-time model is derived using a set of basic assumptions regarding the convincement mechanisms associated with two competing opinions. The model is analyzed with respect to the multiplicity of critical points and the stability of extinction states. Sufficient conditions for extinction are derived in terms of the convincement probabilities and the maximum eigenvalues of the associated connectivity matrices. The influences of exogenous (e.g., mass media-based) effects on decision behavior are analyzed qualitatively. The current analysis predicts: (i) the presence of fixed-point multiplicity (with a maximum number of four different fixed points), multi-stability, and sensitivity with respect to the process parameters; and (ii) the bounded but significant impact of exogenous perturbations on the decision behavior. These predictions were verified using a set of numerical simulations based on a scale-free network topology.
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Privacy-preserving clinical decision support system using Gaussian kernel-based classification.
Rahulamathavan, Yogachandran; Veluru, Suresh; Phan, Raphael C-W; Chambers, Jonathon A; Rajarajan, Muttukrishnan
2014-01-01
A clinical decision support system forms a critical capability to link health observations with health knowledge to influence choices by clinicians for improved healthcare. Recent trends toward remote outsourcing can be exploited to provide efficient and accurate clinical decision support in healthcare. In this scenario, clinicians can use the health knowledge located in remote servers via the Internet to diagnose their patients. However, the fact that these servers are third party and therefore potentially not fully trusted raises possible privacy concerns. In this paper, we propose a novel privacy-preserving protocol for a clinical decision support system where the patients' data always remain in an encrypted form during the diagnosis process. Hence, the server involved in the diagnosis process is not able to learn any extra knowledge about the patient's data and results. Our experimental results on popular medical datasets from UCI-database demonstrate that the accuracy of the proposed protocol is up to 97.21% and the privacy of patient data is not compromised.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
None
1982-01-01
Report XI, Technical Audit, is a compendium of research material used during the Initial Effort in making engineering comparisons and decisions. Volumes 4 and 5 of Report XI present those studies which provide a Critical Review of the Design Basis. The Critical Review Report, prepared by Intercontinental Econergy Associates, Inc., summarizes findings from an extensive review of the data base for the H-Coal process design. Volume 4 presents this review and assessment, and includes supporting material; specifically, Design Data Tabulation (Appendix A), Process Flow Sheets (Appendix B), and References (Appendix C). Volume 5 is a continuation of the references ofmore » Appendix C. Studies of a proprietary nature are noted and referenced, but are not included in these volumes. They are included in the Limited Access versions of these reports and may be reviewed by properly cleared personnel in the offices of Ashland Synthetic Fuels, Inc.« less
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Comprehensive analysis of statistical and model-based overlay lot disposition methods
NASA Astrophysics Data System (ADS)
Crow, David A.; Flugaur, Ken; Pellegrini, Joseph C.; Joubert, Etienne L.
2001-08-01
Overlay lot disposition algorithms in lithography occupy some of the highest leverage decision points in the microelectronic manufacturing process. In a typical large volume sub-0.18micrometers fab the lithography lot disposition decision is made about 500 times per day. Each decision will send a lot of wafers either to the next irreversible process step or back to rework in an attempt to improve unacceptable overlay performance. In the case of rework, the intention is that the reworked lot will represent better yield (and thus more value) than the original lot and that the enhanced lot value will exceed the cost of rework. Given that the estimated cost of reworking a critical-level lot is around 10,000 (based upon the opportunity cost of consuming time on a state-of-the-art DUV scanner), we are faced with the implication that the lithography lot disposition decision process impacts up to 5 million per day in decisions. That means that a 1% error rate in this decision process represents over 18 million per year lost in profit for a representative sit. Remarkably, despite this huge leverage, the lithography lot disposition decision algorithm usually receives minimal attention. In many cases, this lack of attention has resulted in the retention of sub-optimal algorithms from earlier process generations and a significant negative impact on the economic output of many high-volume manufacturing sites. An ideal lot- dispositioning algorithm would be an algorithm that results into the best economic decision being made every time - lots would only be reworked where the expected value (EV) of the reworked lot minus the expected value of the original lot exceeds the cost of the rework: EV(reworked lot)- EV(original lot)>COST(rework process) Calculating the above expected values in real-time has generally been deemed too complicated and maintenance-intensive to be practical for fab operations, so a simplified rule is typically used.
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Examining How Media Literacy and Personality Factors Predict Skepticism Toward Alcohol Advertising.
Austin, Erica Weintraub; Muldrow, Adrienne; Austin, Bruce W
2016-05-01
To examine the potential effectiveness of media literacy education in the context of well-established personality factors, a survey of 472 young adults, focused on the issue of alcohol marketing messages, examined how individual differences in personality associate with constructs representing aspects of media literacy. The results showed that need for cognition predicted social expectancies and wishful identification with media portrayals in alcohol advertising only through critical thinking about media sources and media content, which are foci of media literacy education. Need for affect did not associate with increased or diminished levels of critical thinking. Critical thinking about sources and messages affected skepticism, represented by expectancies through wishful identification, consistent with the message interpretation process model. The results support the view that critical thinking about media sources is an important precursor to critical thinking about media messages. The results also suggest that critical thinking about media (i.e., media literacy) reflects more than personality characteristics and can affect wishful identification with role models observed in media, which appears to be a key influence on decision making. This adds support to the view that media literacy education can improve decision making across personality types regarding alcohol use by decreasing the potential influence of alcohol marketing messages.
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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…
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Zhong, Jimmy Y; Moffat, Scott D
2016-01-01
Previous studies have showed that spatial memory declines with age but have not clarified the relevance of different landmark cues for specifying heading directions among different age groups. This study examined differences between younger, middle-aged and older adults in route learning and memory tasks after they navigated a virtual maze that contained: (a) critical landmarks that were located at decision points (i.e., intersections) and (b) non-critical landmarks that were located at non-decision points (i.e., the sides of the route). Participants were given a recognition memory test for critical and non-critical landmarks and also given a landmark-direction associative learning task. Compared to younger adults, older adults committed more navigation errors during route learning and were poorer at associating the correct heading directions with both critical and non-critical landmarks. Notably, older adults exhibited a landmark-direction associative memory deficit at decision points; this was the first finding to show that an associative memory deficit exist among older adults in a navigational context for landmarks that are pertinent for reaching a goal, and suggest that older adults may expend more cognitive resources on the encoding of landmark/object features than on the binding of landmark and directional information. This study is also the first to show that older adults did not have a tendency to process non-critical landmarks, which were regarded as distractors/irrelevant cues for specifying the directions to reach the goal, to an equivalent or larger extent than younger adults. We explain this finding in view of the low number of non-critical cues in our virtual maze (relative to a real-world urban environment) that might not have evoked older adults' usual tendency toward processing or encoding distractors. We explain the age differences in navigational and cognitive performance with regards to functional and structural changes in the hippocampus and parahippocampus, and recommend further investigations into the functional connectivity between the prefrontal cortex and hippocampus for a better understanding of the landmark-direction associative learning among the elderly. Finally, it is hoped that the current behavioral findings will facilitate efforts to identify the neural markers of Alzheimer's disease, a disease that commonly involves navigational deficits.
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The effect of response mode on lateralized lexical decision performance.
Weems, Scott A; Zaidel, Eran
2005-01-01
We examined the effect of manipulations of response programming, i.e. post-lexical decision making requirements, on lateralized lexical decision. Although response hand manipulations tend to elicit weaker laterality effects than those involving visual field of presentation, the implementation of different lateralized response strategies remains relatively unexplored. Four different response conditions were compared in a between-subjects design: (1) unimanual, (2) bimanual, (3) congruent visual field/response hand, and (4) confounded response hand/target lexicality response. It was observed that hemispheric specialization and interaction effects during the lexical decision task remained unchanged despite the very different response requirements. However, a priori examination of each condition revealed that some manipulations yielded a reduced power to detect laterality effects. The consistent observation of left hemisphere specialization, and both left and right hemisphere lexicality priming effects (interhemispheric transfer), indicate that these effects are relatively robust and unaffected by late occurring processes in the lexical decision task. It appears that the lateralized response mode neither determines nor reflects the laterality of decision processes. In contrast, the target visual half-field is critical for determining the deciding hemisphere and is a sensitive index of hemispheric specialization, as well as of directional interhemispheric transfer.
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Conceptualizing Couples’ Decision Making in PGD: Emerging Cognitive, Emotional, and Moral Dimensions
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
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Evidence-based Sensor Tasking for Space Domain Awareness
NASA Astrophysics Data System (ADS)
Jaunzemis, A.; Holzinger, M.; Jah, M.
2016-09-01
Space Domain Awareness (SDA) is the actionable knowledge required to predict, avoid, deter, operate through, recover from, and/or attribute cause to the loss and/or degradation of space capabilities and services. A main purpose for SDA is to provide decision-making processes with a quantifiable and timely body of evidence of behavior(s) attributable to specific space threats and/or hazards. To fulfill the promise of SDA, it is necessary for decision makers and analysts to pose specific hypotheses that may be supported or refuted by evidence, some of which may only be collected using sensor networks. While Bayesian inference may support some of these decision making needs, it does not adequately capture ambiguity in supporting evidence; i.e., it struggles to rigorously quantify 'known unknowns' for decision makers. Over the past 40 years, evidential reasoning approaches such as Dempster Shafer theory have been developed to address problems with ambiguous bodies of evidence. This paper applies mathematical theories of evidence using Dempster Shafer expert systems to address the following critical issues: 1) How decision makers can pose critical decision criteria as rigorous, testable hypotheses, 2) How to interrogate these hypotheses to reduce ambiguity, and 3) How to task a network of sensors to gather evidence for multiple competing hypotheses. This theory is tested using a simulated sensor tasking scenario balancing search versus track responsibilities.
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Leimbach, Friederike; Georgiev, Dejan; Litvak, Vladimir; Antoniades, Chrystalina; Limousin, Patricia; Jahanshahi, Marjan; Bogacz, Rafal
2018-06-01
During a decision process, the evidence supporting alternative options is integrated over time, and the choice is made when the accumulated evidence for one of the options reaches a decision threshold. Humans and animals have an ability to control the decision threshold, that is, the amount of evidence that needs to be gathered to commit to a choice, and it has been proposed that the subthalamic nucleus (STN) is important for this control. Recent behavioral and neurophysiological data suggest that, in some circumstances, the decision threshold decreases with time during choice trials, allowing overcoming of indecision during difficult choices. Here we asked whether this within-trial decrease of the decision threshold is mediated by the STN and if it is affected by disrupting information processing in the STN through deep brain stimulation (DBS). We assessed 13 patients with Parkinson disease receiving bilateral STN DBS six or more months after the surgery, 11 age-matched controls, and 12 young healthy controls. All participants completed a series of decision trials, in which the evidence was presented in discrete time points, which allowed more direct estimation of the decision threshold. The participants differed widely in the slope of their decision threshold, ranging from constant threshold within a trial to steeply decreasing. However, the slope of the decision threshold did not depend on whether STN DBS was switched on or off and did not differ between the patients and controls. Furthermore, there was no difference in accuracy and RT between the patients in the on and off stimulation conditions and healthy controls. Previous studies that have reported modulation of the decision threshold by STN DBS or unilateral subthalamotomy in Parkinson disease have involved either fast decision-making under conflict or time pressure or in anticipation of high reward. Our findings suggest that, in the absence of reward, decision conflict, or time pressure for decision-making, the STN does not play a critical role in modulating the within-trial decrease of decision thresholds during the choice process.
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Development of cognitive and affective control networks and decision making.
Kar, Bhoomika R; Vijay, Nivita; Mishra, Shreyasi
2013-01-01
Cognitive control and decision making are two important research areas in the realm of higher-order cognition. Control processes such as interference control and monitoring in cognitive and affective contexts have been found to influence the process of decision making. Development of control processes follows a gradual growth pattern associated with the prolonged maturation of underlying neural circuits including the lateral prefrontal cortex, anterior cingulate, and the medial prefrontal cortex. These circuits are also involved in the control of processes that influences decision making, particularly with respect to choice behavior. Developmental studies on affective control have shown distinct patterns of brain activity with adolescents showing greater activation of amygdala whereas adults showing greater activity in ventral prefrontal cortex. Conflict detection, monitoring, and adaptation involve anticipation and subsequent performance adjustments which are also critical to complex decision making. We discuss the gradual developmental patterns observed in two of our studies on conflict monitoring and adaptation in affective and nonaffective contexts. Findings of these studies indicate the need to look at the differences in the effects of the development of cognitive and affective control on decision making in children and particularly adolescents. Neuroimaging studies have shown the involvement of separable neural networks for cognitive (medial prefrontal cortex and anterior cingulate) and affective control (amygdala, ventral medial prefrontal cortex) shows that one system can affect the other also at the neural level. Hence, an understanding of the interaction and balance between the cognitive and affective brain networks may be crucial for self-regulation and decision making during the developmental period, particularly late childhood and adolescence. The chapter highlights the need for empirical investigation on the interaction between the different aspects of cognitive control and decision making from a developmental perspective. Copyright © 2013 Elsevier B.V. All rights reserved.
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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.
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Decision-making in palliative care: a reflective case study.
Birchall, Melissa
2005-01-01
Critical examination of the processes by which we as nurses judge and reach clinical decisions is important. It facilitates the maintenance and refinement of good standards of nursing care and the pinpointing of areas where improvement is needed. In turn this potentially could support broader validation of nurse expertise and contribute to emancipation of the nursing profession. As pure theory, clinical decision-making may appear abstract and alien to nurses struggling in 'the swampy lowlands' (Schon 1983) of the realities of practice. This paper explores some of the key concepts in decision-making theory by introducing, then integrating, them in a reflective case study. The case study, which examines a 'snapshot' of the patient and practitioner's journey, interwoven with theory surrounding clinical decision-making, may aid understanding and utility of concepts and theories in practice.
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Griffiths, Kristi R.; Morris, Richard W.; Balleine, Bernard W.
2014-01-01
The ability to learn contingencies between actions and outcomes in a dynamic environment is critical for flexible, adaptive behavior. Goal-directed actions adapt to changes in action-outcome contingencies as well as to changes in the reward-value of the outcome. When networks involved in reward processing and contingency learning are maladaptive, this fundamental ability can be lost, with detrimental consequences for decision-making. Impaired decision-making is a core feature in a number of psychiatric disorders, ranging from depression to schizophrenia. The argument can be developed, therefore, that seemingly disparate symptoms across psychiatric disorders can be explained by dysfunction within common decision-making circuitry. From this perspective, gaining a better understanding of the neural processes involved in goal-directed action, will allow a comparison of deficits observed across traditional diagnostic boundaries within a unified theoretical framework. This review describes the key processes and neural circuits involved in goal-directed decision-making using evidence from animal studies and human neuroimaging. Select studies are discussed to outline what we currently know about causal judgments regarding actions and their consequences, action-related reward evaluation, and, most importantly, how these processes are integrated in goal-directed learning and performance. Finally, we look at how adaptive decision-making is impaired across a range of psychiatric disorders and how deepening our understanding of this circuitry may offer insights into phenotypes and more targeted interventions. PMID:24904322
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Cognitive debiasing 1: origins of bias and theory of debiasing
Croskerry, Pat; Singhal, Geeta; Mamede, Sílvia
2013-01-01
Numerous studies have shown that diagnostic failure depends upon a variety of factors. Psychological factors are fundamental in influencing the cognitive performance of the decision maker. In this first of two papers, we discuss the basics of reasoning and the Dual Process Theory (DPT) of decision making. The general properties of the DPT model, as it applies to diagnostic reasoning, are reviewed. A variety of cognitive and affective biases are known to compromise the decision-making process. They mostly appear to originate in the fast intuitive processes of Type 1 that dominate (or drive) decision making. Type 1 processes work well most of the time but they may open the door for biases. Removing or at least mitigating these biases would appear to be an important goal. We will also review the origins of biases. The consensus is that there are two major sources: innate, hard-wired biases that developed in our evolutionary past, and acquired biases established in the course of development and within our working environments. Both are associated with abbreviated decision making in the form of heuristics. Other work suggests that ambient and contextual factors may create high risk situations that dispose decision makers to particular biases. Fatigue, sleep deprivation and cognitive overload appear to be important determinants. The theoretical basis of several approaches towards debiasing is then discussed. All share a common feature that involves a deliberate decoupling from Type 1 intuitive processing and moving to Type 2 analytical processing so that eventually unexamined intuitive judgments can be submitted to verification. This decoupling step appears to be the critical feature of cognitive and affective debiasing. PMID:23882089
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Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard
2011-03-14
Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. This paper aims at exploring a comprehensive approach: the "dual-process theory", a model developed by cognitive psychologists over the last few years. After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians' intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed.
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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.
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Shah, Syed Ghulam Sarwar; Farrow, Alexandra; Robinson, Ian
2009-12-01
The representation of end users' perspectives in healthcare decisions requires involvement of their surrogates when the end users, i.e. certain patients, elderly people, children and people with disabilities, are unable to present their views. To review critical issues, and the advantages and disadvantages of involving surrogates in representing end users' perspectives in healthcare decisions. A systematic review of literature published in peer-reviewed journals from 1990 to 2005. Findings show that surrogates are used widely in health care and that they are necessary to represent end users' perspectives in healthcare decisions when the latter are unable to do so themselves. Critical issues in using surrogates include key ethical, social, cultural, legal and medico-technological factors; ascertaining the best interest of end users; potential conflict of interest; possible biased decisions and the burden on surrogates. The key advantage of surrogate involvement in healthcare decisions is their ability to represent end users' needs, values and wishes. The main disadvantages include potential discrepancies between the decisions and conclusions of surrogates and end users; the failure of surrogates to predict end users' preferences accurately and the lack of certainty that useful information will be obtained through the surrogacy process. This systematic review has revealed that the involvement of surrogates is an additional vital way to represent end users' perspectives in healthcare decisions where for a range of reasons their opinions are unable to be effectively ascertained. However, because of the heterogeneity of surrogates and end users, the selection of appropriate surrogates and deploying surrogate decisions require particularly careful consideration of their value in individual cases; thus, subsequent decision-making must be reviewed on a case-to-case basis to seek to ensure that the best interests, needs and wishes of the end user are fully and accurately represented.
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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
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Avila, Irene; Lin, Shih-Chieh
2014-03-01
The survival of animals depends critically on prioritizing responses to motivationally salient stimuli. While it is generally believed that motivational salience increases decision speed, the quantitative relationship between motivational salience and decision speed, measured by reaction time (RT), remains unclear. Here we show that the neural correlate of motivational salience in the basal forebrain (BF), defined independently of RT, is coupled with faster and also more precise decision speed. In rats performing a reward-biased simple RT task, motivational salience was encoded by BF bursting response that occurred before RT. We found that faster RTs were tightly coupled with stronger BF motivational salience signals. Furthermore, the fraction of RT variability reflecting the contribution of intrinsic noise in the decision-making process was actively suppressed in faster RT distributions with stronger BF motivational salience signals. Artificially augmenting the BF motivational salience signal via electrical stimulation led to faster and more precise RTs and supports a causal relationship. Together, these results not only describe for the first time, to our knowledge, the quantitative relationship between motivational salience and faster decision speed, they also reveal the quantitative coupling relationship between motivational salience and more precise RT. Our results further establish the existence of an early and previously unrecognized step in the decision-making process that determines both the RT speed and variability of the entire decision-making process and suggest that this novel decision step is dictated largely by the BF motivational salience signal. Finally, our study raises the hypothesis that the dysregulation of decision speed in conditions such as depression, schizophrenia, and cognitive aging may result from the functional impairment of the motivational salience signal encoded by the poorly understood noncholinergic BF neurons.
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Avila, Irene; Lin, Shih-Chieh
2014-01-01
The survival of animals depends critically on prioritizing responses to motivationally salient stimuli. While it is generally believed that motivational salience increases decision speed, the quantitative relationship between motivational salience and decision speed, measured by reaction time (RT), remains unclear. Here we show that the neural correlate of motivational salience in the basal forebrain (BF), defined independently of RT, is coupled with faster and also more precise decision speed. In rats performing a reward-biased simple RT task, motivational salience was encoded by BF bursting response that occurred before RT. We found that faster RTs were tightly coupled with stronger BF motivational salience signals. Furthermore, the fraction of RT variability reflecting the contribution of intrinsic noise in the decision-making process was actively suppressed in faster RT distributions with stronger BF motivational salience signals. Artificially augmenting the BF motivational salience signal via electrical stimulation led to faster and more precise RTs and supports a causal relationship. Together, these results not only describe for the first time, to our knowledge, the quantitative relationship between motivational salience and faster decision speed, they also reveal the quantitative coupling relationship between motivational salience and more precise RT. Our results further establish the existence of an early and previously unrecognized step in the decision-making process that determines both the RT speed and variability of the entire decision-making process and suggest that this novel decision step is dictated largely by the BF motivational salience signal. Finally, our study raises the hypothesis that the dysregulation of decision speed in conditions such as depression, schizophrenia, and cognitive aging may result from the functional impairment of the motivational salience signal encoded by the poorly understood noncholinergic BF neurons. PMID:24642480
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Boosting bonsai trees for handwritten/printed text discrimination
NASA Astrophysics Data System (ADS)
Ricquebourg, Yann; Raymond, Christian; Poirriez, Baptiste; Lemaitre, Aurélie; Coüasnon, Bertrand
2013-12-01
Boosting over decision-stumps proved its efficiency in Natural Language Processing essentially with symbolic features, and its good properties (fast, few and not critical parameters, not sensitive to over-fitting) could be of great interest in the numeric world of pixel images. In this article we investigated the use of boosting over small decision trees, in image classification processing, for the discrimination of handwritten/printed text. Then, we conducted experiments to compare it to usual SVM-based classification revealing convincing results with very close performance, but with faster predictions and behaving far less as a black-box. Those promising results tend to make use of this classifier in more complex recognition tasks like multiclass problems.
