Conceptualizing surrogate decision making at end of life in the intensive care unit using cognitive task analysis.

PubMed

Dionne-Odom, J Nicholas; Willis, Danny G; Bakitas, Marie; Crandall, Beth; Grace, Pamela J

2015-01-01

Surrogate decision makers (SDMs) face difficult decisions at end of life (EOL) for decisionally incapacitated intensive care unit (ICU) patients. To identify and describe the underlying psychological processes of surrogate decision making for adults at EOL in the ICU. Qualitative case study design using a cognitive task analysis interviewing approach. Participants were recruited from October 2012 to June 2013 from an academic tertiary medical center's ICU located in the rural Northeastern United States. Nineteen SDMs for patients who had died in the ICU completed in-depth semistructured cognitive task analysis interviews. The conceptual framework formulated from data analysis reveals that three underlying, iterative, psychological dimensions (gist impressions, distressing emotions, and moral intuitions) impact an SDM's judgment about the acceptability of either the patient's medical treatments or his or her condition. The framework offers initial insights about the underlying psychological processes of surrogate decision making and may facilitate enhanced decision support for SDMs. Copyright © 2015 Elsevier Inc. All rights reserved.

Hospital image and the positioning of service centers: an application in market analysis and strategy development.

PubMed

Smith, S M; Clark, M

1990-09-01

The research confirms the coexistence of different images for hospitals, service centers within the same hospitals, and service programs offered by each of the service centers. The images of individual service centers are found not to be tied to the image of the host facility. Further, service centers and host facilities have differential rankings on the same service decision attributes. Managerial recommendations are offered for "image differentiation" between a hospital and its care centers.

Hurricane risk assessment to rollback or ride out a cost versus loss decision making approach

NASA Technical Reports Server (NTRS)

Wohlman, Richard A.

1992-01-01

The potential exists that a hurricane striking the Kennedy Space Center while a Space Shuttle is on the pad. Winds in excess of 74.5 knots could cause the failure of the holddown bolts bringing about the catastrophic loss of the entire vehicle. Current plans call for the rollback of the shuttle when winds of that magnitude are forecast to strike the center. As this is costly, a new objective method for making rollback/rideout decisions based upon Bayesian Analysis and economic cost versus loss is presented.

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

Improving accountability in vaccine decision-making.

PubMed

Timmis, James Kenneth; Black, Steven; Rappuoli, Rino

2017-11-01

Healthcare decisions, in particular those affecting entire populations, should be evidence-based and taken by decision-makers sharing broad alignment with affected stakeholders. However, criteria, priorities and procedures for decision-making are sometimes non-transparent, frequently vary considerably across equivalent decision-bodies, do not always consider the broader benefits of new health-measures, and therefore do not necessarily adequately represent the relevant stakeholder-spectrum. Areas covered: To address these issues in the context of the evaluation of new vaccines, we have proposed a first baseline set of core evaluation criteria, primarily selected by members of the vaccine research community, and suggested their implementation in vaccine evaluation procedures. In this communication, we review the consequences and utility of stakeholder-centered core considerations to increase transparency in and accountability of decision-making procedures, in general, and of the benefits gained by their inclusion in Multi-Criteria-Decision-Analysis tools, exemplified by SMART Vaccines, specifically. Expert commentary: To increase effectiveness and comparability of health decision outcomes, decision procedures should be properly standardized across equivalent (national) decision bodies. To this end, including stakeholder-centered criteria in decision procedures would significantly increase their transparency and accountability, support international capacity building to improve health, and reduce societal costs and inequity resulting from suboptimal health decision-making.

Options for Organizing the Tanker Airlift Control Center Flight Dispatch Function: An Exploratory Concept Study

DTIC Science & Technology

2000-06-01

it poised to fall? Am I prepared to pay the applicable capital gains tax ? Each of these questions could represent a decision frame. The...Center (FEDSIM). AMC Corporate Systems Analysis, Design , and Implementation PEP 18 TACC Project. Falls Chruch , VA: Federal Systems Integration and

Exploration of how women make treatment decisions after a breast cancer diagnosis.

PubMed

Spittler, Cheryl A; Pallikathayil, Leonie; Bott, Marjorie

2012-09-01

To examine the information needs of women after receiving a diagnosis of breast cancer, investigate how decisions about treatment options are made, and assess personal responses to the decisions made. Mixed-methods approach using quantitative and qualitative data. The University of Kansas Medical Center and Quinn Plastic Surgery Center, both in the midwestern United States. 102 breast cancer survivors who had completed all forms of treatment for at least three months and less than five years. Phase I participants completed five questionnaires about informational needs, confidence and satisfaction with the decision, decisional regret, and conflict. In phase II, 15 participants were purposively sampled from the 102 survivors to participate in a focus group session. Data analysis included frequencies and multiple regression for phase I and qualitative content analysis for phase II. Informational needs, confidence and satisfaction with the decision, and decisional regret and conflict. The variables (widowed, confidence and satisfaction with decision, and decisional conflict and regret) significantly (p = 0.01) accounted for 14% of the variance in informational needs. Two themes emerged from the study: (a) feelings, thoughts, and essential factors that impact treatment considerations, and (b) tips for enhancing treatment consideration options. The study's results show that women viewed informational needs as very important in making treatment decisions after being diagnosed with breast cancer. The treatment team should provide the information, with consideration of the patient's personal preferences, that will assist women to make informed, confident, and satisfied decisions about treatment choices.

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

Distributed collaborative environments for virtual capability-based planning

NASA Astrophysics Data System (ADS)

McQuay, William K.

2003-09-01

Distributed collaboration is an emerging technology that will significantly change how decisions are made in the 21st century. Collaboration involves two or more geographically dispersed individuals working together to share and exchange data, information, knowledge, and actions. The marriage of information, collaboration, and simulation technologies provides the decision maker with a collaborative virtual environment for planning and decision support. This paper reviews research that is focusing on the applying open standards agent-based framework with integrated modeling and simulation to a new Air Force initiative in capability-based planning and the ability to implement it in a distributed virtual environment. Virtual Capability Planning effort will provide decision-quality knowledge for Air Force resource allocation and investment planning including examining proposed capabilities and cost of alternative approaches, the impact of technologies, identification of primary risk drivers, and creation of executable acquisition strategies. The transformed Air Force business processes are enabled by iterative use of constructive and virtual modeling, simulation, and analysis together with information technology. These tools are applied collaboratively via a technical framework by all the affected stakeholders - warfighter, laboratory, product center, logistics center, test center, and primary contractor.

Applied Swarm-based medicine: collecting decision trees for patterns of algorithms analysis.

PubMed

Panje, Cédric M; Glatzer, Markus; von Rappard, Joscha; Rothermundt, Christian; Hundsberger, Thomas; Zumstein, Valentin; Plasswilm, Ludwig; Putora, Paul Martin

2017-08-16

The objective consensus methodology has recently been applied in consensus finding in several studies on medical decision-making among clinical experts or guidelines. The main advantages of this method are an automated analysis and comparison of treatment algorithms of the participating centers which can be performed anonymously. Based on the experience from completed consensus analyses, the main steps for the successful implementation of the objective consensus methodology were identified and discussed among the main investigators. The following steps for the successful collection and conversion of decision trees were identified and defined in detail: problem definition, population selection, draft input collection, tree conversion, criteria adaptation, problem re-evaluation, results distribution and refinement, tree finalisation, and analysis. This manuscript provides information on the main steps for successful collection of decision trees and summarizes important aspects at each point of the analysis.

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…

Implementing EVM Data Analysis Adding Value from a NASA Project Manager's Perspective

NASA Technical Reports Server (NTRS)

Counts, Stacy; Kerby, Jerald

2006-01-01

Data Analysis is one of the keys to an effective Earned Value Management (EVM) Process. Project Managers (PM) must continually evaluate data in assessing the health of their projects. Good analysis of data can assist PMs in making better decisions in managing projects. To better support our P Ms, National Aeronautics and Space Administration (NASA) - Marshall Space Flight Center (MSFC) recently renewed its emphasis on sound EVM data analysis practices and processes, During this presentation we will discuss the approach that MSFC followed in implementing better data analysis across its Center. We will address our approach to effectively equip and support our projects in applying a sound data analysis process. In addition, the PM for the Space Station Biological Research Project will share her experiences of how effective data analysis can benefit a PM in the decision making process. The PM will discuss how the emphasis on data analysis has helped create a solid method for assessing the project s performance. Using data analysis successfully can be an effective and efficient tool in today s environment with increasing workloads and downsizing workforces

An overview and discussion of the Patient-Centered Outcomes Research Institute's decision aid portfolio.

PubMed

Gayer, Christopher C; Crowley, Matthew J; Lawrence, William F; Gierisch, Jennifer M; Gaglio, Bridget; Williams, John W; Myers, Evan R; Kendrick, Amy; Slutsky, Jean; Sanders, Gillian D

2016-07-01

Decision aids (DAs) help patients make informed healthcare decisions in a manner consistent with their values and preferences. Despite their promise, DAs developed with public research dollars are not being implemented and adopted in real-world patient care settings at a rate consistent with which they are being developed. To appraise the sum of the parts of the portfolio and create a strategic imperative surrounding future funding, the Patient-Centered Outcomes Research Institute (PCORI) tasked the Duke Evidence Synthesis Group with evaluating its DA portfolio. This paper describes PCORI's portfolio of DAs according to the Duke Evidence Synthesis Group's analysis in the context of PCORI's mission and the field of decision science. The results revealed a diversity within PCORI's portfolio of funded DA projects. Findings support the movement toward more rigorous DA development, assessment and maintenance. PCORI's funding priorities related to DAs are clarified and comparative questions of interest are posed.

[Improvement and process optimization transfusion in Morocco: proposal of a new organization].

PubMed

Bennis, I; Janah, S; Benajiba, M

2013-03-01

Propose a new organization for the Moroccan blood transfusion system. Through an analysis of several aspects of the current organization, both qualitatively and quantitatively (Statistics 2011), it was found that several failures of the current system prevent them from achieving it's objectives and ensuring its responsibilities. Using multiple-criteria decision analysis (ELECTRE III), a new organization based on resources pooling is proposed. This new organization concerns the status of the National Blood Transfusion Center, donor management, the geographical location of the various regional centers, logistics, inventory management and the information system. Within the new organization proposed, the number of regional Centers for blood transfusion is reduced from 16 to 7 in accordance with the existing constraints, while redefining the roles of each site. The aspects of inventory management, the information system, increasing the number of donors, the policy communication and marketing and cycle of blood collection and distribution are also redefined. This proposed new organization will provide decision makers with the necessary assistance for decision making, whit respect to the improvement of the entire system Moroccan blood transfusion system. And so help achieving the desired objectives on ensuring blood availability and it' maximum safety. The simulation of this proposal should confirm the choice that was made. Further analysis of complementary aspects such as the financial aspect or human resources, would moreover contribute to refining this proposal. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

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

NASA Astrophysics Data System (ADS)

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

2003-09-01

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

Proceedings of the Annual U.S. Army Operations Research Symposium (13th) , AORS XIII, Held at Fort Lee, Virginia on 29 October - 1 November 1974, Co- Hosted by Army Logistics Center, Fort Lee, Virginia and Army Quartermaster Center and Fort Lee, Virginia. Volume 2

DTIC Science & Technology

1974-11-01

Directorate, Rock Island, Illinois. 538 TITLE: Significant Difference Technique AUTHOR: Mr. Robert P. Lewis, Jr. US Army Logistics Management Center...was first used in a Decision Risk Analysis in August, 1971, at the Army Logistics Management Center, by John Cocker- ham and Harold Stafford. There is

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

PubMed

Militello, Laura G; Saleem, Jason J; Borders, Morgan R; Sushereba, Christen E; Haverkamp, Donald; Wolf, Steven P; Doebbeling, Bradley N

2016-03-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise

PubMed Central

Militello, Laura G.; Saleem, Jason J.; Borders, Morgan R.; Sushereba, Christen E.; Haverkamp, Donald; Wolf, Steven P.; Doebbeling, Bradley N.

2016-01-01

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration’s EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability. PMID:26973441

Development and initial evaluation of a treatment decision dashboard.

PubMed

Dolan, James G; Veazie, Peter J; Russ, Ann J

2013-04-21

For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care.Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making.

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.

What perceptions do patients have of decision making (DM)? Toward an integrative patient-centered care model. A qualitative study using focus-group interviews.

PubMed

Moreau, Alain; Carol, Laurent; Dedianne, Marie Cécile; Dupraz, Christian; Perdrix, Corinne; Lainé, Xavier; Souweine, Gilbert

2012-05-01

To understand patients' perceptions of decision making and identify relationships among decision-making models. This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory. Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making. In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

An Integrated Approach to Life Cycle Analysis

NASA Technical Reports Server (NTRS)

Chytka, T. M.; Brown, R. W.; Shih, A. T.; Reeves, J. D.; Dempsey, J. A.

2006-01-01

Life Cycle Analysis (LCA) is the evaluation of the impacts that design decisions have on a system and provides a framework for identifying and evaluating design benefits and burdens associated with the life cycles of space transportation systems from a "cradle-to-grave" approach. Sometimes called life cycle assessment, life cycle approach, or "cradle to grave analysis", it represents a rapidly emerging family of tools and techniques designed to be a decision support methodology and aid in the development of sustainable systems. The implementation of a Life Cycle Analysis can vary and may take many forms; from global system-level uncertainty-centered analysis to the assessment of individualized discriminatory metrics. This paper will focus on a proven LCA methodology developed by the Systems Analysis and Concepts Directorate (SACD) at NASA Langley Research Center to quantify and assess key LCA discriminatory metrics, in particular affordability, reliability, maintainability, and operability. This paper will address issues inherent in Life Cycle Analysis including direct impacts, such as system development cost and crew safety, as well as indirect impacts, which often take the form of coupled metrics (i.e., the cost of system unreliability). Since LCA deals with the analysis of space vehicle system conceptual designs, it is imperative to stress that the goal of LCA is not to arrive at the answer but, rather, to provide important inputs to a broader strategic planning process, allowing the managers to make risk-informed decisions, and increase the likelihood of meeting mission success criteria.

Market Analysis for Expansion of Surgical Services at USAF Medical Center Wright-Patterson.

DTIC Science & Technology

1991-04-22

Rockville, Maryland: Aspen Malhotra , Naresh K . (1989) Decision Support Systems for Health Care Marketing Managers, Journal of Health Care Marketing Vol 9...information processing, analysis, storage, and distribution. Authors including Nickels (1978), Kropf and Greenberg (1984), Keckley (1988) and Malhotra (1989

Science Operations Management

NASA Astrophysics Data System (ADS)

Squibb, Gael F.

1984-10-01

The operation teams for the Infrared Astronomical Satellite (IRAS) included scientists from the IRAS International Science Team. The scientific decisions on an hour-to-hour basis, as well as the long-term strategic decisions, were made by science team members. The IRAS scientists were involved in the analysis of the instrument performance, the analysis of the quality of the data, the decision to reacquire data that was contaminated by radiation effects, the strategy for acquiring the survey data, and the process for using the telescope for additional observations, as well as the processing decisions required to ensure the publication of the final scientific products by end of flight operations plus one year. Early in the project, two science team members were selected to be responsible for the scientific operational decisions. One, located at the operations control center in England, was responsible for the scientific aspects of the satellite operations; the other, located at the scientific processing center in Pasadena, was responsible for the scientific aspects of the processing. These science team members were then responsible for approving the design and test of the tools to support their responsibilities and then, after launch, for using these tools in making their decisions. The ability of the project to generate the final science data products one year after the end of flight operations is due in a large measure to the active participation of the science team members in the operations. This paper presents a summary of the operational experiences gained from this scientific involvement.

An Organizational Informatics Analysis of Colorectal, Breast, and Cervical Cancer Screening Clinical Decision Support and Information Systems within Community Health Centers

ERIC Educational Resources Information Center

Carney, Timothy Jay

2012-01-01

A study design has been developed that employs a dual modeling approach to identify factors associated with facility-level cancer screening improvement and how this is mediated by the use of clinical decision support. This dual modeling approach combines principles of (1) Health Informatics, (2) Cancer Prevention and Control, (3) Health Services…

Combining conversation analysis and event sequencing to study health communication.

PubMed

Pecanac, Kristen E

2018-06-01

Good communication is essential in patient-centered care. The purpose of this paper is to describe conversation analysis and event sequencing and explain how integrating these methods strengthened the analysis in a study of communication between clinicians and surrogate decision makers in an intensive care unit. Conversation analysis was first used to determine how clinicians introduced the need for decision-making regarding life-sustaining treatment and how surrogate decision makers responded. Event sequence analysis then was used to determine the transitional probability (probability of one event leading to another in the interaction) that a given type of clinician introduction would lead to surrogate resistance or alignment. Conversation analysis provides a detailed analysis of the interaction between participants in a conversation. When combined with a quantitative analysis of the patterns of communication in an interaction, these data add information on the communication strategies that produce positive outcomes. Researchers can apply this mixed-methods approach to identify beneficial conversational practices and design interventions to improve health communication. © 2018 Wiley Periodicals, Inc.

Shunting outcomes in posthemorrhagic hydrocephalus: results of a Hydrocephalus Clinical Research Network prospective cohort study.

PubMed

Wellons, John C; Shannon, Chevis N; Holubkov, Richard; Riva-Cambrin, Jay; Kulkarni, Abhaya V; Limbrick, David D; Whitehead, William; Browd, Samuel; Rozzelle, Curtis; Simon, Tamara D; Tamber, Mandeep S; Oakes, W Jerry; Drake, James; Luerssen, Thomas G; Kestle, John

2017-07-01

OBJECTIVE Previous Hydrocephalus Clinical Research Network (HCRN) retrospective studies have shown a 15% difference in rates of conversion to permanent shunts with the use of ventriculosubgaleal shunts (VSGSs) versus ventricular reservoirs (VRs) as temporization procedures in the treatment of hydrocephalus due to high-grade intraventricular hemorrhage (IVH) of prematurity. Further research in the same study line revealed a strong influence of center-specific decision-making on shunt outcomes. The primary goal of this prospective study was to standardize decision-making across centers to determine true procedural superiority, if any, of VSGS versus VR as a temporization procedure in high-grade IVH of prematurity. METHODS The HCRN conducted a prospective cohort study across 6 centers with an approximate 1.5- to 3-year accrual period (depending on center) followed by 6 months of follow-up. Infants with premature birth, who weighed less than 1500 g, had Grade 3 or 4 IVH of prematurity, and had more than 72 hours of life expectancy were included in the study. Based on a priori consensus, decisions were standardized regarding the timing of initial surgical treatment, upfront shunt versus temporization procedure (VR or VSGS), and when to convert a VR or VSGS to a permanent shunt. Physical examination assessment and surgical technique were also standardized. The primary outcome was the proportion of infants who underwent conversion to a permanent shunt. The major secondary outcomes of interest included infection and other complication rates. RESULTS One hundred forty-five premature infants were enrolled and met criteria for analysis. Using the standardized decision rubrics, 28 infants never reached the threshold for treatment, 11 initially received permanent shunts, 4 were initially treated with endoscopic third ventriculostomy (ETV), and 102 underwent a temporization procedure (36 with VSGSs and 66 with VRs). The 2 temporization cohorts were similar in terms of sex, race, IVH grade, head (orbitofrontal) circumference, and ventricular size at temporization. There were statistically significant differences noted between groups in gestational age, birth weight, and bilaterality of clot burden that were controlled for in post hoc analysis. By Kaplan-Meier analysis, the 180-day rates of conversion to permanent shunts were 63.5% for VSGS and 74.0% for VR (p = 0.36, log-rank test). The infection rate for VSGS was 14% (5/36) and for VR was 17% (11/66; p = 0.71). The overall compliance rate with the standardized decision rubrics was noted to be 90% for all surgeons. CONCLUSIONS A standardized protocol was instituted across all centers of the HCRN. Compliance was high. Choice of temporization techniques in premature infants with IVH does not appear to influence rates of conversion to permanent ventricular CSF diversion. Once management decisions and surgical techniques are standardized across HCRN sites, thus minimizing center effect, the observed difference in conversion rates between VSGSs and VRs is mitigated.

PATIENT-CENTERED DECISION MAKING: LESSONS FROM MULTI-CRITERIA DECISION ANALYSIS FOR QUANTIFYING PATIENT PREFERENCES.

PubMed

Marsh, Kevin; Caro, J Jaime; Zaiser, Erica; Heywood, James; Hamed, Alaa

2018-01-01

Patient preferences should be a central consideration in healthcare decision making. However, stories of patients challenging regulatory and reimbursement decisions has led to questions on whether patient voices are being considered sufficiently during those decision making processes. This has led some to argue that it is necessary to quantify patient preferences before they can be adequately considered. This study considers the lessons from the use of multi-criteria decision analysis (MCDA) for efforts to quantify patient preferences. It defines MCDA and summarizes the benefits it can provide to decision makers, identifies examples of MCDAs that have involved patients, and summarizes good practice guidelines as they relate to quantifying patient preferences. The guidance developed to support the use of MCDA in healthcare provide some useful considerations for the quantification of patient preferences, namely that researchers should give appropriate consideration to: the heterogeneity of patient preferences, and its relevance to decision makers; the cognitive challenges posed by different elicitation methods; and validity of the results they produce. Furthermore, it is important to consider how the relevance of these considerations varies with the decision being supported. The MCDA literature holds important lessons for how patient preferences should be quantified to support healthcare decision making.

GIS and Time-Series Integration in the Kennedy Space Center Environmental Information System

NASA Technical Reports Server (NTRS)

Hinkle, Ross; Costa, Joao Ribeiro da; Engel, Bernard

1996-01-01

NASA started the Ecological Program 14 years ago to collect environmental data which can be used in making environmental management decisions. The EP team created the Mapping Analysis and Planning System (MAPS) to store all the data, including the appropriate tools for data analysis and exploration.

Saving the Lost Boys: Narratives of Discipline Disproportionality

ERIC Educational Resources Information Center

Gray, Mariama Smith

2016-01-01

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

46 CFR 1.03-40 - Appeals from decisions or actions of the National Maritime Center.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Maritime Center. 1.03-40 Section 1.03-40 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES... Appeal § 1.03-40 Appeals from decisions or actions of the National Maritime Center. Any person directly affected by a decision or action of an officer or employee of the National Maritime Center (NMC) involving...

Characteristics Associated With Preferences for Parent-Centered Decision Making in Neonatal Intensive Care.

PubMed

Weiss, Elliott Mark; Xie, Dawei; Cook, Noah; Coughlin, Katherine; Joffe, Steven

2018-05-01

Little is known about how characteristics of particular clinical decisions influence decision-making preferences by patients or their surrogates. A better understanding of the factors underlying preferences is essential to improve the quality of shared decision making. To identify the characteristics of particular decisions that are associated with parents' preferences for family- vs medical team-centered decision making across the spectrum of clinical decisions that arise in the neonatal intensive care unit (NICU). This cross-sectional survey assessed parents' preferences for parent- vs medical team-centered decision making across 16 clinical decisions, along with parents' assessments of 7 characteristics of those decisions. Respondents included 136 parents of infants in 1 of 3 academically affiliated hospital NICUs in Philadelphia, Pennsylvania, from January 7 to July 8, 2016. Respondents represented a wide range of educational levels, employment status, and household income but were predominantly female (109 [80.1%]), white (68 [50.0%]) or African American (53 [39.0%]), and married (81 of 132 responding [61.4%]). Preferences for parent-centered decision making. For each decision characteristic (eg, urgency), multivariable analyses tested whether middle and high levels of that characteristic (compared with low levels) were associated with a preference for parent-centered decision making, resulting in 2 odds ratios (ORs) per decision characteristic. Among the 136 respondents (109 women [80.1%] and 27 men [19.9%]; median age, 30 years [range, 18-43 years]), preferences for parent-centered decision making were positively associated with decisions that involved big-picture goals (middle OR, 2.01 [99% CI, 0.83-4.86]; high OR, 3.38 [99% CI, 1.48-7.75]) and that had the potential to harm the infant (middle OR, 1.32 [99% CI, 0.84-2.08]; high OR, 2.62 [99% CI, 1.67-4.11]). In contrast, preferences for parent-centered decision making were inversely associated with the following 4 decision characteristics: technical decisions (middle OR, 0.82 [99% CI, 0.45-1.52]; high OR, 0.48 [99% CI, 0.25-0.93]), the potential to benefit the infant (middle OR, 0.42 [99% CI, 0.16-1.05]; high OR, 0.21 [99% CI, 0.08-0.52]), requires medical expertise (middle OR, 0.48 [99% CI, 0.22-1.05]; high OR, 0.21 [99% CI, 0.10-0.48]), and a high level of urgency (middle OR, 0.47 [99% CI, 0.24-0.92]; high OR, 0.42 [99% CI, 0.22-0.83]). Preferences for parent-centered vs medical team-centered decision making among parents of infants in the NICU may vary systematically by the characteristics of particular clinical decisions. Incorporating this variation into shared decision making and endorsing models that allow parents to cede control to physicians in appropriate clinical circumstances might improve the quality and outcomes of medical decisions.

