Strategic analytics: towards fully embedding evidence in healthcare decision-making.

PubMed

Garay, Jason; Cartagena, Rosario; Esensoy, Ali Vahit; Handa, Kiren; Kane, Eli; Kaw, Neal; Sadat, Somayeh

2015-01-01

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency's programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making. Copyright © 2014 Longwoods Publishing.

SANDS: a service-oriented architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2008-12-01

In this paper, we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. The SANDS architecture for decision support has several significant advantages over other architectures for clinical decision support. The most salient of these are:

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model.

PubMed

Damij, Nadja; Boškoski, Pavle; Bohanec, Marko; Mileva Boshkoska, Biljana

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies' business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and "what-if" scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support.

PubMed

Downing, Gregory J; Boyle, Scott N; Brinner, Kristin M; Osheroff, Jerome A

2009-10-08

Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment.

Information management to enable personalized medicine: stakeholder roles in building clinical decision support

PubMed Central

2009-01-01

Background Advances in technology and the scientific understanding of disease processes are presenting new opportunities to improve health through individualized approaches to patient management referred to as personalized medicine. Future health care strategies that deploy genomic technologies and molecular therapies will bring opportunities to prevent, predict, and pre-empt disease processes but will be dependent on knowledge management capabilities for health care providers that are not currently available. A key cornerstone to the potential application of this knowledge will be effective use of electronic health records. In particular, appropriate clinical use of genomic test results and molecularly-targeted therapies present important challenges in patient management that can be effectively addressed using electronic clinical decision support technologies. Discussion Approaches to shaping future health information needs for personalized medicine were undertaken by a work group of the American Health Information Community. A needs assessment for clinical decision support in electronic health record systems to support personalized medical practices was conducted to guide health future development activities. Further, a suggested action plan was developed for government, researchers and research institutions, developers of electronic information tools (including clinical guidelines, and quality measures), and standards development organizations to meet the needs for personalized approaches to medical practice. In this article, we focus these activities on stakeholder organizations as an operational framework to help identify and coordinate needs and opportunities for clinical decision support tools to enable personalized medicine. Summary This perspective addresses conceptual approaches that can be undertaken to develop and apply clinical decision support in electronic health record systems to achieve personalized medical care. In addition, to represent meaningful benefits to personalized decision-making, a comparison of current and future applications of clinical decision support to enable individualized medical treatment plans is presented. If clinical decision support tools are to impact outcomes in a clear and positive manner, their development and deployment must therefore consider the needs of the providers, including specific practice needs, information workflow, and practice environment. PMID:19814826

Future of electronic health records: implications for decision support.

PubMed

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data in real-time for decision support and process automation has the potential to both reduce costs and improve the quality of patient care. © 2012 Mount Sinai School of Medicine.

Developing genomic knowledge bases and databases to support clinical management: current perspectives.

PubMed

Huser, Vojtech; Sincan, Murat; Cimino, James J

2014-01-01

Personalized medicine, the ability to tailor diagnostic and treatment decisions for individual patients, is seen as the evolution of modern medicine. We characterize here the informatics resources available today or envisioned in the near future that can support clinical interpretation of genomic test results. We assume a clinical sequencing scenario (germline whole-exome sequencing) in which a clinical specialist, such as an endocrinologist, needs to tailor patient management decisions within his or her specialty (targeted findings) but relies on a genetic counselor to interpret off-target incidental findings. We characterize the genomic input data and list various types of knowledge bases that provide genomic knowledge for generating clinical decision support. We highlight the need for patient-level databases with detailed lifelong phenotype content in addition to genotype data and provide a list of recommendations for personalized medicine knowledge bases and databases. We conclude that no single knowledge base can currently support all aspects of personalized recommendations and that consolidation of several current resources into larger, more dynamic and collaborative knowledge bases may offer a future path forward.

Developing genomic knowledge bases and databases to support clinical management: current perspectives

PubMed Central

Huser, Vojtech; Sincan, Murat; Cimino, James J

2014-01-01

Personalized medicine, the ability to tailor diagnostic and treatment decisions for individual patients, is seen as the evolution of modern medicine. We characterize here the informatics resources available today or envisioned in the near future that can support clinical interpretation of genomic test results. We assume a clinical sequencing scenario (germline whole-exome sequencing) in which a clinical specialist, such as an endocrinologist, needs to tailor patient management decisions within his or her specialty (targeted findings) but relies on a genetic counselor to interpret off-target incidental findings. We characterize the genomic input data and list various types of knowledge bases that provide genomic knowledge for generating clinical decision support. We highlight the need for patient-level databases with detailed lifelong phenotype content in addition to genotype data and provide a list of recommendations for personalized medicine knowledge bases and databases. We conclude that no single knowledge base can currently support all aspects of personalized recommendations and that consolidation of several current resources into larger, more dynamic and collaborative knowledge bases may offer a future path forward. PMID:25276091

XWeB: The XML Warehouse Benchmark

NASA Astrophysics Data System (ADS)

Mahboubi, Hadj; Darmont, Jérôme

With the emergence of XML as a standard for representing business data, new decision support applications are being developed. These XML data warehouses aim at supporting On-Line Analytical Processing (OLAP) operations that manipulate irregular XML data. To ensure feasibility of these new tools, important performance issues must be addressed. Performance is customarily assessed with the help of benchmarks. However, decision support benchmarks do not currently support XML features. In this paper, we introduce the XML Warehouse Benchmark (XWeB), which aims at filling this gap. XWeB derives from the relational decision support benchmark TPC-H. It is mainly composed of a test data warehouse that is based on a unified reference model for XML warehouses and that features XML-specific structures, and its associate XQuery decision support workload. XWeB's usage is illustrated by experiments on several XML database management systems.

New Interoperable Tools to Facilitate Decision-Making to Support Community Sustainability

EPA Science Inventory

Communities, regional planning authorities, regulatory agencies, and other decision-making bodies do not currently have adequate access to spatially explicit information crucial to making decisions that allow them to consider a full accounting of the costs, benefits, and trade-of...

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare.

PubMed

Dolan, James G

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers.Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine "hard data" with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings.The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP).

Multi-criteria clinical decision support: A primer on the use of multiple criteria decision making methods to promote evidence-based, patient-centered healthcare

PubMed Central

Dolan, James G.

2010-01-01

Current models of healthcare quality recommend that patient management decisions be evidence-based and patient-centered. Evidence-based decisions require a thorough understanding of current information regarding the natural history of disease and the anticipated outcomes of different management options. Patient-centered decisions incorporate patient preferences, values, and unique personal circumstances into the decision making process and actively involve both patients along with health care providers as much as possible. Fundamentally, therefore, evidence-based, patient-centered decisions are multi-dimensional and typically involve multiple decision makers. Advances in the decision sciences have led to the development of a number of multiple criteria decision making methods. These multi-criteria methods are designed to help people make better choices when faced with complex decisions involving several dimensions. They are especially helpful when there is a need to combine “hard data” with subjective preferences, to make trade-offs between desired outcomes, and to involve multiple decision makers. Evidence-based, patient-centered clinical decision making has all of these characteristics. This close match suggests that clinical decision support systems based on multi-criteria decision making techniques have the potential to enable patients and providers to carry out the tasks required to implement evidence-based, patient-centered care effectively and efficiently in clinical settings. The goal of this paper is to give readers a general introduction to the range of multi-criteria methods available and show how they could be used to support clinical decision-making. Methods discussed include the balance sheet, the even swap method, ordinal ranking methods, direct weighting methods, multi-attribute decision analysis, and the analytic hierarchy process (AHP) PMID:21394218

The use of the Dutch Self-Sufficiency Matrix (SSM-D) to inform allocation decisions to public mental health care for homeless people.

PubMed

Lauriks, Steve; de Wit, Matty A S; Buster, Marcel C A; Fassaert, Thijs J L; van Wifferen, Ron; Klazinga, Niek S

2014-10-01

The current study set out to develop a decision support tool based on the Self-Sufficiency Matrix (Dutch version; SSM-D) for the clinical decision to allocate homeless people to the public mental health care system at the central access point of public mental health care in Amsterdam, The Netherlands. Logistic regression and receiver operating characteristic-curve analyses were used to model professional decisions and establish four decision categories based on SSM-D scores from half of the research population (Total n = 612). The model and decision categories were found to be accurate and reliable in predicting professional decisions in the second half of the population. Results indicate that the decision support tool based on the SSM-D is useful and feasible. The method to develop the SSM-D as a decision support tool could be applied to decision-making processes in other systems and services where the SSM-D has been implemented, to further increase the utility of the instrument.

Abbreviated Military Decision Making for Brigade Combat Teams

DTIC Science & Technology

2001-06-01

manual, The Enlighted Eye. The current study is field focused, includes self as an instrument, is essentially interpretive in scope, focuses on details...decision making performance deteriorated when more rather than less information was provided.”51 Even under normal circumstances, current technology ...Direct Military Support (10) / Chapter 3 / 12 Critical Technology (3

Extending BPM Environments of Your Choice with Performance Related Decision Support

NASA Astrophysics Data System (ADS)

Fritzsche, Mathias; Picht, Michael; Gilani, Wasif; Spence, Ivor; Brown, John; Kilpatrick, Peter

What-if Simulations have been identified as one solution for business performance related decision support. Such support is especially useful in cases where it can be automatically generated out of Business Process Management (BPM) Environments from the existing business process models and performance parameters monitored from the executed business process instances. Currently, some of the available BPM Environments offer basic-level performance prediction capabilities. However, these functionalities are normally too limited to be generally useful for performance related decision support at business process level. In this paper, an approach is presented which allows the non-intrusive integration of sophisticated tooling for what-if simulations, analytic performance prediction tools, process optimizations or a combination of such solutions into already existing BPM environments. The approach abstracts from process modelling techniques which enable automatic decision support spanning processes across numerous BPM Environments. For instance, this enables end-to-end decision support for composite processes modelled with the Business Process Modelling Notation (BPMN) on top of existing Enterprise Resource Planning (ERP) processes modelled with proprietary languages.

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

NASA Astrophysics Data System (ADS)

Spahr, K.; Hogue, T. S.

2016-12-01

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

D-Side: A Facility and Workforce Planning Group Multi-criteria Decision Support System for Johnson Space Center

NASA Technical Reports Server (NTRS)

Tavana, Madjid

2005-01-01

"To understand and protect our home planet, to explore the universe and search for life, and to inspire the next generation of explorers" is NASA's mission. The Systems Management Office at Johnson Space Center (JSC) is searching for methods to effectively manage the Center's resources to meet NASA's mission. D-Side is a group multi-criteria decision support system (GMDSS) developed to support facility decisions at JSC. D-Side uses a series of sequential and structured processes to plot facilities in a three-dimensional (3-D) graph on the basis of each facility alignment with NASA's mission and goals, the extent to which other facilities are dependent on the facility, and the dollar value of capital investments that have been postponed at the facility relative to the facility replacement value. A similarity factor rank orders facilities based on their Euclidean distance from Ideal and Nadir points. These similarity factors are then used to allocate capital improvement resources across facilities. We also present a parallel model that can be used to support decisions concerning allocation of human resources investments across workforce units. Finally, we present results from a pilot study where 12 experienced facility managers from NASA used D-Side and the organization's current approach to rank order and allocate funds for capital improvement across 20 facilities. Users evaluated D-Side favorably in terms of ease of use, the quality of the decision-making process, decision quality, and overall value-added. Their evaluations of D-Side were significantly more favorable than their evaluations of the current approach. Keywords: NASA, Multi-Criteria Decision Making, Decision Support System, AHP, Euclidean Distance, 3-D Modeling, Facility Planning, Workforce Planning.

SANDS: A Service-Oriented Architecture for Clinical Decision Support in a National Health Information Network

PubMed Central

Wright, Adam; Sittig, Dean F.

2008-01-01

In this paper we describe and evaluate a new distributed architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support), which leverages current health information exchange efforts and is based on the principles of a service-oriented architecture. The architecture allows disparate clinical information systems and clinical decision support systems to be seamlessly integrated over a network according to a set of interfaces and protocols described in this paper. The architecture described is fully defined and developed, and six use cases have been developed and tested using a prototype electronic health record which links to one of the existing prototype National Health Information Networks (NHIN): drug interaction checking, syndromic surveillance, diagnostic decision support, inappropriate prescribing in older adults, information at the point of care and a simple personal health record. Some of these use cases utilize existing decision support systems, which are either commercially or freely available at present, and developed outside of the SANDS project, while other use cases are based on decision support systems developed specifically for the project. Open source code for many of these components is available, and an open source reference parser is also available for comparison and testing of other clinical information systems and clinical decision support systems that wish to implement the SANDS architecture. PMID:18434256

Ranking of Business Process Simulation Software Tools with DEX/QQ Hierarchical Decision Model

PubMed Central

2016-01-01

The omnipresent need for optimisation requires constant improvements of companies’ business processes (BPs). Minimising the risk of inappropriate BP being implemented is usually performed by simulating the newly developed BP under various initial conditions and “what-if” scenarios. An effectual business process simulations software (BPSS) is a prerequisite for accurate analysis of an BP. Characterisation of an BPSS tool is a challenging task due to the complex selection criteria that includes quality of visual aspects, simulation capabilities, statistical facilities, quality reporting etc. Under such circumstances, making an optimal decision is challenging. Therefore, various decision support models are employed aiding the BPSS tool selection. The currently established decision support models are either proprietary or comprise only a limited subset of criteria, which affects their accuracy. Addressing this issue, this paper proposes a new hierarchical decision support model for ranking of BPSS based on their technical characteristics by employing DEX and qualitative to quantitative (QQ) methodology. Consequently, the decision expert feeds the required information in a systematic and user friendly manner. There are three significant contributions of the proposed approach. Firstly, the proposed hierarchical model is easily extendible for adding new criteria in the hierarchical structure. Secondly, a fully operational decision support system (DSS) tool that implements the proposed hierarchical model is presented. Finally, the effectiveness of the proposed hierarchical model is assessed by comparing the resulting rankings of BPSS with respect to currently available results. PMID:26871694

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

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

PubMed

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

2017-01-01

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

Electronic decision support in general practice. What's the hold up?

PubMed

Liaw, S T; Schattner, P

2003-11-01

The uptake of computers in Australian general practice has been for administrative use and prescribing, but the development of electronic decision support (EDS) has been particularly slow. Therefore, computers are not being used to their full potential in assisting general practitioners to care for their patients. This article examines current barriers to EDS in general practice and possible strategies to increase its uptake. Barriers to the uptake of EDS include a lack of a business case, shifting of costs for data collection and management to the clinician, uncertainty about the optimal level of decision support, lack of technical and semantic standards, and resistance to EDS use by the time conscious GP. There is a need for a more strategic and attractive incentives program, greater national coordination, and more effective collaboration between government, the computer industry and the medical profession if current inertia is to be overcome.

Biomedical Informatics for Computer-Aided Decision Support Systems: A Survey

PubMed Central

Belle, Ashwin; Kon, Mark A.; Najarian, Kayvan

2013-01-01

The volumes of current patient data as well as their complexity make clinical decision making more challenging than ever for physicians and other care givers. This situation calls for the use of biomedical informatics methods to process data and form recommendations and/or predictions to assist such decision makers. The design, implementation, and use of biomedical informatics systems in the form of computer-aided decision support have become essential and widely used over the last two decades. This paper provides a brief review of such systems, their application protocols and methodologies, and the future challenges and directions they suggest. PMID:23431259

A cross-sectional survey of supports for evidence-informed decision-making in healthcare organisations: a research protocol.

PubMed

Ouimet, Mathieu; Lavis, John N; Léon, Grégory; Ellen, Moriah E; Bédard, Pierre-Olivier; Grimshaw, Jeremy M; Gagnon, Marie-Pierre

2014-10-09

This protocol builds on the development of a) a framework that identified the various supports (i.e. positions, activities, interventions) that a healthcare organisation or health system can implement for evidence-informed decision-making (EIDM) and b) a qualitative study that showed the current mix of supports that some Canadian healthcare organisations have in place and the ones that are perceived to facilitate the use of research evidence in decision-making. Based on these findings, we developed a web survey to collect cross-sectional data about the specific supports that regional health authorities and hospitals in two Canadian provinces (Ontario and Quebec) have in place to facilitate EIDM. This paper describes the methods for a cross-sectional web survey among 32 regional health authorities and 253 hospitals in the provinces of Quebec and Ontario (Canada) to collect data on the current mix of organisational supports that these organisations have in place to facilitate evidence-informed decision-making. The data will be obtained through a two-step survey design: a 10-min survey among CEOs to identify key units and individuals in regard to our objectives (step 1) and a 20-min survey among managers of the key units identified in step 1 to collect information about the activities performed by their unit regarding the acquisition, assessment, adaptation and/or dissemination of research evidence in decision-making (step 2). The study will target three types of informants: CEOs, library/documentation centre managers and all other key managers whose unit is involved in the acquisition, assessment, adaptation/packaging and/or dissemination of research evidence in decision-making. We developed an innovative data collection system to increase the likelihood that only the best-informed respondent available answers each survey question. The reporting of the results will be done using descriptive statistics of supports by organisation type and by province. This study will be the first to collect and report large-scale cross-sectional data on the current mix of supports health system organisations in the two most populous Canadian provinces have in place for evidence-informed decision-making. The study will also provide useful information to researchers on how to collect organisation-level data with reduced risk of self-reporting bias.

A systematic review of online resources to support patient decision-making for full-thickness rectal prolapse surgery.

PubMed

Fowler, G E; Baker, D M; Lee, M J; Brown, S R

2017-11-01

The internet is becoming an increasingly popular resource to support patient decision-making outside of the clinical encounter. The quality of online health information is variable and largely unregulated. The aim of this study was to assess the quality of online resources to support patient decision-making for full-thickness rectal prolapse surgery. This systematic review was registered on the PROSPERO database (CRD42017058319). Searches were performed on Google and specialist decision aid repositories using a pre-defined search strategy. Sources were analysed according to three measures: (1) their readability using the Flesch-Kincaid Reading Ease score, (2) DISCERN score and (3) International Patient Decision Aids Standards (IPDAS) minimum standards criteria score (IPDASi, v4.0). Overall, 95 sources were from Google and the specialist decision aid repositories. There were 53 duplicates removed, and 18 sources did not meet the pre-defined eligibility criteria, leaving 24 sources included in the full-text analysis. The mean Flesch-Kincaid Reading Ease score was higher than recommended for patient education materials (48.8 ± 15.6, range 25.2-85.3). Overall quality of sources supporting patient decision-making for full-thickness rectal prolapse surgery was poor (median DISCERN score 1/5 ± 1.18, range 1-5). No sources met minimum decision-making standards (median IPDASi score 5/12 ± 2.01, range 1-8). Currently, easily accessible online health information to support patient decision-making for rectal surgery is of poor quality, difficult to read and does not support shared decision-making. It is recommended that professional bodies and medical professionals seek to develop decision aids to support decision-making for full-thickness rectal prolapse surgery.

Next generation data systems and knowledge products to support agricultural producers and science-based policy decision making.

PubMed

Capalbo, Susan M; Antle, John M; Seavert, Clark

2017-07-01

Research on next generation agricultural systems models shows that the most important current limitation is data, both for on-farm decision support and for research investment and policy decision making. One of the greatest data challenges is to obtain reliable data on farm management decision making, both for current conditions and under scenarios of changed bio-physical and socio-economic conditions. This paper presents a framework for the use of farm-level and landscape-scale models and data to provide analysis that could be used in NextGen knowledge products, such as mobile applications or personal computer data analysis and visualization software. We describe two analytical tools - AgBiz Logic and TOA-MD - that demonstrate the current capability of farmlevel and landscape-scale models. The use of these tools is explored with a case study of an oilseed crop, Camelina sativa , which could be used to produce jet aviation fuel. We conclude with a discussion of innovations needed to facilitate the use of farm and policy-level models to generate data and analysis for improved knowledge products.

The Rangeland Vegetation Simulator: A user-driven system for quantifying production, succession, disturbance and fuels in non-forest environments

Treesearch

Matt Reeves; Leonardo Frid

2016-01-01

Rangeland landscapes occupy roughly 662 million acres in the coterminous U.S. (Reeves and Mitchell 2011) and their vegetation responds quickly to climate and management, with high relative growth rates and inter-annual variability. Current national decision support systems in the U.S. such as the Interagency Fuels Treatment Decision Support System (IFT-DSS) require...

Free and open source enabling technologies for patient-centric, guideline-based clinical decision support: a survey.

PubMed

Leong, T Y; Kaiser, K; Miksch, S

2007-01-01

Guideline-based clinical decision support is an emerging paradigm to help reduce error, lower cost, and improve quality in evidence-based medicine. The free and open source (FOS) approach is a promising alternative for delivering cost-effective information technology (IT) solutions in health care. In this paper, we survey the current FOS enabling technologies for patient-centric, guideline-based care, and discuss the current trends and future directions of their role in clinical decision support. We searched PubMed, major biomedical informatics websites, and the web in general for papers and links related to FOS health care IT systems. We also relied on our background and knowledge for specific subtopics. We focused on the functionalities of guideline modeling tools, and briefly examined the supporting technologies for terminology, data exchange and electronic health record (EHR) standards. To effectively support patient-centric, guideline-based care, the computerized guidelines and protocols need to be integrated with existing clinical information systems or EHRs. Technologies that enable such integration should be accessible, interoperable, and scalable. A plethora of FOS tools and techniques for supporting different knowledge management and quality assurance tasks involved are available. Many challenges, however, remain in their implementation. There are active and growing trends of deploying FOS enabling technologies for integrating clinical guidelines, protocols, and pathways into the main care processes. The continuing development and maturation of such technologies are likely to make increasingly significant contributions to patient-centric, guideline-based clinical decision support.

Distributed Cognition in Cancer Treatment Decision Making: An Application of the DECIDE Decision-Making Styles Typology.

PubMed

Krieger, Janice L; Krok-Schoen, Jessica L; Dailey, Phokeng M; Palmer-Wackerly, Angela L; Schoenberg, Nancy; Paskett, Electra D; Dignan, Mark

2017-07-01

Distributed cognition occurs when cognitive and affective schemas are shared between two or more people during interpersonal discussion. Although extant research focuses on distributed cognition in decision making between health care providers and patients, studies show that caregivers are also highly influential in the treatment decisions of patients. However, there are little empirical data describing how and when families exert influence. The current article addresses this gap by examining decisional support in the context of cancer randomized clinical trial (RCT) decision making. Data are drawn from in-depth interviews with rural, Appalachian cancer patients ( N = 46). Analysis of transcript data yielded empirical support for four distinct models of health decision making. The implications of these findings for developing interventions to improve the quality of treatment decision making and overall well-being are discussed.

A knowledge engineering framework towards clinical support for adverse drug event prevention: the PSIP approach.

PubMed

Koutkias, Vassilis; Stalidis, George; Chouvarda, Ioanna; Lazou, Katerina; Kilintzis, Vassilis; Maglaveras, Nicos

2009-01-01

Adverse Drug Events (ADEs) are currently considered as a major public health issue, endangering patients' safety and causing significant healthcare costs. Several research efforts are currently concentrating on the reduction of preventable ADEs by employing Information Technology (IT) solutions, which aim to provide healthcare professionals and patients with relevant knowledge and decision support tools. In this context, we present a knowledge engineering approach towards the construction of a Knowledge-based System (KBS) regarded as the core part of a CDSS (Clinical Decision Support System) for ADE prevention, all developed in the context of the EU-funded research project PSIP (Patient Safety through Intelligent Procedures in Medication). In the current paper, we present the knowledge sources considered in PSIP and the implications they pose to knowledge engineering, the methodological approach followed, as well as the components defining the knowledge engineering framework based on relevant state-of-the-art technologies and representation formalisms.

An Integrated Web-based Decision Support System in Disaster Risk Management

NASA Astrophysics Data System (ADS)

Aye, Z. C.; Jaboyedoff, M.; Derron, M. H.

2012-04-01

Nowadays, web based decision support systems (DSS) play an essential role in disaster risk management because of their supporting abilities which help the decision makers to improve their performances and make better decisions without needing to solve complex problems while reducing human resources and time. Since the decision making process is one of the main factors which highly influence the damages and losses of society, it is extremely important to make right decisions at right time by combining available risk information with advanced web technology of Geographic Information System (GIS) and Decision Support System (DSS). This paper presents an integrated web-based decision support system (DSS) of how to use risk information in risk management efficiently and effectively while highlighting the importance of a decision support system in the field of risk reduction. Beyond the conventional systems, it provides the users to define their own strategies starting from risk identification to the risk reduction, which leads to an integrated approach in risk management. In addition, it also considers the complexity of changing environment from different perspectives and sectors with diverse stakeholders' involvement in the development process. The aim of this platform is to contribute a part towards the natural hazards and geosciences society by developing an open-source web platform where the users can analyze risk profiles and make decisions by performing cost benefit analysis, Environmental Impact Assessment (EIA) and Strategic Environmental Assessment (SEA) with the support of others tools and resources provided. There are different access rights to the system depending on the user profiles and their responsibilities. The system is still under development and the current version provides maps viewing, basic GIS functionality, assessment of important infrastructures (e.g. bridge, hospital, etc.) affected by landslides and visualization of the impact-probability matrix in terms of socio-economic dimension.

Air Traffic Management Research at NASA Ames Research Center

NASA Technical Reports Server (NTRS)

Lee, Katharine

2005-01-01

Since the late 1980's, NASA Ames researchers have been investigating ways to improve the air transportation system through the development of decision support automation. These software advances, such as the Center-TRACON Automation System (eTAS) have been developed with teams of engineers, software developers, human factors experts, and air traffic controllers; some ASA Ames decision support tools are currently operational in Federal Aviation Administration (FAA) facilities and some are in use by the airlines. These tools have provided air traffic controllers and traffic managers the capabilities to help reduce overall delays and holding, and provide significant cost savings to the airlines as well as more manageable workload levels for air traffic service providers. NASA is continuing to collaborate with the FAA, as well as other government agencies, to plan and develop the next generation of decision support tools that will support anticipated changes in the air transportation system, including a projected increase to three times today's air-traffic levels by 2025. The presentation will review some of NASA Ames' recent achievements in air traffic management research, and discuss future tool developments and concepts currently under consideration.

ENVIRONMENTAL FEATURE FINDER: A REMOTE SENSING DECISION SUPPORT TOOL

EPA Science Inventory

Land cover maps are essential to sound environmental stewardship and EPA’s mission to protect human health and the environment, but existing maps are not always sufficiently current, detailed, or appropriate for a given application. Consequently, we are developing a decision sup...

A qualitative exploration of patient and family views and experiences of treatment decision-making in bipolar II disorder.

PubMed

Fisher, Alana; Manicavasagar, Vijaya; Sharpe, Louise; Laidsaar-Powell, Rebekah; Juraskova, Ilona

2018-02-01

Treatment decision-making in bipolar II disorder (BPII) is challenging, yet the decision support needs of patients and family remain unknown. To explore patient and family perspectives of treatment decision-making in BPII. Semistructured, qualitative interviews were conducted with 28 patients with BPII-diagnosis and 13 family members with experience in treatment decision-making in the outpatient setting. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Participant demographics, clinical characteristics and preferences for patient decision-making involvement were assessed. Four inter-related themes emerged: (1) Attitudes and response to diagnosis and treatment; (2) Influences on decision-making; (3) The nature and flow of decision-making; (4) Decision support and challenges. Views differed according to patient involvement preferences, time since diagnosis and patients' current mood symptoms. This is the first known study to provide in-depth patient and family insights into the key factors influencing BPII treatment decision-making, and potential improvements and challenges to this process. Findings will inform the development of BPII treatment decision-making resources that better meet the informational and decision-support priorities of end users. This research was partly funded by a Postgraduate Research Grant awarded to the first author by the University of Sydney. No conflicts of interest declared.

Behavioral Economics: A New Lens for Understanding Genomic Decision Making.

PubMed

Moore, Scott Emory; Ulbrich, Holley H; Hepburn, Kenneth; Holaday, Bonnie; Mayo, Rachel; Sharp, Julia; Pruitt, Rosanne H

2018-05-01

This article seeks to take the next step in examining the insights that nurses and other healthcare providers can derive from applying behavioral economic concepts to support genomic decision making. As genomic science continues to permeate clinical practice, nurses must continue to adapt practice to meet new challenges. Decisions associated with genomics are often not simple and dichotomous in nature. They can be complex and challenging for all involved. This article offers an introduction to behavioral economics as a possible tool to help support patients', families', and caregivers' decision making related to genomics. Using current writings from nursing, ethics, behavioral economic, and other healthcare scholars, we review key concepts of behavioral economics and discuss their relevance to supporting genomic decision making. Behavioral economic concepts-particularly relativity, deliberation, and choice architecture-are specifically examined as new ways to view the complexities of genomic decision making. Each concept is explored through patient decision making and clinical practice examples. This article also discusses next steps and practice implications for further development of the behavioral economic lens in nursing. Behavioral economics provides valuable insight into the unique nature of genetic decision-making practices. Nurses are often a source of information and support for patients during clinical decision making. This article seeks to offer behavioral economic concepts as a framework for understanding and examining the unique nature of genomic decision making. As genetic and genomic testing become more common in practice, it will continue to grow in importance for nurses to be able to support the autonomous decision making of patients, their families, and caregivers. © 2018 Sigma Theta Tau International.

A multimedia electronic patient record (ePR) system to improve decision support in pre- and rehabilitation through clinical and movement analysis

NASA Astrophysics Data System (ADS)

Liu, Brent; Documet, Jorge; McNitt-Gray, Sarah; Requejo, Phil; McNitt-Gray, Jill

2011-03-01

Clinical decisions for improving motor function in patients both with disability as well as improving an athlete's performance are made through clinical and movement analysis. Currently, this analysis facilitates identifying abnormalities in a patient's motor function for a large amount of neuro-musculoskeletal pathologies. However definitively identifying the underlying cause or long-term consequences of a specific abnormality in the patient's movement pattern is difficult since this requires information from multiple sources and formats across different times and currently relies on the experience and intuition of the expert clinician. In addition, this data must be persistent for longitudinal outcomes studies. Therefore a multimedia ePR system integrating imaging informatics data could have a significant impact on decision support within this clinical workflow. We present the design and architecture of such an ePR system as well as the data types that need integration in order to develop relevant decision support tools. Specifically, we will present two data model examples: 1) A performance improvement project involving volleyball athletes and 2) Wheelchair propulsion evaluation of patients with disabilities. The end result is a new frontier area of imaging informatics research within rehabilitation engineering and biomechanics.

COMPUTER SUPPORT SYSTEMS FOR ESTIMATING CHEMICAL TOXICITY: PRESENT CAPABILITIES AND FUTURE TRENDS

EPA Science Inventory

Computer Support Systems for Estimating Chemical Toxicity: Present Capabilities and Future Trends

A wide variety of computer-based artificial intelligence (AI) and decision support systems exist currently to aid in the assessment of toxicity for environmental chemicals. T...

Promoting Shared Decision Making in Disorders of Sex Development (DSD): Decision Aids and Support Tools.

PubMed

Siminoff, L A; Sandberg, D E

2015-05-01

Specific complaints and grievances from adult patients with disorders of sex development (DSD), and their advocates center around the lack of information or misinformation they were given about their condition and feeling stigmatized and shamed by the secrecy surrounding their condition and its management. Many also attribute poor sexual function to damaging genital surgery and/or repeated, insensitive genital examinations. These reports suggest the need to reconsider the decision-making process for the treatment of children born with DSD. This paper proposes that shared decision making, an important concept in adult health care, be operationalized for the major decisions commonly encountered in DSD care and facilitated through the utilization of decision aids and support tools. This approach may help patients and their families make informed decisions that are better aligned with their personal values and goals. It may also lead to greater confidence in decision making with greater satisfaction and less regret. A brief review of the past and current approach to DSD decision making is provided, along with a review of shared decision making and decision aids and support tools. A case study explores the need and potential utility of this suggested new approach. © Georg Thieme Verlag KG Stuttgart · New York.

Decision support for evidence-based integration of disease control: A proof of concept for malaria and schistosomiasis

PubMed Central

Graeden, Ellie; Kerr, Justin; Sorrell, Erin M.; Katz, Rebecca

2018-01-01

Managing infectious disease requires rapid and effective response to support decision making. The decisions are complex and require understanding of the diseases, disease intervention and control measures, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions, the complexity of current models presents a significant barrier to community-level decision makers in using the outputs of the most scientifically robust methods to support pragmatic decisions about implementing a public health response effort, even for endemic diseases with which they are already familiar. Here, we describe the development of an application available on the internet, including from mobile devices, with a simple user interface, to support on-the-ground decision-making for integrating disease control programs, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap, and which result in significant morbidity and mortality in affected regions. Working with data from countries across sub-Saharan Africa and the Middle East, we present a proof-of-principle method and corresponding prototype tool to provide guidance on how to optimize integration of vertical disease control programs. This method and tool demonstrate significant progress in effectively translating the best available scientific models to support practical decision making on the ground with the potential to significantly increase the efficacy and cost-effectiveness of disease control. Author summary Designing and implementing effective programs for infectious disease control requires complex decision-making, informed by an understanding of the diseases, the types of disease interventions and control measures available, and the disease-relevant characteristics of the local community. Though disease modeling frameworks have been developed to address these questions and support decision-making, the complexity of current models presents a significant barrier to on-the-ground end users. The picture is further complicated when considering approaches for integration of different disease control programs, where co-infection dynamics, treatment interactions, and other variables must also be taken into account. Here, we describe the development of an application available on the internet with a simple user interface, to support on-the-ground decision-making for integrating disease control, given local conditions and practical constraints. The model upon which the tool is built provides predictive analysis for the effectiveness of integration of schistosomiasis and malaria control, two diseases with extensive geographical and epidemiological overlap. This proof-of-concept method and tool demonstrate significant progress in effectively translating the best available scientific models to support pragmatic decision-making on the ground, with the potential to significantly increase the impact and cost-effectiveness of disease control. PMID:29649260

Neurocognitive Development of Risk Aversion from Early Childhood to Adulthood

PubMed Central

Paulsen, David J.; Carter, R. McKell; Platt, Michael L.; Huettel, Scott A.; Brannon, Elizabeth M.

2012-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes. PMID:22291627

Neurocognitive development of risk aversion from early childhood to adulthood.

PubMed

Paulsen, David J; Carter, R McKell; Platt, Michael L; Huettel, Scott A; Brannon, Elizabeth M

2011-01-01

Human adults tend to avoid risk. In behavioral economic studies, risk aversion is manifest as a preference for sure gains over uncertain gains. However, children tend to be less averse to risk than adults. Given that many of the brain regions supporting decision-making under risk do not reach maturity until late adolescence or beyond it is possible that mature risk-averse behavior may emerge from the development of decision-making circuitry. To explore this hypothesis, we tested 5- to 8-year-old children, 14- to 16-year-old adolescents, and young adults in a risky-decision task during functional magnetic resonance imaging (fMRI) data acquisition. To our knowledge, this is the youngest sample of children in an fMRI decision-making task. We found a number of decision-related brain regions to increase in activation with age during decision-making, including areas associated with contextual memory retrieval and the incorporation of prior outcomes into the current decision-making strategy, e.g., insula, hippocampus, and amygdala. Further, children who were more risk-averse showed increased activation during decision-making in ventromedial prefrontal cortex and ventral striatum. Our findings indicate that the emergence of adult levels of risk aversion co-occurs with the recruitment of regions supporting decision-making under risk, including the integration of prior outcomes into current decision-making behavior. This pattern of results suggests that individual differences in the development of risk aversion may reflect differences in the maturation of these neural processes.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles.

PubMed

Horne, Avril C; Szemis, Joanna M; Webb, J Angus; Kaur, Simranjit; Stewardson, Michael J; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Informing Environmental Water Management Decisions: Using Conditional Probability Networks to Address the Information Needs of Planning and Implementation Cycles

NASA Astrophysics Data System (ADS)

Horne, Avril C.; Szemis, Joanna M.; Webb, J. Angus; Kaur, Simranjit; Stewardson, Michael J.; Bond, Nick; Nathan, Rory

2018-03-01

One important aspect of adaptive management is the clear and transparent documentation of hypotheses, together with the use of predictive models (complete with any assumptions) to test those hypotheses. Documentation of such models can improve the ability to learn from management decisions and supports dialog between stakeholders. A key challenge is how best to represent the existing scientific knowledge to support decision-making. Such challenges are currently emerging in the field of environmental water management in Australia, where managers are required to prioritize the delivery of environmental water on an annual basis, using a transparent and evidence-based decision framework. We argue that the development of models of ecological responses to environmental water use needs to support both the planning and implementation cycles of adaptive management. Here we demonstrate an approach based on the use of Conditional Probability Networks to translate existing ecological knowledge into quantitative models that include temporal dynamics to support adaptive environmental flow management. It equally extends to other applications where knowledge is incomplete, but decisions must still be made.

Verification and Validation of NASA-Supported Enhancements to Decision Support Tools of PECAD

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; McKellip, Rodney; Moore, Roxzana F.; Fendley, Debbie

2005-01-01

This section of the evaluation report summarizes the verification and validation (V&V) of recently implemented, NASA-supported enhancements to the decision support tools of the Production Estimates and Crop Assessment Division (PECAD). The implemented enhancements include operationally tailored Moderate Resolution Imaging Spectroradiometer (MODIS) products and products of the Global Reservoir and Lake Monitor (GRLM). The MODIS products are currently made available through two separate decision support tools: the MODIS Image Gallery and the U.S. Department of Agriculture (USDA) Foreign Agricultural Service (FAS) MODIS Normalized Difference Vegetation Index (NDVI) Database. Both the Global Reservoir and Lake Monitor and MODIS Image Gallery provide near-real-time products through PECAD's CropExplorer. This discussion addresses two areas: 1. Assessments of the standard NASA products on which these enhancements are based. 2. Characterizations of the performance of the new operational products.

Identifying the decision to be supported: a review of papers from environmental modelling and software

USGS Publications Warehouse

Sojda, Richard S.; Chen, Serena H.; El Sawah, Sondoss; Guillaume, Joseph H.A.; Jakeman, A.J.; Lautenbach, Sven; McIntosh, Brian S.; Rizzoli, A.E.; Seppelt, Ralf; Struss, Peter; Voinov, Alexey; Volk, Martin

2012-01-01

Two of the basic tenets of decision support system efforts are to help identify and structure the decisions to be supported, and to then provide analysis in how those decisions might be best made. One example from wetland management would be that wildlife biologists must decide when to draw down water levels to optimise aquatic invertebrates as food for breeding ducks. Once such a decision is identified, a system or tool to help them make that decision in the face of current and projected climate conditions could be developed. We examined a random sample of 100 papers published from 2001-2011 in Environmental Modelling and Software that used the phrase “decision support system” or “decision support tool”, and which are characteristic of different sectors. In our review, 41% of the systems and tools related to the water resources sector, 34% were related to agriculture, and 22% to the conservation of fish, wildlife, and protected area management. Only 60% of the papers were deemed to be reporting on DSS. This was based on the papers reviewed not having directly identified a specific decision to be supported. We also report on the techniques that were used to identify the decisions, such as formal survey, focus group, expert opinion, or sole judgment of the author(s). The primary underlying modelling system, e.g., expert system, agent based model, Bayesian belief network, geographical information system (GIS), and the like was categorised next. Finally, since decision support typically should target some aspect of unstructured decisions, we subjectively determined to what degree this was the case. In only 23% of the papers reviewed, did the system appear to tackle unstructured decisions. This knowledge should be useful in helping workers in the field develop more effective systems and tools, especially by being exposed to the approaches in different, but related, disciplines. We propose that a standard blueprint for reporting on DSS be developed for consideration by journal editors to aid them in filtering papers that use the term, “decision support”.

Integrated Forecast-Decision Systems For River Basin Planning and Management

NASA Astrophysics Data System (ADS)

Georgakakos, A. P.

2005-12-01

A central application of climatology, meteorology, and hydrology is the generation of reliable forecasts for water resources management. In principle, effective use of forecasts could improve water resources management by providing extra protection against floods, mitigating the adverse effects of droughts, generating more hydropower, facilitating recreational activities, and minimizing the impacts of extreme events on the environment and the ecosystems. In practice, however, realization of these benefits depends on three requisite elements. First is the skill and reliability of forecasts. Second is the existence of decision support methods/systems with the ability to properly utilize forecast information. And third is the capacity of the institutional infrastructure to incorporate the information provided by the decision support systems into the decision making processes. This presentation discusses several decision support systems (DSS) using ensemble forecasting that have been developed by the Georgia Water Resources Institute for river basin management. These DSS are currently operational in Africa, Europe, and the US and address integrated water resources and energy planning and management in river basins with multiple water uses, multiple relevant temporal and spatial scales, and multiple decision makers. The article discusses the methods used and advocates that the design, development, and implementation of effective forecast-decision support systems must bring together disciplines, people, and institutions necessary to address today's complex water resources challenges.

Will Decision Support in Medications Order Entry Save Money? A Return On Investment Analysis of the Case of the Hong Kong Hospital Authority

PubMed Central

Fung, Kin Wah; Vogel, Lynn Harold

2003-01-01

The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drug-allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 – 8.4%. Based on this estimate, a total net saving of $44,000 – $586,000 is expected over five years. The breakeven period is estimated to be between two to four years. PMID:14728171

“Smart Forms” in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management

PubMed Central

Schnipper, Jeffrey L.; Linder, Jeffrey A.; Palchuk, Matvey B.; Einbinder, Jonathan S.; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing “Smart Forms” to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions. PMID:18436911

"Smart Forms" in an Electronic Medical Record: documentation-based clinical decision support to improve disease management.

PubMed

Schnipper, Jeffrey L; Linder, Jeffrey A; Palchuk, Matvey B; Einbinder, Jonathan S; Li, Qi; Postilnik, Anatoly; Middleton, Blackford

2008-01-01

Clinical decision support systems (CDSS) integrated within Electronic Medical Records (EMR) hold the promise of improving healthcare quality. To date the effectiveness of CDSS has been less than expected, especially concerning the ambulatory management of chronic diseases. This is due, in part, to the fact that clinicians do not use CDSS fully. Barriers to clinicians' use of CDSS have included lack of integration into workflow, software usability issues, and relevance of the content to the patient at hand. At Partners HealthCare, we are developing "Smart Forms" to facilitate documentation-based clinical decision support. Rather than being interruptive in nature, the Smart Form enables writing a multi-problem visit note while capturing coded information and providing sophisticated decision support in the form of tailored recommendations for care. The current version of the Smart Form is designed around two chronic diseases: coronary artery disease and diabetes mellitus. The Smart Form has potential to improve the care of patients with both acute and chronic conditions.

Managing Decisions on Changes in the Virtual Enterprise Evolution

NASA Astrophysics Data System (ADS)

Drissen-Silva, Marcus Vinicius; Rabelo, Ricardo José

VE evolution deals with problems that happen during the VE operation and that put on risk planned results. This requires the application of problem-solving mechanisms to guarantee the construction of a new but feasible VE plan. Grounded on Project Management and Decision Support Systems foundations, this paper proposes a distributed collaborative decision support system to manage the VE evolution. Its main rationale is that VE’s members are autonomous and hence that all the affected partners should discuss about the necessary changes on the current VE’s plan. In the proposed approach, this discussion is guided by a decision protocol, and the impact of decisions can be evaluated. Results of a first prototype implementation are presented and discussed, with a special focus on the part which regulates the argumentation, voting and comparison of possible solutions.

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

NASA Technical Reports Server (NTRS)

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

2007-01-01

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

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.

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

PubMed

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

2004-08-01

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

A Multi-Operator Simulation for Investigation of Distributed Air Traffic Management Concepts

NASA Technical Reports Server (NTRS)

Peters, Mark E.; Ballin, Mark G.; Sakosky, John S.

2002-01-01

This paper discusses the current development of an air traffic operations simulation that supports feasibility research for advanced air traffic management concepts. The Air Traffic Operations Simulation (ATOS) supports the research of future concepts that provide a much greater role for the flight crew in traffic management decision-making. ATOS provides representations of the future communications, navigation, and surveillance (CNS) infrastructure, a future flight deck systems architecture, and advanced crew interfaces. ATOS also provides a platform for the development of advanced flight guidance and decision support systems that may be required for autonomous operations.

The Impact of Electronic Knowledge-Based Nursing Content and Decision-Support on Nursing-Sensitive Patient Outcomes

DTIC Science & Technology

2014-02-01

aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information...if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. 1. REPORT DATE February 2014 2... Akre , et al., 2006) content and evidence-based clinical decision support (CDS) tools were embedded into the EHR of one large health care system. Since

'Walking the tightrope': The role of peer support workers in facilitating consumers' participation in decision-making.

PubMed

Cleary, Michelle; Raeburn, Toby; Escott, Phil; West, Sancia; Lopez, Violeta

2018-05-09

In adult mental health services, the participation of consumers is essential. The aim of this study was to explore the challenges faced by peer support workers when involving mental health consumers in decision-making about their care and the strategies they employed to overcome these challenges so as to improve mental health consumers' participation in decision-making and recovery. Semi-structured individual interviews were conducted with six peer support workers currently employed in psychiatric hospitals and/or community mental health systems. Thematic analysis identified challenges related to role definition, power imbalance, doctor-centric medical approaches to care, and lack of resources. Strategies to overcome these challenges that were reported, included the following: facilitating meaningful involvement for service users, appropriate use of the lived experience, building relationships and communication, promoting rights and advocacy, and promoting professionalism of peer support workers (PSWs). Nursing staff need ongoing support and education to understand and value the varied roles of PSWs and thereby empower PSWs to engage in enhancing consumer decision-making. The roles of the PSWs should be viewed as complementary, and greater appreciation and understanding of roles would better support recovery-oriented care. © 2018 Australian College of Mental Health Nurses Inc.

NED-2: A decision support system for integrated forest ecosystem management

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

2005-01-01

NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

NED-2: a decision support system for integrated forest ecosystem management

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; H. Michael Rauscher; Donald E. Nute; Walter D. Potter; Frederick Maier; Jin Wang; Mayukh Dass; Hajime Uchiyama; Astrid Glende; Robin E. Hoffman

2005-01-01

NED-2 is a Windows-based system designed to improve project-level planning and decision making by providing useful and scientifically sound information to natural resource managers. Resources currently addressed include visual quality, ecology, forest health, timber, water, and wildlife. NED-2 expands on previous versions of NED applications by integrating treatment...

Decision Support Framework (DSF) For Planning Land And Resource Use To Sustainably Maintain Healthy Ecosystem Services And Communities

EPA Science Inventory

Land and resource use decisions are typically made to increase the economic viability of an area with little attention to the long term effects on human health and the environment from the resulting environmental condition after an action is taken. Currently, ecosystem services ...

Automatic Generation of Customized, Model Based Information Systems for Operations Management.

DTIC Science & Technology

The paper discusses the need for developing a customized, model based system to support management decision making in the field of operations ... management . It provides a critique of the current approaches available, formulates a framework to classify logistics decisions, and suggests an approach for the automatic development of logistics systems. (Author)

'My kidneys, my choice, decision aid': supporting shared decision making.

PubMed

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.

What can Natural Language Processing do for Clinical Decision Support?

PubMed Central

Demner-Fushman, Dina; Chapman, Wendy W.; McDonald, Clement J.

2009-01-01

Computerized Clinical Decision Support (CDS) aims to aid decision making of health care providers and the public by providing easily accessible health-related information at the point and time it is needed. Natural Language Processing (NLP) is instrumental in using free-text information to drive CDS, representing clinical knowledge and CDS interventions in standardized formats, and leveraging clinical narrative. The early innovative NLP research of clinical narrative was followed by a period of stable research conducted at the major clinical centers and a shift of mainstream interest to biomedical NLP. This review primarily focuses on the recently renewed interest in development of fundamental NLP methods and advances in the NLP systems for CDS. The current solutions to challenges posed by distinct sublanguages, intended user groups, and support goals are discussed. PMID:19683066

Toward patient-centered, personalized and personal decision support and knowledge management: a survey.

PubMed

Leong, T-Y

2012-01-01

This paper summarizes the recent trends and highlights the challenges and opportunities in decision support and knowledge management for patient-centered, personalized, and personal health care. The discussions are based on a broad survey of related references, focusing on the most recent publications. Major advances are examined in the areas of i) shared decision making paradigms, ii) continuity of care infrastructures and architectures, iii) human factors and system design approaches, iv) knowledge management innovations, and v) practical deployment and change considerations. Many important initiatives, projects, and plans with promising results have been identified. The common themes focus on supporting the individual patients who are playing an increasing central role in their own care decision processes. New collaborative decision making paradigms and information infrastructures are required to ensure effective continuity of care. Human factors and usability are crucial for the successful development and deployment of the relevant systems, tools, and aids. Advances in personalized medicine can be achieved through integrating genomic, phenotypic and other biological, individual, and population level information, and gaining useful insights from building and analyzing biological and other models at multiple levels of abstraction. Therefore, new Information and Communication Technologies and evaluation approaches are needed to effectively manage the scale and complexity of biomedical and health information, and adapt to the changing nature of clinical decision support. Recent research in decision support and knowledge management combines heterogeneous information and personal data to provide cost-effective, calibrated, personalized support in shared decision making at the point of care. Current and emerging efforts concentrate on developing or extending conventional paradigms, techniques, systems, and architectures for the new predictive, preemptive, and participatory health care model for patient-centered, personalized medicine. There is also an increasing emphasis on managing complexity with changing care models, processes, and settings.

Getting the Balance Right: Conceptual Considerations Concerning Legal Capacity and Supported Decision-Making.

PubMed

Parker, Malcolm

2016-09-01

The United Nations Convention on the Rights of Persons with Disabilities urges and requires changes to how signatories discharge their duties to people with intellectual disabilities, in the direction of their greater recognition as legal persons with expanded decision-making rights. Australian jurisdictions are currently undertaking inquiries and pilot projects that explore how these imperatives should be implemented. One of the important changes advocated is to move from guardianship models to supported or assisted models of decision-making. A driving force behind these developments is a strong allegiance to the social model of disability, in the formulation of the Convention, in inquiries and pilot projects, in implementation and in the related academic literature. Many of these instances suffer from confusing and misleading statements and conceptual misinterpretations of certain elements such as legal capacity, decision-making capacity, and support for decision-making. This paper analyses some of these confusions and their possible negative implications for supported decision-making instruments and those whose interests these instruments would serve, and advises a more incremental development of existing guardianship regimes. This provides a more realistic balance between neglecting the real limits of those with mental disabilities and thereby ignoring their identity and particularity, and continuing to bring them equally and fully into society.

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals.

PubMed

Geurtzen, R; Van Heijst, Arno; Hermens, Rosella; Scheepers, Hubertina; Woiski, Mallory; Draaisma, Jos; Hogeveen, Marije

2018-01-03

Since 2010, intensive care can be offered in the Netherlands at 24 +0  weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework. Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

7 CFR 3430.60 - Suspension, termination, and withholding of support.

Code of Federal Regulations, 2011 CFR

2011-01-01

.... 3430.60 Section 3430.60 Agriculture Regulations of the Department of Agriculture (Continued) NATIONAL INSTITUTE OF FOOD AND AGRICULTURE COMPETITIVE AND NONCOMPETITIVE NON-FORMULA FEDERAL ASSISTANCE PROGRAMS... decision not to make a non-competing continuation award within the current competitive segment. Support may...

A Decision Making Methodology in Support of the Business Rules Lifecycle

NASA Technical Reports Server (NTRS)

Wild, Christopher; Rosca, Daniela

1998-01-01

The business rules that underlie an enterprise emerge as a new category of system requirements that represent decisions about how to run the business, and which are characterized by their business-orientation and their propensity for change. In this report, we introduce a decision making methodology which addresses several aspects of the business rules lifecycle: acquisition, deployment and evolution. We describe a meta-model for representing business rules in terms of an enterprise model, and also a decision support submodel for reasoning about and deriving the rules. The possibility for lifecycle automated assistance is demonstrated in terms of the automatic extraction of business rules from the decision structure. A system based on the metamodel has been implemented, including the extraction algorithm. This is the final report for Daniela Rosca's PhD fellowship. It describes the work we have done over the past year, current research and the list of publications associated with her thesis topic.