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There is a critical opportunity in the field of nanoscience to compare and integrate information across diverse fields of study through informatics (i.e., nanoinformatics). This paper is one in a series of articles on the data curation process in nanoinformatics (nanocuration). O...
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What's Keeping Us? Some Thoughts on Moving Forward
ERIC Educational Resources Information Center
Kobet, Robert J.
2011-01-01
Recognize we still have a massive job of educating all the critical stakeholders, especially those with administrative decision-making and fiscal responsibility. Understand the potential for LEED and CHPS to enrich the educational delivery process. Ultimately, the goal is to provide the best learning environment possible. Work to optimize the…
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Taking a Risk to Develop Reflective Skills in Business Practitioners
ERIC Educational Resources Information Center
Mackay, Margaret; Tymon, Alex
2016-01-01
Critical reflection can support alternative decision-making in business practice. This paper examines the effectiveness of a risk-based pedagogy to engage practitioners in reflective thinking. Educators adopting a radical pedagogy in professionally accredited programmes face multiple challenges: learners often resist the process of self-reflection…
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A Longitudinal Study of Students' Conceptualization of Ecological Processes.
ERIC Educational Resources Information Center
Hellden, Gustav F.
During the last decades, an increasing awareness has developed that humankind will have to make important decisions about the environment which will demand substantive knowledge of critical ecological phenomena such as the production and decomposition of biomass (World Commission on Environment and Development, 1987). As a biology teacher the…
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Combat Orders: An Analysis of the Tactical Orders Process
1990-06-01
119 How Each System was Adapted to Doctrine .................. 120 T im e, the Critical Factor...Order ............................. 127 Decision Sequencing ... .......................... .............. ........................ 134 Adapting Tactical...overcentralization slows action and leads to inertia." 15 Agility Is the ability of friendly forces to act faster than the enemy. Initiative stresses the ability
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Reaching a Consensus: Terminology and Concepts Used in Coordination and Decision-Making Research.
Pyritz, Lennart W; King, Andrew J; Sueur, Cédric; Fichtel, Claudia
2011-12-01
Research on coordination and decision-making in humans and nonhuman primates has increased considerably throughout the last decade. However, terminology has been used inconsistently, hampering the broader integration of results from different studies. In this short article, we provide a glossary containing the central terms of coordination and decision-making research. The glossary is based on previous definitions that have been critically revised and annotated by the participants of the symposium "Where next? Coordination and decision-making in primate groups" at the XXIIIth Congress of the International Primatological Society (IPS) in Kyoto, Japan. We discuss a number of conceptual and methodological issues and highlight consequences for their implementation. In summary, we recommend that future studies on coordination and decision-making in animal groups do not use the terms "combined decision" and "democratic/despotic decision-making." This will avoid ambiguity as well as anthropocentric connotations. Further, we demonstrate the importance of 1) taxon-specific definitions of coordination parameters (initiation, leadership, followership, termination), 2) differentiation between coordination research on individual-level process and group-level outcome, 3) analyses of collective action processes including initiation and termination, and 4) operationalization of successful group movements in the field to collect meaningful and comparable data across different species.
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Whole mind and shared mind in clinical decision-making.
Epstein, Ronald Mark
2013-02-01
To review the theory, research evidence and ethical implications regarding "whole mind" and "shared mind" in clinical practice in the context of chronic and serious illnesses. Selective critical review of the intersection of classical and naturalistic decision-making theories, cognitive neuroscience, communication research and ethics as they apply to decision-making and autonomy. Decision-making involves analytic thinking as well as affect and intuition ("whole mind") and sharing cognitive and affective schemas of two or more individuals ("shared mind"). Social relationships can help processing of complex information that otherwise would overwhelm individuals' cognitive capacities. Medical decision-making research, teaching and practice should consider both analytic and non-analytic cognitive processes. Further, research should consider that decisions emerge not only from the individual perspectives of patients, their families and clinicians, but also the perspectives that emerge from the interactions among them. Social interactions have the potential to enhance individual autonomy, as well as to promote relational autonomy based on shared frames of reference. Shared mind has the potential to result in wiser decisions, greater autonomy and self-determination; yet, clinicians and patients should be vigilant for the potential of hierarchical relationships to foster coercion or silencing of the patient's voice. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
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Patient and family/friend satisfaction in a sample of Jordanian Critical Care Units.
Mosleh, S; Alja'afreh, M; Lee, A J
2015-12-01
The aim of the study was to assess the validity of family members/friends as proxies by comparing perceptions of satisfaction with care and decision making between critically ill patients and their family/friends. A comparative, descriptive cross-sectional study. Seven Critical Care Units across four public and military hospitals in the centre and southern regions of Jordan. A modified version of the Family Satisfaction-ICU (FS-ICU) questionnaire was distributed to Critical Care Unit (CCU) patients before hospital discharge. In addition, up to two family members/close friends were also asked to complete the questionnaire. A total of 213 patients (response rate 72%) and 246 family members/friends (response rate 79%) completed and returned the questionnaire. Although the majority of family members/friends and patients were satisfied with overall care, patients were generally significantly less satisfied (mean (SD) care subscale 75.6 (17.8) and 70.9 (17.3), respectively, (p=0.005). When individual items were examined, significant differences in nursing care (family/friends 80.1 (20.7) versus patient 75.9 (22.2), p=0.038) and inclusion in decision making (family/friends 53.9 (33.2) versus patient 62.0 (34.2), p=0.010) were found. The study showed a degree of congruence between patients and their family members/friends in relation to their satisfaction with the CCU experience. Thus, views of family/friends may serve as a proxy in assessing care and decision making processes of critically ill patients. Appropriate training of the critical care team and provision of strategies to address the concerns of patients' families are needed to improve overall patient satisfaction. Copyright © 2015 Elsevier Ltd. All rights reserved.
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An Exploration of Dual Systems via Time Pressure Manipulation in Decision-making Problems
NASA Astrophysics Data System (ADS)
Guo, Lisa
Every day, decisions need to be made where time is a limiting factor. Regardless of situation, time constraints often place a premium on rapid decision-making. Researchers have been interested in studying this human behavior and understanding its underlying cognitive processes. In previous studies, scientists have believed that the cognitive processes underlying decision-making behavior were consistent with dual-process modes of thinking. Critics of dual-process theory question the vagueness of its definition, and claim that single-process accounts can explain the data just as well. My aim is to elucidate the cognitive processes that underlie decisions which involve some level of risk through the experimental manipulation of time pressure. Using this method, I hope to distinguish between competing hypotheses related to the origin of the effect. I will explore three types of decisions that illustrate these concepts: risky decision-making involving gambles, intertemporal choice, and one-shot public goods games involving social cooperation. In our experiments, participants made decisions about gambles framed as either gains or losses; decided upon intertemporal choices for smaller but sooner rewards or larger but later rewards; and played a one-shot public goods game involving social cooperation and contributing an amount of money to a group. In each case, we experimentally manipulated time pressure, either within subjects or among individuals. Results showed under time pressure, increased framing effects under in both hypothetical and incentivized choices; and greater contributions and cooperation among individuals, lending support to the dual process hypothesis that these effects arise from a fast, intuitive system. However, our intertemporal choice experiment showed that time constraints led to increased selection of the larger but later options, which suggests that the magnitude of the reward may play larger role in choice selection under cognitive load than previously studied. This diverges from the current dual-process interpretation that myopic choices under time pressure favor smaller but sooner rewards, and suggests that more studies are needed in this realm to disentangle the intuitive from the deliberative system through the manipulation of cognitive load.
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Duke, Devin; Fiacconi, Chris M; Köhler, Stefan
2014-01-01
According to attribution models of familiarity assessment, people can use a heuristic in recognition-memory decisions, in which they attribute the subjective ease of processing of a memory probe to a prior encounter with the stimulus in question. Research in social cognition suggests that experienced positive affect may be the proximal cue that signals fluency in various experimental contexts. In the present study, we compared the effects of positive affect and fluency on recognition-memory judgments for faces with neutral emotional expression. We predicted that if positive affect is indeed the critical cue that signals processing fluency at retrieval, then its manipulation should produce effects that closely mirror those produced by manipulations of processing fluency. In two experiments, we employed a masked-priming procedure in combination with a Remember-Know (RK) paradigm that aimed to separate familiarity- from recollection-based memory decisions. In addition, participants performed a prime-discrimination task that allowed us to take inter-individual differences in prime awareness into account. We found highly similar effects of our priming manipulations of processing fluency and of positive affect. In both cases, the critical effect was specific to familiarity-based recognition responses. Moreover, in both experiments it was reflected in a shift toward a more liberal response bias, rather than in changed discrimination. Finally, in both experiments, the effect was found to be related to prime awareness; it was present only in participants who reported a lack of such awareness on the prime-discrimination task. These findings add to a growing body of evidence that points not only to a role of fluency, but also of positive affect in familiarity assessment. As such they are consistent with the idea that fluency itself may be hedonically marked.
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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.
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Tedford, Stephanie E.; Holtz, Nathan A.; Persons, Amanda L.; Napier, T. Celeste
2014-01-01
Pathological gambling is one manifestation of impulse control disorders. The biological underpinnings of these disorders remain elusive and treatment is far from ideal. Animal models of impulse control disorders are a critical research tool for understanding this condition and for medication development. Modeling such complex behaviors is daunting, but by its deconstruction, scientists have recapitulated in animals critical aspects of gambling. One aspect of gambling is cost/benefit decision-making wherein one weighs the anticipated costs and expected benefits of a course of action. Risk/reward, delay-based and effort-based decision-making all represent cost/benefit choices. These features are studied in humans and have been translated to animal protocols to measure decision-making processes. Traditionally, the positive reinforcer used in animal studies is food. Here, we describe how intracranial self-stimulation can be used for cost/benefit decision-making tasks and overview our recent studies showing how pharmacological therapies alter these behaviors in laboratory rats. We propose that these models may have value in screening new compounds for the ability to promote and prevent aspects of gambling behavior. PMID:24966822
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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.
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Sex Differences in Animal Models of Decision-Making
Orsini, Caitlin A.; Setlow, Barry
2016-01-01
The ability to weigh the costs and benefits of various options in order to make an adaptive decision is critical to an organism’s survival and well-being. Many psychiatric diseases are characterized by maladaptive decision-making, indicating the need to better understand the mechanisms underlying this process and the ways in which it is altered in pathological conditions. Great strides have been made in uncovering these mechanisms, but the majority of what is known comes from studies conducted solely in male subjects. In recent years, decision-making research has begun to include females to determine whether sex differences exist and to identify the mechanisms that contribute to such differences. This review will begin by describing studies that have examined sex differences in animal (largely rodent) models of decision-making. Possible explanations, both theoretical and biological, for such differences in decision- making will then be considered. The review will conclude with a discussion of the implications of sex differences in decision-making for understanding psychiatric conditions. PMID:27870448
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Hough transform for human action recognition
NASA Astrophysics Data System (ADS)
Siemon, Mia S. N.
2016-09-01
Nowadays, the demand of computer analysis, especially regarding team sports, continues drastically growing. More and more decisions are made by electronic devices for the live to become `easier' to a certain context. There already exist application areas in sports, during which critical situations are being handled by means of digital software. This paper aims at the evaluation and introduction to the necessary foundation which would make it possible to develop a concept similar to that of `hawk-eye', a decision-making program to evaluate the impact of a ball with respect to a target line and to apply it to the sport of volleyball. The pattern recognition process is in this case performed by means of the mathematical model of Hough transform which is able of identifying relevant lines and circles in the image in order to later on use them for the necessary evaluation of the image and the decision-making process.
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Ryan, Gery W.; Stern, Stefanie A.; Hilton, Lara; Tucker, Joan S.; Kennedy, David P.; Golinelli, Daniela; Wenzel, Suzanne L.
2010-01-01
Impoverished women worldwide are at high risk for contracting HIV/AIDS. This study explores how homeless women make risky sex decisions and the role that alcohol and drugs play in this process. We analyze 56 in-depth qualitative descriptions of recent sexual episodes among 28 women living in shelters in Los Angeles, California, USA. The sample (age 18–63) was 46% African American, 21% Hispanic/Latina, and 21% white. Findings suggest that: (1) homeless women engage in multiple types of relationships and sexual behaviors; (2) emotion and attachment play critical roles in women’s risky sex choices; and (3) the role of alcohol and drugs on such choices varies across relationship commitment. Understanding the complexity of sexual decision-making among this population has implications for developing successful risk reduction interventions. PMID:20485467
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Trusted Advisors, Decision Models and Other Keys to Communicating Science to Decision Makers
NASA Astrophysics Data System (ADS)
Webb, E.
2006-12-01
Water resource management decisions often involve multiple parties engaged in contentious negotiations that try to navigate through complex combinations of legal, social, hydrologic, financial, and engineering considerations. The standard approach for resolving these issues is some form of multi-party negotiation, a formal court decision, or a combination of the two. In all these cases, the role of the decision maker(s) is to choose and implement the best option that fits the needs and wants of the community. However, each path to a decision carries the risk of technical and/or financial infeasibility as well as the possibility of unintended consequences. To help reduce this risk, decision makers often rely on some type of predictive analysis from which they can evaluate the projected consequences of their decisions. Typically, decision makers are supported in the analysis process by trusted advisors who engage in the analysis as well as the day to day tasks associated with multi-party negotiations. In the case of water resource management, the analysis is frequently a numerical model or set of models that can simulate various management decisions across multiple systems and output results that illustrate the impact on areas of concern. Thus, in order to communicate scientific knowledge to the decision makers, the quality of the communication between the analysts, the trusted advisor, and the decision maker must be clear and direct. To illustrate this concept, a multi-attribute decision analysis matrix will be used to outline the value of computer model-based collaborative negotiation approaches to guide water resources decision making and communication with decision makers. In addition, the critical role of the trusted advisor and other secondary participants in the decision process will be discussed using examples from recent water negotiations.
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Croft, Hayley; Gilligan, Conor; Rasiah, Rohan; Levett-Jones, Tracy; Schneider, Jennifer
2017-01-01
Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists’ clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply. PMID:29301223
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Croft, Hayley; Gilligan, Conor; Rasiah, Rohan; Levett-Jones, Tracy; Schneider, Jennifer
2017-12-31
Medication review and supply by pharmacists involves both cognitive and technical skills related to the safety and appropriateness of prescribed medicines. The cognitive ability of pharmacists to recall, synthesise and memorise information is a critical aspect of safe and optimal medicines use, yet few studies have investigated the clinical reasoning and decision-making processes pharmacists use when supplying prescribed medicines. The objective of this study was to examine the patterns and processes of pharmacists' clinical reasoning and to identify the information sources used, when making decisions about the safety and appropriateness of prescribed medicines. Ten community pharmacists participated in a simulation in which they were required to review a prescription and make decisions about the safety and appropriateness of supplying the prescribed medicines to the patient, whilst at the same time thinking aloud about the tasks required. Following the simulation each pharmacist was asked a series of questions to prompt retrospective thinking aloud using video-stimulated recall. The simulated consultation and retrospective interview were recorded and transcribed for thematic analysis. All of the pharmacists made a safe and appropriate supply of two prescribed medicines to the simulated patient. Qualitative analysis identified seven core thinking processes used during the supply process: considering prescription in context, retrieving information, identifying medication-related issues, processing information, collaborative planning, decision making and reflection; and align closely with other health professionals. The insights from this study have implications for enhancing awareness of decision making processes in pharmacy practice and informing teaching and assessment approaches in medication supply.
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ERIC Educational Resources Information Center
Bifuh-Ambe, Elizabeth
2013-01-01
Writing is a complex, recursive and difficult process that requires strategic decision-making across multiple domains (Graham, 2006; Pritchard & Honeycutt, 2006). Students are expected to use this process to communicate with a variety of audiences for a variety of purposes. Modelling and providing effective instruction is critical, especially…
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Clinical decision-making of rural novice nurses.
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.
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Climate in Context - How partnerships evolve in regions
NASA Astrophysics Data System (ADS)
Parris, A. S.
2014-12-01
In 2015, NOAA's RISA program will celebrate its 20th year of exploration in the development of usable climate information. In the mid-1990s, a vision emerged to develop interdisciplinary research efforts at the regional scale for several important reasons. Recognizable climate patterns, such as the El Nino Southern Oscillation (ENSO), emerge at the regional level where our understanding of observations and models coalesce. Critical resources for society are managed in a context of regional systems, such as water supply and human populations. Multiple scales of governance (local, state, and federal) with complex institutional relationships can be examined across a region. Climate information (i.e. data, science, research etc) developed within these contexts has greater potential for use. All of this work rests on a foundation of iterative engagement between scientists and decision makers. Throughout these interactions, RISAs have navigated diverse politics, extreme events and disasters, socio-economic and ecological disruptions, and advances in both science and technology. Our understanding of information needs is evolving into a richer understanding of complex institutional, legal, political, and cultural contexts within which people can use science to make informed decisions. The outcome of RISA work includes both cases where climate information was used in decisions and cases where capacity for using climate information and making climate resilient decisions has increased over time. In addition to balancing supply and demand of scientific information, RISAs are engaged in a social process of reconciling climate information use with important drivers of society. Because partnerships are critical for sustained engagement, and because engagement is critically important to the use of science, the rapid development of new capacity in regionally-based science programs focused on providing climate decision support is both needed and challenging. New actors can bolster existing partnerships, but also impact trust developed through engagement. Examining other partnership-driven science initiatives, such as Digital Coast or NIDIS, can help identify critical elements of governance and network management that could be applied to the regional climate programs.
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Integrated Process Modeling-A Process Validation Life Cycle Companion.
Zahel, Thomas; Hauer, Stefan; Mueller, Eric M; Murphy, Patrick; Abad, Sandra; Vasilieva, Elena; Maurer, Daniel; Brocard, Cécile; Reinisch, Daniela; Sagmeister, Patrick; Herwig, Christoph
2017-10-17
During the regulatory requested process validation of pharmaceutical manufacturing processes, companies aim to identify, control, and continuously monitor process variation and its impact on critical quality attributes (CQAs) of the final product. It is difficult to directly connect the impact of single process parameters (PPs) to final product CQAs, especially in biopharmaceutical process development and production, where multiple unit operations are stacked together and interact with each other. Therefore, we want to present the application of Monte Carlo (MC) simulation using an integrated process model (IPM) that enables estimation of process capability even in early stages of process validation. Once the IPM is established, its capability in risk and criticality assessment is furthermore demonstrated. IPMs can be used to enable holistic production control strategies that take interactions of process parameters of multiple unit operations into account. Moreover, IPMs can be trained with development data, refined with qualification runs, and maintained with routine manufacturing data which underlines the lifecycle concept. These applications will be shown by means of a process characterization study recently conducted at a world-leading contract manufacturing organization (CMO). The new IPM methodology therefore allows anticipation of out of specification (OOS) events, identify critical process parameters, and take risk-based decisions on counteractions that increase process robustness and decrease the likelihood of OOS events.
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Decision conflict and regret among surrogate decision makers in the medical intensive care unit.
Miller, Jesse J; Morris, Peter; Files, D Clark; Gower, Emily; Young, Michael
2016-04-01
Family members of critically ill patients in the intensive care unit face significant morbidity. It may be the decision-making process that plays a significant role in the psychological morbidity associated with being a surrogate in the ICU. We hypothesize that family members facing end-of-life decisions will have more decisional conflict and decisional regret than those facing non-end-of-life decisions. We enrolled a sample of adult patients and their surrogates in a tertiary care, academic medical intensive care unit. We queried the surrogates regarding decisions they had made on behalf of the patient and assessed decision conflict. We then contacted the family member again to assess decision regret. Forty (95%) of 42 surrogates were able to identify at least 1 decision they had made on behalf of the patient. End-of-life decisions (defined as do not resuscitate [DNR]/do not intubate [DNI] or continuation of life support) accounted for 19 of 40 decisions (47.5%). Overall, the average Decision Conflict Scale (DCS) score was 21.9 of 100 (range 0-100, with 0 being little decisional conflict and 100 being great decisional conflict). The average DCS score for families facing end-of-life decisions was 25.5 compared with 18.7 for all other decisions. Those facing end-of-life decisions scored higher on the uncertainty subscale (subset of DCS questions that indicates level of certainty regarding decision) with a mean score of 43.4 compared with all other decisions with a mean score of 27.0. Overall, very few surrogates experienced decisional regret with an average DRS score of 13.4 of 100. Nearly all surrogates enrolled were faced with decision-making responsibilities on behalf of his or her critically ill family member. In our small pilot study, we found more decisional conflict in those surrogates facing end-of-life decisions, specifically on the subset of questions dealing with uncertainty. Surrogates report low levels of decisional regret. Copyright © 2015 Elsevier Inc. All rights reserved.
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Dual agency in critical care nursing: Balancing responsibilities towards colleagues and patients.