Development and initial evaluation of a treatment decision dashboard

PubMed Central

2013-01-01

Background For many healthcare decisions, multiple alternatives are available with different combinations of advantages and disadvantages across several important dimensions. The complexity of current healthcare decisions thus presents a significant barrier to informed decision making, a key element of patient-centered care. Interactive decision dashboards were developed to facilitate decision making in Management, a field marked by similarly complicated choices. These dashboards utilize data visualization techniques to reduce the cognitive effort needed to evaluate decision alternatives and a non-linear flow of information that enables users to review information in a self-directed fashion. Theoretically, both of these features should facilitate informed decision making by increasing user engagement with and understanding of the decision at hand. We sought to determine if the interactive decision dashboard format can be successfully adapted to create a clinically realistic prototype patient decision aid suitable for further evaluation and refinement. Methods We created a computerized, interactive clinical decision dashboard and performed a pilot test of its clinical feasibility and acceptability using a multi-method analysis. The dashboard summarized information about the effectiveness, risks of side effects and drug-drug interactions, out-of-pocket costs, and ease of use of nine analgesic treatment options for knee osteoarthritis. Outcome evaluations included observations of how study participants utilized the dashboard, questionnaires to assess usability, acceptability, and decisional conflict, and an open-ended qualitative analysis. Results The study sample consisted of 25 volunteers - 7 men and 18 women - with an average age of 51 years. The mean time spent interacting with the dashboard was 4.6 minutes. Mean evaluation scores on scales ranging from 1 (low) to 7 (high) were: mechanical ease of use 6.1, cognitive ease of use 6.2, emotional difficulty 2.7, decision-aiding effectiveness 5.9, clarification of values 6.5, reduction in decisional uncertainty 6.1, and provision of decision-related information 6.0. Qualitative findings were similarly positive. Conclusions Interactive decision dashboards can be adapted for clinical use and have the potential to foster informed decision making. Additional research is warranted to more rigorously test the effectiveness and efficiency of patient decision dashboards for supporting informed decision making and other aspects of patient-centered care, including shared decision making. PMID:23601912

Iraqi Population Displacement Analysis

DTIC Science & Technology

2016-11-01

CENTER FOR ARMY ANALYSIS 6001 GOETHALS ROAD FORT BELVOIR, VA 22060-5230 CAA-2015098 IRAQI POPULATION DISPLACEMENT ANALYSIS NOVEMBER 2016...CONTRACT NUMBER Iraqi Population Displacement Analysis PDMC 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Ms...NOTES 14. ABSTRACT The purpose of this study was to inform CJ34 Civil Military Operations decisions on placement of internally displaced person (IDP

Financial Analysis: A Review of the Methods and Their Application to Employee Training. Training and Development Research Center Project Number Nine.

ERIC Educational Resources Information Center

Mosier, Nancy R.

Financial analysis techniques are tools that help managers make sound financial decisions that contribute to general corporate objectives. A literature review reveals that the most commonly used financial analysis techniques are payback time, average rate of return, present value or present worth, and internal rate of return. Despite the success…

Combining cognitive engineering and information fusion architectures to build effective joint systems

NASA Astrophysics Data System (ADS)

Sliva, Amy L.; Gorman, Joe; Voshell, Martin; Tittle, James; Bowman, Christopher

2016-05-01

The Dual Node Decision Wheels (DNDW) architecture concept was previously described as a novel approach toward integrating analytic and decision-making processes in joint human/automation systems in highly complex sociotechnical settings. In this paper, we extend the DNDW construct with a description of components in this framework, combining structures of the Dual Node Network (DNN) for Information Fusion and Resource Management with extensions on Rasmussen's Decision Ladder (DL) to provide guidance on constructing information systems that better serve decision-making support requirements. The DNN takes a component-centered approach to system design, decomposing each asset in terms of data inputs and outputs according to their roles and interactions in a fusion network. However, to ensure relevancy to and organizational fitment within command and control (C2) processes, principles from cognitive systems engineering emphasize that system design must take a human-centered systems view, integrating information needs and decision making requirements to drive the architecture design and capabilities of network assets. In the current work, we present an approach for structuring and assessing DNDW systems that uses a unique hybrid DNN top-down system design with a human-centered process design, combining DNN node decomposition with artifacts from cognitive analysis (i.e., system abstraction decomposition models, decision ladders) to provide work domain and task-level insights at different levels in an example intelligence, surveillance, and reconnaissance (ISR) system setting. This DNDW structure will ensure not only that the information fusion technologies and processes are structured effectively, but that the resulting information products will align with the requirements of human decision makers and be adaptable to different work settings .

When do cancer patients regret their treatment decision? A path analysis of the influence of clinicians' communication styles and the match of decision-making styles on decision regret.

PubMed

Nicolai, Jennifer; Buchholz, Angela; Seefried, Nathalie; Reuter, Katrin; Härter, Martin; Eich, Wolfgang; Bieber, Christiane

2016-05-01

To test the influence of physician empathy (PE), shared decision making (SDM), and the match between patients' preferred and perceived decision-making styles on patients' decision regret. Patients with breast or colon cancer (n=71) completed questionnaires immediately following (T1) and three months after a consultation (T2). Path analysis was used to examine the relationships among patient demographics, patient reports of PE, SDM, the match between preferred and perceived decision-making styles, and patient decision regret at T2. After controlling for clinician clusters, higher PE was directly associated with more SDM (β=0.43, p<0.01) and lower decision regret (β=-0.28, p<0.01). The match between patients' preferred and perceived roles was negatively associated with decision regret (β=-0.33, p<0.01). Patients who participated less than desired reported more decision regret at T2. There was no significant association between SDM and decision regret (β=0.03, p=0.74). PE and the match between patients' preferred and perceived roles in medical decision making are essential for patient-centered cancer consultations and treatment decisions. Ways to enhance PE and matching the consultation style to patients' expectations should be encouraged. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Performance evaluation of extension education centers in universities based on the balanced scorecard.

PubMed

Wu, Hung-Yi; Lin, Yi-Kuei; Chang, Chi-Hsiang

2011-02-01

This study aims at developing a set of appropriate performance evaluation indices mainly based on balanced scorecard (BSC) for extension education centers in universities by utilizing multiple criteria decision making (MCDM). Through literature reviews and experts who have real practical experiences in extension education, adequate performance evaluation indices have been selected and then utilizing the decision making trial and evaluation laboratory (DEMATEL) and analytic network process (ANP), respectively, further establishes the causality between the four BSC perspectives as well as the relative weights between evaluation indices. According to this previous result, an empirical analysis of the performance evaluation of extension education centers of three universities at Taoyuan County in Taiwan is illustrated by applying VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR). From the analysis results, it indicates that "Learning and growth" is the significant influential factor and it would affect the other three perspectives. In addition, it is discovered that "Internal process" perspective as well as "Financial" perspective play important roles in the performance evaluation of extension education centers. The top three key performance indices are "After-sales service", "Turnover volume", and "Net income". The proposed evaluation model could be considered as a reference for extension education centers in universities to prioritize their improvements on the key performance indices after performing VIKOR analyses. 2010 Elsevier Ltd. All rights reserved.

An Investigation Into the Navy Public Works Centers Specific Work Service Processing Problems.

DTIC Science & Technology

1980-12-01

demonstrated. These computations are from Navy Area Audit Service reports or PWC and NAVFACENGCOM reports. Number One-time Annual Personnel 3,553...study, all of the endorsements, and a Navy Audit Service audit of the cost analysis, the CNO makes the final consolidation decision. With a decision to...organizations to which local activities turn for environmental issue assistance such as noise, water and air polution , airfield encroachment, local

Providing guidance for genomics-based cancer treatment decisions: insights from stakeholder engagement for post-prostatectomy radiation therapy.

PubMed

Abe, James; Lobo, Jennifer M; Trifiletti, Daniel M; Showalter, Timothy N

2017-08-24

Despite the emergence of genomics-based risk prediction tools in oncology, there is not yet an established framework for communication of test results to cancer patients to support shared decision-making. We report findings from a stakeholder engagement program that aimed to develop a framework for using Markov models with individualized model inputs, including genomics-based estimates of cancer recurrence probability, to generate personalized decision aids for prostate cancer patients faced with radiation therapy treatment decisions after prostatectomy. We engaged a total of 22 stakeholders, including: prostate cancer patients, urological surgeons, radiation oncologists, genomic testing industry representatives, and biomedical informatics faculty. Slides were at each meeting to provide background information regarding the analytical framework. Participants were invited to provide feedback during the meeting, including revising the overall project aims. Stakeholder meeting content was reviewed and summarized by stakeholder group and by theme. The majority of stakeholder suggestions focused on aspects of decision aid design and formatting. Stakeholders were enthusiastic about the potential value of using decision analysis modeling with personalized model inputs for cancer recurrence risk, as well as competing risks from age and comorbidities, to generate a patient-centered tool to assist decision-making. Stakeholders did not view privacy considerations as a major barrier to the proposed decision aid program. A common theme was that decision aids should be portable across multiple platforms (electronic and paper), should allow for interaction by the user to adjust model inputs iteratively, and available to patients both before and during consult appointments. Emphasis was placed on the challenge of explaining the model's composite result of quality-adjusted life years. A range of stakeholders provided valuable insights regarding the design of a personalized decision aid program, based upon Markov modeling with individualized model inputs, to provide a patient-centered framework to support for genomic-based treatment decisions for cancer patients. The guidance provided by our stakeholders may be broadly applicable to the communication of genomic test results to patients in a patient-centered fashion that supports effective shared decision-making that represents a spectrum of personal factors such as age, medical comorbidities, and individual priorities and values.

Hospice decision making: diagnosis makes a difference.

PubMed

Waldrop, Deborah P; Meeker, Mary Ann

2012-10-01

This study explored the process of decision making about hospice enrollment and identified factors that influence the timing of that decision. This study employed an exploratory, descriptive, cross-sectional design and was conducted using qualitative methods. In-depth in-person semistructured interviews were conducted with 36 hospice patients and 55 caregivers after 2 weeks of hospice care. The study was guided by Janis and Mann's conflict theory model (CTM) of decision making. Qualitative data analysis involved a directed content analysis using concepts from the CTM. A model of hospice enrollment decision making is presented. Concepts from the CTM (appraisal, surveying and weighing the alternatives, deliberations, adherence) were used as an organizing framework to illustrate the dynamics. Distinct differences were found by diagnosis (cancer vs. other chronic illness, e.g., heart and lung diseases) during the pre-encounter phase or before the hospice referral but no differences emerged during the post-encounter phase. Differences in decision making by diagnosis suggest the need for research about effective means for tailored communication in end-of-life decision making by type of illness. Recognition that decision making about hospice admission varies is important for clinicians who aim to provide person-centered and family-focused care.

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.

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.

Linking data to decision-making: applying qualitative data analysis methods and software to identify mechanisms for using outcomes data.

PubMed

Patel, Vaishali N; Riley, Anne W

2007-10-01

A multiple case study was conducted to examine how staff in child out-of-home care programs used data from an Outcomes Management System (OMS) and other sources to inform decision-making. Data collection consisted of thirty-seven semi-structured interviews with clinicians, managers, and directors from two treatment foster care programs and two residential treatment centers, and individuals involved with developing the OMS; and observations of clinical and quality management meetings. Case study and grounded theory methodology guided analyses. The application of qualitative data analysis software is described. Results show that although staff rarely used data from the OMS, they did rely on other sources of systematically collected information to inform clinical, quality management, and program decisions. Analyses of how staff used these data suggest that improving the utility of OMS will involve encouraging staff to participate in data-based decision-making, and designing and implementing OMS in a manner that reflects how decision-making processes operate.

Development of an evidence-based decision pathway for vestibular schwannoma treatment options.

PubMed

Linkov, Faina; Valappil, Benita; McAfee, Jacob; Goughnour, Sharon L; Hildrew, Douglas M; McCall, Andrew A; Linkov, Igor; Hirsch, Barry; Snyderman, Carl

To integrate multiple sources of clinical information with patient feedback to build evidence-based decision support model to facilitate treatment selection for patients suffering from vestibular schwannomas (VS). This was a mixed methods study utilizing focus group and survey methodology to solicit feedback on factors important for making treatment decisions among patients. Two 90-minute focus groups were conducted by an experienced facilitator. Previously diagnosed VS patients were recruited by clinical investigators at the University of Pittsburgh Medical Center (UPMC). Classical content analysis was used for focus group data analysis. Providers were recruited from practices within the UPMC system and were surveyed using Delphi methods. This information can provide a basis for multi-criteria decision analysis (MCDA) framework to develop a treatment decision support system for patients with VS. Eight themes were derived from these data (focus group + surveys): doctor/health care system, side effects, effectiveness of treatment, anxiety, mortality, family/other people, quality of life, and post-operative symptoms. These data, as well as feedback from physicians were utilized in building a multi-criteria decision model. The study illustrated steps involved in the development of a decision support model that integrates evidence-based data and patient values to select treatment alternatives. Studies focusing on the actual development of the decision support technology for this group of patients are needed, as decisions are highly multifactorial. Such tools have the potential to improve decision making for complex medical problems with alternate treatment pathways. Copyright © 2016 Elsevier Inc. All rights reserved.

The Fort Collins Science Center

USGS Publications Warehouse

Wilson, Juliette T.; Banowetz, Michele M.

2012-01-01

With a focus on biological research, the U.S. Geological Survey Fort Collins Science Center (FORT) develops and disseminates science-based information and tools to support natural resource decision-making. This brochure succinctly describes the integrated science capabilities, products, and services that the FORT science community offers across the disciplines of aquatic systems, ecosystem dynamics, information science, invasive species science, policy analysis and social science assistance, and trust species and habitats.

A practical radial basis function equalizer.

PubMed

Lee, J; Beach, C; Tepedelenlioglu, N

1999-01-01

A radial basis function (RBF) equalizer design process has been developed in which the number of basis function centers used is substantially fewer than conventionally required. The reduction of centers is accomplished in two-steps. First an algorithm is used to select a reduced set of centers that lie close to the decision boundary. Then the centers in this reduced set are grouped, and an average position is chosen to represent each group. Channel order and delay, which are determining factors in setting the initial number of centers, are estimated from regression analysis. In simulation studies, an RBF equalizer with more than 2000-to-1 reduction in centers performed as well as the RBF equalizer without reduction in centers, and better than a conventional linear equalizer.

[Health care reform in the Obama administration: difficulties of reaching a similar agreement in Argentina].

PubMed

Belmartino, Susana

2014-04-01

This article presents a comparative analysis of the processes leading to health care reform in Argentina and in the USA. The core of the analysis centers on the ideological references utilized by advocates of the reform and the decision-making processes that support or undercut such proposals. The analysis begins with a historical summary of the issue in each country. The political process that led to the sanction of the Obama reform is then described. The text defends a hypothesis aiming to show that deficiencies in the institutional capacities of Argentina's decision-making bodies are a severe obstacle to attaining substantial changes in this area within the country.

User-centered design and the development of patient decision aids: protocol for a systematic review.

PubMed

Witteman, Holly O; Dansokho, Selma Chipenda; Colquhoun, Heather; Coulter, Angela; Dugas, Michèle; Fagerlin, Angela; Giguere, Anik Mc; Glouberman, Sholom; Haslett, Lynne; Hoffman, Aubri; Ivers, Noah; Légaré, France; Légaré, Jean; Levin, Carrie; Lopez, Karli; Montori, Victor M; Provencher, Thierry; Renaud, Jean-Sébastien; Sparling, Kerri; Stacey, Dawn; Vaisson, Gratianne; Volk, Robert J; Witteman, William

2015-01-26

Providing patient-centered care requires that patients partner in their personal health-care decisions to the full extent desired. Patient decision aids facilitate processes of shared decision-making between patients and their clinicians by presenting relevant scientific information in balanced, understandable ways, helping clarify patients' goals, and guiding decision-making processes. Although international standards stipulate that patients and clinicians should be involved in decision aid development, little is known about how such involvement currently occurs, let alone best practices. This systematic review consisting of three interlinked subreviews seeks to describe current practices of user involvement in the development of patient decision aids, compare these to practices of user-centered design, and identify promising strategies. A research team that includes patient and clinician representatives, decision aid developers, and systematic review method experts will guide this review according to the Cochrane Handbook and PRISMA reporting guidelines. A medical librarian will hand search key references and use a peer-reviewed search strategy to search MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, the ACM library, IEEE Xplore, and Google Scholar. We will identify articles across all languages and years describing the development or evaluation of a patient decision aid, or the application of user-centered design or human-centered design to tools intended for patient use. Two independent reviewers will assess article eligibility and extract data into a matrix using a structured pilot-tested form based on a conceptual framework of user-centered design. We will synthesize evidence to describe how research teams have included users in their development process and compare these practices to user-centered design methods. If data permit, we will develop a measure of the user-centeredness of development processes and identify practices that are likely to be optimal. This systematic review will provide evidence of current practices to inform approaches for involving patients and other stakeholders in the development of patient decision aids. We anticipate that the results will help move towards the establishment of best practices for the development of patient-centered tools and, in turn, help improve the experiences of people who face difficult health decisions. PROSPERO CRD42014013241.

Negotiating Decisions during Informed Consent for Pediatric Phase I Oncology Trials

PubMed Central

Marshall, Patricia A.; Magtanong, Ruth V.; Leek, Angela C.; Hizlan, Sabahat; Yamokoski, Amy D.; Kodish, Eric D.

2012-01-01

During informed consent conferences (ICCs) for Phase I trials, oncologists must present complex information while addressing concerns. Research on communication that evolves during ICCs remains largely unexplored. We examined communication during ICCs for pediatric Phase I cancer trials using a stratified random sample from six pediatric cancer centers. A grounded theory approach identified key communication steps and factors influencing the negotiation of decisions for trial participation. Analysis suggests that during ICCs, families, patients, and clinicians exercise choice and control by negotiating micro-decisions in two broad domains: drug logic and logistics, and administration/scheduling. Micro-decisions unfold in a four-step communication process: (1) introduction of an issue; (2) response; (3) negotiation of the issue; and (4) resolution and decision. Negotiation over smaller micro-decisions is prominent in ICCs and merits further study. PMID:22565583

Negotiating decisions during informed consent for pediatric Phase I oncology trials.

PubMed

Marshall, Patricia A; Magtanong, Ruth V; Leek, Angela C; Hizlan, Sabahat; Yamokoski, Amy D; Kodish, Eric D

2012-04-01

During informed consent conferences (ICCs) for Phase I trials, oncologists must present complex information while addressing concerns. Research on communication that evolves during ICCs remains largely unexplored. We examined communication during ICCs for pediatric Phase I cancer trials using a stratified random sample from six pediatric cancer centers. A grounded theory approach identified key communication steps and factors influencing the negotiation of decisions for trial participation. Analysis suggests that during ICCs, families, patients, and clinicians exercise choice and control by negotiating micro-decisions in two broad domains: drug logic and logistics, and administration/scheduling. Micro-decisions unfold in a four-step communication process: (1) introduction of an issue; (2) response; (3) negotiation of the issue; and (4) resolution and decision. Negotiation over smaller micro-decisions is prominent in ICCs and merits further study.

Financing of certified centers: a willingness-to-pay analysis.

PubMed

Thiel, Falk C; Scharl, Anton; Hildebrandt, Thomas; Kotziabassis, Efstratios; Schrauder, Michael G; Bani, Mayada R; Müller, Andreas; Hauzenberger, Tanja; Loehberg, Christian R; Jud, Sebastian M; Fasching, Peter A; Hartmann, Arndt; Schulz-Wendtland, Rüdiger; Strnad, Vratislav; Beckmann, Matthias W; Lux, Michael Patrick

2013-03-01

Although care in certified breast centers is now established throughout Germany, numerous services are still not being reimbursed. This also affects other centers involved in the specialty of gynecology such as gynecological cancer centers, perinatal centers, and endometriosis centers. Although a certified center is entitled to charge additional fees, these are in most cases not reimbursed. Calculation of additional costs is limited by the fact that data from the Institute for the Hospital Reimbursement System (Institut für das Entgeltsystem im Krankenhaus, InEK) do not reflect interdisciplinary services and procedures. For decision-makers, society's willingness to pay is an important factor in guiding decisions on the basis of social priorities. A hypothetical maximum willingness to pay can be calculated using a willingness-to-pay analysis, making it possible to identify deficiencies in the arbitrary setting of health budgets at the macro-level. In a multicenter study conducted between November 2009 and December 2010, 2,469 patients at a university hospital and at a non-university hospital were asked about the extent of their awareness of certified centers, the influence of centers on hospital presentation, and about personal attitudes toward quality-oriented reimbursement. A subjective assessment of possible additional charges was calculated using a willingness-to-pay analysis. In the overall group, 53.4 % of the patients were aware of what a certified center is and 27.4 % had specific information (obstetrics 40.0/32.3 %; mastology 66.8/23.2 %; gynecological oncology 54.7/27.3 %; P < 0.001). For 43.8 %, a certified center was one reason or the major reason for presentation (obstetrics 26.2 %; mastology 66.8 %; gynecological oncology 46.6 %; P < 0.001). A total of 72.6 % were in favor of quality-oriented reimbursement and 69.7 % were in favor of an additional charge for a certified center amounting to €538.56 (mastology €643.65, obstetrics €474.67, gynecological oncology €532.47). In all, 33.9 % would accept an increase in health-insurance fees (averaging 0.3865 %), and 28.3 % were in favor of reduced remuneration for non-certified centers. The existence of certified centers is being increasingly recognized by patients. Additional charges for certified centers are generally supported. There is therefore a clear demand for them-from patients as well. This may be useful when negotiations are being conducted.

Integrating Agriculture and Conservation

USGS Publications Warehouse

Vandever, Mark W.

2010-01-01

The USGS produces the needed science-based information to guide management actions and policy decisions that support wildlife habitat and other environmental services compatible with USDA conservation goals and farm operations. The Policy Analysis and Science Assistance Branch of the Fort Collins Science Center (FORT) has conducted research involving a national landowner survey and numerous short- and long-term evaluations regarding vegetation responses to land management practices. This research helps land and resource managers to make informed decisions and resolve resource management conflicts.

Effect of counseling quality on anxiety, grief, and coping after second-trimester abortion for pregnancy complications.

PubMed

Kerns, Jennifer L; Mengesha, Biftu; McNamara, Blair C; Cassidy, Arianna; Pearlson, Geffan; Kuppermann, Miriam

2018-06-01

We sought to explore the relationship between counseling quality, measured by shared decision making and decision satisfaction, and psychological outcomes (anxiety, grief, and posttraumatic stress) after second-trimester abortion for pregnancy complications. We conducted a cross-sectional study of women who underwent second-trimester abortion for complications. We recruited participants from Facebook and online support groups and surveyed them about counseling experiences and psychosocial issues. We used multivariate linear regression to evaluate relationships between counseling quality and psychological outcomes. We analyzed data from 145 respondents. Shared decision making and decision satisfaction scores were positively and strongly correlated in bivariate analysis (r=0.7, p<.0001), as were posttraumatic stress and grief scores (r=0.7, p<.0001). In the adjusted analysis, higher decision satisfaction was associated with lower grief and posttraumatic stress scores (p=.02 and p=.01, respectively) and higher shared decision making was associated with lower posttraumatic stress scores (p=.01). Decision satisfaction and shared decision making have a positive effect on psychological outcomes after second-trimester abortion for pregnancy complications. Counseling quality may be especially important in this setting given the sensitive nature of decisions regarding pregnancy termination for complications. These results highlight the importance of patient-centered counseling for women seeking pregnancy termination. Copyright © 2018. Published by Elsevier Inc.

34 CFR 366.44 - How does a center appeal a decision included in a Director's initial written notice or a Director...

Code of Federal Regulations, 2011 CFR

2011-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION CENTERS FOR INDEPENDENT LIVING Enforcement and Appeals... 34 Education 2 2011-07-01 2010-07-01 true How does a center appeal a decision included in a Director's initial written notice or a Director's final written decision? 366.44 Section 366.44 Education...

34 CFR 366.44 - How does a center appeal a decision included in a Director's initial written notice or a Director...

Code of Federal Regulations, 2010 CFR

2010-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION CENTERS FOR INDEPENDENT LIVING Enforcement and Appeals... 34 Education 2 2010-07-01 2010-07-01 false How does a center appeal a decision included in a Director's initial written notice or a Director's final written decision? 366.44 Section 366.44 Education...

A multicriteria decision making approach based on fuzzy theory and credibility mechanism for logistics center location selection.

PubMed

Wang, Bowen; Xiong, Haitao; Jiang, Chengrui

2014-01-01

As a hot topic in supply chain management, fuzzy method has been widely used in logistics center location selection to improve the reliability and suitability of the logistics center location selection with respect to the impacts of both qualitative and quantitative factors. However, it does not consider the consistency and the historical assessments accuracy of experts in predecisions. So this paper proposes a multicriteria decision making model based on credibility of decision makers by introducing priority of consistency and historical assessments accuracy mechanism into fuzzy multicriteria decision making approach. In this way, only decision makers who pass the credibility check are qualified to perform the further assessment. Finally, a practical example is analyzed to illustrate how to use the model. The result shows that the fuzzy multicriteria decision making model based on credibility mechanism can improve the reliability and suitability of site selection for the logistics center.

A Multicriteria Decision Making Approach Based on Fuzzy Theory and Credibility Mechanism for Logistics Center Location Selection

PubMed Central

Wang, Bowen; Jiang, Chengrui

2014-01-01

As a hot topic in supply chain management, fuzzy method has been widely used in logistics center location selection to improve the reliability and suitability of the logistics center location selection with respect to the impacts of both qualitative and quantitative factors. However, it does not consider the consistency and the historical assessments accuracy of experts in predecisions. So this paper proposes a multicriteria decision making model based on credibility of decision makers by introducing priority of consistency and historical assessments accuracy mechanism into fuzzy multicriteria decision making approach. In this way, only decision makers who pass the credibility check are qualified to perform the further assessment. Finally, a practical example is analyzed to illustrate how to use the model. The result shows that the fuzzy multicriteria decision making model based on credibility mechanism can improve the reliability and suitability of site selection for the logistics center. PMID:25215319

A conceptual framework for patient-centered fertility treatment.

PubMed

Duthie, Elizabeth A; Cooper, Alexandra; Davis, Joseph B; Schoyer, Katherine D; Sandlow, Jay; Strawn, Estil Y; Flynn, Kathryn E

2017-09-07

Patient-centered care is a pillar of quality health care and is important to patients experiencing infertility. In this study we used empirical, in-depth data on couples' experiences of infertility treatment decision making to inform and revise a conceptual framework for patient-centered fertility treatment that was developed based on health care professionals' conceptualizations of fertility treatment, covering effectiveness, burden, safety, and costs. In this prospective, longitudinal mixed methods study, we collected data from both members (separately) of 37 couples who scheduled an initial consult with a reproductive specialist. Data collection occurred 1 week before the initial consultation, 1 week after the initial consultation, and then roughly 2, 4, 8, and 12 months later. Data collection included semi-structured qualitative interviews, self-reported questionnaires, and medical record review. Interviews were recorded, transcribed, and content analyzed in NVivo. A single coder analyzed all transcripts, with > 25% of transcripts coded by a second coder to ensure quality control and consistency. Content analysis of the interview transcripts revealed 6 treatment dimensions: effectiveness, physical and emotional burden, time, cost, potential risks, and genetic parentage. Thus, the revised framework for patient-centered fertility treatment retains much from the original framework, with modification to one dimension (from safety to potential risks) and the addition of two dimensions (time and genetic parentage). For patients and their partners making fertility treatment decisions, tradeoffs are explicitly considered across dimensions as opposed to each dimension being considered on its own. Patient-centered fertility treatment should account for the dimensions of treatment that patients and their partners weigh when making decisions about how to add a child to their family. Based on the lived experiences of couples seeking specialist medical care for infertility, this revised conceptual framework can be used to inform patient-centered treatment and research on infertility and to develop decision support tools for patients and providers.