Examining the Relationship Between Intimate Partner Violence and Concern for Animal Care and Safekeeping.

PubMed

Wuerch, Melissa A; Giesbrecht, Crystal J; Price, Jill A B; Knutson, Tracy; Wach, Frances

2017-03-01

The current study examined the knowledge and experience of animal welfare and human service providers in urban and rural communities of Saskatchewan, Canada. Nine exploratory qualitative interviews were conducted to gather a more in-depth understanding of whether the concern for animal care and safekeeping impacts the decision to leave situations of intimate partner violence. The interviews were semistructured and guided by four questions, which were designed, reviewed, and revised based on feedback from a community-based research team. Thematic analysis highlighted important findings, allowing for the generation of suggestions for improvement of current supports and services offered. The current study findings suggest that concern for animal care and safekeeping creates significant barriers regarding the decision to leave situations of intimate partner violence and abuse, warranting further research to inform support services and resources within a Canadian context.

An Integrated Decision-Making Model for Categorizing Weather Products and Decision Aids

NASA Technical Reports Server (NTRS)

Elgin, Peter D.; Thomas, Rickey P.

2004-01-01

The National Airspace System s capacity will experience considerable growth in the next few decades. Weather adversely affects safe air travel. The FAA and NASA are working to develop new technologies that display weather information to support situation awareness and optimize pilot decision-making in avoiding hazardous weather. Understanding situation awareness and naturalistic decision-making is an important step in achieving this goal. Information representation and situation time stress greatly influence attentional resource allocation and working memory capacity, potentially obstructing accurate situation awareness assessments. Three naturalistic decision-making theories were integrated to provide an understanding of the levels of decision making incorporated in three operational situations and two conditions. The task characteristics associated with each phase of flight govern the level of situation awareness attained and the decision making processes utilized. Weather product s attributes and situation task characteristics combine to classify weather products according to the decision-making processes best supported. In addition, a graphical interface is described that affords intuitive selection of the appropriate weather product relative to the pilot s current flight situation.

Incorporating uncertainty in watershed management decision-making: A mercury TMDL case study

USGS Publications Warehouse

Labiosa, W.; Leckie, J.; Shachter, R.; Freyberg, D.; Rytuba, J.; ,

2005-01-01

Water quality impairment due to high mercury fish tissue concentrations and high mercury aqueous concentrations is a widespread problem in several sub-watersheds that are major sources of mercury to the San Francisco Bay. Several mercury Total Maximum Daily Load regulations are currently being developed to address this problem. Decisions about control strategies are being made despite very large uncertainties about current mercury loading behavior, relationships between total mercury loading and methyl mercury formation, and relationships between potential controls and mercury fish tissue levels. To deal with the issues of very large uncertainties, data limitations, knowledge gaps, and very limited State agency resources, this work proposes a decision analytical alternative for mercury TMDL decision support. The proposed probabilistic decision model is Bayesian in nature and is fully compatible with a "learning while doing" adaptive management approach. Strategy evaluation, sensitivity analysis, and information collection prioritization are examples of analyses that can be performed using this approach.

Towards public health decision support: a systematic review of bidirectional communication approaches.

PubMed

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-05-01

To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows.

Supporting Valid Decision Making: Uses and Misuses of Assessment Data within the Context of RtI

ERIC Educational Resources Information Center

Ball, Carrie R.; Christ, Theodore J.

2012-01-01

Within an RtI problem-solving context, assessment and decision making generally center around the tasks of problem identification, problem analysis, progress monitoring, and program evaluation. We use this framework to discuss the current state of the literature regarding curriculum based measurement, its technical properties, and its utility for…

Anticipatory Emotions in Decision Tasks: Covert Markers of Value or Attentional Processes?

ERIC Educational Resources Information Center

Davis, Tyler; Love, Bradley C.; Maddox, W. Todd

2009-01-01

Anticipatory emotions precede behavioral outcomes and provide a means to infer interactions between emotional and cognitive processes. A number of theories hold that anticipatory emotions serve as inputs to the decision process and code the value or risk associated with a stimulus. We argue that current data do not unequivocally support this…

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

PubMed Central

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

2011-01-01

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

Representing and querying now-relative relational medical data.

PubMed

Anselma, Luca; Piovesan, Luca; Stantic, Bela; Terenziani, Paolo

2018-03-01

Temporal information plays a crucial role in medicine. Patients' clinical records are intrinsically temporal. Thus, in Medical Informatics there is an increasing need to store, support and query temporal data (particularly in relational databases), in order, for instance, to supplement decision-support systems. In this paper, we show that current approaches to relational data have remarkable limitations in the treatment of "now-relative" data (i.e., data holding true at the current time). This can severely compromise their applicability in general, and specifically in the medical context, where "now-relative" data are essential to assess the current status of the patients. We propose a theoretically grounded and application-independent relational approach to cope with now-relative data (which can be paired, e.g., with different decision support systems) overcoming such limitations. We propose a new temporal relational representation, which is the first relational model coping with the temporal indeterminacy intrinsic in now-relative data. We also propose new temporal algebraic operators to query them, supporting the distinction between possible and necessary time, and Allen's temporal relations between data. We exemplify the impact of our approach, and study the theoretical and computational properties of the new representation and algebra. Copyright © 2018 Elsevier B.V. All rights reserved.

Twelve myths about shared decision making.

PubMed

Légaré, France; Thompson-Leduc, Philippe

2014-09-01

As shared decision makes increasing headway in healthcare policy, it is under more scrutiny. We sought to identify and dispel the most prevalent myths about shared decision making. In 20 years in the shared decision making field one of the author has repeatedly heard mention of the same barriers to scaling up shared decision making across the healthcare spectrum. We conducted a selective literature review relating to shared decision making to further investigate these commonly perceived barriers and to seek evidence supporting their existence or not. Beliefs about barriers to scaling up shared decision making represent a wide range of historical, cultural, financial and scientific concerns. We found little evidence to support twelve of the most common beliefs about barriers to scaling up shared decision making, and indeed found evidence to the contrary. Our selective review of the literature suggests that twelve of the most commonly perceived barriers to scaling up shared decision making across the healthcare spectrum should be termed myths as they can be dispelled by evidence. Our review confirms that the current debate about shared decision making must not deter policy makers and clinicians from pursuing its scaling up across the healthcare continuum. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Assessment of the Current Level of Automation in the Manufacture of Fuel Cell Systems for Combined Heat and Power Applications

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

Ulsh, M.; Wheeler, D.; Protopappas, P.

The U.S. Department of Energy (DOE) is interested in supporting manufacturing research and development (R&D) for fuel cell systems in the 10-1,000 kilowatt (kW) power range relevant to stationary and distributed combined heat and power applications, with the intent to reduce manufacturing costs and increase production throughput. To assist in future decision-making, DOE requested that the National Renewable Energy Laboratory (NREL) provide a baseline understanding of the current levels of adoption of automation in manufacturing processes and flow, as well as of continuous processes. NREL identified and visited or interviewed key manufacturers, universities, and laboratories relevant to the study usingmore » a standard questionnaire. The questionnaire covered the current level of vertical integration, the importance of quality control developments for automation, the current level of automation and source of automation design, critical balance of plant issues, potential for continuous cell manufacturing, key manufacturing steps or processes that would benefit from DOE support for manufacturing R&D, the potential for cell or stack design changes to support automation, and the relationship between production volume and decisions on automation.« less

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas

PubMed Central

2013-01-01

Background In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension—the delivery of patient decision aids on the Internet—is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. Methods An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. Results The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. Despite Internet usage ranging from 74% to 85% in developed countries and 80% of users searching for health information, it is unknown how many individuals specifically seek patient decision aids on the Internet. Among the 86 randomized controlled trials in the 2011 Cochrane Collaboration’s review of patient decision aids, only four studies focused on Internet-delivery. Given the limited number of published studies, this paper particularly focused on identifying gaps in the empirical evidence base and identifying emerging areas of research. Conclusions As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies. PMID:24625064

A Framework for a Decision Support System in a Hierarchical Extended Enterprise Decision Context

NASA Astrophysics Data System (ADS)

Boza, Andrés; Ortiz, Angel; Vicens, Eduardo; Poler, Raul

Decision Support System (DSS) tools provide useful information to decision makers. In an Extended Enterprise, a new goal, changes in the current objectives or small changes in the extended enterprise configuration produce a necessary adjustment in its decision system. A DSS in this context must be flexible and agile to make suitable an easy and quickly adaptation to this new context. This paper proposes to extend the Hierarchical Production Planning (HPP) structure to an Extended Enterprise decision making context. In this way, a framework for DSS in Extended Enterprise context is defined using components of HPP. Interoperability details have been reviewed to identify the impact in this framework. The proposed framework allows overcoming some interoperability barriers, identifying and organizing components for a DSS in Extended Enterprise context, and working in the definition of an architecture to be used in the design process of a flexible DSS in Extended Enterprise context which can reuse components for futures Extended Enterprise configurations.

A clinical information systems strategy for a large integrated delivery network.

PubMed Central

Kuperman, G. J.; Spurr, C.; Flammini, S.; Bates, D.; Glaser, J.

2000-01-01

Integrated delivery networks (IDNs) are an emerging class of health care institutions. IDNs are formed from the affiliation of individual health care institutions and are intended to be more efficient in the current fiscal health care environment. To realize efficiencies and support their strategic visions, IDNs rely critically on excellent information technology (IT). Because of its importance to the mission of the IDN, strategic decisions about IT are made by the top leadership of the IDN. At Partners HealthCare System, a large IDN in Boston, MA, a clinical information systems strategy has been created to support the Partners clinical vision. In this paper, we discuss the Partners' structure, clinical vision, and current IT initiatives in place to address the clinical vision. The initiatives are: a clinical data repository, inpatient process support, electronic medical records, a portal strategy, referral applications, knowledge resources, support for product lines, patient computing, confidentiality, and clinical decision support. We address several of the issues encountered in trying to bring excellent information technology to a large IDN. PMID:11079921

In Search of How Principals Change: A Qualitative Study of Events That Help and Hinder Administrator Support for School-Wide PBIS

ERIC Educational Resources Information Center

McIntosh, Kent; Kelm, Joanna L.; Canizal Delabra, Alondra

2016-01-01

Research has shown principal support to be a critical variable for implementing and sustaining evidence-based practices. However, there remains little understanding of the factors that may influence a principal's personal decision to support a practice. The purpose of the current study was to examine events that influenced principals' support for…

Windsor and Perry: reactions of siblings in same-sex and heterosexual couples.

PubMed

Clark, Jennifer B; Riggle, Ellen D B; Rostosky, Sharon S; Rothblum, Esther D; Balsam, Kimberly F

2015-01-01

The U.S. Supreme Court decisions in U.S. v. Windsor (570 U.S. 307) and Hollingsworth v. Perry (570 U.S. 399) created a focal point for public discussion of marriage equality for same-sex couples. This article reports the results of an exploratory study of the reactions of individuals currently or previously in same-sex couple relationships and a heterosexual sibling who is currently or previously married (N = 371) to the Supreme Court decisions. Thematic content analysis was used to explore participants' responses to an open-ended question on a survey. Reactions of individuals from same-sex couples revealed the following themes: (1) longitudinal perspectives on the advancement of rights for same-sex couples; (2) emotional responses celebrating the decisions or expressing relief; (3) affirmation of their relationship or rights; (4) practical consequences of the extension of rights; and (5) minority stress related to anticipation of future prejudice or discrimination. Themes in the heterosexual siblings' responses were (1) ally support; (2) flat support without emotion or elaboration; (3) indifference to or ignorance about the decisions; and (4) disapproval of the decisions. These themes are compared and discussed in light of prior research on reactions to marriage restriction debates and marriage (in)equality and family relationships.

What is lacking in current decision aids on cancer screening?

PubMed Central

Jimbo, Masahito; Rana, Gurpreet K.; Hawley, Sarah; Holmes-Rovner, Margaret; Kelly-Blake, Karen; Nease, Donald E.; Ruffin, Mack T.

2013-01-01

Recent guidelines on cancer screening have given not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians’ support, must decide whether to get screened or not, which modality to use, and how often to get screened. Decision aids could potentially lead to better shared decision making regarding screening between the patient and the clinician. We reviewed 73 decision aids on screening for breast, cervical, colorectal, and prostate cancers. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need for more research, and determine how the decision aids can be currently applied in the real world setting. Most studies used sound study design. Significant variation existed in setting, theoretical framework, and measured outcomes. Just over a third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted in which patient attributes were measured as outcomes. Few studies actually measured shared decision making. Little information was available on the feasibility and outcomes of integrating decision aids into practice. We discuss the implications for future research, as well as what the clinicians can do now to incorporate decision aids into their practice. PMID:23504675

What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

PubMed Central

2013-01-01

Background Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. Objectives The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. Methods In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health. PMID:23915278

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study.

PubMed

Ellen, Moriah E; Léon, Gregory; Bouchard, Gisèle; Lavis, John N; Ouimet, Mathieu; Grimshaw, Jeremy M

2013-08-06

Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a 'knowledge broker') in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff's capacity building. This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health.

Opportunities and Strategies to Incorporate Ecosystem Services Knowledge and Decision Support Tools into Planning and Decision Making in Hawai`i

NASA Astrophysics Data System (ADS)

Bremer, Leah L.; Delevaux, Jade M. S.; Leary, James J. K.; J. Cox, Linda; Oleson, Kirsten L. L.

2015-04-01

Incorporating ecosystem services into management decisions is a promising means to link conservation and human well-being. Nonetheless, planning and management in Hawai`i, a state with highly valued natural capital, has yet to broadly utilize an ecosystem service approach. We conducted a stakeholder assessment, based on semi-structured interviews, with terrestrial ( n = 26) and marine ( n = 27) natural resource managers across the State of Hawai`i to understand the current use of ecosystem services (ES) knowledge and decision support tools and whether, how, and under what contexts, further development would potentially be useful. We found that ES knowledge and tools customized to Hawai`i could be useful for communication and outreach, justifying management decisions, and spatial planning. Greater incorporation of this approach is clearly desired and has a strong potential to contribute to more sustainable decision making and planning in Hawai`i and other oceanic island systems. However, the unique biophysical, socio-economic, and cultural context of Hawai`i, and other island systems, will require substantial adaptation of existing ES tools. Based on our findings, we identified four key opportunities for the use of ES knowledge and tools in Hawai`i: (1) linking native forest protection to watershed health; (2) supporting sustainable agriculture; (3) facilitating ridge-to-reef management; and (4) supporting statewide terrestrial and marine spatial planning. Given the interest expressed by natural resource managers, we envision broad adoption of ES knowledge and decision support tools if knowledge and tools are tailored to the Hawaiian context and coupled with adequate outreach and training.

Opportunities and strategies to incorporate ecosystem services knowledge and decision support tools into planning and decision making in Hawai'i.

PubMed

Bremer, Leah L; Delevaux, Jade M S; Leary, James J K; J Cox, Linda; Oleson, Kirsten L L

2015-04-01

Incorporating ecosystem services into management decisions is a promising means to link conservation and human well-being. Nonetheless, planning and management in Hawai'i, a state with highly valued natural capital, has yet to broadly utilize an ecosystem service approach. We conducted a stakeholder assessment, based on semi-structured interviews, with terrestrial (n = 26) and marine (n = 27) natural resource managers across the State of Hawai'i to understand the current use of ecosystem services (ES) knowledge and decision support tools and whether, how, and under what contexts, further development would potentially be useful. We found that ES knowledge and tools customized to Hawai'i could be useful for communication and outreach, justifying management decisions, and spatial planning. Greater incorporation of this approach is clearly desired and has a strong potential to contribute to more sustainable decision making and planning in Hawai'i and other oceanic island systems. However, the unique biophysical, socio-economic, and cultural context of Hawai'i, and other island systems, will require substantial adaptation of existing ES tools. Based on our findings, we identified four key opportunities for the use of ES knowledge and tools in Hawai'i: (1) linking native forest protection to watershed health; (2) supporting sustainable agriculture; (3) facilitating ridge-to-reef management; and (4) supporting statewide terrestrial and marine spatial planning. Given the interest expressed by natural resource managers, we envision broad adoption of ES knowledge and decision support tools if knowledge and tools are tailored to the Hawaiian context and coupled with adequate outreach and training.

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department

PubMed Central

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

Back to the Bedside: Developing a Bedside Aid for Concussion and Brain Injury Decisions in the Emergency Department.

PubMed

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.

Uncertainty management, spatial and temporal reasoning, and validation of intelligent environmental decision support systems

USGS Publications Warehouse

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.

QuEST for malware type-classification

NASA Astrophysics Data System (ADS)

Vaughan, Sandra L.; Mills, Robert F.; Grimaila, Michael R.; Peterson, Gilbert L.; Oxley, Mark E.; Dube, Thomas E.; Rogers, Steven K.

2015-05-01

Current cyber-related security and safety risks are unprecedented, due in no small part to information overload and skilled cyber-analyst shortages. Advances in decision support and Situation Awareness (SA) tools are required to support analysts in risk mitigation. Inspired by human intelligence, research in Artificial Intelligence (AI) and Computational Intelligence (CI) have provided successful engineering solutions in complex domains including cyber. Current AI approaches aggregate large volumes of data to infer the general from the particular, i.e. inductive reasoning (pattern-matching) and generally cannot infer answers not previously programmed. Whereas humans, rarely able to reason over large volumes of data, have successfully reached the top of the food chain by inferring situations from partial or even partially incorrect information, i.e. abductive reasoning (pattern-completion); generating a hypothetical explanation of observations. In order to achieve an engineering advantage in computational decision support and SA we leverage recent research in human consciousness, the role consciousness plays in decision making, modeling the units of subjective experience which generate consciousness, qualia. This paper introduces a novel computational implementation of a Cognitive Modeling Architecture (CMA) which incorporates concepts of consciousness. We apply our model to the malware type-classification task. The underlying methodology and theories are generalizable to many domains.

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

PubMed

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

2016-02-16

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

A Decision Support Framework for Science-Based, Multi-Stakeholder Deliberation: A Coral Reef Example

NASA Astrophysics Data System (ADS)

Rehr, Amanda P.; Small, Mitchell J.; Bradley, Patricia; Fisher, William S.; Vega, Ann; Black, Kelly; Stockton, Tom

2012-12-01

We present a decision support framework for science-based assessment and multi-stakeholder deliberation. The framework consists of two parts: a DPSIR (Drivers-Pressures-States-Impacts-Responses) analysis to identify the important causal relationships among anthropogenic environmental stressors, processes, and outcomes; and a Decision Landscape analysis to depict the legal, social, and institutional dimensions of environmental decisions. The Decision Landscape incorporates interactions among government agencies, regulated businesses, non-government organizations, and other stakeholders. It also identifies where scientific information regarding environmental processes is collected and transmitted to improve knowledge about elements of the DPSIR and to improve the scientific basis for decisions. Our application of the decision support framework to coral reef protection and restoration in the Florida Keys focusing on anthropogenic stressors, such as wastewater, proved to be successful and offered several insights. Using information from a management plan, it was possible to capture the current state of the science with a DPSIR analysis as well as important decision options, decision makers and applicable laws with a the Decision Landscape analysis. A structured elicitation of values and beliefs conducted at a coral reef management workshop held in Key West, Florida provided a diversity of opinion and also indicated a prioritization of several environmental stressors affecting coral reef health. The integrated DPSIR/Decision landscape framework for the Florida Keys developed based on the elicited opinion and the DPSIR analysis can be used to inform management decisions, to reveal the role that further scientific information and research might play to populate the framework, and to facilitate better-informed agreement among participants.

Guidance on Data Quality Assessment for Life Cycle Inventory Data

EPA Science Inventory

Data quality within Life Cycle Assessment (LCA) is a significant issue for the future support and development of LCA as a decision support tool and its wider adoption within industry. In response to current data quality standards such as the ISO 14000 series, various entities wit...

Decision-making for non-invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individual vs relational autonomy.

PubMed

Lau, J Y C; Yi, H; Ahmed, S

2016-05-01

Individual autonomy in antenatal screening is internationally recognized and supported. Policy and practice guidelines in various countries place emphasis on the woman's right to make her own decision and are related to concepts such as self-determination, independence, and self-sufficiency. In contrast, the dominant perspective in Chinese medical ethics suggests that the family is pivotal in making medical decisions, hence providing support for relational autonomy. This study explored Hong Kong Chinese pregnant women's preferences for individual vs relational autonomy for non-invasive prenatal testing (NIPT) for Down syndrome. A qualitative study was carried out using semi-structured interviews with 36 women who had undertaken NIPT in Hong Kong. The findings show that most Hong Kong Chinese women valued aspects of both relational and individual autonomy in decision-making for NIPT. Women expected support from doctors as experts on the topic and wanted to involve their husband in decision-making while retaining control over the outcome. Somewhat surprisingly, the findings do not provide support for the involvement of family members in decision-making for NIPT. The adequacy of current interpretations of autonomy in prenatal testing policies as an individual approach needs discussion, where policy developers need to find a balance between individual and relational approaches. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Displaying contextual information reduces the costs of imperfect decision automation in rapid retasking of ISR assets.

PubMed

Rovira, Ericka; Cross, Austin; Leitch, Evan; Bonaceto, Craig

2014-09-01

The impact of a decision support tool designed to embed contextual mission factors was investigated. Contextual information may enable operators to infer the appropriateness of data underlying the automation's algorithm. Research has shown the costs of imperfect automation are more detrimental than perfectly reliable automation when operators are provided with decision support tools. Operators may trust and rely on the automation more appropriately if they understand the automation's algorithm. The need to develop decision support tools that are understandable to the operator provides the rationale for the current experiment. A total of 17 participants performed a simulated rapid retasking of intelligence, surveillance, and reconnaissance (ISR) assets task with manual, decision automation, or contextual decision automation differing in two levels of task demand: low or high. Automation reliability was set at 80%, resulting in participants experiencing a mixture of reliable and automation failure trials. Dependent variables included ISR coverage and response time of replanning routes. Reliable automation significantly improved ISR coverage when compared with manual performance. Although performance suffered under imperfect automation, contextual decision automation helped to reduce some of the decrements in performance. Contextual information helps overcome the costs of imperfect decision automation. Designers may mitigate some of the performance decrements experienced with imperfect automation by providing operators with interfaces that display contextual information, that is, the state of factors that affect the reliability of the automation's recommendation.

Establishing a regional network of academic centers to support decision making for new vaccine introduction in Latin America and the Caribbean: the ProVac experience.

PubMed

Toscano, C M; Jauregui, B; Janusz, C B; Sinha, A; Clark, A D; Sanderson, C; Resch, S; Ruiz Matus, C; Andrus, J K

2013-07-02

The Pan American Health Organization's ProVac Initiative, designed to strengthen national decision making regarding the introduction of new vaccines, was initiated in 2004. Central to realizing ProVac's vision of regional capacity building, the ProVac Network of Centers of Excellence (CoEs) was established in 2010 to provide research support to the ProVac Initiative, leveraging existing capacity at Latin American and Caribbean (LAC) universities. We describe the process of establishing the ProVac Network of CoEs and its initial outcomes and challenges. A survey was sent to academic, not-for-profit institutions in LAC that had recently published work in the areas of clinical decision sciences and health economic analysis. Centers invited to join the Network were selected by an international committee on the basis of the survey results. Selection criteria included academic productivity in immunization-related work, team size and expertise, successful collaboration with governmental agencies and international organizations, and experience in training and education. The Network currently includes five academic institutions across LAC. Through open dialog and negotiation, specific projects were assigned to centers according to their areas of expertise. Collaboration among centers was highly encouraged. Faculty from ProVac's technical partners were assigned as focal points for each project. The resulting work led to the development and piloting of tools, methodological guides, and training materials that support countries in assessing existing evidence and generating new evidence on vaccine introduction. The evidence generated is shared with country-level decision makers and the scientific community. As the ProVac Initiative expands to other regions of the world with support from immunization and public health partners, the establishment of other regional and global networks of CoEs will be critical. The experience of LAC in creating the current network could benefit the formation of similar structures that support evidence-based decisions regarding new public health interventions. Copyright © 2013 Elsevier Ltd. All rights reserved.

The changing nature of ICU charge nurses' decision making: from supervision of care delivery to unit resource management.

PubMed

Miller, Anne; Buerhaus, Peter I

2013-01-01

Recent findings that variations in nursing workload may affect inpatient outcomes now highlight nurse workload management and the need for an updated analysis of the role of the charge nurse (CN). Observational data for eight CNs, each at one of eight ICUs in a not-for-profit Level 1 Trauma Center, coded to capture interprofessional interactions, decision making, team coordination phases, and support tools. A researcher shadowed each participant for 12 hours. Each shift began and ended with a face-to-face handoff that included summaries of each patient's condition; the current bed census; anticipated admissions, discharges, and transfers; and the number of nurses available to work the current and coming two shifts. The researcher, using a notebook, recorded the substantive content of all work conversations initiated by or directed to the CN from physicians, staff nurses, allied health workers, other employees, and patients/families. The tools used to support conversations were collected as blank forms or computer screen prints and annotated to describe how they were used, when, and for what purpose. Statistically significant three-way interactions suggest that CNs' conversations with colleagues depend on the team coordination phase and the decision-making level, and that the support tools that CNs use when talking to colleagues depend on the decision-making level and the team coordination phase. The role of ICU CNs appears to be continuing to evolve, now encompassing unit resource management in addition to supervising care delivery. Effective support tools, together with education that would enhance communication and resource management skills, will be essential to CNs' ability to support unit resilience and adaptability in an increasingly complex environment.

FlooDSuM - a decision support methodology for assisting local authorities in flood situations

NASA Astrophysics Data System (ADS)

Schwanbeck, Jan; Weingartner, Rolf

2014-05-01

Decision making in flood situations is a difficult task, especially in small to medium-sized mountain catchments (30 - 500 km2) which are usually characterized by complex topography, high drainage density and quick runoff response to rainfall events. Operating hydrological models driven by numerical weather prediction systems, which have a lead-time of several hours up to few even days, would be beneficial in this case as time for prevention could be gained. However, the spatial and quantitative accuracy of such meteorological forecasts usually decrease with increasing lead-time. In addition, the sensitivity of rainfall-runoff models to inaccuracies in estimations of areal rainfall increases with decreasing catchment size. Accordingly, decisions on flood alerts should ideally be based on areal rainfall from high resolution and short-term numerical weather prediction, nowcasts or even real-time measurements, which is transformed into runoff by a hydrological model. In order to benefit from the best possible rainfall data while retaining enough time for alerting and for prevention, the hydrological model should be fast and easily applicable by decision makers within local authorities themselves. The proposed decision support methodology FlooDSuM (Flood Decision Support Methodology) aims to meet those requirements. Applying FlooDSuM, a few successive binary decisions of increasing complexity have to be processed following a flow-chart-like structure. Prepared data and straightforwardly applicable tools are provided for each of these decisions. Maps showing the current flood disposition are used for the first step. While danger of flooding cannot be excluded more and more complex and time consuming methods will be applied. For the final decision, a set of scatter-plots relating areal precipitation to peak flow is provided. These plots take also further decisive parameters into account such as storm duration, distribution of rainfall intensity in time as well as the catchment's antecedent moisture conditions. The proposed approach is currently tested in two catchments in the Swiss Pre-Alps and Alps. We will show the general setup and selected results. The findings of those case studies will lead to further improvements of the proposed approach.

78 FR 17633 - Notice of Request for Extension of a Currently Approved Information Collection

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF AGRICULTURE Rural Housing Service Notice of Request for Extension of a Currently... Support Staff, Housing and Community Facilities Programs, U.S. Department of Agriculture, Stop 0761, 1400... on the quality of the human environment during agency planning and decision-making processes. For...

Identifying components in consent information needed to support informed decision making about trial participation: An interview study with women managing cancer.

PubMed

Abhyankar, Purva; Velikova, Galina; Summers, Barbara; Bekker, Hilary L

2016-07-01

Research governance requires patients give informed consent to participate in clinical trials. However, there are concerns that consent information may not support patient participation decisions. This study investigates the utility of consent information in supporting women's trial participation decisions when receiving treatment for cancer. An interview study with women receiving cancer treatments at a medical oncology outpatient clinic in Yorkshire (UK). All women over 18 years, not admitted to a hospital ward and who had currently or previously been invited to take part in a trial were invited to take part in the study over a three month period. Interviews were audio-tape recorded, transcribed and analysed using thematic analysis. Of those eligible (n = 41), 21 women with breast (n = 11), ovarian (n = 8) and endometrial (n = 2) cancer participated (mean age = 57 years). Eighteen had made at least one trial decision and three were considering taking part in a trial. Findings are synthesised under two analytical themes: 1) Influence of the cancer and cancer treatment context on decision making for trial participation; and 2) Experiences of the consenting process and their influence on decision making. Designing trial information to represent explicitly the trial participation decision as being between standard care and study-related care options is more likely to effectively support patients in making informed decisions between standard care treatments and taking part in a trial. Copyright © 2016 Elsevier Ltd. All rights reserved.

A web-based decision support tool for prognosis simulation in multiple sclerosis.

PubMed

Veloso, Mário

2014-09-01

A multiplicity of natural history studies of multiple sclerosis provides valuable knowledge of the disease progression but individualized prognosis remains elusive. A few decision support tools that assist the clinician in such task have emerged but have not received proper attention from clinicians and patients. The objective of the current work is to implement a web-based tool, conveying decision relevant prognostic scientific evidence, which will help clinicians discuss prognosis with individual patients. Data were extracted from a set of reference studies, especially those dealing with the natural history of multiple sclerosis. The web-based decision support tool for individualized prognosis simulation was implemented with NetLogo, a program environment suited for the development of complex adaptive systems. Its prototype has been launched online; it enables clinicians to predict both the likelihood of CIS to CDMS conversion, and the long-term prognosis of disability level and SPMS conversion, as well as assess and monitor the effects of treatment. More robust decision support tools, which convey scientific evidence and satisfy the needs of clinical practice by helping clinicians discuss prognosis expectations with individual patients, are required. The web-based simulation model herein introduced proposes to be a step forward toward this purpose. Copyright © 2014 Elsevier B.V. All rights reserved.

Use of Remote Sensing for Decision Support in Africa

NASA Technical Reports Server (NTRS)

Policelli, Frederick S.

2007-01-01

Over the past 30 years, the scientific community has learned a great deal about the Earth as an integrated system. Much of this research has been enabled by the development of remote sensing technologies and their operation from space. Decision makers in many nations have begun to make use of remote sensing data for resource management, policy making, and sustainable development planning. This paper makes an attempt to provide a survey of the current state of the requirements and use of remote sensing for sustainable development in Africa. This activity has shown that there are not many climate data ready decision support tools already functioning in Africa. There are, however, endusers with known requirements who could benefit from remote sensing data.

Decision Support Methods and Tools

NASA Technical Reports Server (NTRS)

Green, Lawrence L.; Alexandrov, Natalia M.; Brown, Sherilyn A.; Cerro, Jeffrey A.; Gumbert, Clyde r.; Sorokach, Michael R.; Burg, Cecile M.

2006-01-01

This paper is one of a set of papers, developed simultaneously and presented within a single conference session, that are intended to highlight systems analysis and design capabilities within the Systems Analysis and Concepts Directorate (SACD) of the National Aeronautics and Space Administration (NASA) Langley Research Center (LaRC). This paper focuses on the specific capabilities of uncertainty/risk analysis, quantification, propagation, decomposition, and management, robust/reliability design methods, and extensions of these capabilities into decision analysis methods within SACD. These disciplines are discussed together herein under the name of Decision Support Methods and Tools. Several examples are discussed which highlight the application of these methods within current or recent aerospace research at the NASA LaRC. Where applicable, commercially available, or government developed software tools are also discussed

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

USGS Publications Warehouse

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

2010-01-01

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

Clinical Use of an Enterprise Data Warehouse

PubMed Central

Evans, R. Scott; Lloyd, James F.; Pierce, Lee A.

2012-01-01

The enormous amount of data being collected by electronic medical records (EMR) has found additional value when integrated and stored in data warehouses. The enterprise data warehouse (EDW) allows all data from an organization with numerous inpatient and outpatient facilities to be integrated and analyzed. We have found the EDW at Intermountain Healthcare to not only be an essential tool for management and strategic decision making, but also for patient specific clinical decision support. This paper presents the structure and two case studies of a framework that has provided us the ability to create a number of decision support applications that are dependent on the integration of previous enterprise-wide data in addition to a patient’s current information in the EMR. PMID:23304288

Decision support systems for clinical radiological practice — towards the next generation

PubMed Central

Stivaros, S M; Gledson, A; Nenadic, G; Zeng, X-J; Keane, J; Jackson, A

2010-01-01

The huge amount of information that needs to be assimilated in order to keep pace with the continued advances in modern medical practice can form an insurmountable obstacle to the individual clinician. Within radiology, the recent development of quantitative imaging techniques, such as perfusion imaging, and the development of imaging-based biomarkers in modern therapeutic assessment has highlighted the need for computer systems to provide the radiological community with support for academic as well as clinical/translational applications. This article provides an overview of the underlying design and functionality of radiological decision support systems with examples tracing the development and evolution of such systems over the past 40 years. More importantly, we discuss the specific design, performance and usage characteristics that previous systems have highlighted as being necessary for clinical uptake and routine use. Additionally, we have identified particular failings in our current methodologies for data dissemination within the medical domain that must be overcome if the next generation of decision support systems is to be implemented successfully. PMID:20965900

What is known about parents' treatment decisions? A narrative review of pediatric decision making.

PubMed

Lipstein, Ellen A; Brinkman, William B; Britto, Maria T

2012-01-01

With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Articles presenting original research on parent decision making were identified from MEDLINE (1966-6/2011), using the terms "decision making," "parent," and "child." We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents' preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child's health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions.

Trajectory-Based Takeoff Time Predictions Applied to Tactical Departure Scheduling: Concept Description, System Design, and Initial Observations

NASA Technical Reports Server (NTRS)

Engelland, Shawn A.; Capps, Alan

2011-01-01

Current aircraft departure release times are based on manual estimates of aircraft takeoff times. Uncertainty in takeoff time estimates may result in missed opportunities to merge into constrained en route streams and lead to lost throughput. However, technology exists to improve takeoff time estimates by using the aircraft surface trajectory predictions that enable air traffic control tower (ATCT) decision support tools. NASA s Precision Departure Release Capability (PDRC) is designed to use automated surface trajectory-based takeoff time estimates to improve en route tactical departure scheduling. This is accomplished by integrating an ATCT decision support tool with an en route tactical departure scheduling decision support tool. The PDRC concept and prototype software have been developed, and an initial test was completed at air traffic control facilities in Dallas/Fort Worth. This paper describes the PDRC operational concept, system design, and initial observations.

Health preferences and decision-making needs of disadvantaged women.

PubMed

Bunn, Helen; Lange, Ilta; Urrutia, Mila; Campos, Maria Sylvia; Campos, Solange; Jaimovich, Sonia; Campos, Cecilia; Jacobsen, Mary Jane; Gaboury, Isabelle

2006-11-01

This paper reports the results of a survey of disadvantaged women in La Pintana, a municipality of Santiago, Chile, to determine their health decision-making needs. Research is needed as there is no published community-based study focusing specifically on health decision-making needs of disadvantaged women. From April to November 1999, we conducted a cross-sectional interview survey of women registered at primary healthcare centres in La Pintana, an impoverished municipality of Santiago, Chile. The survey participants were 554 adult women over 15 years of age. Seventy-five percent reported making current health-related decisions. Types of decisions were primarily about navigation: where, when and from whom to seek care. The most common role in decision-making was sharing the decision with others, specifically husbands and other family members. Fifty-four percent experienced decisional conflict or uncertainty about options. Those reporting more manifestations of decisional conflict were more likely to lack information on available options, pros and cons of the options, and chances of benefits and harms associated with the options; they were also more likely to be unclear about what was important to them, to feel pressure from others, lack skill or ability in decision-making and be older. The most common strategies used when making all types of decisions were obtaining information on options and recommendations, and getting support from others. Participants preferred to receive information about options through counselling from their physicians, rather than nurses, from printed materials and from discussion groups of people facing the same decision. The majority of disadvantaged women were actively involved in decision-making and needed decision support to navigate the healthcare system. Nurses should play a more pivotal role in providing health decision support. This study needs to be replicated in other countries and cultural contexts.

Decision insight into stakeholder conflict for ERN.

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

Siirola, John; Tidwell, Vincent Carroll; Benz, Zachary O.

Participatory modeling has become an important tool in facilitating resource decision making and dispute resolution. Approaches to modeling that are commonly used in this context often do not adequately account for important human factors. Current techniques provide insights into how certain human activities and variables affect resource outcomes; however, they do not directly simulate the complex variables that shape how, why, and under what conditions different human agents behave in ways that affect resources and human interactions related to them. Current approaches also do not adequately reveal how the effects of individual decisions scale up to have systemic level effectsmore » in complex resource systems. This lack of integration prevents the development of more robust models to support decision making and dispute resolution processes. Development of integrated tools is further hampered by the fact that collection of primary data for decision-making modeling is costly and time consuming. This project seeks to develop a new approach to resource modeling that incorporates both technical and behavioral modeling techniques into a single decision-making architecture. The modeling platform is enhanced by use of traditional and advanced processes and tools for expedited data capture. Specific objectives of the project are: (1) Develop a proof of concept for a new technical approach to resource modeling that combines the computational techniques of system dynamics and agent based modeling, (2) Develop an iterative, participatory modeling process supported with traditional and advance data capture techniques that may be utilized to facilitate decision making, dispute resolution, and collaborative learning processes, and (3) Examine potential applications of this technology and process. The development of this decision support architecture included both the engineering of the technology and the development of a participatory method to build and apply the technology. Stakeholder interaction with the model and associated data capture was facilitated through two very different modes of engagement, one a standard interface involving radio buttons, slider bars, graphs and plots, while the other utilized an immersive serious gaming interface. The decision support architecture developed through this project was piloted in the Middle Rio Grande Basin to examine how these tools might be utilized to promote enhanced understanding and decision-making in the context of complex water resource management issues. Potential applications of this architecture and its capacity to lead to enhanced understanding and decision-making was assessed through qualitative interviews with study participants who represented key stakeholders in the basin.« less

Nursing in general practice: organizational possibilities for decision latitude, created skill, social support and identity derived from role.

PubMed

Merrick, Eamon; Duffield, Christine; Baldwin, Richard; Fry, Margaret

2012-03-01

This article is a report of a study to describe the factors that support organizational opportunities for practice nurse decision-making and skill development for nurses employed in general practice in New South Wales, Australia. Corresponding to the availability of subsidies from the Australian universal health insurer (Medicare), there has been an increase in the number of nurses employed in general practice. Currently, there is no Australian evidence as to the organizational possibilities for these practice nurses to make decisions, develop their own skills and abilities, derive identity from their role or how their role is influenced by social support. Over a 8-month period in 2008 practice, nurses employed in general practice in the State of New South Wales were invited to complete a 26-item self-administered online questionnaire utilizing constructs from Karaseks (1998) Job Content Questionnaire (valid n = 160). Confirmatory Factor Analysis indicated that all scales demonstrated acceptable levels of internal consistency. Sequential regression models revealed that social support exerts a weak influence on decision latitude (R(2) = 0·07); the addition of self-identity through work significantly improved the predictive ability of the model (R(2) = 0·16). Social support and self-identity through work exerted a negative influence on created skill (R(2) = 0·347), whereas social support was effective in predicting self-identity through work (R(2) = 0·148).   Collegial and supervisory support in the work environment predicts organizational possibilities for practice nurse decision-making. © 2011 Blackwell Publishing Ltd.

Talking Points: Women's Information Needs for Informed Decision-Making About Noninvasive Prenatal Testing for Down Syndrome.

PubMed

Dane, Aimée C; Peterson, Madelyn; Miller, Yvette D

2018-03-17

Adequate knowledge is a vital component of informed decision-making; however, we do not know what information women value when making decisions about noninvasive prenatal testing (NIPT). The current study aimed to identify women's information needs for decision-making about NIPT as a first-tier, non-contingent test with out-of-pocket expense and, in turn, inform best practice by specifying the information that should be prioritized when providing pre-test counseling to women in a time-limited scenario or space-limited decision support tool. We asked women (N = 242) in Australia to indicate the importance of knowing 24 information items when making a decision about NIPT and to choose two information items they would most value. Our findings suggest that women value having complete information when making decisions about NIPT. Information about the accuracy of NIPT and the pros and cons of NIPT compared to other screening and invasive tests were perceived to be most important. The findings of this study can be used to maximize the usefulness of time-limited discussions or space-limited decision support tools, but should not be routinely relied upon as a replacement for provision of full and tailored information when feasible.

An exploration of clinical decision making in mental health triage.

PubMed

Sands, Natisha

2009-08-01

Mental health (MH) triage is a specialist area of clinical nursing practice that involves complex decision making. The discussion in this article draws on the findings of a Ph.D. study that involved a statewide investigation of the scope of MH triage nursing practice in Victoria, Australia. Although the original Ph.D. study investigated a number of core practices in MH triage, the focus of the discussion in this article is specifically on the findings related to clinical decision making in MH triage, which have not previously been published. The study employed an exploratory descriptive research design that used mixed data collection methods including a survey questionnaire (n = 139) and semistructured interviews (n = 21). The study findings related to decision making revealed a lack of empirically tested evidence-based decision-making frameworks currently in use to support MH triage nursing practice. MH triage clinicians in Australia rely heavily on clinical experience to underpin decision making and have little of knowledge of theoretical models for practice, such as methodologies for rating urgency. A key recommendation arising from the study is the need to develop evidence-based decision-making frameworks such as clinical guidelines to inform and support MH triage clinical decision making.

Towards public health decision support: a systematic review of bidirectional communication approaches

PubMed Central

Dixon, Brian E; Gamache, Roland E; Grannis, Shaun J

2013-01-01

Objective To summarize the literature describing computer-based interventions aimed at improving bidirectional communication between clinical and public health. Materials and Methods A systematic review of English articles using MEDLINE and Google Scholar. Search terms included public health, epidemiology, electronic health records, decision support, expert systems, and decision-making. Only articles that described the communication of information regarding emerging health threats from public health agencies to clinicians or provider organizations were included. Each article was independently reviewed by two authors. Results Ten peer-reviewed articles highlight a nascent but promising area of research and practice related to alerting clinicians about emerging threats. Current literature suggests that additional research and development in bidirectional communication infrastructure should focus on defining a coherent architecture, improving interoperability, establishing clear governance, and creating usable systems that will effectively deliver targeted, specific information to clinicians in support of patient and population decision-making. Conclusions Increasingly available clinical information systems make it possible to deliver timely, relevant knowledge to frontline clinicians in support of population health. Future work should focus on developing a flexible, interoperable infrastructure for bidirectional communications capable of integrating public health knowledge into clinical systems and workflows. PMID:23467470

A consumer guide: tools to manage vegetation and fuels.

Treesearch

David L. Peterson; Louisa Evers; Rebecca A. Gravenmier; Ellen Eberhardt

2007-01-01

Current efforts to improve the scientific basis for fire management on public lands will benefit from more efficient transfer of technical information and tools that support planning, implementation, and effectiveness of vegetation and hazardous fuel treatments. The technical scope, complexity, and relevant spatial scale of analytical and decision support tools differ...

Sequence alignment to predict across species susceptibility (SeqAPASS): Cross species extrapolation in the 21st century

EPA Science Inventory

An objective of the U.S. Environmental Protection Agency is to develop innovative approaches and decision support tools for the safety assessment of current and emerging chemicals in relation to their impact on the environment. To support this goal, there is a compelling need for...

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

PubMed

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

2016-01-01

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

Decision support tool for used oil regeneration technologies assessment and selection.

PubMed

Khelifi, Olfa; Dalla Giovanna, Fabio; Vranes, Sanja; Lodolo, Andrea; Miertus, Stanislav

2006-09-01

Regeneration is the most efficient way of managing used oil. It saves money by preventing costly cleanups and liabilities that are associated with mismanagement of used oil, it helps to protect the environment and it produces a technically renewable resource by enabling an indefinite recycling potential. There are a variety of processes and licensors currently offering ways to deal with used oils. Selecting a regeneration technology for used oil involves "cross-matching" key criteria. Therefore, the first prototype of spent oil regeneration (SPORE), a decision support tool, has been developed to help decision-makers to assess the available technologies and select the preferred used oil regeneration options. The analysis is based on technical, economical and environmental criteria. These criteria are ranked to determine their relative importance for a particular used oil regeneration project. The multi-criteria decision analysis (MCDA) is the core of the SPORE using the PROMETHEE II algorithm.

A study on spatial decision support systems for HIV/AIDS prevention based on COM GIS technology

NASA Astrophysics Data System (ADS)

Yang, Kun; Luo, Huasong; Peng, Shungyun; Xu, Quanli

2007-06-01

Based on the deeply analysis of the current status and the existing problems of GIS technology applications in Epidemiology, this paper has proposed the method and process for establishing the spatial decision support systems of AIDS epidemic prevention by integrating the COM GIS, Spatial Database, GPS, Remote Sensing, and Communication technologies, as well as ASP and ActiveX software development technologies. One of the most important issues for constructing the spatial decision support systems of AIDS epidemic prevention is how to integrate the AIDS spreading models with GIS. The capabilities of GIS applications in the AIDS epidemic prevention have been described here in this paper firstly. Then some mature epidemic spreading models have also been discussed for extracting the computation parameters. Furthermore, a technical schema has been proposed for integrating the AIDS spreading models with GIS and relevant geospatial technologies, in which the GIS and model running platforms share a common spatial database and the computing results can be spatially visualized on Desktop or Web GIS clients. Finally, a complete solution for establishing the decision support systems of AIDS epidemic prevention has been offered in this paper based on the model integrating methods and ESRI COM GIS software packages. The general decision support systems are composed of data acquisition sub-systems, network communication sub-systems, model integrating sub-systems, AIDS epidemic information spatial database sub-systems, AIDS epidemic information querying and statistical analysis sub-systems, AIDS epidemic dynamic surveillance sub-systems, AIDS epidemic information spatial analysis and decision support sub-systems, as well as AIDS epidemic information publishing sub-systems based on Web GIS.

The conceptual foundation of environmental decision support.

PubMed

Reichert, Peter; Langhans, Simone D; Lienert, Judit; Schuwirth, Nele

2015-05-01

Environmental decision support intends to use the best available scientific knowledge to help decision makers find and evaluate management alternatives. The goal of this process is to achieve the best fulfillment of societal objectives. This requires a careful analysis of (i) how scientific knowledge can be represented and quantified, (ii) how societal preferences can be described and elicited, and (iii) how these concepts can best be used to support communication with authorities, politicians, and the public in environmental management. The goal of this paper is to discuss key requirements for a conceptual framework to address these issues and to suggest how these can best be met. We argue that a combination of probability theory and scenario planning with multi-attribute utility theory fulfills these requirements, and discuss adaptations and extensions of these theories to improve their application for supporting environmental decision making. With respect to (i) we suggest the use of intersubjective probabilities, if required extended to imprecise probabilities, to describe the current state of scientific knowledge. To address (ii), we emphasize the importance of value functions, in addition to utilities, to support decisions under risk. We discuss the need for testing "non-standard" value aggregation techniques, the usefulness of flexibility of value functions regarding attribute data availability, the elicitation of value functions for sub-objectives from experts, and the consideration of uncertainty in value and utility elicitation. With respect to (iii), we outline a well-structured procedure for transparent environmental decision support that is based on a clear separation of scientific prediction and societal valuation. We illustrate aspects of the suggested methodology by its application to river management in general and with a small, didactical case study on spatial river rehabilitation prioritization. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Choice-Supportive Misremembering: A New Taxonomy and Review

PubMed Central

Lind, Martina; Visentini, Mimì; Mäntylä, Timo; Del Missier, Fabio

2017-01-01

Although the literature on the influence of memory on decisions is well developed, research on the effects of decision making on memory is rather sparse and scattered. Choice-supportive misremembering (i.e., misremembering choice-related information that boosts the chosen option and/or demotes the foregone options) has been observed in several studies and has the potential to affect future choices. Nonetheless, no attempt has been made to review the relevant literature, categorize the different types of choice-supportive misremembering observed, and critically appraise the existing evidence and proposed explanations. Thus, starting from a new theoretically motivated and empirically grounded taxonomy, we review the current research. Our taxonomy classifies choice-supportive misremembering into four conceptually distinct types: misattribution is when information is attributed to the wrong source, fact distortion when the facts are remembered in a distorted manner, false memory when items that were not part of the original decision scenarios are remembered as presented and, finally, selective forgetting is when information is selectively forgotten. After assessing the impact of various potentially moderating factors, we evaluate the evidence for each type of misremembering and conclude that the support for the phenomenon is solid in relation to misattribution when recognition memory is assessed, but significantly weaker for the other three types, and when other memory tests are used to assess memory. Finally, we review the cognitive and emotional explanations proposed for choice-supportive misremembering in the light of the available evidence and identify the main gaps in the current knowledge and the more promising avenues for future research. PMID:29255436

Mobile clinical decision support systems and applications: a literature and commercial review.

PubMed

Martínez-Pérez, Borja; de la Torre-Díez, Isabel; López-Coronado, Miguel; Sainz-de-Abajo, Beatriz; Robles, Montserrat; García-Gómez, Juan Miguel

2014-01-01

The latest advances in eHealth and mHealth have propitiated the rapidly creation and expansion of mobile applications for health care. One of these types of applications are the clinical decision support systems, which nowadays are being implemented in mobile apps to facilitate the access to health care professionals in their daily clinical decisions. The aim of this paper is twofold. Firstly, to make a review of the current systems available in the literature and in commercial stores. Secondly, to analyze a sample of applications in order to obtain some conclusions and recommendations. Two reviews have been done: a literature review on Scopus, IEEE Xplore, Web of Knowledge and PubMed and a commercial review on Google play and the App Store. Five applications from each review have been selected to develop an in-depth analysis and to obtain more information about the mobile clinical decision support systems. Ninety-two relevant papers and 192 commercial apps were found. Forty-four papers were focused only on mobile clinical decision support systems. One hundred seventy-one apps were available on Google play and 21 on the App Store. The apps are designed for general medicine and 37 different specialties, with some features common in all of them despite of the different medical fields objective. The number of mobile clinical decision support applications and their inclusion in clinical practices has risen in the last years. However, developers must be careful with their interface or the easiness of use, which can impoverish the experience of the users.

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

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

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

Determining Effective Teaching Behaviors through the Hiring Process

ERIC Educational Resources Information Center

Schumacher, Gary; Grigsby, Bettye; Vesey, Winona

2015-01-01

Purpose: One bad hiring decision can lead to low student achievement. Research supports that teachers are the most influential factor in student success. As a result, principals' current practice of hiring teachers based on intuition and likeability must change. Given the current high stakes era, principals need reassurance that the teachers they…

Methodological Approaches in Conducting Overviews: Current State in HTA Agencies

ERIC Educational Resources Information Center

Pieper, Dawid; Antoine, Sunya-Lee; Morfeld, Jana-Carina; Mathes, Tim; Eikermann, Michaela

2014-01-01

Objectives: Overviews search for reviews rather than for primary studies. They might have the potential to support decision making within a shorter time frame by reducing production time. We aimed to summarize available instructions for authors intending to conduct overviews as well as the currently applied methodology of overviews in…

Thinking outside the box: prenatal care and the call for a prenatal advance directive.