Trapani, Josef; Scholes, Julie; Cassar, Maria
2016-10-01
To explore critical care nurses' decisions to seek help from doctors. Despite their well-documented role in improving critically ill patients' outcomes, research indicates that nurses rarely take decisions about patients' treatment modalities on their own and constantly need to seek advice or authorization for their clinical decisions, even for protocol-guided actions. However, research around the factors related to, and the actual process of, such referrals is limited. A grounded theory study, underpinned by a symbolic interactionist perspective. Data collection took place in a general intensive care unit between 2010 - 2012 and involved: 20 hours of non-participant and 50 hours of participant observation; ten informal and ten formal interviews; and two focus groups with ten nurses, selected by purposive and theoretical sampling. Data analysis was guided by the dimensional analysis approach to generating grounded theory. Nurses' decisions to seek help from doctors involve weighing up several occasionally conflicting motivators. A central consideration is that of balancing their moral obligation to safeguard patients' interests with their duty to respect doctors' authority. Subsequently, nurses end up in a position of dual agency as they need to concurrently act as an agent to medical practitioners and patients. Nurses' dual agency relationship with patients and doctors may deter their moral obligation of keeping patients' interest as their utmost concern. Nurse leaders and educators should, therefore, enhance nurses' assertiveness, courage and skills to place patients' interest at the forefront of all their actions and interactions. © 2016 John Wiley & Sons Ltd.
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'My kidneys, my choice, decision aid': supporting shared decision making.
Fortnum, Debbie; Smolonogov, Tatiana; Walker, Rachael; Kairaitis, Luke; Pugh, Debbie
2015-06-01
For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.
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Algorithms for optimizing the treatment of depression: making the right decision at the right time.
Adli, M; Rush, A J; Möller, H-J; Bauer, M
2003-11-01
Medication algorithms for the treatment of depression are designed to optimize both treatment implementation and the appropriateness of treatment strategies. Thus, they are essential tools for treating and avoiding refractory depression. Treatment algorithms are explicit treatment protocols that provide specific therapeutic pathways and decision-making tools at critical decision points throughout the treatment process. The present article provides an overview of major projects of algorithm research in the field of antidepressant therapy. The Berlin Algorithm Project and the Texas Medication Algorithm Project (TMAP) compare algorithm-guided treatments with treatment as usual. The Sequenced Treatment Alternatives to Relieve Depression Project (STAR*D) compares different treatment strategies in treatment-resistant patients.
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Heggland, Liv-Helen; Hausken, Kjell
2013-05-01
The aim of this article is to identify how health care professionals and patients experience patient participation in decision-making processes in hospitals. Eighteen semi-structured interviews with experts from different disciplines such as medicine and nursing in surgical departments as well as patients who have undergone surgical treatment constitute the data. By content analysis four categories of patient participation were identified: information dissemination, formulation of options, integration of information, and control. To meet the increasing demands of patient participation, this categorization with four identified critical areas for participation in decision-making has important implications in guiding information support for patients prior to surgery and during hospitalization.
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Strategic Directions Within Health Care Institutions: The Role of the Physician
McDaniel, Reuben R.; Ashmos, Donde P.
1986-01-01
The nature of the strategic problem faced by health care institutions is identified. Physicians are urged to be involved in the strategic decision-making process and are offered several alternative roles that they might play in strategy development. A set of conceptual frameworks from the generic management decision-making literature is used to organize the analysis in addition to the literature of health care management. This combination affords a different perspective into the nature of the problems and new insights into these critical issues. PMID:3746932
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Improving management decision processes through centralized communication linkages
NASA Technical Reports Server (NTRS)
Simanton, D. F.; Garman, J. R.
1985-01-01
Information flow is a critical element to intelligent and timely decision-making. At NASA's Johnson Space Center the flow of information is being automated through the use of a centralized backbone network. The theoretical basis of this network, its implications to the horizontal and vertical flow of information, and the technical challenges involved in its implementation are the focus of this paper. The importance of the use of common tools among programs and some future concerns related to file transfer, graphics transfer, and merging of voice and data are also discussed.
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NASA Astrophysics Data System (ADS)
Andres Rodriguez, Daniel; Garofolo, Lucas; Lazaro Siqueira Junior, Jose
2013-04-01
Uncertainties in Climate Change projections are affected by irreducible uncertainties due to knowledge's limitations, chaotic nature of climate system and human decision-making process. Such uncertainties affect the impact studies, complicating the decision-making process aimed at mitigation and adaptation. However, these uncertainties allow the possibility to develop exploratory analyses on system's vulnerability to different sceneries. Through these kinds of analyses it is possible to identify critical issues, which must be deeper studied. For this study we used several future's projections from General Circulation Models to feed a Hydrological Model, applied to the Amazonian sub-basin of Ji-Paraná. Hydrological Model integrations are performed for present historical time (1970-1990) and for future period (2010-2100). Extreme values analyses are performed to each simulated time series and results are compared with extremes events in present time. A simple approach to identify potential vulnerabilities consists of evaluating the hydrologic system response to climate variability and extreme events observed in the past, comparing them with the conditions projected for the future. Thus it is possible to identify critical issues that need attention and more detailed studies. For the goal of this work, we used socio-economic data from Brazilian Institute of Geography and Statistics, the Operator of the National Electric System, the Brazilian National Water Agency and scientific and press published information. This information is used to characterize impacts associated to extremes hydrological events in the basin during the present historical time and to evaluate potential impacts in the future face to the different hydrological projections. Results show inter-model variability results in a broad dispersion on projected extreme's values. The impact of such dispersion is differentiated for different aspects of socio-economic and natural systems and must be carefully addressed in order to help in decision-making processes.
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Heidari, Mohammad; Shahbazi, Sara
2016-01-01
Background: The aim of this study was to determine the effect of problem-solving training on decision-making skill and critical thinking in emergency medical personnel. Materials and Methods: This study is an experimental study that performed in 95 emergency medical personnel in two groups of control (48) and experimental (47). Then, a short problem-solving course based on 8 sessions of 2 h during the term, was performed for the experimental group. Of data gathering was used demographic and researcher made decision-making and California critical thinking skills questionnaires. Data were analyzed using SPSS software. Results: The finding revealed that decision-making and critical thinking score in emergency medical personnel are low and problem-solving course, positively affected the personnel’ decision-making skill and critical thinking after the educational program (P < 0.05). Conclusions: Therefore, this kind of education on problem-solving in various emergency medicine domains such as education, research, and management, is recommended. PMID:28149823
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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.
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Evolutionary game dynamics of controlled and automatic decision-making
NASA Astrophysics Data System (ADS)
Toupo, Danielle F. P.; Strogatz, Steven H.; Cohen, Jonathan D.; Rand, David G.
2015-07-01
We integrate dual-process theories of human cognition with evolutionary game theory to study the evolution of automatic and controlled decision-making processes. We introduce a model in which agents who make decisions using either automatic or controlled processing compete with each other for survival. Agents using automatic processing act quickly and so are more likely to acquire resources, but agents using controlled processing are better planners and so make more effective use of the resources they have. Using the replicator equation, we characterize the conditions under which automatic or controlled agents dominate, when coexistence is possible and when bistability occurs. We then extend the replicator equation to consider feedback between the state of the population and the environment. Under conditions in which having a greater proportion of controlled agents either enriches the environment or enhances the competitive advantage of automatic agents, we find that limit cycles can occur, leading to persistent oscillations in the population dynamics. Critically, however, these limit cycles only emerge when feedback occurs on a sufficiently long time scale. Our results shed light on the connection between evolution and human cognition and suggest necessary conditions for the rise and fall of rationality.
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Evolutionary game dynamics of controlled and automatic decision-making.
Toupo, Danielle F P; Strogatz, Steven H; Cohen, Jonathan D; Rand, David G
2015-07-01
We integrate dual-process theories of human cognition with evolutionary game theory to study the evolution of automatic and controlled decision-making processes. We introduce a model in which agents who make decisions using either automatic or controlled processing compete with each other for survival. Agents using automatic processing act quickly and so are more likely to acquire resources, but agents using controlled processing are better planners and so make more effective use of the resources they have. Using the replicator equation, we characterize the conditions under which automatic or controlled agents dominate, when coexistence is possible and when bistability occurs. We then extend the replicator equation to consider feedback between the state of the population and the environment. Under conditions in which having a greater proportion of controlled agents either enriches the environment or enhances the competitive advantage of automatic agents, we find that limit cycles can occur, leading to persistent oscillations in the population dynamics. Critically, however, these limit cycles only emerge when feedback occurs on a sufficiently long time scale. Our results shed light on the connection between evolution and human cognition and suggest necessary conditions for the rise and fall of rationality.
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NASA Astrophysics Data System (ADS)
JiméNez-Aleixandre, Maria-Pilar
2002-11-01
This paper describes a case study involving decision making and argumentation, in the context of wetland environmental management, by 11th-grade students (16-17 years old). The purpose was to study the components of knowledge and skills needed to reach a decision in socio-scientific contexts and to identify them in classroom discourse. The following dimensions of decision making were explored: the use of relevant knowledge to understand and make decisions about the problem; and the critical processing of sources of information and authority and the development of criteria for evaluating possible solutions to the problem. Students' conversations were recorded and analysed using Toulmin's (1958) and Walton's (1996) argument schemes. The students' arguments and warrants were compared with the argument of an external 'official' expert. Issues such as expert status, that is, who can be considered as a source of knowledge and authority and the participation of citizens in scientific practice are also discussed.
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A Cross-Layer User Centric Vertical Handover Decision Approach Based on MIH Local Triggers
NASA Astrophysics Data System (ADS)
Rehan, Maaz; Yousaf, Muhammad; Qayyum, Amir; Malik, Shahzad
Vertical handover decision algorithm that is based on user preferences and coupled with Media Independent Handover (MIH) local triggers have not been explored much in the literature. We have developed a comprehensive cross-layer solution, called Vertical Handover Decision (VHOD) approach, which consists of three parts viz. mechanism for collecting and storing user preferences, Vertical Handover Decision (VHOD) algorithm and the MIH Function (MIHF). MIHF triggers the VHOD algorithm which operates on user preferences to issue handover commands to mobility management protocol. VHOD algorithm is an MIH User and therefore needs to subscribe events and configure thresholds for receiving triggers from MIHF. In this regard, we have performed experiments in WLAN to suggest thresholds for Link Going Down trigger. We have also critically evaluated the handover decision process, proposed Just-in-time interface activation technique, compared our proposed approach with prominent user centric approaches and analyzed our approach from different aspects.
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Putting the value into biosimilar decision making: the judgment value criteria.
Mendes de Abreu, Mirhelen; Strand, Vibeke; Levy, Roger Abramino; Araujo, Denizar Vianna
2014-06-01
Uncertainties remain the key issue surrounding biosimilars, although decisions regarding their use must be made. The challenges for policymakers, doctors, patients and others seeking to navigate in the uncharted waters of biosimilars must be clarified. At the most basic level, scientific understanding of the issue remains limited and when making decisions, policymakers must consider all those affected by health policy decisions, particularly the ultimate recipients of these medicines: the patients. The biosimilar-value chain relies on measurement of comparabilities. The goal is to demonstrate how, from a molecular perspective, closely similar they are or are not and how potential small differences may be relevant to clinical outcomes. To critically understand these points, this conceptual paper will present a knowledge-value chain and discuss each dimension assigning value in the decision making process re-utilization of biosimilars. Copyright © 2014 Elsevier B.V. All rights reserved.
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Integration of Planetary Protection Activities
NASA Technical Reports Server (NTRS)
Race, Margaret S.
2000-01-01
Research and activities under this grant have focused on a systematic examination and analysis of critical questions likely to impact planetary protection (PP) controls and implementation for Mars sample return missions (MSR). Four areas in the non-scientific and social realms were selected for special attention because of their importance to future mission planning and concern about critical timing or possible economic impacts on MSR mission implementation. These include: (1) questions of legal uncertainty and the decision making process, (2) public perception of risks associated with sample return, (3) risk communication and Education/Public Outreach , and (4) planetary protection implications of alternative mission architectures, for both robotic and human sample return missions. In its entirety, NAG 2-986 has encompassed three categories of activity: (1) research and analysis (Race), (2) subcontracted research (MacGregor/Decision Research), and (3) consulting services.
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Using cognitive task analysis to identify critical decisions in the laparoscopic environment.
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.
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FEATURES, EVENTS, AND PROCESSES: SYSTEM-LEVEL AND CRITICALITY
DOE Office of Scientific and Technical Information (OSTI.GOV)
D.L. McGregor
The primary purpose of this Analysis/Model Report (AMR) is to identify and document the screening analyses for the features, events, and processes (FEPs) that do not easily fit into the existing Process Model Report (PMR) structure. These FEPs include the 3 1 FEPs designated as System-Level Primary FEPs and the 22 FEPs designated as Criticality Primary FEPs. A list of these FEPs is provided in Section 1.1. This AMR (AN-WIS-MD-000019) documents the Screening Decision and Regulatory Basis, Screening Argument, and Total System Performance Assessment (TSPA) Disposition for each of the subject Primary FEPs. This AMR provides screening information and decisionsmore » for the TSPA-SR report and provides the same information for incorporation into a project-specific FEPs database. This AMR may also assist reviewers during the licensing-review process.« less
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Murphy, Matthew; MacCarthy, M Jayne; McAllister, Lynda; Gilbert, Robert
2014-12-05
Competency profiles for occupational clusters within Canada's substance abuse workforce (SAW) define the need for skill and knowledge in evidence-based practice (EBP) across all its members. Members of the Senior Management occupational cluster hold ultimate responsibility for decisions made within addiction services agencies and therefore must possess the highest level of proficiency in EBP. The objective of this study was to assess the knowledge of the principles of EBP, and use of the components of the evidence-based decision making (EBDM) process in members of this occupational cluster from selected addiction services agencies in Nova Scotia. A convenience sampling method was used to recruit participants from addiction services agencies. Semi-structured qualitative interviews were conducted with eighteen Senior Management. The interviews were audio-recorded, transcribed verbatim and checked by the participants. Interview transcripts were coded and analyzed for themes using content analysis and assisted by qualitative data analysis software (NVivo 9.0). Data analysis revealed four main themes: 1) Senior Management believe that addictions services agencies are evidence-based; 2) Consensus-based decision making is the norm; 3) Senior Management understand the principles of EBP and; 4) Senior Management do not themselves use all components of the EBDM process when making decisions, oftentimes delegating components of this process to decision support staff. Senior Management possess an understanding of the principles of EBP, however, when making decisions they often delegate components of the EBDM process to decision support staff. Decision support staff are not defined as an occupational cluster in Canada's SAW and have not been ascribed a competency profile. As such, there is no guarantee that this group possesses competency in EBDM. There is a need to advocate for the development of a defined occupational cluster and associated competency profile for this critical group.
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The Critical Middle: A Reason for Hope
ERIC Educational Resources Information Center
Maryland State Department of Education, 2008
2008-01-01
The middle grades are a time of change for adolescent learners. Middle schoolers are in the process of refining their social skills and their self-concept. They begin taking responsibility for their education and making decisions about their own learning. They start planning for college and careers, understanding for the first time how their…
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Some New Facets of the Psychology-Law Interface.
ERIC Educational Resources Information Center
Freeman, James T.
While the field of forensic psychology has emerged as a recognized discipline, psychologists who work within institutional settings frequently feel frustration in dealing with inmates for whom they have had no responsibility or input during the critical pre-trial, trial and sentencing decision-making process. The roles and ways in which psychology…
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Quality assurance, training, and certification in ozone air pollution studies
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...
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-03-22
... Indian scientists critically examined the techniques, the appropriateness of experimental design, the... are, even if true, legally insufficient to alter the decision, the Agency need not grant a hearing... objection fails to note that many of the findings cited in the experimental report were observed both in...
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Educational Reform in South Africa: Decentralization and Parent Engagement
ERIC Educational Resources Information Center
Joubert, Rika; van Rooyen, Jean W.
2011-01-01
The promulgation of the South African Schools Act in 1996 was a critical moment in the process of making a compromise between a centralized and a decentralized system. The act describes the establishment, membership, and responsibilities of school governing bodies as the vehicle for parental engagement and decision making. The article touches on…
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Identifying and Evaluating External Validity Evidence for Passing Scores
ERIC Educational Resources Information Center
Davis-Becker, Susan L.; Buckendahl, Chad W.
2013-01-01
A critical component of the standard setting process is collecting evidence to evaluate the recommended cut scores and their use for making decisions and classifying students based on test performance. Kane (1994, 2001) proposed a framework by which practitioners can identify and evaluate evidence of the results of the standard setting from (1)…
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Reading on the Internet: Realizing and Constructing Potential Texts
ERIC Educational Resources Information Center
Cho, Byeong-Young; Afflerbach, Peter
2015-01-01
Successful Internet reading requires making strategic decisions about what texts to read and a sequence for reading them, all in accordance with readers' goals. In this paper, we describe the process of realizing and constructing potential texts as an important and critical part of successful Internet reading and use verbal report data to…
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Education, Science and Technology in Mexico: Challenges for Innovation
ERIC Educational Resources Information Center
Gómez-Merino, Fernando Carlos; Trejo-Téllez, Libia Iris; Méndez-Cadena, María Esther; Hernández-Cázares, Aleida Selene
2017-01-01
The innovation process is founded on a high-quality education system at all levels, which trains scientists and technologists capable of generating innovations. Education is the most decisive factor in human development, yet in Mexico current statistics reveal a critical situation at every educational level, as only 1 out of every 10 children…
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Advocacy and Ideology: Confrontation in a Rural School District.
ERIC Educational Resources Information Center
McKerrow, Kelly
This paper presents a critical qualitative account and analysis of resistance and contestation over the decision-making process in a special education program. The parties involved were four parent advocates, who formed an advocacy organization, and the school administration in a rural school district in the Midwest. A subtle but powerful bias…
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Morphological Effects in Auditory Word Recognition: Evidence from Danish
ERIC Educational Resources Information Center
Balling, Laura Winther; Baayen, R. Harald
2008-01-01
In this study, we investigate the processing of morphologically complex words in Danish using auditory lexical decision. We document a second critical point in auditory comprehension in addition to the Uniqueness Point (UP), namely the point at which competing morphological continuation forms of the base cease to be compatible with the input,…
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ERIC Educational Resources Information Center
Dorner, Lisa M.
2012-01-01
Implementing policies relies on their design, the will and capacity of implementors, the organizations within which implementation occurs, and individuals' interpretations. Despite the fact that families' decisions are critical to the successful implementation of educational programs, however, few studies examine their sense-making processes.…
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ERIC Educational Resources Information Center
Gelinas, Ulric J., Jr.; Rama, D. V.; Skelton, Terrance M.
1997-01-01
Profiles a writing-across-the-curriculum project in an accountancy program. Notes that the team's collaborative process produced three critical planning decisions: (1) establishing "fitness-for-use" for evaluating student communications; (2) selecting only those forms of communication used in accountancy; and (3) teaching only those…
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A Theory of Argumentation, Rhetorical Criticism and the Universal Audience.
ERIC Educational Resources Information Center
Rohrer, Daniel Morgan
Emphasizing the need for sound logic in the decision making and policy making process, this paper equates the concept of rationality with the universal audience as a means of analyzing argument, evaluating rhetoric, and persuading audiences. The paper argues that the policy systems paradigm most approximates this objective within the context of…
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Who Gets In and Why: A Former Admissions Officer Tells All.
ERIC Educational Resources Information Center
Gose, Ben
1997-01-01
A former Dartmouth College (New Hampshire) admissions officer has written a book about the college admissions process at Ivy League and other selective colleges. She details factors in admissions decision making that contradict stated policies and admissions principles. Admissions professionals at Dartmouth and other colleges criticize the book as…
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How fast and how often: The pharmacokinetics of drug use are decisive in addiction.
Allain, Florence; Minogianis, Ellie-Anna; Roberts, David C S; Samaha, Anne-Noël
2015-09-01
How much, how often and how fast a drug reaches the brain determine the behavioural and neuroplastic changes associated with the addiction process. Despite the critical nature of these variables, the drug addiction field often ignores pharmacokinetic issues, which we argue can lead to false conclusions. First, we review the clinical data demonstrating the importance of the speed of drug onset and of intermittent patterns of drug intake in psychostimulant drug addiction. This is followed by a review of the preclinical literature demonstrating that pharmacokinetic variables play a decisive role in determining behavioural and neurobiological outcomes in animal models of addiction. This literature includes recent data highlighting the importance of intermittent, 'spiking' brain levels of drug in producing an increase in the motivation to take drug over time. Rapid drug onset and intermittent drug exposure both appear to push the addiction process forward most effectively. This has significant implications for refining animal models of addiction and for better understanding the neuroadaptations that are critical for the disorder. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Propp, Kathleen M; Apker, Julie; Zabava Ford, Wendy S; Wallace, Nancy; Serbenski, Michele; Hofmeister, Nancee
2010-01-01
Nurses occupy a central position in today's increasingly collaborative health care teams that place a premium on quality patient care. In this study we examined critical team processes and identified specific nurse-team communication practices that were perceived by team members to enhance patient outcomes. Fifty patient-care team members were interviewed to uncover forms of nurse communication perceived to improve team performance. Using a grounded theory approach and constant comparative analysis, study findings reveal two critical processes nurses contribute to as the most central and consistent members of the health care team: ensuring quality decisions and promoting a synergistic team. Moreover, the findings reveal 15 specific nurse-team communication practices that comprise these processes, and thereby are theorized to improve patient outcomes.