Detection of cyst using image segmentation and building knowledge-based intelligent decision support system as an aid to telemedicine

NASA Astrophysics Data System (ADS)

Janet, J.; Natesan, T. R.; Santhosh, Ramamurthy; Ibramsha, Mohideen

2005-02-01

An intelligent decision support tool to the Radiologist in telemedicine is described. Medical prescriptions are given based on the images of cyst that has been transmitted over computer networks to the remote medical center. The digital image, acquired by sonography, is converted into an intensity image. This image is then subjected to image preprocessing which involves correction methods to eliminate specific artifacts. The image is resized into a 256 x 256 matrix by using bilinear interpolation method. The background area is detected using distinct block operation. The area of the cyst is calculated by removing the background area from the original image. Boundary enhancement and morphological operations are done to remove unrelated pixels. This gives us the cyst volume. This segmented image of the cyst is sent to the remote medical center for analysis by Knowledge based artificial Intelligent Decision Support System (KIDSS). The type of cyst is detected and reported to the control mechanism of KIDSS. Then the inference engine compares this with the knowledge base and gives appropriate medical prescriptions or treatment recommendations by applying reasoning mechanisms at the remote medical center.

Using Computational Modeling to Assess the Impact of Clinical Decision Support on Cancer Screening within Community Health Centers

PubMed Central

Carney, Timothy Jay; Morgan, Geoffrey P.; Jones, Josette; McDaniel, Anna M.; Weaver, Michael; Weiner, Bryan; Haggstrom, David A.

2014-01-01

Our conceptual model demonstrates our goal to investigate the impact of clinical decision support (CDS) utilization on cancer screening improvement strategies in the community health care (CHC) setting. We employed a dual modeling technique using both statistical and computational modeling to evaluate impact. Our statistical model used the Spearman’s Rho test to evaluate the strength of relationship between our proximal outcome measures (CDS utilization) against our distal outcome measure (provider self-reported cancer screening improvement). Our computational model relied on network evolution theory and made use of a tool called Construct-TM to model the use of CDS measured by the rate of organizational learning. We employed the use of previously collected survey data from community health centers Cancer Health Disparities Collaborative (HDCC). Our intent is to demonstrate the added valued gained by using a computational modeling tool in conjunction with a statistical analysis when evaluating the impact a health information technology, in the form of CDS, on health care quality process outcomes such as facility-level screening improvement. Significant simulated disparities in organizational learning over time were observed between community health centers beginning the simulation with high and low clinical decision support capability. PMID:24953241

Integrated corridor management initiative : demonstration phase evaluation, San Diego decision support system analysis test plan.

DOT National Transportation Integrated Search

2000-01-01

This report demonstrates the benefits and potential pitfalls of deploying and operating an integrated freeway and arterial management system. In particular, it discusses the lessons learned about the Medical Center Corridor (MCC) Project deployed in ...

Computerized Decision Aids for Shared Decision Making in Serious Illness: Systematic Review.

PubMed

Staszewska, Anna; Zaki, Pearl; Lee, Joon

2017-10-06

Shared decision making (SDM) is important in achieving patient-centered care. SDM tools such as decision aids are intended to inform the patient. When used to assist in decision making between treatments, decision aids have been shown to reduce decisional conflict, increase ease of decision making, and increase modification of previous decisions. The purpose of this systematic review is to assess the impact of computerized decision aids on patient-centered outcomes related to SDM for seriously ill patients. PubMed and Scopus databases were searched to identify randomized controlled trials (RCTs) that assessed the impact of computerized decision aids on patient-centered outcomes and SDM in serious illness. Six RCTs were identified and data were extracted on study population, design, and results. Risk of bias was assessed by a modified Cochrane Risk of Bias Tool for Quality Assessment of Randomized Controlled Trials. Six RCTs tested decision tools in varying serious illnesses. Three studies compared different computerized decision aids against each other and a control. All but one study demonstrated improvement in at least one patient-centered outcome. Computerized decision tools may reduce unnecessary treatment in patients with low disease severity in comparison with informational pamphlets. Additionally, electronic health record (EHR) portals may provide the opportunity to manage care from the home for individuals affected by illness. The quality of decision aids is of great importance. Furthermore, satisfaction with the use of tools is associated with increased patient satisfaction and reduced decisional conflict. Finally, patients may benefit from computerized decision tools without the need for increased physician involvement. Most computerized decision aids improved at least one patient-centered outcome. All RCTs identified were at a High Risk of Bias or Unclear Risk of Bias. Effort should be made to improve the quality of RCTs testing SDM aids in serious illness. ©Anna Staszewska, Pearl Zaki, Joon Lee. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 06.10.2017.

Use of multiattribute utility theory for formulary management in a health system.

PubMed

Chung, Seonyoung; Kim, Sooyon; Kim, Jeongmee; Sohn, Kieho

2010-01-15

The application, utility, and flexibility of the multiattribute utility theory (MAUT) when used as a formulary decision methodology in a Korean medical center were evaluated. A drug analysis model using MAUT consisting of 10 steps was designed for two drug classes of dihydropyridine calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs). These two drug classes contain the most diverse agents among cardiovascular drugs on Samsung Medical Center's drug formulary. The attributes identified for inclusion in the drug analysis model were effectiveness, safety, patient convenience, and cost, with relative weights of 50%, 30%, 10%, and 10%, respectively. The factors were incorporated into the model to quantify the contribution of each attribute. For each factor, a utility scale of 0-100 was established, and the total utility score for each alternative was calculated. An attempt was made to make the model adaptable to changing health care and regulatory circumstances. The analysis revealed amlodipine besylate to be an alternative agent, with the highest total utility score among the dihydropyridine CCBs, while barnidipine hydrochloride had the lowest score. For ARBs, losartan potassium had the greatest total utility score, while olmesartan medoxomil had the lowest. A drug analysis model based on the MAUT was successfully developed and used in making formulary decisions for dihydropyridine CCBs and ARBs for a Korean health system. The model incorporates sufficient utility and flexibility of a drug's attributes and can be used as an alternative decision-making tool for formulary management in health systems.

A clinical decision support system for integrating tuberculosis and HIV care in Kenya: a human-centered design approach.

PubMed

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

A Clinical Decision Support System for Integrating Tuberculosis and HIV Care in Kenya: A Human-Centered Design Approach

PubMed Central

Catalani, Caricia; Green, Eric; Owiti, Philip; Keny, Aggrey; Diero, Lameck; Yeung, Ada; Israelski, Dennis; Biondich, Paul

2014-01-01

With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context. PMID:25170939

Expert panel reviews of research centers: the site visit process.

PubMed

Lawrenz, Frances; Thao, Mao; Johnson, Kelli

2012-08-01

Site visits are used extensively in a variety of settings within the evaluation community. They are especially common in making summative value decisions about the quality and worth of research programs/centers. However, there has been little empirical research and guidance about how to appropriately conduct evaluative site visits of research centers. We review the processes of two site visit examples using an expert panel review: (1) a process to evaluate four university research centers and (2) a process to review a federally sponsored research center. A set of 14 categories describing the expert panel review process was obtained through content analysis and participant observation. Most categories were addressed differently through the two processes highlighting the need for more research about the most effective processes to use within different contexts. Decisions about how to structure site visits appear to depend on the research context, practical considerations, the level at which the review is being conducted and the intended impact of the report. Future research pertaining to the selection of site visitors, the autonomy of the visitors in data collection and report writing, and the amount and type of information provided would be particularly valuable. Copyright © 2012 Elsevier Ltd. All rights reserved.

Comparative effectiveness of prostate cancer treatments for patient-centered outcomes: A systematic review and meta-analysis (PRISMA Compliant).

PubMed

Jayadevappa, Ravishankar; Chhatre, Sumedha; Wong, Yu-Ning; Wittink, Marsha N; Cook, Ratna; Morales, Knashawn H; Vapiwala, Neha; Newman, Diane K; Guzzo, Thomas; Wein, Alan J; Malkowicz, Stanley B; Lee, David I; Schwartz, Jerome S; Gallo, Joseph J

2017-05-01

In the context of prostate cancer (PCa) characterized by the multiple alternative treatment strategies, comparative effectiveness analysis is essential for informed decision-making. We analyzed the comparative effectiveness of PCa treatments through systematic review and meta-analysis with a focus on outcomes that matter most to newly diagnosed localized PCa patients. We performed a systematic review of literature published in English from 1995 to October 2016. A search strategy was employed using terms "prostate cancer," "localized," "outcomes," "mortality," "health related quality of life," and "complications" to identify relevant randomized controlled trials (RCTs), prospective, and retrospective studies. For observational studies, only those adjusting for selection bias using propensity-score or instrumental-variables approaches were included. Multivariable adjusted hazard ratio was used to assess all-cause and disease-specific mortality. Funnel plots were used to assess the level of bias. Our search strategy yielded 58 articles, of which 29 were RCTs, 6 were prospective studies, and 23 were retrospective studies. The studies provided moderate data for the patient-centered outcome of mortality. Radical prostatectomy demonstrated mortality benefit compared to watchful waiting (all-cause HR = 0.63 CI = 0.45, 0.87; disease-specific HR = 0.48 CI = 0.40, 0.58), and radiation therapy (all-cause HR = 0.65 CI = 0.57, 0.74; disease-specific HR = 0.51 CI = 0.40, 0.65). However, we had minimal comparative information about tradeoffs between and within treatment for other patient-centered outcomes in the short and long-term. Lack of patient-centered outcomes in comparative effectiveness research in localized PCa is a major hurdle to informed and shared decision-making. More rigorous studies that can integrate patient-centered and intermediate outcomes in addition to mortality are needed.

Core domains of shared decision-making during psychiatric visits: scientific and preference-based discussions.

PubMed

Fukui, Sadaaki; Matthias, Marianne S; Salyers, Michelle P

2015-01-01

Shared decision-making (SDM) is imperative to person-centered care, yet little is known about what aspects of SDM are targeted during psychiatric visits. This secondary data analysis (191 psychiatric visits with 11 providers, coded with a validated SDM coding system) revealed two factors (scientific and preference-based discussions) underlying SDM communication. Preference-based discussion occurred less. Both provider and consumer initiation of SDM elements and decision complexity were associated with greater discussions in both factors, but were more strongly associated with scientific discussion. Longer visit length correlated with only scientific discussion. Providers' understanding of core domains could facilitate engaging consumers in SDM.

Decision science and cervical cancer.

PubMed

Cantor, Scott B; Fahs, Marianne C; Mandelblatt, Jeanne S; Myers, Evan R; Sanders, Gillian D

2003-11-01

Mathematical modeling is an effective tool for guiding cervical cancer screening, diagnosis, and treatment decisions for patients and policymakers. This article describes the use of mathematical modeling as outlined in five presentations from the Decision Science and Cervical Cancer session of the Second International Conference on Cervical Cancer held at The University of Texas M. D. Anderson Cancer Center, April 11-14, 2002. The authors provide an overview of mathematical modeling, especially decision analysis and cost-effectiveness analysis, and examples of how it can be used for clinical decision making regarding the prevention, diagnosis, and treatment of cervical cancer. Included are applications as well as theory regarding decision science and cervical cancer. Mathematical modeling can answer such questions as the optimal frequency for screening, the optimal age to stop screening, and the optimal way to diagnose cervical cancer. Results from one mathematical model demonstrated that a vaccine against high-risk strains of human papillomavirus was a cost-effective use of resources, and discussion of another model demonstrated the importance of collecting direct non-health care costs and time costs for cost-effectiveness analysis. Research presented indicated that care must be taken when applying the results of population-wide, cost-effectiveness analyses to reduce health disparities. Mathematical modeling can encompass a variety of theoretical and applied issues regarding decision science and cervical cancer. The ultimate objective of using decision-analytic and cost-effectiveness models is to identify ways to improve women's health at an economically reasonable cost. Copyright 2003 American Cancer Society.

Preliminary Results Obtained in Integrated Safety Analysis of NASA Aviation Safety Program Technologies

NASA Technical Reports Server (NTRS)

2005-01-01

This is a listing of recent unclassified RTO technical publications for January 1, 2005 through March 31, 2005 processed by the NASA Center for AeroSpace Center available on the NASA Aeronautics and Space Database. Contents include 1) Electronic Information Management; 2) Decision Support to Combined Joint Task Force and Component Commanders; 3) RTO Technical Publications : A Quarterly Listing (December 2004); 4) The Role of Humans in Intelligent and Automated Systems.

Cardiological database management system as a mediator to clinical decision support.

PubMed

Pappas, C; Mavromatis, A; Maglaveras, N; Tsikotis, A; Pangalos, G; Ambrosiadou, V

1996-03-01

An object-oriented medical database management system is presented for a typical cardiologic center, facilitating epidemiological trials. Object-oriented analysis and design were used for the system design, offering advantages for the integrity and extendibility of medical information systems. The system was developed using object-oriented design and programming methodology, the C++ language and the Borland Paradox Relational Data Base Management System on an MS-Windows NT environment. Particular attention was paid to system compatibility, portability, the ease of use, and the suitable design of the patient record so as to support the decisions of medical personnel in cardiovascular centers. The system was designed to accept complex, heterogeneous, distributed data in various formats and from different kinds of examinations such as Holter, Doppler and electrocardiography.

The Management of Instruction.

ERIC Educational Resources Information Center

Tosti, Donald T.; Harmon, N. Paul

A new conceptual approach to the analysis of educational systems is defined. It centers attention on the instructional management decision making process, which serves to mediate the activities of the students and learning environment, so that much of the present confusion surrounding the design of educational systems is eliminated. Instructional…

Budgeting-Based Organization of Internal Control

ERIC Educational Resources Information Center

Rogulenko, Tatiana; Ponomareva, Svetlana; Bodiaco, Anna; Mironenko, Valentina; Zelenov, Vladimir

2016-01-01

The article suggests methodical approaches to the budgeting-based organization of internal control, determines the tasks and subtasks of control that consist in the construction of an efficient system for the making, implementation, control, and analysis of managerial decisions. The organization of responsibility centers by means of implementing…

48 CFR 7.403 - General Services Administration assistance.

Code of Federal Regulations, 2011 CFR

2011-10-01

...; and (4) Industry or market trends. (b) Agencies may request information from the following GSA offices: (1) Center for Strategic IT Analysis (MKS), Washington, DC 20405, for information on acquisition of... in lease or purchase decisions by providing information such as— (1) Pending price adjustments to...

Patient centered decision making: use of conjoint analysis to determine risk-benefit trade-offs for preference sensitive treatment choices.

PubMed

Wilson, Leslie; Loucks, Aimee; Bui, Christine; Gipson, Greg; Zhong, Lixian; Schwartzburg, Amy; Crabtree, Elizabeth; Goodin, Douglas; Waubant, Emmanuelle; McCulloch, Charles

2014-09-15

Understanding patient preferences facilitates shared decision-making and focuses on patient-centered outcomes. Little is known about relapsing-remitting multiple sclerosis (RRMS) patient preferences for disease modifying therapies (DMTs). We use choice based conjoint (CBC) analysis to calculate patient preferences for risk/benefit trade-offs for hypothetical DMTs. Patients with RRMS were surveyed between 2012 and 2013. Our CBC survey mimicked the decision-making process and trade-offs of patients choosing DMTs, based on all possible DMT attributes. Mixed-effects logistic regression analyzed preferences. We estimated maximum acceptable risk trade-offs for various DMT benefits. Severe side-effect risks had the biggest impact on patient preference with a 1% risk, decreasing patient preference five-fold compared to no risk. (OR=0.22, p<0.001). Symptom improvement was the most preferred benefit (OR=3.68, p<0.001), followed by prevention of progression of 10 years (OR=2.4, p<0.001). Daily oral administration had the third highest DMT preference rating (OR=2.08, p<0.001). Patients were willing to accept 0.08% severe risk for a year delayed relapse, and 0.22% for 4 vs 2 year prevented progression. We provided patient preferences and risk-benefit trade-offs for attributes of all available DMTs. Evaluation of patient preferences is a key step in shared decision making and may significantly impact early drug initiation and compliance. Copyright © 2014 Elsevier B.V. All rights reserved.

Classification and Sequential Pattern Analysis for Improving Managerial Efficiency and Providing Better Medical Service in Public Healthcare Centers

PubMed Central

Chung, Sukhoon; Rhee, Hyunsill; Suh, Yongmoo

2010-01-01

Objectives This study sought to find answers to the following questions: 1) Can we predict whether a patient will revisit a healthcare center? 2) Can we anticipate diseases of patients who revisit the center? Methods For the first question, we applied 5 classification algorithms (decision tree, artificial neural network, logistic regression, Bayesian networks, and Naïve Bayes) and the stacking-bagging method for building classification models. To solve the second question, we performed sequential pattern analysis. Results We determined: 1) In general, the most influential variables which impact whether a patient of a public healthcare center will revisit it or not are personal burden, insurance bill, period of prescription, age, systolic pressure, name of disease, and postal code. 2) The best plain classification model is dependent on the dataset. 3) Based on average of classification accuracy, the proposed stacking-bagging method outperformed all traditional classification models and our sequential pattern analysis revealed 16 sequential patterns. Conclusions Classification models and sequential patterns can help public healthcare centers plan and implement healthcare service programs and businesses that are more appropriate to local residents, encouraging them to revisit public health centers. PMID:21818426

Entropy-functional-based online adaptive decision fusion framework with application to wildfire detection in video.

PubMed

Gunay, Osman; Toreyin, Behçet Ugur; Kose, Kivanc; Cetin, A Enis

2012-05-01

In this paper, an entropy-functional-based online adaptive decision fusion (EADF) framework is developed for image analysis and computer vision applications. In this framework, it is assumed that the compound algorithm consists of several subalgorithms, each of which yields its own decision as a real number centered around zero, representing the confidence level of that particular subalgorithm. Decision values are linearly combined with weights that are updated online according to an active fusion method based on performing entropic projections onto convex sets describing subalgorithms. It is assumed that there is an oracle, who is usually a human operator, providing feedback to the decision fusion method. A video-based wildfire detection system was developed to evaluate the performance of the decision fusion algorithm. In this case, image data arrive sequentially, and the oracle is the security guard of the forest lookout tower, verifying the decision of the combined algorithm. The simulation results are presented.

An economic theory of patient decision-making.

PubMed

Stewart, Douglas O; DeMarco, Joseph P

2005-01-01

Patient autonomy, as exercised in the informed consent process, is a central concern in bioethics. The typical bioethicist's analysis of autonomy centers on decisional capacity--finding the line between autonomy and its absence. This approach leaves unexplored the structure of reasoning behind patient treatment decisions. To counter that approach, we present a microeconomic theory of patient decision-making regarding the acceptable level of medical treatment from the patient's perspective. We show that a rational patient's desired treatment level typically departs from the level yielding an absence of symptoms, the level we call ideal. This microeconomic theory demonstrates why patients have good reason not to pursue treatment to the point of absence of physical symptoms. We defend our view against possible objections that it is unrealistic and that it fails to adequately consider harm a patient may suffer by curtailing treatment. Our analysis is fruitful in various ways. It shows why decisions often considered unreasonable might be fully reasonable. It offers a theoretical account of how physician misinformation may adversely affect a patient's decision. It shows how billing costs influence patient decision-making. It indicates that health care professionals' beliefs about the 'unreasonable' attitudes of patients might often be wrong. It provides a better understanding of patient rationality that should help to ensure fuller information as well as increased respect for patient decision-making.

Center for the Built Environment: Research on Indoor Environmental Quality

Science.gov Websites

Comfort System Speech Privacy Task Ambient Conditioning Team Space Design Study Thermal Comfort Automotive resulting from HVAC, building, and facade design decisions. Acoustical Analysis in Office Environments Using building energy. The Impact of Team Space Design on Collaboration Assessing individual and group worker

Issues in Television-Centered Instruction.

ERIC Educational Resources Information Center

Richardson, Penelope L.

Current research on the adult learner and on instruction through media has grave flaws, and reviews of research in five areas are needed to assist instructional developers and adopters in making wise decisions. These include a critical analysis of existing telecourse packages, as well as reviews of research on the motivation of various subgroups…

78 FR 61373 - Animal Center Master Plan Record of Decision

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-03

... propose any land use changes outside NIHAC. Therefore, the NIHAC campus is anticipated to remain... analysis, Environmental Justice will not be discussed. Visual Quality The Master Plan's land use plan provides a framework to help organize future development at NIHAC so that similar land use types are...

Parent Training Programs: Insight for Practitioners

ERIC Educational Resources Information Center

Rossi, Carol, Neal

2009-01-01

The Centers for Disease Control and Prevention (CDC) is currently conducting research and analyses to guide practitioners in making evidence-based program decisions. A meta-analysis of the current research literature on training programs for parents with children ages 0 to 7 years old was recently conducted by CDC behavioral scientists. This…

The Research of Spatial-Temporal Analysis and Decision-Making Assistant System for Disabled Person Affairs Based on Mapworld

NASA Astrophysics Data System (ADS)

Zhang, J. H.; Yang, J.; Sun, Y. S.

2015-06-01

This system combines the Mapworld platform and informationization of disabled person affairs, uses the basic information of disabled person as center frame. Based on the disabled person population database, the affairs management system and the statistical account system, the data were effectively integrated and the united information resource database was built. Though the data analysis and mining, the system provides powerful data support to the decision making, the affairs managing and the public serving. It finally realizes the rationalization, normalization and scientization of disabled person affairs management. It also makes significant contributions to the great-leap-forward development of the informationization of China Disabled Person's Federation.

Situation-Assessment And Decision-Aid Production-Rule Analysis System For Nuclear Plant Monitoring And Emergency Preparedness

NASA Astrophysics Data System (ADS)

Gvillo, D.; Ragheb, M.; Parker, M.; Swartz, S.

1987-05-01

A Production-Rule Analysis System is developed for Nuclear Plant Monitoring. The signals generated by the Zion-1 Plant are considered. A Situation-Assessment and Decision-Aid capability is provided for monitoring the integrity of the Plant Radiation, the Reactor Coolant, the Fuel Clad, and the Containment Systems. A total of 41 signals are currently fed as facts to an Inference Engine functioning in the backward-chaining mode and built along the same structure as the E-Mycin system. The Goal-Tree constituting the Knowledge Base was generated using a representation in the form of Fault Trees deduced from plant procedures information. The system is constructed in support of the Data Analysis and Emergency Preparedness tasks at the Illinois Radiological Emergency Assessment Center (REAC).

Shared Decision Making and Autonomy Among US Participants with Multiple Sclerosis in the NARCOMS Registry

PubMed Central

Thomas, Nina; Tyry, Tuula; Fox, Robert J.; Salter, Amber

2017-01-01

Background: Treatment decisions in multiple sclerosis (MS) are affected by many factors and are made by the patient, doctor, or both. With new disease-modifying therapies (DMTs) emerging, the complexity surrounding treatment decisions is increasing, further emphasizing the importance of understanding decision-making preferences. Methods: North American Research Committee on Multiple Sclerosis (NARCOMS) Registry participants completed the Fall 2014 Update survey, which included the Control Preferences Scale (CPS). The CPS consists of five images showing different patient/doctor roles in treatment decision making. The images were collapsed to three categories: patient-centered, shared, and physician-centered decision-making preferences. Associations between decision-making preferences and demographic and clinical factors were evaluated using multivariable logistic regression. Results: Of 7009 participants, 79.3% were women and 93.5% were white (mean [SD] age, 57.6 [10.3] years); 56.7% reported a history of relapses. Patient-centered decision making was most commonly preferred by participants (47.9%), followed by shared decision making (SDM; 42.8%). SDM preference was higher for women and those taking DMTs and increased with age and disease duration (all P < .05). Patient-centered decisions were most common for respondents not taking a DMT at the time of the survey and were preferred by those who had no DMT history compared with those who had previously taken a DMT (P < .0001). There was no difference in SDM preference by current MS disease course after adjusting for other disease-related factors. Conclusions: Responders reported most commonly considering their doctor's opinion before making a treatment decision and making decisions jointly with their doctor. DMT use, gender, and age were associated with decision-making preference. PMID:29270088

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

Horowitz, Kelsey A; Bench Reese, Samantha R; Remo, Timothy W

This brochure, published as an annual research highlight of the Clean Energy Manufacturing Analysis Center (CEMAC), summarizes CEMAC analysis of silicon carbide (SiC) power electronics for variable frequency motor drives. The key finding presented is that variations in manufacturing expertise, yields, and access to existing facilities impact regional costs and manufacturing location decisions for SiC ingots, wafers, chips, and power modules more than do core country-specific factors such as labor and electricity costs.

Decision Support Preferences Among Hispanic and Non-Hispanic White Older Adults With Chronic Musculoskeletal Pain.

PubMed

Riffin, Catherine; Pillemer, Karl; Reid, Manny C; Lӧckenhoff, Corinna E

2016-09-01

Despite broad recognition that social networks play a key role in the management of chronic musculoskeletal pain (CMP), little is known about when and why older adults with CMP choose to involve others in treatment decisions. This study investigates the types (i.e., informational, emotional, and instrumental) and sources (i.e., formal and informal) of support Hispanic and non-Hispanic White CMP patients desire and receive when making decisions about their pain care. Semi-structured interviews were conducted with Hispanic and non-Hispanic White older adults with CMP (N = 63) recruited from one medical center and one senior center in New York City. Interviews were transcribed and then analyzed using content analysis. CMP patients sought network members who supported their emotional well-being throughout the decision-making process. When considering high-stakes treatment decisions, participants selectively involved individuals who had similar pain conditions or first-hand experience with the procedure. Participants' perceptions of the decision-making process were contingent upon the congruence between the decision they made and the support they received for it. For Spanish-speaking participants, positive perceptions were linked with satisfactory language competence by their providers. On the other hand, lack of language competence among providers hindered Spanish speakers' ability to obtain adequate informational support. Results reveal the importance of empathic patient-provider exchanges across diverse patient populations and cultural sensitivity for Spanish-speaking patients. Findings suggest that social networks beyond the patient-provider dyad influence patients' decision-making satisfaction. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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.