PubMed

Catlin, Anita

2005-01-01

The concept of advance directives is well-known in the care of adults as a mechanism for choosing in advance the extent of medical interventions desired in clinical situations, particularly life-extending interventions such as ventilation support and drugs to maintain cardiopulmonary status. Infants born extremely prematurely often require life-supporting measures for which their parents or guardians report feeling unprepared to make decisions about. Current prenatal care does not include an educational component that teaches women about the length of gestation needed for a healthy viability, survivorship, and outcome without major impairment. Women who go into preterm labor are asked to make immediate decisions during times of crisis without any formal education base for this decision making. Feminist ethics (the philosophical stance that articulates that women's moral experience is worthy of respect and disallows women's subordination) (Becker LB, Becker CB, eds. Feminist ethics. In: Encyclopedia of Ethics. New York: Routledge Press; 2001) requires that healthcare decisions be based on education, context, and particular situations. The purpose of this article is to examine the current content of typical prenatal care and education and to suggest an additional educational component to prenatal care-education of women about infant viability and the planning of future decisions if a nonviable or critically ill newborn is delivered. A prenatal discussion and parental/family directive is suggested.

Using Human Factors Methods to Design a New Interface for an Electronic Medical Record

PubMed Central

Saleem, Jason J.; Patterson, Emily S.; Militello, Laura; Asch, Steven M.; Doebbeling, Bradley N.; Render, Marta L.

2007-01-01

The Veterans Health Administration (VHA) is a leader in development and use of electronic patient records and clinical decision support. The VHA is currently reengineering a somewhat dated platform for its Computerized Patient Record System (CPRS). This process affords a unique opportunity to implement major changes to the current design and function of the system. We report on two human factors studies designed to provide input and guidance during this reengineering process. One study involved a card sort to better understand how providers tend to cognitively organize clinical data, and how that understanding can help guide interface design. The other involved a simulation to assess the impact of redesign modifications on computerized clinical reminders, a form of clinical decision support in the CPRS, on the learnability of the system for first-time users. PMID:18693914

Multiple perspectives on shared decision-making and interprofessional collaboration in mental healthcare.

PubMed

Chong, Wei Wen; Aslani, Parisa; Chen, Timothy F

2013-05-01

Shared decision-making is an essential element of patient-centered care in mental health. Since mental health services involve healthcare providers from different professions, a multiple perspective to shared decision-making may be valuable. The objective of this study was to explore the perceptions of different healthcare professionals on shared decision-making and current interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers from a range of professions, which included medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Findings indicated that healthcare providers supported the notion of shared decision-making in mental health, but felt that it should be condition dependent. Medical practitioners advocated a more active participation from consumers in treatment decision-making; whereas other providers (e.g. pharmacists, occupational therapists) focused more toward acknowledging consumers' needs in decisions, perceiving themselves to be in an advisory role in supporting consumers' decision-making. Although healthcare providers acknowledged the importance of interprofessional collaboration, only a minority discussed it within the context of shared decision-making. In conclusion, healthcare providers appeared to have differing perceptions on the level of consumer involvement in shared decision-making. Interprofessional roles to facilitate shared decision-making in mental health need to be acknowledged, understood and strengthened, before an interprofessional approach to shared decision-making in mental health can be effectively implemented.

Thalamocortical and corticothalamic pathways differentially contribute to goal-directed behaviors in the rat

PubMed Central

Alcaraz, Fabien; Fresno, Virginie; Marchand, Alain R; Kremer, Eric J; Coutureau, Etienne

2018-01-01

Highly distributed neural circuits are thought to support adaptive decision-making in volatile and complex environments. Notably, the functional interactions between prefrontal and reciprocally connected thalamic nuclei areas may be important when choices are guided by current goal value or action-outcome contingency. We examined the functional involvement of selected thalamocortical and corticothalamic pathways connecting the dorsomedial prefrontal cortex (dmPFC) and the mediodorsal thalamus (MD) in the behaving rat. Using a chemogenetic approach to inhibit projection-defined dmPFC and MD neurons during an instrumental learning task, we show that thalamocortical and corticothalamic pathways differentially support goal attributes. Both pathways participate in adaptation to the current goal value, but only thalamocortical neurons are required to integrate current causal relationships. These data indicate that antiparallel flow of information within thalamocortical circuits may convey qualitatively distinct aspects of adaptive decision-making and highlight the importance of the direction of information flow within neural circuits. PMID:29405119

The state of shared decision making in Malaysia.

PubMed

Lee, Yew Kong; Ng, Chirk Jenn

2017-06-01

Shared decision making (SDM) activities in Malaysia began around 2010. Although the concept is not widespread, there are opportunities to implement SDM in both the public and private healthcare sectors. Malaysia has a multicultural society and cultural components (such as language differences, medical paternalism, strong family involvement, religious beliefs and complementary medicine) influence medical decision making. In terms of policy, the Ministry of Health has increasingly mentioned patient-centered care as a component of healthcare delivery while the Malaysian Medical Council's guidelines on doctors' duties mentioned collaborative partnerships as a goal of doctor-patient relationships. Current research on SDM comprises baseline surveys of decisional role preferences, development and implementation of locally developed patient decision aids, and conducting of SDM training workshops. Most of this research is carried out by public research universities. In summary, the current state of SDM in Malaysia is still at its infancy. However, there are increasing recognition and efforts from the academic institutions and Ministry of Health to conduct research in SDM, develop patient decision support tools and initiate national discussion on patient involvement in decision making. Copyright © 2017. Published by Elsevier GmbH.

Empowering citizens in international governance of nanotechnologies.

PubMed

Malsch, Ineke; Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Marcomini, Antonio; Mullins, Martin; Hester, Karena; McAlea, Eamonn; Murphy, Finbarr; Tofail, Syed A M

The international dialogue on responsible governance of nanotechnologies engages a wide range of actors with conflicting as well as common interests. It is also characterised by a lack of evidence-based data on uncertain risks of in particular engineered nanomaterials. The present paper aims at deepening understanding of the collective decision making context at international level using the grounded theory approach as proposed by Glaser and Strauss in "The Discovery of Grounded Theory" (1967). This starts by discussing relevant concepts from different fields including sociological and political studies of international relations as well as political philosophy and ethics. This analysis of current trends in international law making is taken as starting point for exploring the role that a software decision support tool could play in multi-stakeholder global governance of nanotechnologies. These theoretical ideas are then compared with the current design of the SUN Decision Support System (SUNDS) under development in the European project on Sustainable Nanotechnologies (SUN, www.sun-fp7.eu). Through constant comparison, the ideas are also compared with requirements of different stakeholders as expressed during a user workshop. This allows for highlighting discussion points for further consideration.

Empowering citizens in international governance of nanotechnologies

NASA Astrophysics Data System (ADS)

Malsch, Ineke; Subramanian, Vrishali; Semenzin, Elena; Hristozov, Danail; Marcomini, Antonio; Mullins, Martin; Hester, Karena; McAlea, Eamonn; Murphy, Finbarr; Tofail, Syed A. M.

2015-05-01

The international dialogue on responsible governance of nanotechnologies engages a wide range of actors with conflicting as well as common interests. It is also characterised by a lack of evidence-based data on uncertain risks of in particular engineered nanomaterials. The present paper aims at deepening understanding of the collective decision making context at international level using the grounded theory approach as proposed by Glaser and Strauss in "The Discovery of Grounded Theory" (1967). This starts by discussing relevant concepts from different fields including sociological and political studies of international relations as well as political philosophy and ethics. This analysis of current trends in international law making is taken as starting point for exploring the role that a software decision support tool could play in multi-stakeholder global governance of nanotechnologies. These theoretical ideas are then compared with the current design of the SUN Decision Support System (SUNDS) under development in the European project on Sustainable Nanotechnologies (SUN, www.sun-fp7.eu). Through constant comparison, the ideas are also compared with requirements of different stakeholders as expressed during a user workshop. This allows for highlighting discussion points for further consideration.

Solutions Network Formulation Report. Improving NOAA's Tides and Currents Through Enhanced Data Inputs from NASA's Ocean Surface Topography Mission

NASA Technical Reports Server (NTRS)

Guest, DeNeice C.

2006-01-01

The Nation uses water-level data for a variety of practical purposes, including hydrography, nautical charting, maritime navigation, coastal engineering, and tsunami and storm surge warnings (NOAA, 2002; Digby et al., 1999). Long-term applications include marine boundary determinations, tidal predictions, sea-level trend monitoring, oceanographic research, and climate research. Accurate and timely information concerning sea-level height, tide, and ocean current is needed to understand their impact on coastal management, disaster management, and public health. Satellite altimeter data products are currently used by hundreds of researchers and operational users to monitor ocean circulation and to improve scientists understanding of the role of the oceans in climate and weather. The NOAA (National Oceanic and Atmospheric Administration) National Ocean Service has been monitoring sea-level variations for many years (NOAA, 2006). NOAA s Tides & Currents DST (decision support tool, managed by the Center for Operational Oceanographic Products and Services, is the portal to a vast collection of oceanographic and meteorological data (historical and real-time), predictions, and nowcasts and forecasts. This report assesses the capacity of NASA s satellite altimeter data to meet societal decision support needs through incorporation into NOAA s Tides & Currents.

AQUATOOL, a generalized decision-support system for water-resources planning and operational management

NASA Astrophysics Data System (ADS)

Andreu, J.; Capilla, J.; Sanchís, E.

1996-04-01

This paper describes a generic decision-support system (DSS) which was originally designed for the planning stage of dicision-making associated with complex river basins. Subsequently, it was expanded to incorporate modules relating to the operational stage of decision-making. Computer-assisted design modules allow any complex water-resource system to be represented in graphical form, giving access to geographically referenced databases and knowledge bases. The modelling capability includes basin simulation and optimization modules, an aquifer flow modelling module and two modules for risk assessment. The Segura and Tagus river basins have been used as case studies in the development and validation phases. The value of this DSS is demonstrated by the fact that both River Basin Agencies currently use a version for the efficient management of their water resources.

What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

PubMed Central

Lipstein, Ellen A.; Brinkman, William B.; Britto, Maria T.

2013-01-01

Background With the increasing complexity of decisions in pediatric medicine, there is a growing need to understand the pediatric decision-making process. Objective To conduct a narrative review of the current research on parent decision making about pediatric treatments and identify areas in need of further investigation. Methods Articles presenting original research on parent decision making were identified from MEDLINE (1966–6/2011), using the terms “decision making,” “parent,” and “child.” We included papers focused on treatment decisions but excluded those focused on information disclosure to children, vaccination, and research participation decisions. Results We found 55 papers describing 52 distinct studies, the majority being descriptive, qualitative studies of the decision-making process, with very limited assessment of decision outcomes. Although parents’ preferences for degree of participation in pediatric decision making vary, most are interested in sharing the decision with the provider. In addition to the provider, parents are influenced in their decision making by changes in their child’s health status, other community members, prior knowledge, and personal factors, such as emotions and faith. Parents struggle to balance these influences as well as to know when to include their child in decision making. Conclusions Current research demonstrates a diversity of influences on parent decision making and parent decision preferences; however, little is known about decision outcomes or interventions to improve outcomes. Further investigation, using prospective methods, is needed in order to understand how to support parents through the difficult treatment decisions. PMID:21969136

Are electronic medical records helpful for care coordination? Experiences of physician practices.

PubMed

O'Malley, Ann S; Grossman, Joy M; Cohen, Genna R; Kemper, Nicole M; Pham, Hoangmai H

2010-03-01

Policies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination. We examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges. Semi-structured telephone interviews in 12 randomly selected communities. Sixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders. Six major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity). There is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

A systematic review of clinical decision support systems for antimicrobial management: are we failing to investigate these interventions appropriately?

PubMed

Rawson, T M; Moore, L S P; Hernandez, B; Charani, E; Castro-Sanchez, E; Herrero, P; Hayhoe, B; Hope, W; Georgiou, P; Holmes, A H

2017-08-01

Clinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimize antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems. PRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management and Global Health databases were searched from 1 January 1980 to 31 October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation. Fifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have a rules-based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor. Greater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Imaging informatics-based multimedia ePR system for data management and decision support in rehabilitation research

NASA Astrophysics Data System (ADS)

Wang, Ximing; Verma, Sneha; Qin, Yi; Sterling, Josh; Zhou, Alyssa; Zhang, Jeffrey; Martinez, Clarisa; Casebeer, Narissa; Koh, Hyunwook; Winstein, Carolee; Liu, Brent

2013-03-01

With the rapid development of science and technology, large-scale rehabilitation centers and clinical rehabilitation trials usually involve significant volumes of multimedia data. Due to the global aging crisis, millions of new patients with age-related chronic diseases will produce huge amounts of data and contribute to soaring costs of medical care. Hence, a solution for effective data management and decision support will significantly reduce the expenditure and finally improve the patient life quality. Inspired from the concept of the electronic patient record (ePR), we developed a prototype system for the field of rehabilitation engineering. The system is subject or patient-oriented and customized for specific projects. The system components include data entry modules, multimedia data presentation and data retrieval. To process the multimedia data, the system includes a DICOM viewer with annotation tools and video/audio player. The system also serves as a platform for integrating decision-support tools and data mining tools. Based on the prototype system design, we developed two specific applications: 1) DOSE (a phase 1 randomized clinical trial to determine the optimal dose of therapy for rehabilitation of the arm and hand after stroke.); and 2) NEXUS project from the Rehabilitation Engineering Research Center(RERC, a NIDRR funded Rehabilitation Engineering Research Center). Currently, the system is being evaluated in the context of the DOSE trial with a projected enrollment of 60 participants over 5 years, and will be evaluated by the NEXUS project with 30 subjects. By applying the ePR concept, we developed a system in order to improve the current research workflow, reduce the cost of managing data, and provide a platform for the rapid development of future decision-support tools.

Exploration-Related Research on the International Space Station: Connecting Science Results to the Design of Future Missions

NASA Technical Reports Server (NTRS)

Rhatigan, Jennifer L.; Robinson, Julie A.; Sawin, Charles F.; Ahlf, Peter R.

2005-01-01

In January, 2004, the US President announced a vision for space exploration, and charged NASA with utilizing the International Space Station (ISS) for research and technology targeted at supporting the US space exploration goals. This paper describes: 1) what we have learned from the first four years of research on ISS relative to the exploration mission, 2) the on-going research being conducted in this regard, 3) our current understanding of the major exploration mission risks that the ISS can be used to address, and 4) current progress in realigning NASA s research portfolio for ISS to support exploration missions. Specifically, we discuss the focus of research on solving the perplexing problems of maintaining human health on long-duration missions, and the development of countermeasures to protect humans from the space environment, enabling long duration exploration missions. The interchange between mission design and research needs is dynamic, where design decisions influence the type of research needed, and results of research influence design decisions. The fundamental challenge to science on ISS is completing experiments that answer key questions in time to shape design decisions for future exploration. In this context, exploration-relevant research must do more than be conceptually connected to design decisions-it must become a part of the mission design process.

Interpersonal reactivity and the attribution of emotional reactions.

PubMed

Haas, Brian W; Anderson, Ian W; Filkowski, Megan M

2015-06-01

The ability to identify the cause of another person's emotional reaction is an important component associated with improved success of social relationships and survival. Although many studies have investigated the mechanisms involved in emotion recognition, very little is currently known regarding the processes involved during emotion attribution decisions. Research on complementary "emotion understanding" mechanisms, including empathy and theory of mind, has demonstrated that emotion understanding decisions are often made through relatively emotion- or cognitive-based processing streams. The current study was designed to investigate the behavioral and brain mechanisms involved in emotion attribution decisions. We predicted that dual processes, emotional and cognitive, are engaged during emotion attribution decisions. Sixteen healthy adults completed the Interpersonal Reactivity Index to characterize individual differences in tendency to make emotion- versus cognitive-based interpersonal decisions. Participants then underwent functional MRI while making emotion attribution decisions. We found neuroimaging evidence that emotion attribution decisions engage a similar brain network as other forms of emotion understanding. Further, we found evidence in support of a dual processes model involved during emotion attribution decisions. Higher scores of personal distress were associated with quicker emotion attribution decisions and increased anterior insula activity. Conversely, higher scores in perspective taking were associated with delayed emotion attribution decisions and increased prefrontal cortex and premotor activity. These findings indicate that the making of emotion attribution decisions relies on dissociable emotional and cognitive processing streams within the brain. (c) 2015 APA, all rights reserved).

Social Support as a Neglected E-Learning Motivator Affecting Trainee's Decisions of Continuous Intentions of Usage

ERIC Educational Resources Information Center

Weng, Cathy; Tsai, Chin-Chung; Weng, Apollo

2015-01-01

Drawing from the social influence theory and acknowledging that the others' support within the work context affects employees' learning, values, and behaviours, an alternative framework was proposed to explain employees' learning satisfaction and future intention to participate in e-training programs in the current study. 578 survey data collected…

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

PubMed

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

2018-02-01

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

The Development and Validation of the Rational and Intuitive Decision Styles Scale.

PubMed

Hamilton, Katherine; Shih, Shin-I; Mohammed, Susan

2016-01-01

Decision styles reflect the typical manner by which individuals make decisions. The purpose of this research was to develop and validate a decision style scale that addresses conceptual and psychometric problems with current measures. The resulting 10-item scale captures a broad range of the rational and intuitive styles construct domain. Results from 5 independent samples provide initial support for the dimensionality and reliability of the new scale, as demonstrated by a clear factor structure and high internal consistency. In addition, our results show evidence of convergent and discriminant validity through expected patterns of correlations across decision-making individual differences and the International Personality Item Pool (IPIP) Big Five traits. Research domains that would benefit from incorporating the concept of decision styles are discussed.

A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems.

PubMed

Phansalkar, Shobha; Edworthy, Judy; Hellier, Elizabeth; Seger, Diane L; Schedlbauer, Angela; Avery, Anthony J; Bates, David W

2010-01-01

The objective of this review is to describe the implementation of human factors principles for the design of alerts in clinical information systems. First, we conduct a review of alarm systems to identify human factors principles that are employed in the design and implementation of alerts. Second, we review the medical informatics literature to provide examples of the implementation of human factors principles in current clinical information systems using alerts to provide medication decision support. Last, we suggest actionable recommendations for delivering effective clinical decision support using alerts. A review of studies from the medical informatics literature suggests that many basic human factors principles are not followed, possibly contributing to the lack of acceptance of alerts in clinical information systems. We evaluate the limitations of current alerting philosophies and provide recommendations for improving acceptance of alerts by incorporating human factors principles in their design.

A decision support system for real-time hydropower scheduling in a competitive power market environment

NASA Astrophysics Data System (ADS)

Shawwash, Ziad Khaled Elias

2000-10-01

The electricity supply market is rapidly changing from a monopolistic to a competitive environment. Being able to operate their system of reservoirs and generating facilities to get maximum benefits out of existing assets and resources is important to the British Columbia Hydro Authority (B.C. Hydro). A decision support system has been developed to help B.C. Hydro operate their system in an optimal way. The system is operational and is one of the tools that are currently used by the B.C. Hydro system operations engineers to determine optimal schedules that meet the hourly domestic load and also maximize the value B.C. Hydro obtains from spot transactions in the Western U.S. and Alberta electricity markets. This dissertation describes the development and implementation of the decision support system in production mode. The decision support system consists of six components: the input data preparation routines, the graphical user interface (GUI), the communication protocols, the hydraulic simulation model, the optimization model, and the results display software. A major part of this work involved the development and implementation of a practical and detailed large-scale optimization model that determines the optimal tradeoff between the long-term value of water and the returns from spot trading transactions in real-time operations. The postmortem-testing phase showed that the gains in value from using the model accounted for 0.25% to 1.0% of the revenues obtained. The financial returns from using the decision support system greatly outweigh the costs of building it. Other benefits are the savings in the time needed to prepare the generation and trading schedules. The system operations engineers now can use the time saved to focus on other important aspects of their job. The operators are currently experimenting with the system in production mode, and are gradually gaining confidence that the advice it provides is accurate, reliable and sensible. The main lesson learned from developing and implementing the system was that there is no alternative to working very closely with the intended end-users of the system, and with the people who have deep knowledge, experience and understanding of how the system is and should be operated.

Incorporating Pharmacogenomics into Health Information Technology, Electronic Health Record and Decision Support System: An Overview.

PubMed

Alanazi, Abdullah

2017-02-01

As the adoption of information technology in healthcare is rising, the potentiality of moving Pharmacogenomics from benchside to bedside is aggravated. This paper reviews the current status of Pharmacogenomics (PGx) information and the attempts for incorporating them into the Electronic Health Record (EHR) system through Decision Support Systems (DSSs). Rigorous review strategies of PGx information and providing context-relevant recommendations in form of action plan- dose adjustment, lab tests rather than just information- would be ideal for making clinical recommendations out of PGx information. Lastly, realistic projections of what pharmacogenomics can provide is another important aspect in incorporating Pharmacogenomics into health information technology.

Use of decision support systems as a drought management tool

USGS Publications Warehouse

Frevert, D.; Lins, H.; ,

2005-01-01

Droughts present a unique challenge to water managers throughout the world and the current drought in the western United States is taxing facilities to the limit. Coping with this severe drought requires state of the art decision support systems including efficient and accurate hydrologic process models, detailed hydrologic data bases and effective river systems management modeling frameworks. This paper will outline a system of models developed by the Bureau of Reclamation, the US Geological Survey, the University of Colorado and a number of other governmental and university partners. The application of the technology to drought management in several key western river basins will be discussed.

Distributed collaborative decision support environments for predictive awareness

NASA Astrophysics Data System (ADS)

McQuay, William K.; Stilman, Boris; Yakhnis, Vlad

2005-05-01

The past decade has produced significant changes in the conduct of military operations: asymmetric warfare, the reliance on dynamic coalitions, stringent rules of engagement, increased concern about collateral damage, and the need for sustained air operations. Mission commanders need to assimilate a tremendous amount of information, rapidly assess the enemy"s course of action (eCOA) or possible actions and promulgate their own course of action (COA) - a need for predictive awareness. Decision support tools in a distributed collaborative environment offer the capability of decomposing complex multitask processes and distributing them over a dynamic set of execution assets that include modeling, simulations, and analysis tools. Revolutionary new approaches to strategy generation and assessment such as Linguistic Geometry (LG) permit the rapid development of COA vs. enemy COA (eCOA). LG tools automatically generate and permit the operators to take advantage of winning strategies and tactics for mission planning and execution in near real-time. LG is predictive and employs deep "look-ahead" from the current state and provides a realistic, reactive model of adversary reasoning and behavior. Collaborative environments provide the framework and integrate models, simulations, and domain specific decision support tools for the sharing and exchanging of data, information, knowledge, and actions. This paper describes ongoing research efforts in applying distributed collaborative environments to decision support for predictive mission awareness.

Radiological emergency response for community agencies with cognitive task analysis, risk analysis, and decision support framework.

PubMed

Meyer, Travis S; Muething, Joseph Z; Lima, Gustavo Amoras Souza; Torres, Breno Raemy Rangel; del Rosario, Trystyn Keia; Gomes, José Orlando; Lambert, James H

2012-01-01

Radiological nuclear emergency responders must be able to coordinate evacuation and relief efforts following the release of radioactive material into populated areas. In order to respond quickly and effectively to a nuclear emergency, high-level coordination is needed between a number of large, independent organizations, including police, military, hazmat, and transportation authorities. Given the complexity, scale, time-pressure, and potential negative consequences inherent in radiological emergency responses, tracking and communicating information that will assist decision makers during a crisis is crucial. The emergency response team at the Angra dos Reis nuclear power facility, located outside of Rio de Janeiro, Brazil, presently conducts emergency response simulations once every two years to prepare organizational leaders for real-life emergency situations. However, current exercises are conducted without the aid of electronic or software tools, resulting in possible cognitive overload and delays in decision-making. This paper describes the development of a decision support system employing systems methodologies, including cognitive task analysis and human-machine interface design. The decision support system can aid the coordination team by automating cognitive functions and improving information sharing. A prototype of the design will be evaluated by plant officials in Brazil and incorporated to a future trial run of a response simulation.

Evaluation of technology to identify and assess overweight children and adolescents.

PubMed

Gance-Cleveland, Bonnie; Gilbert, Lynn H; Kopanos, Taynin; Gilbert, Kevin C

2010-01-01

The current obesity epidemic has produced a generation of children that may be the first to have a life expectancy shorter than their parents. To address the obesity epidemic, experts have published recommendations for providers. Research suggests the publication of guidelines may not change provider behavior. This study evaluates computer assistance for implementing obesity guidelines in school-based health centers. Significant improvements in identification and assessment of obesity in children with technology support were noted. Computer decision support shows promise for promoting the implementation of current recommendations by supporting providers in identifying, assessing, and providing tailored recommendations for children at risk of obesity.

Study protocol: Improving patient choice in treating low back pain (IMPACT - LBP): A randomised controlled trial of a decision support package for use in physical therapy

PubMed Central

2011-01-01

Background Low back pain is a common and costly condition. There are several treatment options for people suffering from back pain, but there are few data on how to improve patients' treatment choices. This study will test the effects of a decision support package (DSP), designed to help patients seeking care for back pain to make better, more informed choices about their treatment within a physiotherapy department. The package will be designed to assist both therapist and patient. Methods/Design Firstly, in collaboration with physiotherapists, patients and experts in the field of decision support and decision aids, we will develop the DSP. The work will include: a literature and evidence review; secondary analysis of existing qualitative data; exploration of patients' perspectives through focus groups and exploration of experts' perspectives using a nominal group technique and a Delphi study. Secondly, we will carry out a pilot single centre randomised controlled trial within NHS Coventry Community Physiotherapy. We will randomise physiotherapists to receive either training for the DSP or not. We will randomly allocate patients seeking treatment for non specific low back pain to either a physiotherapist trained in decision support or to receive usual care. Our primary outcome measure will be patient satisfaction with treatment at three month follow-up. We will also estimate the cost-effectiveness of the intervention, and assess the value of conducting further research. Discussion Informed shared decision-making should be an important part of any clinical consultation, particularly when there are several treatments, which potentially have moderate effects. The results of this pilot will help us determine the benefits of improving the decision-making process in clinical practice on patient satisfaction. Trial registration Current Controlled Trials ISRCTN46035546 PMID:21352528

Information systems: the key to evidence-based health practice.

PubMed Central

Rodrigues, R. J.

2000-01-01

Increasing prominence is being given to the use of best current evidence in clinical practice and health services and programme management decision-making. The role of information in evidence-based practice (EBP) is discussed, together with questions of how advanced information systems and technology (IS&T) can contribute to the establishment of a broader perspective for EBP. The author examines the development, validation and use of a variety of sources of evidence and knowledge that go beyond the well-established paradigm of research, clinical trials, and systematic literature review. Opportunities and challenges in the implementation and use of IS&T and knowledge management tools are examined for six application areas: reference databases, contextual data, clinical data repositories, administrative data repositories, decision support software, and Internet-based interactive health information and communication. Computerized and telecommunications applications that support EBP follow a hierarchy in which systems, tasks and complexity range from reference retrieval and the processing of relatively routine transactions, to complex "data mining" and rule-driven decision support systems. PMID:11143195

Critical Infrastructure: The National Asset Database

DTIC Science & Technology

2006-09-14

NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION...that, in its current form, it is being used inappropriately as the basis upon which federal resources, including infrastructure protection grants , are...National Asset Database has been used to support federal grant -making decisions, according to a DHS official, it does not drive those decisions. In July

LEEDS Decision Tools for E-Craft

DTIC Science & Technology

2011-02-15

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

Bridging groundwater models and decision support with a Bayesian network

USGS Publications Warehouse

Fienen, Michael N.; Masterson, John P.; Plant, Nathaniel G.; Gutierrez, Benjamin T.; Thieler, E. Robert

2013-01-01

Resource managers need to make decisions to plan for future environmental conditions, particularly sea level rise, in the face of substantial uncertainty. Many interacting processes factor in to the decisions they face. Advances in process models and the quantification of uncertainty have made models a valuable tool for this purpose. Long-simulation runtimes and, often, numerical instability make linking process models impractical in many cases. A method for emulating the important connections between model input and forecasts, while propagating uncertainty, has the potential to provide a bridge between complicated numerical process models and the efficiency and stability needed for decision making. We explore this using a Bayesian network (BN) to emulate a groundwater flow model. We expand on previous approaches to validating a BN by calculating forecasting skill using cross validation of a groundwater model of Assateague Island in Virginia and Maryland, USA. This BN emulation was shown to capture the important groundwater-flow characteristics and uncertainty of the groundwater system because of its connection to island morphology and sea level. Forecast power metrics associated with the validation of multiple alternative BN designs guided the selection of an optimal level of BN complexity. Assateague island is an ideal test case for exploring a forecasting tool based on current conditions because the unique hydrogeomorphological variability of the island includes a range of settings indicative of past, current, and future conditions. The resulting BN is a valuable tool for exploring the response of groundwater conditions to sea level rise in decision support.

Capacity for Preferences: Respecting Patients with Compromised Decision-Making.

PubMed

Wasserman, Jason Adam; Navin, Mark Christopher

2018-05-01

When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient's best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional source of guidance for decisions about patients who lack decision-making capacity. Our proposal builds on other efforts to help patients who lack decision-making capacity provide input into decisions about their care. For example, "supported," "assisted," or "guided" decision-making models reflect a commitment to humanistic patient engagement and create a more supportive process for patients, families, and health care teams. But often, they are supportive processes for guiding a patient toward a decision that the surrogate or team believes to be in the patient's medical best interests. Another approach holds that taking seriously the preferences of such a patient can help surrogates develop a better account of what the patient's treatment choices would have been if the patient had retained decision-making capacity; the surrogate then must try to integrate features of the patient's formerly rational self with the preferences of the patient's currently compromised self. Patients who lack decision-making capacity are well served by these efforts to solicit and use their preferences to promote best interests or to craft would-be autonomous patient images for use by surrogates. However, we go further: the moral reasons for valuing the preferences of patients without decision-making capacity are not reducible to either best-interests or (surrogate) autonomy considerations but can be grounded in the values of liberty and respect for persons. This has important consequences for treatment decisions involving these vulnerable patients. © 2018 The Hastings Center.

Personalized health care and health information technology policy: an exploratory analysis.

PubMed

Wald, Jonathan S; Shapiro, Michael

2013-01-01

Personalized healthcare (PHC) is envisioned to enhance clinical practice decision-making using new genome-driven knowledge that tailors diagnosis, treatment, and prevention to the individual patient. In 2012, we conducted a focused environmental scan and informal interviews with fifteen experts to anticipate how PHC might impact health Information Technology (IT) policy in the United States. Findings indicatedthat PHC has a variable impact on current clinical practice, creates complex questions for providers, patients, and policy-makers, and will require a robust health IT infrastructure with advanced data architecture, clinical decision support, provider workflow tools, and re-use of clinical data for research. A number of health IT challenge areas were identified, along with five policy areas including: interoperable clinical decision support, standards for patient values and preferences, patient engagement, data transparency, and robust privacy and security.

A decision support system for delivering optimal quality peach and tomato

NASA Technical Reports Server (NTRS)

Thai, C. N.; Pease, J. N.; Shewfelt, R. L.

1990-01-01

Several studies have indicated that color and firmness are the two quality attributes most important to consumers in making purchasing decisions of fresh peaches and tomatoes. However, at present, retail produce managers do not have the proper information for handling fresh produce so it has the most appealing color and firmness when it reaches the consumer. This information should help them predict the consumer color and firmness perception and preference for produce from various storage conditions. Since 1987, for 'Redglobe' peach and 'Sunny' tomato, we have been generating information about their physical quality attributes (firmness and color) and their corresponding consumer sensory scores. This article reports on our current progress toward the goal of integrating such information into a model-based decision support system for retail level managers in handling fresh peaches and tomatoes.

Current Directions in Adding Value to Earth Observation Products for Decision Support

NASA Astrophysics Data System (ADS)

Ryker, S. J.

2015-12-01

Natural resource managers and infrastructure planners face increasingly complex challenges, given competing demands for resources and changing conditions due to climate and land use change. These pressures create demand for high-quality, timely data; for both one-time decision support and long-term monitoring; and for techniques to articulate the value of resources in monetary and nonmonetary terms. To meet the need for data, the U.S. government invests several billion dollars per year in Earth observations collected from satellite, airborne, terrestrial, and ocean-based systems. Earth observation-based decision support is coming of age; user surveys show that these data are used in an increasing variety of analyses. For example, since the U.S. Department of the Interior/U.S. Geological Survey's (USGS) 2008 free and open data policy for the Landsat satellites, downloads from the USGS archive have increased from 20,000 Landsat scenes per year to 10 million per year and climbing, with strong growth in both research and decision support fields. However, Earth observation-based decision support still poses users a number of challenges. Many of those Landsat downloads support a specialized community of remote sensing scientists, though new technologies promise to increase the usability of remotely sensed data for the larger GIS community supporting planning and resource management. Serving this larger community also requires supporting the development of increasingly interpretive products, and of new approaches to host and update products. For example, automating updates will add value to new essential climate variable products such as surface water extent and wildfire burned area extent. Projections of future urbanization in the southeastern U.S. are most useful when long-term land cover trends are integrated with street-level community data and planning tools. The USGS assessment of biological carbon sequestration in vegetation and shallow soils required a significant research investment in satellite and in situ measurements and biogeochemical and climate modeling, and is already providing decision support at a variety of scales; once operationalized, it will be a tool for adaptive management from field-scale soil and wetland conservation projects to national-scale policy.

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

NASA Astrophysics Data System (ADS)

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

2014-05-01

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

Noneconomic factors influencing scrap metal disposition decisions at DOE and NRC-licensed nuclear facilities

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

Ewen, M.D.; Robinson, L.A.

1997-02-01

The U.S. Environmental Protection Agency (EPA) is currently developing radiation protection standards for scrap metal, which will establish criteria for the unconditional clearance of scrap from nuclear facilities. In support of this effort, Industrial Economics, Incorporated is assessing the costs and benefits attributable to the rulemaking. The first step in this analysis is to develop an in-depth understanding of the factors influencing scrap disposition decisions, so that one can predict current and future practices under existing requirements and compare them to the potential effects of EPA`s rulemaking. These baseline practices are difficult to predict due to a variety of factors.more » First, because decommissioning activities are just beginning at many sites, current practices do not necessarily provide an accurate indicator of how these practices may evolve as site managers gain experience with related decisions. Second, a number of different regulations and policies apply to these decisions, and the interactive effects of these requirements can be difficult to predict. Third, factors other than regulatory constraints and costs may have a significant effect on related decisions, such as concerns about public perceptions. In general, research suggests that these factors tend to discourage the unconditional clearance of scrap metal.« less

Integrated Modeling for Road Condition Prediction (IMRCP)

DOT National Transportation Integrated Search

2018-01-17

Intelligent transportation system deployments have enabled great advances in operational awareness and response based on the data they gather on the current state of the roadways. The next step in decision support is to forecast road conditions and b...

Risk assessment and decision making about in-labour transfer from rural maternity care: a social judgment and signal detection analysis

PubMed Central

2012-01-01

Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making. PMID:23114289

Workshop summary: 'Integrating air quality and climate mitigation - is there a need for new metrics to support decision making?'

NASA Astrophysics Data System (ADS)

von Schneidemesser, E.; Schmale, J.; Van Aardenne, J.

2013-12-01

Air pollution and climate change are often treated at national and international level as separate problems under different regulatory or thematic frameworks and different policy departments. With air pollution and climate change being strongly linked with regard to their causes, effects and mitigation options, the integration of policies that steer air pollutant and greenhouse gas emission reductions might result in cost-efficient, more effective and thus more sustainable tackling of the two problems. To support informed decision making and to work towards an integrated air quality and climate change mitigation policy requires the identification, quantification and communication of present-day and potential future co-benefits and trade-offs. The identification of co-benefits and trade-offs requires the application of appropriate metrics that are well rooted in science, easy to understand and reflect the needs of policy, industry and the public for informed decision making. For the purpose of this workshop, metrics were loosely defined as a quantified measure of effect or impact used to inform decision-making and to evaluate mitigation measures. The workshop held on October 9 and 10 and co-organized between the European Environment Agency and the Institute for Advanced Sustainability Studies brought together representatives from science, policy, NGOs, and industry to discuss whether current available metrics are 'fit for purpose' or whether there is a need to develop alternative metrics or reassess the way current metrics are used and communicated. Based on the workshop outcome the presentation will (a) summarize the informational needs and current application of metrics by the end-users, who, depending on their field and area of operation might require health, policy, and/or economically relevant parameters at different scales, (b) provide an overview of the state of the science of currently used and newly developed metrics, and the scientific validity of these metrics, (c) identify gaps in the current information base, whether from the scientific development of metrics or their application by different users.

Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review.

PubMed

Munro, Sarah; Stacey, Dawn; Lewis, Krystina B; Bansback, Nick

2016-04-01

To understand how well patients make value congruent decisions with and without patient decision aids (PtDAs) for screening and treatment options, and identify issues with its measurement and evaluation. A sub-analysis of trials included in the 2014 Cochrane Review of Decision Aids. Eligible trials measured value congruence with chosen option. Two reviewers independently screened 115 trials. Among 18 included trials, 8 (44%) measured value congruence using the Multidimensional Measure of Informed Choice (MMIC), 7 (39%) used heterogeneous methods, and 3 (17%) used unclear methods. Pooled results of trials that used heterogeneous measures were statistically non-significant (n=3). Results from trials that used the MMIC suggest patients are 48% more likely to make value congruent decisions when exposed to a PtDA for a screening decision (RR 1.48, 95% CI 1.01 to 2.16, n=8). Patients struggle to make value congruent decisions, but PtDAs may help. While the absolute improvement is relatively small it may be underestimated due to sample size issues, definitions, and heterogeneity of measures. Current approaches are inadequate to support patients making decisions that are consistent with their values. There is some evidence that PtDAs support patients with achieving values congruent decisions for screening choices. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Integrating Water Quality and River Rehabilitation Management - A Decision-Analytical Perspective

NASA Astrophysics Data System (ADS)

Reichert, P.; Langhans, S.; Lienert, J.; Schuwirth, N.

2009-04-01

Integrative river management involves difficult decisions about alternative measures to improve their ecological state. For this reason, it seems useful to apply knowledge from the decision sciences to support river management. We discuss how decision-analytical elements can be employed for designing an integrated river management procedure. An important aspect of this procedure is to clearly separate scientific predictions of the consequences of alternatives from objectives to be achieved by river management. The key elements of the suggested procedure are (i) the quantitative elicitation of the objectives from different stakeholder groups, (ii) the compilation of the current scientific knowledge about the consequences of the effects resulting from suggested measures in the form of a probabilistic mathematical model, and (iii) the use of these predictions and valuations to prioritize alternatives, to uncover conflicting objectives, to support the design of better alternatives, and to improve the transparency of communication about the chosen management strategy. The development of this procedure led to insights regarding necessary steps to be taken for rational decision-making in river management, to guidelines about the use of decision-analytical techniques for performing these steps, but also to new insights about the application of decision-analytical techniques in general. In particular, the consideration of the spatial distribution of the effects of measures and the potential added value of connected rehabilitated river reaches leads to favoring measures that have a positive effect beyond a single river reach. As these effects only propagate within the river network, this results in a river basin oriented management concept as a consequence of a rational decision support procedure, rather than as an a priori management paradigm. There are also limitations to the support that can be expected from the decision-analytical perspective. It will not provide the societal values that are driving prioritization in river management, it will only support their elicitation and rational use. This is particularly important for the assessment of micro-pollutants because of severe limitations in scientific knowledge of their effects on river ecosystems. This makes the influence of pollution by micro-pollutants on prioritization of measures strongly dependent on the weight of the precautionary principle relative to other societal objectives of river management.

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

PubMed

Suner, Aslı; Karakülah, Gökhan; Dicle, Oğuz

2014-01-01

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

Rationality versus reality: the challenges of evidence-based decision making for health policy makers

PubMed Central

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

Rationality versus reality: the challenges of evidence-based decision making for health policy makers.

PubMed

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.

SU-E-J-04: A Data-Driven, Response-Based, Multi-Criteria Decision Support System for Personalized Lung Radiation Treatment Planning

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

Luo, Y; McShan, D; Schipper, M

2014-06-01

Purpose: To develop a decision support tool to predict a patient's potential overall survival (OS) and radiation induced toxicity (RIT) based on clinical factors and responses during the course of radiotherapy, and suggest appropriate radiation dose adjustments to improve therapeutic effect. Methods: Important relationships between a patient's basic information and their clinical features before and during the radiation treatment are identified from historical clinical data by using statistical learning and data mining approaches. During each treatment period, a data analysis (DA) module predicts radiotherapy features such as time to local progression (TTLP), time to distant metastases (TTDM), radiation toxicity tomore » different organs, etc., under possible future treatment plans based on patient specifics or responses. An information fusion (IF) module estimates intervals for a patient's OS and the probabilities of RIT from a treatment plan by integrating the outcomes of module DA. A decision making (DM) module calculates “satisfaction” with the predicted radiation outcome based on trade-offs between OS and RIT, and finds the best treatment plan for the next time period via multi-criteria optimization. Results: Using physical and biological data from 130 lung cancer patients as our test bed, we were able to train and implement the 3 modules of our decision support tool. Examples demonstrate how it can help predict a new patient's potential OS and RIT with different radiation dose plans along with how these combinations change with dose, thus presenting a range of satisfaction/utility for use in individualized decision support. Conclusion: Although the decision support tool is currently developed from a small patient sample size, it shows the potential for the improvement of each patient's satisfaction in personalized radiation therapy. The radiation treatment outcome prediction and decision making model needs to be evaluated with more patients and demonstrated for use in radiation treatments for other cancers. P01-CA59827;R01CA142840.« less

The contribution of perceived parental support to the career self-efficacy of deaf, hard-of-hearing, and hearing adolescents.

PubMed

Michael, Rinat; Most, Tova; Cinamon, Rachel Gali

2013-01-01

The current study examined the contribution of different types of parental support to career self-efficacy among 11th and 12th grade students (N = 160): 66 students with hearing loss (23 hard of hearing and 43 deaf) and 94 hearing students. Participants completed the Career-Related Parent Support Scale, the Career Decision-Making Self-Efficacy Scale, and the Self-Efficacy for the Management of Work-Family Conflict questionnaire. Different aspects of parental support predicted different types of career self-efficacies across the 3 groups. Differences among groups were also found when levels of parental support were compared. The deaf group perceived lower levels of parental career-related modeling and verbal encouragement in comparison with the hard-of-hearing students and higher levels of parental emotional support compared with the hearing participants. No significant differences were found among the research groups in career decision-making self-efficacy and self-efficacy in managing work-family conflict. Implications for theory and practice are discussed.

Collaborating with Youth to Inform and Develop Tools for Psychotropic Decision Making

PubMed Central

Murphy, Andrea; Gardner, David; Kutcher, Stan; Davidson, Simon; Manion, Ian

2010-01-01

Introduction: Youth oriented and informed resources designed to support psychopharmacotherapeutic decision-making are essentially unavailable. This article outlines the approach taken to design such resources, the product that resulted from the approach taken, and the lessons learned from the process. Methods: A project team with psychopharmacology expertise was assembled. The project team reviewed best practices regarding medication educational materials and related tools to support decisions. Collaboration with key stakeholders who were thought of as primary end-users and target groups occurred. A graphic designer and a plain language consultant were also retained. Results: Through an iterative and collaborative process over approximately 6 months, Med Ed and Med Ed Passport were developed. Literature and input from key stakeholders, in particular youth, was instrumental to the development of the tools and materials within Med Ed. A training program utilizing a train-the-trainer model was developed to facilitate the implementation of Med Ed in Ontario, which is currently ongoing. Conclusion: An evidence-informed process that includes youth and key stakeholder engagement is required for developing tools to support in psychopharmacotherapeutic decision-making. The development process fostered an environment of reciprocity between the project team and key stakeholders. PMID:21037916

Evaluation of SOVAT: an OLAP-GIS decision support system for community health assessment data analysis.

PubMed

Scotch, Matthew; Parmanto, Bambang; Monaco, Valerie

2008-06-09

Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture.On-Line Analytical Processing (OLAP) is a multidimensional datawarehouse designed to facilitate querying of large numerical data. Coupling the spatial capabilities of GIS with the numerical analysis of OLAP, might enhance CHA data analysis. OLAP-GIS systems have been developed by university researchers and corporations, yet their potential for CHA data analysis is not well understood. To evaluate the potential of an OLAP-GIS decision support system for CHA problem solving, we compared OLAP-GIS to the standard information technology (IT) currently used by many public health professionals. SOVAT, an OLAP-GIS decision support system developed at the University of Pittsburgh, was compared against current IT for data analysis for CHA. For this study, current IT was considered the combined use of SPSS and GIS ("SPSS-GIS"). Graduate students, researchers, and faculty in the health sciences at the University of Pittsburgh were recruited. Each round consisted of: an instructional video of the system being evaluated, two practice tasks, five assessment tasks, and one post-study questionnaire. Objective and subjective measurement included: task completion time, success in answering the tasks, and system satisfaction. Thirteen individuals participated. Inferential statistics were analyzed using linear mixed model analysis. SOVAT was statistically significant (alpha = .01) from SPSS-GIS for satisfaction and time (p < .002). Descriptive results indicated that participants had greater success in answering the tasks when using SOVAT as compared to SPSS-GIS. Using SOVAT, tasks were completed more efficiently, with a higher rate of success, and with greater satisfaction, than the combined use of SPSS and GIS. The results from this study indicate a potential for OLAP-GIS decision support systems as a valuable tool for CHA data analysis.

Evaluation of SOVAT: An OLAP-GIS decision support system for community health assessment data analysis

PubMed Central

Scotch, Matthew; Parmanto, Bambang; Monaco, Valerie

2008-01-01

Background Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture. On-Line Analytical Processing (OLAP) is a multidimensional datawarehouse designed to facilitate querying of large numerical data. Coupling the spatial capabilities of GIS with the numerical analysis of OLAP, might enhance CHA data analysis. OLAP-GIS systems have been developed by university researchers and corporations, yet their potential for CHA data analysis is not well understood. To evaluate the potential of an OLAP-GIS decision support system for CHA problem solving, we compared OLAP-GIS to the standard information technology (IT) currently used by many public health professionals. Methods SOVAT, an OLAP-GIS decision support system developed at the University of Pittsburgh, was compared against current IT for data analysis for CHA. For this study, current IT was considered the combined use of SPSS and GIS ("SPSS-GIS"). Graduate students, researchers, and faculty in the health sciences at the University of Pittsburgh were recruited. Each round consisted of: an instructional video of the system being evaluated, two practice tasks, five assessment tasks, and one post-study questionnaire. Objective and subjective measurement included: task completion time, success in answering the tasks, and system satisfaction. Results Thirteen individuals participated. Inferential statistics were analyzed using linear mixed model analysis. SOVAT was statistically significant (α = .01) from SPSS-GIS for satisfaction and time (p < .002). Descriptive results indicated that participants had greater success in answering the tasks when using SOVAT as compared to SPSS-GIS. Conclusion Using SOVAT, tasks were completed more efficiently, with a higher rate of success, and with greater satisfaction, than the combined use of SPSS and GIS. The results from this study indicate a potential for OLAP-GIS decision support systems as a valuable tool for CHA data analysis. PMID:18541037

The benefit of using additional hydrological information from earth observations and reanalysis data on water allocation decisions in irrigation districts

NASA Astrophysics Data System (ADS)

Kaune, Alexander; López, Patricia; Werner, Micha; de Fraiture, Charlotte

2017-04-01

Hydrological information on water availability and demand is vital for sound water allocation decisions in irrigation districts, particularly in times of water scarcity. However, sub-optimal water allocation decisions are often taken with incomplete hydrological information, which may lead to agricultural production loss. In this study we evaluate the benefit of additional hydrological information from earth observations and reanalysis data in supporting decisions in irrigation districts. Current water allocation decisions were emulated through heuristic operational rules for water scarce and water abundant conditions in the selected irrigation districts. The Dynamic Water Balance Model based on the Budyko framework was forced with precipitation datasets from interpolated ground measurements, remote sensing and reanalysis data, to determine the water availability for irrigation. Irrigation demands were estimated based on estimates of potential evapotranspiration and coefficient for crops grown, adjusted with the interpolated precipitation data. Decisions made using both current and additional hydrological information were evaluated through the rate at which sub-optimal decisions were made. The decisions made using an amended set of decision rules that benefit from additional information on demand in the districts were also evaluated. Results show that sub-optimal decisions can be reduced in the planning phase through improved estimates of water availability. Where there are reliable observations of water availability through gauging stations, the benefit of the improved precipitation data is found in the improved estimates of demand, equally leading to a reduction of sub-optimal decisions.

Development of a patient decision aid for choice of surgical treatment for breast cancer

PubMed Central

Sawka, Carol A.; Goel, Vivek; Mahut, Catherine A.; Taylor, Glen A.; Thiel, Elaine C.; O'Connor, Annette M.; Ackerman, Ida; Burt, Janet H.; Gort, Elaine H.

2002-01-01

Purpose A patient decision aid for the surgical treatment of early stage breast cancer was developed and evaluated. The rationale for its development was the knowledge that breast conserving therapy (lumpectomy followed by breast radiation) and mastectomy produce equivalent outcomes, and the current general agreement that the decision for the type of surgery should rest with the patient. Methods A decision aid was developed and evaluated in sequential pilot studies of 18 and 10 women with newly diagnosed breast cancer who were facing a decision for breast conserving therapy or mastectomy. Both qualitative (general reaction, self‐reported anxiety, clarity, satisfaction) and quantitative (knowledge and decisional conflict) measures were assessed. Results The decision aid consists of an audiotape and workbook and takes 36 min to complete. Based on qualitative comments and satisfaction ratings, 17 of 18 women reported a positive reaction to the decision aid, and all 18 reported that it helped clarify information given by the surgeon. Women did not report an increase in anxiety and 17 of 18 women were either satisfied or very satisfied with the decision aid. Conclusion This pilot study supports the hypothesis that this decision aid may be a helpful adjunct in the decision for surgical management of early stage breast cancer. We are currently conducting a randomized trial of the decision aid versus a simple educational pamphlet to evaluate its efficacy as measured by knowledge, decisional conflict, anxiety and post‐decisional regret. PMID:11281859

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions

PubMed Central

2017-01-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy. PMID:29209469

Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.

PubMed

Nantha, Yogarabindranath Swarna

2017-11-01

A prescriptive model approach in decision making could help achieve better diagnostic accuracy in clinical practice through methods that are less reliant on probabilistic assessments. Various prescriptive measures aimed at regulating factors that influence heuristics and clinical reasoning could support clinical decision-making process. Clinicians could avoid time-consuming decision-making methods that require probabilistic calculations. Intuitively, they could rely on heuristics to obtain an accurate diagnosis in a given clinical setting. An extensive literature review of cognitive psychology and medical decision-making theory was performed to illustrate how heuristics could be effectively utilized in daily practice. Since physicians often rely on heuristics in realistic situations, probabilistic estimation might not be a useful tool in everyday clinical practice. Improvements in the descriptive model of decision making (heuristics) may allow for greater diagnostic accuracy.

Neural substrates of decision-making.

PubMed

Broche-Pérez, Y; Herrera Jiménez, L F; Omar-Martínez, E

2016-06-01

Decision-making is the process of selecting a course of action from among 2 or more alternatives by considering the potential outcomes of selecting each option and estimating its consequences in the short, medium and long term. The prefrontal cortex (PFC) has traditionally been considered the key neural structure in decision-making process. However, new studies support the hypothesis that describes a complex neural network including both cortical and subcortical structures. The aim of this review is to summarise evidence on the anatomical structures underlying the decision-making process, considering new findings that support the existence of a complex neural network that gives rise to this complex neuropsychological process. Current evidence shows that the cortical structures involved in decision-making include the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and dorsolateral prefrontal cortex (DLPFC). This process is assisted by subcortical structures including the amygdala, thalamus, and cerebellum. Findings to date show that both cortical and subcortical brain regions contribute to the decision-making process. The neural basis of decision-making is a complex neural network of cortico-cortical and cortico-subcortical connections which includes subareas of the PFC, limbic structures, and the cerebellum. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

An Environment for Guideline-based Decision Support Systems for Outpatients Monitoring.