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Investigating Miranda waiver decisions: An examination of the rational consequences.
Blackwood, Hayley L; Rogers, Richard; Steadham, Jennifer A; Fiduccia, Chelsea E
2015-01-01
Millions of custodial suspects waive their Miranda rights each year without the benefit of legal counsel. Miranda understanding, appreciation, and reasoning abilities are essential to courts' acceptance of Miranda waivers (Grisso, 2003; Rogers & Shuman, 2005). The question posed to forensic psychologists and psychiatrists in the disputed Miranda waivers is whether a particular waiver decision was knowing, intelligent, and voluntary. Despite the remarkable development of Miranda research in recent decades, studies have generally focused on understanding and appreciation of Miranda rights, but with comparatively minimal emphasis on Miranda reasoning and attendant waiver decisions. Research on defendants' decisional capacities constitutes a critical step in further developing theoretical and clinical models for Miranda waiver decisions. The current study evaluated Miranda waiver decisions for 80 pretrial defendants from two Oklahoma jails to study systematically how rational decision abilities affect defendants' personal waiver decisions. In stark contrast to what was expected, many defendants were able to identify a rational decisional process in their own legal cases, yet cast such reasoning aside and chose a completely contradictory Miranda waiver decision. Published by Elsevier Ltd.
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The approaches for the decision support in case natural hazards
NASA Astrophysics Data System (ADS)
Vyazilov, Evgeny; Chunyaev, Nikita
2013-04-01
In spite of using highly automated systems of measurement, collecting, storing, handling, prediction and delivery of information on the marine environment, including natural hazards, the amount of damage from natural phenomena increases. Because information on the marine environment delivered to the industrial facilities not effectively used. To such information pays little attention by individual decision-makers and not always perform preventive measures necessary for reduce and prevent damage. Automation of information support will improve the efficiency management of the marine activities. In Russia develops "The Unified system of the information about World ocean" (ESIMO, http://esimo.ru/), that integrates observation, analysis, prognostic and climate data. Necessary to create tools to automatic selection natural disasters through all integrated data; notification decision-makers about arising natural hazards - software agent; provision of information in a compact form for the decision-makers; assessment of possible damage and costs to the preventive measures; providing information on the impacts of environment on economic facilities and recommendations for decision-making; the use of maps, diagrams, tables for reporting. Tools for automatic selection designed for identification of natural phenomena based on the resources ESIMO and corresponding critical values of the indicators environment. The result of this module will be constantly updated database of critical situations of environment for each object or technological process. To operational notify and provide current information about natural hazards proposes using a software agent that is installed on the computer decision-makers, which is activated in case critical situations and provides a minimum of information. In the event of natural disaster software agent should be able to inform decision-makers about this, providing information on the current situation, and the possibility for more and detailed information about natural hazard. Software agent must be able to be configured by the user to a specific object: a specific station or a drilling rigs that region or area, regardless of the size of the object. And depending on the selected settings and parameters it needs to apply the values of critical indexes. There is a need for real-time display hydrometeorological information with compact scheme that reflects the environment indicators that affect industrial facility in the form of devices (thermometer, aneroid, footstock, speedometer, hygrometer, thermograph, barograph, rain gauge, wind vane, etc.) with the ability to display indicators exceed a critical value. This scheme is designed to provide maximum information in the shortest possible time reference that provides an intuitive interface (display by generally accepted standardized instruments). Analytical services ESIMO combined with geographic information service provides information about area or point to decision-makers of showing the dynamics of changes of parameters in the form of graphics, diagrams, maps, tables. If the data sources are updated, analytical services automatically provides the relevance of the data in the analytical views of the complex. Analytical services works with database of integrated data and used for the preparation and presentation of the consumers of the federal and regional level for the analysis of information on the World Oceans. The analytic services show a set of indicators about the situation in the World Ocean. The complex provides the processing, analysis of qualitative and quantitative characteristics (indexes) of the marine environment and maritime activities of the Russian Federation. To assess the need for preventive measures, decision-makers require information in the form of potential economic consequences of natural hazard, cost of preventive measures to prevent damage. We can use for that the economic and mathematical models. When making the decision decision-makers must understand the possible consequences of natural phenomena and rely on the advice that they receive from a decision support system. Such information about the impacts and recommendations are based on the knowledge base (rules of "if, then"), formed on the basis of experience gained in the past. This should take into account not only the critical values for each object and technological process, but also the type of information (observations, forecasting, climate, and after the phenomenon), the level of decision-making, the season of the year, the climate zone where the object is located. Within ESIMO created integrated database that containing the results of the monitoring of the marine environment. The database includes the observation, analysis, and forecasting and climate data. Operational data is updated automatically at specified intervals of a few minutes to a week, depending on the frequency of observations. Climatic data is updated as needed, for example, once a year or once every five years. Integrated database contains a set of indicators related to a specific object, and to a certain geographic area, according to the observations made and the data entered data. In addition to hydrometeorological parameters database contains socio-economic information. At present, was created the database of critical values and information about the impacts of and recommendations for the 30 natural hazards, developed the data structure and software is under development. The interaction of all components of an information support will reduce the economic damage from natural disaster on individual objects economy (ships, ports, etc.) and improve public safety through more prompt delivery of information to decision-makers and the public, besides receive more informative data (district with symptoms natural phenomena , assessment of possible damage, the impact of and recommendations).
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EHR in emergency rooms: exploring the effect of key information components on main complaints.
Ben-Assuli, Ofir; Shabtai, Itamar; Leshno, Moshe; Hill, Shawndra
2014-04-01
This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors' decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians' decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients' medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Adam, J. C.; Stephens, J. C.; Chung, Serena
As managers of agricultural and natural resources are confronted with uncertainties in global change impacts, the complexities associated with the interconnected cycling of nitrogen, carbon, and water present daunting management challenges. Existing models provide detailed information on specific sub-systems (land, air, water, economics, etc). An increasing awareness of the unintended consequences of management decisions resulting from interconnectedness of these sub-systems, however, necessitates coupled regional earth system models (EaSMs). Decision makers’ needs and priorities can be integrated into the model design and development processes to enhance decision-making relevance and "usability" of EaSMs. BioEarth is a current research initiative with a focusmore » on the U.S. Pacific Northwest region that explores the coupling of multiple stand-alone EaSMs to generate usable information for resource decision-making. Direct engagement between model developers and non-academic stakeholders involved in resource and environmental management decisions throughout the model development process is a critical component of this effort. BioEarth utilizes a "bottom-up" approach, upscaling a catchment-scale model to basin and regional scales, as opposed to the "top-down" approach of downscaling global models utilized by most other EaSM efforts. This paper describes the BioEarth initiative and highlights opportunities and challenges associated with coupling multiple stand-alone models to generate usable information for agricultural and natural resource decision-making.« less
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Healthcare4VideoStorm: Making Smart Decisions Based on Storm Metrics.
Zhang, Weishan; Duan, Pengcheng; Chen, Xiufeng; Lu, Qinghua
2016-04-23
Storm-based stream processing is widely used for real-time large-scale distributed processing. Knowing the run-time status and ensuring performance is critical to providing expected dependability for some applications, e.g., continuous video processing for security surveillance. The existing scheduling strategies' granularity is too coarse to have good performance, and mainly considers network resources without computing resources while scheduling. In this paper, we propose Healthcare4Storm, a framework that finds Storm insights based on Storm metrics to gain knowledge from the health status of an application, finally ending up with smart scheduling decisions. It takes into account both network and computing resources and conducts scheduling at a fine-grained level using tuples instead of topologies. The comprehensive evaluation shows that the proposed framework has good performance and can improve the dependability of the Storm-based applications.
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Toward a methodology for moral decision making in medicine.
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.
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Hebscher, Melissa; Gilboa, Asaf
2016-09-01
The ventromedial prefrontal cortex (vmPFC) has been implicated in a wide array of functions across multiple domains. In this review, we focus on the vmPFC's involvement in mediating strategic aspects of memory retrieval, memory-related schema functions, and decision-making. We suggest that vmPFC generates a confidence signal that informs decisions and memory-guided behaviour. Confidence is central to these seemingly diverse functions: (1) Strategic retrieval: lesions to the vmPFC impair an early, automatic, and intuitive monitoring process ("feeling of rightness"; FOR) often associated with confabulation (spontaneous reporting of erroneous memories). Critically, confabulators typically demonstrate high levels of confidence in their false memories, suggesting that faulty monitoring following vmPFC damage may lead to indiscriminate confidence signals. (2) Memory schemas: the vmPFC is critically involved in instantiating and maintaining contextually relevant schemas, broadly defined as higher level knowledge structures that encapsulate lower level representational elements. The correspondence between memory retrieval cues and these activated schemas leads to FOR monitoring. Stronger, more elaborate schemas produce stronger FOR and influence confidence in the veracity of memory candidates. (3) Finally, we review evidence on the vmPFC's role in decision-making, extending this role to decision-making during memory retrieval. During non-mnemonic and mnemonic decision-making the vmPFC automatically encodes confidence. Confidence signal in the vmPFC is revealed as a non-linear relationship between a first-order monitoring assessment and second-order action or choice. Attempting to integrate the multiple functions of the vmPFC, we propose a posterior-anterior organizational principle for this region. More posterior vmPFC regions are involved in earlier, automatic, subjective, and contextually sensitive functions, while more anterior regions are involved in controlled actions based on these earlier functions. Confidence signals reflect the non-linear relationship between first-order, posterior-mediated and second-order, anterior-mediated processes and are represented along the entire axis. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Christian, Michael D; Sprung, Charles L; King, Mary A; Dichter, Jeffrey R; Kissoon, Niranjan; Devereaux, Asha V; Gomersall, Charles D
2014-10-01
Pandemics and disasters can result in large numbers of critically ill or injured patients who may overwhelm available resources despite implementing surge-response strategies. If this occurs, critical care triage, which includes both prioritizing patients for care and rationing scarce resources, will be required. The suggestions in this chapter are important for all who are involved in large-scale pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Triage topic panel reviewed previous task force suggestions and the literature to identify 17 key questions for which specific literature searches were then conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Suggestions from the previous task force that were not being updated were also included for validation by the expert panel. The suggestions from the task force outline the key principles upon which critical care triage should be based as well as a path for the development of the plans, processes, and infrastructure required. This article provides 11 suggestions regarding the principles upon which critical care triage should be based and policies to guide critical care triage. Ethical and efficient critical care triage is a complex process that requires significant planning and preparation. At present, the prognostic tools required to produce an effective decision support system (triage protocol) as well as the infrastructure, processes, legal protections, and training are largely lacking in most jurisdictions. Therefore, critical care triage should be a last resort after mass critical care surge strategies.
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Lieder, Falk; Griffiths, Thomas L; Hsu, Ming
2018-01-01
People's decisions and judgments are disproportionately swayed by improbable but extreme eventualities, such as terrorism, that come to mind easily. This article explores whether such availability biases can be reconciled with rational information processing by taking into account the fact that decision makers value their time and have limited cognitive resources. Our analysis suggests that to make optimal use of their finite time decision makers should overrepresent the most important potential consequences relative to less important, put potentially more probable, outcomes. To evaluate this account, we derive and test a model we call utility-weighted sampling. Utility-weighted sampling estimates the expected utility of potential actions by simulating their outcomes. Critically, outcomes with more extreme utilities have a higher probability of being simulated. We demonstrate that this model can explain not only people's availability bias in judging the frequency of extreme events but also a wide range of cognitive biases in decisions from experience, decisions from description, and memory recall. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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Mission, Margin, and the Role of Consumer Governance in Decision-Making at Community Health Centers
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
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Downey, Erin L; Andress, Knox; Schultz, Carl H
2013-06-01
The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita. This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument. Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to identify and coordinate with community resources. Hospital evacuation requires coordinated processes and resources, including situational awareness that reflects the condition of the community as a result of the incident. Successful hospital evacuation decision making is influenced by community-wide situational awareness and transportation deficits. Planning with the community to create realistic EOPs that accurately reflect available resources and protocols is critical to informing hospital decision making during a crisis. Knowledge of these factors could improve decision making and evacuation practices, potentially reducing evacuation times in future hurricanes.
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Flamm, Richard Owen; Reynolds, John Elliot; Harmak, Craig
2013-01-01
We used southwestern Florida as a case study to lay the groundwork for an intended and organized decision-making process for managing warm-water habitat needed by endangered manatees to survive winters in Florida. Scientists and managers have prioritized (a) projecting how the network of warm-water sites will change over the next 50 years as warmed industrial discharges may expire and as flows of natural springs are reduced through redirection of water for human uses, and (b) mitigating such changes to prevent undue consequences to manatees. Given the complexities introduced by manatee ecology; agency organizational structure; shifting public demands; fluctuating resource availability; and managing within interacting cultural, social, political, and environmental contexts, it was clear that a structured decision process was needed. To help promote such a process, we collected information relevant to future decisions including maps of known and suspected warm-water sites and prototyped a characterization of sites and networks. We propose steps that would lead to models that might serve as core tools in manatee/warm-water decision-making, and we summarized topics relevant for informed decision-making (e.g., manatee spatial cognition, risk of cold-stress morbidity and mortality, and human dimensions). A major impetus behind this effort is to ensure proactively that robust modeling tools are available well in advance of the anticipated need for a critical management decision.
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NASA Astrophysics Data System (ADS)
Flamm, Richard Owen; Reynolds, John Elliot; Harmak, Craig
2013-01-01
We used southwestern Florida as a case study to lay the groundwork for an intended and organized decision-making process for managing warm-water habitat needed by endangered manatees to survive winters in Florida. Scientists and managers have prioritized (a) projecting how the network of warm-water sites will change over the next 50 years as warmed industrial discharges may expire and as flows of natural springs are reduced through redirection of water for human uses, and (b) mitigating such changes to prevent undue consequences to manatees. Given the complexities introduced by manatee ecology; agency organizational structure; shifting public demands; fluctuating resource availability; and managing within interacting cultural, social, political, and environmental contexts, it was clear that a structured decision process was needed. To help promote such a process, we collected information relevant to future decisions including maps of known and suspected warm-water sites and prototyped a characterization of sites and networks. We propose steps that would lead to models that might serve as core tools in manatee/warm-water decision-making, and we summarized topics relevant for informed decision-making (e.g., manatee spatial cognition, risk of cold-stress morbidity and mortality, and human dimensions). A major impetus behind this effort is to ensure proactively that robust modeling tools are available well in advance of the anticipated need for a critical management decision.
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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.
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How robotics programs influence young women's career choices : a grounded theory model
NASA Astrophysics Data System (ADS)
Craig, Cecilia Dosh-Bluhm
The fields of engineering, computer science, and physics have a paucity of women despite decades of intervention by universities and organizations. Women's graduation rates in these fields continue to stagnate, posing a critical problem for society. This qualitative grounded theory (GT) study sought to understand how robotics programs influenced young women's career decisions and the program's effect on engineering, physics, and computer science career interests. To test this, a study was mounted to explore how the FIRST (For Inspiration and Recognition of Science and Technology) Robotics Competition (FRC) program influenced young women's college major and career choices. Career theories suggested that experiential programs coupled with supportive relationships strongly influence career decisions, especially for science, technology, engineering, and mathematics careers. The study explored how and when young women made career decisions and how the experiential program and! its mentors and role models influenced career choice. Online focus groups and interviews (online and face-to-face) with 10 female FRC alumnae and GT processes (inductive analysis, open coding, categorizations using mind maps and content clouds) were used to generate a general systems theory style model of the career decision process for these young women. The study identified gender stereotypes and other career obstacles for women. The study's conclusions include recommendations to foster connections to real-world challenges, to develop training programs for mentors, and to nurture social cohesion, a mostly untapped area. Implementing these recommendations could help grow a critical mass of women in engineering, physics, and computer science careers, a social change worth pursuing.
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NASA Astrophysics Data System (ADS)
Spahr, K.; Hogue, T. S.
2016-12-01
Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.
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Exploratory Decision-Making as a Function of Lifelong Experience, Not Cognitive Decline
2016-01-01
Older adults perform worse than younger adults in some complex decision-making scenarios, which is commonly attributed to age-related declines in striatal and frontostriatal processing. Recently, this popular account has been challenged by work that considered how older adults’ performance may differ as a function of greater knowledge and experience, and by work showing that, in some cases, older adults outperform younger adults in complex decision-making tasks. In light of this controversy, we examined the performance of older and younger adults in an exploratory choice task that is amenable to model-based analyses and ostensibly not reliant on prior knowledge. Exploration is a critical aspect of decision-making poorly understood across the life span. Across 2 experiments, we addressed (a) how older and younger adults differ in exploratory choice and (b) to what extent observed differences reflect processing capacity declines. Model-based analyses suggested that the strategies used by the 2 groups were qualitatively different, resulting in relatively worse performance for older adults in 1 decision-making environment but equal performance in another. Little evidence was found that differences in processing capacity drove performance differences. Rather the results suggested that older adults’ performance might result from applying a strategy that may have been shaped by their wealth of real-word decision-making experience. While this strategy is likely to be effective in the real world, it is ill suited to some decision environments. These results underscore the importance of taking into account effects of experience in aging studies, even for tasks that do not obviously tap past experiences. PMID:26726916
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Hsu, Chun-Wei; Goh, Joshua O. S.
2016-01-01
When comparing between the values of different choices, human beings can rely on either more cognitive processes, such as using mathematical computation, or more affective processes, such as using emotion. However, the neural correlates of how these two types of processes operate during value-based decision-making remain unclear. In this study, we investigated the extent to which neural regions engaged during value-based decision-making overlap with those engaged during mathematical and emotional processing in a within-subject manner. In a functional magnetic resonance imaging experiment, participants viewed stimuli that always consisted of numbers and emotional faces that depicted two choices. Across tasks, participants decided between the two choices based on the expected value of the numbers, a mathematical result of the numbers, or the emotional face stimuli. We found that all three tasks commonly involved various cortical areas including frontal, parietal, motor, somatosensory, and visual regions. Critically, the mathematical task shared common areas with the value but not emotion task in bilateral striatum. Although the emotion task overlapped with the value task in parietal, motor, and sensory areas, the mathematical task also evoked responses in other areas within these same cortical structures. Minimal areas were uniquely engaged for the value task apart from the other two tasks. The emotion task elicited a more expansive area of neural activity whereas value and mathematical task responses were in more focal regions. Whole-brain spatial correlation analysis showed that valuative processing engaged functional brain responses more similarly to mathematical processing than emotional processing. While decisions on expected value entail both mathematical and emotional processing regions, mathematical processes have a more prominent contribution particularly in subcortical processes. PMID:27375466
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Hsu, Chun-Wei; Goh, Joshua O S
2016-01-01
When comparing between the values of different choices, human beings can rely on either more cognitive processes, such as using mathematical computation, or more affective processes, such as using emotion. However, the neural correlates of how these two types of processes operate during value-based decision-making remain unclear. In this study, we investigated the extent to which neural regions engaged during value-based decision-making overlap with those engaged during mathematical and emotional processing in a within-subject manner. In a functional magnetic resonance imaging experiment, participants viewed stimuli that always consisted of numbers and emotional faces that depicted two choices. Across tasks, participants decided between the two choices based on the expected value of the numbers, a mathematical result of the numbers, or the emotional face stimuli. We found that all three tasks commonly involved various cortical areas including frontal, parietal, motor, somatosensory, and visual regions. Critically, the mathematical task shared common areas with the value but not emotion task in bilateral striatum. Although the emotion task overlapped with the value task in parietal, motor, and sensory areas, the mathematical task also evoked responses in other areas within these same cortical structures. Minimal areas were uniquely engaged for the value task apart from the other two tasks. The emotion task elicited a more expansive area of neural activity whereas value and mathematical task responses were in more focal regions. Whole-brain spatial correlation analysis showed that valuative processing engaged functional brain responses more similarly to mathematical processing than emotional processing. While decisions on expected value entail both mathematical and emotional processing regions, mathematical processes have a more prominent contribution particularly in subcortical processes.
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Miller, Matthew James; McGuire, Kerry M.; Feigh, Karen M.
2016-01-01
The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity. The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design. PMID:28491008
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Miller, Matthew James; McGuire, Kerry M; Feigh, Karen M
2017-06-01
The design and adoption of decision support systems within complex work domains is a challenge for cognitive systems engineering (CSE) practitioners, particularly at the onset of project development. This article presents an example of applying CSE techniques to derive design requirements compatible with traditional systems engineering to guide decision support system development. Specifically, it demonstrates the requirements derivation process based on cognitive work analysis for a subset of human spaceflight operations known as extravehicular activity . The results are presented in two phases. First, a work domain analysis revealed a comprehensive set of work functions and constraints that exist in the extravehicular activity work domain. Second, a control task analysis was performed on a subset of the work functions identified by the work domain analysis to articulate the translation of subject matter states of knowledge to high-level decision support system requirements. This work emphasizes an incremental requirements specification process as a critical component of CSE analyses to better situate CSE perspectives within the early phases of traditional systems engineering design.