Supporting Clinical Cognition: A Human-Centered Approach to a Novel ICU Information Visualization Dashboard.

PubMed

Faiola, Anthony; Srinivas, Preethi; Duke, Jon

2015-01-01

Advances in intensive care unit bedside displays/interfaces and electronic medical record (EMR) technology have not adequately addressed the topic of visual clarity of patient data/information to further reduce cognitive load during clinical decision-making. We responded to these challenges with a human-centered approach to designing and testing a decision-support tool: MIVA 2.0 (Medical Information Visualization Assistant, v.2). Envisioned as an EMR visualization dashboard to support rapid analysis of real-time clinical data-trends, our primary goal originated from a clinical requirement to reduce cognitive overload. In the study, a convenience sample of 12 participants were recruited, in which quantitative and qualitative measures were used to compare MIVA 2.0 with ICU paper medical-charts, using time-on-task, post-test questionnaires, and interviews. Findings demonstrated a significant difference in speed and accuracy with the use of MIVA 2.0. Qualitative outcomes concurred, with participants acknowledging the potential impact of MIVA 2.0 for reducing cognitive load and enabling more accurate and quicker decision-making.

A prospective analysis of implementation of multi-disciplinary team decisions in breast cancer.

PubMed

English, Rachel; Metcalfe, Chris; Day, James; Rayter, Zenon; Blazeby, Jane M

2012-09-01

Multi-disciplinary teams (MDTs) management of patients with cancer is mandatory in the United Kingdom, and auditing team decision-making by examining rates of decision implementation and reasons for nonimplementation may inform this practice. Consecutive breast cancer MDT decisions, subsequent decision implementation, and reasons for nonimplementation were prospectively recorded. Factors associated with nonimplementation of the MDT decision were analyzed with logistic regression. Of 289 consecutive MDT decisions involving 210 women, 20 (6.9%, 95% CIs 4.3%-10.5%) were not implemented. Most changed MDT decisions did so because of patient preferences (n = 13, 65%), with the discovery of new clinical information (n = 3) and individual doctor's views (n = 4) also leading to decision nonimplementation. MDT decisions were significantly less likely to be adhered to in patients with confirmed malignant disease compared to those with benign or 'unknown' disease categories (p < 0.001) and MDT decisions in older patients were significantly more likely not to be implemented than in younger patients (p = 0.002). Auditing nonimplementation of MDT recommendations and examining reasons for changed decisions is a useful process to monitor team performance and to identify factors that need more attention during the MDT meeting to ensure that the process makes optimal patient centered decisions. © 2012 Wiley Periodicals, Inc.

Celebrity Health Announcements and Online Health Information Seeking: An Analysis of Angelina Jolie's Preventative Health Decision.

PubMed

Dean, Marleah

2016-01-01

On May 14, 2013, Angelina Jolie disclosed she carries BRCA1, which means she has an 87% risk of developing breast cancer during her lifetime. Jolie decided to undergo a preventative bilateral mastectomy (PBM), reducing her risk to 5%. The purpose of this study was to analyze the type of information individuals are exposed to when using the Internet to search health information regarding Jolie's decision. Qualitative content analysis revealed four main themes--information about genetics, information about a PBM, information about health care, and information about Jolie's gender identity. Broadly, the identified websites mention Jolie's high risk for developing cancer due to the genetic mutation BRCA1, describe a PBM occasionally noting reasons why she had this surgery and providing alternatives to the surgery, discuss issues related to health care services, costs, and insurances about Jolie's health decision, and portray Jolie as a sexual icon, a partner to Brad Pitt, a mother of six children, and an inspirational humanitarian. The websites also depict Jolie's health decision in positive, negative, and/or both ways. Discussion centers on how this actress' health decision impacts the public.

Dual-Use Space Technology Transfer Conference and Exhibition. Volume 2

NASA Technical Reports Server (NTRS)

Krishen, Kumar (Compiler)

1994-01-01

This is the second volume of papers presented at the Dual-Use Space Technology Transfer Conference and Exhibition held at the Johnson Space Center February 1-3, 1994. Possible technology transfers covered during the conference were in the areas of information access; innovative microwave and optical applications; materials and structures; marketing and barriers; intelligent systems; human factors and habitation; communications and data systems; business process and technology transfer; software engineering; biotechnology and advanced bioinstrumentation; communications signal processing and analysis; medical care; applications derived from control center data systems; human performance evaluation; technology transfer methods; mathematics, modeling, and simulation; propulsion; software analysis and decision tools; systems/processes in human support technology; networks, control centers, and distributed systems; power; rapid development; perception and vision technologies; integrated vehicle health management; automation technologies; advanced avionics; and robotics technologies.

School Governance and the Pursuit of Democratic Participation: Lessons from South Africa

ERIC Educational Resources Information Center

Lewis, Suzanne Grant; Naidoo, Jordan

2006-01-01

This article examines experiences in Gauteng and KwaZulu-Natal provinces with devolved school governance, introduced in 1996 to promote democratic participation in education decision making. Utilizing the ''theory of action'' framework, this analysis is an effort to de-center the school governance debate by moving from a central government…

Development and Validation of the Controller Acceptance Rating Scale (CARS): Results of Empirical Research

NASA Technical Reports Server (NTRS)

Lee, Katharine K.; Kerns, Karol; Bone, Randall

2001-01-01

The measurement of operational acceptability is important for the development, implementation, and evolution of air traffic management decision support tools. The Controller Acceptance Rating Scale was developed at NASA Ames Research Center for the development and evaluation of the Passive Final Approach Spacing Tool. CARS was modeled after a well-known pilot evaluation rating instrument, the Cooper-Harper Scale, and has since been used in the evaluation of the User Request Evaluation Tool, developed by MITRE's Center for Advanced Aviation System Development. In this paper, we provide a discussion of the development of CARS and an analysis of the empirical data collected with CARS to examine construct validity. Results of intraclass correlations indicated statistically significant reliability for the CARS. From the subjective workload data that were collected in conjunction with the CARS, it appears that the expected set of workload attributes was correlated with the CARS. As expected, the analysis also showed that CARS was a sensitive indicator of the impact of decision support tools on controller operations. Suggestions for future CARS development and its improvement are also provided.

Decision making in liver transplant selection committees: a multicenter study.

PubMed

Volk, Michael L; Biggins, Scott W; Huang, Mary Ann; Argo, Curtis K; Fontana, Robert J; Anspach, Renee R

2011-10-18

To receive a liver transplant, patients must first be placed on a waiting list-a decision made at most transplant centers by a multidisciplinary committee. The function of these committees has never been studied. To describe decision making in liver transplant committees and identify opportunities for process improvement. Observational multicenter study. 4 liver transplant centers in the United States. 68 members of liver transplant committees across the 4 centers. 63 meetings were observed, and 50 committee members were interviewed. Recorded transcripts and field notes were analyzed by using standard qualitative sociologic methods. Although the structure of the meetings varied by center, the process was uniform and primarily involved inductive reasoning to review possible reasons for patient exclusion. Patients were excluded if they were too well, too sick (in the setting of advanced liver disease), or too old or had nonhepatic comorbid conditions, substance abuse problems, or other psychosocial barriers. Dominant themes in the discussions included member angst over deciding who lived or died, a high correlation between psychosocial barriers to transplantation and the patient's socioeconomic status, and the influence of external forces on decision making. Unwritten center policies and confusion regarding advocacy versus stewardship roles were consistently identified as barriers to effective group decision making. The use of qualitative methods provides broad understanding but limits specific inferences. The 4 centers may not reflect the practices of every transplant center nationwide. The difficult decisions made by liver transplant committees are reasonably consistent and well-intentioned, but the process might be improved by having more explicit written policies and clarifying roles. This may inform resource allocation in other areas of medicine. The Greenwall Foundation and the National Institutes of Health.

Decision Making in Liver Transplant Selection Committees

PubMed Central

Volk, Michael L; Biggins, Scott W; Huang, Mary Ann; Argo, Curtis K; Fontana, Robert J; Anspach, Renee R

2011-01-01

Background In order to receive a liver transplant, patients must first be placed on the waiting list – a decision made in most transplant centers by a multidisciplinary committee. The function of these committees has never been studied. Objectives To describe decision making in liver transplant committees and identify opportunities for process improvement. Design Observational multi-center Setting We observed 63 meetings and interviewed 50 committee members at 4 liver transplant centers. Study Subjects Transplant committee members. Measurements Recorded transcripts and field notes were analyzed using standard qualitative sociological methods. Results While the structure of meetings varied by center, the process was uniform and involved reviewing possible reasons for patient exclusion using primarily inductive reasoning. Stated justifications for excluding patients were a) too well, b) non-hepatic comorbidities or advanced age, c) too sick in the setting of advanced liver disease, d) substance abuse, or e) other psychosocial barriers. Dominant themes identified included members’ angst over deciding who lives and dies, a high correlation between psychosocial barriers to transplant and patients’ socioeconomic status, and the influence of external forces on decision making. Consistently identified barriers to effective group decision making were: 1) unwritten center policies, and 2) confusion regarding advocacy versus stewardship roles. Limitations The use of qualitative methods provides broad understanding but limits specific inferences. These four centers may not be reflective of every transplant center nationwide. Conclusion The difficult decisions made by these committees are reasonably consistent and always well-intentioned, but might be improved by more explicit written policies and clarifying roles. This process may help inform resource allocation in other areas of medicine. Primary funding source The Greenwall Foundation. PMID:22007044

Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery.

PubMed

Haut, Sheryl R; Berg, Anne T; Shinnar, Shlomo; Cohen, Hillel W; Bazil, Carl W; Sperling, Michael R; Langfitt, John T; Pacia, Steven V; Walczak, Thaddeus S; Spencer, Susan S

2002-11-01

To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers. Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions. Interrater reliability was assessed by using intraclass correlation coefficients (ICCs), validated for use with multiple raters, and calculated in a two-way random model based on absolute agreement. Agreement for ICC values: > or = 0.75, excellent; 0.60-0.74, good; 0.40-0.59, fair; < or = 0.39, poor. One center was excluded for missing data. Agreement was excellent for extracranial EEG lateralization (0.8039), magnetic resonance imaging (MRI) lateralization (0.9521) and localization (0.9130), Wada lateralization (0.9453), and intracranial EEG localization (0.7905). Agreement was good for extracranial EEG localization (0.7384) and neuropsychological testing lateralization (0.7178) and localization (0.6891). Consensus about the decision to perform intracranial monitoring was fair (0.5397), in part reflecting one center's tendency toward intracranial monitoring. Overall agreements on whether to perform surgery (0.8311) and specific surgery recommended (0.8164) were excellent. High interrater reliability among six epilepsy centers was present for interpretation of most components of presurgical testing. Although consensus for the decision to perform intracranial monitoring was only fair, agreements for the ultimate decision about resective surgery and specific choice of resection were excellent. We believe that this study demonstrates the feasibility of implementing multicenter protocols for neurologic management, especially those involving localization, as well as protocols combining study results with clinical decision making.

Keeping Teachers in the Center: A Framework of Data-Driven Decision-Making

ERIC Educational Resources Information Center

Light, Daniel; Wexler, Dara H.; Heinze, Juliette

2004-01-01

The Education Development Center's Center for Children and Technology (CCT) conducted a three year study of a large-scale data reporting system, developed by the Grow Network for New York City's Department of Education. This paper presents a framework based on two years of research exploring the intersection of decision-support technologies,…

45 CFR 96.101 - Review of a State decision to discontinue funding of a community health center.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Review of a State decision to discontinue funding of a community health center. 96.101 Section 96.101 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION BLOCK GRANTS Primary Care Block Grants § 96.101 Review of a State decision...

Putting Families in the Center: Family Perspectives on Decision Making and ADHD and Implications for ADHD Care

ERIC Educational Resources Information Center

Davis, Catherine C.; Claudius, Milena; Palinkas, Lawrence A.; Wong, John B.; Leslie, Laurel K.

2012-01-01

Objective: To examine components of family-centered care in families' stories about treatment decision making for their child with ADHD. Method: Twenty-eight families participated in qualitative interviews that addressed families' perspectives on (a) the treatment decision-making process, (b) the cause and impact of their child's symptoms, and (c)…

More Than a Destination: Contraceptive Decision Making as a Journey.

PubMed

Downey, Margaret Mary; Arteaga, Stephanie; Villaseñor, Elodia; Gomez, Anu Manchikanti

Contraceptive use is widely recognized as a means of reducing adverse health-related outcomes. However, dominant paradigms of contraceptive counseling may rely on a narrow definition of "evidence" (i.e., scientifically accurate but exclusive of individual women's experiences). Given increased enthusiasm for long-acting, reversible contraceptive methods, such paradigms may reinforce counseling that overprivileges effectiveness, particularly for groups considered at high risk of unintended pregnancy. This study investigates where and how women's experiences fit into the definition of evidence these counseling protocols use. Using a qualitative approach, this analysis draws on semistructured interviews with 38 young (ages 18-24) Black and Latina women. We use a qualitative content analysis approach, with coding categories derived directly from the textual data. Our analysis suggests that contraceptive decision making is an iterative, relational, reflective journey. Throughout contraceptive histories, participants described experiences evolving to create a foundation from which decision-making power was drawn. The same contraceptive-related decisions were revisited repeatedly, with knowledge accrued along the way. The cumulative experience of using, assigning meanings to, and developing values around contraception meant that young women experienced contraceptive decision making as a dynamic process. This journey creates a rich body of evidence that informs contraceptive decision making. To provide appropriate, acceptable, patient-centered family planning care, providers must engage with evidence grounded in women's expertise on their contraceptive use in addition to medically accurate data on method effectiveness, side effects, and contraindications. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Clinical decision-making: the case against the new casuistry.

PubMed

Ananth, Mahesh

2017-01-01

Albert Jonsen and Stephen Toulmin have argued that the best way to resolve the complex issues in medical settings is to focus on the actual details of cases and then determine what to do in the given cases. This approach to medical decision-making, labeled "casuistry," has met with much criticism. In response, Carson Strong has attempted to save much of Jonsen and Toulmin's version of casuistry. This analysis reveals that Strong's recent salvage efforts fail to deflect the major criticisms. The upshot of this analysis is that Jonsen and Toulmin's version of casuistry is not an appropriate framework from which to resolve complex issues in clinical settings. Copyright © 2017 by the National Legal Center for the Medically Dependent and Disabled, Inc.

Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: a qualitative study.

PubMed

Katz, Jeffrey N; Lyons, Nancy; Wolff, Lisa S; Silverman, Jodie; Emrani, Parastu; Holt, Holly L; Corbett, Kelly L; Escalante, Agustin; Losina, Elena

2011-04-21

Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics.

Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions.

PubMed

Poost-Foroosh, Laya; Jennings, Mary Beth; Cheesman, Margaret F

2015-03-01

Despite clinical recognition of the adverse effects of acquired hearing loss, only a small proportion of adults who could benefit use hearing aids. Hearing aid adoption has been studied in relationship to client-related and hearing aid technology-related factors. The influence of the client-clinician interaction in the decision to purchase hearing aids has not been explored in any depth. Importance ratings of a sample of adults having a recent hearing aid recommendation (clients) and hearing healthcare professionals (clinicians) from across Canada were compared on factors in client-clinician interactions that influence hearing aid purchase decisions. A cross-sectional approach was used to obtain online and paper-based concept ratings. Participants were 43 adults (age range, 45-85 yr) who had received a first hearing aid recommendation in the 3 mo before participation. A total of 54 audiologists and 20 hearing instrument practitioners from a variety of clinical settings who prescribed or dispensed hearing aids completed the concept-rating task. The task consisted of 122 items that had been generated via concept mapping in a previous study and which resulted in the identification of eight concepts that may influence hearing aid purchase decisions. Participants rated "the importance of each of the statements in a person's decision to purchase a hearing aid" on a 5-point Likert scale, from 1 = minimally important to 5 = extremely important. For the initial data analysis, the ratings for each of the items included in each concept were averaged for each participant to provide an estimate of the overall importance rating of each concept. Multivariate analysis of variance was used to compare the mean importance ratings of the clients to the clinicians. Ratings of individual statements were also compared in order to investigate the directionality of the importance ratings within concepts. There was a significant difference in the mean ratings for clients and clinicians for the concepts understanding and meeting client needs, conveying device information by clinician, supporting choices and shared decision making, and factors in client readiness. Three concepts-understanding and meeting client needs, conveying device information by clinician, and supporting choices and shared decision making-were rated as more important by clients than by clinicians. One concept (ie, factors in client readiness) was rated as more important by clinicians than by clients. The concepts rated as most important by clients and clinicians are consistent with components of several existing models of client-centered and patient-centered care. These concepts reflect the clients' perception of the importance of their involvement in the decision-making process. A preliminary model of client-centered care within the hearing aid uptake process and implications for clinical audiology are described. American Academy of Audiology.

The experience of Latino parents of hospitalized children during family-centered rounds.

PubMed

Walker-Vischer, Lisa; Hill, Constance; Mendez, Suzanne S

2015-03-01

The aim of this study is to describe the experience of Latino parents of hospitalized children during family-centered rounds (FCRs). Family-centered rounds provide a mechanism to exchange information and facilitate shared decision making. Latino parents may have a suboptimal experience during FCRs. Understanding this experience helps nurse leaders improve patient satisfaction. Using a convenience sample, written surveys in Spanish were given to 20 parents who had attended at least 2 FCRs. The surveys were translated into English for data analysis. The narrative data were analyzed for common themes using content analysis. Four themes were identified: valued perception, inclusion and care, facilitated communication, and meeting expectations. Parents in this study felt that their participation and input were valued and that these positively impacted care. Family-centered rounds helped them understand the plan and facilitated communication when done in Spanish. Nurse leaders play a key role in improving satisfaction and increasing access to translation services or bilingual staff.

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care.

PubMed

Boisvert, Isabelle; Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M

2017-01-01

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices.

The Annapolis Accords on the use of toxicology in decision-making. Annapolis Center Workshop Report.

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

Gray, G.M.; Baskin, S.I.; Charnley, G.

2000-12-01

The science of toxicology plays an important role in identifying safe conditions of use or exposure for many different kinds of environmental agents. The use of toxicologic information in risk assessment requires careful analysis, evaluation of data, and scientific judgment. These Annapolis Accords are intended to guide appropriate use in risk assessment of the scientific information from toxicology. We believe that application of these principles will improve the scientific credibility of risk assessment and the quality of decisions aimed at reducing and eliminating risks to human health and the environment.

Comparativism and the Grounds for Person-Centered Care and Shared Decision Making.

PubMed

Herlitz, Anders

2017-01-01

This article provides a new argument and a new value-theoretical ground for person-centered care and shared decision making that ascribes to it the role of enabling rational choice in situations involving clinical choice. Rather than referring to good health outcomes and/or ethical grounds such as patient autonomy, it argues that a plausible justification and ground for person-centered care and shared decision making is preservation of rationality in the face of comparative non-determinacy in clinical settings. Often, no alternative treatment will be better than or equal to every other alternative. In the face of such comparative non-determinacy, Ruth Chang has argued that we can make rational decisions by invoking reasons that are created through acts of willing. This article transfers this view to clinical decision making and argues that shared decision making provides a solution to non-determinacy problems in clinical settings. This view of the role of shared decision making provides a new understanding of its nature, and it also allows us to better understand when caregivers should engage in shared decision making and when they should not. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

Defining optimum treatment of patients with pancreatic adenocarcinoma using regret-based decision curve analysis.

PubMed

Hernandez, Jonathan M; Tsalatsanis, Athanasios; Humphries, Leigh Ann; Miladinovic, Branko; Djulbegovic, Benjamin; Velanovich, Vic

2014-06-01

To use regret decision theory methodology to assess three treatment strategies in pancreatic adenocarcinoma. Pancreatic adenocarcinoma is uniformly fatal without operative intervention. Resection can prolong survival in some patients; however, it is associated with significant morbidity and mortality. Regret theory serves as a novel framework linking both rationality and intuition to determine the optimal course for physicians facing difficult decisions related to treatment. We used the Cox proportional hazards model to predict survival of patients with pancreatic adenocarcinoma and generated a decision model using regret-based decision curve analysis, which integrates both the patient's prognosis and the physician's preferences expressed in terms of regret associated with a certain action. A physician's treatment preferences are indicated by a threshold probability, which is the probability of death/survival at which the physician is uncertain whether or not to perform surgery. The analysis modeled 3 possible choices: perform surgery on all patients; never perform surgery; and act according to the prediction model. The records of 156 consecutive patients with pancreatic adenocarcinoma were retrospectively evaluated by a single surgeon at a tertiary referral center. Significant independent predictors of overall survival included preoperative stage [P = 0.005; 95% confidence interval (CI), 1.19-2.27], vitality (P < 0.001; 95% CI, 0.96-0.98), daily physical function (P < 0.001; 95% CI, 0.97-0.99), and pathological stage (P < 0.001; 95% CI, 3.06-16.05). Compared with the "always aggressive" or "always passive" surgical treatment strategies, the survival model was associated with the least amount of regret for a wide range of threshold probabilities. Regret-based decision curve analysis provides a novel perspective for making treatment-related decisions by incorporating the decision maker's preferences expressed as his or her estimates of benefits and harms associated with the treatment considered.

All Source Solution Decision Support Products Created for Stennis Space Center in Response to Hurricane Katrina

NASA Technical Reports Server (NTRS)

Ross, Kenton W.; Graham, William D.

2007-01-01

In the aftermath of Hurricane Katrina and in response to the needs of SSC (Stennis Space Center), NASA required the generation of decision support products with a broad range of geospatial inputs. Applying a systems engineering approach, the NASA ARTPO (Applied Research and Technology Project Office) at SSC evaluated the Center's requirements and source data quality. ARTPO identified data and information products that had the potential to meet decision-making requirements; included were remotely sensed data ranging from high-spatial-resolution aerial images through high-temporal-resolution MODIS (Moderate Resolution Imaging Spectroradiometer) products. Geospatial products, such as FEMA's (Federal Emergency Management Agency's) Advisory Base Flood Elevations, were also relevant. Where possible, ARTPO applied SSC calibration/validation expertise to both clarify the quality of various data source options and to validate that the inputs that were finally chosen met SSC requirements. ARTPO integrated various information sources into multiple decision support products, including two maps: Hurricane Katrina Inundation Effects at Stennis Space Center (highlighting surge risk posture) and Vegetation Change In and Around Stennis Space Center: Katrina and Beyond (highlighting fire risk posture).

Dual-Use Space Technology Transfer Conference and Exhibition. Volume 1

NASA Technical Reports Server (NTRS)

Krishen, Kumar (Compiler)

1994-01-01

This document contains papers presented at the Dual-Use Space Technology Transfer Conference and Exhibition held at the Johnson Space Center February 1-3, 1994. Possible technology transfers covered during the conference were in the areas of information access; innovative microwave and optical applications; materials and structures; marketing and barriers; intelligent systems; human factors and habitation; communications and data systems; business process and technology transfer; software engineering; biotechnology and advanced bioinstrumentation; communications signal processing and analysis; new ways of doing business; medical care; applications derived from control center data systems; human performance evaluation; technology transfer methods; mathematics, modeling, and simulation; propulsion; software analysis and decision tools systems/processes in human support technology; networks, control centers, and distributed systems; power; rapid development perception and vision technologies; integrated vehicle health management; automation technologies; advanced avionics; ans robotics technologies. More than 77 papers, 20 presentations, and 20 exhibits covering various disciplines were presented b experts from NASA, universities, and industry.

False alarms and incorrect rejections in an information security center: correlation with the frequency of incidents.

PubMed

Bruno, Thiers; Abrahão, Julia

2012-01-01

This study examines the actions taken by operators aimed at preventing and combating information security incidents at a banking organization. The work utilizes the theoretical framework of ergonomics and cognitive psychology. The method is workplace ergonomic analysis. Its focus is directed towards examining the cognitive dimension of the work environment with special attention to the occurrence of correlations between variability in incident frequency and the results of sign detection actions. It categorizes 45,142 operator decisions according to the theory of signal detection (Sternberg, 2000). It analyzes the correlation between incident proportions (indirectly associated with the cognitive efforts demanded from the operator) and operator decisions. The study demonstrated the existence of a positive correlation between incident proportions and false positive decisions (false alarms). However, this correlation could not be observed in relation to decisions of the false-negative type (incorrect rejection).

Factors influencing bereaved families' decisions about organ donation: an integrative literature review.

PubMed

Walker, Wendy; Broderick, Andrew; Sque, Magi

2013-11-01

This article reports on the process and outcomes of a systematic integrative literature review, designed to enhance understanding of the factors influencing bereaved families' decisions to agree or decline the donation of their deceased relative's organs for transplantation. Research originating from eight Western countries (N = 20 studies) provided an international perspective to the review. Thematic analysis and synthesis of textual data culminated in the development of three global themes (past, present, and future) that captured the temporal dimensions of family decision making. The review findings provide valuable insight into ways of increasing the rate of consent to organ donation through the development family-centered care interventions that reflect the needs of the bereaved. Further research to explore the pathway of donation after circulatory death and the experiences of bereaved families who decline organ donation is essential to providing a more complete understanding of the factors affecting donation decisions.

Mapping clinical outcomes expectations to treatment decisions: an application to vestibular schwannoma management.

PubMed

Cheung, Steven W; Aranda, Derick; Driscoll, Colin L W; Parsa, Andrew T

2010-02-01

Complex medical decision making obligates tradeoff assessments among treatment outcomes expectations, but an accessible tool to perform the necessary analysis is conspicuously absent. We aimed to demonstrate methodology and feasibility of adapting conjoint analysis for mapping clinical outcomes expectations to treatment decisions in vestibular schwannoma (VS) management. Prospective. Tertiary medical center and US-based otologists/neurotologists. Treatment preference profiles among VS stakeholders-61 younger and 74 older prospective patients, 61 observation patients, and 60 surgeons-were assessed for the synthetic VS case scenario of a 10-mm tumor in association with useful hearing and normal facial function. Treatment attribute utility. Conjoint analysis attribute levels were set in accordance to the results of a meta-analysis. Forty-five case series were disaggregated to formulate microsurgery facial nerve and hearing preservation outcomes expectations models. Attribute utilities were computed and mapped to the realistic treatment choices of translabyrinthine craniotomy, middle fossa craniotomy, and gamma knife radiosurgery. Among the treatment attributes of likelihoods of causing deafness, temporary facial weakness for 2 months, and incurable cancer within 20 years, and recovery time, permanent deafness was less important to tumor surgeons, and temporary facial weakness was more important to tumor surgeons and observation patients (Wilcoxon rank-sum, p < 0.001). Inverse mapping of preference profiles to realistic treatment choices showed all study cohorts were inclined to choose gamma knife radiosurgery. Mapping clinical outcomes expectations to treatment decisions for a synthetic clinical scenario revealed inhomogeneous drivers of choice selection among study cohorts. Medical decision engines that analyze personal preferences of outcomes expectations for VS and many other diseases may be developed to promote shared decision making among health care stakeholders and transparency in the informed consent process.