PubMed

Zini, Elisa M; Lanzola, Giordano; Bossi, Paolo; Quaglini, Silvana

2017-08-11

We propose an architecture for monitoring outpatients that relies on mobile technologies for acquiring data. The goal is to better control the onset of possible side effects between the scheduled visits at the clinic. We analyze the architectural components required to ensure a high level of abstraction from data. Clinical practice guidelines were formalized with Alium, an authoring tool based on the PROforma language, using SNOMED-CT as a terminology standard. The Alium engine is accessible through a set of APIs that may be leveraged for implementing an application based on standard web technologies to be used by doctors at the clinic. Data sent by patients using mobile devices need to be complemented with those already available in the Electronic Health Record to generate personalized recommendations. Thus a middleware pursuing data abstraction is required. To comply with current standards, we adopted the HL7 Virtual Medical Record for Clinical Decision Support Logical Model, Release 2. The developed architecture for monitoring outpatients includes: (1) a guideline-based Decision Support System accessible through a web application that helps the doctors with prevention, diagnosis and treatment of therapy side effects; (2) an application for mobile devices, which allows patients to regularly send data to the clinic. In order to tailor the monitoring procedures to the specific patient, the Decision Support System also helps physicians with the configuration of the mobile application, suggesting the data to be collected and the associated collection frequency that may change over time, according to the individual patient's conditions. A proof of concept has been developed with a system for monitoring the side effects of chemo-radiotherapy in head and neck cancer patients. Our environment introduces two main innovation elements with respect to similar works available in the literature. First, in order to meet the specific patients' needs, in our work the Decision Support System also helps the physicians in properly configuring the mobile application. Then the Decision Support System is also continuously fed by patient-reported outcomes.

The Conservation Effects Assessment Project (CEAP): a national scale natural resources and conservation needs assessment and decision support tool

NASA Astrophysics Data System (ADS)

Johnson, M.-V. V.; Norfleet, M. L.; Atwood, J. D.; Behrman, K. D.; Kiniry, J. R.; Arnold, J. G.; White, M. J.; Williams, J.

2015-07-01

The Conservation Effects Assessment Project (CEAP) was initiated to quantify the impacts of agricultural conservation practices at the watershed, regional, and national scales across the United States. Representative cropland acres in all major U.S. watersheds were surveyed in 2003-2006 as part of the seminal CEAP Cropland National Assessment. Two process-based models, the Agricultural Policy Environmental eXtender(APEX) and the Soil Water Assessment Tool (SWAT), were applied to the survey data to provide a quantitative assessment of current conservation practice impacts, establish a benchmark against which future conservation trends and efforts could be measured, and identify outstanding conservation concerns. The flexibility of these models and the unprecedented amount of data on current conservation practices across the country enabled Cropland CEAP to meet its Congressional mandate of quantifying the value of current conservation practices. It also enabled scientifically grounded exploration of a variety of conservation scenarios, empowering CEAP to not only inform on past successes and additional needs, but to also provide a decision support tool to help guide future policy development and conservation practice decision making. The CEAP effort will repeat the national survey in 2015-2016, enabling CEAP to provide analyses of emergent conservation trends, outstanding needs, and potential costs and benefits of pursuing various treatment scenarios for all agricultural watersheds across the United States.

Questioning the Relevance of Model-Based Probability Statements on Extreme Weather and Future Climate

NASA Astrophysics Data System (ADS)

Smith, L. A.

2007-12-01

We question the relevance of climate-model based Bayesian (or other) probability statements for decision support and impact assessment on spatial scales less than continental and temporal averages less than seasonal. Scientific assessment of higher resolution space and time scale information is urgently needed, given the commercial availability of "products" at high spatiotemporal resolution, their provision by nationally funded agencies for use both in industry decision making and governmental policy support, and their presentation to the public as matters of fact. Specifically we seek to establish necessary conditions for probability forecasts (projections conditioned on a model structure and a forcing scenario) to be taken seriously as reflecting the probability of future real-world events. We illustrate how risk management can profitably employ imperfect models of complicated chaotic systems, following NASA's study of near-Earth PHOs (Potentially Hazardous Objects). Our climate models will never be perfect, nevertheless the space and time scales on which they provide decision- support relevant information is expected to improve with the models themselves. Our aim is to establish a set of baselines of internal consistency; these are merely necessary conditions (not sufficient conditions) that physics based state-of-the-art models are expected to pass if their output is to be judged decision support relevant. Probabilistic Similarity is proposed as one goal which can be obtained even when our models are not empirically adequate. In short, probabilistic similarity requires that, given inputs similar to today's empirical observations and observational uncertainties, we expect future models to produce similar forecast distributions. Expert opinion on the space and time scales on which we might reasonably expect probabilistic similarity may prove of much greater utility than expert elicitation of uncertainty in parameter values in a model that is not empirically adequate; this may help to explain the reluctance of experts to provide information on "parameter uncertainty." Probability statements about the real world are always conditioned on some information set; they may well be conditioned on "False" making them of little value to a rational decision maker. In other instances, they may be conditioned on physical assumptions not held by any of the modellers whose model output is being cast as a probability distribution. Our models will improve a great deal in the next decades, and our insight into the likely climate fifty years hence will improve: maintaining the credibility of the science and the coherence of science based decision support, as our models improve, require a clear statement of our current limitations. What evidence do we have that today's state-of-the-art models provide decision-relevant probability forecasts? What space and time scales do we currently have quantitative, decision-relevant information on for 2050? 2080?

Evaluation of Pushback Decision-Support Tool Concept for Charlotte Douglas International Airport Ramp Operations

NASA Technical Reports Server (NTRS)

Hayashi, Miwa; Hoang, Ty; Jung, Yoon C.; Malik, Waqar; Lee, Hanbong; Dulchinos, Victoria L.

2015-01-01

This paper proposes a new departure pushback decision-support tool (DST) for airport ramp-tower controllers. It is based on NASA's Spot and Runway Departure Advisor (SARDA) collaborative decision-making concept, except with the modification that the gate releases now are controlled by tactical pushback (or gate-hold) advisories instead of strategic pre-assignments of target pushback times to individual departure flights. The proposed ramp DST relies on data exchange with the airport traffic control tower (ATCT) to coordinate pushbacks with the ATCT's flow-management intentions under current operational constraints, such as Traffic Management Initiative constraints. Airlines would benefit in reduced taxi delay and fuel burn. The concept was evaluated in a human-in-the-loop simulation experiment with current ramp-tower controllers at the Charlotte Douglas International Airport as participants. The results showed that the tool helped reduce taxi time by one minute per flight and overall departure flight fuel consumption by 10-12% without reducing runway throughput. Expect Departure Clearance Time (EDCT) conformance also was improved when advisories were provided. These benefits were attained without increasing the ramp-tower controllers' workload. Additionally, the advisories reduced the ATCT controllers' workload.

An Overview Of The Ecosystem Services Research Program Decision Support Framework

EPA Science Inventory

There is an increasing understanding that top-down regulatory and technology driven responses are not sufficient to address current and emerging environmental challenges such as climate change, sustainable communities, and environmental justice. Such problems require ways to dee...

A Decision Support Framework for Evaluation of Engineered Nanomaterials

EPA Science Inventory

Engineered nanomaterials (ENM) are currently being developed and applied at rates that far exceed our ability to evaluate their potential for environmental or human health risks. The gap between material development and capacity for assessment grows wider every day. Transforma...

The future of intelligent assistive technologies for cognition: devices under development to support independent living and aging-with-choice.

PubMed

Boger, Jennifer; Mihailidis, Alex

2011-01-01

A person's ability to be independent is dependent on his or her overall health, mobility, and ability to complete activities of daily living. Intelligent assistive technologies (IATs) are devices that incorporate context into their decision-making process, which enables them to provide customised and dynamic assistance in an appropriate manner. IATs have tremendous potential to support people with cognitive impairments as they can be used to support many facets of well-being; from augmenting memory and decision making tasks to providing autonomous and early detection of possible changes in health. This paper presents IATs that are currently in development in the research community to support tasks that can be impacted by compromised cognition. While they are not yet ready for the general public, these devices showcase the capabilities of technologies one can expect to see in the consumer marketplace in the near future.

Carpal tunnel syndrome: assessment of surgeon and patient preferences and priorities for decision-making.

PubMed

Hageman, Michiel G J S; Kinaci, Ahmet; Ju, Kevin; Guitton, Thierry G; Mudgal, Chaitanya S; Ring, David

2014-09-01

This study tested the null hypothesis that there are no differences between the preferences of hand surgeons and those patients with carpal tunnel syndrome (CTS) facing decisions about management of CTS (ie, the preferred content of a decision aid). One hundred three hand surgeons of the Science of Variation Group and 79 patients with CTS completed a survey about their priorities and preferences in decision making regarding the management of CTS. The questionnaire was structured according the Ottawa Decision Support Framework for the development of a decision aid. Important areas on which patient and hand surgeon interests differed included a preference for nonpainful, nonoperative treatment and confirmation of the diagnosis with electrodiagnostic testing. For patients, the main disadvantage of nonoperative treatment was that it was likely to be only palliative and temporary. Patients preferred, on average, to take the lead in decision making, whereas physicians preferred shared decision making. Patients and physicians agreed on the value of support from family and other physicians in the decision-making process. There were some differences between patient and surgeon priorities and preferences regarding decision making for CTS, particularly the risks and benefits of diagnostic and therapeutic procedures. Information that helps inform patients of their options based on current best evidence might help patients understand their own preferences and values, reduce decisional conflict, limit surgeon-to-surgeon variations, and improve health. Copyright © 2014 American Society for Surgery of the Hand. All rights reserved.

Examining the Relationships Between Education, Social Networks and Democratic Support With ABM

NASA Technical Reports Server (NTRS)

Drucker, Nick; Campbell, Kenyth

2011-01-01

This paper introduces an agent-based model that explores the relationships between education, social networks, and support for democratic ideals. This study examines two factors thai affect democratic support, education, and social networks. Current theory concerning these two variables suggests that positive relationships exist between education and democratic support and between social networks and the spread of ideas. The model contains multiple variables of democratic support, two of which are evaluated through experimentation. The model allows individual entities within the system to make "decisions" about their democratic support independent of one another. The agent based approach also allows entities to utilize their social networks to spread ideas. Current theory supports experimentation results. In addion , these results show the model is capable of reproducing real world outcomes. This paper addresses the model creation process and the experimentation procedure, as well as future research avenues and potential shortcomings of the model

Teacher Work Environments Are Toddler Learning Environments: Teacher Professional Well-Being, Classroom Emotional Support, and Toddlers' Emotional Expressions and Behaviours

ERIC Educational Resources Information Center

Cassidy, Deborah J.; King, Elizabeth K.; Wang, Yudan C.; Lower, Joanna K.; Kintner-Duffy, Victoria L.

2017-01-01

The current study examines the professional well-being of teachers, the classroom emotional support, and the emotional experiences of toddlers in their care. Professional well-being of teachers is conceptualized to include teacher feelings about their work, autonomy in decision-making, actual wages, and perceptions of fairness of wages within the…

Decision Support for Integrated Energy-Water Planning

NASA Astrophysics Data System (ADS)

Tidwell, V. C.; William, H.; Klise, G.; Kobos, P. H.; Malczynski, L. A.

2008-12-01

Currently, electrical power generation uses about 140 billion gallons of water per day accounting for over 40% of all freshwater withdrawals thus competing with irrigated agriculture as the leading user of water. To meet their demand for water, proposed power plants must often target waterways and aquifers prone to overdraft or which may be home to environmentally sensitive species. Acquisition of water rights, permits and public support may therefore be a formidable hurdle when licensing new power plants. Given these current difficulties, what does the future hold when projected growth in population and the economy may require a 30% increase in power generation capacity by 2025? Technology solutions can only take us so far, as noted by the National Energy-Water Roadmap Exercise. This roadmap identified the need for long-term and integrated resource planning supported with scientifically credible models as a leading issue. To address this need a decision support framework is being developed that targets the shared needs of energy and water producers, resource managers, regulators, and decision makers at the federal, state and local levels. The framework integrates analysis and optimization capabilities to help identify potential trade-offs, and "best" alternatives among an overwhelming number of energy/water options and objectives. The decision support tool is comprised of three basic elements: a system dynamics model coupling the physical and economic systems important to integrated energy-water planning and management; an optimization toolbox; and a software wrapper that integrates the aforementioned elements along with additional external energy/water models, databases, and visualization products. An interactive interface allows direct interaction with the model and access to real-time results organized according to a variety of reference systems, e.g., from a political, watershed, or electric power grid perspective. With this unique synthesis of various perspectives, the tool may help highlight looming changes where policy, technical, economic, and data collection options may alleviate stresses within the underlying water systems that support electricity generation. Sandia is a multiprogram laboratory operated by Sandia Corporation, a Lockheed Martin Company, for the United States Department of Energy's National Nuclear Security Administration under contract DE-AC04- 94AL85000.

The use of control charts by laypeople and hospital decision-makers for guiding decision making.

PubMed

Schmidtke, K A; Watson, D G; Vlaev, I

2017-07-01

Graphs presenting healthcare data are increasingly available to support laypeople and hospital staff's decision making. When making these decisions, hospital staff should consider the role of chance-that is, random variation. Given random variation, decision-makers must distinguish signals (sometimes called special-cause data) from noise (common-cause data). Unfortunately, many graphs do not facilitate the statistical reasoning necessary to make such distinctions. Control charts are a less commonly used type of graph that support statistical thinking by including reference lines that separate data more likely to be signals from those more likely to be noise. The current work demonstrates for whom (laypeople and hospital staff) and when (treatment and investigative decisions) control charts strengthen data-driven decision making. We present two experiments that compare people's use of control and non-control charts to make decisions between hospitals (funnel charts vs. league tables) and to monitor changes across time (run charts with control lines vs. run charts without control lines). As expected, participants more accurately identified the outlying data using a control chart than using a non-control chart, but their ability to then apply that information to more complicated questions (e.g., where should I go for treatment?, and should I investigate?) was limited. The discussion highlights some common concerns about using control charts in hospital settings.

Involved, inputting or informing: "Shared" decision making in adult mental health care.

PubMed

Bradley, Eleanor; Green, Debra

2018-02-01

A diagnosis of serious mental illness can impact on the whole family. Families informally provide significant amounts of care but are disproportionately at risk of carer burden when compared to those supporting people with other long-term conditions. Shared decision making (SDM) is an ethical model of health communication associated with positive health outcomes; however, there has been little research to evaluate how routinely family is invited to participate in SDM, or what this looks like in practice. This UK study aimed to better understand how the family caregivers of those diagnosed with SMI are currently involved in decision making, particularly decisions about treatment options including prescribed medication. Objectives were to Explore the extent to which family members wish to be involved in decisions about prescribed medication Determine how and when professionals engage family in these decisions Identify barriers and facilitators associated with the engagement of family in decisions about treatment. Open-ended questions were sent to professionals and family members to elicit written responses. Qualitative responses were analysed thematically. Themes included the definition of involvement and "rules of engagement." Staff members are gatekeepers for family involvement, and the process is not democratic. Family and staff ascribe practical, rather than recovery-oriented roles to family, with pre-occupation around notions of adherence. Staff members need support, training and education to apply SDM. Time to exchange information is vital but practically difficult. Negotiated teams, comprising of staff, service users, family, peers as applicable, with ascribed roles and responsibilities could support SDM. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Evaluating a Modular Decision Support Application for Colorectal Cancer Screening

PubMed Central

Diiulio, Julie B.; Borders, Morgan R.; Sushereba, Christen E.; Saleem, Jason J.; Haverkamp, Donald; Imperiale, Thomas F.

2017-01-01

Summary Background There is a need for health information technology evaluation that goes beyond randomized controlled trials to include consideration of usability, cognition, feedback from representative users, and impact on efficiency, data quality, and clinical workflow. This article presents an evaluation illustrating one approach to this need using the Decision-Centered Design framework. Objective To evaluate, through a Decision-Centered Design framework, the ability of the Screening and Surveillance App to support primary care clinicians in tracking and managing colorectal cancer testing. Methods We leveraged two evaluation formats, online and in-person, to obtain feedback from a range primary care clinicians and obtain comparative data. Both the online and in-person evaluations used mock patient data to simulate challenging patient scenarios. Primary care clinicians responded to a series of colorectal cancer-related questions about each patient and made recommendations for screening. We collected data on performance, perceived workload, and usability. Key elements of Decision-Centered Design include evaluation in the context of realistic, challenging scenarios and measures designed to explore impact on cognitive performance. Results Comparison of means revealed increases in accuracy, efficiency, and usability and decreases in perceived mental effort and workload when using the Screening and Surveillance App. Conclusion The results speak to the benefits of using the Decision-Centered Design approach in the analysis, design, and evaluation of Health Information Technology. Furthermore, the Screening and Surveillance App shows promise for filling decision support gaps in current electronic health records. PMID:28197619

Optimal Medical Equipment Maintenance Service Proposal Decision Support System combining Activity Based Costing (ABC) and the Analytic Hierarchy Process (AHP).

PubMed

da Rocha, Leticia; Sloane, Elliot; M Bassani, Jose

2005-01-01

This study describes a framework to support the choice of the maintenance service (in-house or third party contract) for each category of medical equipment based on: a) the real medical equipment maintenance management system currently used by the biomedical engineering group of the public health system of the Universidade Estadual de Campinas located in Brazil to control the medical equipment maintenance service, b) the Activity Based Costing (ABC) method, and c) the Analytic Hierarchy Process (AHP) method. Results show the cost and performance related to each type of maintenance service. Decision-makers can use these results to evaluate possible strategies for the categories of equipment.

Don't panic--prepare: towards crisis-aware models of emergency department operations.

PubMed

Ceglowski, Red; Churilov, Leonid; Wasserheil, Jeff

2005-12-01

The existing models of Emergency Department (ED) operations that are based on the "flow-shop" management logic do not provide adequate decision support in dealing with the ED overcrowding crises. A conceptually different crisis-aware approach to ED modelling and operational decision support is introduced in this paper. It is based on Perrow's theory of "normal accidents" and calls for recognizing the inevitable nature of ED overcrowding crises within current health system setup. Managing the crisis before it happens--a standard approach in crisis management area--should become an integral part of ED operations management. The potential implications of adopting such a crisis-aware perspective for health services research and ED management are outlined.

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

PubMed

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

2008-11-01

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

A public health decision support system model using reasoning methods.

PubMed

Mera, Maritza; González, Carolina; Blobel, Bernd

2015-01-01

Public health programs must be based on the real health needs of the population. However, the design of efficient and effective public health programs is subject to availability of information that can allow users to identify, at the right time, the health issues that require special attention. The objective of this paper is to propose a case-based reasoning model for the support of decision-making in public health. The model integrates a decision-making process and case-based reasoning, reusing past experiences for promptly identifying new population health priorities. A prototype implementation of the model was performed, deploying the case-based reasoning framework jColibri. The proposed model contributes to solve problems found today when designing public health programs in Colombia. Current programs are developed under uncertain environments, as the underlying analyses are carried out on the basis of outdated and unreliable data.

The role of social support and parity in contraceptive use in Cambodia.

PubMed

Samandari, Ghazaleh; Speizer, Ilene S; O'Connell, Kathryn

2010-09-01

In Cambodia, unmet need for contraception is high. Studies suggest that social support and parity each play a role in contraceptive decision making. A representative sample of 706 married women aged 15-49 from two rural provinces in Cambodia who wished to delay childbirth were interviewed about their contraceptive use and their perceptions of their husband's, peers' and elders' support of contraception. Multivariate analyses examined associations between support measures and women's current use of modern methods, among all women and by parity. Overall, 43% of women were currently using a modern method. Women who believed that their husband had a positive attitude toward contraception were more likely than those who did not to use a method (odds ratio, 3.4), whereas women who were nervous about talking with their husband about contraception were less likely than others to use a method (0.6); these associations remained in analyses by parity. Among all women and high-parity women, those whose husband made the final decision about contraception were less likely than other women to use a method (0.6 and 0.4, respectively). Perceiving that most of one's peers practice contraception was strongly associated with method use among low-parity women (4.4). Among all groups, women who agreed that one should not practice contraception if an elder says not to had decreased odds of method use (0.5 each). To promote contraceptive use, family planning programs should focus on increasing men's approval of contraception, improving partner communication around family planning and bolstering women's confidence in their reproductive decision making.

Current Capabilities and Planned Enhancements of SUSTAIN

EPA Science Inventory

Efforts have been under way by the U.S. Environmental Protection Agency (EPA) since 2003 to develop a decision-support system for placement of BMPs at strategic locations in urban watersheds. This system is call the System for Urban Stormwater Treatment and Analysis INtergration...

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

DOT National Transportation Integrated Search

2013-12-01

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

Scoreboards for Schools: ASCD Special Report.

ERIC Educational Resources Information Center

Betts, Frank

1997-01-01

A program developed by the Association for Curriculum and Supervision Development and Group Decisions Support Systems, Inc., aims to enhance accountability and improve school district/community communication. Scoreboards for Schools addresses inadequacies of current financial reporting systems by providing tightly linked planning strategies for…

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

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-11

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

75 FR 81037 - Waste Confidence Decision Update

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-23

... well beyond the current analysis that supports at least 60 years of post-licensed life storage with... environmental factors including surrounding population density, water resources, seismicity, subsurface geology... expiration of the 60-year post licensed life period, the Commission will revisit the Waste Confidence...

Clinical decision support of radiotherapy treatment planning: A data-driven machine learning strategy for patient-specific dosimetric decision making.

PubMed

Valdes, Gilmer; Simone, Charles B; Chen, Josephine; Lin, Alexander; Yom, Sue S; Pattison, Adam J; Carpenter, Colin M; Solberg, Timothy D

2017-12-01

Clinical decision support systems are a growing class of tools with the potential to impact healthcare. This study investigates the construction of a decision support system through which clinicians can efficiently identify which previously approved historical treatment plans are achievable for a new patient to aid in selection of therapy. Treatment data were collected for early-stage lung and postoperative oropharyngeal cancers treated using photon (lung and head and neck) and proton (head and neck) radiotherapy. Machine-learning classifiers were constructed using patient-specific feature-sets and a library of historical plans. Model accuracy was analyzed using learning curves, and historical treatment plan matching was investigated. Learning curves demonstrate that for these datasets, approximately 45, 60, and 30 patients are needed for a sufficiently accurate classification model for radiotherapy for early-stage lung, postoperative oropharyngeal photon, and postoperative oropharyngeal proton, respectively. The resulting classification model provides a database of previously approved treatment plans that are achievable for a new patient. An exemplary case, highlighting tradeoffs between the heart and chest wall dose while holding target dose constant in two historical plans is provided. We report on the first artificial-intelligence based clinical decision support system that connects patients to past discrete treatment plans in radiation oncology and demonstrate for the first time how this tool can enable clinicians to use past decisions to help inform current assessments. Clinicians can be informed of dose tradeoffs between critical structures early in the treatment process, enabling more time spent on finding the optimal course of treatment for individual patients. Copyright © 2017. Published by Elsevier B.V.

Software Tools For Building Decision-support Models For Flood Emergency Situations

NASA Astrophysics Data System (ADS)

Garrote, L.; Molina, M.; Ruiz, J. M.; Mosquera, J. C.

The SAIDA decision-support system was developed by the Spanish Ministry of the Environment to provide assistance to decision-makers during flood situations. SAIDA has been tentatively implemented in two test basins: Jucar and Guadalhorce, and the Ministry is currently planning to have it implemented in all major Spanish basins in a few years' time. During the development cycle of SAIDA, the need for providing as- sistance to end-users in model definition and calibration was clearly identified. System developers usually emphasise abstraction and generality with the goal of providing a versatile software environment. End users, on the other hand, require concretion and specificity to adapt the general model to their local basins. As decision-support models become more complex, the gap between model developers and users gets wider: Who takes care of model definition, calibration and validation?. Initially, model developers perform these tasks, but the scope is usually limited to a few small test basins. Before the model enters operational stage, end users must get involved in model construction and calibration, in order to gain confidence in the model recommendations. However, getting the users involved in these activities is a difficult task. The goal of this re- search is to develop representation techniques for simulation and management models in order to define, develop and validate a mechanism, supported by a software envi- ronment, oriented to provide assistance to the end-user in building decision models for the prediction and management of river floods in real time. The system is based on three main building blocks: A library of simulators of the physical system, an editor to assist the user in building simulation models, and a machine learning method to calibrate decision models based on the simulation models provided by the user.

Redefining risk research priorities for nanomaterials

NASA Astrophysics Data System (ADS)

Grieger, Khara D.; Baun, Anders; Owen, Richard

2010-02-01

Chemical-based risk assessment underpins the current approach to responsible development of nanomaterials (NM). It is now recognised, however, that this process may take decades, leaving decision makers with little support in the near term. Despite this, current and near future research efforts are largely directed at establishing (eco)toxicological and exposure data for NM, and comparatively little research has been undertaken on tools or approaches that may facilitate near-term decisions, some of which we briefly outline in this analysis. We propose a reprioritisation of NM risk research efforts to redress this imbalance, including the development of more adaptive risk governance frameworks, alternative/complementary tools to risk assessment, and health and environment surveillance.

Decision making and coping in healthcare: the Coping in Deliberation (CODE) framework.

PubMed

Witt, Jana; Elwyn, Glyn; Wood, Fiona; Brain, Kate

2012-08-01

To develop a framework of decision making and coping in healthcare that describes the twin processes of appraisal and coping faced by patients making preference-sensitive healthcare decisions. We briefly review the literature for decision making theories and coping theories applicable to preference-sensitive decisions in healthcare settings. We describe first decision making, then coping and finally attempt to integrate these processes by building on current theory. Deliberation in healthcare may be described as a six step process, comprised of the presentation of a health threat, choice, options, preference construction, the decision itself and consolidation post-decision. Coping can be depicted in three stages, beginning with a threat, followed by primary and secondary appraisal and ultimately resulting in a coping effort. Drawing together concepts from prominent decision making theories and coping theories, we propose a multidimensional, interactive framework which integrates both processes and describes coping in deliberation. The proposed framework offers an insight into the complexity of decision making in preference-sensitive healthcare contexts from a patient perspective and may act as theoretical basis for decision support. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Diagnostic Tests to Support Late-Stage Control Programs for Schistosomiasis and Soil-Transmitted Helminthiases.

PubMed

Hawkins, Kenneth R; Cantera, Jason L; Storey, Helen L; Leader, Brandon T; de Los Santos, Tala

2016-12-01

Global efforts to address schistosomiasis and soil-transmitted helminthiases (STH) include deworming programs for school-aged children that are made possible by large-scale drug donations. Decisions on these mass drug administration (MDA) programs currently rely on microscopic examination of clinical specimens to determine the presence of parasite eggs. However, microscopy-based methods are not sensitive to the low-intensity infections that characterize populations that have undergone MDA. Thus, there has been increasing recognition within the schistosomiasis and STH communities of the need for improved diagnostic tools to support late-stage control program decisions, such as when to stop or reduce MDA. Failure to adequately address the need for new diagnostics could jeopardize achievement of the 2020 London Declaration goals. In this report, we assess diagnostic needs and landscape potential solutions and determine appropriate strategies to improve diagnostic testing to support control and elimination programs. Based upon literature reviews and previous input from experts in the schistosomiasis and STH communities, we prioritized two diagnostic use cases for further exploration: to inform MDA-stopping decisions and post-MDA surveillance. To this end, PATH has refined target product profiles (TPPs) for schistosomiasis and STH diagnostics that are applicable to these use cases. We evaluated the limitations of current diagnostic methods with regards to these use cases and identified candidate biomarkers and diagnostics with potential application as new tools. Based on this analysis, there is a need to develop antigen-detecting rapid diagnostic tests (RDTs) with simplified, field-deployable sample preparation for schistosomiasis. Additionally, there is a need for diagnostic tests that are more sensitive than the current methods for STH, which may include either a field-deployable molecular test or a simple, low-cost, rapid antigen-detecting test.

Exploring morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones.

PubMed

Gammon, D; Christiansen, E K; Wynn, R

2009-07-01

Patient self-management of disease is increasingly supported by technologies that can monitor a wide range of behavioural and biomedical parameters. Incorporated into everyday devices such as cell phones and clothes, these technologies become integral to the psychosocial aspects of everyday life. Many technologies are likely to be marketed directly to families with ill members, and families may enlist the support of clinicians in shaping use. Current ethical frameworks are mainly conceptualised from the perspective of caregivers, researchers, developers and regulators in order to ensure the ethics of their own practices. This paper focuses on families as autonomous decision-makers outside the regulated context of healthcare. We discuss some morally relevant issues facing families in their decisions to monitor the health-related behaviours of loved ones. An example - remote parental monitoring of adolescent blood glucose - is presented and discussed through the lens of two contrasting accounts of ethics; one reflecting the predominant focus on health outcomes within the health technology assessment (HTA) framework and the other that attends to the broader sociocultural contexts shaping technologies and their implications. Issues discussed include the focus of assessments, informed consent and child assent, and family co-creation of system characteristics and implications. The parents' decisions to remotely monitor their child has relational implications that are likely to influence conflict levels and thus also health outcomes. Current efforts to better integrate outcome assessments with social and ethical assessments are particularly relevant for informed decision-making about health monitoring technologies in families.

Decision support at home (DS@HOME) – system architectures and requirements

PubMed Central

2012-01-01

Background Demographic change with its consequences of an aging society and an increase in the demand for care in the home environment has triggered intensive research activities in sensor devices and smart home technologies. While many advanced technologies are already available, there is still a lack of decision support systems (DSS) for the interpretation of data generated in home environments. The aim of the research for this paper is to present the state-of-the-art in DSS for these data, to define characteristic properties of such systems, and to define the requirements for successful home care DSS implementations. Methods A literature review was performed along with the analysis of cross-references. Characteristic properties are proposed and requirements are derived from the available body of literature. Results 79 papers were identified and analyzed, of which 20 describe implementations of decision components. Most authors mention server-based decision support components, but only few papers provide details about the system architecture or the knowledge base. A list of requirements derived from the analysis is presented. Among the primary drawbacks of current systems are the missing integration of DSS in current health information system architectures including interfaces, the missing agreement among developers with regard to the formalization and customization of medical knowledge and a lack of intelligent algorithms to interpret data from multiple sources including clinical application systems. Conclusions Future research needs to address these issues in order to provide useful information – and not only large amounts of data – for both the patient and the caregiver. Furthermore, there is a need for outcome studies allowing for identifying successful implementation concepts. PMID:22640470

Advanced Satellite Workstation - An integrated workstation environment for operational support of satellite system planning and analysis

NASA Astrophysics Data System (ADS)

Hamilton, Marvin J.; Sutton, Stewart A.

A prototype integrated environment, the Advanced Satellite Workstation (ASW), which was developed and delivered for evaluation and operator feedback in an operational satellite control center, is described. The current ASW hardware consists of a Sun Workstation and Macintosh II Workstation connected via an ethernet Network Hardware and Software, Laser Disk System, Optical Storage System, and Telemetry Data File Interface. The central objective of ASW is to provide an intelligent decision support and training environment for operator/analysis of complex systems such as satellites. Compared to the many recent workstation implementations that incorporate graphical telemetry displays and expert systems, ASW provides a considerably broader look at intelligent, integrated environments for decision support, based on the premise that the central features of such an environment are intelligent data access and integrated toolsets.

Towards integration of clinical decision support in commercial hospital information systems using distributed, reusable software and knowledge components.

PubMed

Müller, M L; Ganslandt, T; Eich, H P; Lang, K; Ohmann, C; Prokosch, H U

2001-12-01

Clinicians' acceptance of clinical decision support depends on its workflow-oriented, context-sensitive accessibility and availability at the point of care, integrated into the Electronic Patient Record (EPR). Commercially available Hospital Information Systems (HIS) often focus on administrative tasks and mostly do not provide additional knowledge based functionality. Their traditionally monolithic and closed software architecture encumbers integration of and interaction with external software modules. Our aim was to develop methods and interfaces to integrate knowledge sources into two different commercial hospital information systems to provide the best decision support possible within the context of available patient data. An existing, proven standalone scoring system for acute abdominal pain was supplemented by a communication interface. In both HIS we defined data entry forms and developed individual and reusable mechanisms for data exchange with external software modules. We designed an additional knowledge support frontend which controls data exchange between HIS and the knowledge modules. Finally, we added guidelines and algorithms to the knowledge library. Despite some major drawbacks which resulted mainly from the HIS' closed software architectures we showed exemplary, how external knowledge support can be integrated almost seamlessly into different commercial HIS. This paper describes the prototypical design and current implementation and discusses our experiences.

From data mining rules to medical logical modules and medical advices.

PubMed

Gomoi, Valentin; Vida, Mihaela; Robu, Raul; Stoicu-Tivadar, Vasile; Bernad, Elena; Lupşe, Oana

2013-01-01

Using data mining in collaboration with Clinical Decision Support Systems adds new knowledge as support for medical diagnosis. The current work presents a tool which translates data mining rules supporting generation of medical advices to Arden Syntax formalism. The developed system was tested with data related to 2326 births that took place in 2010 at the Bega Obstetrics - Gynaecology Hospital, Timişoara. Based on processing these data, 14 medical rules regarding the Apgar score were generated and then translated in Arden Syntax language.

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

PubMed

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

2007-01-01

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

A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes

PubMed Central

Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-01-01

Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope®; Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations. PMID:25347226

A decision support tool for appropriate glucose-lowering therapy in patients with type 2 diabetes.

PubMed

Ampudia-Blasco, F Javier; Benhamou, Pierre Yves; Charpentier, Guillaume; Consoli, Agostino; Diamant, Michaela; Gallwitz, Baptist; Khunti, Kamlesh; Mathieu, Chantal; Ridderstråle, Martin; Seufert, Jochen; Tack, Cees; Vilsbøll, Tina; Phan, Tra-Mi; Stoevelaar, Herman

2015-03-01

Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.

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

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

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

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

Discrete Mathematics and Curriculum Reform.

ERIC Educational Resources Information Center

Kenney, Margaret J.

1996-01-01

Defines discrete mathematics as the mathematics necessary to effect reasoned decision making in finite situations and explains how its use supports the current view of mathematics education. Discrete mathematics can be used by curriculum developers to improve the curriculum for students of all ages and abilities. (SLD)

Current Capabilities and Planned Enhancements of SUSTAIN - Paper

EPA Science Inventory

Efforts have been under way by the U.S. Environmental Protection Agency (EPA) since 2003 to develop a decision-support tool for placement of best management practices (BMPs) at strategic locations in urban watersheds. The tool is called the System for Urban Stormwater Treatment ...

48 CFR 13.106-3 - Award and documentation.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Supporting the award decision if other than price-related factors were considered in selecting the supplier...) Comparison of the proposed price with prices found reasonable on previous purchases; (iii) Current price... being purchased; (vi) Comparison to an independent Government estimate; or (vii) Any other reasonable...

Shared decision making in the management of children with newly diagnosed immune thrombocytopenia.

PubMed

Beck, Carolyn E; Boydell, Katherine M; Stasiulis, Elaine; Blanchette, Victor S; Llewellyn-Thomas, Hilary; Birken, Catherine S; Breakey, Vicky R; Parkin, Patricia C

2014-10-01

This study aimed to examine the treatment decision-making process for children hospitalized with newly diagnosed immune thrombocytopenia (ITP). Using focus groups, we studied children with ITP, parents of children with ITP, and health care professionals, inquiring about participants' experience with decision support and decision making in newly diagnosed ITP. Data were examined using thematic analysis. Themes that emerged from children were feelings of "anxiety, fear, and confusion"; the need to "understand information"; and "treatment choice," the experience of which was age dependent. For parents, "anxiety, fear, and confusion" was a dominant theme; "treatment choice" revealed that participants felt directed toward intravenous immune globulin (IVIG) for initial treatment. For health care professionals, "comfort level" highlighted factors contributing to professionals' comfort with offering options; "assumptions" were made about parental desire for participation in shared decision making (SDM) and parental acceptance of treatment options; "providing information" was informative regarding modes of facilitating SDM; and "treatment choice" revealed a discrepancy between current practice (directed toward IVIG) and the ideal of SDM. At our center, families of children with newly diagnosed ITP are not experiencing SDM. Our findings support the implementation of SDM to facilitate patient-centered care for the management of pediatric ITP.

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

PubMed

Kretschmer, Alexander; Tilki, Derya

2017-12-01

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

Embedding technology into inter-professional best practices in home safety evaluation.

PubMed

Burns, Suzanne Perea; Pickens, Noralyn Davel

2017-08-01

To explore inter-professional home evaluators' perspectives and needs for building useful and acceptable decision-support tools for the field of home modifications. Twenty semi-structured interviews were conducted with a range of home modification professionals from different regions of the United States. The interview transcripts were analyzed with a qualitative, descriptive, perspective approach. Technology supports current best practice and has potential to inform decision making through features that could enhance home evaluation processes, quality, efficiency and inter-professional communication. Technological advances with app design have created numerous opportunities for the field of home modifications. Integrating technology and inter-professional best practices will improve home safety evaluation and intervention development to meet client-centred and societal needs. Implications for rehabilitation Understanding home evaluators technology needs for home safety evaluations contributes to the development of app-based assessments. Integrating inter-professional perspectives of best practice and technological needs in an app for home assessments improves processes. Novice and expert home evaluators would benefit from decision support systems embedded in app-based assessments. Adoption of app-based assessment would improve efficiency while remaining client-centred.

Personalization and Patient Involvement in Decision Support Systems: Current Trends

PubMed Central

Sacchi, L.; Lanzola, G.; Viani, N.

2015-01-01

Summary Objectives This survey aims at highlighting the latest trends (2012-2014) on the development, use, and evaluation of Information and Communication Technologies (ICT) based decision support systems (DSSs) in medicine, with a particular focus on patient-centered and personalized care. Methods We considered papers published on scientific journals, by querying PubMed and Web of Science™. Included studies focused on the implementation or evaluation of ICT-based tools used in clinical practice. A separate search was performed on computerized physician order entry systems (CPOEs), since they are increasingly embedding patient-tailored decision support. Results We found 73 papers on DSSs (53 on specific ICT tools) and 72 papers on CPOEs. Although decision support through the delivery of recommendations is frequent (28/53 papers), our review highlighted also DSSs only based on efficient information presentation (25/53). Patient participation in making decisions is still limited (9/53), and mostly focused on risk communication. The most represented medical area is cancer (12%). Policy makers are beginning to be included among stakeholders (6/73), but integration with hospital information systems is still low. Concerning knowledge representation/management issues, we identified a trend towards building inference engines on top of standard data models. Most of the tools (57%) underwent a formal assessment study, even if half of them aimed at evaluating usability and not effectiveness. Conclusions Overall, we have noticed interesting evolutions of medical DSSs to improve communication with the patient, consider the economic and organizational impact, and use standard models for knowledge representation. However, systems focusing on patient-centered care still do not seem to be available at large. PMID:26293857

Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice.

PubMed

Trivedi, Madhukar H; Daly, Ella J

2007-05-01

Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the "next best" treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses.

Measurement-Based Care for Refractory Depression: A Clinical Decision Support Model for Clinical Research and Practice

PubMed Central

Trivedi, Madhukar H.; Daly, Ella J.

2009-01-01

Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the “next best” treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses. PMID:17320312

Exploring views on current and future cochlear implant service delivery: the perspectives of users, parents and professionals at cochlear implant centres and in the community.

PubMed

Athalye, Sheetal; Archbold, Sue; Mulla, Imran; Lutman, Mark; Nikolopoulous, Thomas

2015-09-01

The objective of this survey was to explore the perceptions of implant users/carers and professionals across the UK about current and future cochlear implant service delivery and the challenges. Data were collected via an online questionnaire consisting of totally 22 questions. The questionnaire contained both open- and close-ended questions. Totally, seven hundred and forty-eight responses were received. In spite of the wide range of respondents, there was a broad consensus of opinion across groups. The majority of participants were satisfied with the service they currently receive, but wanted some changes. They reported their current experience of implant services to be mainly driven by decisions made by the implant team. For the future, they preferred the service to be mainly driven by decisions made jointly by the team and the user and/or parent/carer. The majority of participants wanted the cochlear implant services to be integrated into local audiology and other services such as education. Restrictions on number of candidates funded and political decisions and issues were seen as major challenges. Qualitative analysis of the open-ended responses supported the questionnaire responses. This research highlighted the benefits and limitations of the current cochlear implant service delivery as well as the potential implications for the long term. While respondents were generally happy with the current cochlear implant service provision, they expressed some concerns about the long-term sustainability and management, wanting integration into the local services, and more involvement of parents and users in decisions.

Current Capabilities, Issues, and Trends in LMSs and Authoring Tools

DTIC Science & Technology

2009-08-18

architecture  Embedded best-practice design principles  Support for immersive learning technologies  Support for social media 8 LMSs LMS Functionality is... Learning System Multimedia content Application demos VOIP Real-time Collaboration technologies from Adobe Connect Pro, WebEx, LiveMeeting, & Centra...ORGANIZATION NAME(S) AND ADDRESS(ES) Advanced Decision Learning (ADL),ADL Co-Lab,1901 N. Beauregard Street Suite 600,Alexandria,VA,22311 8

Decision Support | Solar Research | NREL

Science.gov Websites

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

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

PubMed

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

2016-04-01

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

A decision support tool to determine cost-to-benefit of a family-centered in-home program for at-risk adolescents.

PubMed

Wilson, Fernando A; Araz, Ozgur M; Thompson, Ronald W; Ringle, Jay L; Mason, W Alex; Stimpson, Jim P

2016-06-01

Family-centered program research has demonstrated its effectiveness in improving adolescent outcomes. However, given current fiscal constraints faced by governmental agencies, a recent report from the Institute of Medicine and National Research Council highlighted the need for cost-benefit analyses to inform decision making by policymakers. Furthermore, performance management tools such as balanced scorecards and dashboards do not generally include cost-benefit analyses. In this paper, we describe the development of an Excel-based decision support tool that can be used to evaluate a selected family-based program for at-risk children and adolescents relative to a comparison program or the status quo. This tool incorporates the use of an efficient, user-friendly interface with results provided in concise tabular and graphical formats that may be interpreted without need for substantial training in economic evaluation. To illustrate, we present an application of this tool to evaluate use of Boys Town's In-Home Family Services (IHFS) relative to detention and out-of-home placement in New York City. Use of the decision support tool can help mitigate the need for programs to contract experts in economic evaluation, especially when there are financial or time constraints. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed

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

2014-01-01

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

Patient information leaflets (PILs) for UK randomised controlled trials: a feasibility study exploring whether they contain information to support decision making about trial participation.

PubMed

Gillies, Katie; Huang, Wan; Skea, Zoë; Brehaut, Jamie; Cotton, Seonaidh

2014-02-18

Informed consent is regarded as a cornerstone of ethical healthcare research and is a requirement for most clinical research studies. Guidelines suggest that prospective randomised controlled trial (RCT) participants should understand a basic amount of key information about the RCTs they are being asked to enrol in in order to provide valid informed consent. This information is usually provided to potential participants in a patient information leaflet (PIL). There is evidence that some trial participants fail to understand key components of trial processes or rationale. As such, the existing approach to information provision for potential RCT participants may not be optimal. Decision aids have been used for a variety of treatment and screening decisions to improve knowledge, but focus more on overall decision quality, and may be helpful to those making decisions about participating in an RCT. We investigated the feasibility of using a tool to identify which items recommended for good quality decision making are present in UK PILs. PILs were sampled from UK registered Clinical Trials Unit websites across a range of clinical areas. The evaluation tool, which is based on standards for supporting decision making, was applied to 20 PILs. Two researchers independently rated each PIL using the tool. In addition, word count and readability were assessed. PILs scored poorly on the evaluation tool with the majority of leaflets scoring less than 50%. Specifically, presenting probabilities, clarifying and expressing values and structured guidance in deliberation and communication sub-sections scored consistently poorly. Tool score was associated with word count (r=0.802, P <0.01); there was no association between score and readability (r=-0.372, P=0.106). The tool was feasible to use to evaluate PILs for UK RCTs. PILs did not meet current standards of information to support good quality decision making. Writers of information leaflets could use the evaluation tool as a framework during PIL development to help ensure that items are included which promote and support more informed decisions about trial participation. Further research is required to evaluate the inclusion of such information.

Informed shared decision-making supported by decision coaches for women with ductal carcinoma in situ: study protocol for a cluster randomized controlled trial.

PubMed

Berger-Höger, Birte; Liethmann, Katrin; Mühlhauser, Ingrid; Haastert, Burkhard; Steckelberg, Anke

2015-10-12

Women with breast cancer want to participate in treatment decision-making. Guidelines have confirmed the right of informed shared decision-making. However, previous research has shown that the implementation of informed shared decision-making is suboptimal for reasons of limited resources of physicians, power imbalances between patients and physicians and missing evidence-based patient information. We developed an informed shared decision-making program for women with primary ductal carcinoma in situ (DCIS). The program provides decision coaching for women by specialized nurses and aims at supporting involvement in decision-making and informed choices. In this trial, the informed shared decision-making program will be evaluated in breast care centers. A cluster randomized controlled trial will be conducted to compare the informed shared decision-making program with standard care. The program comprises an evidence-based patient decision aid and training of physicians (2 hours) and specialized breast care and oncology nurses (4 days) in informed shared decision-making. Sixteen certified breast care centers will be included, with 192 women with primary DCIS being recruited. Primary outcome is the extent of patients' involvement in shared decision-making as assessed by the MAPPIN-Odyad (Multifocal approach to the 'sharing' in shared decision-making: observer instrument dyad). Secondary endpoints include the sub-measures of the MAPPIN-inventory (MAPPIN-Onurse, MAPPIN-Ophysician, MAPPIN-Opatient, MAPPIN-Qnurse, MAPPIN-Qpatient and MAPPIN-Qphysician), informed choice, decisional conflict and the duration of encounters. It is expected that decision coaching and the provision of evidence-based patient decision aids will increase patients' involvement in decision-making with informed choices and reduce decisional conflicts and duration of physician encounters. Furthermore, an accompanying process evaluation will be conducted. To our knowledge, this is the first study investigating the implementation of decision coaches in German breast care centers. Current Controlled Trials ISRCTN46305518 , date of registration: 5 June 2015.

Future perspectives toward the early definition of a multivariate decision-support scheme employed in clinical decision making for senior citizens.

PubMed

Frantzidis, Christos A; Gilou, Sotiria; Billis, Antonis; Karagianni, Maria; Bratsas, Charalampos D; Bamidis, Panagiotis

2016-03-01

Recent neuroscientific studies focused on the identification of pathological neurophysiological patterns (emotions, geriatric depression, memory impairment and sleep disturbances) through computerised clinical decision-support systems. Almost all these research attempts employed either resting-state condition (e.g. eyes-closed) or event-related potentials extracted during a cognitive task known to be affected by the disease under consideration. This Letter reviews existing data mining techniques and aims to enhance their robustness by proposing a holistic decision framework dealing with comorbidities and early symptoms' identification, while it could be applied in realistic occasions. Multivariate features are elicited and fused in order to be compared with average activities characteristic of each neuropathology group. A proposed model of the specific cognitive function which may be based on previous findings (a priori information) and/or validated by current experimental data should be then formed. So, the proposed scheme facilitates the early identification and prevention of neurodegenerative phenomena. Neurophysiological semantic annotation is hypothesised to enhance the importance of the proposed framework in facilitating the personalised healthcare of the information society and medical informatics research community.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study

PubMed Central

Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-01-01

Objectives Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Design Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Setting Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Participants Purposeful sample of 10 patients with a diagnosis of cancer–dementia, informal caregivers (n=9) and oncology HCPs (n=12). Results Four themes were identified: (1) leading to the initial consultation—HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information—informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care—patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment—there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Conclusions Although patients with cancer–dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. PMID:29654025

It's Not Just About More Data: Translation of Science and Decision Support Evaluation for Climate Impact Indicators

NASA Astrophysics Data System (ADS)

Kenney, M. A.

2014-12-01

The U.S. Global Change Research Program is currently considering establishing a National Climate Indicators System, which would be a set of physical, ecological, and societal indicators that would communicate key aspects of climate changes, impacts, vulnerabilities, and preparedness to inform mitigation and adaptation decisions. Thus, over the past several years 150+ scientists and practitioners representing a range of expertise from the climate system to natural systems to human sectors have developed a set of indicator recommendations that could be used as a first step to establishing such an indicator system. These recommendations have been implemented into a pilot system, with the goal of working with stakeholder communities to evaluate the understandability of individual indicators and learn how users are combining indicators for their own understanding or decision needs through this multiple Federal agency decision support platform. This prototype system provides the perfect test bed for evaluating the translation of scientific data - observations, remote sensing, and citizen science data -- and data products, such as indicators, for decision-making audiences. Often translation of scientific information into decision support products is developed and improved given intuition and feedback. Though this can be useful in many cases, more rigorous testing using social science methodologies would provide greater assurance that the data products are useful for the intended audiences. I will present some initial research using surveys to assess the understandability of indicators and whether that understanding is influenced by one's attitude toward climate change. Such information is critical to assess whether products developed for scientists by scientists have been appropriately translated for non-scientists, thus assuring that the data will have some value for the intended audience. Such survey information will provide a data driven approach to further develop and improve the National Climate Indicators System and could be applied to improve other decision support systems.

NASA Applied Sciences Program Rapid Prototyping Results and Conclusions

NASA Astrophysics Data System (ADS)

Cox, E. L.

2007-12-01

NASA's Applied Sciences Program seeks to expand the use of Earth science research results to benefit current and future operational systems tasked with making policy and management decisions. The Earth Science Division within the Science Mission Directorate sponsors over 1000 research projects annually to answer the fundamental research question: How is the Earth changing and what are the consequences for life on Earth? As research results become available, largely from satellite observations and Earth system model outputs, the Applied Sciences Program works diligently with scientists and researchers (internal and external to NASA) , and other government agency officials (USDA, EPA, CDC, DOE, US Forest Service, US Fish and Wildlife Service, DHS, USAID) to determine useful applications for these results in decision-making, ultimately benefiting society. The complexity of Earth science research results and the breadth of the Applied Sciences Program national priority areas dictate a broad scope and multiple approaches available to implement their use in decision-making. Over the past five years, the Applied Sciences Program has examined scientific and engineering practices and solicited the community for methods and steps that can lead to the enhancement of operational systems (Decision Support Systems - DSS) required for decision-making. In November 2006, the Applied Sciences Program launched an initiative aimed at demonstrating the applicability of NASA data (satellite observations, models, geophysical parameters from data archive centers) being incorporated into decision support systems and their related environments at a low cost and quick turnaround of results., i.e. designed rapid prototyping. Conceptually, an understanding of Earth science research (and results) coupled with decision-making requirements and needs leads to a demonstration (experiment) depicting enhancements or improvements to an operational decisions process through the use of NASA data. Five NASA centers (GSFC, LaRC, SSC, MSFC, ARC) participated and are currently conducting fifteen prototyping experiments covering eight of the twelve national priority applications - Energy, Coastal, Carbon, and Disaster Management; Agricultural Efficiency, Aviation, Air Quality, and Ecological Forecasting. Results from six experiments will be discussed highlighting purpose, expected results, enhancement to the decision-making process achieved, and the potential plans for future collaboration and sustainable projects.

Development of decision support tools to assess pedestrian and bicycle safety : focus on population, demographic and socio-economic spectra.

DOT National Transportation Integrated Search

2016-06-30

Despite the increase of these non-motorized trips, bicyclists and pedestrians remain vulnerable road users that are often over represented in traffic crashes. While the currently used methods that identify hazardous locations serve their purpose well...

Modeling Approaches for Characterizing and Evaluating Environmental Exposure to Engineered Nanomaterials in Support of Risk-Based Decision Making

EPA Science Inventory

As the use of engineered nanomaterials becomes more prevalent, the likelihood of unintended exposure to these materials also increases. Given the current scarcity of experimental data regarding fate, transport, and bioavailability, determining potential environmental exposure to ...

Development of Decision Support System for Remote Monitoring of PIP Corn

EPA Science Inventory

The EPA is developing a multi-level approach that utilizes satellite and airborne remote sensing to locate and monitor genetically modified corn in the agricultural landscape and pest infestation. The current status of the EPA IRM monitoring program based on remote sensed imager...