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Mars Wars: The Rise and Fall of the Space Exploration Initiative
NASA Astrophysics Data System (ADS)
Hogan, Thor
2007-08-01
The rise of Space Exploration Initiative (SEI) and its eventual demise represents one of the landmark episodes in the history of the American space program ranking with the creation of NASA, the decision to go to the Moon, the post-Apollo planning process, and the space station decision. The story of this failed initiative is one shaped by key protagonists and critical battles. It is a tale of organizational, cultural, and personal confrontation. Organizational skirmishes involved the Space Council versus NASA, the White House versus congressional appropriators, and the Johnson Space Center versus the rest of the space agency all seeking control of the national space policy process. Cultural struggles pitted the increasingly conservative engineering ethos of NASA against the faster, better, cheaper philosophy of a Space Council looking for innovative solutions to technical problems. Personality clashes matched Vice President Dan Quayle and Space Council Executive Secretary Mark Albrecht against NASA Administrator Dick Truly and Johnson Space Center Director Aaron Cohen. In the final analysis, the demise of SEI was a classic example of a defective decision-making process one that lacked adequate high-level policy guidance, failed to address critical fiscal constraints, developed inadequate programmatic alternatives, and garnered no congressional support. Some space policy experts have argued that SEI was doomed to fail, due primarily to the immense budgetary pressures facing the nation during the early 1990's. This book will argue, however, that the failure of the initiative was not predetermined; instead, it was the result of a deeply flawed policy process that failed to develop (or even consider) policy options that may have been politically acceptable given the existing political environment.
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Decision Making in Armored Platoon Command
1990-07-01
throughout the study, the Critical Decision method was again useful. We applied it differently in this study, focusing more on situational awareness...Additional work with the Critical Decision method may provide the sharpest insights into the nature of expert-novice differences in real world settings...cwre contrasted to traditional decision--akinL ’ I iteca-turo. Training methods were recommended that would in- corporate the i:mplications of the
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Avoiding bias in medical ethical decision-making. Lessons to be learnt from psychology research.
Albisser Schleger, Heidi; Oehninger, Nicole R; Reiter-Theil, Stella
2011-05-01
When ethical decisions have to be taken in critical, complex medical situations, they often involve decisions that set the course for or against life-sustaining treatments. Therefore the decisions have far-reaching consequences for the patients, their relatives, and often for the clinical staff. Although the rich psychology literature provides evidence that reasoning may be affected by undesired influences that may undermine the quality of the decision outcome, not much attention has been given to this phenomenon in health care or ethics consultation. In this paper, we aim to contribute to the sensitization of the problem of systematic reasoning biases by showing how exemplary individual and group biases can affect the quality of decision-making on an individual and group level. We are addressing clinical ethicists as well as clinicians who guide complex decision-making processes of ethical significance. Knowledge regarding exemplary group psychological biases (e.g. conformity bias), and individual biases (e.g. stereotypes), will be taken from the disciplines of social psychology and cognitive decision science and considered in the field of ethical decision-making. Finally we discuss the influence of intuitive versus analytical (systematical) reasoning on the validity of ethical decision-making.
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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.
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Knowledge bases, clinical decision support systems, and rapid learning in oncology.
Yu, Peter Paul
2015-03-01
One of the most important benefits of health information technology is to assist the cognitive process of the human mind in the face of vast amounts of health data, limited time for decision making, and the complexity of the patient with cancer. Clinical decision support tools are frequently cited as a technologic solution to this problem, but to date useful clinical decision support systems (CDSS) have been limited in utility and implementation. This article describes three unique sources of health data that underlie fundamentally different types of knowledge bases which feed into CDSS. CDSS themselves comprise a variety of models which are discussed. The relationship of knowledge bases and CDSS to rapid learning health systems design is critical as CDSS are essential drivers of rapid learning in clinical care. Copyright © 2015 by American Society of Clinical Oncology.
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Schaafsma, Joanna D; van der Graaf, Yolanda; Rinkel, Gabriel J E; Buskens, Erik
2009-12-01
The lack of a standard methodology in diagnostic research impedes adequate evaluation before implementation of constantly developing diagnostic techniques. We discuss the methodology of diagnostic research and underscore the relevance of decision analysis in the process of evaluation of diagnostic tests. Overview and conceptual discussion. Diagnostic research requires a stepwise approach comprising assessment of test characteristics followed by evaluation of added value, clinical outcome, and cost-effectiveness. These multiple goals are generally incompatible with a randomized design. Decision-analytic models provide an important alternative through integration of the best available evidence. Thus, critical assessment of clinical value and efficient use of resources can be achieved. Decision-analytic models should be considered part of the standard methodology in diagnostic research. They can serve as a valid alternative to diagnostic randomized clinical trials (RCTs).
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The hospital tech laboratory: quality innovation in a new era of value-conscious care.
Keteyian, Courtland K; Nallamothu, Brahmajee K; Ryan, Andrew M
2017-08-01
For decades, the healthcare industry has been incentivized to develop new diagnostic technologies, but this limitless progress fueled rapidly growing expenditures. With an emphasis on value, the future will favor information synthesis and processing over pure data generation, and hospitals will play a critical role in developing these systems. A Michigan Medicine, IBM, and AirStrip partnership created a robust streaming analytics platform tasked with creating predictive algorithms for critical care with the potential to support clinical decisions and deliver significant value.
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NASA Astrophysics Data System (ADS)
Mogk, D. W.; Geissman, J. W.
2015-12-01
There is a compelling need to develop the geoscience workforce of the future to address the "grand challenges" that face humanity. This workforce must have a strong understanding of Earth history, processes and materials and be able to communicate effectively and responsibly to inform public policy and personal and societal actions, particularly with regard to geohazards and natural resources. Curricula to train future geoscientists must be designed to help students develop critical thinking skills across the curriculum, from introductory to senior capstone courses. Students will be challenged in their pre-professional training as geoscientists as they encounter an incomplete geologic record, ambiguity and uncertainty in observed and experimental results, temporal reasoning ("deep time", frequency, recurrence intervals), spatial reasoning (from microns to mountains), and complex system behavior. Four instructional approaches can be combined to address these challenges and help students develop critical thinking skills: 1) Geoethics and ethical decision making includes review and integration of the context/facts of the situation, stakeholders, decision-makers, and possible alternative actions and expected outcomes; 2) The affective domain which encompasses factors such as student motivation to learn, curiosity, fear, attitudes, perceptions, social barriers and values; 3) Metacognition which encourages students to be aware about their own thinking processes, and to develop self-monitoring and self-regulating behaviors; and 4) Systems thinking which requires integrative thinking about the interactions between physical, chemical, biological and human processes, feedback mechanisms and emergent phenomena. Guided inquiry and scaffolded exercises can be used to present increasingly complex situations that require a thorough understanding of geologic principles and processes as applied to issues of societal concern. These approaches are not "owned" by any single course or instructor, and we encourage all teaching faculty to commit a part of their coursework to develop these critical-thinking skills. A collection of geologic case studies is available at the Teaching Geoethics Across the Geoscience Curriculum website http://serc.carleton.edu/74990.
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Carson, Shannon S.; Vu, Maihan; Danis, Marion; Camhi, Sharon L.; Scheunemann, Leslie P.; Cox, Christopher E.; Hanson, Laura C.; Nelson, Judith E.
2012-01-01
Objective Families and other surrogate decision-makers for chronically critically ill patients often lack information about patient prognosis or options for care. This study describes an approach to develop and validate a printed information brochure about chronic critical illness aimed at improving comprehension of the disease process and outcomes for patients’ families and other surrogate decision-makers. Design Investigators reviewed existing literature to identify key domains of informational needs. Content of these domains was incorporated in a draft brochure that included graphics and a glossary of terms. Clinical sensibility, balance, and emotional sensitivity of the draft brochure were tested in a series of evaluations by cohorts of experienced clinicians (n=49) and clinical content experts (n=8), with revisions after each review. Cognitive testing of the brochure was performed through interviews of 10 representative family members of chronically critically ill patients with quantitative and qualitative analysis of responses. Measurements and Main Results Clinical sensibility and balance were rated in the two most favorable categories on a 5-point scale by more than two thirds of clinicians and content experts. After review, family members described the brochure as clear and readable and recommended that the brochure be delivered to family members by clinicians, followed by a discussion of its contents. They indicated that the glossary was useful and recommended supplementation by additional lists of local resources. After reading the brochure, their prognostic estimates became more consistent with actual outcomes. Conclusions We have developed and validated a printed information brochure that may improve family comprehension of chronic critical illness and its outcomes. The structured process that is described can serve as a template for the development of other information aids for use with seriously ill populations. PMID:21926610
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Dynamical crossover in a stochastic model of cell fate decision
NASA Astrophysics Data System (ADS)
Yamaguchi, Hiroki; Kawaguchi, Kyogo; Sagawa, Takahiro
2017-07-01
We study the asymptotic behaviors of stochastic cell fate decision between proliferation and differentiation. We propose a model of a self-replicating Langevin system, where cells choose their fate (i.e., proliferation or differentiation) depending on local cell density. Based on this model, we propose a scenario for multicellular organisms to maintain the density of cells (i.e., homeostasis) through finite-ranged cell-cell interactions. Furthermore, we numerically show that the distribution of the number of descendant cells changes over time, thus unifying the previously proposed two models regarding homeostasis: the critical birth death process and the voter model. Our results provide a general platform for the study of stochastic cell fate decision in terms of nonequilibrium statistical mechanics.
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Subjective experience guides betting decisions beyond accuracy: evidence from a metamemory illusion.
Hembacher, Emily; Ghetti, Simona
2017-05-01
The goal of this research was to test whether subjective memory experiences drive accuracy regulation decisions above and beyond objective memory indices. In four experiments (n = 115) subjective recollection (i.e., reporting "Remember" in the Remember-Know task) was dissociated from memory accuracy by manipulating retrieval during a two-alternative forced-choice recognition task: in the Match condition the distracter was a novel exemplar of the target (e.g., a studied and an unstudied toaster) and in the Non-match condition the distracter was a novel exemplar of another studied but untested item (e.g., a studied toaster and an unstudied birdhouse). Participants were more accurate on Match trials, but reported subjective recollection more frequently on Non-match trials. Critically, participants also bet more often on Non-match trials to the detriment of their score (Experiment 1). This pattern persisted when participants were additionally required to retrieve details about items (Experiment 2) and when confidence assessments were collected (Experiment 3). Finally, participants bet more on Non-match trials even when subjective judgments were not elicited, suggesting that the decision process does not require reporting on subjective experience (Experiment 4). These results indicate that subjective memory experiences guide decision-making independent of objective accuracy and thus are critical to accuracy regulation.
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Pelaccia, Thierry; Tardif, Jacques; Triby, Emmanuel; Charlin, Bernard
2011-01-01
Context Clinical reasoning plays a major role in the ability of doctors to make diagnoses and decisions. It is considered as the physician's most critical competence, and has been widely studied by physicians, educationalists, psychologists and sociologists. Since the 1970s, many theories about clinical reasoning in medicine have been put forward. Purpose This paper aims at exploring a comprehensive approach: the “dual-process theory”, a model developed by cognitive psychologists over the last few years. Discussion After 40 years of sometimes contradictory studies on clinical reasoning, the dual-process theory gives us many answers on how doctors think while making diagnoses and decisions. It highlights the importance of physicians’ intuition and the high level of interaction between analytical and non-analytical processes. However, it has not received much attention in the medical education literature. The implications of dual-process models of reasoning in terms of medical education will be discussed. PMID:21430797
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The distinctiveness heuristic in false recognition and false recall.
McCabe, David P; Smith, Anderson D
2006-07-01
The effects of generative processing on false recognition and recall were examined in four experiments using the Deese-Roediger-McDermott false memory paradigm (Deese, 1959; Roediger & McDermott, 1995). In each experiment, a Generate condition in which subjects generated studied words from audio anagrams was compared to a Control condition in which subjects simply listened to studied words presented normally. Rates of false recognition and false recall were lower for critical lures associated with generated lists, than for critical lures associated with control lists, but only in between-subjects designs. False recall and recognition did not differ when generate and control conditions were manipulated within-subjects. This pattern of results is consistent with the distinctiveness heuristic (Schacter, Israel, & Racine, 1999), a metamemorial decision-based strategy whereby global changes in decision criteria lead to reductions of false memories. This retrieval-based monitoring mechanism appears to operate in a similar fashion in reducing false recognition and false recall.
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Predicting adverse hemodynamic events in critically ill patients.
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.
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Critical Thinking as a Leadership Attribute.
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.
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Review of ecological-based risk management approaches used at five Army Superfund sites.
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.
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Cognitive analysis of physicians' medication ordering activity.
Pelayo, Sylvia; Leroy, Nicolas; Guerlinger, Sandra; Degoulet, Patrice; Meaux, Jean-Jacques; Beuscart-Zéphir, Marie-Catherine
2005-01-01
Computerized Physician Order Entry (CPOE) addresses critical functions in healthcare systems. As the name clearly indicates, these systems focus on order entry. With regard to medication orders, such systems generally force physicians to enter exhaustively documented orders. But a cognitive analysis of the physician's medication ordering task shows that order entry is the last (and least) important step of the entire cognitive therapeutic decision making task. We performed a comparative analysis of these complex cognitive tasks in two working environments, computer-based and paper-based. The results showed that information gathering, selection and interpretation are critical cognitive functions to support the therapeutic decision making. Thus the most important requirement from the physician's perspective would be an efficient display of relevant information provided first in the form of a summarized view of the patient's current treatment, followed by in a more detailed focused display of those items pertinent to the current situation. The CPOE system examined obviously failed to provide the physicians this critical summarized view. Following these results, consistent with users' complaints, the Company decided to engage in a significant re-engineering process of their application.
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NASA Astrophysics Data System (ADS)
Enquist, C.; Jackson, S. T.; Garfin, G. M.
2017-12-01
Translational ecology is an approach by which ecologists, stakeholders, and decision-makers work collaboratively to develop and deliver ecological research that, ideally, results in actionable science that leads to improved environmental decision-making. We analyzed a diverse array of real-world case studies and distilled six principles that characterize the practice of translational ecology: communication, commitment, collaboration, engagement, process, and decision-framing. In this talk, we highlight a subset of the case studies that illustrate these principles. Notably, we found that translational ecology is distinct from both basic and applied ecological research. As a practice, the approach deliberately extends research beyond theory or opportunistic applications, motivated by a search for outcomes that directly serve the needs of natural resource managers and decision-makers. Translational ecology is also distinct from knowledge co-production in that it does not require deep engagement between collaborators, although incorporating differing modes of co-production relative to the decision context, associated time frame, and available financial resources can greatly enhance the translational approach. Although there is a need for incentives to pursue in this type of work, we found that the creativity and context-specific knowledge of resource managers, practitioners, and decision-makers informs and enriches the scientific process, helping shape actionable science. Moreover, the process of addressing research questions arising from on-the-ground management issues, rather than from the top-down or expert-oriented perspectives of traditional science, can foster the long-term trust and commitment that is critical for long-term, sustained engagement between partners. Now, perhaps more than ever, the climate and environmental issues facing society are complex, often politicized, and value-laden. We argue that ecological science should play a key role in informing these problems and ecologists can engage as important partners committed to finding solutions. More broadly, scientists that embrace translational approaches are poised to make science-informed decision-making a reality in the face of a rapidly changing global environment.
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Boutkhoum, Omar; Hanine, Mohamed; Boukhriss, Hicham; Agouti, Tarik; Tikniouine, Abdessadek
2016-01-01
At present, environmental issues become real critical barriers for many supply chain corporations concerning the sustainability of their businesses. In this context, several studies have been proposed from both academia and industry trying to develop new measurements related to green supply chain management (GSCM) practices to overcome these barriers, which will help create new environmental strategies, implementing those practices in their manufacturing processes. The objective of this study is to present the technical and analytical contribution that multi-criteria decision making analysis (MCDA) can bring to environmental decision making problems, and especially to GSCM field. For this reason, a multi-criteria decision-making methodology, combining fuzzy analytical hierarchy process and fuzzy technique for order preference by similarity to ideal solution (fuzzy TOPSIS), is proposed to contribute to a better understanding of new sustainable strategies through the identification and evaluation of the most appropriate GSCM practices to be adopted by industrial organizations. The fuzzy AHP process is used to construct hierarchies of the influential criteria, and then identify the importance weights of the selected criteria, while the fuzzy TOPSIS process employs these weighted criteria as inputs to evaluate and measure the performance of each alternative. To illustrate the effectiveness and performance of our MCDA approach, we have applied it to a chemical industry corporation located in Safi, Morocco.
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Orsini, Caitlin A; Hernandez, Caesar M; Singhal, Sarthak; Kelly, Kyle B; Frazier, Charles J; Bizon, Jennifer L; Setlow, Barry
2017-11-29
Decision making is a multifaceted process, consisting of several distinct phases that likely require different cognitive operations. Previous work showed that the basolateral amygdala (BLA) is a critical substrate for decision making involving risk of punishment; however, it is unclear how the BLA is recruited at different stages of the decision process. To this end, the current study used optogenetics to inhibit the BLA during specific task phases in a model of risky decision making (risky decision-making task) in which rats choose between a small, "safe" reward and a large reward accompanied by varying probabilities of footshock punishment. Male Long-Evans rats received intra-BLA microinjections of viral vectors carrying either halorhodopsin (eNpHR3.0-mCherry) or mCherry alone (control) followed by optic fiber implants and were trained in the risky decision-making task. Laser delivery during the task occurred during intertrial interval, deliberation, or reward outcome phases, the latter of which was further divided into the three possible outcomes (small, safe; large, unpunished; large, punished). Inhibition of the BLA selectively during the deliberation phase decreased choice of the large, risky outcome (decreased risky choice). In contrast, BLA inhibition selectively during delivery of the large, punished outcome increased risky choice. Inhibition had no effect during the other phases, nor did laser delivery affect performance in control rats. Collectively, these data indicate that the BLA can either inhibit or promote choice of risky options, depending on the phase of the decision process in which it is active. SIGNIFICANCE STATEMENT To date, most behavioral neuroscience research on neural mechanisms of decision making has used techniques that preclude assessment of distinct phases of the decision process. Here we show that optogenetic inhibition of the BLA has opposite effects on choice behavior in a rat model of risky decision making, depending on the phase in which inhibition occurs. BLA inhibition during a period of deliberation between small, safe and large, risky outcomes decreased risky choice. In contrast, BLA inhibition during receipt of the large, punished outcome increased risky choice. These findings highlight the importance of temporally targeted approaches to understand neural substrates underlying complex cognitive processes. More importantly, they reveal novel information about dynamic BLA modulation of risky choice. Copyright © 2017 the authors 0270-6474/17/3711537-12$15.00/0.
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Future Skill Needs in Europe: Critical Labour Force Trends. Cedefop Research Paper. No 59
ERIC Educational Resources Information Center
Cedefop - European Centre for the Development of Vocational Training, 2016
2016-01-01
The European labour market is challenged by changes in the demographic composition of the labour force and increasing work complexities and processes. Skills forecasting makes useful contribution to decisions by policy-makers, experts and individuals. In this publication, Cedefop presents the latest results of skills supply and demand forecasts.…
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Graduate Career-Making and Business Start-Up: A Literature Review
ERIC Educational Resources Information Center
Nabi, Ghulam; Holden, Rick; Walmsley, Andreas
2006-01-01
Purpose: The purpose of this article is to provide a selective review of literature on the career-related decision-making processes in terms of the transition from student to business start-up, and the nature and influence of support and guidance. Design/methodology/approach: Primarily, a critical review of a range of recently published literature…
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ERIC Educational Resources Information Center
Lee, Mun Yee
2011-01-01
Memories of our schooling and teaching experiences shape our curriculum and pedagogical decision-making process in art education when we become teachers and teacher educators. In this paper, using Hannah Arendt's Actor-Spectator Theory, I engage in retrospective critical introspection of my practices as an art teacher and curriculum developer in…
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ERIC Educational Resources Information Center
Onwuegbuzie, Anthony J.; Frels, Rebecca K.
2015-01-01
Although focus group discussions (FGDs) represent a popular data collection tool for researchers, they contain an extremely serious flaw: FGD researchers have ultimate power over all decisions made at every stage of the research process--from the conceptualization of the research, to the planning of the research study, to the implementation of the…
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The University Supervisor, edTPA, and the New Making of the Teacher
ERIC Educational Resources Information Center
Donovan, Martha K.; Cannon, Susan O.
2018-01-01
As university supervisors at a large, urban university in the southern US, we examined the ways that the Education Teacher Performance Assessment (edTPA) shaped the pedagogic relationships and decision-making processes of our students and ourselves during the spring of 2016. We situated this study of edTPA within the framework of critical policy…
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Evaluating User Participation and User Influence in an Enterprise System
ERIC Educational Resources Information Center
Gibbs, Martin D.
2010-01-01
Does user influence have an impact on the data quality of an information systems development project? What decision making should users have? How can users effectively be engaged in the process? What is success? User participation is considered to be a critical success factor for Enterprise Resource Planning (ERP) projects, yet there is little…
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Bringing Vision to Practice: Planning and Provisioning the New Library Resource Center
ERIC Educational Resources Information Center
Wilson, Lisa
2004-01-01
The most critical factor in creating a successful school library is the development of a clear vision of the mission and functionality of this integral learning space. However, the process of bringing a vision to realization involves harsh realities and sensible planning. The budget will determine many purchasing decisions and therefore it is…
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The Influence of Semantic Neighbours on Visual Word Recognition
ERIC Educational Resources Information Center
Yates, Mark
2012-01-01
Although it is assumed that semantics is a critical component of visual word recognition, there is still much that we do not understand. One recent way of studying semantic processing has been in terms of semantic neighbourhood (SN) density, and this research has shown that semantic neighbours facilitate lexical decisions. However, it is not clear…
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Educators Have Little Voice in the Texas Inclusion Policy for Children with Disabilities.