Clinical process analysis and activity-based costing at a heart center.

PubMed

Ridderstolpe, Lisa; Johansson, Andreas; Skau, Tommy; Rutberg, Hans; Ahlfeldt, Hans

2002-08-01

Cost studies, productivity, efficiency, and quality of care measures, the links between resources and patient outcomes, are fundamental issues for hospital management today. This paper describes the implementation of a model for process analysis and activity-based costing (ABC)/management at a Heart Center in Sweden as a tool for administrative cost information, strategic decision-making, quality improvement, and cost reduction. A commercial software package (QPR) containing two interrelated parts, "ProcessGuide and CostControl," was used. All processes at the Heart Center were mapped and graphically outlined. Processes and activities such as health care procedures, research, and education were identified together with their causal relationship to costs and products/services. The construction of the ABC model in CostControl was time-consuming. However, after the ABC/management system was created, it opened the way for new possibilities including process and activity analysis, simulation, and price calculations. Cost analysis showed large variations in the cost obtained for individual patients undergoing coronary artery bypass grafting (CABG) surgery. We conclude that a process-based costing system is applicable and has the potential to be useful in hospital management.

Management System Design for a Learner Centered School.

ERIC Educational Resources Information Center

Wagner, Kathleen

2000-01-01

Examines how a learner-centered Montessori school in Toronto, Ontario, defines, specifies, and implements its management decision-support system. Findings indicate a tightly integrated management system comprised of a few student-focused decision-support elements. Identifies relationships, resources, and particular organizational arrangements as…

Comments on Professor Lortie's Paper Entitled "The Cracked Cake of Educational Custom and Emerging Issues in Evaluation." Center for the Study of Evaluation of Instructional Programs Occasional Report No. 20.

ERIC Educational Resources Information Center

Gordon, C. Wayne

This paper suggests that the variety of decision making proposed by Professor Lortie will not afford the luxury of evaluative systems of the kind he describes. Professor Gordon feels that, had Professor Lortie pursued a line of functional analysis of many outcomes, he would have arrived at an entirely new analysis of the justification for…

Business Case Analysis of the Towed Gilder Air Launched System (TGALS)

NASA Technical Reports Server (NTRS)

Webb, Darryl W.; Nguyen, McLinton B.; Seibold, Robert W.; Wong, Frank C.; Budd, Gerald D.

2017-01-01

The Aerospace Corporation developed an integrated Business Case Analysis (BCA) model on behalf of the NASA Armstrong Flight Research Center (AFRC). This model evaluated the potential profitability of the Towed Glider Air Launched System (TGALS) concept, under development at AFRC, identifying potential technical, programmatic, and business decisions that could improve its business viability. The model addressed system performance metrics; development, production and operation cost estimates; market size and product service positioning; pricing alternatives; and market share.

Shared decision making: relevant concepts and facilitating strategies.

PubMed

Bae, Jong-Myon

2017-01-01

As the paradigm in healthcare nowadays is the evidence-based, patient-centered decision making, the issue of shared decision making (SDM) is highlighted. The aims of this manuscript were to look at the relevant concepts and suggest the facilitating strategies for overcoming barriers of conducting SDM. While the definitions of SDM were discordant, several concepts such as good communication, individual autonomy, patient participants, and patient-centered decision-making were involved. Further, the facilitating strategies of SDM were to educate and train physician, to apply clinical practice guidelines and patient decision aids, to develop valid measurement tools for evaluation of SDM processes, and to investigate the impact of SDM.

The use of decision analysis to examine ethical decision making by critical care nurses.

PubMed

Hughes, K K; Dvorak, E M

1997-01-01

To examine the extent to which critical care staff nurses make ethical decisions that coincide with those recommended by a decision analytic model. Nonexperimental, ex post facto. Midwestern university-affiliated 500 bed tertiary care medical center. One hundred critical care staff nurses randomly selected from seven critical care units. Complete responses were obtained from 82 nurses (for a final response rate of 82%). The dependent variable--consistent decision making--was measured as staff nurses' abilities to make ethical decisions that coincided with those prescribed by the decision model. Subjects completed two instruments, the Ethical Decision Analytic Model, a computer-administered instrument designed to measure staff nurses' abilities to make consistent decisions about a chemically-impaired colleague; and a Background Inventory. The results indicate marked consensus among nurses when informal methods were used. However, there was little consistency between the nurses' informal decisions and those recommended by the decision analytic model. Although 50% (n = 41) of all nurses chose a course of action that coincided with the model's least optimal alternative, few nurses agreed with the model as to the most optimal course of action. The findings also suggest that consistency was unrelated (p > 0.05) to the nurses' educational background or years of clinical experience; that most subjects reported receiving little or no education in decision making during their basic nursing education programs; but that exposure to decision-making strategies was related to years of nursing experience (p < 0.05). The findings differ from related studies that have found a moderate degree of consistency between nurses and decision analytic models for strictly clinical decision tasks, especially when those tasks were less complex. However, the findings partially coincide with other findings that decision analysis may not be particularly well-suited to the critical care environment. Additional research is needed to determine whether critical care nurses use the same decision-making methods as do other nurses; and to clarify the effects of decision task (clinical versus ethical) on nurses' decision making. It should not be assumed that methods used to study nurses' clinical decision making are applicable for all nurses or all types of decisions, including ethical decisions.

Analysis of Parallelogram Mechanism used to Preserve Remote Center of Motion for Surgical Telemanipulator

NASA Astrophysics Data System (ADS)

Trochimczuk, R.

2017-02-01

This paper presents an analysis of a parallelogram mechanism commonly used to provide a kinematic remote center of motion in surgical telemanipulators. Selected types of parallel manipulator designs, encountered in commercial and laboratory-made designs described in the medical robotics literature, will serve as the research material. Among other things, computer simulations in the ANSYS 13.0 CAD/CAE software environment, employing the finite element method, will be used. The kinematics of the solution of manipulator with the parallelogram mechanism will be determined in order to provide a more complete description. These results will form the basis for the decision regarding the possibility of applying a parallelogram mechanism in an original prototype of a telemanipulator arm.

Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study

PubMed Central

2011-01-01

Background Musculoskeletal disorders affect all racial and ethnic groups, including Hispanics. Because these disorders are not life-threatening, decision-making is generally preference-based. Little is known about whether Hispanics in the U.S. differ from non-Hispanic Whites with respect to key decision making preferences. Methods We assembled six focus groups of Hispanic and non-Hispanic White patients with chronic back or knee pain at an urban medical center to discuss management of their conditions and the roles they preferred in medical decision-making. Hispanic groups were further stratified by socioeconomic status, using neighborhood characteristics as proxy measures. Discussions were led by a moderator, taped, transcribed and analyzed using a grounded theory approach. Results The analysis revealed ethnic differences in several areas pertinent to medical decision-making. Specifically, Hispanic participants were more likely to permit their physician to take the predominant role in making health decisions. Also, Hispanics of lower socioeconomic status generally preferred to use non-internet sources of health information to make medical decisions and to rely on advice obtained by word of mouth. Hispanics emphasized the role of faith and religion in coping with musculoskeletal disability. The analysis also revealed broad areas of concordance across ethnic strata including the primary role that pain and achieving pain relief play in patients' experiences and decisions. Conclusions These findings suggest differences between Hispanics and non-Hispanic Whites in preferred information sources and decision-making roles. These findings are hypothesis-generating. If confirmed in further research, they may inform the development of interventions to enhance preference-based decision-making among Hispanics. PMID:21510880

Decision-Making in Audiology: Balancing Evidence-Based Practice and Patient-Centered Care

PubMed Central

Clemesha, Jennifer; Lundmark, Erik; Crome, Erica; Barr, Caitlin; McMahon, Catherine M.

2017-01-01

Health-care service delivery models have evolved from a practitioner-centered approach toward a patient-centered ideal. Concurrently, increasing emphasis has been placed on the use of empirical evidence in decision-making to increase clinical accountability. The way in which clinicians use empirical evidence and client preferences to inform decision-making provides an insight into health-care delivery models utilized in clinical practice. The present study aimed to investigate the sources of information audiologists use when discussing rehabilitation choices with clients, and discuss the findings within the context of evidence-based practice and patient-centered care. To assess the changes that may have occurred over time, this study uses a questionnaire based on one of the few studies of decision-making behavior in audiologists, published in 1989. The present questionnaire was completed by 96 audiologists who attended the World Congress of Audiology in 2014. The responses were analyzed using qualitative and quantitative approaches. Results suggest that audiologists rank clinical test results and client preferences as the most important factors for decision-making. Discussion with colleagues or experts was also frequently reported as an important source influencing decision-making. Approximately 20% of audiologists mentioned utilizing research evidence to inform decision-making when no clear solution was available. Information shared at conferences was ranked low in terms of importance and reliability. This study highlights an increase in awareness of concepts associated with evidence-based practice and patient-centered care within audiology settings, consistent with current research-to-practice dissemination pathways. It also highlights that these pathways may not be sufficient for an effective clinical implementation of these practices. PMID:28752808

75 FR 43918 - National Center for Toxicological Research, et al.; Notice of Consolidated Decision on...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... Research, et al.; Notice of Consolidated Decision on Applications for Duty-Free Entry of Electron...: National Center for Toxicological Research, (USFDA), Jefferson, AK 72079. Instrument: Electron Microscope.... Applicant: University of Virginia, Charlottesville, VA 22903. Instrument: Electron Microscope. Manufacturer...

The Different Moral Bases of Patient and Surrogate Decision-Making.

PubMed

Brudney, Daniel

2018-01-01

My topic is a problem with our practice of surrogate decision-making in health care, namely, the problem of the surrogate who is not doing her job-the surrogate who cannot be reached or the surrogate who seems to refuse to understand or to be unable to understand the clinical situation. The analysis raises a question about the surrogate who simply disagrees with the medical team. One might think that such a surrogate is doing her job-the team just doesn't like how she is doing it. My analysis raises the question of whether (or perhaps when) she should be overridden. In approaching this problem, I focus not on the range of difficulties in practice but on the underlying moral conceptual issue. My concern will be to show that the moral values that underpin patient decision-making are fundamentally different from those that underpin surrogate decision-making. Identifying the distinctions will set parameters for any successful solution to the "Who should decide?" A patient has a specific kind of moral right to make her own medical decisions. A surrogate has no analogous moral right to decide for someone else. We want the surrogate to make the decision because we believe that she has a relevant epistemological advantage over anyone else on the scene. If and when she has no such advantage or if she refuses or is unable to use it, then there might not be sufficient reason to let her be the decision-maker. © 2018 The Hastings Center.

Role of the Internet in Care Initiation by People Living With HIV.

PubMed

Perazzo, Joseph; Haas, Stephen; Webel, Allison; Voss, Joachim

2017-02-01

People frequently use the internet to obtain information, including information about health, but we lack understanding of how people living with HIV (PLHIV) use the internet in their care and treatment decisions. In this secondary analysis, interviews with 23 individuals who initiated HIV care at an urban, Midwestern medical center and mentioned internet use were analyzed using qualitative content analysis to explore how they used the internet during the process of initiating HIV care. HIV care had been initiated by this sample from less than one month to three years post-diagnosis. Participants discussed the internet as a source of information about their diagnosis that influenced their care and treatment decisions. Five themes were predominant: (i) The internet alerted me to the possibility of HIV, (ii) the internet showed me a solution is available, (iii) the internet influenced my decisions about care, (iv) the internet empowered me to participate in my treatment decisions, and (v) the internet gave me hope for my future. The results suggest that the internet has the potential to provide information that can profoundly influence PLHIVs' acceptance of care and treatment decisions. Clinicians face a new reality in which patients use internet resources to obtain information and shape opinions about HIV treatment and care initiation decision-making. Guiding PLHIV in their selection of online resources is one approach to educating and empowering individuals as they cope with their diagnosis and contemplate decisions regarding HIV care and treatment. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Inside the Black Box: The Case Review Process of an Elder Abuse Forensic Center.

PubMed

Navarro, Adria E; Wysong, Julia; DeLiema, Marguerite; Schwartz, Elizabeth L; Nichol, Michael B; Wilber, Kathleen H

2016-08-01

Preliminary evidence suggests that elder abuse forensic centers improve victim welfare by increasing necessary prosecutions and conservatorships and reducing the recurrence of protective service referrals. Center team members gather information and make decisions designed to protect clients and their assets, yet the collective process of how these case reviews are conducted remains unexamined. The purpose of this study is to present a model describing the interprofessional approach of investigation and response to financial exploitation (FE), a frequent and complex type of abuse of vulnerable adults. To develop an understanding of the case review process at the Los Angeles County Elder Abuse Forensic Center (Center), a quasi-Delphi field study approach was used involving direct observations of meetings, surveying team members, and review from the Center's Advisory Council. The goal of this iterative analysis was to understand the case review process for suspected FE in Los Angeles County. A process map of key forensic center elements was developed that may be useful for replication in other settings. The process map includes: (a) multidisciplinary data collection, (b) key decisions for consideration, and (c) strategic actions utilized by an interprofessional team focused on elder justice. Elder justice relies on a complex system of providers. Elder abuse forensic centers provide a process designed to efficiently address client safety, client welfare, and protection of assets. Study findings provide a process map that may help other communities replicate an established multidisciplinary team, one experienced with justice system outcomes designed to protect FE victims. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sometimes doing the right thing sucks: frame combinations and multi-fetal pregnancy reduction decision difficulty.

PubMed

Britt, David W; Evans, Mark I

2007-12-01

Data are analyzed for 54 women who made an appointment with a North American Center specializing in multifetal pregnancy reduction (MFPR) to be counseled and possibly have a reduction. The impact on decision difficulty of combinations of three frames through which patients may understand and consider their options and use to justify their decisions are examined: a conceptional frame marked by a belief that life begins at conception; a medical frame marked by a belief in the statistics regarding risk and risk prevention through selective reduction; and a lifestyle frame marked by a belief that a balance of children and career has normative value. All data were gathered through semi-structured interviews and observation during the visit to the center over an average 2.5h period. Decision difficulty was indicated by self-assessed decision difficulty and by residual emotional turmoil surrounding the decision. Qualitative comparative analysis was used to analyze the impact of combinations of frames on decision difficulty. Separate analyses were conducted for those reducing only to three fetuses (or deciding not to reduce) and women who chose to reduce below three fetuses. Results indicated that for those with a non-intense conceptional frame, the decision was comparatively easy no matter whether the patients had high or low values of medical and lifestyle frames. For those with an intense conceptional frame, the decision was almost uniformly difficult, with the exception of those who chose to reduce only to three fetuses. Simplifying the results to their most parsimonious scenarios oversimplifies the results and precludes an understanding of how women can feel pulled in different directions by the dictates of the frames they hold. Variations in the characterization of intense medical frames, for example, can both pull toward reduction to two fetuses and neutralize shame and guilt by seeming to remove personal responsibility for the decision. We conclude that the examination of frame combinations is an important tool for understanding the way women carrying multiple fetuses negotiate their way through multi-fetal pregnancies, and that it may have more general relevance for understanding pregnancy decisions in context.

Shared Decision Making and Motivational Interviewing: Achieving Patient-Centered Care Across the Spectrum of Health Care Problems

PubMed Central

Elwyn, Glyn; Dehlendorf, Christine; Epstein, Ronald M.; Marrin, Katy; White, James; Frosch, Dominick L.

2014-01-01

Patient-centered care requires different approaches depending on the clinical situation. Motivational interviewing and shared decision making provide practical and well-described methods to accomplish patient-centered care in the context of situations where medical evidence supports specific behavior changes and the most appropriate action is dependent on the patient’s preferences. Many clinical consultations may require elements of both approaches, however. This article describes these 2 approaches—one to address ambivalence to medically indicated behavior change and the other to support patients in making health care decisions in cases where there is more than one reasonable option—and discusses how clinicians can draw on these approaches alone and in combination to achieve patient-centered care across the range of health care problems. PMID:24821899

Use of a computerized medication shared decision making tool in community mental health settings: impact on psychotropic medication adherence.

PubMed

Stein, Bradley D; Kogan, Jane N; Mihalyo, Mark J; Schuster, James; Deegan, Patricia E; Sorbero, Mark J; Drake, Robert E

2013-04-01

Healthcare reform emphasizes patient-centered care and shared decision-making. This study examined the impact on psychotropic adherence of a decision support center and computerized tool designed to empower and activate consumers prior to an outpatient medication management visit. Administrative data were used to identify 1,122 Medicaid-enrolled adults receiving psychotropic medication from community mental health centers over a two-year period from community mental health centers. Multivariate linear regression models were used to examine if tool users had higher rates of 180-day medication adherence than non-users. Older clients, Caucasian clients, those without recent hospitalizations, and those who were Medicaid-eligible due to disability had higher rates of 180-day medication adherence. After controlling for sociodemographics, clinical characteristics, baseline adherence, and secular changes over time, using the computerized tool did not affect adherence to psychotropic medications. The computerized decision tool did not affect medication adherence among clients in outpatient mental health clinics. Additional research should clarify the impact of decision-making tools on other important outcomes such as engagement, patient-prescriber communication, quality of care, self-management, and long-term clinical and functional outcomes.

Patients' understanding of shared decision making in a mental health setting.

PubMed

Eliacin, Johanne; Salyers, Michelle P; Kukla, Marina; Matthias, Marianne S

2015-05-01

Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients' perspectives. We examined patients' accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients' understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient-provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient-provider relationship as a fundamental element of shared decision making and point to areas for potential improvement. © The Author(s) 2014.

Determining rules for closing customer service centers: A public utility company's fuzzy decision

NASA Technical Reports Server (NTRS)

Dekorvin, Andre; Shipley, Margaret F.

1992-01-01

In the present work, we consider the general problem of knowledge acquisition under uncertainty. A commonly used method is to learn by examples. We observe how the expert solves specific cases and from this infer some rules by which the decision was made. Unique to this work is the fuzzy set representation of the conditions or attributes upon which the decision make may base his fuzzy set decision. From our examples, we infer certain and possible rules containing fuzzy terms. It should be stressed that the procedure determines how closely the expert follows the conditions under consideration in making his decision. We offer two examples pertaining to the possible decision to close a customer service center of a public utility company. In the first example, the decision maker does not follow too closely the conditions. In the second example, the conditions are much more relevant to the decision of the expert.

Facilitators and barriers of independent decisions by midwives during labor and birth.

PubMed

Everly, Marcee C

2012-01-01

The purpose of this study was to explore the factors that affect labor management decisions of midwives in hospitals and freestanding birth centers. A qualitative study was conducted using one-on-one tape recorded interviews of midwives who had experience managing labor and birth in both hospitals and freestanding birth centers. Ten interviews consisting of several open-ended questions were conducted, coded, and analyzed in a stepwise fashion to identify codes, categories, and themes. Seven participants reviewed the final framework and confirmed credibility and trustworthiness. Four overall themes were identified: trust birth, the woman, the environment, and the labor team. When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions. © 2011 by the American College of Nurse-Midwives.

The Resolution of Identity in a Cross-Cultural Crisis.

ERIC Educational Resources Information Center

Spaventa, Lou

This paper describes an educator's decision to change careers from that of foreign service officer to teacher of English as a Second Language is traced to a December 1985 event in Korea in which the American Cultural Center in Kwangju was occupied by protesting Korean students. Analysis of this event and its effect on the educator focuses on the…

An Analysis for Capital Expenditure Decisions at a Naval Regional Medical Center.

DTIC Science & Technology

1981-12-01

Service Equipment Review Committee 1. Portable defibrilator Computed tomographic scanner and cardioscope 2. ECG cart Automated blood cell counter 3. Gas...system sterilizer Gas system sterilizer 4. Automated blood cell Portable defibrilator and counter cardioscope 5. Computed tomographic ECG cart scanner...dictating and automated typing) systems. e. Filing equipment f. Automatic data processing equipment including data communications equipment. g

Office for Civil Rights Survey Redesign: A Feasibility Survey. Contractor Report. Statistical Analysis Report.

ERIC Educational Resources Information Center

Mansfield, Wendy; Farris, Elizabeth

This report provides results of a Fast Response Survey System (FRSS) study conducted by the National Center for Education Statistics for the Office for Civil Rights (OCR). The OCR wanted input for their decision-making process on possible modifications to their biennial survey of a national sample of public school districts (PSDs). The survey, the…

Metric Selection for Ecosystem Restoration

DTIC Science & Technology

2013-06-01

focus on wetlands, submerged aquatic vegetation, oyster reefs, riparian forest, and wet prairie (Miner 2005). The objective of these Corps...of coastal habitats, Volume Two: Tools for monitoring coastal habitats. NOAA Coastal Ocean Program Decision Analysis Series No. 23. Silver Spring, MD...NOAA National Centers for Coastal Ocean Science. Thom, R. M., and K. F. Wellman. 1996. Planning aquatic ecosystem restoration monitoring programs

Reentry into Out-of-Home Care: Implications of Child Welfare Workers' Assessments of Risk and Safety

ERIC Educational Resources Information Center

Wells, Melissa; Correia, Melissa

2012-01-01

This longitudinal analysis examined predictors of reentry to foster care among children and youths who entered foster care between 2001 and 2007. Three sources of administrative data (Chapin Hall Center for Children longitudinal files, National Child Abuse and Neglect Data System, and structured decision making) from one state were used to assess…

U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization? Comment on "Decentralisation of Health Services in Fiji: A Decision Space Analysis".

PubMed

Bustamante, Arturo Vargas

2016-06-07

For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. © 2016 by Kerman University of Medical Sciences.

The Social Basis of Vaccine Questioning and Refusal: A Qualitative Study Employing Bourdieu’s Concepts of ‘Capitals’ and ‘Habitus’

PubMed Central

Meyer, Samantha B.

2018-01-01

This article is an in-depth analysis of the social nature of vaccine decision-making. It employs the sociological theory of Bourdieu and Ingram to consider how parents experience non-vaccination as a valued form of capital in specific communities, and how this can affect their decision-making. Drawing on research conducted in two Australian cities, our qualitative analysis of new interview data shows that parents experience disjuncture and tugs towards ‘appropriate’ forms of vaccination behavior in their social networks, as these link to broader behaviors around food, school choices and birth practices. We show how differences emerge between the two cities based on study designs, such that we are able to see some parents at the center of groups valorizing their decisions, whilst others feel marginalized within their communities for their decisions to vaccinate. We draw on the work of philosopher Mark Navin to consider how all parents join epistemic communities that reward compliance and conformity with the status quo and consider what this means for interventions that seek to influence the flow of pro-vaccine information through vaccine-critical social groups. PMID:29789482

Using family paradigms to improve evidence-based practice.

PubMed

Hidecker, Mary Jo Cooley; Jones, Rebecca S; Imig, David R; Villarruel, Francisco A

2009-08-01

Evidence-based practice (EBP) describes clinical decision making using research, clinical experience, and client values. For family-centered practices, the client's family is integral to this process. This article proposes that using family paradigms, a family science framework, may help elicit and understand client/family values within family-centered EBP. This article describes the family paradigms framework: 4 classic paradigms of "closed," "random," "open," and "synchronous." Its applicability to family-centered EBP is proposed using augmentative and alternative communication examples. A family-centered approach to EBP requires families to be an integral part of clinical decision making, but some families may need assistance in enumerating their views and values. Family paradigms (which consider how a family uses its resources of time, space, energy, and material in the pursuit of its goals of control, affect, meaning, and content) may be a way to elicit family values and preferences relevant to clinical decisions. Family and client values can be incorporated throughout the EBP steps. Considering family paradigms may increase awareness and understanding of how families' views of their goals and resources affect clinical decisions. Further research is needed into both the processes and effectiveness of using family paradigms to conduct family-centered EBP.

Advanced Interval Management: A Benefit Analysis

NASA Technical Reports Server (NTRS)

Timer, Sebastian; Peters, Mark

2016-01-01

This document is the final report for the NASA Langley Research Center (LaRC)- sponsored task order 'Possible Benefits for Advanced Interval Management Operations.' Under this research project, Architecture Technology Corporation performed an analysis to determine the maximum potential benefit to be gained if specific Advanced Interval Management (AIM) operations were implemented in the National Airspace System (NAS). The motivation for this research is to guide NASA decision-making on which Interval Management (IM) applications offer the most potential benefit and warrant further research.

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

The Benchmarks of Global Clean Energy Manufacturing will help policymakers and industry gain deeper understanding of global manufacturing of clean energy technologies. Increased knowledge of the product supply chains can inform decisions related to manufacturing facilities for extracting and processing raw materials, making the array of required subcomponents, and assembling and shipping the final product. This brochure summarized key findings from the analysis and includes important figures from the report. The report was prepared by the Clean Energy Manufacturing Analysis Center (CEMAC) analysts at the U.S. Department of Energy's National Renewable Energy Laboratory.