MCSDSS: A Multi-Criteria Decision Support System for Merging Geoscience Information with Natural User Interfaces, Preference Ranking, and Interactive Data Utilities

NASA Astrophysics Data System (ADS)

Pierce, S. A.; Gentle, J.

2015-12-01

The multi-criteria decision support system (MCSDSS) is a newly completed application for touch-enabled group decision support that uses D3 data visualization tools, a geojson conversion utility that we developed, and Paralelex to create an interactive tool. The MCSDSS is a prototype system intended to demonstrate the potential capabilities of a single page application (SPA) running atop a web and cloud based architecture utilizing open source technologies. The application is implemented on current web standards while supporting human interface design that targets both traditional mouse/keyboard interactions and modern touch/gesture enabled interactions. The technology stack for MCSDSS was selected with the goal of creating a robust and dynamic modular codebase that can be adjusted to fit many use cases and scale to support usage loads that range between simple data display to complex scientific simulation-based modelling and analytics. The application integrates current frameworks for highly performant agile development with unit testing, statistical analysis, data visualization, mapping technologies, geographic data manipulation, and cloud infrastructure while retaining support for traditional HTML5/CSS3 web standards. The software lifecylcle for MCSDSS has following best practices to develop, share, and document the codebase and application. Code is documented and shared via an online repository with the option for programmers to see, contribute, or fork the codebase. Example data files and tutorial documentation have been shared with clear descriptions and data object identifiers. And the metadata about the application has been incorporated into an OntoSoft entry to ensure that MCSDSS is searchable and clearly described. MCSDSS is a flexible platform that allows for data fusion and inclusion of large datasets in an interactive front-end application capable of connecting with other science-based applications and advanced computing resources. In addition, MCSDSS offers functionality that enables communication with non-technical users for policy, education, or engagement with groups around scientific topics with societal relevance.

"Decisions, decisions, decisions": transfer and specificity of decision-making skill between sports.

PubMed

Causer, Joe; Ford, Paul R

2014-08-01

The concept of transfer of learning holds that previous practice or experience in one task or domain will enable successful performance in another related task or domain. In contrast, specificity of learning holds that previous practice or experience in one task or domain does not transfer to other related tasks or domains. The aim of the current study is to examine whether decision-making skill transfers between sports that share similar elements, or whether it is specific to a sport. Participants (n = 205) completed a video-based temporal occlusion decision-making test in which they were required to decide on which action to execute across a series of 4 versus 4 soccer game situations. A sport engagement questionnaire was used to identify 106 soccer players, 43 other invasion sport players and 58 other sport players. Positive transfer of decision-making skill occurred between soccer and other invasion sports, which are related and have similar elements, but not from volleyball, supporting the concept of transfer of learning.

Comparison of Selected Weather Translation Products

NASA Technical Reports Server (NTRS)

Kulkarni, Deepak

2017-01-01

Weather is a primary contributor to the air traffic delays within the National Airspace System (NAS). At present, it is the individual decision makers who use weather information and assess its operational impact in creating effective air traffic management solutions. As a result, the estimation of the impact of forecast weather and the quality of ATM response relies on the skill and experience level of the decision maker. FAA Weather-ATM working groups have developed a Weather-ATM integration framework that consists of weather collection, weather translation, ATM impact conversion and ATM decision support. Some weather translation measures have been developed for hypothetical operations such as decentralized free flight, whereas others are meant to be relevant in current operations. This paper does comparative study of two different weather translation products relevant in current operations and finds that these products have strong correlation with each other. Given inaccuracies in prediction of weather, these differences would not be expected to be of significance in statistical study of a large number of decisions made with a look-ahead time of two hours or more.

PATHway: Decision Support in Exercise Programmes for Cardiac Rehabilitation.

PubMed

Filos, Dimitris; Triantafyllidis, Andreas; Chouvarda, Ioanna; Buys, Roselien; Cornelissen, Véronique; Budts, Werner; Walsh, Deirdre; Woods, Catherine; Moran, Kieran; Maglaveras, Nicos

2016-01-01

Rehabilitation is important for patients with cardiovascular diseases (CVD) to improve health outcomes and quality of life. However, adherence to current exercise programmes in cardiac rehabilitation is limited. We present the design and development of a Decision Support System (DSS) for telerehabilitation, aiming to enhance exercise programmes for CVD patients through ensuring their safety, personalising the programme according to their needs and performance, and motivating them toward meeting their physical activity goals. The DSS processes data originated from a Microsoft Kinect camera, a blood pressure monitor, a heart rate sensor and questionnaires, in order to generate a highly individualised exercise programme and improve patient adherence. Initial results within the EU-funded PATHway project show the potential of our approach.

Multidisciplinary Modelling of Symptoms and Signs with Archetypes and SNOMED-CT for Clinical Decision Support.

PubMed

Marco-Ruiz, Luis; Maldonado, J Alberto; Karlsen, Randi; Bellika, Johan G

2015-01-01

Clinical Decision Support Systems (CDSS) help to improve health care and reduce costs. However, the lack of knowledge management and modelling hampers their maintenance and reuse. Current EHR standards and terminologies can allow the semantic representation of the data and knowledge of CDSS systems boosting their interoperability, reuse and maintenance. This paper presents the modelling process of respiratory conditions' symptoms and signs by a multidisciplinary team of clinicians and information architects with the help of openEHR, SNOMED and clinical information modelling tools for a CDSS. The information model of the CDSS was defined by means of an archetype and the knowledge model was implemented by means of an SNOMED-CT based ontology.

Creating and sharing clinical decision support content with Web 2.0: Issues and examples.

PubMed

Wright, Adam; Bates, David W; Middleton, Blackford; Hongsermeier, Tonya; Kashyap, Vipul; Thomas, Sean M; Sittig, Dean F

2009-04-01

Clinical decision support is a powerful tool for improving healthcare quality and patient safety. However, developing a comprehensive package of decision support interventions is costly and difficult. If used well, Web 2.0 methods may make it easier and less costly to develop decision support. Web 2.0 is characterized by online communities, open sharing, interactivity and collaboration. Although most previous attempts at sharing clinical decision support content have worked outside of the Web 2.0 framework, several initiatives are beginning to use Web 2.0 to share and collaborate on decision support content. We present case studies of three efforts: the Clinfowiki, a world-accessible wiki for developing decision support content; Partners Healthcare eRooms, web-based tools for developing decision support within a single organization; and Epic Systems Corporation's Community Library, a repository for sharing decision support content for customers of a single clinical system vendor. We evaluate the potential of Web 2.0 technologies to enable collaborative development and sharing of clinical decision support systems through the lens of three case studies; analyzing technical, legal and organizational issues for developers, consumers and organizers of clinical decision support content in Web 2.0. We believe the case for Web 2.0 as a tool for collaborating on clinical decision support content appears strong, particularly for collaborative content development within an organization.

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

PubMed

Spaulding, William; Deogun, Jitender

2011-09-01

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

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

PubMed Central

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

2016-01-01

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

Linking Theoretical Decision-making Mechanisms in the Simon Task with Electrophysiological Data: A Model-based Neuroscience Study in Humans.

PubMed

Servant, Mathieu; White, Corey; Montagnini, Anna; Burle, Borís

2016-10-01

A current challenge for decision-making research is in extending models of simple decisions to more complex and ecological choice situations. Conflict tasks (e.g., Simon, Stroop, Eriksen flanker) have been the focus of much interest, because they provide a decision-making context representative of everyday life experiences. Modeling efforts have led to an elaborated drift diffusion model for conflict tasks (DMC), which implements a superimposition of automatic and controlled decision activations. The DMC has proven to capture the diversity of behavioral conflict effects across various task contexts. This study combined DMC predictions with EEG and EMG measurements to test a set of linking propositions that specify the relationship between theoretical decision-making mechanisms involved in the Simon task and brain activity. Our results are consistent with a representation of the superimposed decision variable in the primary motor cortices. The decision variable was also observed in the EMG activity of response agonist muscles. These findings provide new insight into the neurophysiology of human decision-making. In return, they provide support for the DMC model framework.

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

PubMed

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

2016-07-01

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

Dynamic Routing of Aircraft in the Presence of Adverse Weather Using a POMDP Framework

NASA Technical Reports Server (NTRS)

Balaban, Edward; Roychoudhury, Indranil; Spirkovska, Lilly; Sankararaman, Shankar; Kulkarni, Chetan; Arnon, Tomer

2017-01-01

Each year weather-related airline delays result in hundreds of millions of dollars in additional fuel burn, maintenance, and lost revenue, not to mention passenger inconvenience. The current approaches for aircraft route planning in the presence of adverse weather still mainly rely on deterministic methods. In contrast, this work aims to deal with the problem using a Partially Observable Markov Decision Processes (POMDPs) framework, which allows for reasoning over uncertainty (including uncertainty in weather evolution over time) and results in solutions that are more robust to disruptions. The POMDP-based decision support system is demonstrated on several scenarios involving convective weather cells and is benchmarked against a deterministic planning system with functionality similar to those currently in use or under development.

Biomedical wellness challenges and opportunities

NASA Astrophysics Data System (ADS)

Tangney, John F.

2012-06-01

The mission of ONR's Human and Bioengineered Systems Division is to direct, plan, foster, and encourage Science and Technology in cognitive science, computational neuroscience, bioscience and bio-mimetic technology, social/organizational science, training, human factors, and decision making as related to future Naval needs. This paper highlights current programs that contribute to future biomedical wellness needs in context of humanitarian assistance and disaster relief. ONR supports fundamental research and related technology demonstrations in several related areas, including biometrics and human activity recognition; cognitive sciences; computational neurosciences and bio-robotics; human factors, organizational design and decision research; social, cultural and behavioral modeling; and training, education and human performance. In context of a possible future with automated casualty evacuation, elements of current science and technology programs are illustrated.

Attention as an effect not a cause

PubMed Central

Krauzlis, Richard J.; Bollimunta, Anil; Arcizet, Fabrice; Wang, Lupeng

2014-01-01

Attention is commonly thought to be important for managing the limited resources available in sensory areas of neocortex. Here we present an alternative view that attention arises as a byproduct of circuits centered on the basal ganglia involved in value-based decision-making. The central idea is that decision-making depends on properly estimating the current state of the animal and its environment, and that the weighted inputs to the currently prevailing estimate give rise to the filter-like properties of attention. After outlining this new framework, we describe findings from physiology, anatomy, computational and clinical work that support this point of view. We conclude that the brain mechanisms responsible for attention employ a conserved circuit motif that predates the emergence of the neocortex. PMID:24953964

Sensemaking Strategies for Ethical Decision-making.

PubMed

Caughron, Jay J; Antes, Alison L; Stenmark, Cheryl K; Thiel, Chaise E; Wang, Xiaoqian; Mumford, Michael D

2011-01-01

The current study uses a sensemaking model and thinking strategies identified in earlier research to examine ethical decision-making. Using a sample of 163 undergraduates, a low fidelity simulation approach is used to study the effects personal involvement (in causing the problem and personal involvement in experiencing the outcomes of the problem) could have on the use of cognitive reasoning strategies that have been shown to promote ethical decision-making. A mediated model is presented which suggests that environmental factors influence reasoning strategies, reasoning strategies influence sensemaking, and sensemaking in turn influences ethical decision-making. Findings were mixed but generally supported the hypothesized model. Interestingly, framing the outcomes of ethically charged situations in terms of more global organizational outcomes rather than personal outcomes was found to promote the use of pro-ethical cognitive reasoning strategies.

Enhancing the role of science in the decision-making of the European Union.

PubMed

Allio, Lorenzo; Ballantine, Bruce; Meads, Richard

2006-02-01

Used well, science provides effective ways of identifying potential risks, protecting citizens, and using resources wisely. It enables government decisions to be based on evidence and provides a foundation for a rule-based framework that supports global trade. To ensure that the best available science becomes a key input in the decisions made by EU institutions, this abridged version of a working paper produced for the European Policy Centre, a leading, independent think tank, considers how science is currently used in the policy and decision-making processes of the EU, what the limitations of scientific evidence are, and how a risk assessment process based on scientific 'good practices' can be advantageous. Finally, the paper makes recommendations on how to improve the use of science by EU institutions.

Sensemaking Strategies for Ethical Decision-making

PubMed Central

Caughron, Jay J.; Antes, Alison L.; Stenmark, Cheryl K.; Thiel, Chaise E.; Wang, Xiaoqian; Mumford, Michael D.

2015-01-01

The current study uses a sensemaking model and thinking strategies identified in earlier research to examine ethical decision-making. Using a sample of 163 undergraduates, a low fidelity simulation approach is used to study the effects personal involvement (in causing the problem and personal involvement in experiencing the outcomes of the problem) could have on the use of cognitive reasoning strategies that have been shown to promote ethical decision-making. A mediated model is presented which suggests that environmental factors influence reasoning strategies, reasoning strategies influence sensemaking, and sensemaking in turn influences ethical decision-making. Findings were mixed but generally supported the hypothesized model. Interestingly, framing the outcomes of ethically charged situations in terms of more global organizational outcomes rather than personal outcomes was found to promote the use of pro-ethical cognitive reasoning strategies. PMID:26257505

Climate Change and Sea Level Rise: A Challenge to Science and Society

NASA Astrophysics Data System (ADS)

Plag, H.

2009-12-01

Society is challenged by the risk of an anticipated rise of coastal Local Sea Level (LSL) as a consequence of future global warming. Many low-lying and often subsiding and densely populated coastal areas are under risk of increased inundation, with potentially devastating consequences for the global economy, society, and environment. Faced with a trade-off between imposing the very high costs of coastal protection and adaptation upon today's national economies and leaving the costs of potential major disasters to future generations, governments and decision makers are in need of scientific support for the development of mitigation and adaptation strategies for the coastal zone. Low-frequency to secular changes in LSL are the result of many interacting Earth system processes. The complexity of the Earth system makes it difficult to predict Global Sea Level (GSL) rise and, even more so, LSL changes over the next 100 to 200 years. Humans have re-engineered the planet and changed major features of the Earth surface and the atmosphere, thus ruling out extrapolation of past and current changes into the future as a reasonable approach. The risk of rapid changes in ocean circulation and ice sheet mass balance introduces the possibility of unexpected changes. Therefore, science is challenged with understanding and constraining the full range of plausible future LSL trajectories and with providing useful support for informed decisions. In the face of largely unpredictable future sea level changes, monitoring of the relevant processes and development of a forecasting service on realistic time scales is crucial as decision support. Forecasting and "early warning" for LSL rise would have to aim at decadal time scales, giving coastal managers sufficient time to react if the onset of rapid changes would require an immediate response. The social, environmental, and economic risks associated with potentially large and rapid LSL changes are enormous. Therefore, in the light of the current uncertainties and the unpredictable nature of some of the forcing processes for LSL changes, the focus of scientific decision support may have to shift from projections of LSL trajectories on century time scales to the development of models and monitoring systems for a forecasting service on decadal time scales. The requirements for such a LSL forecasting service and the current obstacles will be discussed.

Sustainability in Health care by Allocating Resources Effectively (SHARE) 7: supporting staff in evidence-based decision-making, implementation and evaluation in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Dyer, Tim; Brooke, Vanessa; Garrubba, Marie; Melder, Angela; Voutier, Catherine; Gust, Anthony; Farjou, Dina

2017-06-21

This is the seventh in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The SHARE Program was a systematic, integrated, evidence-based program for resource allocation within a large Australian health service. It aimed to facilitate proactive use of evidence from research and local data; evidence-based decision-making for resource allocation including disinvestment; and development, implementation and evaluation of disinvestment projects. From the literature and responses of local stakeholders it was clear that provision of expertise and education, training and support of health service staff would be required to achieve these aims. Four support services were proposed. This paper is a detailed case report of the development, implementation and evaluation of a Data Service, Capacity Building Service and Project Support Service. An Evidence Service is reported separately. Literature reviews, surveys, interviews, consultation and workshops were used to capture and process the relevant information. Existing theoretical frameworks were adapted for evaluation and explication of processes and outcomes. Surveys and interviews identified current practice in use of evidence in decision-making, implementation and evaluation; staff needs for evidence-based practice; nature, type and availability of local health service data; and preferred formats for education and training. The Capacity Building and Project Support Services were successful in achieving short term objectives; but long term outcomes were not evaluated due to reduced funding. The Data Service was not implemented at all. Factors influencing the processes and outcomes are discussed. Health service staff need access to education, training, expertise and support to enable evidence-based decision-making and to implement and evaluate the changes arising from those decisions. Three support services were proposed based on research evidence and local findings. Local factors, some unanticipated and some unavoidable, were the main barriers to successful implementation. All three proposed support services hold promise as facilitators of EBP in the local healthcare setting. The findings from this study will inform further exploration.

Electronic decision support for diagnostic imaging in a primary care setting

PubMed Central

Reed, Martin H

2011-01-01

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

Philanthropic Motivations of Community College Donors

ERIC Educational Resources Information Center

Carter, Linnie S.; Duggan, Molly H.

2011-01-01

This descriptive study surveyed current, lapsed, and major gift donors to explore the impact of college communications on donors' decisions to contribute to the college, the likelihood of donor financial support for various college projects, and the philanthropic motivation profiles of the donors of a midsized, multicampus community college in…

Technology Enhanced Analytics (TEA) in Higher Education

ERIC Educational Resources Information Center

Daniel, Ben Kei; Butson, Russell

2013-01-01

This paper examines the role of Big Data Analytics in addressing contemporary challenges associated with current changes in institutions of higher education. The paper first explores the potential of Big Data Analytics to support instructors, students and policy analysts to make better evidence based decisions. Secondly, the paper presents an…

An Expertise Based Energy Information System.

ERIC Educational Resources Information Center

Rosenberg, S.

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

Decision support: Vulnerability, conservation, and restoration (Chapter 8)

Treesearch

Megan M. Friggens; Jeremiah R. Pinto; R. Kasten Dumroese; Nancy L. Shaw

2012-01-01

Current predictive tools, management options, restoration paradigms, and conservation programs are insufficient to meet the challenges of climate change in western North America. Scientific and management capabilities and resources will be sapped trying to identify risks to genetic resources and ecosystems and determine new approaches for mitigating and managing...

Artificial neural network models: A decision support tool for enhancing seedling selection in sugarcane

USDA-ARS?s Scientific Manuscript database

Currently, sugarcane selection begins at the seedling stage with visual selection for cane yield and other yield-related traits. Although subjective and inefficient, visual selection remains the primary method for selection. Visual selection is inefficient because of the confounding effect of genoty...

GAPS OF DECISION SUPPORT MODELS FOR PIPELINE RENEWAL AND RECOMMENDATIONS FOR IMPROVEMENT - Paper

EPA Science Inventory

As part of the U.S. Environmental Protection Agency (EPA)’s Aging Water Infrastructure Research Program, one key area of research pursued, in collaboration with wastewater and water utilities, was a study of the current approaches available for making rehabilitation versus replac...

Designing Privacy Notices: Supporting User Understanding and Control

ERIC Educational Resources Information Center

Kelley, Patrick Gage

2013-01-01

Users are increasingly expected to manage complex privacy settings in their normal online interactions. From shopping to social networks, users make decisions about sharing their personal information with corporations and contacts, frequently with little assistance. Current solutions require consumers to read long documents or go out of their way…

IDESSA: An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas

NASA Astrophysics Data System (ADS)

Meyer, Hanna; Authmann, Christian; Dreber, Niels; Hess, Bastian; Kellner, Klaus; Morgenthal, Theunis; Nauss, Thomas; Seeger, Bernhard; Tsvuura, Zivanai; Wiegand, Kerstin

2017-04-01

Bush encroachment is a syndrome of land degradation that occurs in many savannas including those of southern Africa. The increase in density, cover or biomass of woody vegetation often has negative effects on a range of ecosystem functions and services, which are hardly reversible. However, despite its importance, neither the causes of bush encroachment, nor the consequences of different resource management strategies to combat or mitigate related shifts in savanna states are fully understood. The project "IDESSA" (An Integrative Decision Support System for Sustainable Rangeland Management in Southern African Savannas) aims to improve the understanding of the complex interplays between land use, climate patterns and vegetation dynamics and to implement an integrative monitoring and decision-support system for the sustainable management of different savanna types. For this purpose, IDESSA follows an innovative approach that integrates local knowledge, botanical surveys, remote-sensing and machine-learning based time-series of atmospheric and land-cover dynamics, spatially explicit simulation modeling and analytical database management. The integration of the heterogeneous data will be implemented in a user oriented database infrastructure and scientific workflow system. Accessible via web-based interfaces, this database and analysis system will allow scientists to manage and analyze monitoring data and scenario computations, as well as allow stakeholders (e. g. land users, policy makers) to retrieve current ecosystem information and seasonal outlooks. We present the concept of the project and show preliminary results of the realization steps towards the integrative savanna management and decision-support system.

A collaborative framework for contributing DICOM RT PHI (Protected Health Information) to augment data mining in clinical decision support

NASA Astrophysics Data System (ADS)

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

2014-03-01

We have built a decision support system that provides recommendations for customizing radiation therapy treatment plans, based on patient models generated from a database of retrospective planning data. This database consists of relevant metadata and information derived from the following DICOM objects - CT images, RT Structure Set, RT Dose and RT Plan. The usefulness and accuracy of such patient models partly depends on the sample size of the learning data set. Our current goal is to increase this sample size by expanding our decision support system into a collaborative framework to include contributions from multiple collaborators. Potential collaborators are often reluctant to upload even anonymized patient files to repositories outside their local organizational network in order to avoid any conflicts with HIPAA Privacy and Security Rules. We have circumvented this problem by developing a tool that can parse DICOM files on the client's side and extract de-identified numeric and text data from DICOM RT headers for uploading to a centralized system. As a result, the DICOM files containing PHI remain local to the client side. This is a novel workflow that results in adding only relevant yet valuable data from DICOM files to the centralized decision support knowledge base in such a way that the DICOM files never leave the contributor's local workstation in a cloud-based environment. Such a workflow serves to encourage clinicians to contribute data for research endeavors by ensuring protection of electronic patient data.

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

PubMed

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

2013-10-11

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

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

PubMed Central

2013-01-01

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

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

PubMed

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-11-01

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

A Regional Monitoring and Visualization System for Decision Support and Disaster Management Applications for the Mesoamerican Biological Corridor and Beyond

NASA Technical Reports Server (NTRS)

Irwin, Daniel

2002-01-01

The Mesoamerican Biological Corridor (MBC)-a network of managed and protected areas extending from Mexico to Columbia-is a crucial initiative for the Mesoamerican region, with a central development concept of integrating conservation and sustainable use of biodiversity within the framework of sustainable economic development. The MBC is of particular importance to the Central American Commission for Environment and Development (CCAD), which is comprised of the environmental ministers from the seven Central American countries. Responsible for determining priority areas for action in the corridor, CCAD decision makers require current and accurate information, and access to the dynamic knowledge of the changes in the MBC such as deforestation hotspots, fires, and the effects of natural disasters. Currently this information is not integrated and in disparate locations throughout the region and the world. Leveraging NASA technology, satellite data, and capability, we propose to team with the World Bank and the CCAD to develop a regional monitoring and visualization system-with central nodes at the NASA/Marshall Space Flight Center and at CCAD headquarters. This system will assimilate NASA spatial datasets (e.g. MODIS, Landsat, etc.), spatial data from other sources (commercial and public-domain), and ancillary data developed in each of the seven Central American countries (soils, transportation networks, biodiversity indicator maps, etc.). The system will function as a "virtual dashboard" for monitoring the MBC and provide the critical decision support tools for CCAD decision makers. The CCAD central node will also serve as a high-tech showcase for the corridor among the international community, other decision-makers, the media, and students.

Flight Deck Weather Avoidance Decision Support: Implementation and Evaluation

NASA Technical Reports Server (NTRS)

Wu, Shu-Chieh; Luna, Rocio; Johnson, Walter W.

2013-01-01

Weather related disruptions account for seventy percent of the delays in the National Airspace System (NAS). A key component in the weather plan of the Next Generation of Air Transportation System (NextGen) is to assimilate observed weather information and probabilistic forecasts into the decision process of flight crews and air traffic controllers. In this research we explore supporting flight crew weather decision making through the development of a flight deck predicted weather display system that utilizes weather predictions generated by ground-based radar. This system integrates and presents this weather information, together with in-flight trajectory modification tools, within a cockpit display of traffic information (CDTI) prototype. that the CDTI features 2D and perspective 3D visualization models of weather. The weather forecast products that we implemented were the Corridor Integrated Weather System (CIWS) and the Convective Weather Avoidance Model (CWAM), both developed by MIT Lincoln Lab. We evaluated the use of CIWS and CWAM for flight deck weather avoidance in two part-task experiments. Experiment 1 compared pilots' en route weather avoidance performance in four weather information conditions that differed in the type and amount of predicted forecast (CIWS current weather only, CIWS current and historical weather, CIWS current and forecast weather, CIWS current and forecast weather and CWAM predictions). Experiment 2 compared the use of perspective 3D and 21/2D presentations of weather for flight deck weather avoidance. Results showed that pilots could take advantage of longer range predicted weather forecasts in performing en route weather avoidance but more research will be needed to determine what combinations of information are optimal and how best to present them.

Value of information analysis in healthcare: a review of principles and applications.

PubMed

Tuffaha, Haitham W; Gordon, Louisa G; Scuffham, Paul A

2014-06-01

Economic evaluations are increasingly utilized to inform decisions in healthcare; however, decisions remain uncertain when they are not based on adequate evidence. Value of information (VOI) analysis has been proposed as a systematic approach to measure decision uncertainty and assess whether there is sufficient evidence to support new technologies. The objective of this paper is to review the principles and applications of VOI analysis in healthcare. Relevant databases were systematically searched to identify VOI articles. The findings from the selected articles were summarized and narratively presented. Various VOI methods have been developed and applied to inform decision-making, optimally designing research studies and setting research priorities. However, the application of this approach in healthcare remains limited due to technical and policy challenges. There is a need to create more awareness about VOI analysis, simplify its current methods, and align them with the needs of decision-making organizations.

Acquisition and production of skilled behavior in dynamic decision-making tasks

NASA Technical Reports Server (NTRS)

Kirlik, Alex

1993-01-01

Summaries of the four projects completed during the performance of this research are included. The four projects described are: Perceptual Augmentation Aiding for Situation Assessment, Perceptual Augmentation Aiding for Dynamic Decision-Making and Control, Action Advisory Aiding for Dynamic Decision-Making and Control, and Display Design to Support Time-Constrained Route Optimization. Papers based on each of these projects are currently in preparation. The theoretical framework upon which the first three projects are based, Ecological Task Analysis, was also developed during the performance of this research, and is described in a previous report. A project concerned with modeling strategies in human control of a dynamic system was also completed during the performance of this research.

Exploring patient values in medical decision making: a qualitative study.

PubMed

Lee, Yew Kong; Low, Wah Yun; Ng, Chirk Jenn

2013-01-01

Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28-67 years old. Our sample comprised 9 women and 12 men. Three main themes, 'treatment-specific values', 'life goals and philosophies', and 'personal and social background', emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients' decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients' priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values.

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

PubMed Central

2012-01-01

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

Detection of Hard Exudates in Colour Fundus Images Using Fuzzy Support Vector Machine-Based Expert System.

PubMed

Jaya, T; Dheeba, J; Singh, N Albert

2015-12-01

Diabetic retinopathy is a major cause of vision loss in diabetic patients. Currently, there is a need for making decisions using intelligent computer algorithms when screening a large volume of data. This paper presents an expert decision-making system designed using a fuzzy support vector machine (FSVM) classifier to detect hard exudates in fundus images. The optic discs in the colour fundus images are segmented to avoid false alarms using morphological operations and based on circular Hough transform. To discriminate between the exudates and the non-exudates pixels, colour and texture features are extracted from the images. These features are given as input to the FSVM classifier. The classifier analysed 200 retinal images collected from diabetic retinopathy screening programmes. The tests made on the retinal images show that the proposed detection system has better discriminating power than the conventional support vector machine. With the best combination of FSVM and features sets, the area under the receiver operating characteristic curve reached 0.9606, which corresponds to a sensitivity of 94.1% with a specificity of 90.0%. The results suggest that detecting hard exudates using FSVM contribute to computer-assisted detection of diabetic retinopathy and as a decision support system for ophthalmologists.

How do ants make sense of gravity? A Boltzmann Walker analysis of Lasius niger trajectories on various inclines.

PubMed

Khuong, Anaïs; Lecheval, Valentin; Fournier, Richard; Blanco, Stéphane; Weitz, Sébastian; Bezian, Jean-Jacques; Gautrais, Jacques

2013-01-01

The goal of this study is to describe accurately how the directional information given by support inclinations affects the ant Lasius niger motion in terms of a behavioral decision. To this end, we have tracked the spontaneous motion of 345 ants walking on a 0.5×0.5 m plane canvas, which was tilted with 5 various inclinations by [Formula: see text] rad ([Formula: see text] data points). At the population scale, support inclination favors dispersal along uphill and downhill directions. An ant's decision making process is modeled using a version of the Boltzmann Walker model, which describes an ant's random walk as a series of straight segments separated by reorientation events, and was extended to take directional influence into account. From the data segmented accordingly ([Formula: see text] segments), this extension allows us to test separately how average speed, segments lengths and reorientation decisions are affected by support inclination and current walking direction of the ant. We found that support inclination had a major effect on average speed, which appeared approximately three times slower on the [Formula: see text] incline. However, we found no effect of the walking direction on speed. Contrastingly, we found that ants tend to walk longer in the same direction when they move uphill or downhill, and also that they preferentially adopt new uphill or downhill headings at turning points. We conclude that ants continuously adapt their decision making about where to go, and how long to persist in the same direction, depending on how they are aligned with the line of maximum declivity gradient. Hence, their behavioral decision process appears to combine klinokinesis with geomenotaxis. The extended Boltzmann Walker model parameterized by these effects gives a fair account of the directional dispersal of ants on inclines.

The Watershed and River Systems Management Program: Decision Support for Water- and Environmental-Resource Management

NASA Astrophysics Data System (ADS)

Leavesley, G.; Markstrom, S.; Frevert, D.; Fulp, T.; Zagona, E.; Viger, R.

2004-12-01

Increasing demands for limited fresh-water supplies, and increasing complexity of water-management issues, present the water-resource manager with the difficult task of achieving an equitable balance of water allocation among a diverse group of water users. The Watershed and River System Management Program (WARSMP) is a cooperative effort between the U.S. Geological Survey (USGS) and the Bureau of Reclamation (BOR) to develop and deploy a database-centered, decision-support system (DSS) to address these multi-objective, resource-management problems. The decision-support system couples the USGS Modular Modeling System (MMS) with the BOR RiverWare tools using a shared relational database. MMS is an integrated system of computer software that provides a research and operational framework to support the development and integration of a wide variety of hydrologic and ecosystem models, and their application to water- and ecosystem-resource management. RiverWare is an object-oriented reservoir and river-system modeling framework developed to provide tools for evaluating and applying water-allocation and management strategies. The modeling capabilities of MMS and Riverware include simulating watershed runoff, reservoir inflows, and the impacts of resource-management decisions on municipal, agricultural, and industrial water users, environmental concerns, power generation, and recreational interests. Forecasts of future climatic conditions are a key component in the application of MMS models to resource-management decisions. Forecast methods applied in MMS include a modified version of the National Weather Service's Extended Streamflow Prediction Program (ESP) and statistical downscaling from atmospheric models. The WARSMP DSS is currently operational in the Gunnison River Basin, Colorado; Yakima River Basin, Washington; Rio Grande Basin in Colorado and New Mexico; and Truckee River Basin in California and Nevada.

How Do Ants Make Sense of Gravity? A Boltzmann Walker Analysis of Lasius niger Trajectories on Various Inclines

PubMed Central

Khuong, Anaïs; Lecheval, Valentin; Fournier, Richard; Blanco, Stéphane; Weitz, Sébastian; Bezian, Jean-Jacques; Gautrais, Jacques

2013-01-01

The goal of this study is to describe accurately how the directional information given by support inclinations affects the ant Lasius niger motion in terms of a behavioral decision. To this end, we have tracked the spontaneous motion of 345 ants walking on a 0.5×0.5 m plane canvas, which was tilted with 5 various inclinations by rad ( data points). At the population scale, support inclination favors dispersal along uphill and downhill directions. An ant's decision making process is modeled using a version of the Boltzmann Walker model, which describes an ant's random walk as a series of straight segments separated by reorientation events, and was extended to take directional influence into account. From the data segmented accordingly ( segments), this extension allows us to test separately how average speed, segments lengths and reorientation decisions are affected by support inclination and current walking direction of the ant. We found that support inclination had a major effect on average speed, which appeared approximately three times slower on the incline. However, we found no effect of the walking direction on speed. Contrastingly, we found that ants tend to walk longer in the same direction when they move uphill or downhill, and also that they preferentially adopt new uphill or downhill headings at turning points. We conclude that ants continuously adapt their decision making about where to go, and how long to persist in the same direction, depending on how they are aligned with the line of maximum declivity gradient. Hence, their behavioral decision process appears to combine klinokinesis with geomenotaxis. The extended Boltzmann Walker model parameterized by these effects gives a fair account of the directional dispersal of ants on inclines. PMID:24204636

The Cool Hand Luke Effect: Failure to Communicate Effectively (Invited)

NASA Astrophysics Data System (ADS)

Davidson, M. A.

2010-12-01

There is a growing concern with the accelerating rate of local sea level change and its implications for local and regional planning and development. While there are a growing number of local governments that are beginning to seriously consider their adaptation options, the vast majority of local leaders have not yet developed confidence in the various scenarios that are currently available. To adequately address the range of possible impacts and options for addressing local sea level change, one must have more than high resolution data, model output and decision support tools. We need to have a better understandin of the range of likely impacts upon and the value of local ecosystem services as well as as understanding of the foundations of the local economies. A sound scientific foundation must exist to support 'decision making under uncertainty' but we also need to understand the very local specific cultural frameworks within which decision makers must work. This is why working with local civic organizations, NGOs and other boundary organizations is increasingly important.

Decision making technical support study for the US Army's Chemical Stockpile Disposal Program

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

Feldman, D.L.; Dobson, J.E.

1990-08-01

This report examines the adequacy of current command and control systems designed to make timely decisions that would enable sufficient warning and protective response to an accident at the Edgewood area of Aberdeen Proving Ground (APG), Maryland, and at Pine Bluff Arsenal (PBA), Arkansas. Institutional procedures designed to facilitate rapid accident assessment, characterization, warning, notification, and response after the onset of an emergency and computer-assisted decision-making aids designed to provide salient information to on- and-off-post emergency responders are examined. The character of emergency decision making at APG and PBA, as well as potential needs for improvements to decision-making practices, procedures,more » and automated decision-support systems (ADSSs), are described and recommendations are offered to guide equipment acquisition and improve on- and off-post command and control relationships. We recommend that (1) a continued effort be made to integrate on- and off-post command control, and decision-making procedures to permit rapid decision making; (2) the pathways for alert and notification among on- and off-post officials be improved and that responsibilities and chain of command among off-post agencies be clarified; (3) greater attention be given to organizational and social context factors that affect the adequacy of response and the likelihood that decision-making systems will work as intended; and (4) faster improvements be made to on-post ADSSs being developed at APG and PBA, which hold considerable promise for depicting vast amounts of information. Phased development and procurement of computer-assisted decision-making tools should be undertaken to balance immediate needs against available resources and to ensure flexibility, equity among sites, and compatibility among on- and off-post systems. 112 refs., 6 tabs.« less

Development of the Supported Decision Making Inventory System.

PubMed

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

2017-12-01

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

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

PubMed

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

2017-12-01

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

Substitute decision-making for adults with intellectual disabilities living in residential care: learning through experience.

PubMed

Dunn, Michael C; Clare, Isabel C H; Holland, Anthony J

2008-03-01

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, 'strategic substitute decision-making', paralleled the MCA's legal and ethical framework, whilst the second process, 'relational substitute decision-making', was markedly different from these statutory procedures. In this setting, 'relational substitute decision-making' underpinned everyday personal and social interventions connected with residents' daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed.

Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean.

PubMed

Horey, Dell; Kealy, Michelle; Davey, Mary-Ann; Small, Rhonda; Crowther, Caroline A

2013-07-30

Pregnant women who have previously had a caesarean birth and who have no contraindication for vaginal birth after caesarean (VBAC) may need to decide whether to choose between a repeat caesarean birth or to commence labour with the intention of achieving a VBAC. Women need information about their options and interventions designed to support decision-making may be helpful. Decision support interventions can be implemented independently, or shared with health professionals during clinical encounters or used in mediated social encounters with others, such as telephone decision coaching services. Decision support interventions can include decision aids, one-on-one counselling, group information or support sessions and decision protocols or algorithms. This review considers any decision support intervention for pregnant women making birth choices after a previous caesarean birth. To examine the effectiveness of interventions to support decision-making about vaginal birth after a caesarean birth.Secondary objectives are to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013), Current Controlled Trials (22 July 2013), the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (22 July 2013) and reference lists of retrieved articles. We also conducted citation searches of included studies to identify possible concurrent qualitative studies. All published, unpublished, and ongoing randomised controlled trials (RCTs) and quasi-randomised trials with reported data of any intervention designed to support pregnant women who have previously had a caesarean birth make decisions about their options for birth. Studies using a cluster-randomised design were eligible for inclusion but none were identified. Studies using a cross-over design were not eligible for inclusion. Studies published in abstract form only would have been eligible for inclusion if data were able to be extracted. Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies. Data were checked for accuracy. We contacted authors of included trials for additional information. All included interventions were classified as independent, shared or mediated decision supports. Consensus was obtained for classifications. Verification of the final list of included studies was undertaken by three review authors. Three randomised controlled trials involving 2270 women from high-income countries were eligible for inclusion in the review. Outcomes were reported for 1280 infants in one study. The interventions assessed in the trials were designed to be used either independently by women or mediated through the involvement of independent support. No studies looked at shared decision supports, that is, interventions designed to facilitate shared decision-making with health professionals during clinical encounters.We found no difference in planned mode of birth: VBAC (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.97 to 1.10; I² = 0%) or caesarean birth (RR 0.96, 95% CI 0.84 to 1.10; I² = 0%). The proportion of women unsure about preference did not change (RR 0.87, 95% CI 0.62 to 1.20; I² = 0%).There was no difference in adverse outcomes reported between intervention and control groups (one trial, 1275 women/1280 babies): permanent (RR 0.66, 95% CI 0.32 to 1.36); severe (RR 1.02, 95% CI 0.77 to 1.36); unclear (0.66, 95% CI 0.27, 1.61). Overall, 64.8% of those indicating preference for VBAC achieved it, while 97.1% of those planning caesarean birth achieved this mode of birth. We found no difference in the proportion of women achieving congruence between preferred and actual mode of birth (RR 1.02, 95% CI 0.96 to 1.07) (three trials, 1921 women).More women had caesarean births (57.3%), including 535 women where it was unplanned (42.6% all caesarean deliveries and 24.4% all births). We found no difference in actual mode of birth between groups, (average RR 0.97, 95% CI 0.89 to 1.06) (three trials, 2190 women).Decisional conflict about preferred mode of birth was lower (less uncertainty) for women with decisional support (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.02; two trials, 787 women; I² = 48%). There was also a significant increase in knowledge among women with decision support compared with those in the control group (SMD 0.74, 95% CI 0.46 to 1.03; two trials, 787 women; I² = 65%). However, there was considerable heterogeneity between the two studies contributing to this outcome ( I² = 65%) and attrition was greater than 15 per cent and the evidence for this outcome is considered to be moderate quality only. There was no difference in satisfaction between women with decision support and those without it (SMD 0.06, 95% CI -0.09 to 0.20; two trials, 797 women; I² = 0%). No study assessed decisional regret or whether women's information needs were met.Qualitative data gathered in interviews with women and health professionals provided information about acceptability of the decision support and its feasibility of implementation. While women liked the decision support there was concern among health professionals about their impact on their time and workload. Evidence is limited to independent and mediated decision supports. Research is needed on shared decision support interventions for women considering mode of birth in a pregnancy after a caesarean birth to use with their care providers.

Combining multi-criteria decision analysis and mini-health technology assessment: A funding decision-support tool for medical devices in a university hospital setting.

PubMed

Martelli, Nicolas; Hansen, Paul; van den Brink, Hélène; Boudard, Aurélie; Cordonnier, Anne-Laure; Devaux, Capucine; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

2016-02-01

At the hospital level, decisions about purchasing new and oftentimes expensive medical devices must take into account multiple criteria simultaneously. Multi-criteria decision analysis (MCDA) is increasingly used for health technology assessment (HTA). One of the most successful hospital-based HTA approaches is mini-HTA, of which a notable example is the Matrix4value model. To develop a funding decision-support tool combining MCDA and mini-HTA, based on Matrix4value, suitable for medical devices for individual patient use in French university hospitals - known as the IDA tool, short for 'innovative device assessment'. Criteria for assessing medical devices were identified from a literature review and a survey of 18 French university hospitals. Weights for the criteria, representing their relative importance, were derived from a survey of 25 members of a medical devices committee using an elicitation technique involving pairwise comparisons. As a test of its usefulness, the IDA tool was applied to two new drug-eluting beads (DEBs) for transcatheter arterial chemoembolization. The IDA tool comprises five criteria and weights for each of two over-arching categories: risk and value. The tool revealed that the two new DEBs conferred no additional value relative to DEBs currently available. Feedback from participating decision-makers about the IDA tool was very positive. The tool could help to promote a more structured and transparent approach to HTA decision-making in French university hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

Developing a Value Framework: The Need to Reflect the Opportunity Costs of Funding Decisions.

PubMed

Sculpher, Mark; Claxton, Karl; Pearson, Steven D

2017-02-01

A growing number of health care systems internationally use formal economic evaluation methods to support health care funding decisions. Recently, a range of organizations have been advocating forms of analysis that have been termed "value frameworks." There has also been a push for analytical methods to reflect a fuller range of benefits of interventions through multicriteria decision analysis. A key principle that is invariably neglected in current and proposed frameworks is the need to reflect evidence on the opportunity costs that health systems face when making funding decisions. The mechanisms by which opportunity costs are realized vary depending on the system's financial arrangements, but they always mean that a decision to fund a specific intervention for a particular patient group has the potential to impose costs on others in terms of forgone benefits. These opportunity costs are rarely explicitly reflected in analysis to support decisions, but recent developments to quantify benefits forgone make more appropriate analyses feasible. Opportunity costs also need to be reflected in decisions if a broader range of attributes of benefit is considered, and opportunity costs are a key consideration in determining the appropriate level of total expenditure in a system. The principles by which opportunity costs can be reflected in analysis are illustrated in this article by using the example of the proposed methods for value-based pricing in the United Kingdom. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

What factors influence the decisions of mental health professionals to release service users from seclusion?

PubMed

Jackson, Haley; Baker, John; Berzins, Kathyrn

2018-06-22

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion. © 2018 Australian College of Mental Health Nurses Inc.

Supporting Evidence-Informed Teaching in Biomedical and Health Professions Education Through Knowledge Translation: An Interdisciplinary Literature Review.

PubMed

Tractenberg, Rochelle E; Gordon, Morris

2017-01-01

Phenomenon: The purpose of "systematic" reviews/reviewers of medical and health professions educational research is to identify best practices. This qualitative article explores the question of whether systematic reviews can support "evidence informed" teaching and contrasts traditional systematic reviewing with a knowledge translation (KT) approach to this objective. Degrees of freedom analysis (DOFA) is used to examine the alignment of systematic review methods with educational research and the pedagogical strategies and approaches that might be considered with a decision-making framework developed to support valid assessment. This method is also used to explore how KT can be used to inform teaching and learning. The nature of educational research is not compatible with most (11/14) methods for systematic review. The inconsistency of systematic reviewing with the nature of educational research impedes both the identification and implementation of "best-evidence" pedagogy and teaching. This is primarily because research questions that do support the purposes of review do not support educational decision making. By contrast to systematic reviews of the literature, both a DOFA and KT are fully compatible with informing teaching using evidence. A DOFA supports the translation of theory to a specific teaching or learning case, so could be considered a type of KT. The DOFA results in a test of alignment of decision options with relevant educational theory, and KT leads to interventions in teaching or learning that can be evaluated. Examples of how to structure evaluable interventions are derived from a KT approach that are simply not available from a systematic review. Insights: Systematic reviewing of current empirical educational research is not suitable for deriving or supporting best practices in education. However, both "evidence-informed" and scholarly approaches to teaching can be supported as KT projects, which are inherently evaluable and can generate actionable evidence about whether the decision or intervention worked for students, instructors, and the institution. A DOFA can also support evidence- and theory-informed teaching to develop an understanding of what works, why, and for whom. Thus KT, but not systematic reviewing, can support decision making around pedagogy (and pedagogical innovation) that can also inform new teaching and learning initiatives; it can also point to new avenues of empirical research in education that are informed by, and can inform, theory.

Transportation systems evaluation methodology development and applications, phase 3

NASA Technical Reports Server (NTRS)

Kuhlthau, A. R.; Jacobson, I. D.; Richards, L. C.

1981-01-01

Transportation systems or proposed changes in current systems are evaluated. Four principal evaluation criteria are incorporated in the process, operating performance characteristics as viewed by potential users, decisions based on the perceived impacts of the system, estimating what is required to reduce the system to practice; and predicting the ability of the concept to attract financial support. A series of matrix multiplications in which the various matrices represent evaluations in a logical sequence of the various discrete steps in a management decision process is used. One or more alternatives are compared with the current situation, and the result provides a numerical rating which determines the desirability of each alternative relative to the norm and to each other. The steps in the decision process are isolated so that contributions of each to the final result are readily analyzed. The ability to protect against bias on the part of the evaluators, and the fact that system parameters which are basically qualitative in nature can be easily included are advantageous.

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

ERIC Educational Resources Information Center

Watson, Joanne; Wilson, Erin; Hagiliassis, Nick

2017-01-01

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

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

Treesearch

Erin K. Noonan-Wright; Tonja S. Opperman

2015-01-01

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

Decision support for clinical laboratory capacity planning.

PubMed

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

1995-01-01

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

Features of computerized clinical decision support systems supportive of nursing practice: a literature review.

PubMed

Lee, Seonah

2013-10-01

This study aimed to organize the system features of decision support technologies targeted at nursing practice into assessment, problem identification, care plans, implementation, and outcome evaluation. It also aimed to identify the range of the five stage-related sequential decision supports that computerized clinical decision support systems provided. MEDLINE, CINAHL, and EMBASE were searched. A total of 27 studies were reviewed. The system features collected represented the characteristics of each category from patient assessment to outcome evaluation. Several features were common across the reviewed systems. For the sequential decision support, all of the reviewed systems provided decision support in sequence for patient assessment and care plans. Fewer than half of the systems included problem identification. There were only three systems operating in an implementation stage and four systems in outcome evaluation. Consequently, the key steps for sequential decision support functions were initial patient assessment, problem identification, care plan, and outcome evaluation. Providing decision support in such a full scope will effectively help nurses' clinical decision making. By organizing the system features, a comprehensive picture of nursing practice-oriented computerized decision support systems was obtained; however, the development of a guideline for better systems should go beyond the scope of a literature review.

Gaming against medical errors: methods and results from a design game on CPOE.

PubMed

Kanstrup, Anne Marie; Nøhr, Christian

2009-01-01

The paper presents design game as a technique for participatory design for a Computerized Decision Support System (CDSS) for minimizing medical errors. Design game is used as a technique for working with the skills of users, the complexity of the use practice and the negotiation of design here within the challenging domain of medication. The paper presents a developed design game based on game inspiration from a computer game, theoretical inspiration on electronic decision support, and empirical grounding in scenarios of medical errors. The game has been played in a two-hour workshop with six clinicians. The result is presented as a list of central themes for design of CDSS and derived design principles from these themes. These principles are currently under further exploration in follow up prototype based activities.

GROTTO visualization for decision support

NASA Astrophysics Data System (ADS)

Lanzagorta, Marco O.; Kuo, Eddy; Uhlmann, Jeffrey K.

1998-08-01

In this paper we describe the GROTTO visualization projects being carried out at the Naval Research Laboratory. GROTTO is a CAVE-like system, that is, a surround-screen, surround- sound, immersive virtual reality device. We have explored the GROTTO visualization in a variety of scientific areas including oceanography, meteorology, chemistry, biochemistry, computational fluid dynamics and space sciences. Research has emphasized the applications of GROTTO visualization for military, land and sea-based command and control. Examples include the visualization of ocean current models for the simulation and stud of mine drifting and, inside our computational steering project, the effects of electro-magnetic radiation on missile defense satellites. We discuss plans to apply this technology to decision support applications involving the deployment of autonomous vehicles into contaminated battlefield environments, fire fighter control and hostage rescue operations.

Factors motivating Cambodian American students to go to college and to study STEM fields

NASA Astrophysics Data System (ADS)

Sann, Visna

Cambodian Americans graduate from college at a lower rate than most Asian American groups. This qualitative study involved interviewing five current Cambodian American college students. This study examined how participants' high school experiences contributed to their decisions to go to college and to study STEM fields, how parental influences guided participants to college, and how college experiences influenced their decisions to stay and succeed in STEM fields. Findings from this study suggest: having supportive teachers in high school may have been important in motivating participants to go to college and to study STEM Fields, Cambodian parents tell stories of their lives in Cambodia to motivate their children to go to college, and Cambodian club on campus was a socially and academically supportive place.

Conceptual Model of Iodine Behavior in the Subsurface at the Hanford Site

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

Truex, Michael J.; Lee, Brady D.; Johnson, Christian D.

The fate and transport of 129I in the environment and potential remediation technologies are currently being studied as part of environmental remediation activities at the Hanford Site. A conceptual model describing the nature and extent of subsurface contamination, factors that control plume behavior, and factors relevant to potential remediation processes is needed to support environmental remedy decisions. Because 129I is an uncommon contaminant, relevant remediation experience and scientific literature are limited. Thus, the conceptual model also needs to both describe known contaminant and biogeochemical process information and to identify aspects about which additional information needed to effectively support remedy decisions.more » this document summarizes the conceptual model of iodine behavior relevant to iodine in the subsurface environment at the Hanford site.« less

Process-Based Governance in Public Administrations Using Activity-Based Costing

NASA Astrophysics Data System (ADS)

Becker, Jörg; Bergener, Philipp; Räckers, Michael

Decision- and policy-makers in public administrations currently lack on missing relevant information for sufficient governance. In Germany the introduction of New Public Management and double-entry accounting enable public administrations to get the opportunity to use cost-centered accounting mechanisms to establish new governance mechanisms. Process modelling in this case can be a useful instrument to help the public administrations decision- and policy-makers to structure their activities and capture relevant information. In combination with approaches like Activity-Based Costing, higher management level can be supported with a reasonable data base for fruitful and reasonable governance approaches. Therefore, the aim of this article is combining the public sector domain specific process modelling method PICTURE and concept of activity-based costing for supporting Public Administrations in process-based Governance.

An integrative model for in-silico clinical-genomics discovery science.

PubMed

Lussier, Yves A; Sarkar, Indra Nell; Cantor, Michael

2002-01-01

Human Genome discovery research has set the pace for Post-Genomic Discovery Research. While post-genomic fields focused at the molecular level are intensively pursued, little effort is being deployed in the later stages of molecular medicine discovery research, such as clinical-genomics. The objective of this study is to demonstrate the relevance and significance of integrating mainstream clinical informatics decision support systems to current bioinformatics genomic discovery science. This paper is a feasibility study of an original model enabling novel "in-silico" clinical-genomic discovery science and that demonstrates its feasibility. This model is designed to mediate queries among clinical and genomic knowledge bases with relevant bioinformatic analytic tools (e.g. gene clustering). Briefly, trait-disease-gene relationships were successfully illustrated using QMR, OMIM, SNOMED-RT, GeneCluster and TreeView. The analyses were visualized as two-dimensional dendrograms of clinical observations clustered around genes. To our knowledge, this is the first study using knowledge bases of clinical decision support systems for genomic discovery. Although this study is a proof of principle, it provides a framework for the development of clinical decision-support-system driven, high-throughput clinical-genomic technologies which could potentially unveil significant high-level functions of genes.