ERIC Educational Resources Information Center
Baxt, Virginia P.
This paper explores the education policy adoption process in the Texas legislature and role of professional educators in influencing critical decisions relating to the inclusion of students with disabilities in general education classes. This case study traced the wielders of power, power interactions, the actors and sources of their power, and…
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Good Vibrations: Cross-Frequency Coupling in the Human Nucleus Accumbens during Reward Processing
ERIC Educational Resources Information Center
Cohen, Michael X.; Axmacher, Nikolai; Lenartz, Doris; Elger, Christian E.; Sturm, Volker; Schlaepfer, Thomas E.
2009-01-01
The nucleus accumbens is critical for reward-guided learning and decision-making. It is thought to "gate" the flow of a diverse range of information (e.g., rewarding, aversive, and novel events) from limbic afferents to basal ganglia outputs. Gating and information encoding may be achieved via cross-frequency coupling, in which bursts of…
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Let's Get Parents Ready for Their Initial IEP Meeting
ERIC Educational Resources Information Center
Hammond, Helen; Ingalls, Lawrence
2017-01-01
Parental participation in the initial Individual Education Program (IEP) meeting is a critical component of the process. Even though parents have rights to be equally involved in making decisions at the IEP meetings, frequently parents aren't prepared to be equal members on the team with school personnel. This study focused on a preparation…
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Key Decision Record Creation and Approval Module
NASA Technical Reports Server (NTRS)
Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted
2012-01-01
Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications
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Tan, Judy Y; Xu, Lucy J; Lopez, Fanny Y; Jia, Justin L; Pho, Mai T; Kim, Karen E; Chin, Marshall H
2016-10-01
Shared decision making (SDM) is a model of patient-provider communication. Little is known about the role of SDM in health disparities among Asian American and Pacific Islander (AAPI) sexual and gender minorities (SGM). We illustrate how issues at the intersection of AAPI and SGM identities affect SDM processes and health outcomes. We discuss experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination. Recommendations for clinical practice, research, policy, community development, and education are offered.
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NASA Technical Reports Server (NTRS)
Galvan, Jose Ramon; Saxena, Abhinav; Goebel, Kai Frank
2012-01-01
This article discusses several aspects of uncertainty representation and management for model-based prognostics methodologies based on our experience with Kalman Filters when applied to prognostics for electronics components. In particular, it explores the implications of modeling remaining useful life prediction as a stochastic process, and how it relates to uncertainty representation, management and the role of prognostics in decision-making. A distinction between the interpretations of estimated remaining useful life probability density function is explained and a cautionary argument is provided against mixing interpretations for two while considering prognostics in making critical decisions.
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Spares Management : Optimizing Hardware Usage for the Space Shuttle Main Engine
NASA Technical Reports Server (NTRS)
Gulbrandsen, K. A.
1999-01-01
The complexity of the Space Shuttle Main Engine (SSME), combined with mounting requirements to reduce operations costs have increased demands for accurate tracking, maintenance, and projections of SSME assets. The SSME Logistics Team is developing an integrated asset management process. This PC-based tool provides a user-friendly asset database for daily decision making, plus a variable-input hardware usage simulation with complex logic yielding output that addresses essential asset management issues. Cycle times on critical tasks are significantly reduced. Associated costs have decreased as asset data quality and decision-making capability has increased.
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NASA Astrophysics Data System (ADS)
Shinya, A.; Ishihara, T.; Inoue, K.; Nozaki, K.; Kita, S.; Notomi, M.
2018-02-01
We propose an optical parallel adder based on a binary decision diagram that can calculate simply by propagating light through electrically controlled optical pass gates. The CARRY and CARRY operations are multiplexed in one circuit by a wavelength division multiplexing scheme to reduce the number of optical elements, and only a single gate constitutes the critical path for one digit calculation. The processing time reaches picoseconds per digit when we use a 100-μm-long optical path gates, which is ten times faster than a CMOS circuit.
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Developing inventory and monitoring programs based on multiple objectives
NASA Astrophysics Data System (ADS)
Schmoldt, Daniel L.; Peterson, David L.; Silsbee, David G.
1994-09-01
Resource inventory and monitoring (I&M) programs in national parks combine multiple objectives in order to create a plan of action over a finite time horizon. Because all program activities are constrained by time and money, it is critical to plan I&M activities that make the best use of available agency resources. However, multiple objectives complicate a relatively straightforward allocation process. The analytic hierarchy process (AHP) offers a structure for multiobjective decision making so that decision-makers’ preferences can be formally incorporated in seeking potential solutions. Within the AHP, inventory and monitoring program objectives and decision criteria are organized into a hierarchy. Pairwise comparisons among decision elements at any level of the hierarchy provide a ratio scale ranking of those elements. The resulting priority values for all projects are used as each project’s contribution to the value of an overall I&M program. These priorities, along with budget and personnel constraints, are formulated as a zero/one integer programming problem that can be solved to select those projects that produce the best program. An extensive example illustrates how this approach is being applied to I&M projects in national parks in the Pacific Northwest region of the United States. The proposed planning process provides an analytical framework for multicriteria decisionmaking that is rational, consistent, explicit, and defensible.
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Clinical Intuition in Family Medicine: More Than First Impressions
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
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Clinical intuition in family medicine: more than first impressions.
Woolley, Amanda; Kostopoulou, Olga
2013-01-01
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. 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. 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. 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.
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Blair, R J R
2008-08-12
The current paper examines the functional contributions of the amygdala and ventromedial prefrontal cortex (vmPFC) and the evidence that the functioning of these systems is compromised in individuals with psychopathy. The amygdala is critical for the formation of stimulus-reinforcement associations, both punishment and reward based, and the processing of emotional expressions. vmPFC is critical for the representation of reinforcement expectancies and, owing to this, decision making. Neuropsychological and neuroimaging data from individuals with psychopathy are examined. It is concluded that these critical functions of the amygdala and vmPFC, and their interaction, are compromised in individuals with the disorder. It is argued that these impairments lead to the development of psychopathy.
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Deal or No Deal: using games to improve student learning, retention and decision-making
NASA Astrophysics Data System (ADS)
Chow, Alan F.; Woodford, Kelly C.; Maes, Jeanne
2011-03-01
Student understanding and retention can be enhanced and improved by providing alternative learning activities and environments. Education theory recognizes the value of incorporating alternative activities (games, exercises and simulations) to stimulate student interest in the educational environment, enhance transfer of knowledge and improve learned retention with meaningful repetition. In this case study, we investigate using an online version of the television game show, 'Deal or No Deal', to enhance student understanding and retention by playing the game to learn expected value in an introductory statistics course, and to foster development of critical thinking skills necessary to succeed in the modern business environment. Enhancing the thinking process of problem solving using repetitive games should also improve a student's ability to follow non-mathematical problem-solving processes, which should improve the overall ability to process information and make logical decisions. Learning and retention are measured to evaluate the success of the students' performance.
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Opportunities for Launch Site Integrated System Health Engineering and Management
NASA Technical Reports Server (NTRS)
Waterman, Robert D.; Langwost, Patricia E.; Waterman, Susan J.
2005-01-01
The launch site processing flow involves operations such as functional verification, preflight servicing and launch. These operations often include hazards that must be controlled to protect human life and critical space hardware assets. Existing command and control capabilities are limited to simple limit checking durig automated monitoring. Contingency actions are highly dependent on human recognition, decision making, and execution. Many opportunities for Integrated System Health Engineering and Management (ISHEM) exist throughout the processing flow. This paper will present the current human-centered approach to health management as performed today for the shuttle and space station programs. In addition, it will address some of the more critical ISHEM needs, and provide recommendations for future implementation of ISHEM at the launch site.
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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.
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Reproductive Health Decision-Making in Perinatally HIV-Infected Adolescents and Young Adults
Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad
2013-01-01
With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a “think tank” session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed. PMID:22736033
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Reproductive health decision-making in perinatally HIV-infected adolescents and young adults.
Fair, Cynthia; Wiener, Lori; Zadeh, Sima; Albright, Jamie; Mellins, Claude Ann; Mancilla, Michael; Tepper, Vicki; Trexler, Connie; Purdy, Julia; Osherow, Janet; Lovelace, Susan; Kapetanovic, Suad
2013-07-01
With widespread access to antiretroviral therapy in the United States, many perinatally HIV-infected (PHIV+) children are surviving into adolescence and adulthood, becoming sexually active and making decisions about their reproductive health. The literature focusing on the reproductive decisions of individuals behaviorally infected with HIV can serve as a springboard for understanding the decision-making process of PHIV+ youth. Yet, there are many differences that critically distinguish reproductive health and related decision-making of PHIV+ youth. Given the potential public health implications of their reproductive decisions, better understanding of factors influencing the decision-making process is needed to help inform the development of salient treatment and prevention interventions. To begin addressing this understudied area, a "think tank" session, comprised of clinicians, medical providers, and researchers with expertise in the area of adolescent HIV, was held in Bethesda, MD, on September 21, 2011. The focus was to explore what is known about factors that influence the reproductive decision-making of PHIV+ adolescents and young adults, determine what important data are needed in order to develop appropriate intervention for PHIV+ youth having children, and to recommend future directions for the field in terms of designing and carrying out collaborative studies. In this report, we summarize the findings from this meeting. The paper is organized around the key themes that emerged, including utilizing a developmental perspective to create an operational definition of reproductive decision-making, integration of psychosocial services with medical management, and how to design future research studies. Case examples are presented and model program components proposed.
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Teaching ethics to engineers: ethical decision making parallels the engineering design process.
Bero, Bridget; Kuhlman, Alana
2011-09-01
In order to fulfill ABET requirements, Northern Arizona University's Civil and Environmental engineering programs incorporate professional ethics in several of its engineering courses. This paper discusses an ethics module in a 3rd year engineering design course that focuses on the design process and technical writing. Engineering students early in their student careers generally possess good black/white critical thinking skills on technical issues. Engineering design is the first time students are exposed to "grey" or multiple possible solution technical problems. To identify and solve these problems, the engineering design process is used. Ethical problems are also "grey" problems and present similar challenges to students. Students need a practical tool for solving these ethical problems. The step-wise engineering design process was used as a model to demonstrate a similar process for ethical situations. The ethical decision making process of Martin and Schinzinger was adapted for parallelism to the design process and presented to students as a step-wise technique for identification of the pertinent ethical issues, relevant moral theories, possible outcomes and a final decision. Students had greatest difficulty identifying the broader, global issues presented in an ethical situation, but by the end of the module, were better able to not only identify the broader issues, but also to more comprehensively assess specific issues, generate solutions and a desired response to the issue.
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NASA Astrophysics Data System (ADS)
Baisden, T. W.
2013-12-01
Setting limits on pollution is an inherently political process negotiated between stakeholders within society. Science has a critical, but not dominant role in setting environmental limits. Over the past 20 years, nations have had the opportunity to build on a period of major international successes, limiting ozone-depleting chemicals and sulphur emissions causing acid rain. The science and politics of solutions attempted during this time has become vastly more complicated, and the outcome has been disappointing: global greenhouse gas emissions remain at business-as-usual trajectories. It seems logical and timely to examine the landscape before forging onward. In a brief review of lessons learned from the perspective of earth-system science within New Zealand, I highlight key examples and opportunities for creating more promising way forward. Among the lessons are that small-scale limit setting can host important innovation, while collapses can occur when systems that are too-big-to-fail but lack critical pre-requisites. In this sense, implementation of cap-and-trade for water quality may represent the former, while the collapse of C prices highlight the latter. Of critical importance is the simple observation that perceived uncertainties must be brought within bounds that make decisions possible. The way in which system are framed scientifically can be of overarching significance. Cap and trade for nutrients in New Zealand catchments has enabled small-scale illustrations of how the system frame can be vital in successful policy. For example, the N budget of Lake Taupo is simplified by focusing on inputs to the land, while 100-year forcing equivalence still raises questions about managing climate change. Relationships between emissions and activity must be distilled based on sound science, in a manner simple and certain enough for people and businesses to meaningfully consider in decisions that are made every day. With trust becoming a major limiting factor in the political process, the mechanisms by which science is incorporated in decision-making are likely to require simplicity and accessibility to democratic processes. Science must support both simple rules and verification. It must also allow a shared way forward to be identified across a quorum of the many identities present in society, such that the science communication and projection of outcomes is widely acceptable. New Zealand's constitutional recognition of Maori people, and their indigenous right to participate in decision making has formed a perhaps surprising role in successes to date by ensuring the inclusion of Maori identities. Ultimately, the implementation of these points, through science and other pre-requisites, will be critical in restoring confidence to the process of dealing with climate change and the setting of other limits. A major challenge presented by failure so far to control emissions related to climate change is that we now need to prepare to incorporate not just climate mitigation, but also climate impacts and adaptation and other environmental limits within many singular decisions made by businesses and government.
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Understanding Decision Making in Critical Care
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
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Simmons, Magenta B; Coates, Dominiek; Batchelor, Samantha; Dimopoulos-Bick, Tara; Howe, Deborah
2017-12-12
Youth participation is central to early intervention policy and quality frameworks. There is good evidence for peer support (individuals with lived experience helping other consumers) and shared decision making (involving consumers in making decisions about their own care) in adult settings. However, youth programs are rarely tested or described in detail. This report aims to fill this gap by describing a consumer focused intervention in an early intervention service. This paper describes the development process, intervention content and implementation challenges of the Choices about Healthcare Options Informed by Client Experiences and Expectations (CHOICE) Pilot Project. This highly novel and innovative project combined both youth peer work and youth shared decision making. Eight peer workers were employed to deliver an online shared decision-making tool at a youth mental health service in New South Wales, Australia. The intervention development involved best practice principles, including international standards and elements of co-design. The implementation of the peer workforce in the service involved a number of targeted strategies designed to support this new service model. However, several implementation challenges were experienced which resulted in critical learning about how best to deliver these types of interventions. Delivering peer work and shared decision making within an early intervention service is feasible, but not without challenges. Providing adequate detail about interventions and implementation strategies fills a critical gap in the literature. Understanding optimal youth involvement strategies assists others to deliver acceptable and effective services to young people who experience mental ill health. © 2017 John Wiley & Sons Australia, Ltd.
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Miller, A; Pilcher, D; Mercaldo, N; Leong, T; Scheinkestel, C; Schildcrout, J
2010-08-01
Screen designs in computerized clinical information systems (CIS) have been modeled on their paper predecessors. However, limited understanding about how paper forms support clinical work means that we risk repeating old mistakes and creating new opportunities for error and inefficiency as illustrated by problems associated with computerized provider order entry systems. This study was designed to elucidate principles underlying a successful ICU paper-based CIS. The research was guided by two exploratory hypotheses: (1) paper-based artefacts (charts, notes, equipment, order forms) are used differently by nurses, doctors and other healthcare professionals in different (formal and informal) conversation contexts and (2) different artefacts support different decision processes that are distributed across role-based conversations. All conversations undertaken at the bedsides of five patients were recorded with any supporting artefacts for five days per patient. Data was coded according to conversational role-holders, clinical decision process, conversational context and artefacts. 2133 data points were analyzed using Poisson logistic regression analyses. Results show significant interactions between artefacts used during different professional conversations in different contexts (chi(2)((df=16))=55.8, p<0.0001). The interaction between artefacts used during different professional conversations for different clinical decision processes was not statistically significant although all two-way interactions were statistically significant. Paper-based CIS have evolved to support complex interdisciplinary decision processes. The translation of two design principles - support interdisciplinary perspectives and integrate decision processes - from paper to computerized CIS may minimize the risks associated with computerization. 2010 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Matso, Kalle E.; Becker, Mimi L.
2014-12-01
Many reports and studies have noted that a significant portion of problem-oriented coastal science does not actually link to decisions. Here, three competitively funded project case studies are studied to determine what funders can and should do to better link science with decisions. The qualitative analysis used for this study indicates that the studied program was seen as being unusually attentive to the issue of linking science to decisions, as opposed to simply generating new knowledge. Nevertheless, much of the data indicate that funders can and should do more. Three ideas figured most prominently in the qualitative data: (1) funders should do more to ensure that the problem itself is defined more thoroughly with people who are envisioned as potential users of the science; (2) funders need to allocate more resources and attention to communicating effectively (with users) throughout the project; and (3) funders need to demand more engagement of users throughout the project. These findings have important implications for how funders review and support science, especially when competitive processes are used. Most importantly, funders should adjust what kind of science they ask for. Secondly, funders need to change who is involved in the review process. Currently, review processes focus on knowledge generation, which means that the reviewers themselves have expertise in that area. Instead, review panels should be balanced between those who focus on knowledge generation and those who focus on linking knowledge to decisions; this is a separate but critical discipline currently left out of the review process.
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Effects of Gain/Loss Framing in Cyber Defense Decision-Making
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bos, Nathan; Paul, Celeste; Gersh, John
Cyber defense requires decision making under uncertainty. Yet this critical area has not been a strong focus of research in judgment and decision-making. Future defense systems, which will rely on software-defined networks and may employ ‘moving target’ defenses, will increasingly automate lower level detection and analysis, but will still require humans in the loop for higher level judgment. We studied the decision making process and outcomes of 17 experienced network defense professionals who worked through a set of realistic network defense scenarios. We manipulated gain versus loss framing in a cyber defense scenario, and found significant effects in one ofmore » two focal problems. Defenders that began with a network already in quarantine (gain framing) used a quarantine system more than those that did not (loss framing). We also found some difference in perceived workload and efficacy. Alternate explanations of these findings and implications for network defense are discussed.« less
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Dopaminergic circuitry and risk/reward decision making: implications for schizophrenia.
Stopper, Colin M; Floresco, Stan B
2015-01-01
Abnormal reinforcement learning and representations of reward value are present in schizophrenia, and these impairments can manifest as deficits in risk/reward decision making. These abnormalities may be due in part to dopaminergic dysfunction within cortico-limbic-striatal circuitry. Evidence from studies with laboratory animal have revealed that normal DA activity within different nodes of these circuits is critical for mediating dissociable processes that can refine decision biases. Moreover, both phasic and tonic dopamine transmission appear to play separate yet complementary roles in these processes. Tonic dopamine release within the prefrontal cortex and nucleus accumbens, serves as a "running rate-meter" of reward and reflects contextual information such as reward uncertainty and overt choice behavior. On the other hand, manipulations of outcome-related phasic dopamine bursts and dips suggest these signals provide rapid feedback to allow for quick adjustments in choice as reward contingencies change. The lateral habenula is a key input to the DA system that phasic signals is necessary for expressing subjective decision biases; as suppression of activity within this nucleus leads to catastrophic impairments in decision making and random patterns of choice behavior. As schizophrenia is characterized by impairments in using positive and negative feedback to appropriately guide decision making, these findings suggest that these deficits in these processes may be mediated, at least in part, by abnormalities in both tonic and phasic dopamine transmission. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.
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NASA Astrophysics Data System (ADS)
Logar, N. J.
2006-12-01
Does the research performed by government mission agencies contribute to improved decision-making? Climate research within the U.S. Department of Agriculture (USDA) has the stated goal of providing "optimal benefit" to decision makers on all levels, and the meteorology division of Department of Defense's Naval Research Laboratory promises research directed towards application. Assuming that research can lead to benefit for decision makers with minimal guidance can lead to irrelevance, wasted effort, and missed opportunities. Moving beyond the assumption leads to critical consideration of processes creating climate and meteorological science. I report the results of contextual mapping, of research on decision processes, and of interviews with agency scientists and users of science to evaluate their science regimes. In the case of the USDA scientists do target stakeholders through formal and informal mechanisms, but much of the science does not find use due to institutional constraints, political considerations, and disciplinary inertia. The research results will provide options for closing these policy gaps, such as higher-level stakeholder interaction and better representation of diverse interests. I apply the economic concept of supply and demand to describe where supply of science provides decision support that matches user demand, and where science policies might miss opportunities or mischaracterize research as useful to a specific user. This analysis leads to increased understanding of how factors such as the definition of scientific problems, hierarchies in science decision-making structures, quality control mechanisms beyond peer review, distribution of participants in the knowledge production enterprise, and social accountability guide the process of producing useful information.
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Enhanced decision making through neuroscience
NASA Astrophysics Data System (ADS)
Szu, Harold; Jung, TP; Makeig, Scott
2012-06-01
We propose to enhance the decision making of pilot, co-pilot teams, over a range of vehicle platforms, with the aid of neuroscience. The goal is to optimize this collaborative decision making interplay in time-critical, stressful situations. We will research and measure human facial expressions, personality typing, and brainwave measurements to help answer questions related to optimum decision-making in group situations. Further, we propose to examine the nature of intuition in this decision making process. The brainwave measurements will be facilitated by a University of California, San Diego (UCSD) developed wireless Electroencephalography (EEG) sensing cap. We propose to measure brainwaves covering the whole head area with an electrode density of N=256, and yet keep within the limiting wireless bandwidth capability of m=32 readouts. This is possible because solving Independent Component Analysis (ICA) and finding the hidden brainwave sources allow us to concentrate selective measurements with an organized sparse source -->s sensing matrix [Φs], rather than the traditional purely random compressive sensing (CS) matrix[Φ].