The Establishment of a Management Information Systems Research Center at the Naval Postgraduate School

DTIC Science & Technology

1989-09-01

Project WP 88-03 GDSS Technology in Practice: A Study D. Straub R. Beauclair WP 88-04 Interaction Analysis in GDSS Research: I. Zigurs Description of an...03 GDSS Technology in Practice: A Study (D. Straub and R. Beauclair ) 4. WP 88-04 Interaction Analysis in GDSS Research: Description of an Experience...Implementing an Information Architecture," Data Base, forthcoming. 25 Straub, D. W. and R. A. Beauclair . "A New Dimension to Decision Support

Belief Function Based Decision Fusion for Decentralized Target Classification in Wireless Sensor Networks

PubMed Central

Zhang, Wenyu; Zhang, Zhenjiang

2015-01-01

Decision fusion in sensor networks enables sensors to improve classification accuracy while reducing the energy consumption and bandwidth demand for data transmission. In this paper, we focus on the decentralized multi-class classification fusion problem in wireless sensor networks (WSNs) and a new simple but effective decision fusion rule based on belief function theory is proposed. Unlike existing belief function based decision fusion schemes, the proposed approach is compatible with any type of classifier because the basic belief assignments (BBAs) of each sensor are constructed on the basis of the classifier’s training output confusion matrix and real-time observations. We also derive explicit global BBA in the fusion center under Dempster’s combinational rule, making the decision making operation in the fusion center greatly simplified. Also, sending the whole BBA structure to the fusion center is avoided. Experimental results demonstrate that the proposed fusion rule has better performance in fusion accuracy compared with the naïve Bayes rule and weighted majority voting rule. PMID:26295399

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.

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

DTIC Science & Technology

1998-04-01

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

Surgical Versus Conservative Intervention for Acute Achilles Tendon Rupture: A PRISMA-Compliant Systematic Review of Overlapping Meta-Analyses.

PubMed

Zhang, Hao; Tang, Hao; He, Qianyun; Wei, Qiang; Tong, Dake; Wang, Chuangfeng; Wu, Dajiang; Wang, Guangchao; Zhang, Xin; Ding, Wenbin; Li, Di; Ding, Chen; Liu, Kang; Ji, Fang

2015-11-01

Although many meta-analyses comparing surgical intervention with conservative treatment have been conducted for acute Achilles tendon rupture, discordant conclusions are shown. This study systematically reviewed the overlapping meta-analyses relating to surgical versus conservative intervention of acute Achilles tendon rupture to assist decision makers select among conflicting meta-analyses, and to offer intervention recommendations based on the currently best evidence.Multiple databases were comprehensively searched for meta-analyses comparing surgical with conservative treatment of acute Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors independently evaluated the meta-analysis quality and extracted data. The Jadad decision algorithm was applied to ascertain which meta-analysis offered the best evidence.A total of 9 meta-analyses were included. Only RCTs were determined as Level-II evidence. The scores of Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 5 to 10 (median 7). A high-quality meta-analysis with more RCTs was selected according to the Jadad decision algorithm. This study found that when functional rehabilitation was used, conservative intervention was equal to surgical treatment regarding the incidence of rerupture, range of motion, calf circumference, and functional outcomes, while reducing the incidence of other complications. Where functional rehabilitation was not performed, conservative intervention could significantly increase rerupture rate.Conservative intervention may be preferred for acute Achilles tendon rupture at centers offering functional rehabilitation, because it shows a similar rerupture rate with a lower risk of other complications when compared with surgical treatment. However, surgical treatment should be considered at centers without functional rehabilitation as this can reduce the incidence of rerupture.

Decentralized Hypothesis Testing in Energy Harvesting Wireless Sensor Networks

NASA Astrophysics Data System (ADS)

Tarighati, Alla; Gross, James; Jalden, Joakim

2017-09-01

We consider the problem of decentralized hypothesis testing in a network of energy harvesting sensors, where sensors make noisy observations of a phenomenon and send quantized information about the phenomenon towards a fusion center. The fusion center makes a decision about the present hypothesis using the aggregate received data during a time interval. We explicitly consider a scenario under which the messages are sent through parallel access channels towards the fusion center. To avoid limited lifetime issues, we assume each sensor is capable of harvesting all the energy it needs for the communication from the environment. Each sensor has an energy buffer (battery) to save its harvested energy for use in other time intervals. Our key contribution is to formulate the problem of decentralized detection in a sensor network with energy harvesting devices. Our analysis is based on a queuing-theoretic model for the battery and we propose a sensor decision design method by considering long term energy management at the sensors. We show how the performance of the system changes for different battery capacities. We then numerically show how our findings can be used in the design of sensor networks with energy harvesting sensors.

Real-time science operations to support a lunar polar volatiles rover mission

NASA Astrophysics Data System (ADS)

Heldmann, Jennifer L.; Colaprete, Anthony; Elphic, Richard C.; Mattes, Greg; Ennico, Kimberly; Fritzler, Erin; Marinova, Margarita M.; McMurray, Robert; Morse, Stephanie; Roush, Ted L.; Stoker, Carol R.

2015-05-01

Future human exploration of the Moon will likely rely on in situ resource utilization (ISRU) to enable long duration lunar missions. Prior to utilizing ISRU on the Moon, the natural resources (in this case lunar volatiles) must be identified and characterized, and ISRU demonstrated on the lunar surface. To enable future uses of ISRU, NASA and the CSA are developing a lunar rover payload that can (1) locate near subsurface volatiles, (2) excavate and analyze samples of the volatile-bearing regolith, and (3) demonstrate the form, extractability and usefulness of the materials. Such investigations are important both for ISRU purposes and for understanding the scientific nature of these intriguing lunar volatile deposits. Temperature models and orbital data suggest near surface volatile concentrations may exist at briefly lit lunar polar locations outside persistently shadowed regions. A lunar rover could be remotely operated at some of these locations for the ∼ 2-14 days of expected sunlight at relatively low cost. Due to the limited operational time available, both science and rover operations decisions must be made in real time, requiring immediate situational awareness, data analysis, and decision support tools. Given these constraints, such a mission requires a new concept of operations. In this paper we outline the results and lessons learned from an analog field campaign in July 2012 which tested operations for a lunar polar rover concept. A rover was operated in the analog environment of Hawaii by an off-site Flight Control Center, a rover navigation center in Canada, a Science Backroom at NASA Ames Research Center in California, and support teams at NASA Johnson Space Center in Texas and NASA Kennedy Space Center in Florida. We find that this type of mission requires highly efficient, real time, remotely operated rover operations to enable low cost, scientifically relevant exploration of the distribution and nature of lunar polar volatiles. The field demonstration illustrated the need for science operations personnel in constant communications with the flight mission operators and the Science Backroom to provide immediate and continual science support and validation throughout the mission. Specific data analysis tools are also required to enable immediate data monitoring, visualization, and decision making. The field campaign demonstrated that this novel methodology of real-time science operations is possible and applicable to providing important new insights regarding lunar polar volatiles for both science and exploration.

Real-Time Science Operations to Support a Lunar Polar Volatiles Rover Mission

NASA Technical Reports Server (NTRS)

Heldmann, Jennifer L.; Colaprete, Anthony; Elphic, Richard C.; Mattes, Greg; Ennico, Kimberly; Fritzler, Erin; Marinova, Margarita M.; McMurray, Robert; Morse, Stephanie; Roush, Ted L.;

Development of the Surface Management System Integrated with CTAS Arrival Tools

NASA Technical Reports Server (NTRS)

Jung, Yoon C.; Jara, Dave

2005-01-01

The Surface Management System (SMS) developed by NASA Ames Research Center in coordination with the Federal Aviation Administration (FAA) is a decision support tool to help tower traffic coordinators and Ground/Local controllers in managing and controlling airport surface traffic in order to increase capacity, efficiency, and flexibility. SMS provides common situation awareness to personnel at various air traffic control facilities such as airport traffic control towers (ATCT s), airline ramp towers, Terminal Radar Approach Control (TRACON), and Air Route Traffic Control Center (ARTCC). SMS also provides a traffic management tool to assist ATCT traffic management coordinators (TMCs) in making decisions such as airport configuration and runway load balancing. The Build 1 of the SMS tool was installed and successfully tested at Memphis International Airport (MEM) and received high acceptance scores from ATCT controllers and coordinators, as well as airline ramp controllers. NASA Ames Research Center continues to develop SMS under NASA s Strategic Airspace Usage (SAU) project in order to improve its prediction accuracy and robustness under various modeling uncertainties. This paper reports the recent development effort performed by the NASA Ames Research Center: 1) integration of Center TRACON Automation System (CTAS) capability with SMS and 2) an alternative approach to obtain airline gate information through a publicly available website. The preliminary analysis results performed on the air/surface traffic data at the DFW airport have shown significant improvement in predicting airport arrival demand and IN time at the gate. This paper concludes with recommendations for future research and development.

The financial management of research centers and institutes at U.S. medical schools: findings from six institutions.

PubMed

Mallon, William T

2006-06-01

To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.

Beyond Bioethics: A Child Rights-Based Approach to Complex Medical Decision-Making.

PubMed

Wade, Katherine; Melamed, Irene; Goldhagen, Jeffrey

2016-01-01

This analysis adopts a child rights approach-based on the principles, standards, and norms of child rights and the U.N. Convention on the Rights of the Child (CRC)-to explore how decisions could be made with regard to treatment of a severely impaired infant (Baby G). While a child rights approach does not provide neat answers to ethically complex issues, it does provide a framework for decision-making in which the infant is viewed as an independent rights-holder. The state has obligations to develop the capacity of those who make decisions for infants in such situations to meet their obligations to respect, protect, and fulfill their rights as delineated in the CRC. Furthermore, a child rights approach requires procedural clarity and transparency in decision-making processes. As all rights in the CRC are interdependent and indivisible, all must be considered in the process of ethical decision-making, and the reasons for decisions must be delineated by reference to how these rights were considered. It is also important that decisions that are made in this context be monitored and reviewed to ensure consistency. A rights-based framework ensures decision-making is child-centered and that there are transparent criteria and legitimate procedures for making decisions regarding the child's most basic human right: the right to life, survival, and development.

Hospital site selection using fuzzy AHP and its derivatives.

PubMed

Vahidnia, Mohammad H; Alesheikh, Ali A; Alimohammadi, Abbas

2009-07-01

Environmental managers are commonly faced with sophisticated decisions, such as choosing the location of a new facility subject to multiple conflicting criteria. This paper considers the specific problem of creating a well-distributed network of hospitals that delivers its services to the target population with minimal time, pollution and cost. We develop a Multi-Criteria Decision Analysis process that combines Geographical Information System (GIS) analysis with the Fuzzy Analytical Hierarchy Process (FAHP), and use this process to determine the optimum site for a new hospital in the Tehran urban area. The GIS was used to calculate and classify governing criteria, while FAHP was used to evaluate the decision factors and their impacts on alternative sites. Three methods were used to estimate the total weights and priorities of the candidate sites: fuzzy extent analysis, center-of-area defuzzification, and the alpha-cut method. The three methods yield identical priorities for the five alternatives considered. Fuzzy extent analysis provides less discriminating power, but is simpler to implement and compute than the other two methods. The alpha-cut method is more complicated, but integrates the uncertainty and overall attitude of the decision-maker. The usefulness of the new hospital site is evaluated by computing an accessibility index for each pixel in the GIS, defined as the ratio of population density to travel time. With the addition of a new hospital at the optimum site, this index improved over about 6.5 percent of the geographical area.

Exploring Effective Decision Making through Human-Centered and Computational Intelligence Methods

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

Han, Kyungsik; Cook, Kristin A.; Shih, Patrick C.

Decision-making has long been studied to understand a psychological, cognitive, and social process of selecting an effective choice from alternative options. Its studies have been extended from a personal level to a group and collaborative level, and many computer-aided decision-making systems have been developed to help people make right decisions. There has been significant research growth in computational aspects of decision-making systems, yet comparatively little effort has existed in identifying and articulating user needs and requirements in assessing system outputs and the extent to which human judgments could be utilized for making accurate and reliable decisions. Our research focus ismore » decision-making through human-centered and computational intelligence methods in a collaborative environment, and the objectives of this position paper are to bring our research ideas to the workshop, and share and discuss ideas.« less

Propulsion Airframe Aeroacoustics Technology Evaluation and Selection Using a Multi-Attribute Decision Making Process and Non-Deterministic Design

NASA Technical Reports Server (NTRS)

Burg, Cecile M.; Hill, Geoffrey A.; Brown, Sherilyn A.; Geiselhart, Karl A.

2004-01-01

The Systems Analysis Branch at NASA Langley Research Center has investigated revolutionary Propulsion Airframe Aeroacoustics (PAA) technologies and configurations for a Blended-Wing-Body (BWB) type aircraft as part of its research for NASA s Quiet Aircraft Technology (QAT) Project. Within the context of the long-term NASA goal of reducing the perceived aircraft noise level by a factor of 4 relative to 1997 state of the art, major configuration changes in the propulsion airframe integration system were explored with noise as a primary design consideration. An initial down-select and assessment of candidate PAA technologies for the BWB was performed using a Multi-Attribute Decision Making (MADM) process consisting of organized brainstorming and decision-making tools. The assessments focused on what effect the PAA technologies had on both the overall noise level of the BWB and what effect they had on other major design considerations such as weight, performance and cost. A probabilistic systems analysis of the PAA configurations that presented the best noise reductions with the least negative impact on the system was then performed. Detailed results from the MADM study and the probabilistic systems analysis will be published in the near future.

Parent Resource Centers: An Innovative Mechanism for Parental Involvement in School Choice Decisions

ERIC Educational Resources Information Center

Wao, Hesborn; Hein, Vanessa L.; Villamar, Roger; Chanderbhan-Forde, Susan; Lee, Reginald S.

2017-01-01

This qualitative investigation reports on the use of Parent Resource Centers (PRCs) as a mechanism for parental involvement in public school choice decisions. Interviews with parents and staff at seven PRCs in Florida revealed that PRCs employ multiple strategies to communicate choice information to parents: community-, school- and media-based…

78 FR 63971 - Notice of Availability of Record of Decision for Outdoor Research, Development, Test and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

... Outdoor Research, Development, Test and Evaluation Activities at Naval Surface Warfare Center, Dahlgren Division, Dahlgren, VA AGENCY: Department of the Navy, DoD. ACTION: Notice. SUMMARY: The Department of the... proposed action, announces its decision to expand the Naval Surface Warfare Center, Dahlgren Division's...

Marketing for Special Libraries and Information Centers: The Positioning Process.

ERIC Educational Resources Information Center

Sterngold, Arthur

1982-01-01

The positioning process of marketing used by special libraries and information centers involves two key decisions from which other decisions are derived: to which user groups marketing programs and services will be directed; and which information needs will be served. Two cases are discussed and a bibliography is provided. (EJS)

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.

Toward a more data-driven supervision of collegiate counseling centers.

PubMed

Varlotta, Lori E

2012-01-01

Hearing the national call for higher education accountability, the author of this tripartite article urges university administrators to move towards a more data-driven approach to counseling center supervision. Toward that end, the author first examines a key factor--perceived increase in student pathology--that appears to shape budget and staffing decisions in many university centers. Second, she reviews the emerging but conflicting research of clinician-scholars who are trying to empirically verify or refute that perception; their conflicting results suggest that no study alone should be used as the "final word" in evidence-based decision-making. Third, the author delineates the campus-specific data that should be gathered to guide staffing and budgeting decisions on each campus. She concludes by reminding readers that data-driven decisions can and should foster high-quality care that is concurrently efficient, effective, and in sync with the needs of a particular university and student body.

Participation in medical decision-making across Europe: An international longitudinal multicenter study.

PubMed

Bär Deucher, A; Hengartner, M P; Kawohl, W; Konrad, J; Puschner, B; Clarke, E; Slade, M; Del Vecchio, V; Sampogna, G; Égerházi, A; Süveges, Á; Krogsgaard Bording, M; Munk-Jørgensen, P; Rössler, W

2016-05-01

The purpose of this paper was to examine national differences in the desire to participate in decision-making of people with severe mental illness in six European countries. The data was taken from a European longitudinal observational study (CEDAR; ISRCTN75841675). A sample of 514 patients with severe mental illness from the study centers in Ulm, Germany, London, England, Naples, Italy, Debrecen, Hungary, Aalborg, Denmark and Zurich, Switzerland were assessed as to desire to participate in medical decision-making. Associations between desire for participation in decision-making and center location were analyzed with generalized estimating equations. We found large cross-national differences in patients' desire to participate in decision-making, with the center explaining 47.2% of total variance in the desire for participation (P<0.001). Averaged over time and independent of patient characteristics, London (mean=2.27), Ulm (mean=2.13) and Zurich (mean=2.14) showed significantly higher scores in desire for participation, followed by Aalborg (mean=1.97), where scores were in turn significantly higher than in Debrecen (mean=1.56). The lowest scores were reported in Naples (mean=1.14). Over time, the desire for participation in decision-making increased significantly in Zurich (b=0.23) and decreased in Naples (b=-0.14). In all other centers, values remained stable. This study demonstrates that patients' desire for participation in decision-making varies by location. We suggest that more research attention be focused on identifying specific cultural and social factors in each country to further explain observed differences across Europe. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Beyond Control Centers

NASA Technical Reports Server (NTRS)

Trimble, Jay

2017-01-01

For NASA's Resource Prospector (RP) Lunar Rover Mission, we are moving away from a control center concept, to a fully distributed operation utilizing control nodes, with decision support from anywhere via mobile devices. This operations concept will utilize distributed information systems, notifications, mobile data access, and optimized mobile data display for off-console decision support. We see this concept of operations as a step in the evolution of mission operations from a central control center concept to a mission operations anywhere concept. The RP example is part of a trend, in which mission expertise for design, development and operations is distributed across countries and across the globe. Future spacecraft operations will be most cost efficient and flexible by following this distributed expertise, enabling operations from anywhere. For the RP mission we arrived at the decision to utilize a fully distributed operations team, where everyone operates from their home institution, based on evaluating the following factors: the requirement for physical proximity for near-real time command and control decisions; the cost of distributed control nodes vs. a centralized control center; the impact on training and mission preparation of flying the team to a central location. Physical proximity for operational decisions is seldom required, though certain categories of decisions, such as launch abort, or close coordination for mission or safety-critical near-real-time command and control decisions may benefit from co-location. The cost of facilities and operational infrastructure has not been found to be a driving factor for location in our studies. Mission training and preparation benefit from having all operators train and operate from home institutions.

The Education and Training Nexus: Employers' Use of Academic Screens and the Provision of New-Hire Training. EQW Working Papers WP38.

ERIC Educational Resources Information Center

Zemsky, Robert; And Others

A study explored the savings and/or costs associated with employers' decisions to use school measures--grades, teacher recommendations, school reputation--to screen job applicants. Using the results of the National Center on the Educational Quality of the Workforce's National Employer Survey, the analysis focused on two questions: (1) whether…

Hope, Life, and Death: A Qualitative Analysis of Dying Cancer Patients' Talk about Hope

ERIC Educational Resources Information Center

Eliott, Jaklin A.; Olver, Ian N.

2009-01-01

Although deemed vital to patient well-being, hope in persons who are terminally ill is often thought to be problematic, particularly when centered on cure. As part of a study on end-of-life decision-making, we asked 28 patients with cancer, believed to be within weeks of their death, to talk about hope. Responses were transcribed and discursively…

Identifying environmental features for land management decisions

NASA Technical Reports Server (NTRS)

1982-01-01

The major accomplishments of the Center for Remote Sensing and Cartography are outlined. The analysis and inventory of the Parker Mountain rangeland and the use of multitemporal data to study aspen succession stages are discussed. New and continuing projects are also described including a Salt Lake County land use study, Wasatch-Cache riparian study, and Humboldt River riparian habitat study. Finally, progress in digital processing techniques is reported.

Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

NASA Technical Reports Server (NTRS)

Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

2008-01-01

Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

Complex Decision-Making in Heart Failure: A Systematic Review and Thematic Analysis.

PubMed

Hamel, Aimee V; Gaugler, Joseph E; Porta, Carolyn M; Hadidi, Niloufar Niakosari

Heart failure follows a highly variable and difficult course. Patients face complex decisions, including treatment with implantable cardiac defibrillators, mechanical circulatory support, and heart transplantation. The course of decision-making across multiple treatments is unclear yet integral to providing informed and shared decision-making. Recognizing commonalities across treatment decisions could help nurses and physicians to identify opportunities to introduce discussions and support shared decision-making. The specific aims of this review are to examine complex treatment decision-making, specifically implantable cardiac defibrillators, ventricular assist device, and cardiac transplantation, and to recognize commonalities and key points in the decisional process. MEDLINE, CINAHL, PsycINFO, and Web of Science were searched for English-language studies that included qualitative findings reflecting the complexity of heart failure decision-making. Using a 3-step process, findings were synthesized into themes and subthemes. Twelve articles met criteria for inclusion. Participants included patients, caregivers, and clinicians and included decisions to undergo and decline treatment. Emergent themes were "processing the decision," "timing and prognostication," and "considering the future." Subthemes described how participants received and understood information about the therapy, making and changing a treatment decision, timing their decision and gauging health status outcomes in the context of their decision, the influence of a life or death decision, and the future as a factor in their decisional process. Commonalities were present across therapies, which involved the timing of discussions, the delivery of information, and considerations of the future. Exploring this further could help support patient-centered care and optimize shared decision-making interventions.

Overview of NASA Langley's Systems Analysis Capabilities

NASA Technical Reports Server (NTRS)

Cavanaugh, Stephen; Kumar, Ajay; Brewer, Laura; Kimmel, Bill; Korte, John; Moul, Tom

2006-01-01

The Systems Analysis and Concepts Directorate (SACD) has been in the systems analysis business line supporting National Aeronautics and Space Administration (NASA) aeronautics, exploration, space operations and science since the 1960 s. Our current organization structure is shown in Figure 1. SACD mission can be summed up in the following statements: 1. We conduct advanced concepts for Agency decision makers and programs. 2. We provide aerospace systems analysis products such as mission architectures, advanced system concepts, system and technology trades, life cycle cost and risk analysis, system integration and pre-decisional sensitive information. 3. Our work enables informed technical, programmatic and budgetary decisions. SACD has a complement of 114 government employees and approximately 50 on-site contractors which is equally split between supporting aeronautics and exploration. SACD strives for technical excellence and creditability of the systems analysis products delivered to its customers. The Directorate office is continuously building market intelligence and working with other NASA centers and external partners to expand our business base. The Branches strive for technical excellence and credibility of our systems analysis products by seeking out existing and new partnerships that are critical for successful systems analysis. The Directorates long term goal is to grow the amount of science systems analysis business base.

Theories of Health Care Decision Making at the End of Life: A Meta-Ethnography.

PubMed

Kim, Kyounghae; Heinze, Katherine; Xu, Jiayun; Kurtz, Melissa; Park, Hyunjeong; Foradori, Megan; Nolan, Marie T

2017-08-01

The aim of this meta-ethnography is to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decision making among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS) and their caregivers or providers. We used PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases to extract English-language articles published between January 2002 and April 2015. Forty-three articles were included. The most common theories included decision-making models ( n = 14) followed by family-centered ( n = 11) and behavioral change models ( n = 7). A conceptual framework was developed using themes including context of decision making, communication and negotiation of decision making, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes. Future research should enhance and apply these theories to guide research to develop patient-centered decision-making programs that facilitate informed and shared decision making at the end of life among patients with advanced illness and their caregivers.

Clinical Utility of Risk Models to Refer Patients with Adnexal Masses to Specialized Oncology Care: Multicenter External Validation Using Decision Curve Analysis.

PubMed

Wynants, Laure; Timmerman, Dirk; Verbakel, Jan Y; Testa, Antonia; Savelli, Luca; Fischerova, Daniela; Franchi, Dorella; Van Holsbeke, Caroline; Epstein, Elisabeth; Froyman, Wouter; Guerriero, Stefano; Rossi, Alberto; Fruscio, Robert; Leone, Francesco Pg; Bourne, Tom; Valentin, Lil; Van Calster, Ben

2017-09-01

Purpose: To evaluate the utility of preoperative diagnostic models for ovarian cancer based on ultrasound and/or biomarkers for referring patients to specialized oncology care. The investigated models were RMI, ROMA, and 3 models from the International Ovarian Tumor Analysis (IOTA) group [LR2, ADNEX, and the Simple Rules risk score (SRRisk)]. Experimental Design: A secondary analysis of prospectively collected data from 2 cross-sectional cohort studies was performed to externally validate diagnostic models. A total of 2,763 patients (2,403 in dataset 1 and 360 in dataset 2) from 18 centers (11 oncology centers and 7 nononcology hospitals) in 6 countries participated. Excised tissue was histologically classified as benign or malignant. The clinical utility of the preoperative diagnostic models was assessed with net benefit (NB) at a range of risk thresholds (5%-50% risk of malignancy) to refer patients to specialized oncology care. We visualized results with decision curves and generated bootstrap confidence intervals. Results: The prevalence of malignancy was 41% in dataset 1 and 40% in dataset 2. For thresholds up to 10% to 15%, RMI and ROMA had a lower NB than referring all patients. SRRisks and ADNEX demonstrated the highest NB. At a threshold of 20%, the NBs of ADNEX, SRrisks, and RMI were 0.348, 0.350, and 0.270, respectively. Results by menopausal status and type of center (oncology vs. nononcology) were similar. Conclusions: All tested IOTA methods, especially ADNEX and SRRisks, are clinically more useful than RMI and ROMA to select patients with adnexal masses for specialized oncology care. Clin Cancer Res; 23(17); 5082-90. ©2017 AACR . ©2017 American Association for Cancer Research.

Immunizing Children: A Qualitative Analysis of Future Parental Decision Making.

PubMed

Espeleta, Hannah C; Beasley, Lana O; Ridings, Leigh E; Smith, Tyler J; Shields, Jennifer D

2017-10-01

Vaccinations are considered one of public health's greatest accomplishments. Despite evidence for vaccine effectiveness, uptake levels are still well below the Centers for Disease Control and Prevention's guidelines. The immunization decision-making process for parents is complex and depends on factors associated with knowledge and experiences. This qualitative study sought to expand on a previous decision-making model for immunizations by examining how individuals receive vaccination information, determining the role of experience in influencing decisions, and understanding how young adults might locate vaccination information in the future. Three focus groups were conducted with 29 undergraduate students without children. Results suggest that young adults exhibit an awareness of information regarding vaccine use and effectiveness, value doctor opinions and recommendations, and desire more robust research on vaccinations. Implications of these results include the importance of (1) disseminating vaccination education to young adults, (2) enhancing consistency/trust between medical professionals and youth, and (3) expanding public policy to increase vaccine uptake.

Outcry Consistency and Prosecutorial Decisions in Child Sexual Abuse Cases.