A decision-support tool to inform Australian strategies for preventing suicide and suicidal behaviour.

PubMed

Page, Andrew; Atkinson, Jo-An; Heffernan, Mark; McDonnell, Geoff; Hickie, Ian

2017-04-27

Dynamic simulation modelling is increasingly being recognised as a valuable decision-support tool to help guide investments and actions to address complex public health issues such as suicide. In particular, participatory system dynamics (SD) modelling provides a useful tool for asking high-level 'what if' questions, and testing the likely impacts of different combinations of policies and interventions at an aggregate level before they are implemented in the real world. We developed an SD model for suicide prevention in Australia, and investigated the hypothesised impacts over the next 10 years (2015-2025) of a combination of current intervention strategies proposed for population interventions in Australia: 1) general practitioner (GP) training, 2) coordinated aftercare in those who have attempted suicide, 3) school-based mental health literacy programs, 4) brief-contact interventions in hospital settings, and 5) psychosocial treatment approaches. Findings suggest that the largest reductions in suicide were associated with GP training (6%) and coordinated aftercare approaches (4%), with total reductions of 12% for all interventions combined. This paper highlights the value of dynamic modelling methods for managing complexity and uncertainty, and demonstrates their potential use as a decision-support tool for policy makers and program planners for community suicide prevention actions.

Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

PubMed

Hill, James R

2016-05-01

Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

Monitoring Citrus Soil Moisture and Nutrients Using an IoT Based System.

PubMed

Zhang, Xueyan; Zhang, Jianwu; Li, Lin; Zhang, Yuzhu; Yang, Guocai

2017-02-23

Chongqing mountain citrus orchard is one of the main origins of Chinese citrus. Its planting terrain is complex and soil parent material is diverse. Currently, the citrus fertilization, irrigation and other management processes still have great blindness. They usually use the same pattern and the same formula rather than considering the orchard terrain features, soil differences, species characteristics and the state of tree growth. With the help of the ZigBee technology, artificial intelligence and decision support technology, this paper has developed the research on the application technology of agricultural Internet of Things for real-time monitoring of citrus soil moisture and nutrients as well as the research on the integration of fertilization and irrigation decision support system. Some achievements were obtained including single-point multi-layer citrus soil temperature and humidity detection wireless sensor nodes and citrus precision fertilization and irrigation management decision support system. They were applied in citrus base in the Three Gorges Reservoir Area. The results showed that the system could help the grower to scientifically fertilize or irrigate, improve the precision operation level of citrus production, reduce the labor cost and reduce the pollution caused by chemical fertilizer.

Coping strategies and immune neglect in affective forecasting: Direct evidence and key moderators

PubMed Central

Hoerger, Michael

2012-01-01

Affective forecasting skills have important implications for decision making. However, recent research suggests that immune neglect – the tendency to overlook coping strategies that reduce future distress – may lead to affective forecasting problems. Prior evidence for immune neglect has been indirect. More direct evidence and a deeper understanding of immune neglect are vital to informing the design of future decision-support interventions. In the current study, young adults (N = 325) supplied predicted, actual, and recollected reactions to an emotionally-evocative interpersonal event, Valentine’s Day. Based on participants’ qualitative descriptions of the holiday, a team of raters reliably coded the effectiveness of their coping strategies. Supporting the immune neglect hypothesis, participants overlooked the powerful role of coping strategies when predicting their emotional reactions. Immune neglect was present not only for those experiencing the holiday negatively (non-daters) but also for those experiencing it positively (daters), suggesting that the bias may be more robust than originally theorized. Immune neglect was greater for immediate emotional reactions than more enduring reactions. Further, immune neglect was conspicuously absent from recollected emotional reactions. Implications for decision-support interventions are discussed. PMID:22375161

Improved representation of situational awareness within a dismounted small combat unit constructive simulation

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.

Selection for inpatient rehabilitation after severe stroke: what factors influence rehabilitation assessor decision-making?

PubMed

Hakkennes, Sharon; Hill, Keith D; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2013-01-01

This study aimed to identify factors that assessors considered important in decision-making regarding suitability for inpatient rehabilitation after acute severe stroke. Multi-site prospective observational cohort study. Consecutive acute, severe stroke patients and their assessors for inpatient rehabilitation. Rehabilitation assessors completed a questionnaire, rating the importance (10 point visual analogue scale) and direction (positive, negative or neutral) of 15 patient related and 2 organisational items potentially affecting their decision regarding patients' acceptance to rehabilitation. Of the 75 patients referred to rehabilitation and included in this study 61 (81.3%) were accepted for inpatient rehabilitation. The items considered to be most important in the decision to accept the patient for rehabilitation were pre-morbid cognition, pre-morbid mobility and pre-morbid communication. For those not accepted the most important items were current mobility, social support and current cognition. Factor analysis revealed 3 underlying factors, interpreted as post-stroke status, pre-morbid status, and social attributes, accounting for 61.8% of the total variance. All were independently associated with acceptance for rehabilitation (p < 0.05). This study highlights the importance of pre-morbid function and social factors in addition to post-stroke function in the decision making process for acceptance to rehabilitation following severe stroke. Future models for selection for rehabilitation should consider inclusion of these factors.

Estimating the potential water reuse based on fuzzy reasoning.

PubMed

Almeida, Giovana; Vieira, José; Marques, Alfeu Sá; Kiperstok, Asher; Cardoso, Alberto

2013-10-15

Studies worldwide suggest that the risk of water shortage in regions affected by climate change is growing. Decision support tools can help governments to identify future water supply problems in order to plan mitigation measures. Treated wastewater is considered a suitable alternative water resource and it is used for non-potable applications in many dry regions around the world. This work describes a decision support system (DSS) that was developed to identify current water reuse potential and the variables that determine the reclamation level. The DSS uses fuzzy inference system (FIS) as a tool and multi-criteria decision making is the conceptual approach behind the DSS. It was observed that water reuse level seems to be related to environmental factors such as drought, water exploitation index, water use, population density and the wastewater treatment rate, among others. A dataset was built to analyze these features through water reuse potential with a FIS that considered 155 regions and 183 cities. Despite some inexact fit between the classification and simulation data for agricultural and urban water reuse potential it was found that the FIS was suitable to identify the water reuse trend. Information on the water reuse potential is important because it issues a warning about future water supply needs based on climate change scenarios, which helps to support decision making with a view to tackling water shortage. Copyright © 2013 Elsevier Ltd. All rights reserved.

School Mapping and Geospatial Analysis of the Schools in Jasra Development Block of India

NASA Astrophysics Data System (ADS)

Agrawal, S.; Gupta, R. D.

2016-06-01

GIS is a collection of tools and techniques that works on the geospatial data and is used in the analysis and decision making. Education is an inherent part of any civil society. Proper educational facilities generate the high quality human resource for any nation. Therefore, government needs an efficient system that can help in analysing the current state of education and its progress. Government also needs a system that can support in decision making and policy framing. GIS can serve the mentioned requirements not only for government but also for the general public. In order to meet the standards of human development, it is necessary for the government and decision makers to have a close watch on the existing education policy and its implementation condition. School mapping plays an important role in this aspect. School mapping consists of building the geospatial database of schools that supports in the infrastructure development, policy analysis and decision making. The present research work is an attempt for supporting Right to Education (RTE) and Sarv Sikha Abhiyaan (SSA) programmes run by Government of India through the use of GIS. School mapping of the study area is performed which is followed by the geospatial analysis. This research work will help in assessing the present status of educational infrastructure in Jasra block of Allahabad district, India.

Clinical decision support systems in child and adolescent psychiatry: a systematic review.

PubMed

Koposov, Roman; Fossum, Sturla; Frodl, Thomas; Nytrø, Øystein; Leventhal, Bennett; Sourander, Andre; Quaglini, Silvana; Molteni, Massimo; de la Iglesia Vayá, María; Prokosch, Hans-Ulrich; Barbarini, Nicola; Milham, Michael Peter; Castellanos, Francisco Xavier; Skokauskas, Norbert

2017-11-01

Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.

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.

Decision Making and Reward in Frontal Cortex

PubMed Central

Kennerley, Steven W.; Walton, Mark E.

2011-01-01

Patients with damage to the prefrontal cortex (PFC)—especially the ventral and medial parts of PFC—often show a marked inability to make choices that meet their needs and goals. These decision-making impairments often reflect both a deficit in learning concerning the consequences of a choice, as well as deficits in the ability to adapt future choices based on experienced value of the current choice. Thus, areas of PFC must support some value computations that are necessary for optimal choice. However, recent frameworks of decision making have highlighted that optimal and adaptive decision making does not simply rest on a single computation, but a number of different value computations may be necessary. Using this framework as a guide, we summarize evidence from both lesion studies and single-neuron physiology for the representation of different value computations across PFC areas. PMID:21534649

Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.

PubMed

Dunnenberger, Henry M; Crews, Kristine R; Hoffman, James M; Caudle, Kelly E; Broeckel, Ulrich; Howard, Scott C; Hunkler, Robert J; Klein, Teri E; Evans, William E; Relling, Mary V

2015-01-01

Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.

Pharmacogenomic knowledge representation, reasoning and genome-based clinical decision support based on OWL 2 DL ontologies.

PubMed

Samwald, Matthias; Miñarro Giménez, Jose Antonio; Boyce, Richard D; Freimuth, Robert R; Adlassnig, Klaus-Peter; Dumontier, Michel

2015-02-22

Every year, hundreds of thousands of patients experience treatment failure or adverse drug reactions (ADRs), many of which could be prevented by pharmacogenomic testing. However, the primary knowledge needed for clinical pharmacogenomics is currently dispersed over disparate data structures and captured in unstructured or semi-structured formalizations. This is a source of potential ambiguity and complexity, making it difficult to create reliable information technology systems for enabling clinical pharmacogenomics. We developed Web Ontology Language (OWL) ontologies and automated reasoning methodologies to meet the following goals: 1) provide a simple and concise formalism for representing pharmacogenomic knowledge, 2) finde errors and insufficient definitions in pharmacogenomic knowledge bases, 3) automatically assign alleles and phenotypes to patients, 4) match patients to clinically appropriate pharmacogenomic guidelines and clinical decision support messages and 5) facilitate the detection of inconsistencies and overlaps between pharmacogenomic treatment guidelines from different sources. We evaluated different reasoning systems and test our approach with a large collection of publicly available genetic profiles. Our methodology proved to be a novel and useful choice for representing, analyzing and using pharmacogenomic data. The Genomic Clinical Decision Support (Genomic CDS) ontology represents 336 SNPs with 707 variants; 665 haplotypes related to 43 genes; 22 rules related to drug-response phenotypes; and 308 clinical decision support rules. OWL reasoning identified CDS rules with overlapping target populations but differing treatment recommendations. Only a modest number of clinical decision support rules were triggered for a collection of 943 public genetic profiles. We found significant performance differences across available OWL reasoners. The ontology-based framework we developed can be used to represent, organize and reason over the growing wealth of pharmacogenomic knowledge, as well as to identify errors, inconsistencies and insufficient definitions in source data sets or individual patient data. Our study highlights both advantages and potential practical issues with such an ontology-based approach.

A National Crop Progress Monitoring and Decision Support System Based on NASA Earth Science Results

NASA Astrophysics Data System (ADS)

di, L.; Yang, Z.

2009-12-01

Timely and accurate information on weekly crop progress and development is essential to a dynamic agricultural industry in the U. S. and the world. By law, the National Agricultural Statistics Service (NASS) of the U. S. Department of Agriculture’s (USDA) is responsible for monitoring and assessing U.S. agricultural production. Currently NASS compiles and issues weekly state and national crop progress and development reports based on reports from knowledgeable state and county agricultural officials and farmers. Such survey-based reports are subjectively estimated for an entire county, lack spatial coverage, and are labor intensive. There has been limited use of remote sensing data to assess crop conditions. NASS produces weekly 1-km resolution un-calibrated AVHRR-based NDVI static images to represent national vegetation conditions but there is no quantitative crop progress information. This presentation discusses the early result for developing a National Crop Progress Monitoring and Decision Support System. The system will overcome the shortcomings of the existing systems by integrating NASA satellite and model-based land surface and weather products, NASS’ wealth of internal crop progress and condition data and Cropland Data Layers (CDL), and the Farm Service Agency’s (FSA) Common Land Units (CLU). The system, using service-oriented architecture and web service technologies, will automatically produce and disseminate quantitative national crop progress maps and associated decision support data at 250-m resolution, as well as summary reports to support NASS and worldwide users in their decision-making. It will provide overall and specific crop progress for individual crops from the state level down to CLU field level to meet different users’ needs on all known croplands. This will greatly enhance the effectiveness and accuracy of the NASS aggregated crop condition data and charts of and provides objective and scientific evidence and guidance for the adjustment of NASS survey data. This presentation will discuss the architecture, Earth observation data, and the crop progress model used in the decision support system.

HUMAN HEALTH METRICS FOR ENVIRONMENTAL DECISION SUPPORT TOOLS: LESSONS FROM HEALTH ECONOMICS AND DECISION ANALYSIS: PUBLISHED REPORT

EPA Science Inventory

NRMRL-CIN-1351A Hofstetter**, P., and Hammitt, J. K. Human Health Metrics for Environmental Decision Support Tools: Lessons from Health Economics and Decision Analysis. EPA/600/R-01/104 (NTIS PB2002-102119). Decision makers using environmental decision support tools are often ...

Fostering Scientific Reasoning in Education--Meta-Analytic Evidence from Intervention Studies

ERIC Educational Resources Information Center

Engelmann, Katharina; Neuhaus, Birgit J.; Fischer, Frank

2016-01-01

Scientific reasoning skills are not just for researchers, they are also increasingly relevant for making informed decisions in our everyday lives. How can these skills be facilitated? The current state of research on supporting scientific reasoning includes intervention studies but lacks an integrated analysis of the approaches to foster…

Community Support for Basic Education in Sub-Saharan Africa. Africa Region Human Development Working Paper Series.

ERIC Educational Resources Information Center

Watt, Patrick

Currently, Africa stands out as the world's poorest and most educationally deprived region. Where communities are empowered to identify their own needs and priorities, participate in decisions about resource allocation, and hold education providers accountable for ensuring that children receive a minimum acceptable standard of education, schooling…

EPA leadership on Science, Innovation, and Decision Support Tools for Addressing Current and Future Challenges

EPA Science Inventory

When the U.S. Environmental Protection Agency (EPA) was established nearly 50 years ago, the nation faced serious threats to its air, land, and water, which in turn impacted human health. These threats were effectively addressed by the creation of EPA (in 1970) and many subsequen...

Assessing Intelligence in Children and Youth Living in the Netherlands

ERIC Educational Resources Information Center

Hurks, Petra P. M.; Bakker, Helen

2016-01-01

In this article, we briefly describe the history of intelligence test use with children and youth in the Netherlands, explain which models of intelligence guide decisions about test use, and detail how intelligence tests are currently being used in Dutch school settings. Empirically supported and theoretical models studying the structure of human…

Generative Intersections: Supporting Honors through College Composition

ERIC Educational Resources Information Center

Camp, Heather C.

2014-01-01

Given the current emphasis on acceleration toward graduation, common sense might seem to argue against First-Year Composition (FYC) as a compelling course offering in an honors curriculum. Dual enrollment is changing the landscape of students' first two years of college, in many cases affecting their decision about whether to enroll in FYC. Trends…

The Design and Implementation of INGRES.

ERIC Educational Resources Information Center

Stonebraker, Michael; And Others

The currently operational version of the INGRES data base management system gives a relational view of data, supports two high level, non-procedural data sublanguages, and runs as a collection of user processes on top of a UNIX operating system. The authors stress the design decisions and tradeoffs in relation to (1) structuring the system into…

Does the Medium Really Matter in L2 Development? The Validity of Call Research Designs

ERIC Educational Resources Information Center

Cerezo, Luis; Baralt, Melissa; Suh, Bo-Ram; Leow, Ronald P.

2014-01-01

Currently, an increasing number of educational institutions are redefining second/foreign language (L2) classrooms by enhancing--or even replacing--traditional face-to-face (FTF) instruction with computer-assisted language learning (CALL). However, are these curricular decisions supported by research? Overall, a cursory review of empirical studies…

NED-2 User's Guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2011-01-01

This is the user's guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows...

NED-2 reference guide

Treesearch

Mark J. Twery; Peter D. Knopp; Scott A. Thomasma; Donald E. Nute

2012-01-01

This is the reference guide for NED-2, which is the latest version of NED, a forest ecosystem management decision support system. This software is part of a family of software products intended to help resource managers develop goals, assess current and future conditions, and produce sustainable management plans for forest properties. Designed for stand-alone Windows-...

The Value of Fidelity of Implementation Criteria to Evaluate School-Based Science Curriculum Innovations

ERIC Educational Resources Information Center

Lee, Yew-Jin; Chue, Shien

2013-01-01

School-based curriculum innovations, including those in science education, are usually not adequately evaluated, if at all. Furthermore, current procedures and instruments for programme evaluations are often unable to support evidence-based decision-making. We suggest that adopting fidelity of implementation (FOI) criteria from healthcare research…

New methods in hydrologic modeling and decision support for culvert flood risk under climate change

NASA Astrophysics Data System (ADS)

Rosner, A.; Letcher, B. H.; Vogel, R. M.; Rees, P. S.

2015-12-01

Assessing culvert flood vulnerability under climate change poses an unusual combination of challenges. We seek a robust method of planning for an uncertain future, and therefore must consider a wide range of plausible future conditions. Culverts in our case study area, northwestern Massachusetts, USA, are predominantly found in small, ungaged basins. The need to predict flows both at numerous sites and under numerous plausible climate conditions requires a statistical model with low data and computational requirements. We present a statistical streamflow model that is driven by precipitation and temperature, allowing us to predict flows without reliance on reference gages of observed flows. The hydrological analysis is used to determine each culvert's risk of failure under current conditions. We also explore the hydrological response to a range of plausible future climate conditions. These results are used to determine the tolerance of each culvert to future increases in precipitation. In a decision support context, current flood risk as well as tolerance to potential climate changes are used to provide a robust assessment and prioritization for culvert replacements.

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

PubMed

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

2013-01-01

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

Making the Most of Continuing Medical Education: Evidence of Transformative Learning During a Course in Evidence-Based Medicine and Decision Making.

PubMed

Sokol, Randi G; Shaughnessy, Allen F

2018-01-01

Continuing medical information courses have been criticized for not promoting behavior change among their participants. For behavior change to occur, participants often need to consciously reject previous ideas and transform their way of thinking. Transformational learning is a process that cultivates deep emotional responses and can lead to cognitive and behavioral change in learners, potentially facilitating rich learning experiences and expediting knowledge translation. We explored participants' experiences at a 2-day conference designed to support transformative learning as they encounter new concepts within Information Mastery, which challenge their previous frameworks around the topic of medical decision making. Using the lens of transformative learning theory, we asked: how does Information Mastery qualitatively promote perspective transformation and hence behavior change? We used a hermeneutic phenomenologic approach to capture the lived experience of 12 current and nine previous attendees of the "Information Mastery" course through individual interviews, focus groups, and observation. Data were thematically analyzed. Both prevoius and current conference attendees described how the delivery of new concepts about medical decision making evoked strong emotional responses, facilitated personal transformation, and propelled expedited behavior change around epistemological, moral, and information management themes, resulting in a newfound sense of self-efficacy, confidence, and ownership in their ability to make medical decisions. When the topic area holds the potential to foster a qualitative reframing of learners' guiding paradigms and worldviews, attention should be paid to supporting learners' personalized meaning-making process through transformative learning opportunities to promote translation into practice.

Precautionary principles: a jurisdiction-free framework for decision-making under risk.

PubMed

Ricci, Paolo F; Cox, Louis A; MacDonald, Thomas R

2004-12-01

Fundamental principles of precaution are legal maxims that ask for preventive actions, perhaps as contingent interim measures while relevant information about causality and harm remains unavailable, to minimize the societal impact of potentially severe or irreversible outcomes. Such principles do not explain how to make choices or how to identify what is protective when incomplete and inconsistent scientific evidence of causation characterizes the potential hazards. Rather, they entrust lower jurisdictions, such as agencies or authorities, to make current decisions while recognizing that future information can contradict the scientific basis that supported the initial decision. After reviewing and synthesizing national and international legal aspects of precautionary principles, this paper addresses the key question: How can society manage potentially severe, irreversible or serious environmental outcomes when variability, uncertainty, and limited causal knowledge characterize their decision-making? A decision-analytic solution is outlined that focuses on risky decisions and accounts for prior states of information and scientific beliefs that can be updated as subsequent information becomes available. As a practical and established approach to causal reasoning and decision-making under risk, inherent to precautionary decision-making, these (Bayesian) methods help decision-makers and stakeholders because they formally account for probabilistic outcomes, new information, and are consistent and replicable. Rational choice of an action from among various alternatives--defined as a choice that makes preferred consequences more likely--requires accounting for costs, benefits and the change in risks associated with each candidate action. Decisions under any form of the precautionary principle reviewed must account for the contingent nature of scientific information, creating a link to the decision-analytic principle of expected value of information (VOI), to show the relevance of new information, relative to the initial (and smaller) set of data on which the decision was based. We exemplify this seemingly simple situation using risk management of BSE. As an integral aspect of causal analysis under risk, the methods developed in this paper permit the addition of non-linear, hormetic dose-response models to the current set of regulatory defaults such as the linear, non-threshold models. This increase in the number of defaults is an important improvement because most of the variants of the precautionary principle require cost-benefit balancing. Specifically, increasing the set of causal defaults accounts for beneficial effects at very low doses. We also show and conclude that quantitative risk assessment dominates qualitative risk assessment, supporting the extension of the set of default causal models.

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

PubMed

Hansen, Dominique; Dendale, Paul; Coninx, Karin; Vanhees, Luc; Piepoli, Massimo F; Niebauer, Josef; Cornelissen, Veronique; Pedretti, Roberto; Geurts, Eva; Ruiz, Gustavo R; Corrà, Ugo; Schmid, Jean-Paul; Greco, Eugenio; Davos, Constantinos H; Edelmann, Frank; Abreu, Ana; Rauch, Bernhard; Ambrosetti, Marco; Braga, Simona S; Barna, Olga; Beckers, Paul; Bussotti, Maurizio; Fagard, Robert; Faggiano, Pompilio; Garcia-Porrero, Esteban; Kouidi, Evangelia; Lamotte, Michel; Neunhäuserer, Daniel; Reibis, Rona; Spruit, Martijn A; Stettler, Christoph; Takken, Tim; Tonoli, Cajsa; Vigorito, Carlo; Völler, Heinz; Doherty, Patrick

2017-07-01

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

A comparative assessment of tools for ecosystem services quantification and valuation

USGS Publications Warehouse

Bagstad, Kenneth J.; Semmens, Darius; Waage, Sissel; Winthrop, Robert

2013-01-01

To enter widespread use, ecosystem service assessments need to be quantifiable, replicable, credible, flexible, and affordable. With recent growth in the field of ecosystem services, a variety of decision-support tools has emerged to support more systematic ecosystem services assessment. Despite the growing complexity of the tool landscape, thorough reviews of tools for identifying, assessing, modeling and in some cases monetarily valuing ecosystem services have generally been lacking. In this study, we describe 17 ecosystem services tools and rate their performance against eight evaluative criteria that gauge their readiness for widespread application in public- and private-sector decision making. We describe each of the tools′ intended uses, services modeled, analytical approaches, data requirements, and outputs, as well time requirements to run seven tools in a first comparative concurrent application of multiple tools to a common location – the San Pedro River watershed in southeast Arizona, USA, and northern Sonora, Mexico. Based on this work, we offer conclusions about these tools′ current ‘readiness’ for widespread application within both public- and private-sector decision making processes. Finally, we describe potential pathways forward to reduce the resource requirements for running ecosystem services models, which are essential to facilitate their more widespread use in environmental decision making.

Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.

PubMed Central

Grant, A. M.; Richard, Y.; Deland, E.; Després, N.; de Lorenzi, F.; Dagenais, A.; Buteau, M.

1997-01-01

The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies. PMID:9357733

Data collection and information presentation for optimal decision making by clinical managers--the Autocontrol Project.

PubMed

Grant, A M; Richard, Y; Deland, E; Després, N; de Lorenzi, F; Dagenais, A; Buteau, M

1997-01-01

The Autocontrol methodology has been developed in order to support the optimisation of decision-making and the use of resources in the context of a clinical unit. The theoretical basis relates to quality assurance and information systems and is influenced by management and cognitive research in the health domain. The methodology uses population rather than individual decision making and because of its dynamic feedback design promises to have rapid and profound effect on practice. Most importantly the health care professional is the principle user of the Autocontrol system. In this methodology we distinguish three types of evidence necessary for practice change: practice based or internal evidence, best evidence derived from the literature or external evidence concerning the practice in question, and process based evidence on how to optimise the process of practice change. The software used by the system is of the executive decision support type which facilitates interrogation of large databases. The Autocontrol system is designed to interrogate the data of the patient medical record however the latter often lacks data on concomitant resource use and this must be supplemented. This paper reviews the Autocontrol methodology and gives examples from current studies.

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

PubMed

2002-12-01

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

Pain relief in labour: a qualitative study to determine how to support women to make decisions about pain relief in labour

PubMed Central

2014-01-01

Background Engagement in decision making is a key priority of modern healthcare. Women are encouraged to make decisions about pain relief in labour in the ante-natal period based upon their expectations of what labour pain will be like. Many women find this planning difficult. The aim of this qualitative study was to explore how women can be better supported in preparing for, and making, decisions during pregnancy and labour regarding pain management. Methods Semi-structured interviews were conducted with 13 primiparous and 10 multiparous women at 36 weeks of pregnancy and again within six weeks postnatally. Data collection and analysis occurred concurrently to identify key themes. Results Three main themes emerged from the data. Firstly, during pregnancy women expressed a degree of uncertainty about the level of pain they would experience in labour and the effect of different methods of pain relief. Secondly, women reflected on how decisions had been made regarding pain management in labour and the degree to which they had felt comfortable making these decisions. Finally, women discussed their perceived levels of control, both desired and experienced, over both their bodies and the decisions they were making. Conclusion This study suggests that the current approach of antenatal preparation in the NHS, of asking women to make decisions antenatally for pain relief in labour, needs reviewing. It would be more beneficial to concentrate efforts on better informing women and on engaging them in discussions around their values, expectations and preferences and how these affect each specific choice rather than expecting them to make to make firm decisions in advance of such an unpredictable event as labour. PMID:24397421

Treatment decision-making processes in the systemic treatment of ovarian cancer: review of the scientific evidence.

PubMed

Luketina, Hrvoje; Fotopoulou, Christina; Luketina, Ruzica-Rosalia; Pilger, Adak; Sehouli, Jalid

2012-09-01

The systemic treatment of epithelial ovarian cancer (OC) is one of the cornerstones in the multimodal management of advanced OC in both primary and recurrent stages of this disease. In most situations various treatment options are available but only few data exists about the treatment decision-making process. Therefore, we conducted a review of the current literature regarding the decision-making process concerning the systemic therapy in patients with advanced ovarian cancer. The electronic database MEDLINE (PubMed) was systematically reviewed for studies that evaluate the treatment decision-making processes in patients with advanced OC. The PubMed database was searched in detail for all titles and abstracts of potentially relevant studies published between 1995 and 2011. An initial search identified 15 potentially relevant studies, but only seven met all inclusion criteria. Factors that influence treatment decisions in patients with OC include not only rational arguments and medical reasons, but also individual attitudes, fears, existential questions, various projections resulting from the physician patient relationship and the social environment. The physician's personal experience with OC treatment seems to be an important factor, followed by previous personal experience with medical issues, and the fear of side-effects and future metastases. Family and self-support organisations also seem to play a significant role in the treatment decision-making process. This review underlines the need for more research activities to explore the treatment decision-making process to enable the best individual support for patients in treatment decision-making. It is a challenge for clinicians to determine the individual information needs of women with OC and to involve them during the decision-making process to the extent they wish.

Linking Science and Management in an Interactive Geospatial, Mutli-Criterion, Structured Decision Support Framework: Use Case Studies of the "Future Forests Geo-visualization and Decision Support Tool

NASA Astrophysics Data System (ADS)

Pontius, J.; Duncan, J.

2017-12-01

Land managers are often faced with balancing management activities to accomplish a diversity of management objectives, in systems faced with many stress agents. Advances in ecosystem modeling provide a rich source of information to inform management. Coupled with advances in decision support techniques and computing capabilities, interactive tools are now accessible for a broad audience of stakeholders. Here we present one such tool designed to capture information on how climate change may impact forested ecosystems, and how that impact varies spatially across the landscape. This tool integrates empirical models of current and future forest structure and function in a structured decision framework that allows users to customize weights for multiple management objectives and visualize suitability outcomes across the landscape. Combined with climate projections, the resulting products allow stakeholders to compare the relative success of various management objectives on a pixel by pixel basis and identify locations where management outcomes are most likely to be met. Here we demonstrate this approach with the integration of several of the preliminary models developed to map species distributions, sugar maple health, forest fragmentation risk and hemlock vulnerability to hemlock woolly adelgid under current and future climate scenarios. We compare three use case studies with objective weightings designed to: 1) Identify key parcels for sugarbush conservation and management, 2) Target state lands that may serve as hemlock refugia from hemlock woolly adelgid induced mortality, and 3) Examine how climate change may alter the success of managing for both sugarbush and hemlock across privately owned lands. This tool highlights the value of flexible models that can be easily run with customized weightings in a dynamic, integrated assessment that allows users to hone in on their potentially complex management objectives, and to visualize and prioritize locations across the landscape. It also demonstrates the importance of including climate considerations for long-term management. This merging of scientific knowledge with the diversity of stakeholder needs is an important step towards using science to inform management and policy decisions.

SANDS: an architecture for clinical decision support in a National Health Information Network.

PubMed

Wright, Adam; Sittig, Dean F

2007-10-11

A new architecture for clinical decision support called SANDS (Service-oriented Architecture for NHIN Decision Support) is introduced and its performance evaluated. The architecture provides a method for performing clinical decision support across a network, as in a health information exchange. Using the prototype we demonstrated that, first, a number of useful types of decision support can be carried out using our architecture; and, second, that the architecture exhibits desirable reliability and performance characteristics.

Monitoring Drought Conditions in the Navajo Nation Using NASA Earth Observations

NASA Technical Reports Server (NTRS)

Ly, Vickie; Gao, Michael; Cary, Cheryl; Turnbull-Appell, Sophie; Surunis, Anton

2016-01-01

The Navajo Nation, a 65,700 sq km Native American territory located in the southwestern United States, has been increasingly impacted by severe drought events and changes in climate. These events are coupled with a lack of domestic water infrastructure and economic resources, leaving approximately one-third of the population without access to potable water in their homes. Current methods of monitoring drought are dependent on state-based monthly Standardized Precipitation Index value maps calculated by the Western Regional Climate Center. However, these maps do not provide the spatial resolution needed to illustrate differences in drought severity across the vast Nation. To better understand and monitor drought events and drought regime changes in the Navajo Nation, this project created a geodatabase of historical climate information specific to the area, and a decision support tool to calculate average Standardized Precipitation Index values for user-specified areas. The tool and geodatabase use Tropical Rainfall Monitoring Mission (TRMM) and Global Precipitation Monitor (GPM) observed precipitation data and Parameter-elevation Relationships on Independent Slopes Model modeled historical precipitation data, as well as NASA's modeled Land Data Assimilation Systems deep soil moisture, evaporation, and transpiration data products. The geodatabase and decision support tool will allow resource managers in the Navajo Nation to utilize current and future NASA Earth observation data for increased decision-making capacity regarding future climate change impact on water resources.

Developing Flexible, Integrated Hydrologic Modeling Systems for Multiscale Analysis in the Midwest and Great Lakes Region

NASA Astrophysics Data System (ADS)

Hamlet, A. F.; Chiu, C. M.; Sharma, A.; Byun, K.; Hanson, Z.

2016-12-01

Physically based hydrologic modeling of surface and groundwater resources that can be flexibly and efficiently applied to support water resources policy/planning/management decisions at a wide range of spatial and temporal scales are greatly needed in the Midwest, where stakeholder access to such tools is currently a fundamental barrier to basic climate change assessment and adaptation efforts, and also the co-production of useful products to support detailed decision making. Based on earlier pilot studies in the Pacific Northwest Region, we are currently assembling a suite of end-to-end tools and resources to support various kinds of water resources planning and management applications across the region. One of the key aspects of these integrated tools is that the user community can access gridded products at any point along the end-to-end chain of models, looking backwards in time about 100 years (1915-2015), and forwards in time about 85 years using CMIP5 climate model projections. The integrated model is composed of historical and projected future meteorological data based on station observations and statistical and dynamically downscaled climate model output respectively. These gridded meteorological data sets serve as forcing data for the macro-scale VIC hydrologic model implemented over the Midwest at 1/16 degree resolution. High-resolution climate model (4km WRF) output provides inputs for the analyses of urban impacts, hydrologic extremes, agricultural impacts, and impacts to the Great Lakes. Groundwater recharge estimated by the surface water model provides input data for fine-scale and macro-scale groundwater models needed for specific applications. To highlight the multi-scale use of the integrated models in support of co-production of scientific information for decision making, we briefly describe three current case studies addressing different spatial scales of analysis: 1) Effects of climate change on the water balance of the Great Lakes, 2) Future hydropower resources in the St. Joseph River basin, 3) Effects of climate change on carbon cycling in small lakes in the Northern Highland Lakes District.

Using health technology assessment to support optimal use of technologies in current practice: the challenge of "disinvestment".

PubMed

Henshall, Chris; Schuller, Tara; Mardhani-Bayne, Logan

2012-07-01

Health systems face rising patient expectations and economic pressures; decision makers seek to enhance efficiency to improve access to appropriate care. There is international interest in the role of HTA to support decisions to optimize use of established technologies, particularly in "disinvesting" from low-benefit uses. This study summarizes main points from an HTAi Policy Forum meeting on this topic, drawing on presentations, discussions among attendees, and an advance background paper. Optimization involves assessment or re-assessment of a technology, a decision on optimal use, and decision implementation. This may occur within a routine process to improve safety and quality and create "headroom" for new technologies, or ad hoc in response to financial constraints. The term "disinvestment" is not always helpful in describing these processes. HTA contributes to optimization, but there is scope to increase its role in many systems. Stakeholders may have strong views on access to technology, and stakeholder involvement is essential. Optimization faces challenges including loss aversion and entitlement, stakeholder inertia and entrenchment, heterogeneity in patient outcomes, and the need to demonstrate convincingly absence of benefit. While basic HTA principles remain applicable, methodological developments are needed better to support optimization. These include mechanisms for candidate technology identification and prioritization, enhanced collection and analysis of routine data, and clinician engagement. To maximize value to decision makers, HTA should consider implementation strategies and barriers. Improving optimization processes calls for a coordinated approach, and actions are identified for system leaders, HTA and other health organizations, and industry.

Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making.

PubMed

Coombs, Maureen A; Parker, Roses; de Vries, Kay

2017-07-01

Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.

Adaptive Multi-scale PHM for Robotic Assembly Processes

PubMed Central

Choo, Benjamin Y.; Beling, Peter A.; LaViers, Amy E.; Marvel, Jeremy A.; Weiss, Brian A.

2017-01-01

Adaptive multiscale prognostics and health management (AM-PHM) is a methodology designed to support PHM in smart manufacturing systems. As a rule, PHM information is not used in high-level decision-making in manufacturing systems. AM-PHM leverages and integrates component-level PHM information with hierarchical relationships across the component, machine, work cell, and production line levels in a manufacturing system. The AM-PHM methodology enables the creation of actionable prognostic and diagnostic intelligence up and down the manufacturing process hierarchy. Decisions are made with the knowledge of the current and projected health state of the system at decision points along the nodes of the hierarchical structure. A description of the AM-PHM methodology with a simulated canonical robotic assembly process is presented. PMID:28664161

Intelligent Work Process Engineering System

NASA Technical Reports Server (NTRS)

Williams, Kent E.

2003-01-01

Optimizing performance on work activities and processes requires metrics of performance for management to monitor and analyze in order to support further improvements in efficiency, effectiveness, safety, reliability and cost. Information systems are therefore required to assist management in making timely, informed decisions regarding these work processes and activities. Currently information systems regarding Space Shuttle maintenance and servicing do not exist to make such timely decisions. The work to be presented details a system which incorporates various automated and intelligent processes and analysis tools to capture organize and analyze work process related data, to make the necessary decisions to meet KSC organizational goals. The advantages and disadvantages of design alternatives to the development of such a system will be discussed including technologies, which would need to bedesigned, prototyped and evaluated.

Acceptance and barriers pertaining to a general practice decision support system for multiple clinical conditions: A mixed methods evaluation.

PubMed

Arts, Derk L; Medlock, Stephanie K; van Weert, Henk C P M; Wyatt, Jeremy C; Abu-Hanna, Ameen

2018-01-01

Many studies have investigated the use of clinical decision support systems as a means to improve care, but have thus far failed to show significant effects on patient-related outcomes. We developed a clinical decision support system that attempted to address issues that were identified in these studies. The system was implemented in Dutch general practice and was designed to be both unobtrusive and to respond in real time. Despite our efforts, usage of the system was low. In the current study we perform a mixed methods evaluation to identify remediable barriers which led to disappointing usage rates for our system. A mixed methods evaluation employing an online questionnaire and focus group. The focus group was organized to clarify free text comments and receive more detailed feedback from general practitioners. Topics consisted of items based on results from the survey and additional open questions. The response rate for the questionnaire was 94%. Results from the questionnaire and focus group can be summarized as follows: The system was perceived as interruptive, despite its design. Participants felt that there were too many recommendations and that the relevance of the recommendations varied. Demographic based recommendations (e.g. age) were often irrelevant, while specific risk-based recommendations (e.g. diagnosis) were more relevant. The other main barrier to use was lack of time during the patient visit. These results are likely to be useful to other researchers who are attempting to address the problems of interruption and alert fatigue in decision support.

RF-CLASS: A Remote-sensing-based Interoperable Web service system for Flood Crop Loss Assessment

NASA Astrophysics Data System (ADS)

Di, L.; Yu, G.; Kang, L.

2014-12-01

Flood is one of the worst natural disasters in the world. Flooding often causes significant crop loss over large agricultural areas in the United States. Two USDA agencies, the National Agricultural Statistics Service (NASS) and Risk Management Agency (RMA), make decisions on flood statistics, crop insurance policy, and recovery management by collecting, analyzing, reporting, and utilizing flooded crop acreage and crop loss information. NASS has the mandate to report crop loss after all flood events. RMA manages crop insurance policy and uses crop loss information to guide the creation of the crop insurance policy and the aftermath compensation. Many studies have been conducted in the recent years on monitoring floods and assessing the crop loss due to floods with remote sensing and geographic information technologies. The Remote-sensing-based Flood Crop Loss Assessment Service System (RF-CLASS), being developed with NASA and USDA support, aims to significantly improve the post-flood agricultural decision-making supports in USDA by integrating and advancing the recently developed technologies. RF-CLASS will operationally provide information to support USDA decision making activities on collecting and archiving flood acreage and duration, recording annual crop loss due to flood, assessing the crop insurance rating areas, investigating crop policy compliance, and spot checking of crop loss claims. This presentation will discuss the remote sensing and GIS based methods for deriving the needed information to support the decision making, the RF-CLASS cybersystem architecture, the standards and interoperability arrangements in the system, and the current and planned capabilities of the system.

Predicting Fire Severity and Hydrogeomorphic Effects for Wildland Fire Decision Support

NASA Astrophysics Data System (ADS)

Hyde, K.; Woods, S. W.; Calkin, D.; Ryan, K.; Keane, R.

2007-12-01

The Wildland Fire Decision Support System (WFDSS) uses the Fire Spread Probability (FSPro) model to predict the spatial extent of fire, and to assess values-at-risk within probable spread zones. This information is used to support Appropriate Management Response (AMR), which involves decision making regarding fire-fighter deployment, fire suppression requirements, and identification of areas where fire may be safely permitted to take its course. Current WFDSS assessments are generally limited to a binary prediction of whether or not a fire will reach a given location and an assessment of the infrastructure which may be damaged or destroyed by fire. However, an emerging challenge is to expand the capabilities of WFDSS so that it also estimates the probable fire severity, and hence the effect on soil, vegetation and on hydrologic and geomorphic processes such as runoff and soil erosion. We present a conceptual framework within which derivatives of predictive fire modelling are used to predict impacts upon vegetation and soil, from which fire severity and probable post-fire watershed response can be inferred, before a fire actually occurs. Fire severity predictions are validated using Burned Area Reflectance Classification imagery. Recent tests indicate that satellite derived BARC images are a simple and effective means to predict post-fire erosion response based on relative vegetation disturbance. A fire severity prediction which reasonably approximates a BARC image may therefore be used to assess post-fire erosion and flood potential before fire reaches an area. This information may provide a new avenue of reliable support for fire management decisions.

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

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

Chen, Chen; Wang, Jianhui; Ton, Dan

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

Physical, Ecological, and Societal Indicators for the National Climate Assessment

NASA Technical Reports Server (NTRS)

Kenney, Melissa A.; Chen, Robert; Baptista, Sandra R.; Quattrochi, Dale; O'Brien, Sheila

2011-01-01

The National Climate Assessment (NCA) is being conducted under the auspices of the U.S. Global Change Research Program (USGCRP), pursuant to the Global Change Research Act of 1990, Section 106, which requires a report to Congress every 4 years. The current NCA (http://globalchange.gov/what-we-do/assessment/) differs in multiple ways from previous U.S. climate assessment efforts, being: (1) more focused on supporting the Nation s activities in adaptation and mitigation and on evaluating the current state of scientific knowledge relative to climate impacts and trends; (2) a long-term, consistent process for evaluation of climate risks and opportunities and providing information to support decision-making processes within regions and sectors; and (3) establishing a permanent assessment capacity both inside and outside of the federal government. As a part of ongoing, long-term assessment activities, the NCA intends to develop an integrated strategic framework and deploy climate-relevant physical, ecological, and societal indicators. The NCA indicators framework is underdevelopment by the NCA Development and Advisory Committee Indicators Working Group and are envisioned as a relatively small number of policy-relevant integrated indicators designed to provide a consistent, objective, and transparent overview of major variations in climate impacts, vulnerabilities, adaptation, and mitigation activities across sectors, regions, and timeframes. The potential questions that could be addressed by these indicators include: How do we know that there is a changing climate and how is it expected to change in the future? Are important climate impacts and opportunities occurring or predicted to occur in the future? Are we adapting successfully? What are the vulnerabilities and resiliencies given a changing climate? Are we preparing adequately for extreme events? It is not expected that the NCA societal indicators would be linked directly to a single decision or portfolio of decisions, but subsets of indicators, or the data supporting the indicator, might be used to inform decision-making processes such as the development and implementation of climate adaptation strategies in a particular sector or region.

Physical, Ecological, and Societal Indicators for the National Climate Assessment

NASA Astrophysics Data System (ADS)

O'Brien, S.; Kenney, M.; Chen, R. S.; Baptista, S. R.; Quattrochi, D. A.

2011-12-01

The National Climate Assessment (NCA) is being conducted under the auspices of the U.S. Global Change Research Program (USGCRP), pursuant to the Global Change Research Act of 1990, Section 106, which requires a report to Congress every 4 years. The current NCA (http://globalchange.gov/what-we-do/assessment/) differs in multiple ways from previous U.S. climate assessment efforts, being: (1) more focused on supporting the Nation's activities in adaptation and mitigation and on evaluating the current state of scientific knowledge relative to climate impacts and trends; (2) a long-term, consistent process for evaluation of climate risks and opportunities and providing information to support decision-making processes within regions and sectors; and (3) establishing a permanent assessment capacity both inside and outside of the federal government. As a part of ongoing, long-term assessment activities, the NCA intends to develop an integrated strategic framework and deploy climate-relevant physical, ecological, and societal indicators. The NCA indicators framework is underdevelopment by the NCA Development and Advisory Committee Indicators Working Group and are envisioned as a relatively small number of policy-relevant integrated indicators designed to provide a consistent, objective, and transparent overview of major variations in climate impacts, vulnerabilities, adaptation, and mitigation activities across sectors, regions, and timeframes. The potential questions that could be addressed by these indicators include: -How do we know that there is a changing climate and how is it expected to change in the future? -Are important climate impacts and opportunities occurring or predicted to occur in the future? -Are we adapting successfully? -What are the vulnerabilities and resiliencies given a changing climate? -Are we preparing adequately for extreme events? It is not expected that the NCA indicators would be linked directly to a single decision or portfolio of decisions, but subsets of indicators, or the data supporting the indicator, might be used to inform decision-making processes such as the development and implementation of climate adaptation strategies in a particular sector or region.

Exploring Patient Values in Medical Decision Making: A Qualitative Study

PubMed Central

Lee, Yew Kong; Low, Wah Yun; Ng, Chirk Jenn

2013-01-01

Background Patient decisions are influenced by their personal values. However, there is a lack of clarity and attention on the concept of patient values in the clinical context despite clear emphasis on patient values in evidence-based medicine and shared decision making. The aim of the study was to explore the concept of patient values in the context of making decisions about insulin initiation among people with type 2 diabetes. Methods and Findings We conducted individual in-depth interviews with people with type 2 diabetes who were making decisions about insulin treatment. Participants were selected purposively to achieve maximum variation. A semi-structured topic guide was used to guide the interviews which were audio-recorded and analysed using a thematic approach. We interviewed 21 participants between January 2011 and March 2012. The age range of participants was 28–67 years old. Our sample comprised 9 women and 12 men. Three main themes, ‘treatment-specific values’, ‘life goals and philosophies’, and ‘personal and social background’, emerged from the analysis. The patients reported a variety of insulin-specific values, which were negative and/or positive beliefs about insulin. They framed insulin according to their priorities and philosophies in life. Patients’ decisions were influenced by sociocultural (e.g. religious background) and personal backgrounds (e.g. family situations). Conclusions This study highlighted the need for expanding the current concept of patient values in medical decision making. Clinicians should address more than just values related to treatment options. Patient values should include patients’ priorities, life philosophy and their background. Current decision support tools, such as patient decision aids, should consider these new dimensions when clarifying patient values. PMID:24282518

Can streamlined multi-criteria decision analysis be used to implement shared decision making for colorectal cancer screening?

PubMed Central

Dolan, James G.; Boohaker, Emily; Allison, Jeroan; Imperiale, Thomas F.

2013-01-01

Background Current US colorectal cancer screening guidelines that call for shared decision making regarding the choice among several recommended screening options are difficult to implement. Multi-criteria decision analysis (MCDA) is an established methodology well suited for supporting shared decision making. Our study goal was to determine if a streamlined form of MCDA using rank order based judgments can accurately assess patients’ colorectal cancer screening priorities. Methods We converted priorities for four decision criteria and three sub-criteria regarding colorectal cancer screening obtained from 484 average risk patients using the Analytic Hierarchy Process (AHP) in a prior study into rank order-based priorities using rank order centroids. We compared the two sets of priorities using Spearman rank correlation and non-parametric Bland-Altman limits of agreement analysis. We assessed the differential impact of using the rank order-based versus the AHP-based priorities on the results of a full MCDA comparing three currently recommended colorectal cancer screening strategies. Generalizability of the results was assessed using Monte Carlo simulation. Results Correlations between the two sets of priorities for the seven criteria ranged from 0.55 to 0.92. The proportions of absolute differences between rank order-based and AHP-based priorities that were more than ± 0.15 ranged from 1% to 16%. Differences in the full MCDA results were minimal and the relative rankings of the three screening options were identical more than 88% of the time. The Monte Carlo simulation results were similar. Conclusion Rank order-based MCDA could be a simple, practical way to guide individual decisions and assess population decision priorities regarding colorectal cancer screening strategies. Additional research is warranted to further explore the use of these methods for promoting shared decision making. PMID:24300851

Carbon Cycle Science in Support of Decision-Making

NASA Astrophysics Data System (ADS)

Brown, M. E.; West, T. O.; McGlynn, E.; Gurwick, N. P.; Duren, R. M.; Ocko, I.; Paustian, K.

2016-12-01

There has been an extensive amount of basic and applied research conducted on biogeochemical cycles, land cover change, watershed to earth system modeling, climate change, and energy efficiency. Concurrently, there continues to be interest in how to best reduce net carbon emissions, including maintaining or augmenting global carbon stocks and decreasing fossil fuel emissions. Decisions surrounding reductions in net emissions should be grounded in, and informed by, existing scientific knowledge and analyses in order to be most effective. The translation of scientific research to decision-making is rarely direct, and often requires coordination of objectives or intermediate research steps. For example, complex model output may need to be simplified to provide mean estimates for given activities; biogeochemical models used for climate change prediction may need to be altered to estimate net carbon flux associated with particular activities; or scientific analyses may need to aggregate and analyze data in a different manner to address specific questions. In the aforementioned cases, expertise and capabilities of researchers and decision-makers are both needed, and early coordination and communication is most effective. Initial analysis of existing science and current decision-making needs indicate that (a) knowledge that is co-produced by scientists and decision-makers has a higher probability of being usable for decision making, (b) scientific work in the past decade to integrate activity data into models has resulted in more usable information for decision makers, (c) attribution and accounting of carbon cycle fluxes is key to using carbon cycle science for decision-making, and (d) stronger, long-term links among research on climate and management of carbon-related sectors (e.g., energy, land use, industry, and buildings) are needed to adequately address current issues.

Toward a Multilingual, Experiential Environment for Learning Decision Technology.

ERIC Educational Resources Information Center

Yeo, Gee Kin; Tan, Seng Teen

1999-01-01

Describes work at the National University of Singapore on the Internet in expanding a simulation game used in supporting a course in decision technology. Topics include decision support systems, multilingual support for cross-cultural decision studies, process support in a World Wide Web-enhanced multiuser domain (MUD) learning environment, and…

Maintenance and operations decision support tool : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

Weather affects almost all maintenance activity decisions. The Federal Highway Administration (FHWA) tested a new decision support system for maintenance in Iowa, Indiana, and Illinois called the Maintenance and Operations Decision Support System (MO...

S4HARA: System for HIV/AIDS resource allocation.

PubMed

Lasry, Arielle; Carter, Michael W; Zaric, Gregory S

2008-03-26

HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA) that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation. S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa. The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease. Condom uptake at the clinic should be increased by changing the condom distribution policy from a pull system to a push system. NGOs and donors promoting antiretroviral programs at the clinic should be sensitized to the results of the model and urged to invest in wellness programs aimed at the prevention and treatment of opportunistic infections. S4HARA differentiates itself from other decision support tools by providing rational HIV/AIDS resource allocation capabilities as well as consideration of the realities facing authorities in their decision-making process.

Configural displays can improve nutrition-related. decisions: an application of the proximity compatibility principle.

PubMed

Marino, Christopher J; Mahan, Robert R

2005-01-01

The nutrition label format currently used by consumers to make dietary-related decisions presents significant information-processing demands for integration-based decisions; however, those demands were not considered as primary factors when the format was adopted. Labels designed in accordance with known principles of cognitive psychology might enhance the kind of decision making that food labeling was intended to facilitate. Three experiments were designed on the basis of the proximity compatibility principle (PCP) to investigate the relationship between nutrition label format and decision making; the experiments involved two types of integration decisions and one type of filtering decision. Based on the PCP, decision performance was measured to test the overall hypothesis that matched task-display tandems would result in better decision performance than would mismatched tandems. In each experiment, a statistically significant increase in mean decision performance was found when the display design was cognitively matched to the demands of the task. Combined, the results from all three experiments support the general hypothesis that task-display matching is a design principle that may enhance the utility of nutrition labeling in nutrition-related decision making. Actual or potential applications of this research include developing robust display solutions that aid in less effortful assimilation of nutrition-related information for consumers.

Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study.

PubMed

McWilliams, Lorna; Farrell, Carole; Keady, John; Swarbrick, Caroline; Burgess, Lorraine; Grande, Gunn; Bellhouse, Sarah; Yorke, Janelle

2018-04-12

Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway. © 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.

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation.

PubMed

Grant, Stuart W; Sperrin, Matthew; Carlson, Eric; Chinai, Natasha; Ntais, Dionysios; Hamilton, Matthew; Dunn, Graham; Buchan, Iain; Davies, Linda; McCollum, Charles N

2015-04-01

Abdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities. To develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice. The UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases. A combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit. The analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty. Lack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation. The ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice. The National Institute for Health Research Health Technology Assessment programme.

Uncertainty and probability in wildfire management decision support: An example from the United States [Chapter 4

Treesearch

Matthew Thompson; David Calkin; Joe H. Scott; Michael Hand

2017-01-01

Wildfire risk assessment is increasingly being adopted to support federal wildfire management decisions in the United States. Existing decision support systems, specifically the Wildland Fire Decision Support System (WFDSS), provide a rich set of probabilistic and risk‐based information to support the management of active wildfire incidents. WFDSS offers a wide range...

Interprofessional practice and decision support: an organizational framework applied to a mental health setting.

PubMed

Campbell, Susan; Stowe, Karen; Ozanne, Elissa M

2011-11-01

Decision support as a means to assist people in making healthcare decisions has been discussed extensively in the medical literature. However, the potential for use of decision support and decision aids with people with psychiatric disabilities in order to promote recovery has only begun to be researched and discussed in the mental health literature. Organizational factors that foster interprofessional practice within a decision support environment focused on mental health issues are examined in this paper.

Information Technology and Community Restoration Studies/Task 1: Information Technology

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

Upton, Jaki F.; Lesperance, Ann M.; Stein, Steven L.

2009-11-19

Executive Summary The Interagency Biological Restoration Demonstration—a program jointly funded by the Department of Defense's Defense Threat Reduction Agency and the Department of Homeland Security's (DHS's) Science and Technology Directorate—is developing policies, methods, plans, and applied technologies to restore large urban areas, critical infrastructures, and Department of Defense installations following the intentional release of a biological agent (anthrax) by terrorists. There is a perception that there should be a common system that can share information both vertically and horizontally amongst participating organizations as well as support analyses. A key question is: "How far away from this are we?" As partmore » of this program, Pacific Northwest National Laboratory conducted research to identify the current information technology tools that would be used by organizations in the greater Seattle urban area in such a scenario, to define criteria for use in evaluating information technology tools, and to identify current gaps. Researchers interviewed 28 individuals representing 25 agencies in civilian and military organizations to identify the tools they currently use to capture data needed to support operations and decision making. The organizations can be grouped into five broad categories: defense (Department of Defense), environmental/ecological (Environmental Protection Agency/Ecology), public health and medical services, emergency management, and critical infrastructure. The types of information that would be communicated in a biological terrorism incident include critical infrastructure and resource status, safety and protection information, laboratory test results, and general emergency information. The most commonly used tools are WebEOC (web-enabled crisis information management systems with real-time information sharing), mass notification software, resource tracking software, and NW WARN (web-based information to protect critical infrastructure systems). It appears that the current information management tools are used primarily for information gathering and sharing—not decision making. Respondents identified the following criteria for a future software system. It is easy to learn, updates information in real time, works with all agencies, is secure, uses a visualization or geographic information system feature, enables varying permission levels, flows information from one stage to another, works with other databases, feeds decision support tools, is compliant with appropriate standards, and is reasonably priced. Current tools have security issues, lack visual/mapping functions and critical infrastructure status, and do not integrate with other tools. It is clear that there is a need for an integrated, common operating system. The system would need to be accessible by all the organizations that would have a role in managing an anthrax incident to enable regional decision making. The most useful tool would feature a GIS visualization that would allow for a common operating picture that is updated in real time. To capitalize on information gained from the interviews, the following activities are recommended: • Rate emergency management decision tools against the criteria specified by the interviewees. • Identify and analyze other current activities focused on information sharing in the greater Seattle urban area. • Identify and analyze information sharing systems/tools used in other regions.« less

Implementation of workflow engine technology to deliver basic clinical decision support functionality.

PubMed

Huser, Vojtech; Rasmussen, Luke V; Oberg, Ryan; Starren, Justin B

2011-04-10

Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform.

An integrated decision support system for diagnosing and managing patients with community-acquired pneumonia.

PubMed Central

Aronsky, D.; Haug, P. J.

1999-01-01

Decision support systems that integrate guidelines have become popular applications to reduce variation and deliver cost-effective care. However, adverse characteristics of decision support systems, such as additional and time-consuming data entry or manually identifying eligible patients, result in a "behavioral bottleneck" that prevents decision support systems to become part of the clinical routine. This paper describes the design and the implementation of an integrated decision support system that explores a novel approach for bypassing the behavioral bottleneck. The real-time decision support system does not require health care providers to enter additional data and consists of a diagnostic and a management component. Images Fig. 1 Fig. 2 Fig. 3 PMID:10566348

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

NASA Astrophysics Data System (ADS)

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

2017-05-01

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

NWS Alaska Sea Ice Program: Operations and Decision Support Services

NASA Astrophysics Data System (ADS)

Schreck, M. B.; Nelson, J. A., Jr.; Heim, R.

2015-12-01

The National Weather Service's Alaska Sea Ice Program is designed to service customers and partners operating and planning operations within Alaska waters. The Alaska Sea Ice Program offers daily sea ice and sea surface temperature analysis products. The program also delivers a five day sea ice forecast 3 times each week, provides a 3 month sea ice outlook at the end of each month, and has staff available to respond to sea ice related information inquiries. These analysis and forecast products are utilized by many entities around the state of Alaska and nationally for safety of navigation and community strategic planning. The list of current customers stem from academia and research institutions, to local state and federal agencies, to resupply barges, to coastal subsistence hunters, to gold dredgers, to fisheries, to the general public. Due to a longer sea ice free season over recent years, activity in the waters around Alaska has increased. This has led to a rise in decision support services from the Alaska Sea Ice Program. The ASIP is in constant contact with the National Ice Center as well as the United States Coast Guard (USCG) for safety of navigation. In the past, the ASIP provided briefings to the USCG when in support of search and rescue efforts. Currently, not only does that support remain, but our team is also briefing on sea ice outlooks into the next few months. As traffic in the Arctic increases, the ASIP will be called upon to provide more and more services on varying time scales to meet customer needs. This talk will address the many facets of the current Alaska Sea Ice Program as well as delve into what we see as the future of the ASIP.

Cyborg practices: call-handlers and computerised decision support systems in urgent and emergency care.

PubMed

Pope, Catherine; Halford, Susan; Turnbull, Joanne; Prichard, Jane

2014-06-01

This article draws on data collected during a 2-year project examining the deployment of a computerised decision support system. This computerised decision support system was designed to be used by non-clinical staff for dealing with calls to emergency (999) and urgent care (out-of-hours) services. One of the promises of computerised decisions support technologies is that they can 'hold' vast amounts of sophisticated clinical knowledge and combine it with decision algorithms to enable standardised decision-making by non-clinical (clerical) staff. This article draws on our ethnographic study of this computerised decision support system in use, and we use our analysis to question the 'automated' vision of decision-making in healthcare call-handling. We show that embodied and experiential (human) expertise remains central and highly salient in this work, and we propose that the deployment of the computerised decision support system creates something new, that this conjunction of computer and human creates a cyborg practice.

Development of a decision support system for analysis and solutions of prolonged standing in the workplace.

PubMed

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-06-01

Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially.

Development of a Decision Support System for Analysis and Solutions of Prolonged Standing in the Workplace

PubMed Central

Halim, Isa; Arep, Hambali; Kamat, Seri Rahayu; Abdullah, Rohana; Omar, Abdul Rahman; Ismail, Ahmad Rasdan

2014-01-01

Background Prolonged standing has been hypothesized as a vital contributor to discomfort and muscle fatigue in the workplace. The objective of this study was to develop a decision support system that could provide systematic analysis and solutions to minimize the discomfort and muscle fatigue associated with prolonged standing. Methods The integration of object-oriented programming and a Model Oriented Simultaneous Engineering System were used to design the architecture of the decision support system. Results Validation of the decision support system was carried out in two manufacturing companies. The validation process showed that the decision support system produced reliable results. Conclusion The decision support system is a reliable advisory tool for providing analysis and solutions to problems related to the discomfort and muscle fatigue associated with prolonged standing. Further testing of the decision support system is suggested before it is used commercially. PMID:25180141

Changes in DSTO Support to Projects Arising From the 6th July 2006 DCIC Decision: Updated Guidance for Project S&T Plans

DTIC Science & Technology

2007-02-01

responsible to the Government for certifying these technical risks [4] and [5] The current funding model for Project S&T Plans is: • Pre-First...the new costing spreadsheets at Annexes C-E. 3.1 A complete set of S&T Activities The 6th July 2006 DCIC decisions to change the funding model increase...changes to the funding model mean that the set of S&T Activities in the Project S&T Plans will need to be categorised in new ways to fit in with the

The Association Between Social Support and Stages of Change in Survivors of Intimate Partner Violence.

PubMed

Zapor, Heather; Wolford-Clevenger, Caitlin; Johnson, Dawn M

2018-04-01

For survivors of intimate partner violence (IPV), it is often difficult to take steps to establish safety and obtain a violence free life. Researchers have applied stage of change theory to aid in understanding the experience of survivors, as well as, the factors that can help women who desire to make changes in or break free from a violent relationship. Social support is one factor that can be helpful to IPV survivors who are attempting to make changes in their relationship. The purpose of the current study was to examine the differences in social support experienced by women who are at varying points in the process of change. Shelter residents ( N = 191) participated in this cross-sectional non-experimental study. Analyses demonstrated five distinct clusters or profiles of change among study participants and were labeled by the authors as follows: preparticipation, decision making, engagement, ambivalent, and action. All forms of social support (i.e., structural, functional, and satisfaction) were generally higher for individuals more engaged in the process of change. More specifically, differences were noted between the action and decision-making clusters and the engagement and decision-making clusters. These findings suggest that it is vital that clinicians working with survivors of IPV not only assess but also tailor interventions to meet survivors where they are in the process of change. Further, interventions that foster survivors' abilities to develop reliable and satisfying social support networks will be beneficial for survivors of IPV.

Developing the U.S. Wildland Fire Decision Support System

Treesearch

Erin Noonan-Wright; Tonja S. Opperman; Mark A. Finney; Tom Zimmerman; Robert C. Seli; Lisa M. Elenz; David E. Calkin; John R. Fiedler

2011-01-01

A new decision support tool, the Wildland Fire Decision Support System (WFDSS) has been developed to support risk-informed decision-making for individual fires in the United States. WFDSS accesses national weather data and forecasts, fire behavior prediction, economic assessment, smoke management assessment, and landscape databases to efficiently formulate and apply...

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

NASA Astrophysics Data System (ADS)

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

2017-01-01

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

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

NASA Astrophysics Data System (ADS)

Brennan-Tonetta, Margaret

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

A Web-Based Decision Support System for Assessing Regional Water-Quality Conditions and Management Actions

NASA Astrophysics Data System (ADS)

Booth, N. L.; Everman, E.; Kuo, I.; Sprague, L.; Murphy, L.

2011-12-01

A new web-based decision support system has been developed as part of the U.S. Geological Survey (USGS) National Water Quality Assessment Program's (NAWQA) effort to provide ready access to Spatially Referenced Regressions On Watershed attributes (SPARROW) results of stream water-quality conditions and to offer sophisticated scenario testing capabilities for research and water-quality planning via an intuitive graphical user interface with a map-based display. The SPARROW Decision Support System (DSS) is delivered through a web browser over an Internet connection, making it widely accessible to the public in a format that allows users to easily display water-quality conditions, distribution of nutrient sources, nutrient delivery to downstream waterbodies, and simulations of altered nutrient inputs including atmospheric and agricultural sources. The DSS offers other features for analysis including various background map layers, model output exports, and the ability to save and share prediction scenarios. SPARROW models currently supported by the DSS are based on the modified digital versions of the 1:500,000-scale River Reach File (RF1) and 1:100,000-scale National Hydrography Dataset (medium-resolution, NHDPlus) stream networks. The underlying modeling framework and server infrastructure illustrate innovations in the information technology and geosciences fields for delivering SPARROW model predictions over the web by performing intensive model computations and map visualizations of the predicted conditions within the stream network.

A Web-Based Decision Support System for Assessing Regional Water-Quality Conditions and Management Actions

USGS Publications Warehouse

Booth, N.L.; Everman, E.J.; Kuo, I.-L.; Sprague, L.; Murphy, L.

2011-01-01

The U.S. Geological Survey National Water Quality Assessment Program has completed a number of water-quality prediction models for nitrogen and phosphorus for the conterminous United States as well as for regional areas of the nation. In addition to estimating water-quality conditions at unmonitored streams, the calibrated SPAtially Referenced Regressions On Watershed attributes (SPARROW) models can be used to produce estimates of yield, flow-weighted concentration, or load of constituents in water under various land-use condition, change, or resource management scenarios. A web-based decision support infrastructure has been developed to provide access to SPARROW simulation results on stream water-quality conditions and to offer sophisticated scenario testing capabilities for research and water-quality planning via a graphical user interface with familiar controls. The SPARROW decision support system (DSS) is delivered through a web browser over an Internet connection, making it widely accessible to the public in a format that allows users to easily display water-quality conditions and to describe, test, and share modeled scenarios of future conditions. SPARROW models currently supported by the DSS are based on the modified digital versions of the 1:500,000-scale River Reach File (RF1) and 1:100,000-scale National Hydrography Dataset (medium-resolution, NHDPlus) stream networks. ?? 2011 American Water Resources Association. This article is a U.S. Government work and is in the public domain in the USA.

Whose decision is it anyway? How clinicians support decision-making participation after acquired brain injury.

PubMed

Knox, Lucy; Douglas, Jacinta M; Bigby, Christine

2013-01-01

To raise professional awareness of factors that may influence the support offered by clinicians to people with acquired brain injury (ABI), and to consider the potential implications of these factors in terms of post-injury rehabilitation and living. A review of the literature was conducted to identify factors that determine how clinicians provide support and influence opportunities for individuals with ABI to participate in decision making across the rehabilitation continuum. Clinical case studies are used to highlight two specific issues: (1) hidden assumptions on the part of the practitioner, and (2) perceptions of risk operating in clinical practice. There are a range of factors which may influence the decision-making support provided by clinicians and, ultimately, shape lifetime outcomes for individuals with ABI. A multidimensional framework may assist clinicians to identify relevant factors and consider their potential implications including those that influence how clinicians involved in supporting decision making approach this task. Participation in decision making is an undisputed human right and central to the provision of person-centred care. Further research is required to understand how clinical practice can maximise both opportunities and support for increased decision-making participation by individuals with ABI. There is an increasing focus on the rights of all individuals to be supported to participate in decision making about their life. A number of changes associated with ABI mean that individuals with ABI will require support with decision making. Clinicians have a critical role in providing this support over the course of the rehabilitation continuum. Clinicians need to be aware of the range of factors that may influence the decision-making support they provide. A multidimensional framework may be used by clinicians to identify influences on the decision-making support they provide.

Selecting essential information for biosurveillance--a multi-criteria decision analysis.

PubMed

Generous, Nicholas; Margevicius, Kristen J; Taylor-McCabe, Kirsten J; Brown, Mac; Daniel, W Brent; Castro, Lauren; Hengartner, Andrea; Deshpande, Alina

2014-01-01

The National Strategy for Biosurveillance defines biosurveillance as "the process of gathering, integrating, interpreting, and communicating essential information related to all-hazards threats or disease activity affecting human, animal, or plant health to achieve early detection and warning, contribute to overall situational awareness of the health aspects of an incident, and to enable better decision-making at all levels." However, the strategy does not specify how "essential information" is to be identified and integrated into the current biosurveillance enterprise, or what the metrics qualify information as being "essential". The question of data stream identification and selection requires a structured methodology that can systematically evaluate the tradeoffs between the many criteria that need to be taken in account. Multi-Attribute Utility Theory, a type of multi-criteria decision analysis, can provide a well-defined, structured approach that can offer solutions to this problem. While the use of Multi-Attribute Utility Theoryas a practical method to apply formal scientific decision theoretical approaches to complex, multi-criteria problems has been demonstrated in a variety of fields, this method has never been applied to decision support in biosurveillance.We have developed a formalized decision support analytic framework that can facilitate identification of "essential information" for use in biosurveillance systems or processes and we offer this framework to the global BSV community as a tool for optimizing the BSV enterprise. To demonstrate utility, we applied the framework to the problem of evaluating data streams for use in an integrated global infectious disease surveillance system.

The reciprocal dynamic model of career decision ambiguity tolerance with career indecision: A longitudinal three-wave investigation.

PubMed

Xu, Hui; Tracey, Terence J G

2017-10-01

The current study investigated the dynamic interplay of career decision ambiguity tolerance and career indecision over 3 assessment times in a sample of college students (n = 583). While the previous research has repeatedly shown an association of career decision ambiguity tolerance with career indecision, the direction of this association has not been adequately assessed with longitudinal investigation. It was hypothesized in this study that there is a reciprocal pattern of career decision ambiguity tolerance leading to subsequent career indecision and career indecision leading to subsequent career decision ambiguity tolerance. Using a cross-lagged panel design, this study found support for the reciprocal pattern that aversion to ambiguity led to increased negative affect and choice anxiety in career decision making, while negative affect and choice anxiety led to increased aversion to ambiguity. Additionally, this study revealed that aversion led to decreased readiness for career decision making and readiness for career decision making led to increased interests in new information. The key findings were discussed with respect to the theoretical and clinical implications for career counseling along with limitations and suggestions for future research. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Flight deck engine advisor

NASA Technical Reports Server (NTRS)

Shontz, W. D.; Records, R. M.; Antonelli, D. R.

1992-01-01

The focus of this project is on alerting pilots to impending events in such a way as to provide the additional time required for the crew to make critical decisions concerning non-normal operations. The project addresses pilots' need for support in diagnosis and trend monitoring of faults as they affect decisions that must be made within the context of the current flight. Monitoring and diagnostic modules developed under the NASA Faultfinder program were restructured and enhanced using input data from an engine model and real engine fault data. Fault scenarios were prepared to support knowledge base development activities on the MONITAUR and DRAPhyS modules of Faultfinder. An analysis of the information requirements for fault management was included in each scenario. A conceptual framework was developed for systematic evaluation of the impact of context variables on pilot action alternatives as a function of event/fault combinations.

Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success.

PubMed

Murphy, Elizabeth V

2014-06-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the "meaningful use" of electronic medical record systems. An important component of the "Meaningful Use" legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study.

Offshore oil spill response practices and emerging challenges.

PubMed

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

2016-09-15

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

Season-ahead Drought Forecast Models for the Lower Colorado River Authority in Texas

NASA Astrophysics Data System (ADS)

Block, P. J.; Zimmerman, B.; Grzegorzewski, M.; Watkins, D. W., Jr.; Anderson, R.

2014-12-01

The Lower Colorado River Authority (LCRA) in Austin, Texas, manages the Highland Lakes reservoir system in Central Texas, a series of six lakes on the Lower Colorado River. This system provides water to approximately 1.1 million people in Central Texas, supplies hydropower to a 55-county area, supports rice farming along the Texas Gulf Coast, and sustains in-stream flows in the Lower Colorado River and freshwater inflows to Matagorda Bay. The current, prolonged drought conditions are severely taxing the LCRA's system, making allocation and management decisions exceptionally challenging, and affecting the ability of constituents to conduct proper planning. In this work, we further develop and evaluate season-ahead statistical streamflow and precipitation forecast models for integration into LCRA decision support models. Optimal forecast lead time, predictive skill, form, and communication are all considered.

[The health care system requires individuals to take more personal responsibility].

PubMed

Schaefer, Corinna; Weißbach, Lothar

2012-01-01

In the health care context, the phrase "personal responsibility" is frequently used as a euphemism for restricting publicly funded health care services. The concept of responsibility, however, primarily comprises the individual's own autonomous choices in consideration of their possible implications. In order to be able to act responsibly in respect to health care issues, the individual must rely on objective information about the possible consequences of his or her decision. The current profit-oriented competitive medical care environment prevents the distribution of objective information. A mutually supportive community benefits from its members acting responsibly, since citizens are capable of supporting themselves before they avail themselves of community support. This requires the State to respect the individual and his or her autonomous decision-making. If the community established rules as to what is considered a healthy lifestyle or even required people to adopt one, it would, to a large part, take away the citizens' autonomy and thus prevent them to assume responsibility. Copyright © 2012. Published by Elsevier GmbH.

ADESSA: A Real-Time Decision Support Service for Delivery of Semantically Coded Adverse Drug Event Data

PubMed Central

Duke, Jon D.; Friedlin, Jeff

2010-01-01

Evaluating medications for potential adverse events is a time-consuming process, typically involving manual lookup of information by physicians. This process can be expedited by CDS systems that support dynamic retrieval and filtering of adverse drug events (ADE’s), but such systems require a source of semantically-coded ADE data. We created a two-component system that addresses this need. First we created a natural language processing application which extracts adverse events from Structured Product Labels and generates a standardized ADE knowledge base. We then built a decision support service that consumes a Continuity of Care Document and returns a list of patient-specific ADE’s. Our database currently contains 534,125 ADE’s from 5602 product labels. An NLP evaluation of 9529 ADE’s showed recall of 93% and precision of 95%. On a trial set of 30 CCD’s, the system provided adverse event data for 88% of drugs and returned these results in an average of 620ms. PMID:21346964

Artificial intelligent decision support for low-cost launch vehicle integrated mission operations

NASA Astrophysics Data System (ADS)

Szatkowski, Gerard P.; Schultz, Roger

1988-11-01

The feasibility, benefits, and risks associated with Artificial Intelligence (AI) Expert Systems applied to low cost space expendable launch vehicle systems are reviewed. This study is in support of the joint USAF/NASA effort to define the next generation of a heavy-lift Advanced Launch System (ALS) which will provide economical and routine access to space. The significant technical goals of the ALS program include: a 10 fold reduction in cost per pound to orbit, launch processing in under 3 weeks, and higher reliability and safety standards than current expendables. Knowledge-based system techniques are being explored for the purpose of automating decision support processes in onboard and ground systems for pre-launch checkout and in-flight operations. Issues such as: satisfying real-time requirements, providing safety validation, hardware and Data Base Management System (DBMS) interfacing, system synergistic effects, human interfaces, and ease of maintainability, have an effect on the viability of expert systems as a useful tool.

Artificial intelligent decision support for low-cost launch vehicle integrated mission operations

NASA Technical Reports Server (NTRS)

Szatkowski, Gerard P.; Schultz, Roger

1988-01-01

The feasibility, benefits, and risks associated with Artificial Intelligence (AI) Expert Systems applied to low cost space expendable launch vehicle systems are reviewed. This study is in support of the joint USAF/NASA effort to define the next generation of a heavy-lift Advanced Launch System (ALS) which will provide economical and routine access to space. The significant technical goals of the ALS program include: a 10 fold reduction in cost per pound to orbit, launch processing in under 3 weeks, and higher reliability and safety standards than current expendables. Knowledge-based system techniques are being explored for the purpose of automating decision support processes in onboard and ground systems for pre-launch checkout and in-flight operations. Issues such as: satisfying real-time requirements, providing safety validation, hardware and Data Base Management System (DBMS) interfacing, system synergistic effects, human interfaces, and ease of maintainability, have an effect on the viability of expert systems as a useful tool.

Anticipatory Emotions in Decision Tasks: Covert Markers of Value or Attentional Processes?

PubMed Central

Davis, Tyler; Love, Bradley C.; Maddox, Todd

2009-01-01

Anticipatory emotions precede behavioral outcomes and provide a means to infer interactions between emotional and cognitive processes. A number of theories hold that anticipatory emotions serve as inputs to the decision process and code the value or risk associated with a stimulus. We argue that current data do not unequivocally support this theory. We present an alternative theory whereby anticipatory emotions reflect the outcome of a decision process and serve to ready the subject for new information when making an uncertain response. We test these two accounts, which we refer to as emotions-as-input and emotions-as-outcome, in a task that allows risky stimuli to be dissociated from uncertain responses. We find that emotions are associated with responses as opposed to stimuli. This finding is contrary to the emotions-as-input perspective as it shows that emotions arise from decision processes. PMID:19428002

Building Capacity to Use Earth Observations in Decision Making: A Case Study of NASA's DEVELOP National Program Methods and Best Practices

NASA Astrophysics Data System (ADS)

Childs-Gleason, L. M.; Ross, K. W.; Crepps, G.; Miller, T. N.; Favors, J. E.; Rogers, L.; Allsbrook, K. N.; Bender, M. R.; Ruiz, M. L.

2015-12-01

NASA's DEVELOP National Program fosters an immersive research environment for dual capacity building. Through rapid feasibility Earth science projects, the future workforce and current decision makers are engaged in research projects to build skills and capabilities to use Earth observation in environmental management and policy making. DEVELOP conducts over 80 projects annually, successfully building skills through partnerships with over 150 organizations and providing over 350 opportunities for project participants each year. Filling a void between short-term training courses and long-term research projects, the DEVELOP model has been successful in supporting state, local, federal and international government organizations to adopt methodologies and enhance decision making processes. This presentation will highlight programmatic best practices, feedback from participants and partner organizations, and three sample case studies of successful adoption of methods in the decision making process.

Creative Design of Digital Cognitive Games: Application of Cognitive Toys and Isomorphism

ERIC Educational Resources Information Center

Sedig, Kamran; Haworth, Robert

2012-01-01

Digital cognitive games (DCGs) are games whose primary purpose is to mediate (i.e., support, develop, and enhance) cognitive activities such as problem solving, decision making, planning, and critical reasoning. As these games increase in popularity and usage, more attention should be paid to their design. Currently, there is a lack of design…

Computer-based tools for decision support in agroforestry: Current state and future needs

Treesearch

E.A. Ellis; G. Bentrup; Michelle M. Schoeneberger

2004-01-01

Successful design of agroforestry practices hinges on the ability to pull together very diverse and sometimes large sets of information (i.e., biophysical, economic and social factors), and then implementing the synthesis of this information across several spatial scales from site to landscape. Agroforestry, by its very nature, creates complex systems with impacts...

Automation of peanut drying with a sensor network including an in-shell kernel moisture sensor

USDA-ARS?s Scientific Manuscript database

Peanut drying is an essential task in the processing and handling of peanuts. Peanuts leave the fields with kernel moisture contents > 20% wet basis and need to be dried to < 10.5% w.b. for grading and storage purposes. Current peanut drying processes utilize decision support software based on model...

Soil Quality Standards Monitoring Program administration and implementation

Treesearch

Randy L. Davis; Felipe Sanchez; Sharon DeHart

2010-01-01

Forest managers and resource scientists and specialists are engaged in a partnership to sustain the natural resource value of our national forests. Managers are faced with deciding which activities provide the best resource benefits with the least resource damage. Many, but not all, aspects of the decision process must be based on the science supporting our current...

Update on EPA’s ToxCast Program: Providing High Throughput Decision Support Tools for Chemical Risk Management

EPA Science Inventory

The field of toxicology is on the cusp of a major transformation in how the safety and hazard of chemicals are evaluated for potential effects on human health and the environment. Brought on by the recognition of the limitations of the current paradigm in terms of cost, time, and...

Talking high-tech turkey: USDA uses new software to analyze habitat management scenarios

Treesearch

H. Michael Rauscher; John E. Spearman; C. Preston Fout; Robert H. Giles; Mark J. Twery

2001-01-01

Researchers at the USDA Forest Service, Northeastern and Southern Research Stations, with many collaborators, have been developing a computer software product called the NED Decision Support System. This program is designed to help forestry consultants and their private landowner clients develop goals, assess current and potential conditions, provide ways to study and...

Interoceptive awareness moderates neural activity during decision-making.

PubMed

Werner, Natalie S; Schweitzer, Nicola; Meindl, Thomas; Duschek, Stefan; Kambeitz, Joseph; Schandry, Rainer

2013-12-01

The current study examined the relationship between conscious perception of somatic feedback (interoceptive awareness) and neural responses preceding decision-making. Previous research has suggested that decision-making is influenced by body signals from the periphery or the central representation of the periphery. Using event-related fMRI, participants whose interoceptive awareness was assessed using a heartbeat perception paradigm performed the Iowa Gambling Task. The results show a positive relationship between the degree of interoceptive awareness and selection related activity in the right anterior insula and the left postcentral gyrus. Neural activity within the right anterior insula was associated with decision-making performance only in individuals with accurate but not in those with non-accurate interoceptive awareness. These findings support the role of somatic feedback in decision-making processes. They indicate that the right anterior insula holds a representation of somatic markers and that these are more strongly processed with increased interoceptive awareness. Copyright © 2013 Elsevier B.V. All rights reserved.

Toward the Modularization of Decision Support Systems

NASA Astrophysics Data System (ADS)

Raskin, R. G.

2009-12-01

Decision support systems are typically developed entirely from scratch without the use of modular components. This “stovepiped” approach is inefficient and costly because it prevents a developer from leveraging the data, models, tools, and services of other developers. Even when a decision support component is made available, it is difficult to know what problem it solves, how it relates to other components, or even that the component exists, The Spatial Decision Support (SDS) Consortium was formed in 2008 to organize the body of knowledge in SDS within a common portal. The portal identifies the canonical steps in the decision process and enables decision support components to be registered, categorized, and searched. This presentation describes how a decision support system can be assembled from modular models, data, tools and services, based on the needs of the Earth science application.

CIRUN: Climate Information Responding to User Needs

NASA Astrophysics Data System (ADS)

Busalacchi, A. J.

2009-12-01

The Earth System will experience real climate change over the next 50 years, exceeding the scope of natural climate variability. A paramount question facing society is how to adapt to this certainty of climate variability and change. In response, OSTP and NOAA are considering how comprehensive climate services would best inform decisions about adaptation. Similarly, NASA is considering the optimal configuration of the next generation of Earth, environmental, and climate observations to be deployed over the coming 10-20 years. Moreover, much of the added-value information for specific climate-related decisions will be provided by private, academic and non-governmental organizations. In this context, over the past several years the University of Maryland has established the CIRUN (Climate Information: Responding to User Needs) initiative to identify the nature of national needs for climate information and services from a decision support perspective. To date, CIRUN has brought together decisionmakers in a number of sectors to help understand their perspectives on climate with the goal of improving the usefulness of climate information, observations and prediction products to specific user communities. CIRUN began with a major workshop in October 2007 that convened 430 participants in agriculture, parks and recreation, terrestrial ecosystems, insurance/investment, energy, national security, state/local/municipal, water, human health, commerce and manufacturing, transportation, and coastal/marine sectors. Plenary speakers such as Norman Augustine, R. James Woolsey, James Mahoney, and former Senator Joseph Tydings, breakout panel sessions, and participants provided input based on the following: - How would you characterize the exposure or vulnerability to climate variability or change impacting your organization? - Does climate variability and/or change currently factor into your organization's objectives or operations? - Are any of your existing plans being affected by climate or projections of climate change? - Is your organization developing a plan for adapting to climate change? - What are your needs for climate observations, predictions, and services? Please cite one or more specific examples when possible. - Do you currently have access to the climate information your organization needs? - What next steps are needed to assure effective use of climate services in your decision making? As a result, a dialogue with various user communities and a subsequent series of more sector specific workshops has been established regarding how significantly enhanced climate observations, data management, modeling, and predictions can provide valuable decision support for business and policy decisions. In particular, CIRUN has helped - To identify how users, stakeholders, and decision makers are influenced by climate on time scales from seasons to decades - To identify the needs and requirements of users, stakeholders, and decision makers for climate information, observations, predictions, and services from global to local scales - To identify what adaptation measures are being considered in the private and public sectors, and how this might result in new classes of information for decision support - To recommend principal elements of the path forward toward more effective use of climate services in decision making.

From products to processes: Academic events to foster interdisciplinary and iterative dialogue in a changing climate

NASA Astrophysics Data System (ADS)

Addor, Nans; Ewen, Tracy; Johnson, Leigh; Ćöltekin, Arzu; Derungs, Curdin; Muccione, Veruska

2015-08-01

In the context of climate change, both climate researchers and decision makers deal with uncertainties, but these uncertainties differ in fundamental ways. They stem from different sources, cover different temporal and spatial scales, might or might not be reducible or quantifiable, and are generally difficult to characterize and communicate. Hence, a mutual understanding between current and future climate researchers and decision makers must evolve for adaptation strategies and planning to progress. Iterative two-way dialogue can help to improve the decision making process by bridging current top-down and bottom-up approaches. One way to cultivate such interactions is by providing venues for these actors to interact and exchange on the uncertainties they face. We use a workshop-seminar series involving academic researchers, students, and decision makers as an opportunity to put this idea into practice and evaluate it. Seminars, case studies, and a round table allowed participants to reflect upon and experiment with uncertainties. An opinion survey conducted before and after the workshop-seminar series allowed us to qualitatively evaluate its influence on the participants. We find that the event stimulated new perspectives on research products and communication processes, and we suggest that similar events may ultimately contribute to the midterm goal of improving support for decision making in a changing climate. Therefore, we recommend integrating bridging events into university curriculum to foster interdisciplinary and iterative dialogue among researchers, decision makers, and students.

Designing Dynamic Adaptive Policy Pathways using Many-Objective Robust Decision Making

NASA Astrophysics Data System (ADS)

Kwakkel, Jan; Haasnoot, Marjolijn

2017-04-01

Dealing with climate risks in water management requires confronting a wide variety of deeply uncertain factors, while navigating a many dimensional space of trade-offs amongst objectives. There is an emerging body of literature on supporting this type of decision problem, under the label of decision making under deep uncertainty. Two approaches within this literature are Many-Objective Robust Decision Making, and Dynamic Adaptive Policy Pathways. In recent work, these approaches have been compared. One of the main conclusions of this comparison was that they are highly complementary. Many-Objective Robust Decision Making is a model based decision support approach, while Dynamic Adaptive Policy Pathways is primarily a conceptual framework for the design of flexible strategies that can be adapted over time in response to how the future is actually unfolding. In this research we explore this complementarity in more detail. Specifically, we demonstrate how Many-Objective Robust Decision Making can be used to design adaptation pathways. We demonstrate this combined approach using a water management problem, in the Netherlands. The water level of Lake IJselmeer, the main fresh water resource of the Netherlands, is currently managed through discharge by gravity. Due to climate change, this won't be possible in the future, unless water levels are changed. Changing the water level has undesirable flood risk and spatial planning consequences. The challenge is to find promising adaptation pathways that balance objectives related to fresh water supply, flood risk, and spatial issues, while accounting for uncertain climatic and land use change. We conclude that the combination of Many-Objective Robust Decision Making and Dynamic Adaptive Policy Pathways is particularly suited for dealing with deeply uncertain climate risks.

The relationship between patient data and pooled clinical management decisions.

PubMed

Ludbrook, G I; O'Loughlin, E J; Corcoran, T B; Grant, C

2013-01-01

A strong relationship between patient data and preoperative clinical decisions could potentially be used to support clinical decisions in preoperative management. The aim of this exploratory study was to determine the relationship between key patient data and pooled clinical opinions on management. In a previous study, panels of anaesthetists compared the quality of computer-assisted patient health assessments with outpatient consultations and made decisions on the need for preoperative tests, no preoperative outpatient assessment, possible postoperative intensive care unit/high dependency unit requirements and aspiration prophylaxis. In the current study, the relationship between patient data and these decisions was examined using binomial logistic regression analysis. Backward stepwise regression was used to identify independent predictors of each decision (at P >0.15), which were then incorporated into a predictive model. The number of factors related to each decision varied: blood picture (four factors), biochemistry (six factors), coagulation studies (three factors), electrocardiography (eight factors), chest X-ray (seven factors), preoperative outpatient assessment (17 factors), intensive care unit requirement (eight factors) and aspiration prophylaxis (one factor). The factor types also varied, but included surgical complexity, age, gender, number of medications or comorbidities, body mass index, hypertension, central nervous system condition, heart disease, sleep apnoea, smoking, persistent pain and stroke. Models based on these relationships usually demonstrated good sensitivity and specificity, with receiver operating characteristics in the following areas under curve: blood picture (0.75), biochemistry (0.86), coagulation studies (0.71), electrocardiography (0.90), chest X-ray (0.85), outpatient assessment (0.85), postoperative intensive care unit requirement (0.88) and aspiration prophylaxis (0.85). These initial results suggest modelling of patient data may have utility supporting clinicians' preoperative decisions.

Comparisons of guardianship laws and surrogate decision-making practices in China, Japan, Thailand and Australia: a review by the Asia Consortium, International Psychogeriatric Association (IPA) capacity taskforce.

PubMed

Tsoh, Joshua; Peisah, Carmelle; Narumoto, Jin; Wongpakaran, Nahathai; Wongpakaran, Tinakon; O'Neill, Nick; Jiang, Tao; Ogano, Shoichi; Mimura, Masaru; Kato, Yuka; Chiu, Helen

2015-06-01

The International Psychogeriatric Association (IPA) capacity taskforce was established to promote the autonomy, proper access to care, and dignity of persons with decision-making disabilities (DMDs) across nations. The Asia Consortium of the taskforce was established to pursue these goals in the Asia-Pacific region. This paper is part of the Asia Consortium's initiative to promote understanding and advocacy in regard to surrogate decision-making across the region. The current guardianship laws are compared, and jurisdictional variations in the processes for proxy decision-making to support persons with DMDs and other health and social needs in China, Japan, Thailand, and Australia are explored. The different Asia-Pacific countries have various proxy decision-making mechanisms in place for persons with DMDs, which are both formalized according to common law, civil law, and other legislation, and shaped by cultural practices. Various processes for guardianship and mechanisms for medical decision-making and asset management exist across the region. Processes that are still evolving across the region include those that facilitate advanced planning as a result of the paucity of legal structures for enduring powers of attorney (EPA) and guardianship in some regions, and the struggle to achieve consensual positions in regard to end-of-life decision-making. Formal processes for supporting decision-making are yet to be developed. The diverse legal approaches to guardianship and administration must be understood to meet the challenges of the rapidly ageing population in the Asia-Pacific region. Commonalities in the solutions and difficulties faced in encountering these challenges have global significance.

Primum Non Nocere: is shared decision-making the answer?

PubMed

Santhirapala, Ramai; Moonesinghe, Ramani

2016-01-01

Surgical ambition is rising, with the Royal College of Surgeons reporting an increase in the number of procedures by a million over the past decade (Royal College of Surgeons. Surgery and the NHS in Numbers. Available from https://www.rcseng.ac.uk). Underpinning, this is a rapidly growing population, especially those in the over 85 age group, coupled with rising perioperative expertise; options for surgery are now present where conditions were once managed conservatively. Matching the right patient to the right procedure has never been so pertinent (Bader, Am Soc Anesthesiol 78(6), 2014). At the heart of these increasingly complex decisions, which may prove fatal or result in serious morbidity, lies the aspiration of shared decision-making (SDM) (Glance et al., N Engl J Med 370:1379-81, 2014). Shared decision-making is a patient-centred approach taking into account the beliefs, preferences and views of the patient as an expert in what is right for them, supported by clinicians who are the experts in diagnostics and valid therapeutic options (Coulter and Collins, Making shared decision-making a reality: no decision about me, without me, 2011). It has been described as the pinnacle of patient-centred care (Barry et al., N Engl J Med 366:780-1, 2012). In this commentary, we explore further the concept of shared decision-making, supported by a recent article which highlights critical deficits in current perioperative practice (Ankuda et al., Patient Educ Couns 94(3):328-33, 2014). This article was chosen for the purposes of this commentary as it is a large study across several surgical specialties investigating preoperative shared decision-making, and to our knowledge, the only of this kind.

Preemptive Clinical Pharmacogenetics Implementation: Current programs in five United States medical centers

PubMed Central

Dunnenberger, Henry M.; Crews, Kristine R.; Hoffman, James M.; Caudle, Kelly E.; Broeckel, Ulrich; Howard, Scott C.; Hunkler, Robert J.; Klein, Teri E.; Evans, William E.; Relling, Mary V.

2015-01-01

Although the field of pharmacogenetics has existed for decades, the implementation of, pharmacogenetic testing in clinical care has been slow. There are numerous publications, describing the barriers to clinical implementation of pharmacogenetics. Recently, several freely, available resources have been developed to help address these barriers. In this review we, discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of, patients. Array-based preemptive testing includes a large number of relevant pharmacogenes, that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to, be available prior to any prescribing decision so that genomic variation may be considered as, an inherent patient characteristic in the planning of therapy. This review describes the common, elements among programs that have implemented preemptive genotyping and highlights key, processes for implementation, including clinical decision support. PMID:25292429

Equilibrium approach towards water resource management and pollution control in coal chemical industrial park.

PubMed

Xu, Jiuping; Hou, Shuhua; Xie, Heping; Lv, Chengwei; Yao, Liming

2018-08-01

In this study, an integrated water and waste load allocation model is proposed to assist decision makers in better understanding the trade-offs between economic growth, resource utilization, and environmental protection of coal chemical industries which characteristically have high water consumption and pollution. In the decision framework, decision makers in a same park, each of whom have different goals and preferences, work together to seek a collective benefit. Similar to a Stackelberg-Nash game, the proposed approach illuminates the decision making interrelationships and involves in the conflict coordination between the park authority and the individual coal chemical company stockholders. In the proposed method, to response to climate change and other uncertainties, a risk assessment tool, Conditional Value-at-Risk (CVaR) and uncertainties through reflecting parameters and coefficients using probability and fuzzy set theory are integrated in the modeling process. Then a case study from Yuheng coal chemical park is presented to demonstrate the practicality and efficiency of the optimization model. To reasonable search the potential consequences of different responses to water and waste load allocation strategies, a number of scenario results considering environmental uncertainty and decision maker' attitudes are examined to explore the tradeoffs between economic development and environmental protection and decision makers' objectives. The results are helpful for decision/police makers to adjust current strategies adapting for current changes. Based on the scenario analyses and discussion, some propositions and operational policies are given and sensitive adaptation strategies are presented to support the efficient, balanced and sustainable development of coal chemical industrial parks. Copyright © 2018 Elsevier Ltd. All rights reserved.

Corporate dashboard for payphone service

NASA Astrophysics Data System (ADS)

Siraj, Fadzilah; Shadan, Hezlin

2015-12-01

Making assured that managements are kept abreast of what is happening in the company is not an easy task. The quantity of data generated by the business process is astonishing large and non-centralized. The challenge facing business organizations is how to extract, load, transform data, and then deliver useful information to key decision makers. The major challenge for the payphone industries is in making a good decision, particularly to increase quality of service, customer satisfaction while achieving high revenue. With current practice, the process is very time consuming and therefore, a systematic and informative corporate dashboard needs to be provided especially for managerial level in supporting their decision making process. This paper proposed a dashboard application design that provides a single-screen display of relevant information such as the phone performance and coin collection reports, as well as generated revenue to enable faster and more effective decision making. The development of the dashboard is divided into requirement, design and implementation phases. The implementation using real data has demonstrated the potential use of the dashboard. The evaluation results indicate that the dashboard can be used as a tool that can support payphone operation works and decision process by providing the analytical analysis of the KPI report and the performance status. In addition, the results can be used as a guideline for the dashboard developer to understand the process and focuses on the key elements and the principle in designing the effective dashboard.

Deciding Where to Turn: A Qualitative Investigation of College Students' Helpseeking Decisions After Sexual Assault.

PubMed

DeLoveh, Heidi L M; Cattaneo, Lauren Bennett

2017-03-01

Sexual assault is a widespread problem on college campuses that has been the subject of substantial attention in recent years (Ali, 2011; Krebs, Lindquist, Berzofsky, Shook-Sa, & Peterson, 2016). Resources designed to address the problem exist, but there is evidence that they are underutilized by survivors (Campbell, 2008). The current study used grounded theory to explore how sexual assault survivors make decisions about helpseeking. In-depth interviews were conducted with 14 college sexual assault survivors to develop a theoretical model for their decision-making process. The resulting model, Deciding Where to Turn, suggests that survivors engage in three key decision points: determining if there is a problem related to the sexual assault (Do I Need Help), considering options (What Can I Do), and weighing the consequences of these options (What Will I Do). This process results in one of four behavioral choices: cope on one's own, seek support from friends/family, seek support from formal resources, or covert helpseeking, where needs are met without disclosure. Deciding Where to Turn contributes to the literature by providing a framework for understanding helpseeking decisions after sexual assault, highlighting the need to match reactions to survivor perceptions. The concept of covert helpseeking in particular adds to the way researchers and practitioners think about helpseeking. Research and practice implications are discussed. © Society for Community Research and Action 2017.

How to guide - transit operations decision support systems (TODSS).

DOT National Transportation Integrated Search

2014-12-01

Transit Operations Decision Support Systems (TODSS) are decision support systems designed to support dispatchers in real-time bus operations management in response to incidents, special events, and other changing conditions in order to restore servic...

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

Dyadic OPTION: Measuring perceptions of shared decision-making in practice.

PubMed

Melbourne, Emma; Roberts, Stephen; Durand, Marie-Anne; Newcombe, Robert; Légaré, France; Elwyn, Glyn

2011-04-01

Current models of the medical consultation emphasize shared decision-making (SDM), whereby the expertise of both the doctor and the patient are recognised and seen to equally contribute to the consultation. The evidence regarding the desirability and effectiveness of the SDM approach is often conflicting. It is proposed that the conflicts are due to the nature of assessment, with current assessments from the perspective of an outside observer. To empirically assess perceived involvement in the medical consultation using the dyadic OPTION instrument. 36 simulated medical consultations were organised between general practitioners and standardized- patients, using the observer OPTION and the newly developed dyadic OPTION instruments. SDM behaviours observed in the consultations were seen to depend on both members of the doctor and patient dyad, rather than each in isolation. Thus a dyadic approach to measurement is supported. This current study highlights the necessity for a dyadic approach to assessment and introduces a novel research instrument: the dyadic OPTION instrument. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Modeling approaches for characterizing and evaluating environmental exposure to engineered nanomaterials in support of risk-based decision making.

PubMed

Hendren, Christine Ogilvie; Lowry, Michael; Grieger, Khara D; Money, Eric S; Johnston, John M; Wiesner, Mark R; Beaulieu, Stephen M

2013-02-05

As the use of engineered nanomaterials becomes more prevalent, the likelihood of unintended exposure to these materials also increases. Given the current scarcity of experimental data regarding fate, transport, and bioavailability, determining potential environmental exposure to these materials requires an in depth analysis of modeling techniques that can be used in both the near- and long-term. Here, we provide a critical review of traditional and emerging exposure modeling approaches to highlight the challenges that scientists and decision-makers face when developing environmental exposure and risk assessments for nanomaterials. We find that accounting for nanospecific properties, overcoming data gaps, realizing model limitations, and handling uncertainty are key to developing informative and reliable environmental exposure and risk assessments for engineered nanomaterials. We find methods suited to recognizing and addressing significant uncertainty to be most appropriate for near-term environmental exposure modeling, given the current state of information and the current insufficiency of established deterministic models to address environmental exposure to engineered nanomaterials.

[Shared decision-making in mental health care: a role model from youth mental health care].

PubMed

Westermann, G M A; Maurer, J M G

2015-01-01

In the communication and interaction between doctor and patient in Western health care there has been a paradigm shift from the paternalistic approach to shared decision-making. To summarise the background situation, recent developments and the current level of shared decision-making in (youth) mental health care. We conducted a critical review of the literature relating to the methodology development, research and the use of counselling and decision-making in mental health care. The majority of patients, professionals and other stakeholders consider shared decision-making to be desirable and important for improving the quality and efficiency of care. Up till recently most research and studies have concentrated on helping patients to develop decision-making skills and on showing patients how and where to access information. At the moment more attention is being given to the development of skills and circumstances that will increase patients' interaction with care professionals and patients' emotional involvement in shared decision-making. In mental health for children and adolescents, more often than in adult mental health care, it has been customary to give more attention to these aspects of shared decision-making, particularly during counselling sessions that mark the transition from diagnosis to treatment. This emphasis has been apparent for a long time in textbooks, daily practice, methodology development and research in youth mental health care. Currently, a number of similar developments are taking place in adult mental health care. Although most health professionals support the policy of shared decision-making, the implementation of the policy in mental health care is still at an early stage. In practice, a number of obstacles still have to be surmounted. However, the experience gained with counselling and decision-making in (youth) mental health care may serve as an example to other sections of mental health care and play an important role in the further development of shared decision-making.

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

PubMed

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

2017-11-25

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

CorRECTreatment: A Web-based Decision Support Tool for Rectal Cancer Treatment that Uses the Analytic Hierarchy Process and Decision Tree

PubMed Central

Karakülah, G.; Dicle, O.; Sökmen, S.; Çelikoğlu, C.C.

2015-01-01

Summary Background The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians’ decision making. Objective The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. Methods The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. Results In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. Conclusions The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options. PMID:25848413

CorRECTreatment: a web-based decision support tool for rectal cancer treatment that uses the analytic hierarchy process and decision tree.

PubMed

Suner, A; Karakülah, G; Dicle, O; Sökmen, S; Çelikoğlu, C C

2015-01-01

The selection of appropriate rectal cancer treatment is a complex multi-criteria decision making process, in which clinical decision support systems might be used to assist and enrich physicians' decision making. The objective of the study was to develop a web-based clinical decision support tool for physicians in the selection of potentially beneficial treatment options for patients with rectal cancer. The updated decision model contained 8 and 10 criteria in the first and second steps respectively. The decision support model, developed in our previous study by combining the Analytic Hierarchy Process (AHP) method which determines the priority of criteria and decision tree that formed using these priorities, was updated and applied to 388 patients data collected retrospectively. Later, a web-based decision support tool named corRECTreatment was developed. The compatibility of the treatment recommendations by the expert opinion and the decision support tool was examined for its consistency. Two surgeons were requested to recommend a treatment and an overall survival value for the treatment among 20 different cases that we selected and turned into a scenario among the most common and rare treatment options in the patient data set. In the AHP analyses of the criteria, it was found that the matrices, generated for both decision steps, were consistent (consistency ratio<0.1). Depending on the decisions of experts, the consistency value for the most frequent cases was found to be 80% for the first decision step and 100% for the second decision step. Similarly, for rare cases consistency was 50% for the first decision step and 80% for the second decision step. The decision model and corRECTreatment, developed by applying these on real patient data, are expected to provide potential users with decision support in rectal cancer treatment processes and facilitate them in making projections about treatment options.

Energy Decision Science and Informatics | Integrated Energy Solutions |

Science.gov Websites

Science Advanced decision science methods include multi-objective and multi-criteria decision support. Our decision science methods, including multi-objective and multi-criteria decision support. For example, we

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

PubMed Central

2018-01-01

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

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

PubMed

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

2018-01-01

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

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed

Martinez, Kathryn A; Resnicow, Ken; Williams, Geoffrey C; Silva, Marlene; Abrahamse, Paul; Shumway, Dean A; Wallner, Lauren P; Katz, Steven J; Hawley, Sarah T

2016-12-01

Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Among the 1690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Autonomy-supportive communication by cancer doctors can improve patients' perceived decision quality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does physician communication style impact patient report of decision quality for breast cancer treatment?