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Striatal activation reflects urgency in perceptual decision making.
van Maanen, Leendert; Fontanesi, Laura; Hawkins, Guy E; Forstmann, Birte U
2016-10-01
Deciding between multiple courses of action often entails an increasing need to do something as time passes - a sense of urgency. This notion of urgency is not incorporated in standard theories of speeded decision making that assume information is accumulated until a critical fixed threshold is reached. Yet, it is hypothesized in novel theoretical models of decision making. In two experiments, we investigated the behavioral and neural evidence for an "urgency signal" in human perceptual decision making. Experiment 1 found that as the duration of the decision making process increased, participants made a choice based on less evidence for the selected option. Experiment 2 replicated this finding, and additionally found that variability in this effect across participants covaried with activation in the striatum. We conclude that individual differences in susceptibility to urgency are reflected by striatal activation. By dynamically updating a response threshold, the striatum is involved in signaling urgency in humans. Copyright © 2016 Elsevier Inc. All rights reserved.
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Bravo, Paulina; Contreras, Aixa; Dois, Angelina; Villarroel, Luis
2018-05-01
There is a worldwide interest in involving patients in health related decisions, so patients can actively search for therapeutic options and choose course of action that allows them to have better quality of life and wellbeing. The majority of the instruments available to capture the degree of participation in medical decision-making are in English and have been developed in high income countries. To adapt and validate for the Chilean context the instrument CollaboRATE™, to measure women's participation in medical decisions during the reproductive process. Cross-sectional study to adapt and validate the instrument CollaboRATE™. Maternity units in Santiago, Chile. Puerperal women in maternity units of three public hospitals. Translation and back-translation, cultural and linguistic relevance with service users and final revision by experts. Study for validation with 90 puerperal women. The Chilean version of CollaboRATE™ demonstrated to be a reliable instrument to capture the degree of patients' participation in medical decision-making. Cronbach alpha was above 0.89. This study provides the first instrument to capture the prevalence of SDM in a Latin American country. This instrument will be critical in future research efforts that seek to explore to what extent people are being involved in the decisions related to their healthcare. Copyright © 2017. Publicado por Elsevier España, S.L.U.
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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.
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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.
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Adam, Jennifer C.; Stephens, Jennie C.; Chung, Serena H.; ...
2014-04-24
Uncertainties in global change impacts, the complexities associated with the interconnected cycling of nitrogen, carbon, and water present daunting management challenges. Existing models provide detailed information on specific sub-systems (e.g., land, air, water, and economics). An increasing awareness of the unintended consequences of management decisions resulting from interconnectedness of these sub-systems, however, necessitates coupled regional earth system models (EaSMs). Decision makers’ needs and priorities can be integrated into the model design and development processes to enhance decision-making relevance and “usability” of EaSMs. BioEarth is a research initiative currently under development with a focus on the U.S. Pacific Northwest region thatmore » explores the coupling of multiple stand-alone EaSMs to generate usable information for resource decision-making. Direct engagement between model developers and non-academic stakeholders involved in resource and environmental management decisions throughout the model development process is a critical component of this effort. BioEarth utilizes a bottom-up approach for its land surface model that preserves fine spatial-scale sensitivities and lateral hydrologic connectivity, which makes it unique among many regional EaSMs. Here, we describe the BioEarth initiative and highlights opportunities and challenges associated with coupling multiple stand-alone models to generate usable information for agricultural and natural resource decision-making.« less
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TreePOD: Sensitivity-Aware Selection of Pareto-Optimal Decision Trees.
Muhlbacher, Thomas; Linhardt, Lorenz; Moller, Torsten; Piringer, Harald
2018-01-01
Balancing accuracy gains with other objectives such as interpretability is a key challenge when building decision trees. However, this process is difficult to automate because it involves know-how about the domain as well as the purpose of the model. This paper presents TreePOD, a new approach for sensitivity-aware model selection along trade-offs. TreePOD is based on exploring a large set of candidate trees generated by sampling the parameters of tree construction algorithms. Based on this set, visualizations of quantitative and qualitative tree aspects provide a comprehensive overview of possible tree characteristics. Along trade-offs between two objectives, TreePOD provides efficient selection guidance by focusing on Pareto-optimal tree candidates. TreePOD also conveys the sensitivities of tree characteristics on variations of selected parameters by extending the tree generation process with a full-factorial sampling. We demonstrate how TreePOD supports a variety of tasks involved in decision tree selection and describe its integration in a holistic workflow for building and selecting decision trees. For evaluation, we illustrate a case study for predicting critical power grid states, and we report qualitative feedback from domain experts in the energy sector. This feedback suggests that TreePOD enables users with and without statistical background a confident and efficient identification of suitable decision trees.
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Koren, Hila; Kaminer, Ido
2016-01-01
Widely used information diffusion models such as Independent Cascade Model, Susceptible Infected Recovered (SIR) and others fail to acknowledge that information is constantly subject to modification. Some aspects of information diffusion are best explained by network structural characteristics while in some cases strong influence comes from individual decisions. We introduce reinvention, the ability to modify information, as an individual level decision that affects the diffusion process as a whole. Based on a combination of constructs from the Diffusion of Innovations and the Critical Mass Theories, the present study advances the CMS (consume, modify, share) model which accounts for the interplay between network structure and human behavior and interactions. The model's building blocks include processes leading up to and following the formation of a critical mass of information adopters and disseminators. We examine the formation of an inflection point, information reach, sustainability of the diffusion process and collective value creation. The CMS model is tested on two directed networks and one undirected network, assuming weak or strong ties and applying constant and relative modification schemes. While all three networks are designed for disseminating new knowledge they differ in structural properties. Our findings suggest that modification enhances the diffusion of information in networks that support undirected connections and carries the biggest effect when information is shared via weak ties. Rogers' diffusion model and traditional information contagion models are fine tuned. Our results show that modifications not only contribute to a sustainable diffusion process, but also aid information in reaching remote areas of the network. The results point to the importance of cultivating weak ties, allowing reciprocal interaction among nodes and supporting the modification of information in promoting diffusion processes. These results have theoretical and practical implications for designing networks aimed at accelerating the creation and diffusion of information. PMID:27798636
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Koren, Hila; Kaminer, Ido; Raban, Daphne Ruth
2016-01-01
Widely used information diffusion models such as Independent Cascade Model, Susceptible Infected Recovered (SIR) and others fail to acknowledge that information is constantly subject to modification. Some aspects of information diffusion are best explained by network structural characteristics while in some cases strong influence comes from individual decisions. We introduce reinvention, the ability to modify information, as an individual level decision that affects the diffusion process as a whole. Based on a combination of constructs from the Diffusion of Innovations and the Critical Mass Theories, the present study advances the CMS (consume, modify, share) model which accounts for the interplay between network structure and human behavior and interactions. The model's building blocks include processes leading up to and following the formation of a critical mass of information adopters and disseminators. We examine the formation of an inflection point, information reach, sustainability of the diffusion process and collective value creation. The CMS model is tested on two directed networks and one undirected network, assuming weak or strong ties and applying constant and relative modification schemes. While all three networks are designed for disseminating new knowledge they differ in structural properties. Our findings suggest that modification enhances the diffusion of information in networks that support undirected connections and carries the biggest effect when information is shared via weak ties. Rogers' diffusion model and traditional information contagion models are fine tuned. Our results show that modifications not only contribute to a sustainable diffusion process, but also aid information in reaching remote areas of the network. The results point to the importance of cultivating weak ties, allowing reciprocal interaction among nodes and supporting the modification of information in promoting diffusion processes. These results have theoretical and practical implications for designing networks aimed at accelerating the creation and diffusion of information.
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NASA Astrophysics Data System (ADS)
Purohit, Kiran Dilip
Secondary science teachers make many daily decisions in the enactment of curriculum. Although curriculum materials are widely available to address science content, practices, and skills, the consideration that goes into deciding how and whether to use such materials is complicated by teachers' beliefs about science, their understandings of school-level accountability and testing measures, and their perspectives on the adolescent students they teach. This study addresses the need to understand how teachers consider multiple forces in their enactment of science curriculum. The purpose of this study was to explore the ways that discourses around accountability, science, and science education emerge in the narratives around teachers' decision-making in secondary science classrooms. Using a case study approach, I worked at two school sites with two pairs of science teachers. We established criteria for critical incidents together, then teachers identified critical decision-making moments in their classrooms. We analyzed those incidents together using a consultancy protocol, allowing teachers to focus their thinking on reframing the incidents and imagining other possible outcomes. Using post-structuralist rhizomatics, I assembled analyses of teachers' discussions of the critical incidents in the form of dramatization--scenes and monologues. I then developed two major interpretive strands. First, I connected teachers' sense of having "no time" to blocs of affect tied to larger discourses of national security, teacher accountability, and the joy of scientific discovery. Second, I demonstrated how teachers' concern in following logical pathways and sequences in science relates to the imposition of accountability measures that echo the outcomes-driven logic of the learning sciences. Across both interpretations, I found accountability to be complex, multidirectional, and unpredictable in how it works on and through teachers as they make decisions. Research in this area has important practical implications in the fields of professional development, curriculum development, and school change. As more states (including New York) adopt standards derived from the Next Generation Science Standards (NGSS), the importance of privileging teachers' investment and critical decision-making in the process of new curriculum development is vital. I suggest that tools like video-based coaching and consultancy protocol discussions support this kind of thoughtful curricular change.
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Task allocation in a distributed computing system
NASA Technical Reports Server (NTRS)
Seward, Walter D.
1987-01-01
A conceptual framework is examined for task allocation in distributed systems. Application and computing system parameters critical to task allocation decision processes are discussed. Task allocation techniques are addressed which focus on achieving a balance in the load distribution among the system's processors. Equalization of computing load among the processing elements is the goal. Examples of system performance are presented for specific applications. Both static and dynamic allocation of tasks are considered and system performance is evaluated using different task allocation methodologies.
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Baron, C H
2000-06-01
Determining competence to request physician-assisted suicide should be no more difficult than determining competence to refuse life-prolonging treatment. In both cases, criteria and procedures should be developed out of the process of actually making capacity determinations; they should not be promulgated a priori. Because patient demeanor plays a critical role in capacity determinations, it should be made part of the record of such determinations through greater use of video- and audiotapes.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
1996-03-01
This module covers EPA`s Superfund community involvement program, a set of requirements under the National Contingency Plan (NCP) designed to ensure that public is informed about site conditions and given the opportunity to comment on the proposed remedy of a Superfund site. The NCP serves to uphold the public`s right to voice opinions and express concerns about Superfund site activities. EPA must involve communities throughout Superfund process - particularly at critical decision-making steps in the process.
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Srinivasan, Narayanan; Mukherjee, Sumitava; Mishra, Maruti V.; Kesarwani, Smriti
2013-01-01
Attention is a key process used to conceptualize and define modes of thought, but we lack information about the role of specific attentional processes on preferential choice and memory in multi-attribute decision making. In this study, we examine the role of attention based on two dimensions, attentional scope and load on choice preference strength and memory using a paradigm that arguably elicits unconscious thought. Scope of attention was manipulated by using global or local processing during distraction (Experiment 1) and before the information-encoding stage (Experiment 2). Load was manipulated by using the n-back task in Experiment 1. Results from Experiment 1 show that global processing or distributed attention during distraction results in stronger preference irrespective of load but better memory only at low cognitive load. Task difficulty or load did not have any effect on preference or memory. In Experiment 2, distributed attention before attribute encoding facilitated only memory but did not influence preference. Results show that attentional processes at different stages of processing like distraction and information-encoding influence decision making processes. Scope of attention not only influences preference and memory but the manner in which attentional scope influences them depends on both load and stage of information processing. The results indicate the important role of attention in processes critical for decision making and calls for a re-evaluation of the unconscious thought theory (UTT) and the need for reconceptualizing the role of attention. PMID:23382726
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Srinivasan, Narayanan; Mukherjee, Sumitava; Mishra, Maruti V; Kesarwani, Smriti
2013-01-01
Attention is a key process used to conceptualize and define modes of thought, but we lack information about the role of specific attentional processes on preferential choice and memory in multi-attribute decision making. In this study, we examine the role of attention based on two dimensions, attentional scope and load on choice preference strength and memory using a paradigm that arguably elicits unconscious thought. Scope of attention was manipulated by using global or local processing during distraction (Experiment 1) and before the information-encoding stage (Experiment 2). Load was manipulated by using the n-back task in Experiment 1. Results from Experiment 1 show that global processing or distributed attention during distraction results in stronger preference irrespective of load but better memory only at low cognitive load. Task difficulty or load did not have any effect on preference or memory. In Experiment 2, distributed attention before attribute encoding facilitated only memory but did not influence preference. Results show that attentional processes at different stages of processing like distraction and information-encoding influence decision making processes. Scope of attention not only influences preference and memory but the manner in which attentional scope influences them depends on both load and stage of information processing. The results indicate the important role of attention in processes critical for decision making and calls for a re-evaluation of the unconscious thought theory (UTT) and the need for reconceptualizing the role of attention.
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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
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Young, Liane; Koenigs, Michael
2007-01-01
Human moral decision-making has long been a topic of philosophical debate, and, more recently, a topic for empirical investigation. Central to this investigation is the extent to which emotional processes underlie our decisions about moral right and wrong. Neuroscience offers a unique perspective on this question by addressing whether brain regions associated with emotional processing are involved in moral cognition. We conduct a narrative review of neuroscientific studies focused on the role of emotion in morality. Specifically, we describe evidence implicating the ventromedial prefrontal cortex (VMPC), a brain region known to be important for emotional processing. Functional imaging studies demonstrate VMPC activation during tasks probing moral cognition. Studies of clinical populations, including patients with VMPC damage, reveal an association between impairments in emotional processing and impairments in moral judgement and behaviour. Considered together, these studies indicate that not only are emotions engaged during moral cognition, but that emotions, particularly those mediated by VMPC, are in fact critical for human morality.
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Argumentation: A Methodology to Facilitate Critical Thinking.
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.
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ERIC Educational Resources Information Center
Fisher-Yoshida, Beth; Geller, Kathy D.; Wasserman, Ilene C.
2005-01-01
Today's complex global environment calls for leaders to be agile decision makers, engage in critical self-reflection, integrate reflection with action, and partner with those who are different in significant ways. These capabilities and skills are the core qualities of transformative learning. This paper weaves research findings that explore…
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Mothers' Perspectives and Experiences of Speech Generating Devices
ERIC Educational Resources Information Center
Lee, Yeunjoo; Vega, Luis A.
2017-01-01
Families play a critical role in the lives of students who use a speech generating device (SGD). This study address (a) mothers' experiences of having a child who uses a SGD, (b) their perception of the effectiveness of a SGD(s), (c) their perceived impacts of SGDs on their family dynamics, and (d) their perception of decision making process. Data…
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ERIC Educational Resources Information Center
Yeste, Carme Garcia; Ferrada, Donatila; Ruiz, Laura
2011-01-01
Dialogic feminism has emphasized the need to include all women, particularly those who have traditionally been most excluded, into participation and decision making in different areas of society. The critical communicative methodology (CCM) has responded to this need by including the voices of the Other Women into research processes and dialogue…
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Interactive Simulation of Hardwood Log Veneer Slicing Using CT Images
Daniel L Schmoldt; Pei Li; Philip A. Araman
1996-01-01
Veneer producers must make critical processing decisions based solely on external examination of logs. Unlike sawlog breakdown, however, little research has investigated ways in which veneer logs can best be flitched and sliced for increased value. This gap exists largely due to the variety of ways in which veneer is produced and used and the variety of buyers that...
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Update on soil fumigation: MBr alternatives and reregistration decisions
Scott A. Enebak
2011-01-01
This article gives a brief history of the importance of methyl bromide in the production of forest seedlings in the southern United States and the timeline for the Montreal Protocol and Clean Air Act to phase out ozone-depleting compounds. In addition, the process, steps, and potential for continued MBr use under the Critical Use Exemption and Quarantine Pre-shipment...
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ERIC Educational Resources Information Center
Finley, Jane B.; Taylor, Susan Lee; Warren, D. Lee
2007-01-01
Researchers agree that students' critical thinking and decision making skills are enhanced through exposure to new cultures and global markets. Thus, one way of bringing about improvement in these areas is through international travel courses. The purpose of this study is threefold. One, to describe the process involved in the creation of a…
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A Review of Protocols in Higher Education; How My Experience Made Me Question the Process
ERIC Educational Resources Information Center
Ryan, Brendan M.
2017-01-01
This paper is a discussion and critical review of grading practices at a large flagship public university. In this paper, I examine the rights a student has when calling into question the authority and decision-making abilities of teachers in a classroom setting. Following my recent experience with a professor (noted at the beginning of this…
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Value-Added and Observational Measures Used in the Teacher Evaluation Process: A Validation Study
ERIC Educational Resources Information Center
Guerere, Claudia
2013-01-01
Scores from value-added models (VAMs), as used for educational accountability, represent the educational effect teachers have on their students. The use of these scores in teacher evaluations for high-stakes decision making is new for the State of Florida. Validity evidence that supports or questions the use of these scores is critically needed.…
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The Modeling of Human Intelligence in the Computer as Demonstrated in the Game of DIPLOMAT.
ERIC Educational Resources Information Center
Collins, James Edward; Paulsen, Thomas Dean
An attempt was made to develop human-like behavior in the computer. A theory of the human learning process was described. A computer game was presented which simulated the human capabilities of reasoning and learning. The program was required to make intelligent decisions based on past experiences and critical analysis of the present situation.…
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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.
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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...
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Ventral anterior cingulate cortex and social decision-making.
Lockwood, Patricia L; Wittmann, Marco K
2018-06-07
Studies in the field of social neuroscience have recently made use of computational models of decision-making to provide new insights into how we learn about the self and others during social interactions. Importantly, these studies have increasingly drawn attention to brain areas outside of classical cortical "social brain" regions that may be critical for social processing. In particular, two portions of the ventral anterior cingulate cortex (vACC), subgenual anterior cingulate cortex and perigenual anterior cingulate cortex, have been linked to social and self learning signals, respectively. Here we discuss the emerging parallels between these studies. Uncovering the function of vACC during social interactions could provide important new avenues to understand social decision-making in health and disease. Copyright © 2018 Elsevier Ltd. All rights reserved.
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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.
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Attenuated Neural Processing of Risk in Young Adults at Risk for Stimulant Dependence
Reske, Martina; Stewart, Jennifer L.; Flagan, Taru M.; Paulus, Martin P.
2015-01-01
Objective Approximately 10% of young adults report non-medical use of stimulants (cocaine, amphetamine, methylphenidate), which puts them at risk for the development of dependence. This fMRI study investigates whether subjects at early stages of stimulant use show altered decision making processing. Methods 158 occasional stimulants users (OSU) and 50 comparison subjects (CS) performed a “risky gains” decision making task during which they could select safe options (cash in 20 cents) or gamble them for double or nothing in two consecutive gambles (win or lose 40 or 80 cents, “risky decisions”). The primary analysis focused on risky versus safe decisions. Three secondary analyses were conducted: First, a robust regression examined the effect of lifetime exposure to stimulants and marijuana; second, subgroups of OSU with >1000 (n = 42), or <50 lifetime marijuana uses (n = 32), were compared to CS with <50 lifetime uses (n = 46) to examine potential marijuana effects; third, brain activation associated with behavioral adjustment following monetary losses was probed. Results There were no behavioral differences between groups. OSU showed attenuated activation across risky and safe decisions in prefrontal cortex, insula, and dorsal striatum, exhibited lower anterior cingulate cortex (ACC) and dorsal striatum activation for risky decisions and greater inferior frontal gyrus activation for safe decisions. Those OSU with relatively more stimulant use showed greater dorsal ACC and posterior insula attenuation. In comparison, greater lifetime marijuana use was associated with less neural differentiation between risky and safe decisions. OSU who chose more safe responses after losses exhibited similarities with CS relative to those preferring risky options. Discussion Individuals at risk for the development of stimulant use disorders presented less differentiated neural processing of risky and safe options. Specifically, OSU show attenuated brain response in regions critical for performance monitoring, reward processing and interoceptive awareness. Marijuana had additive effects by diminishing neural risk differentiation. PMID:26076493
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Biodiversity, conservation biology, and rational choice.
Frank, David
2014-03-01
This paper critically discusses two areas of Sahotra Sarkar's recent work in environmental philosophy: biodiversity and conservation biology and roles for decision theory in incorporating values explicitly in the environmental policy process. I argue that Sarkar's emphasis on the practices of conservation biologists, and especially the role of social and cultural values in the choice of biodiversity constituents, restricts his conception of biodiversity to particular practical conservation contexts. I argue that life scientists have many reasons to measure many types of diversity, and that biodiversity metrics could be value-free. I argue that Sarkar's emphasis on the limitations of normative decision theory is in tension with his statement that decision theory can "put science and ethics together." I also challenge his claim that multi-criteria decision tools lacking axiomatic foundations in preference and utility theory are "without a rational basis," by presenting a case of a simple "outranking" multi-criteria decision rule that can violate a basic normative requirement of preferences (transitivity) and ask whether there may nevertheless be contexts in which such a procedure might assist decision makers. Copyright © 2013 Elsevier Ltd. All rights reserved.
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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
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Snyder, Jeremy; Crooks, Valorie A; Johnston, Rory; Dharamsi, Shafik
2013-09-22
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. 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. 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. 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.