PubMed

Bracewell, Tammy E

2018-05-18

This study examines the correlation between the consistency in a child's sexual abuse outcry and the prosecutorial decision to accept or reject cases of child sexual abuse. Case-specific information was obtained from one Texas Children's Advocacy Center on all cases from 2010 to 2013. After the needed deletion, the total number of cases included in the analysis was 309. An outcry was defined as a sexual abuse disclosure. Consistency was measured at both the forensic interview and the sexual assault exam. Logistic regression was used to evaluate whether a correlation existed between disclosure and prosecutorial decisions. Disclosure was statistically significant. Partial disclosure (disclosure at one point in time and denial at another) versus full disclosure (disclosure at two points in time) had a statistically significant odds ratio of 4.801. Implications are discussed, specifically, how the different disciplines involved in child protection should take advantage of the expertise of both forensic interviewers and forensic nurses to inform their decisions.

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

PubMed Central

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

2015-01-01

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

A Look at Person- and Family-Centered Care Among Older Adults: Results from a National Survey [corrected].

PubMed

Wolff, Jennifer L; Boyd, Cynthia M

2015-10-01

Person-centered and family-centered care represents the pinnacle of health care quality, but delivering it is challenging, as is assessing whether it has occurred. Prior studies portray older adults as passive in health decisions and burdened by care-but emphasize age-based differences or focus on vulnerable subgroups. We aimed to examine domains of person-centered and family-centered care among older adults and whether the social context in which older adults manage their health relates to preferences for participating in health decisions and experiences with care. This was an observational study of a nationally representative survey of adults aged 65+ years, conducted in concert with the 2012 National Health and Aging Trends Study (n = 2040). Approach to managing health (self-manage, co-manage, delegate); preferences for making health care decisions with: (1) doctors, (2) family/close friends; and experiences with care pertaining to treatment burden were measured. Approximately two-thirds of older adults self-manage (69.4 %) and one-third co-manage (19.6 %) or delegate (11.0 %) health care activities. The majority prefer an independent or shared role when making health decisions with doctors (84.7 %) and family/close friends (95.9 %). Nearly four in ten older adults (37.9 %) experience treatment burden-that managing health care activities are sometimes or often hard for either them or their family/close friends, that health care activities get delayed or don't get done, or that they are cumulatively too much to do. Relative to older adults who self-manage, those who delegate health care activities are more likely to prefer to share or leave health decisions to doctors (aOR = 1.79 (95 % CI, 1.37-2.33) and family/close friends (aOR = 3.12 (95 % CI, 2.23-4.36), and are more likely to experience treatment burden (aOR = 2.37 (95 % CI, 1.61-3.47). Attaining person-centered and family-centered care will require strategies that respect diverse decision-making preferences, minimize treatment burden, and support the broader social context in which older adults manage their health.

Predictive factors of synchronous colorectal peritoneal metastases: Development of a nomogram and study of its utilities using decision curve analysis.

PubMed

Mo, Shaobo; Dai, Weixing; Xiang, Wenqiang; Li, Qingguo; Wang, Renjie; Cai, Guoxiang

2018-05-03

The objective of this study was to summarize the clinicopathological and molecular features of synchronous colorectal peritoneal metastases (CPM). We then combined clinical and pathological variables associated with synchronous CPM into a nomogram and confirmed its utilities using decision curve analysis. Synchronous metastatic colorectal cancer (mCRC) patients who received primary tumor resection and underwent KRAS, NRAS, and BRAF gene mutation detection at our center from January 2014 to September 2015 were included in this retrospective study. An analysis was performed to investigate the clinicopathological and molecular features for independent risk factors of synchronous CPM and to subsequently develop a nomogram for synchronous CPM based on multivariate logistic regression. Model performance was quantified in terms of calibration and discrimination. We studied the utility of the nomogram using decision curve analysis. In total, 226 patients were diagnosed with synchronous mCRC, of whom 50 patients (22.1%) presented with CPM. After uni- and multivariate analysis, a nomogram was built based on tumor site, histological type, age, and T4 status. The model had good discrimination with an area under the curve (AUC) at 0.777 (95% CI 0.703-0.850) and adequate calibration. By decision curve analysis, the model was shown to be relevant between thresholds of 0.10 and 0.66. Synchronous CPM is more likely to happen to patients with age ≤60, right-sided primary lesions, signet ring cell cancer or T4 stage. This is the first nomogram to predict synchronous CPM. To ensure generalizability, this model needs to be externally validated. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

La tecnología y las monjitas: constellations of authoritative knowledge at a religious birthing center in south Texas.

PubMed

Fleuriet, K Jill

2009-09-01

In this article, I contrast conceptualizations of authoritative knowledge in pregnancy and birth between U.S. midwives and their Mexican immigrant clients at a religious birthing center in south Texas. Although the two groups share certain orientations to pregnancy management, essential differences in prenatal care and birth epistemologies underscore distinct social and economic positions. I use narrative data to document and explain these differences, which throw into relief the hierarchies of identity and need that structure immigrant women's reproductive experiences. Unveiling the different epistemologies can also help to explain sometimes radically divergent ideas that have impacted the very survivability of the birthing center. By focusing on Mexican immigrant women's reproductive decision making in an alternative birthing center, this analysis responds to feminists' call to look to the margins to understand the diversity of women's responses to what Rapp and Ginsburg have called "stratified reproduction".

Predictive factors of pathologic complete response of HER2-positive breast cancer after preoperative chemotherapy with trastuzumab: development of a specific predictor and study of its utilities using decision curve analysis.

PubMed

Jankowski, Clémentine; Guiu, S; Cortet, M; Charon-Barra, C; Desmoulins, I; Lorgis, V; Arnould, L; Fumoleau, P; Coudert, B; Rouzier, R; Coutant, C; Reyal, F

2017-01-01

The aim of this study was to assess the Institut Gustave Roussy/M.D. Anderson Cancer Center (IGR/MDACC) nomogram in predicting pathologic complete response (pCR) to preoperative chemotherapy in a cohort of human epidermal growth factor receptor 2 (HER2)-positive tumors treated with preoperative chemotherapy with trastuzumab. We then combine clinical and pathological variables associated with pCR into a new nomogram specific to HER2-positive tumors treated by preoperative chemotherapy with trastuzumab. Data from 270 patients with HER2-positive tumors treated with preoperative chemotherapy with trastuzumab at the Institut Curie and at the Georges François Leclerc Cancer Center were used to assess the IGR/MDACC nomogram and to subsequently develop a new nomogram for pCR based on multivariate logistic regression. Model performance was quantified in terms of calibration and discrimination. We studied the utility of the new nomogram using decision curve analysis. The IGR/MDACC nomogram was not accurate for the prediction of pCR in HER2-positive tumors treated by preoperative chemotherapy with trastuzumab, with poor discrimination (AUC = 0.54, 95% CI 0.51-0.58) and poor calibration (p = 0.01). After uni- and multivariate analysis, a new pCR nomogram was built based on T stage (TNM), hormone receptor status, and Ki67 (%). The model had good discrimination with an area under the curve (AUC) at 0.74 (95% CI 0.70-0.79) and adequate calibration (p = 0.93). By decision curve analysis, the model was shown to be relevant between thresholds of 0.3 and 0.7. To the best of our knowledge, ours is the first nomogram to predict pCR in HER2-positive tumors treated by preoperative chemotherapy with trastuzumab. To ensure generalizability, this model needs to be externally validated.

Visualization Component of Vehicle Health Decision Support System

NASA Technical Reports Server (NTRS)

Jacob, Joseph; Turmon, Michael; Stough, Timothy; Siegel, Herbert; Walter, patrick; Kurt, Cindy

2008-01-01

The visualization front-end of a Decision Support System (DSS) also includes an analysis engine linked to vehicle telemetry, and a database of learned models for known behaviors. Because the display is graphical rather than text-based, the summarization it provides has a greater information density on one screen for evaluation by a flight controller.This tool provides a system-level visualization of the state of a vehicle, and drill-down capability for more details and interfaces to separate analysis algorithms and sensor data streams. The system-level view is a 3D rendering of the vehicle, with sensors represented as icons, tied to appropriate positions within the vehicle body and colored to indicate sensor state (e.g., normal, warning, anomalous state, etc.). The sensor data is received via an Information Sharing Protocol (ISP) client that connects to an external server for real-time telemetry. Users can interactively pan, zoom, and rotate this 3D view, as well as select sensors for a detail plot of the associated time series data. Subsets of the plotted data can be selected and sent to an external analysis engine to either search for a similar time series in an historical database, or to detect anomalous events. The system overview and plotting capabilities are completely general in that they can be applied to any vehicle instrumented with a collection of sensors. This visualization component can interface with the ISP for data streams used by NASA s Mission Control Center at Johnson Space Center. In addition, it can connect to, and display results from, separate analysis engine components that identify anomalies or that search for past instances of similar behavior. This software supports NASA's Software, Intelligent Systems, and Modeling element in the Exploration Systems Research and Technology Program by augmenting the capability of human flight controllers to make correct decisions, thus increasing safety and reliability. It was designed specifically as a tool for NASA's flight controllers to monitor the International Space Station and a future Crew Exploration Vehicle.

78 FR 28622 - Notice of Approval of Record of Decision for Extending F-Line Streetcar Service to Fort Mason...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

...] Notice of Approval of Record of Decision for Extending F-Line Streetcar Service to Fort Mason Center... Environmental Impact Statement (Final EIS) for extending the F-Line historic streetcar service to Fort Mason... turnaround terminus at the Fort Mason Center; and installing appurtenant features such as signals, crossings...

Rationality in the Academy: Why Responsibility Center Budgeting Is a Wrong Step Down the Wrong Road.

ERIC Educational Resources Information Center

Adams, E. M.

1997-01-01

Responsibility Center Budgeting/Management in higher education places at the heart of the university a mode of rationality in decision making that subverts educational policy and weakens the institution's ability for corrective cultural criticism. Academic leaders should make academic and research decisions based on students' and society's…

The Effects of Enhanced Informed Consent in a Pro-Life Pregnancy Counseling Center.

ERIC Educational Resources Information Center

Mardirosian, Kathryn; And Others

1990-01-01

Investigated effects of enhanced informed consent condition on attitudes of female clients (n=60) toward a counselor, counseling situation, and decision making in a pro-life pregnancy center. Results suggest enhanced consent did not lead to increased or decreased decisions to abort nor to differential attitudes toward counselor or setting.…

Superfund record of decision (EPA Region 3): Langley AFB/NASA Langley Center, Tabbs Creek Operable Unit, Hampton, VA, September 30, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents remedial action for the Tabbs Creek Operable Unit (OU) at the NASA Langley Research Center (LaRC) in Hampton, Virginia (the Site). This action addresses the principle threat at the OU by dredging and disposing contaminated sediment.

[Human body meridian spatial decision support system for clinical treatment and teaching of acupuncture and moxibustion].

PubMed

Wu, Dehua

2016-01-01

The spatial position and distribution of human body meridian are expressed limitedly in the decision support system (DSS) of acupuncture and moxibustion at present, which leads to the failure to give the effective quantitative analysis on the spatial range and the difficulty for the decision-maker to provide a realistic spatial decision environment. Focusing on the limit spatial expression in DSS of acupuncture and moxibustion, it was proposed that on the basis of the geographic information system, in association of DSS technology, the design idea was developed on the human body meridian spatial DSS. With the 4-layer service-oriented architecture adopted, the data center integrated development platform was taken as the system development environment. The hierarchical organization was done for the spatial data of human body meridian via the directory tree. The structured query language (SQL) server was used to achieve the unified management of spatial data and attribute data. The technologies of architecture, configuration and plug-in development model were integrated to achieve the data inquiry, buffer analysis and program evaluation of the human body meridian spatial DSS. The research results show that the human body meridian spatial DSS could reflect realistically the spatial characteristics of the spatial position and distribution of human body meridian and met the constantly changeable demand of users. It has the powerful spatial analysis function and assists with the scientific decision in clinical treatment and teaching of acupuncture and moxibustion. It is the new attempt to the informatization research of human body meridian.

Factor structure of the autonomy preference index in people with severe mental illness.

PubMed

Bonfils, Kelsey A; Adams, Erin L; Mueser, Kim T; Wright-Berryman, Jennifer L; Salyers, Michelle P

2015-08-30

People vary in the amount of control they want to exercise over decisions about their healthcare. Given the importance of patient-centered care, accurate measurement of these autonomy preferences is critical. This study aimed to assess the factor structure of the Autonomy Preference Index (API), used widely in general healthcare, in individuals with severe mental illness. Data came from two studies of people with severe mental illness (N=293) who were receiving mental health and/or primary care/integrated care services. Autonomy preferences were assessed with the API regarding both psychiatric and primary care services. Confirmatory factor analysis was used to evaluate fit of the hypothesized two-factor structure of the API (decision-making autonomy and information-seeking autonomy). Results indicated the hypothesized structure for the API did not adequately fit the data for either psychiatric or primary care services. Three problematic items were dropped, resulting in adequate fit for both types of treatment. These results suggest that with relatively minor modifications the API has an acceptable factor structure when asking people with severe mental illness about their preferences to be involved in decision-making. The modified API has clinical and research utility for this population in the burgeoning field of autonomy in patient-centered healthcare. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

National Foster Care and Adoption Directory Search

MedlinePlus

... Home Topics Family-Centered Practice Philosophy and Key Elements of Family-Centered Practice Family-Centered Practice Across the Service Continuum Engaging Families Family-Centered Casework Practice Family Group Decision-Making Engaging Communities to Support Families Creating a Family- ...

How do we estimate survival? External validation of a tool for survival estimation in patients with metastatic bone disease-decision analysis and comparison of three international patient populations.

PubMed

Piccioli, Andrea; Spinelli, M Silvia; Forsberg, Jonathan A; Wedin, Rikard; Healey, John H; Ippolito, Vincenzo; Daolio, Primo Andrea; Ruggieri, Pietro; Maccauro, Giulio; Gasbarrini, Alessandro; Biagini, Roberto; Piana, Raimondo; Fazioli, Flavio; Luzzati, Alessandro; Di Martino, Alberto; Nicolosi, Francesco; Camnasio, Francesco; Rosa, Michele Attilio; Campanacci, Domenico Andrea; Denaro, Vincenzo; Capanna, Rodolfo

2015-05-22

We recently developed a clinical decision support tool, capable of estimating the likelihood of survival at 3 and 12 months following surgery for patients with operable skeletal metastases. After making it publicly available on www.PATHFx.org , we attempted to externally validate it using independent, international data. We collected data from patients treated at 13 Italian orthopaedic oncology referral centers between 2010 and 2013, then applied to PATHFx, which generated a probability of survival at three and 12-months for each patient. We assessed accuracy using the area under the receiver-operating characteristic curve (AUC), clinical utility using Decision Curve Analysis (DCA), and compared the Italian patient data to the training set (United States) and first external validation set (Scandinavia). The Italian dataset contained 287 records with at least 12 months follow-up information. The AUCs for the three-month and 12-month estimates was 0.80 and 0.77, respectively. There were missing data, including the surgeon's estimate of survival that was missing in the majority of records. Physiologically, Italian patients were similar to patients in the training and first validation sets. However notable differences were observed in the proportion of those surviving three and 12-months, suggesting differences in referral patterns and perhaps indications for surgery. PATHFx was successfully validated in an Italian dataset containing missing data. This study demonstrates its broad applicability to European patients, even in centers with differing treatment philosophies from those previously studied.

Detroit deicing decision support tool : description, operation, and simulation results

DOT National Transportation Integrated Search

2006-01-01

The John A. Volpe National Transportation Systems Center, sponsored by the National Aeronautics and Space Administration, : developed a deicing decision support tool, for Detroit Metropolitan Wayne County Airport (DTW).1 The deicing decision support ...

Identifying environmental features for land management decisions

NASA Technical Reports Server (NTRS)

1981-01-01

The benefits of changes in management organization and facilities for the Center for Remote Sensing and Cartography in Utah are reported as well as interactions with and outreach to state and local agencies. Completed projects are described which studied (1) Unita Basin wetland/land use; (2) Davis County foothill development; (3) Farmington Bay shoreline fluctuation; (4) irrigation detection; and (5) satellite investigation of snow cover/mule deer relationships. Techniques developed for composite computer mapping, contrast enhancement, U-2 CIR/LANDSAT digital interface; factor analysis, and multivariate statistical analysis are described.

Analysis on factors affecting consumers decision on purchasing simple-type houses

NASA Astrophysics Data System (ADS)

Rumintang, A.; Sholichin, I.

2018-01-01

In line with the increase of the population and the need of comfortable houses, as affected by modernization era, the house demand is getting higher. Hence, conducting a research on consumers need and want in buying a house should be seriously attempted to succeed marketing activity. Using an analysis consumers’ behavior, the researcher will know few affecting factors related to consumers’ satisfaction in buying a house. Among other, the factors in question include: house price, house condition, facilities, location and accessability. The sample of this research was drawn from the residents of Graha Asri Housing, Taman Bulang Permai, and Sukodono Permai. Based on the analysis and discussion, some conclusions are made as follow: the factors and variables affecting the consumers’ decision on each choice of house is different and also the same variables on three sources of data include housing atmosphere, cleaning service, ease of access to shopping center, health clinics or hospitals, tourism spot, schools, and the bus station.

Joint Center for Operational Analysis Journal. Volume 12, Issue 1, Spring 2010

DTIC Science & Technology

2010-01-01

enable research into captured records with “complete openness and rigid adherence to acadamic freedom and integrity.” The CRRC will thereby...various levels of effort in the former area, the latter provides a common ground and opportunities for developing close collaborations. This allows...consequence management (CM) capability, specifi cally the use of the CM Decision Support Tool (DST) developed by the DTRA. Ms. Jessica Iannotti

Ethics in Service to the American People

DTIC Science & Technology

2014-06-13

standardized punishments to self regulate. An attempt was made to acquire statistical analysis of ethical behavior from the Center for the Army...fruition? What would it consist of, and what standards would be set that if violated, would result in corresponding punishment ? The idea to self -regulate...fell five votes shy of breaking a filibuster. The Military Justice Improvement Act moves the decision whether to prosecute any crime punishable by

Lessons from innovation in drug-device combination products.

PubMed

Couto, Daniela S; Perez-Breva, Luis; Saraiva, Pedro; Cooney, Charles L

2012-01-01

Drug-device combination products introduced a new dynamic on medical product development, regulatory approval, and corporate interaction that provide valuable lessons for the development of new generations of combination products. This paper examines the case studies of drug-eluting stents and transdermal patches to facilitate a detailed understanding of the challenges and opportunities introduced by combination products when compared to previous generations of traditional medical or drug delivery devices. Our analysis indicates that the largest barrier to introduce a new kind of combination products is the determination of the regulatory center that is to oversee its approval. The first product of a new class of combination products offers a learning opportunity for the regulator and the sponsor. Once that first product is approved, the leading regulatory center is determined, and the uncertainty about the entire class of combination products is drastically reduced. The sponsor pioneering a new class of combination products assumes a central role in reducing this uncertainty by advising the decision on the primary function of the combination product. Our analysis also suggests that this decision influences the nature (pharmaceutical, biotechnology, or medical devices) of the companies that will lead the introduction of these products into the market, and guide the structure of corporate interaction thereon. Copyright © 2011 Elsevier B.V. All rights reserved.

A model study on the circuit mechanism underlying decision-making in Drosophila.

PubMed

Wu, Zhihua; Guo, Aike

2011-05-01

Previous elegant experiments in a flight simulator showed that conditioned Drosophila is able to make a clear-cut decision to avoid potential danger. When confronted with conflicting visual cues, the relative saliency of two competing cues is found to be a sensory ruler for flies to judge which cue should be used for decision-making. Further genetic manipulations and immunohistological analysis revealed that the dopamine system and mushroom bodies are indispensable for such a clear-cut or nonlinear decision. The neural circuit mechanism, however, is far from being clear. In this paper, we adopt a computational modeling approach to investigate how different brain areas and the dopamine system work together to drive a fly to make a decision. By developing a systems-level neural network, a two-pathway circuit is proposed. Besides a direct pathway from a feature binding area to the motor center, another connects two areas via the mushroom body, a target of dopamine release. A raised dopamine level is hypothesized to be induced by complex choice tasks and to enhance lateral inhibition and steepen the units' response gain in the mushroom body. Simulations show that training helps to assign values to formerly neutral features. For a circuit model with a blocked mushroom body, the direct pathway passes all alternatives to the motor center without changing original values, giving rise to a simple choice characterized by a linear choice curve. With respect to an intact circuit, enhanced lateral inhibition dependent on dopamine critically promotes competition between alternatives, turning the linear- into nonlinear choice behavior. Results account well for experimental data, supporting the reasonableness of model working hypotheses. Several testable predictions are made for future studies. Copyright © 2011 Elsevier Ltd. All rights reserved.

Evidence synthesis activities of a hospital evidence-based practice center and impact on hospital decision making.

PubMed

Jayakumar, Kishore L; Lavenberg, Julia A; Mitchell, Matthew D; Doshi, Jalpa A; Leas, Brian; Goldmann, David R; Williams, Kendal; Brennan, Patrick J; Umscheid, Craig A

2016-03-01

Hospital evidence-based practice centers (EPCs) synthesize and disseminate evidence locally, but their impact on institutional decision making is unclear. To assess the evidence synthesis activities and impact of a hospital EPC serving a large academic healthcare system. Descriptive analysis of the EPC's database of rapid systematic reviews since EPC inception (July 2006-June 2014), and survey of report requestors from the EPC's last 4 fiscal years. Descriptive analyses examined requestor and report characteristics; questionnaire examined report usability, impact, and requestor satisfaction (higher scores on 5-point Likert scales reflected greater agreement). The EPC completed 249 evidence reviews since inception. The most common requestors were clinical departments (29%, n = 72), chief medical officers (19%, n = 47), and purchasing committees (14%, n = 35). The most common technologies reviewed were drugs (24%, n = 60), devices (19%, n = 48), and care processes (12%, n = 31). Mean report completion time was 70 days. Thirty reports (12%) informed computerized decision support interventions. More than half of reports (56%, n = 139) were completed in the last 4 fiscal years for 65 requestors. Of the 64 eligible participants, 46 responded (72%). Requestors were satisfied with the report (mean = 4.4), and agreed it was delivered promptly (mean = 4.4), answered the questions posed (mean = 4.3), and informed their final decision (mean = 4.1). This is the first examination of evidence synthesis activities by a hospital EPC in the United States. Our findings suggest hospital EPCs can efficiently synthesize and disseminate evidence addressing a range of clinical topics for diverse stakeholders, and can influence local decision making. © 2015 Society of Hospital Medicine.

Algorithms in the First-Line Treatment of Metastatic Clear Cell Renal Cell Carcinoma--Analysis Using Diagnostic Nodes.

PubMed

Rothermundt, Christian; Bailey, Alexandra; Cerbone, Linda; Eisen, Tim; Escudier, Bernard; Gillessen, Silke; Grünwald, Viktor; Larkin, James; McDermott, David; Oldenburg, Jan; Porta, Camillo; Rini, Brian; Schmidinger, Manuela; Sternberg, Cora; Putora, Paul M

2015-09-01

With the advent of targeted therapies, many treatment options in the first-line setting of metastatic clear cell renal cell carcinoma (mccRCC) have emerged. Guidelines and randomized trial reports usually do not elucidate the decision criteria for the different treatment options. In order to extract the decision criteria for the optimal therapy for patients, we performed an analysis of treatment algorithms from experts in the field. Treatment algorithms for the treatment of mccRCC from experts of 11 institutions were obtained, and decision trees were deduced. Treatment options were identified and a list of unified decision criteria determined. The final decision trees were analyzed with a methodology based on diagnostic nodes, which allows for an automated cross-comparison of decision trees. The most common treatment recommendations were determined, and areas of discordance were identified. The analysis revealed heterogeneity in most clinical scenarios. The recommendations selected for first-line treatment of mccRCC included sunitinib, pazopanib, temsirolimus, interferon-α combined with bevacizumab, high-dose interleukin-2, sorafenib, axitinib, everolimus, and best supportive care. The criteria relevant for treatment decisions were performance status, Memorial Sloan Kettering Cancer Center risk group, only or mainly lung metastases, cardiac insufficiency, hepatic insufficiency, age, and "zugzwang" (composite of multiple, related criteria). In the present study, we used diagnostic nodes to compare treatment algorithms in the first-line treatment of mccRCC. The results illustrate the heterogeneity of the decision criteria and treatment strategies for mccRCC and how available data are interpreted and implemented differently among experts. The data provided in the present report should not be considered to serve as treatment recommendations for the management of treatment-naïve patients with multiple metastases from metastatic clear cell renal cell carcinoma outside a clinical trial; however, the data highlight the different treatment options and the criteria used to select them. The diversity in decision making and how results from phase III trials can be interpreted and implemented differently in daily practice are demonstrated. ©AlphaMed Press.

Incorporating location, routing, and inventory decisions in a bi-objective supply chain design problem with risk-pooling

NASA Astrophysics Data System (ADS)

Tavakkoli-Moghaddam, Reza; Forouzanfar, Fateme; Ebrahimnejad, Sadoullah

2013-07-01

This paper considers a single-sourcing network design problem for a three-level supply chain. For the first time, a novel mathematical model is presented considering risk-pooling, the inventory existence at distribution centers (DCs) under demand uncertainty, the existence of several alternatives to transport the product between facilities, and routing of vehicles from distribution centers to customer in a stochastic supply chain system, simultaneously. This problem is formulated as a bi-objective stochastic mixed-integer nonlinear programming model. The aim of this model is to determine the number of located distribution centers, their locations, and capacity levels, and allocating customers to distribution centers and distribution centers to suppliers. It also determines the inventory control decisions on the amount of ordered products and the amount of safety stocks at each opened DC, selecting a type of vehicle for transportation. Moreover, it determines routing decisions, such as determination of vehicles' routes starting from an opened distribution center to serve its allocated customers and returning to that distribution center. All are done in a way that the total system cost and the total transportation time are minimized. The Lingo software is used to solve the presented model. The computational results are illustrated in this paper.

WHY THEY CAME TO THE EAST-WEST CENTER, A COMPARISON OF ASIAN PACIFIC AND AMERICAN GRANTEES.

ERIC Educational Resources Information Center

MEREDITH, GERALD M.