PubMed Central

Resnicow, Ken; Williams, Geoffrey C.; Silva, Marlene; Abrahamse, Paul; Shumway, Dean; Wallner, Lauren; Katz, Steven; Hawley, Sarah

2016-01-01

Objective Provider communication that supports patient autonomy has been associated with numerous positive patient outcomes. However, to date, no research has examined the relationship between perceived provider communication style and patient-assessed decision quality in breast cancer. Methods Using a population-based sample of women with localized breast cancer, we assessed patient perceptions of autonomy-supportive communication from their surgeons and medical oncologists, as well as patient-reported decision quality. We used multivariable linear regression to examine the association between autonomy-supportive communication and subjective decision quality for surgery and chemotherapy decisions, controlling for sociodemographic and clinical factors, as well as patient-reported communication preference (non-directive or directive). Results Among the 1,690 women included in the overall sample, patient-reported decision quality scores were positively associated with higher levels of perceived autonomy-supportive communication from surgeons (β=0.30; p<0.001) and medical oncologists (β=0.26; p<0.001). Patient communication style preference moderated the association between physician communication style received and perceived decision quality. Conclusion Autonomy-supportive communication by physicians was associated with higher subjective decision quality among women with localized breast cancer. These results support future efforts to design interventions that enhance autonomy-supportive communication. Practice Implications Autonomy-supportive communication by cancer doctors can improve patients’ perceived decision quality. PMID:27395750

Implementation of workflow engine technology to deliver basic clinical decision support functionality

PubMed Central

2011-01-01

Background Workflow engine technology represents a new class of software with the ability to graphically model step-based knowledge. We present application of this novel technology to the domain of clinical decision support. Successful implementation of decision support within an electronic health record (EHR) remains an unsolved research challenge. Previous research efforts were mostly based on healthcare-specific representation standards and execution engines and did not reach wide adoption. We focus on two challenges in decision support systems: the ability to test decision logic on retrospective data prior prospective deployment and the challenge of user-friendly representation of clinical logic. Results We present our implementation of a workflow engine technology that addresses the two above-described challenges in delivering clinical decision support. Our system is based on a cross-industry standard of XML (extensible markup language) process definition language (XPDL). The core components of the system are a workflow editor for modeling clinical scenarios and a workflow engine for execution of those scenarios. We demonstrate, with an open-source and publicly available workflow suite, that clinical decision support logic can be executed on retrospective data. The same flowchart-based representation can also function in a prospective mode where the system can be integrated with an EHR system and respond to real-time clinical events. We limit the scope of our implementation to decision support content generation (which can be EHR system vendor independent). We do not focus on supporting complex decision support content delivery mechanisms due to lack of standardization of EHR systems in this area. We present results of our evaluation of the flowchart-based graphical notation as well as architectural evaluation of our implementation using an established evaluation framework for clinical decision support architecture. Conclusions We describe an implementation of a free workflow technology software suite (available at http://code.google.com/p/healthflow) and its application in the domain of clinical decision support. Our implementation seamlessly supports clinical logic testing on retrospective data and offers a user-friendly knowledge representation paradigm. With the presented software implementation, we demonstrate that workflow engine technology can provide a decision support platform which evaluates well against an established clinical decision support architecture evaluation framework. Due to cross-industry usage of workflow engine technology, we can expect significant future functionality enhancements that will further improve the technology's capacity to serve as a clinical decision support platform. PMID:21477364

An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records.

PubMed

Müller-Staub, Maria; de Graaf-Waar, Helen; Paans, Wolter

2016-11-01

Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.

Developing an electronic health record (EHR) for methadone treatment recording and decision support

PubMed Central

2011-01-01

Background In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. Methods A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. Results The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. Conclusions The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. PMID:21284849

PopHR: a knowledge-based platform to support integration, analysis, and visualization of population health data.

PubMed

Shaban-Nejad, Arash; Lavigne, Maxime; Okhmatovskaia, Anya; Buckeridge, David L

2017-01-01

Population health decision makers must consider complex relationships between multiple concepts measured with differential accuracy from heterogeneous data sources. Population health information systems are currently limited in their ability to integrate data and present a coherent portrait of population health. Consequentially, these systems can provide only basic support for decision makers. The Population Health Record (PopHR) is a semantic web application that automates the integration and extraction of massive amounts of heterogeneous data from multiple distributed sources (e.g., administrative data, clinical records, and survey responses) to support the measurement and monitoring of population health and health system performance for a defined population. The design of the PopHR draws on the theories of the determinants of health and evidence-based public health to harmonize and explicitly link information about a population with evidence about the epidemiology and control of chronic diseases. Organizing information in this manner and linking it explicitly to evidence is expected to improve decision making related to the planning, implementation, and evaluation of population health and health system interventions. In this paper, we describe the PopHR platform and discuss the architecture, design, key modules, and its implementation and use. © 2016 New York Academy of Sciences.

Which species? A decision-support tool to guide plant selection in stormwater biofilters

NASA Astrophysics Data System (ADS)

Payne, Emily G. I.; Pham, Tracey; Deletic, Ana; Hatt, Belinda E.; Cook, Perran L. M.; Fletcher, Tim D.

2018-03-01

Plant species are diverse in form, function and environmental response. This provides enormous potential for designing nature-based stormwater treatment technologies, such as biofiltration systems. However, species can vary dramatically in their pollutant-removal performance, particularly for nitrogen removal. Currently, there is a lack of information on how to efficiently select from the vast palette of species. This study aimed to identify plant traits beneficial to performance and create a decision-support tool to screen species for further testing. A laboratory experiment using 220 biofilter columns paired plant morphological characteristics with nitrogen removal and water loss for 20 Australian native species and two lawn grasses. Testing was undertaken during wet and dry conditions, for two biofilter designs (saturated zone and free-draining). An extensive root system and high total biomass were critical to the effective removal of total nitrogen (TN) and nitrate (NO3-), driven by high nitrogen assimilation. The same characteristics were key to performance under dry conditions, and were associated with high water use for Australian native plants; linking assimilation and transpiration. The decision-support tool uses these scientific relationships and readily-available information to identify the morphology, natural distribution and stress tolerances likely to be good predictors of plant nitrogen and water uptake.

The Effects of Perceptions of Organizational Structure on Job Involvement, Job Satisfaction, and Organizational Commitment Among Indian Police Officers.

PubMed

Lambert, Eric G; Qureshi, Hanif; Klahm, Charles; Smith, Brad; Frank, James

2017-12-01

Successful police organizations rely on involved, satisfied, and committed workers. The concepts of job involvement (i.e., connection with the job), job satisfaction (i.e., affective feeling toward the job), and organizational commitment (i.e., bond with the employing organization) have been shown to significantly affect intentions and behaviors of employees. The current study used multivariate ordinary least squares (OLS) regression analysis on survey results from a sample of 827 Indian police officers to explore how perceptions of work environment factors affect officers' job involvement, job satisfaction, and organizational commitment. Organizational support, formalization (i.e., level of codified written rules and guidelines), promotional opportunities, institutional communication (i.e., salient work information is transmitted), and input into decision-making (i.e., having a voice in the process) significantly influenced the job involvement, job satisfaction, and organizational commitment of Indian police officers. Specifically, in the multivariate analysis, perceptions of formalization and instrumental communication had a positive relationship with job involvement; perceptions of organizational support, promotional opportunities, instrumental communication, and input into decision-making had positive associations with job satisfaction; and perceptions of organizational support, formalization, promotional opportunities, instrumental communication, and input into decision-making had positive relationships with organizational commitment.

Are electronic health records ready for genomic medicine?

PubMed

Scheuner, Maren T; de Vries, Han; Kim, Benjamin; Meili, Robin C; Olmstead, Sarah H; Teleki, Stephanie

2009-07-01

The goal of this project was to assess genetic/genomic content in electronic health records. Semistructured interviews were conducted with key informants. Questions addressed documentation, organization, display, decision support and security of family history and genetic test information, and challenges and opportunities relating to integrating genetic/genomics content in electronic health records. There were 56 participants: 10 electronic health record specialists, 18 primary care clinicians, 16 medical geneticists, and 12 genetic counselors. Few clinicians felt their electronic record met their current genetic/genomic medicine needs. Barriers to integration were mostly related to problems with family history data collection, documentation, and organization. Lack of demand for genetics content and privacy concerns were also mentioned as challenges. Data elements and functionality requirements that clinicians see include: pedigree drawing; clinical decision support for familial risk assessment and genetic testing indications; a patient portal for patient-entered data; and standards for data elements, terminology, structure, interoperability, and clinical decision support rules. Although most said that there is little impact of genetics/genomics on electronic records today, many stated genetics/genomics would be a driver of content in the next 5-10 years. Electronic health records have the potential to enable clinical integration of genetic/genomic medicine and improve delivery of personalized health care; however, structured and standardized data elements and functionality requirements are needed.

Environmental risk management for radiological accidents: integrating risk assessment and decision analysis for remediation at different spatial scales.

PubMed

Yatsalo, Boris; Sullivan, Terrence; Didenko, Vladimir; Linkov, Igor

2011-07-01

The consequences of the Tohuku earthquake and subsequent tsunami in March 2011 caused a loss of power at the Fukushima Daiichi nuclear power plant, in Japan, and led to the release of radioactive materials into the environment. Although the full extent of the contamination is not currently known, the highly complex nature of the environmental contamination (radionuclides in water, soil, and agricultural produce) typical of nuclear accidents requires a detailed geospatial analysis of information with the ability to extrapolate across different scales with applications to risk assessment models and decision making support. This article briefly summarizes the approach used to inform risk-based land management and remediation decision making after the Chernobyl, Soviet Ukraine, accident in 1986. Copyright © 2011 SETAC.

Choice and Control Within Family Relationships: The Lived Experience of Adults With Intellectual Disability.

PubMed

Curryer, Bernadette; Stancliffe, Roger J; Dew, Angela; Wiese, Michele Y

2018-06-01

Increased choice and control is a driving force of current disability policy in Australia for people with disability and their families. Yet little is known of how adults with intellectual disability (ID) actually experience choice and control within their family relationships. We used interpretative phenomenological analysis of individual, semistructured interviews conducted with 8 Australian adults with ID to understand the meaning given to their experience of family support received around choice and decision making. Three themes were identified: (1) centrality of family, (2) experience of self-determination, and (3) limitations to choice and control. The participants identified trusted family members from whom guidance around choice and decision making was both sought and received, often involving mutual decision making and limitations to control.

Study on optimized decision-making model of offshore wind power projects investment

NASA Astrophysics Data System (ADS)

Zhao, Tian; Yang, Shangdong; Gao, Guowei; Ma, Li

2018-02-01

China’s offshore wind energy is of great potential and plays an important role in promoting China’s energy structure adjustment. However, the current development of offshore wind power in China is inadequate, and is much less developed than that of onshore wind power. On the basis of considering all kinds of risks faced by offshore wind power development, an optimized model of offshore wind power investment decision is established in this paper by proposing the risk-benefit assessment method. To prove the practicability of this method in improving the selection of wind power projects, python programming is used to simulate the investment analysis of a large number of projects. Therefore, the paper is dedicated to provide decision-making support for the sound development of offshore wind power industry.

Localized prostate cancer treatment decision-making information online: improving its effectiveness and dissemination for nonprofit and government-supported organizations.

PubMed

Silk, Kami J; Perrault, Evan K; Nazione, Samantha; Pace, Kristin; Hager, Polly; Springer, Steven

2013-12-01

The current study reports findings from evaluation research conducted to identify how online prostate cancer treatment decision-making information can be both improved and more effectively disseminated to those who need it most. A multi-method, multi-target approach was used and guided by McGuire's Communication Matrix Model. Focus groups (n = 31) with prostate cancer patients and their family members, and in-depth interviews with physicians (n = 8), helped inform a web survey (n = 89). Results indicated that physicians remain a key information source for medical advice and the Internet is a primary channel used to help make informed prostate cancer treatment decisions. Participants reported a need for more accessible information related to treatment options and treatment side effects. Additionally, physicians indicated that the best way for agencies to reach them with new information to deliver to patients is by contacting them directly and meeting with them one-on-one. Advice for organizations to improve their current prostate cancer web offerings and further ways to improve information dissemination are discussed.

Military Medical Decision Support for Homeland Defense During Emergency

DTIC Science & Technology

2004-12-01

abstraction hierarchy, three levels of information requirement for designing emergency training interface are recognized. These are epistemological ...support human decision making process is considered to be decision-centric. A typical decision-centric interface is supported by at least four design ... Designing Emergency Training Interface ......................................................................................... 5 Epistemological

Strategies to support drug discovery through integration of systems and data.

PubMed

Waller, Chris L; Shah, Ajay; Nolte, Matthias

2007-08-01

Much progress has been made over the past several years to provide technologies for the integration of drug discovery software applications and the underlying data bits. Integration at the application layer has focused primarily on developing and delivering applications that support specific workflows within the drug discovery arena. A fine balance between creating behemoth applications and providing business value must be maintained. Heterogeneous data sources have typically been integrated at the data level in an effort to provide a more holistic view of the data packages supporting key decision points. This review will highlight past attempts, current status, and potential future directions for systems and data integration strategies in support of drug discovery efforts.

Solutions Network Formulation Report: Improving NOAA's PORTS(R) Through Enhanced Data Inputs from NASA's Ocean Surface Topography Mission

NASA Technical Reports Server (NTRS)

Guest, DeNeice

2007-01-01

The Nation uses water-level data for a variety of practical purposes, including nautical charting, maritime navigation, hydrography, coastal engineering, and tsunami and storm surge warnings. Long-term applications include marine boundary determinations, tidal predictions, sea-level trend monitoring, oceanographic research, and climate research. Accurate and timely information concerning sea-level height, tide, and ocean current is needed to understand their impact on coastal management, disaster management, and public health. Satellite altimeter data products are currently used by hundreds of researchers and operational users to monitor ocean circulation and to improve scientists understanding of the role of the oceans in climate and weather. The NOAA (National Oceanic and Atmospheric Administration) National Ocean Service has been monitoring sea-level variations for many years. NOAA s PORTS (Physical Oceanographic Real-Time System) DST (decision support tool), managed by the Center for Operational Oceanographic Products and Services, supports safe and cost-efficient navigation by providing ship masters and pilots with accurate real-time information required to avoid groundings and collisions. This report assesses the capacity of NASA s satellite altimeter data to meet societal decision support needs through incorporation into NOAA s PORTS. NASA has a long heritage of collecting data for ocean research, including its current Terra and Aqua missions. Numerous other missions provide additional important information for coastal management issues, and data collection will continue in the coming decade with such missions as the OSTM (Ocean Surface Topography Mission). OSTM will provide data on sea-surface heights for determining ocean circulation, climate change, and sea-level rise. We suggest that NASA incorporate OSTM altimeter data (C- and Ku-band) into NOAA s PORTS DST in support of NASA s Coastal Management National Application with secondary support to the Disaster Management and Public Health National Applications.

Creation of an Open Framework for Point-of-Care Computer-Assisted Reporting and Decision Support Tools for Radiologists.

PubMed

Alkasab, Tarik K; Bizzo, Bernardo C; Berland, Lincoln L; Nair, Sujith; Pandharipande, Pari V; Harvey, H Benjamin

2017-09-01

Decreasing unnecessary variation in radiology reporting and producing guideline-concordant reports is fundamental to radiology's success in value-based payment models and good for patient care. In this article, we present an open authoring system for point-of-care clinical decision support tools integrated into the radiologist reporting environment referred to as the computer-assisted reporting and decision support (CAR/DS) framework. The CAR/DS authoring system, described herein, includes: (1) a definition format for representing radiology clinical guidelines as structured, machine-readable Extensible Markup Language documents and (2) a user-friendly reference implementation to test the fidelity of the created definition files with the clinical guideline. The proposed definition format and reference implementation will enable content creators to develop CAR/DS tools that voice recognition software (VRS) vendors can use to extend the commercial tools currently in use. In making the definition format and reference implementation software freely available, we hope to empower individual radiologists, expert groups such as the ACR, and VRS vendors to develop a robust ecosystem of CAR/DS tools that can further improve the quality and efficiency of the patient care that our field provides. We hope that this initial effort can serve as the basis for a community-owned open standard for guideline definition that the imaging informatics and VRS vendor communities will embrace and strengthen. To this end, the ACR Assist™ initiative is intended to make the College's clinical content, including the Incidental Findings Committee White Papers, available for decision support tool creation based upon the herein described CAR/DS framework. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Comparing multi-criteria decision analysis and integrated assessment to support long-term water supply planning

PubMed Central

Maurer, Max; Lienert, Judit

2017-01-01

We compare the use of multi-criteria decision analysis (MCDA)–or more precisely, models used in multi-attribute value theory (MAVT)–to integrated assessment (IA) models for supporting long-term water supply planning in a small town case study in Switzerland. They are used to evaluate thirteen system scale water supply alternatives in four future scenarios regarding forty-four objectives, covering technical, social, environmental, and economic aspects. The alternatives encompass both conventional and unconventional solutions and differ regarding technical, spatial and organizational characteristics. This paper focuses on the impact assessment and final evaluation step of the structured MCDA decision support process. We analyze the performance of the alternatives for ten stakeholders. We demonstrate the implications of model assumptions by comparing two IA and three MAVT evaluation model layouts of different complexity. For this comparison, we focus on the validity (ranking stability), desirability (value), and distinguishability (value range) of the alternatives given the five model layouts. These layouts exclude or include stakeholder preferences and uncertainties. Even though all five led us to identify the same best alternatives, they did not produce identical rankings. We found that the MAVT-type models provide higher distinguishability and a more robust basis for discussion than the IA-type models. The needed complexity of the model, however, should be determined based on the intended use of the model within the decision support process. The best-performing alternatives had consistently strong performance for all stakeholders and future scenarios, whereas the current water supply system was outperformed in all evaluation layouts. The best-performing alternatives comprise proactive pipe rehabilitation, adapted firefighting provisions, and decentralized water storage and/or treatment. We present recommendations for possible ways of improving water supply planning in the case study and beyond. PMID:28481881

Semantic Clinical Guideline Documents

PubMed Central

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

2005-01-01

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

Looking at CER from Medicare's perspective.

PubMed

Mohr, Penny

2012-05-01

Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly enhance CMS's ability to make decisions regarding coverage and payment that will benefit both the agency and their patient population.

Using Best Practices to Extract, Organize, and Reuse Embedded Decision Support Content Knowledge Rules from Mature Clinical Systems.

PubMed

DesAutels, Spencer J; Fox, Zachary E; Giuse, Dario A; Williams, Annette M; Kou, Qing-Hua; Weitkamp, Asli; Neal R, Patel; Bettinsoli Giuse, Nunzia

2016-01-01

Clinical decision support (CDS) knowledge, embedded over time in mature medical systems, presents an interesting and complex opportunity for information organization, maintenance, and reuse. To have a holistic view of all decision support requires an in-depth understanding of each clinical system as well as expert knowledge of the latest evidence. This approach to clinical decision support presents an opportunity to unify and externalize the knowledge within rules-based decision support. Driven by an institutional need to prioritize decision support content for migration to new clinical systems, the Center for Knowledge Management and Health Information Technology teams applied their unique expertise to extract content from individual systems, organize it through a single extensible schema, and present it for discovery and reuse through a newly created Clinical Support Knowledge Acquisition and Archival Tool (CS-KAAT). CS-KAAT can build and maintain the underlying knowledge infrastructure needed by clinical systems.

Medication-related clinical decision support in computerized provider order entry systems: a review.

PubMed

Kuperman, Gilad J; Bobb, Anne; Payne, Thomas H; Avery, Anthony J; Gandhi, Tejal K; Burns, Gerard; Classen, David C; Bates, David W

2007-01-01

While medications can improve patients' health, the process of prescribing them is complex and error prone, and medication errors cause many preventable injuries. Computer provider order entry (CPOE) with clinical decision support (CDS), can improve patient safety and lower medication-related costs. To realize the medication-related benefits of CDS within CPOE, one must overcome significant challenges. Healthcare organizations implementing CPOE must understand what classes of CDS their CPOE systems can support, assure that clinical knowledge underlying their CDS systems is reasonable, and appropriately represent electronic patient data. These issues often influence to what extent an institution will succeed with its CPOE implementation and achieve its desired goals. Medication-related decision support is probably best introduced into healthcare organizations in two stages, basic and advanced. Basic decision support includes drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced decision support includes dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking. In this paper, the authors outline some of the challenges associated with both basic and advanced decision support and discuss how those challenges might be addressed. The authors conclude with summary recommendations for delivering effective medication-related clinical decision support addressed to healthcare organizations, application and knowledge base vendors, policy makers, and researchers.

Research on web-based decision support system for sports competitions

NASA Astrophysics Data System (ADS)

Huo, Hanqiang

2010-07-01

This paper describes the system architecture and implementation technology of the decision support system for sports competitions, discusses the design of decision-making modules, management modules and security of the system, and proposes the development idea of building a web-based decision support system for sports competitions.

CPOE in Iran--a viable prospect? Physicians' opinions on using CPOE in an Iranian teaching hospital.

PubMed

Kazemi, Alireza; Ellenius, Johan; Tofighi, Shahram; Salehi, Aref; Eghbalian, Fatemeh; Fors, Uno G

2009-03-01

In recent years, the theory that on-line clinical decision support systems can improve patients' safety among hospitalised individuals has gained greater acceptance. However, the feasibility of implementing such a system in a middle or low-income country has rarely been studied. Understanding the current prescription process and a proper needs assessment of prescribers can act as the key to successful implementation. The aim of this study was to explore physicians' opinions on the current prescription process, and the expected benefits and perceived obstacles to employ Computerised Physician Order Entry in an Iranian teaching hospital. Initially, the interview guideline was developed through focus group discussions with eight experts. Then semi-structured interviews were held with 19 prescribers. After verbatim transcription, inductive thematic analysis was performed on empirical data. Forty hours of on-looker observations were performed in different wards to explore the current prescription process. The current prescription process was identified as a physician-centred, top-down, model, where prescribers were found to mostly rely on their memories as well as being overconfident. Some errors may occur during different paper-based registrations, transcriptions and transfers. Physician opinions on Computerised Physician Order Entry were categorised into expected benefits and perceived obstacles. Confidentiality issues, reduction of medication errors and educational benefits were identified as three themes in the expected benefits category. High cost, social and cultural barriers, data entry time and problems with technical support emerged as four themes in the perceived obstacles category. The current prescription process has a high possibility of medication errors. Although there are different barriers confronting the implementation and continuation of Computerised Physician Order Entry in Iranian hospitals, physicians have a willingness to use them if these systems provide significant benefits. A pilot study in a limited setting and a comprehensive analysis of health outcomes and economic indicators should be performed, to assess the merits of introducing Computerised Physician Order Entry with decision support capabilities in Iran.

EPA Leadership on Science, Innovation, and Decision Support Tools for Addressing Current and Future Challenges.

PubMed

Hecht, Alan D; Ferster, Aaron; Summers, Kevin

2017-10-16

When the U.S. Environmental Protection Agency (EPA) was established nearly 50 years ago, the nation faced serious threats to its air, land, and water, which in turn impacted human health. These threats were effectively addressed by the creation of EPA (in 1970) and many subsequent landmark environmental legislations which in turn significantly reduced threats to the Nation's environment and public health. A key element of historic legislation is research aimed at dealing with current and future problems. Today we face national and global challenges that go beyond classic media-specific (air, land, water) environmental legislation and require an integrated paradigm of action and engagement based on (1) innovation based on science and technology, (2) stakeholder engagement and collaboration, and (3) public education and support. This three-pronged approach recognizes that current environmental problems, include social as well as physical and environmental factors, are best addressed through collaborative problem solving, the application of innovation in science and technology, and multiple stakeholder engagement. To achieve that goal, EPA's Office of Research and Development (ORD) is working directly with states and local communities to develop and apply a suite of accessible decision support tools (DST) that aim to improve environmental conditions, protect human health, enhance economic opportunity, and advance a resilient and sustainability society. This paper showcases joint EPA and state actions to develop tools and approaches that not only meet current environmental and public health challenges, but do so in a way that advances sustainable, healthy, and resilient communities well into the future. EPA's future plans should build on current work but aim to effectively respond to growing external pressures. Growing pressures from megatrends are a major challenge for the new Administration and for cities and states across the country. The recent hurricanes hitting Texas and the Gulf Coast, part of the increase in extreme weather events, make it clear that building resilient infrastructure is a crucial step to sustainability.

Fusion Analytics: A Data Integration System for Public Health and Medical Disaster Response Decision Support

PubMed Central

Passman, Dina B.

2013-01-01

Objective The objective of this demonstration is to show conference attendees how they can integrate, analyze, and visualize diverse data type data from across a variety of systems by leveraging an off-the-shelf enterprise business intelligence (EBI) solution to support decision-making in disasters. Introduction Fusion Analytics is the data integration system developed by the Fusion Cell at the U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Preparedness and Response (ASPR). Fusion Analytics meaningfully augments traditional public and population health surveillance reporting by providing web-based data analysis and visualization tools. Methods Fusion Analytics serves as a one-stop-shop for the web-based data visualizations of multiple real-time data sources within ASPR. The 24-7 web availability makes it an ideal analytic tool for situational awareness and response allowing stakeholders to access the portal from any internet-enabled device without installing any software. The Fusion Analytics data integration system was built using off-the-shelf EBI software. Fusion Analytics leverages the full power of statistical analysis software and delivers reports to users in a secure web-based environment. Fusion Analytics provides an example of how public health staff can develop and deploy a robust public health informatics solution using an off-the shelf product and with limited development funding. It also provides the unique example of a public health information system that combines patient data for traditional disease surveillance with manpower and resource data to provide overall decision support for federal public health and medical disaster response operations. Conclusions We are currently in a unique position within public health. One the one hand, we have been gaining greater and greater access to electronic data of all kinds over the last few years. On the other, we are working in a time of reduced government spending to support leveraging this data for decision support with robust analytics and visualizations. Fusion Analytics provides an opportunity for attendees to see how various types of data are integrated into a single application for population health decision support. It also can provide them with ideas of how they can use their own staff to create analyses and reports that support their public health activities.

A Computational Model of Reasoning from the Clinical Literature

PubMed Central

Rennels, Glenn D.

1986-01-01

This paper explores the premise that a formalized representation of empirical studies can play a central role in computer-based decision support. The specific motivations underlying this research include the following propositions: 1. Reasoning from experimental evidence contained in the clinical literature is central to the decisions physicians make in patient care. 2. A computational model, based upon a declarative representation for published reports of clinical studies, can drive a computer program that selectively tailors knowledge of the clinical literature as it is applied to a particular case. 3. The development of such a computational model is an important first step toward filling a void in computer-based decision support systems. Furthermore, the model may help us better understand the general principles of reasoning from experimental evidence both in medicine and other domains. Roundsman is a developmental computer system which draws upon structured representations of the clinical literature in order to critique plans for the management of primary breast cancer. Roundsman is able to produce patient-specific analyses of breast cancer management options based on the 24 clinical studies currently encoded in its knowledge base. The Roundsman system is a first step in exploring how the computer can help to bring a critical analysis of the relevant literature to the physician, structured around a particular patient and treatment decision.

Using an Atrial Fibrillation Decision Support Tool for Thromboprophylaxis in Atrial Fibrillation: Effect of Sex and Age.

PubMed

Eckman, Mark H; Lip, Gregory Y H; Wise, Ruth E; Speer, Barbara; Sullivan, Megan; Walker, Nita; Kissela, Brett; Flaherty, Matthew L; Kleindorfer, Dawn; Baker, Peter; Ireton, Robert; Hoskins, Dave; Harnett, Brett M; Aguilar, Carlos; Leonard, Anthony; Arduser, Lora; Steen, Dylan; Costea, Alexandru; Kues, John

2016-05-01

To assess the appropriateness of oral anticoagulant therapy (OAT) in women and elderly adults, looking for patterns of undertreatment or unnecessary treatment. Retrospective cohort study. Primary care practices of an academic healthcare system. Adults (aged 28-93) with nonvalvular atrial fibrillation (AF) seen between March 2013 and February 2014 (N = 1,585). Treatment recommendations were made using an AF decision support tool (AFDST) based on projections of quality-adjusted life expectancy calculated using a decision analytical model that integrates individual-specific risk factors for stroke and hemorrhage. Treatment was discordant from AFDST-recommended treatment in 45% (326/725) of women and 39% (338/860) of men (P = .02). Although current treatment was discordant from recommended in 35% (89/258) of participants aged 85 and older and in 43% (575/1,328) of those younger than 85 (P = .01), many undertreated elderly adults were receiving aspirin as the sole antithrombotic agent. Physicians should understand that female sex is a significant risk factor for AF-related stroke and incorporate this into decision-making about thromboprophylaxis. Treating older adults with aspirin instead of OAT exposes them to significant risk of bleeding with little to no reduction in AF-related stroke risk. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Delaying investments in sensor technology: The rationality of dairy farmers' investment decisions illustrated within the framework of real options theory.

PubMed

Rutten, C J; Steeneveld, W; Oude Lansink, A G J M; Hogeveen, H

2018-05-02

The adoption rate of sensors on dairy farms varies widely. Whereas some sensors are hardly adopted, others are adopted by many farmers. A potential rational explanation for the difference in adoption may be the expected future technological progress in the sensor technology and expected future improved decision support possibilities. For some sensors not much progress can be expected because the technology has already made enormous progress in recent years, whereas for sensors that have only recently been introduced on the market, much progress can be expected. The adoption of sensors may thus be partly explained by uncertainty about the investment decision, in which uncertainty lays in the future performance of the sensors and uncertainty about whether improved informed decision support will become available. The overall aim was to offer a plausible example of why a sensor may not be adopted now. To explain this, the role of uncertainty about technological progress in the investment decision was illustrated for highly adopted sensors (automated estrus detection) and hardly adopted sensors (automated body condition score). This theoretical illustration uses the real options theory, which accounts for the role of uncertainty in the timing of investment decisions. A discrete event model, simulating a farm of 100 dairy cows, was developed to estimate the net present value (NPV) of investing now and investing in 5 yr in both sensor systems. The results show that investing now in automated estrus detection resulted in a higher NPV than investing 5 yr from now, whereas for the automated body condition score postponing the investment resulted in a higher NPV compared with investing now. These results are in line with the observation that farmers postpone investments in sensors. Also, the current high adoption of automated estrus detection sensors can be explained because the NPV of investing now is higher than the NPV of investing in 5 yr. The results confirm that uncertainty about future sensor performance and uncertainty about whether improved decision support will become available play a role in investment decisions. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

A gaze through the lens of decision theory toward knowledge translation science.

PubMed

Bucknall, Tracey

2007-01-01

Research findings become evidence when an individual decides that the information is relevant and useful to a particular circumstance. Prior to that point, they are unrelated facts. For research translation to occur, research evidence needs filtering, interpretation, and application by individuals to the specific situation. For this reason, decision science is complementary to knowledge translation science. Both aim to support the individual in deciding the most appropriate action in a dynamic environment where there are masses of uncensored and nonprioritized information readily available. Decision science employs research theories to study the cognitive processes underpinning the filtering and integration of current scientific information into changing contexts. Two meta-theories, coherence and correspondence theories, have been used to provide alternative views and prompt significant debate to advance the science. The aim of this article is to stimulate debate about the relationship between decision theory and knowledge translation. Discussed is the critical role of cognition in clinical decision making, with a focus on knowledge translation. A critical commentary of the knowledge utilization modeling papers is presented from a decision science perspective. The article concludes with a discussion on the implications for knowledge translation when viewed through the lens of decision science.

Reward-related decision making in eating and weight disorders: A systematic review and meta-analysis of the evidence from neuropsychological studies.

PubMed

Wu, Mudan; Brockmeyer, Timo; Hartmann, Mechthild; Skunde, Mandy; Herzog, Wolfgang; Friederich, Hans-Christoph

2016-02-01

Eating disorders (EDs) and overweight/obesity (OW/OB) are serious public health concerns that share common neuropsychological features and patterns of disturbed eating. Reward-related decision making as a basic neurocognitive function may trans-diagnostically underlie both pathological overeating and restricted eating. The present meta-analysis synthesizes the evidence from N=82 neuropsychological studies for altered reward-related decision making in all ED subtypes, OW and OB. The overall effect sizes for the differences between currently-ill ED patients and OW/OB people and controls were Hedge's g=-0.49 [CI: -0.63; -0.35], and Hedge's g=-0.39 [CI: -0.53; -0.25], respectively. Decision making was found to be altered to similar degrees in all ED subtypes and OB. Effect sizes, however, diverged for the different measures of decision making. Adolescents appear to be less affected than adults. When foods were used as rewarding stimuli, decision making was found to be intact in OB. The findings support that altered general reward-related decision making is a salient neuropsychological factor across eating and weight disorders in adulthood. Copyright © 2015 Elsevier Ltd. All rights reserved.

Clinical decision rules for termination of resuscitation in out-of-hospital cardiac arrest.

PubMed

Sherbino, Jonathan; Keim, Samuel M; Davis, Daniel P

2010-01-01

Out-of-hospital cardiac arrest (OHCA) has a low probability of survival to hospital discharge. Four clinical decision rules (CDRs) have been validated to identify patients with no probability of survival. Three of these rules focus on exclusive prehospital basic life support care for OHCA, and two of these rules focus on prehospital advanced life support care for OHCA. Can a CDR for the termination of resuscitation identify a patient with no probability of survival in the setting of OHCA? Six validation studies were selected from a PubMed search. A structured review of each of the studies is presented. In OHCA receiving basic life support care, the BLS-TOR (basic life support termination of resuscitation) rule has a positive predictive value for death of 99.5% (95% confidence interval 98.9-99.8%), and decreases the transportation of all patients by 62.6%. This rule has been appropriately validated for widespread use. In OHCA receiving advanced life support care, no current rule has been appropriately validated for widespread use. The BLS-TOR rule is a simple rule that identifies patients who will not survive OHCA. Further research is required to identify similarly robust CDRs for patients receiving advanced life support care in the setting of OHCA. Copyright 2010 Elsevier Inc. All rights reserved.

Integrating Climate and Risk-Informed Science to Support Critical Decisions

ScienceCinema

None

2018-01-16

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

Integrating Climate and Risk-Informed Science to Support Critical Decisions

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

None

2016-07-27

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

A two-stage clinical decision support system for early recognition and stratification of patients with sepsis: an observational cohort study.

PubMed

Amland, Robert C; Lyons, Jason J; Greene, Tracy L; Haley, James M

2015-10-01

To examine the diagnostic accuracy of a two-stage clinical decision support system for early recognition and stratification of patients with sepsis. Observational cohort study employing a two-stage sepsis clinical decision support to recognise and stratify patients with sepsis. The stage one component was comprised of a cloud-based clinical decision support with 24/7 surveillance to detect patients at risk of sepsis. The cloud-based clinical decision support delivered notifications to the patients' designated nurse, who then electronically contacted a provider. The second stage component comprised a sepsis screening and stratification form integrated into the patient electronic health record, essentially an evidence-based decision aid, used by providers to assess patients at bedside. Urban, 284 acute bed community hospital in the USA; 16,000 hospitalisations annually. Data on 2620 adult patients were collected retrospectively in 2014 after the clinical decision support was implemented. 'Suspected infection' was the established gold standard to assess clinical decision support clinimetric performance. A sepsis alert activated on 417 (16%) of 2620 adult patients hospitalised. Applying 'suspected infection' as standard, the patient population characteristics showed 72% sensitivity and 73% positive predictive value. A postalert screening conducted by providers at bedside of 417 patients achieved 81% sensitivity and 94% positive predictive value. Providers documented against 89% patients with an alert activated by clinical decision support and completed 75% of bedside screening and stratification of patients with sepsis within one hour from notification. A clinical decision support binary alarm system with cross-checking functionality improves early recognition and facilitates stratification of patients with sepsis.

New Elements To Consider When Modeling the Hazards Associated with Botulinum Neurotoxin in Food.

PubMed

Ihekwaba, Adaoha E C; Mura, Ivan; Malakar, Pradeep K; Walshaw, John; Peck, Michael W; Barker, G C

2016-01-15

Botulinum neurotoxins (BoNTs) produced by the anaerobic bacterium Clostridium botulinum are the most potent biological substances known to mankind. BoNTs are the agents responsible for botulism, a rare condition affecting the neuromuscular junction and causing a spectrum of diseases ranging from mild cranial nerve palsies to acute respiratory failure and death. BoNTs are a potential biowarfare threat and a public health hazard, since outbreaks of foodborne botulism are caused by the ingestion of preformed BoNTs in food. Currently, mathematical models relating to the hazards associated with C. botulinum, which are largely empirical, make major contributions to botulinum risk assessment. Evaluated using statistical techniques, these models simulate the response of the bacterium to environmental conditions. Though empirical models have been successfully incorporated into risk assessments to support food safety decision making, this process includes significant uncertainties so that relevant decision making is frequently conservative and inflexible. Progression involves encoding into the models cellular processes at a molecular level, especially the details of the genetic and molecular machinery. This addition drives the connection between biological mechanisms and botulism risk assessment and hazard management strategies. This review brings together elements currently described in the literature that will be useful in building quantitative models of C. botulinum neurotoxin production. Subsequently, it outlines how the established form of modeling could be extended to include these new elements. Ultimately, this can offer further contributions to risk assessments to support food safety decision making. Copyright © 2015 Ihekwaba et al.

A Decision Support Personnel Monitoring Database System Prototype for the United States Marine Corps.

DTIC Science & Technology

1985-12-19

Officer. The second space represents the current pay grade. The third space E indi- cates the officer has a least four years of enlisted active service...second space can only be 1-6. The third space can only be E or blank. Warrant Officers and PGRD 04 and above will have the third space blank even if

Response to Intervention (RtI) in the Social, Emotional, and Behavioral Domains: Current Challenges and Emerging Possibilities

ERIC Educational Resources Information Center

Saeki, Elina; Jimerson, Shane R.; Earhart, James; Hart, Shelley R.; Renshaw, Tyler; Singh, Renee D.; Stewart, Kaitlyn

2011-01-01

As many schools move toward a three-tier model that incorporates a Response to Intervention (RtI) service delivery model in the social, emotional, and behavioral domains, school psychologists may provide leadership. The decision-making process for filtering students through multiple tiers of support and intervention and examining change is an area…

Biogeochemical Considerations Related To The Remediation Of I-129 Plumes

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

Kaplan, D. I.; Yeager, C.; Denham, M. E.

2012-09-24

The objectives of this report were to: provide a current state of the science of radioiodine biogeochemistry relevant to its fate and transport at the Hanford Site; conduct a review of Hanford Site data dealing with groundwater {sup 129}I; and identify critical knowledge gaps necessary for successful selection, implementation, and technical defensibility in support of remediation decisions.

"What with Your Grades?" Students' Motivation for and Experiences of Vocational Courses in Further Education

ERIC Educational Resources Information Center

Fuller, C.; Macfadyen, T.

2012-01-01

In this article we seek to explore the motivations for studying a vocational qualification of 40 students currently in further education. We consider student decision making, in terms of the support and guidance received, and examine the value these students place on their training, particularly with respect to their future employment. Drawing on…

Criteria for Drug Reimbursement Decision-Making: An Emerging Public Health Challenge in Bulgaria

PubMed Central

Iskrov, Georgi; Stefanov, Rumen

2016-01-01

Background: During times of fiscal austerity, means of reimbursement decision-making are of particular interest for public health theory and practice. Introduction of advanced health technologies, growing health expenditures and increased public scrutiny over drug reimbursement decisions have pushed governments to consider mechanisms that promote the use of effective health technologies, while constraining costs. Aims: The study’s aim was to explore the current rationale of the drug reimbursement decision-making framework in Bulgaria. Our pilot research focused on one particular component of this process – the criteria used – because of the critical role that criteria are known to have in setting budgets and priorities in the field of public health. The analysis pursued two objectives: to identify important criteria relevant to drug reimbursement decision-making and to unveil relationships between theory and practice. Study Design: Cross-sectional study. Methods: The study was realized through a closed-ended survey on reimbursement criteria among four major public health stakeholders – medical professionals, patients, health authorities, and industry. Empirical outcomes were then cross-compared with the theoretical framework, as defined by current Bulgarian public health legislation. Analysis outlined what is done and what needs to be done in the field of public health reimbursement decision-making. Results: Bulgarian public health stakeholders agreed on 15 criteria to form a tentative optimal framework for drug reimbursement decision-making. The most apparent gap between the empirically found preferences and the official legislation is the lack of consideration for the strength of evidence in reimbursement decisions. Conclusion: Bulgarian policy makers need to address specific gaps, such as formal consideration for strength of evidence, explicit role of efficiency criteria, and means to effectively empower patient and citizen involvement in public health decision-making. Drug reimbursement criteria have to be integrated into legitimate public health decision support tools that ensure the achievement of national public health objectives. These recommendations could be expanded to all Eastern European countries who share common public health problems. PMID:26966615

Losing Your Gut Feelings. Intuition in Depression

PubMed Central

Remmers, Carina; Michalak, Johannes

2016-01-01

Whereas in basic research, intuition has become a topic of great interest, clinical research and depression research in specific have not applied to the topic of intuition, yet. This is astonishing because a well-known phenomenon during depression is that patients have difficulties to judge and decide. In contrast to healthy individuals who take most daily life decisions intuitively (Kahneman, 2011), depressed individuals seem to have difficulties to come to fast and adaptive decisions. The current article pursues three goals. First, our aim is to establish the hypothesis that intuition is impaired in depression against the background of influential theoretical accounts as well as empirical evidence from basic and clinical research. The second aim of the current paper is to provide explanations for recent findings on the depression-intuition interplay and to present directions for future research that may help to broaden our understanding of decision difficulties in depression. Third, we seek to propose ideas on how therapeutic interventions can support depressed individuals in taking better decisions. Even though our knowledge regarding this topic is still limited, we will tentatively launch the idea that an important first step may be to enhance patients’ access to intuitions. Overall, this paper seeks to introduce the topic of intuition to clinical research on depression and to hereby set the stage for upcoming theory and practice. PMID:27602015

Losing Your Gut Feelings. Intuition in Depression.

PubMed

Remmers, Carina; Michalak, Johannes

2016-01-01

Whereas in basic research, intuition has become a topic of great interest, clinical research and depression research in specific have not applied to the topic of intuition, yet. This is astonishing because a well-known phenomenon during depression is that patients have difficulties to judge and decide. In contrast to healthy individuals who take most daily life decisions intuitively (Kahneman, 2011), depressed individuals seem to have difficulties to come to fast and adaptive decisions. The current article pursues three goals. First, our aim is to establish the hypothesis that intuition is impaired in depression against the background of influential theoretical accounts as well as empirical evidence from basic and clinical research. The second aim of the current paper is to provide explanations for recent findings on the depression-intuition interplay and to present directions for future research that may help to broaden our understanding of decision difficulties in depression. Third, we seek to propose ideas on how therapeutic interventions can support depressed individuals in taking better decisions. Even though our knowledge regarding this topic is still limited, we will tentatively launch the idea that an important first step may be to enhance patients' access to intuitions. Overall, this paper seeks to introduce the topic of intuition to clinical research on depression and to hereby set the stage for upcoming theory and practice.

A Successful Implementation Strategy to Support Adoption of Decision Making in Mental Health Services.

PubMed

MacDonald-Wilson, Kim L; Hutchison, Shari L; Karpov, Irina; Wittman, Paul; Deegan, Patricia E

2017-04-01

Individual involvement in treatment decisions with providers, often through the use of decision support aids, improves quality of care. This study investigates an implementation strategy to bring decision support to community mental health centers (CMHC). Fifty-two CMHCs implemented a decision support toolkit supported by a 12-month learning collaborative using the Breakthrough Series model. Participation in learning collaborative activities was high, indicating feasibility of the implementation model. Progress by staff in meeting process aims around utilization of components of the toolkit improved significantly over time (p < .0001). Survey responses by individuals in service corroborate successful implementation. Community-based providers were able to successfully implement decision support in mental health services as evidenced by improved process outcomes and sustained practices over 1 year through the structure of the learning collaborative model.

An Air Revitalization Model (ARM) for Regenerative Life Support Systems (RLSS)

NASA Technical Reports Server (NTRS)

Hart, Maxwell M.

1990-01-01

The primary objective of the air revitalization model (ARM) is to determine the minimum buffer capacities that would be necessary for long duration space missions. Several observations are supported by the current configuration sizes: the baseline values for each gas and the day to day or month to month fluctuations that are allowed. The baseline values depend on the minimum safety tolerances and the quantities of life support consumables necessary to survive the worst case scenarios within those tolerances. Most, it not all, of these quantities can easily be determined by ARM once these tolerances are set. The day to day fluctuations also require a command decision. It is already apparent from the current configuration of ARM that the tighter these fluctuations are controlled, the more energy used, the more nonregenerable hydrazine consumed, and the larger the required capacities for the various gas generators. All of these relationships could clearly be quantified by one operational ARM.

Automated lifestyle coaching for cerebro-cardiovascular disease prevention.

PubMed

Spassova, Lübomira; Vittore, Debora; Droste, Dirk; Rösch, Norbert

2013-01-01

As soon as telemedicine aims at supporting the prevention of ischemic events (e.g., stroke and myocardial infarction), the mere monitoring of vital parameters is not sufficient. Instead, the patients should be supported in their efforts to actively reduce their individual risk factors and to achieve and maintain a healthier lifestyle. The Luxembourg-based CAPSYS project (Computer-Aided Prevention System) aims at combining the advantages of telephone coaching with those of home telemonitoring and with methods of computer-aided decision support in direct contact with the patients. The suitability and user acceptance of the system is currently being evaluated in a first pilot study.

Decision Support System for Reservoir Management and Operation in Africa

NASA Astrophysics Data System (ADS)

Navar, D. A.

2016-12-01

Africa is currently experiencing a surge in dam construction for flood control, water supply and hydropower production, but ineffective reservoir management has caused problems in the region, such as water shortages, flooding and loss of potential hydropower generation. Our research aims to remedy ineffective reservoir management by developing a novel Decision Support System(DSS) to equip water managers with a technical planning tool based on the state of the art in hydrological sciences. The DSS incorporates a climate forecast model, a hydraulic model of the watershed, and an optimization model to effectively plan for the operation of a system of cascade large-scale reservoirs for hydropower production, while treating water supply and flood control as constraints. Our team will use the newly constructed hydropower plants in the Omo Gibe basin of Ethiopia as the test case. Using the basic HIDROTERM software developed in Brazil, the General Algebraic Modeling System (GAMS) utilizes a combination of linear programing (LP) and non-linear programming (NLP) in conjunction with real time hydrologic and energy demand data to optimize the monthly and daily operations of the reservoir system. We compare the DSS model results with the current reservoir operating policy used by the water managers of that region. We also hope the DSS will eliminate the current dangers associated with the mismanagement of large scale water resources projects in Africa.

The money blind: how to stop industry bias in biomedical science, without violating the First Amendment.

PubMed

Robertson, Christopher T

2011-01-01

The pharmaceutical and medical device industries use billions of dollars to support the biomedical science that physicians, regulators, and patients use to make healthcare decisions--the decisions that drive an increasingly large portion of the American economy. Compelling evidence suggests that this industry money buys favorable results, biasing the outcomes of scientific research. Current efforts to manage the problem, including disclosure mandates and peer reviews, are ineffective. A blinding mechanism, operating through an intermediary such as the National Institutes of Health, could instead be developed to allow industry support of science without allowing undue influence. If the editors of biomedical journals fail to mandate that industry funders utilize such a solution, the federal government has several regulatory levers available, including conditioning federal funding and direct regulation, both of which could be done without violating the First Amendment.

Gaming in Nursing Education: A Literature Review.

PubMed

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

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

The public health response to 'do-it-yourself' urbanism.

PubMed

Sibbald, Shannon L; Graham, Ross; Gilliland, Jason

2017-09-01

Greater understanding of the important and complex relationship between the built environment and human health has made 'healthy places' a focus of public health and health promotion. While current literature concentrates on creating healthy places through traditional decision-making pathways (namely, municipal land use planning and urban design processes), this paper explores do-it-yourself (DIY) urbanism: a movement circumventing traditional pathways to, arguably, create healthy places and advance social justice. Despite being aligned with several health promotion goals, DIY urbanism interventions are typically illegal and have been categorized as a type of civil disobedience. This is challenging for public health officials who may value DIY urbanism outcomes, but do not necessarily support the means by which it is achieved. Based on the literature, we present a preliminary approach to health promotion decision-making in this area. Public health officials can voice support for DIY urbanism interventions in some instances, but should proceed cautiously.

Clinical Decision Support: Effectiveness in Improving Quality Processes and Clinical Outcomes and Factors That May Influence Success

PubMed Central

Murphy, Elizabeth V.

2014-01-01

The use of electronic health records has skyrocketed following the 2009 HITECH Act, which provides financial incentives to health care providers for the “meaningful use” of electronic medical record systems. An important component of the “Meaningful Use” legislation is the integration of Clinical Decision Support Systems (CDSS) into the computerized record, providing up-to-date medical knowledge and evidence-based guidance to the physician at the point of care. As reimbursement is increasingly tied to process and clinical outcomes, CDSS will be integral to future medical practice. Studies of CDSS indicate improvement in preventive services, appropriate care, and clinical and cost outcomes with strong evidence for CDSS effectiveness in process measures. Increasing provider adherence to CDSS recommendations is essential in improving CDSS effectiveness, and factors that influence adherence are currently under study. PMID:24910564

A First Step towards a Clinical Decision Support System for Post-traumatic Stress Disorders.

PubMed

Ma, Sisi; Galatzer-Levy, Isaac R; Wang, Xuya; Fenyö, David; Shalev, Arieh Y

2016-01-01

PTSD is distressful and debilitating, following a non-remitting course in about 10% to 20% of trauma survivors. Numerous risk indicators of PTSD have been identified, but individual level prediction remains elusive. As an effort to bridge the gap between scientific discovery and practical application, we designed and implemented a clinical decision support pipeline to provide clinically relevant recommendation for trauma survivors. To meet the specific challenge of early prediction, this work uses data obtained within ten days of a traumatic event. The pipeline creates personalized predictive model for each individual, and computes quality metrics for each predictive model. Clinical recommendations are made based on both the prediction of the model and its quality, thus avoiding making potentially detrimental recommendations based on insufficient information or suboptimal model. The current pipeline outperforms the acute stress disorder, a commonly used clinical risk factor for PTSD development, both in terms of sensitivity and specificity.

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

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Krishnamurthy, Karthik

2004-01-01

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

Southern California Disasters II

NASA Technical Reports Server (NTRS)

Nicholson, Heather; Todoroff, Amber L.; LeBoeuf, Madeline A.

2015-01-01

The USDA Forest Service (USFS) has multiple programs in place which primarily utilize Landsat imagery to produce burn severity indices for aiding wildfire damage assessment and mitigation. These indices provide widely-used wildfire damage assessment tools to decision makers. When the Hyperspectral Infrared Imager (HyspIRI) is launched in 2022, the sensor's hyperspectral resolution will support new methods for assessing natural disaster impacts on ecosystems, including wildfire damage to forests. This project used simulated HyspIRI data to study three southern California fires: Aspen, French, and King. Burn severity indices were calculated from the data and the results were quantitatively compared to the comparable USFS products currently in use. The final results from this project illustrate how HyspIRI data may be used in the future to enhance assessment of fire-damaged areas and provide additional monitoring tools for decision support to the USFS and other land management agencies.

Overview of EPA tools for supporting local-, state- and regional-level decision makers addressing energy and environmental issues: NYC MARKAL Energy Systems Model and Municipal Solid Waste Decision Support Tool

EPA Science Inventory

A workshop will be conducted to demonstrate and focus on two decision support tools developed at EPA/ORD: 1. Community-scale MARKAL model: an energy-water technology evaluation tool and 2. Municipal Solid Waste Decision Support Tool (MSW DST). The Workshop will be part of Southea...

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

DOT National Transportation Integrated Search

2000-07-14

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

Analytical Support Capabilities of Turkish General Staff Scientific Decision Support Centre (SDSC) to Defence Transformation

DTIC Science & Technology

2005-04-01

RTO-MP-SAS-055 4 - 1 UNCLASSIFIED/UNLIMITED UNCLASSIFIED/UNLIMITED Analytical Support Capabilities of Turkish General Staff Scientific...the end failed to achieve anything commensurate with the effort. The analytical support capabilities of Turkish Scientific Decision Support Center to...percent of the İpekkan, Z.; Özkil, A. (2005) Analytical Support Capabilities of Turkish General Staff Scientific Decision Support Centre (SDSC) to