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Agency behind bars: Advance care planning with aging and dying offenders.
Sanders, Sara; Stensland, Meredith; Juraco, Kim
2018-01-01
Aging and terminally ill individuals in U.S. prisons are increasing, making critical the need for appropriate end-of-life (EOL) care and advance care planning (ACP). Applying Bandura's agentic perspective, the authors examined 20 aging/dying offenders' EOL preferences and ACP. Findings include 6 themes: decisions in the shadow of the past, what works best for me, feeling blessed, what is really going on, can anyone be trusted, and turning agency over to someone else. This study provides critical information that will assist professionals who work with dying offenders, as it presents a vivid illustration of their dying process.
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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.
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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.
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Self-management support for insulin therapy in type 2 diabetes.
Funnell, Martha M; Kruger, Davida F; Spencer, Mary
2004-01-01
The purpose of this article is to describe the self-management support that can be provided by diabetes educators for type 2 diabetes patients who are transitioning from therapy with oral hypoglycemic agents to insulin. The role of the diabetes educator in patient education and self-management support during all aspects of insulin therapy is discussed. Phases during which support may be especially important include the decision-making process, initiation, and maintenance. Although some patients make the decision fairly easily, the introduction of insulin therapy is likely to raise many issues and questions for many type 2 diabetes patients. The more reluctant patients may experience psychological insulin resistance, a syndrome where insulin therapy is viewed as a threat or failure, which can affect health professionals as well. The diabetes educator can provide support and approaches to help diminish this resistance and make the transition to insulin therapy easier and more effective for patients with type 2 diabetes. Education and ongoing self-management support are needed for informed decision making and the initiation and maintenance of insulin therapy. Therefore, diabetes educators have a critical role to play during both the decision-making process and the safe transition to insulin therapy.
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Decision support for redesigning wastewater treatment technologies.
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.
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Understanding The Decision Context: DPSIR, Decision Landscape, And Social Network Analysis
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...
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NASA Astrophysics Data System (ADS)
Garfin, G. M.; Petersen, A.; Shafer, M.; MacClune, K.; Hayhoe, K.; Riley, R.; Nasser, E.; Kos, L.; Allan, C.; Stults, M.; LeRoy, S. R.
2016-12-01
Many communities in the United States are already vulnerable to extreme events; many of these vulnerabilities are likely to increase with climate change. In order to promote the development of effective community responses to climate change, we tested a participatory process for developing usable climate science, in which our project team worked with decision-makers to identify extreme event parameters and critical thresholds associated with policy development and adaptation actions. Our hypothesis is that conveying climate science and data through user-defined parameters and thresholds will help develop capacity to streamline the use of climate projections in developing strategies and actions, and motivate participation by a variety of preparedness planners. Our team collaborated with urban decision-makers, in departments that included resilience, planning, public works, public health, emergency management, and others, in four cities in the semi-arid south-central plains and intermountain areas of Colorado, New Mexico, Oklahoma, and Texas. Through an iterative process, we homed in on both simple and hybrid indicators for which we could develop credible city-specific projections, to stimulate discussion about adaptation actions; throughout the process, we communicated information about confidence and uncertainty, in order to develop a blend of historic and projected climate data, as appropriate, depending on levels of uncertainty. Our collaborations have resulted in (a) the identification of more than 50 unique indicators and thresholds across the four communities, (b) the development of adaptation action strategies in each community, and (c) the implementation of actions, ranging from a climate leadership training program for city staff members, to a rainwater capture project to improve responses to expected increases in both stormwater runoff and water capture for drought episodes.
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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.
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Bayesian methods to estimate urban growth potential
Smith, Jordan W.; Smart, Lindsey S.; Dorning, Monica; Dupéy, Lauren Nicole; Méley, Andréanne; Meentemeyer, Ross K.
2017-01-01
Urban growth often influences the production of ecosystem services. The impacts of urbanization on landscapes can subsequently affect landowners’ perceptions, values and decisions regarding their land. Within land-use and land-change research, very few models of dynamic landscape-scale processes like urbanization incorporate empirically-grounded landowner decision-making processes. Very little attention has focused on the heterogeneous decision-making processes that aggregate to influence broader-scale patterns of urbanization. We examine the land-use tradeoffs faced by individual landowners in one of the United States’ most rapidly urbanizing regions − the urban area surrounding Charlotte, North Carolina. We focus on the land-use decisions of non-industrial private forest owners located across the region’s development gradient. A discrete choice experiment is used to determine the critical factors influencing individual forest owners’ intent to sell their undeveloped properties across a series of experimentally varied scenarios of urban growth. Data are analyzed using a hierarchical Bayesian approach. The estimates derived from the survey data are used to modify a spatially-explicit trend-based urban development potential model, derived from remotely-sensed imagery and observed changes in the region’s socioeconomic and infrastructural characteristics between 2000 and 2011. This modeling approach combines the theoretical underpinnings of behavioral economics with spatiotemporal data describing a region’s historical development patterns. By integrating empirical social preference data into spatially-explicit urban growth models, we begin to more realistically capture processes as well as patterns that drive the location, magnitude and rates of urban growth.
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Preceptor questioning and student critical thinking.
Myrick, Florence; Yonge, Olive
2002-01-01
Questioning is fundamental to student learning. Not only does it enable students to elevate their level of thinking, but in the process it also affords them the opportunity to deal with their world intelligently. The practice setting is an environment rich in opportunity for enabling critical thinking through the use of questioning. In the preceptorship experience, preceptors are in a prime position to use questioning behaviors that can challenge the way preceptees think, encourage them to justify or clarify their assertions, promote the generation of original ideas, explanations, or solutions to patient problems, provide mental and emotional tools to help resolve dilemmas, promote discussion, and evaluate learning. This article discusses the importance of preceptor questioning for the development and promotion of student critical thinking. Contextually, the authors draw on the findings of a recent study in which preceptor questioning of the knowledge base, decision making, and actions of the preceptee were found to directly bring about or trigger their critical thinking. This article allows for some further reflection on that process and its contribution to the enhancement of the preceptorship experience. Copyright 2002, Elsevier Science (USA). All rights reserved.
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Ogawa, Masaaki
2017-11-01
In response to changing internal and external situations, we always need to adapt our behavior based on previous experiences, particularly, acquired stimulus-outcome information. The orbitofrontal cortex (OFC), a prefrontal cortical region, is critical for this type of decision-making. The current understanding of the fundamental functions of the OFC has been reviewed by introducing, as an example, how the OFC contributes to the processing of uncertain rewards. Furthermore, the importance of revealing context and temporally specific causal roles of neural circuits including the OFC in decision-making, as well as the techniques to achieve the goal, have been discussed.
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Xu, Lucy J.; Lopez, Fanny Y.; Jia, Justin L.; Pho, Mai T.; Kim, Karen E.; Chin, Marshall H.
2016-01-01
Abstract Shared decision making (SDM) is a model of patient-provider communication. Little is known about the role of SDM in health disparities among Asian American and Pacific Islander (AAPI) sexual and gender minorities (SGM). We illustrate how issues at the intersection of AAPI and SGM identities affect SDM processes and health outcomes. We discuss experiences of AAPI SGM that are affected by AAPI heterogeneity, SGM stigma, multiple minority group identities, and sources of discrimination. Recommendations for clinical practice, research, policy, community development, and education are offered. PMID:27158858
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Feedback produces divergence from prospect theory in descriptive choice.
Jessup, Ryan K; Bishara, Anthony J; Busemeyer, Jerome R
2008-10-01
A recent study demonstrated that individuals making experience-based choices underweight small probabilities, in contrast to the overweighting observed in a typical descriptive paradigm. We tested whether trial-by-trial feedback in a repeated descriptive paradigm would engender choices more correspondent with experiential or descriptive paradigms. The results of a repeated gambling task indicated that individuals receiving feedback underweighted small probabilities, relative to their no-feedback counterparts. These results implicate feedback as a critical component during the decision-making process, even in the presence of fully specified descriptive information. A model comparison at the individual-subject level suggested that feedback drove individuals' decision weights toward objective probability weighting.
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Democracy versus dictatorship in self-organized models of financial markets
NASA Astrophysics Data System (ADS)
D'Hulst, R.; Rodgers, G. J.
2000-06-01
Models to mimic the transmission of information in financial markets are introduced. As an attempt to generate the demand process, we distinguish between dictatorship associations, where groups of agents rely on one of them to make decision, and democratic associations, where each agent takes part in the group decision. In the dictatorship model, agents segregate into two distinct populations, while the democratic model is driven towards a critical state where groups of agents of all sizes exist. Hence, both models display a level of organization, but only the democratic model is self-organized. We show that the dictatorship model generates less-volatile markets than the democratic model.
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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.
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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.
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Reward Expectation Modulates Feedback-Related Negativity and EEG Spectra
Cohen, Michael X; Elger, Christian E.; Ranganath, Charan
2007-01-01
The ability to evaluate outcomes of previous decisions is critical to adaptive decision-making. The feedback-related negativity (FRN) is an event-related potential (ERP) modulation that distinguishes losses from wins, but little is known about the effects of outcome probability on these ERP responses. Further, little is known about the frequency characteristics of feedback processing, for example, event-related oscillations and phase synchronizations. Here, we report an EEG experiment designed to address these issues. Subjects engaged in a probabilistic reinforcement learning task in which we manipulated, across blocks, the probability of winning and losing to each of two possible decision options. Behaviorally, all subjects quickly adapted their decision-making to maximize rewards. ERP analyses revealed that the probability of reward modulated neural responses to wins, but not to losses. This was seen both across blocks as well as within blocks, as learning progressed. Frequency decomposition via complex wavelets revealed that EEG responses to losses, compared to wins, were associated with enhanced power and phase coherence in the theta frequency band. As in the ERP analyses, power and phase coherence values following wins but not losses were modulated by reward probability. Some findings between ERP and frequency analyses diverged, suggesting that these analytic approaches provide complementary insights into neural processing. These findings suggest that the neural mechanisms of feedback processing may differ between wins and losses. PMID:17257860
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NASA Technical Reports Server (NTRS)
Sawin, Charles F.
1999-01-01
The product of the critical path roadmap project is an integrated strategy for mitigating the risks associated with human exploration class missions. It is an evolving process that will assure the ability to communicate the integrated critical path roadmap. Unlike previous reports, this one will not sit on a shelf - it has the full support of the JSC Space and Life Sciences Directorate (SA) and is already being used as a decision making tool (e.g., budget and investigation planning for Shuttle and Space Station mission). Utility of this product depends on many efforts, namely: providing the required information (completed risk data sheets, critical question information, technology data). It is essential to communicate the results of the critical path roadmap to the scientific community - this meeting is a good opportunity to do so. The web site envisioned for the critical path roadmap will provide the capability to communicate to a broader community and to track and update the system routinely.
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Dhaliwal, Rupinder; Cahill, Naomi; Lemieux, Margot; Heyland, Daren K
2014-02-01
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.
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A Possible Approach for Addressing Neglected Human Factors Issues of Systems Engineering
NASA Technical Reports Server (NTRS)
Johnson, Christopher W.; Holloway, C. Michael
2011-01-01
The increasing complexity of safety-critical applications has led to the introduction of decision support tools in the transportation and process industries. Automation has also been introduced to support operator intervention in safety-critical applications. These innovations help reduce overall operator workload, and filter application data to maximize the finite cognitive and perceptual resources of system operators. However, these benefits do not come without a cost. Increased computational support for the end-users of safety-critical applications leads to increased reliance on engineers to monitor and maintain automated systems and decision support tools. This paper argues that by focussing on the end-users of complex applications, previous research has tended to neglect the demands that are being placed on systems engineers. The argument is illustrated through discussing three recent accidents. The paper concludes by presenting a possible strategy for building and using highly automated systems based on increased attention by management and regulators, improvements in competency and training for technical staff, sustained support for engineering team resource management, and the development of incident reporting systems for infrastructure failures. This paper represents preliminary work, about which we seek comments and suggestions.
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Stewart, R; Bhagwanjee, A
1999-07-01
Despite the growing popularity of the empowerment construct among social scientists, relatively few empowerment studies involving groupwork with people with physical disabilities exist. This article accordingly describes and analyses the organic development of the empowerment process within a spinal cord injury self-help group, set against the backdrop of policy imperatives for disability in post-apartheid South Africa. The treatise on the group empowerment process is located within the context of a group evaluation conducted within a participatory research framework. Key variables informing the research approach included: quality of participation, control over resources and decision-making, shift in critical consciousness and understanding, malleability of roles within the group and role of the health professional. Group members assumed ownership of group management and decision-making and shifted from a professionally-led to a peer-led self-help group. Group objectives changed from providing mutual support to community education and outreach activities. The role of the health professional shifted from group facilitator to invited consultant. This case study demonstrates how group participation, promoted by a critically informed therapeutic and research praxis, can unlock the inherent potential for self-reliance and empowerment of socially marginalized collectives. It offers important insights with regard to group process, participatory research and the role of the health professional in creating opportunities for empowerment and self-reliance of people with disability.
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Groen-van de Ven, Leontine; Smits, Carolien; de Graaff, Fuusje; Span, Marijke; Eefsting, Jan; Jukema, Jan; Vernooij-Dassen, Myrra
2017-01-01
Objective To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories. Design A qualitative study with a prospective, multiperspective design, based on 244 semistructured interviews, conducted during three interview rounds over the course of a year. Analysis was by means of content analysis and typology construction. Setting Community settings and nursing homes in the Netherlands. Participants 19 people with dementia, 36 of their informal caregivers and 38 of their professionals (including nurses, daycare employees and case managers). Results The participants’ responses related to three critical points in the decision-making trajectory about daycare: (1) the initial positive or negative expectations of daycare; (2) negotiation about trying out daycare by promoting, resisting or attuning to others; and (3) trying daycare, which resulted in positive or negative reactions from people with dementia and led to a decision. The ways in which care networks proceeded through these three critical points resulted in a typology of participation trajectories, including (1) working together positively toward daycare, (2) bringing conflicting perspectives together toward trying daycare and (3) not reaching commitment to try daycare. Conclusion Shared decision making with people with dementia is possible and requires and adapted process of decision making. Our results show that initial preferences based on information alone may change when people with dementia experience daycare. It is important to have a try-out period so that people with dementia can experience daycare without having to decide whether to continue it. Whereas shared decision making in general aims at moving from initial preferences to informed preferences, professionals should focus more on moving from initial preferences to experienced preferences for people with dementia. Professionals can play a crucial role in facilitating the possibilities for a try-out period. PMID:29133329
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A description of nurses' decision-making in managing electrocardiographic monitor alarms.
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.
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Diverse decisions. How culture affects ethical decision making.
Wright, F; Cohen, S; Caroselli, C
1997-03-01
Even under optimal conditions, assisting patients and families in making ethical decisions is difficult at best. Often these decisions revolve around the end-of-life issues that require acknowledgement that the patient is unlikely to survive, which may be perceived as a failure to both the family and the staff. At the very least, it can be a sad time, fraught with uncertainty and indecision. When these difficulties are coupled with ineffective communication related to cultural insensitivity or unawareness, the effects can be devastating to the decision-making process. All CCNs are expected to master the skills necessary for assisting patients and families through the harrowing experience of life-threatening illness. Whereas much of critical care focuses on managing pathophysiologic disturbances, emotional needs are equally important. It follows then that the CCN must assume responsibility for assisting patients and families in coping with the crisis of critical illness and working through ethical issues, which often include end-of-life decisions and organ donation. Culturally competent care is required when addressing patient needs holistically, but it is so much more. It is an opportunity to enrich and deepen the CCN/patient/family relationship, advocate for the patient, and broaden the opportunities for communication among staff. This article has provided some beginning steps for increasing nursing cultural awareness and has offered some initial strategies to consider when designing a plan of care. Through continuing efforts, CCNs and organizations can do much to decrease the alienation that many patients and families have traditionally encountered in the CCU, an estrangement that is exacerbated when their culture is different from the predominant culture of the unit. The effort to become more culturally aware may appear to require extraordinary effort; however, the rewards of optimizing patient care are unsurpassed.
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Melnick, Edward R.; Lopez, Kevin; Hess, Erik P.; Abujarad, Fuad; Brandt, Cynthia A.; Shiffman, Richard N.; Post, Lori A.
2015-01-01
Context: Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider’s already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts. Case Description: This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing. Lessons Learned: We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility. Conclusions: Successful implementation of this tool will require seamless integration into the provider’s workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well. PMID:26290885
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Melnick, Edward R; Lopez, Kevin; Hess, Erik P; Abujarad, Fuad; Brandt, Cynthia A; Shiffman, Richard N; Post, Lori A
2015-01-01
Current information-rich electronic health record (EHR) interfaces require large, high-resolution screens running on desktop computers. This interface compromises the provider's already limited time at the bedside by physically separating the patient from the doctor. The case study presented here describes a patient-centered clinical decision support (CDS) design process that aims to bring the physician back to the bedside by integrating a patient decision aid with CDS for shared use by the patient and provider on a touchscreen tablet computer for deciding whether or not to obtain a CT scan for minor head injury in the emergency department, a clinical scenario that could benefit from CDS but has failed previous implementation attempts. This case study follows the user-centered design (UCD) approach to build a bedside aid that is useful and usable, and that promotes shared decision-making between patients and their providers using a tablet computer at the bedside. The patient-centered decision support design process focuses on the prototype build using agile software development, but also describes the following: (1) the requirement gathering phase including triangulated qualitative research (focus groups and cognitive task analysis) to understand current challenges, (2) features for patient education, the physician, and shared decision-making, (3) system architecture and technical requirements, and (4) future plans for formative usability testing and field testing. We share specific lessons learned and general recommendations from critical insights gained in the patient-centered decision support design process about early stakeholder engagement, EHR integration, external expert feedback, challenges to two users on a single device, project management, and accessibility. Successful implementation of this tool will require seamless integration into the provider's workflow. This protocol can create an effective interface for shared decision-making and safe resource reduction at the bedside in the austere and dynamic clinical environment of the ED and is generalizable for these purposes in other clinical environments as well.
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Who Is the "Parent"? Guidance from Case Law on Parental Participation in the IEP Process
ERIC Educational Resources Information Center
Losinski, Mickey; Katsiyannis, Antonis; White, Sherry; Wiseman, Nicole
2016-01-01
Given that parental participation is such a critical feature of IDEA (20 U.S.C. § 1400[c][5][B]), the question of who is a parent often presents a challenge. Specifically, with regard to educational decisions, states may include more options under the definition of a parent than those provided in the Individuals with Disabilities Education Act…
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Bridging Research and Environmental Regulatory Processes: The Role of Knowledge Brokers
Pennell, Kelly G.; Thompson, Marcella; Rice, James W.; Senier, Laura; Brown, Phil; Suuberg, Eric
2013-01-01
Federal funding agencies increasingly require research investigators to ensure that federally-sponsored research demonstrates broader societal impact. Specifically, the National Institutes of Environmental Health Sciences (NIEHS) Superfund Research Program (SRP) requires research centers to include research translation and community engagement cores to achieve broader impacts, with special emphasis on improving environmental health policies through better scientific understanding. This paper draws on theoretical insights from the social sciences to show how incorporating knowledge brokers in research centers can facilitate translation of scientific expertise to influence regulatory processes and thus promote public health. Knowledge brokers connect academic researchers with decision-makers, to facilitate the translation of research findings into policies and programs. In this article, we describe the stages of the regulatory process and highlight the role of the knowledge broker and scientific expert at each stage. We illustrate the cooperation of knowledge brokers, scientific experts and policymakers using a case from the Brown University (Brown) SRP. We show how the Brown SRP incorporated knowledge brokers to engage scientific experts with regulatory officials around the emerging public health problem of vapor intrusion. In the Brown SRP, the knowledge broker brought regulatory officials into the research process, to help scientific experts understand the critical nature of this emerging public health threat, and helped scientific experts develop a research agenda that would inform the development of timely measures to protect public health. Our experience shows that knowledge brokers can enhance the impact of environmental research on public health by connecting policy decision-makers with scientific experts at critical points throughout the regulatory process. PMID:24083557
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NASA Astrophysics Data System (ADS)
Kubo, Hideyuki
2008-07-01
In the context of state forestland management in tropical regions, the implementation of a co-management approach has been widely advocated in order to include the voices of local people and accommodate their interests in management decision-making. Most co-management literatures, however, underestimate the significance of statutory authority held by state to control forestlands and resources. By clarifying the implications of state ownership of forestland, this article aims to critically examine co-management processes with reference to Foucault’s notion of power and subject. Case studies were conducted at two co-management pilot sites in Gunung Halimun-Salak National Park, West Java, Indonesia. Findings demonstrate that co-management processes actually materialize shared decision-making arrangements between state forest bureaucracy and rural people through the application of equity approaches, such as deliberation, negotiation, and experimentation. At the same time, these processes can also function to diffuse state policy discourse in rural spheres, which makes rural subjects who accept and practice the policy discourse. The research also reveals that the diffusion process is complex and does not necessarily make a durable subject unless they are pertinently organized. The results of this research indicate that co-management of state forestlands is a double-edged process for local people who risk becoming a proxy of state bureaucracy in the implementation of state policy. Proponents of co-management should, therefore, critically examine whether new institutional arrangements, which are developed through co-management, truly reflect values and needs of local people and assist them to develop a pertinent subject to deal with it.