MAJOR COMPONENTS IN REASONS GIVEN BY ASIAN-PACIFIC AND AMERICAN GRANTEES FOR THE DECISION TO ATTEND THE EAST-WEST CENTER ARE IDENTIFIED. THE STUDY HELPED TO--(1) IDENTIFY MAJOR FACTORS IN REASONS GIVEN FOR ATTENDANCE, (2) CLARIFY THE SELF-REPORTED MOTIVATIONAL STRUCTURE BEHIND EDUCATIONAL-VOCATIONAL DECISIONS, AND (3) EXAMINE THE RELATIONSHIP OF…

Advancing Patient-centered Outcomes in Emergency Diagnostic Imaging: A Research Agenda.

PubMed

Kanzaria, Hemal K; McCabe, Aileen M; Meisel, Zachary M; LeBlanc, Annie; Schaffer, Jason T; Bellolio, M Fernanda; Vaughan, William; Merck, Lisa H; Applegate, Kimberly E; Hollander, Judd E; Grudzen, Corita R; Mills, Angela M; Carpenter, Christopher R; Hess, Erik P

2015-12-01

Diagnostic imaging is integral to the evaluation of many emergency department (ED) patients. However, relatively little effort has been devoted to patient-centered outcomes research (PCOR) in emergency diagnostic imaging. This article provides background on this topic and the conclusions of the 2015 Academic Emergency Medicine consensus conference PCOR work group regarding "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." The goal was to determine a prioritized research agenda to establish which outcomes related to emergency diagnostic imaging are most important to patients, caregivers, and other key stakeholders and which methods will most optimally engage patients in the decision to undergo imaging. Case vignettes are used to emphasize these concepts as they relate to a patient's decision to seek care at an ED and the care received there. The authors discuss applicable research methods and approaches such as shared decision-making that could facilitate better integration of patient-centered outcomes and patient-reported outcomes into decisions regarding emergency diagnostic imaging. Finally, based on a modified Delphi process involving members of the PCOR work group, prioritized research questions are proposed to advance the science of patient-centered outcomes in ED diagnostic imaging. © 2015 by the Society for Academic Emergency Medicine.

Assessment of Unconscious Decision Aids Applied to Complex Patient-Centered Medical Decisions

PubMed Central

Manigault, Andrew Wilhelm; Whillock, Summer Rain

2015-01-01

Background To improve patient health, recent research urges for medical decision aids that are designed to enhance the effectiveness of specific medically related decisions. Many such decisions involve complex information, and decision aids that independently use deliberative (analytical and slower) or intuitive (more affective and automatic) cognitive processes for such decisions result in suboptimal decisions. Unconscious thought can arguably use both intuitive and deliberative (slow and analytic) processes, and this combination may further benefit complex patient (or practitioner) decisions as medical decision aids. Indeed, mounting research demonstrates that individuals render better decisions generally if they are distracted from thinking consciously about complex information after it is presented (but can think unconsciously), relative to thinking about that information consciously or not at all. Objective The current research tested whether the benefits of unconscious thought processes can be replicated using an Internet platform for a patient medical decision involving complex information. This research also explored the possibility that judgments reported after a period of unconscious thought are actually the result of a short period of conscious deliberation occurring during the decision report phase. Methods A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while reporting judgments. Cognitive load was manipulated by having participants memorize semi-random (high), line structured (low), or no dot patterns and recall these intermittently with their decision reports. Overall then, participants were randomly assigned to the conditions of a 3 (thought condition) by 3 (cognitive-load level) between-subjects design. Results A logistic regression analysis indicated that the odds of participants choosing the best treatment were 2.25 times higher in the unconscious-thought condition compared to the immediate-decision condition (b=.81, Wald=4.32, P=.04, 95% CI 1.048-4.836), and 2.39 times greater compared to the conscious-thought condition (b=.87, Wald=4.87, P=.027, 95% CI 1.103-5.186). No difference was observed between the conscious-thought condition compared to the immediate-decision condition, and cognitive load manipulations did not affect choices or alter the above finding. Conclusions This research demonstrates a plausible benefit of unconscious thinking as a decision aid for complex medical decisions, and represents the first use of unconscious thought processes as a patient-centered medical decision aid. Further, the quality of decisions reached unconsciously does not appear to be affected by the amount of cognitive load participants experienced. PMID:25677337

Factors in Client–Clinician Interaction That Influence Hearing Aid Adoption

PubMed Central

Jennings, Mary Beth; Shaw, Lynn; Meston, Christine N.; Cheesman, Margaret F.

2011-01-01

The influence of client–clinician interactions has not been emphasized in hearing health care, despite the extensive evidence of the impact of the provider–patient interaction on health outcomes. The purpose of this study was to identify factors in the client–clinician interaction that may influence hearing aid adoption. Thirteen adults who had received a hearing aid recommendation within the previous 3 months and 10 audiologists participated in a study to generate, sort, and rate the importance of factors in client–clinician interaction that may influence the hearing aid purchase decision. A concept mapping approach was used to define meaningful clusters of factors. Quantitative analysis and qualitative interpretation of the statements resulted in eight concepts. The concepts in order of their importance are (a) Ensuring client comfort, (b) Understanding and meeting client needs, (c) Client-centered traits and actions, (d) Acknowledging client as an individual, (e) Imposing undue pressure and discomfort, (f) Conveying device information by clinician, (g) Supporting choices and shared decision making, and (h) Factors in client readiness. Two overarching themes of client-centered interaction and client empowerment were identified. Results highlight the influence of the client–clinician interaction in hearing aid adoption and suggest the possibility of improving hearing aid adoption by empowering clients through a client-centered interaction. PMID:22155784

Bridging the gap. The separate worlds of evidence-based medicine and patient-centered medicine.

PubMed

Bensing, J

2000-01-01

Modern medical care is influenced by two paradigms: 'evidence-based medicine' and 'patient-centered medicine'. In the last decade, both paradigms rapidly gained in popularity and are now both supposed to affect the process of clinical decision making during the daily practice of physicians. However, careful analysis shows that they focus on different aspects of medical care and have, in fact, little in common. Evidence-based medicine is a rather young concept that entered the scientific literature in the early 1990s. It has basically a positivistic, biomedical perspective. Its focus is on offering clinicians the best available evidence about the most adequate treatment for their patients, considering medicine merely as a cognitive-rational enterprise. In this approach the uniqueness of patients, their individual needs and preferences, and their emotional status are easily neglected as relevant factors in decision-making. Patient-centered medicine, although not a new phenomenon, has recently attracted renewed attention. It has basically a humanistic, biopsychosocial perspective, combining ethical values on 'the ideal physician', with psychotherapeutic theories on facilitating patients' disclosure of real worries, and negotiation theories on decision making. It puts a strong focus on patient participation in clinical decision making by taking into account the patients' perspective, and tuning medical care to the patients' needs and preferences. However, in this approach the ideological base is better developed than its evidence base. In modern medicine both paradigms are highly relevant, but yet seem to belong to different worlds. The challenge for the near future is to bring these separate worlds together. The aim of this paper is to give an impulse to this integration. Developments within both paradigms can benefit from interchanging ideas and principles from which eventually medical care will benefit. In this process a key role is foreseen for communication and communication research.

Shared Decision-Making in Oncology - A Qualitative Analysis of Healthcare Providers' Views on Current Practice.

PubMed

Frerichs, Wiebke; Hahlweg, Pola; Müller, Evamaria; Adis, Christine; Scholl, Isabelle

2016-01-01

Despite an increased awareness of shared decision-making (SDM) and its prominent position on the health policy agenda, its implementation in routine care remains a challenge in Germany. In order to overcome this challenge, it is important to understand healthcare providers' views regarding SDM and to take their perspectives and opinions into account in the development of an implementation program. The present study aimed at exploring a) the attitudes of different healthcare providers regarding SDM in oncology and b) their experiences with treatment decisions in daily practice. A qualitative study was conducted using focus groups and individual interviews with different healthcare providers at the University Cancer Center Hamburg, Germany. Focus groups and interviews were audio-recorded, transcribed and analyzed using conventional content analysis and descriptive statistics. N = 4 focus groups with a total of N = 25 participants and N = 17 individual interviews were conducted. Attitudes regarding SDM varied greatly between the different participants, especially concerning the definition of SDM, the attitude towards the degree of patient involvement in decision-making and assumptions about when SDM should take place. Experiences on how treatment decisions are currently made varied. Negative experiences included time and structural constraints, and a lack of (multidisciplinary) communication. Positive experiences comprised informed patients, involvement of relatives and a good physician-patient relationship. The results show that German healthcare providers in oncology have a range of attitudes that currently function as barriers towards the implementation of SDM. Also, their experiences on how decision-making is currently done reveal difficulties in actively involving patients in decision-making processes. It will be crucial to take these attitudes and experiences seriously and to subsequently disentangle existing misconceptions in future implementation programs.

Culinary Decision Making.

ERIC Educational Resources Information Center

Curtis, Rob

1987-01-01

Advises directors of ways to include day care workers in the decision-making process. Enumerates benefits of using staff to help focus and direct changes in the day care center and discusses possible pitfalls in implementation of a collective decision-making approach to management. (NH)

Determining rules for closing customer service centers: A public utility company's fuzzy decision

NASA Technical Reports Server (NTRS)

Dekorvin, Andre; Shipley, Margaret F.; Lea, Robert N.

1992-01-01

In the present work, we consider the general problem of knowledge acquisition under uncertainty. Simply stated, the problem reduces to the following: how can we capture the knowledge of an expert when the expert is unable to clearly formulate how he or she arrives at a decision? A commonly used method is to learn by examples. We observe how the expert solves specific cases and from this infer some rules by which the decision may have been made. Unique to our work is the fuzzy set representation of the conditions or attributes upon which the expert may possibly base his fuzzy decision. From our examples, we infer certain and possible fuzzy rules for closing a customer service center and illustrate the importance of having the decision closely relate to the conditions under consideration.

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis.

PubMed

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755-0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691-0.783) and 0.742 (0.698-0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction.

Termination of pregnancy following a prenatal diagnosis of Down syndrome: A qualitative study of the decision-making process of pregnant couples.

PubMed

Lou, Stina; Carstensen, Kathrine; Petersen, Olav Bjørn; Nielsen, Camilla Palmhøj; Hvidman, Lone; Lanther, Maja Retpen; Vogel, Ida

2018-05-23

In Denmark, first trimester screening has a very high uptake (>90%). If Down syndrome is diagnosed, termination rates are high (>95%). The aim of this study was to investigate the timing of the decision to terminate pregnancy following a diagnosis of Down syndrome and the factors influencing this decision. Semi-structured, qualitative interview study with 21 couples who had received a prenatal diagnosis of Down syndrome and decided to terminate the pregnancy. Participants were recruited from obstetric departments between February 2016 and July 2017. Data were analyzed using thematic analysis. Five themes were identified: "initial decision-making", "consolidating the decision", "reasons and concerns shaping the termination of pregnancy decision", "the right decision is also burdensome", and "perceived influences in decision-making". For most couples, the initial decision to terminate pregnancy was made before or during the diagnostic process, but it was re-addressed and consolidated following the actual diagnosis. Imagining a family future with a severely affected Down syndrome child was the main factor influencing the termination of pregnancy decision. The decision was articulated as "right" but also as existentially burdensome for some, due to fear of regret and concern about ending a potential life. The decision to terminate pregnancy was considered a private matter between the couple, but was refined through interactions with clinicians and social networks. All couples made an initial decision prior to receiving the Down syndrome diagnosis. Knowledge of the couple's initial decision may facilitate patient-centered communication during and after the diagnostic process. Couples may benefit from counseling to deal with grief and existential concerns. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

Technology assessment for the anesthesiologist.

PubMed

Abenstein, J P

2006-12-01

The expense associated with modern heath care in the United States is very high, in excess of 15% of the GDP, continues to grow and has become a significant public policy issue. New technologies, defined as all drugs, devices, procedures, and organizational systems, are major contributors to rising health care costs. The use of health technology assessment tools can assist those in leadership positions in making rational decisions as to which new technologies to adopt. The classical approach is to use data from prospective, randomized, clinical trials that compare the outcomes of those treated with the new technology and the accepted therapy. Using this information and detailed economic data, the cost-effectiveness ratio can be determined. The accepted metrics are either dollars per life year saved or dollars per quality-adjusted life year saved. If the new medical intervention costs less than $50,000 to 80,000 dollars per life year saved, it is considered to be cost-effective and worthy of adoption. This kind of analysis is complex and expensive. In addition, the required information is not always available, limiting the applicability of this approach. Finally, the economic analysis often includes down-stream expense and benefit not relevant from a medical center perspective. Another approach is to focus the analysis to what impacts the medical center. This includes determining whether the technology has received the necessary approvals and has been shown to be effective, to improve health outcomes, to be at least as effective as standard therapy, and to be achievable outside the investigative setting. A fiscal analysis also must be done to determine what will it cost to acquire and operate the technology, what are the anticipated patient volumes and payer mix, and what will be the down-stream consequences to the medical center. If the process concludes that the technology works, makes a positive difference to patient care, and is fiscally and operationally acceptable, it should be purchased. After the technology has been installed and has been used, a postimplementation review should be done. This review should go over the same attributes that led to the decision to purchase. It should be determined whether the expected patient volumes, outcomes, income, and expenses were seen. If not, the technology assessment process should be refined to make better decisions in the future. Finally, if the results are at a substantial negative variance from what was anticipated, abandoning the technology should be considered. Anesthesiology either directly controls or indirectly influences a significant portion of medical technology in every medical center. Therefore, the processes that have been discussed in this article should be used by the department of anesthesiology to assure optimal patient care and the fiscal stability of the organization.

Patient-centered knowledge sharing in healthcare organizations: Identifying the external barriers.

PubMed

Zhou, Lihong

2017-12-01

This paper reports on a research study, which aims to identify, qualify, and theorize the external barriers that prevent and hinder the exercises and activities of patient-centered knowledge sharing (KS) in healthcare organizations. The project adopted a qualitative secondary analysis approach as the overarching methodology to guide the analysis of data collected in a previously completed research study. Specifically, 46 semi-structured interview data were included and analyzed using a thematic analysis approach. The secondary analysis showed that healthcare KS is strongly influenced and hindered by five external barriers: social belief and preference, cultural values, healthcare education structure, political decisions, and economic environment and constraints. Moreover, the research findings suggest that these external barriers cannot be overlooked in KS implementation and operation in healthcare organizations and should be carefully assessed beginning in the early stages of KS design and strategic planning. Based on the secondary analysis, this paper proposes a conceptual model, which will contribute to the development of hypotheses in the future for building a generalized knowledge. The case study used is Chinese healthcare, but the KS problems studied can be shared across international borders.

Lexical Decision with Left, Right and Center Visual Field Presentation: A Comparison between Dyslexic and Regular Readers by Means of Electrophysiological and Behavioral Measures

ERIC Educational Resources Information Center

Shaul, Shelley

2012-01-01

This study examined the differences in processing between regular and dyslexic readers in a lexical decision task in different visual field presentations (left, right, and center). The research utilized behavioral measures that provide information on accuracy and reaction time and electro-physiological measures that permit the examination of brain…

The Florida Student Student Services Centers: Factors Influencing Students' Decisions To Enroll in Nova Southeastern University's Programs.

ERIC Educational Resources Information Center

Atherton, Blair

A brief survey was administered to 182 students in selected business master's program classes in April and May 2001 at the Florida Student Service Centers of Nova Southeastern University (NSU). The purpose was to gain insight into the factors that led to students' decisions to attend NSU rather than some other institution. The survey included…

Mapping Perceptions of Lupus Medication Decision-Making Facilitators: The Importance of Patient Context.

PubMed

Qu, Haiyan; Shewchuk, Richard M; Alarcón, Graciela; Fraenkel, Liana; Leong, Amye; Dall'Era, Maria; Yazdany, Jinoos; Singh, Jasvinder A

2016-12-01

Numerous factors can impede or facilitate patients' medication decision-making and adherence to physicians' recommendations. Little is known about how patients and physicians jointly view issues that affect the decision-making process. Our objective was to derive an empirical framework of patient-identified facilitators to lupus medication decision-making from key stakeholders (including 15 physicians, 5 patients/patient advocates, and 8 medical professionals) using a patient-centered cognitive mapping approach. We used nominal group patient panels to identify facilitators to lupus treatment decision-making. Stakeholders independently sorted the identified facilitators (n = 98) based on their similarities and rated the importance of each facilitator in patient decision-making. Data were analyzed using multidimensional scaling and hierarchical cluster analysis. A cognitive map was derived that represents an empirical framework of facilitators for lupus treatment decisions from multiple stakeholders' perspectives. The facilitator clusters were 1) hope for a normal/healthy life, 2) understand benefits and effectiveness of taking medications, 3) desire to minimize side effects, 4) medication-related data, 5) medication effectiveness for "me," 6) family focus, 7) confidence in physician, 8) medication research, 9) reassurance about medication, and 10) medication economics. Consideration of how different stakeholders perceive the relative importance of lupus medication decision-making clusters is an important step toward improving patient-physician communication and effective shared decision-making. The empirically derived framework of medication decision-making facilitators can be used as a guide to develop a lupus decision aid that focuses on improving physician-patient communication. © 2016, American College of Rheumatology.

Analysis of the 60-Hz power system at KSC: The Orsino substation

NASA Technical Reports Server (NTRS)

Kalu, Alex O.

1989-01-01

An analysis of the Orsino Substation, a component (50 percent) of the 60-Hertz electric power system at the Kennedy Space Center, is presented. Presented here are separate single-line diagrams of the sixteen feeder circuits to permit easy access to information on the individual feeders for future planning. The load condition of each feeder and load break switch are presented and a heuristic reliability analysis of the system is performed. Information is given about the system fashion useful for decision making purposes. The beauty of it is in the simplified manner by which information about the system can be obtained.

Development of Distributed Research Center for analysis of regional climatic and environmental changes

NASA Astrophysics Data System (ADS)

Gordov, E.; Shiklomanov, A.; Okladnikov, I.; Prusevich, A.; Titov, A.

2016-11-01

We present an approach and first results of a collaborative project being carried out by a joint team of researchers from the Institute of Monitoring of Climatic and Ecological Systems, Russia and Earth Systems Research Center UNH, USA. Its main objective is development of a hardware and software platform prototype of a Distributed Research Center (DRC) for monitoring and projecting of regional climatic and environmental changes in the Northern extratropical areas. The DRC should provide the specialists working in climate related sciences and decision-makers with accurate and detailed climatic characteristics for the selected area and reliable and affordable tools for their in-depth statistical analysis and studies of the effects of climate change. Within the framework of the project, new approaches to cloud processing and analysis of large geospatial datasets (big geospatial data) inherent to climate change studies are developed and deployed on technical platforms of both institutions. We discuss here the state of the art in this domain, describe web based information-computational systems developed by the partners, justify the methods chosen to reach the project goal, and briefly list the results obtained so far.

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

PubMed

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

2015-11-30

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

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

PubMed Central

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

2015-01-01

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

Summary and results of the joint WMD-DAC/Alameda County bioterrorism response plan exercise.

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

Manley, Dawn Kataoka; Lipkin, Joel; West, Todd H.

2003-11-01

On June 12,2003, the Alameda County Public Health Department and Sandia National Laboratories/CA jointly conducted an exercise that used a Weapons of Mass Destruction-Decision Analysis Center (WMD-DAC) bioterrorism attack simulation to test the effectiveness of the county's emergency response plan. The exercise was driven by an assumed release (in the vicinity of the Berkeley Marina), and subsequent spread, of a small quantity of aerosolized, weapons-grade anthrax spores. The simulation used several key WMD-DAC capabilities, namely: (1) integration with an atmospheric dispersion model to calculate expected dose levels in the affected areas, (2) a individual-tracking capability for both infected and non-infectedmore » persons as they made decisions, sought treatment, and received prophylaxis drugs, and (3) a user interface that allows exercise participants to affect the scenario evolution and outcome. The analysis of the county's response plan included documenting and reviewing the decisions made by participants during the exercise. Twenty-six local and regional officials representing the health care system, emergency medical services and law enforcement were involved in responding to the simulated attack. The results of this joint effort include lessons learned both by the Alameda County officials regarding implementation of their bioterrorism response plan and by the Sandia representatives about conducting exercises of this type. These observations are reviewed in this report, and they form a basis for providing a better understanding of group/individual decision processes and for identifying effective communication options among decision makers.« less

Cognitive Systems Modeling and Analysis of Command and Control Systems

NASA Technical Reports Server (NTRS)

Norlander, Arne

2012-01-01

Military operations, counter-terrorism operations and emergency response often oblige operators and commanders to operate within distributed organizations and systems for safe and effective mission accomplishment. Tactical commanders and operators frequently encounter violent threats and critical demands on cognitive capacity and reaction time. In the future they will make decisions in situations where operational and system characteristics are highly dynamic and non-linear, i.e. minor events, decisions or actions may have serious and irreversible consequences for the entire mission. Commanders and other decision makers must manage true real time properties at all levels; individual operators, stand-alone technical systems, higher-order integrated human-machine systems and joint operations forces alike. Coping with these conditions in performance assessment, system development and operational testing is a challenge for both practitioners and researchers. This paper reports on research from which the results led to a breakthrough: An integrated approach to information-centered systems analysis to support future command and control systems research development. This approach integrates several areas of research into a coherent framework, Action Control Theory (ACT). It comprises measurement techniques and methodological advances that facilitate a more accurate and deeper understanding of the operational environment, its agents, actors and effectors, generating new and updated models. This in turn generates theoretical advances. Some good examples of successful approaches are found in the research areas of cognitive systems engineering, systems theory, and psychophysiology, and in the fields of dynamic, distributed decision making and naturalistic decision making.

Rural Health, Center of Excellence for Remote and Medically Under-Served Areas (CERMUSA). Addendum

DTIC Science & Technology

2010-07-01

questions. Table 1: Advanced Airway Management Item Analysis Question Pretest Posttest Difference N % N % N % Question 1 5 42% 4 33% -1 -8...those of the author (s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other...solutions. Three departments, namely Telehealth, Distance Learning, and Information Technology, work hand-in-hand to design and execute the research

Developing a Campaign Plan to Target Centers of Gravity Within Economic Systems

DTIC Science & Technology

1995-05-01

Conclusion 67 CHAPTER 7: CURRENT AND FUTURE CONCERNS 69 Decision Making and Planning 69 Conclusion 72 CHAPTER 8: CONCLUSION 73 APPENDIX A: STATISTICS 80...Terminology and Statistical Tests 80 Country Analysis 84 APPENDIX B 154 BIBLIOGRAPHY 157 VITAE 162 IV LIST OF FIGURES Figure 1. Air Campaign...This project furthers the original statistical effort and adds to this a campaign planning approach (including both systems and operational level

Information Center Help Desk

DTIC Science & Technology

1991-09-01

listed is made. Many factors beyond what is included in the short list of features go into making that decision. Data on optical disk drives, scanners and...support existed due to lack of hardware or software. To do this analysis the IC responses were studied in relationship to the following three issues...each based on the developed criteria. No weighting factors in terms of relative importance of each criteria can be applied in this environment. As

Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.

PubMed

Al-Amin, Mona; Housman, Michael

2012-01-01

General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers' demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today's reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals' survival. The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations. Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida's Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data. Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density. The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs while making market-entry decisions and while developing their strategic plans.

Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

PubMed

Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

2014-01-01

This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

Decision making in acquiring medical technologies in Israeli medical centers: a preliminary study.

PubMed

Greenberg, Dan; Pliskin, Joseph S; Peterburg, Yitzhak

2003-01-01

This preliminary study had two objectives: a) charting the considerations relevant to decisions about acquisition of new medical technology at the hospital level; and b) creating a basis for the development of a research tool that will examine the function of the Israeli health system in assessment of new medical technologies. A comprehensive literature review and in-depth interviews with decision makers at different levels allowed formulation of criteria considered by decision makers when they decide to purchase and use (or disallow the use) of new medical technology. The resulting questionnaire was sent to medical center directors, along with a letter explaining the goals of the study. The questionnaire included 31 possible considerations for decision making concerning the acquisition of new medical technology by medical centers. The interviewees were asked to indicate the relevance of each consideration in the decision-making process. The most relevant criteria for the adoption of new technologies related to the need for a large capital investment, clinical efficacy of the technology as well as its influence on side effects and complication rates, and a formal approval by the Ministry of Health. Most interviewees stated that pressures exerted by the industry, by patients, or by senior physicians in the hospital are less relevant to decision making. Very small and usually not statistically significant differences in the ranking of hospital directors were found according to the hospitals' ownership, size, or location. The present study is a basis for a future study that will map and describe the function of hospital decision makers within the area of new technology assessment and the decision-making process in the adoption of new healthcare technologies.

A decision analysis approach for risk management of near-earth objects

NASA Astrophysics Data System (ADS)

Lee, Robert C.; Jones, Thomas D.; Chapman, Clark R.

2014-10-01

Risk management of near-Earth objects (NEOs; e.g., asteroids and comets) that can potentially impact Earth is an important issue that took on added urgency with the Chelyabinsk event of February 2013. Thousands of NEOs large enough to cause substantial damage are known to exist, although only a small fraction of these have the potential to impact Earth in the next few centuries. The probability and location of a NEO impact are subject to complex physics and great uncertainty, and consequences can range from minimal to devastating, depending upon the size of the NEO and location of impact. Deflecting a potential NEO impactor would be complex and expensive, and inter-agency and international cooperation would be necessary. Such deflection campaigns may be risky in themselves, and mission failure may result in unintended consequences. The benefits, risks, and costs of different potential NEO risk management strategies have not been compared in a systematic fashion. We present a decision analysis framework addressing this hazard. Decision analysis is the science of informing difficult decisions. It is inherently multi-disciplinary, especially with regard to managing catastrophic risks. Note that risk analysis clarifies the nature and magnitude of risks, whereas decision analysis guides rational risk management. Decision analysis can be used to inform strategic, policy, or resource allocation decisions. First, a problem is defined, including the decision situation and context. Second, objectives are defined, based upon what the different decision-makers and stakeholders (i.e., participants in the decision) value as important. Third, quantitative measures or scales for the objectives are determined. Fourth, alternative choices or strategies are defined. Fifth, the problem is then quantitatively modeled, including probabilistic risk analysis, and the alternatives are ranked in terms of how well they satisfy the objectives. Sixth, sensitivity analyses are performed in order to examine the impact of uncertainties. Finally, the need for further analysis, data collection, or refinement is determined. The first steps of defining the problem and the objectives are critical to constructing an informative decision analysis. Such steps must be undertaken with participation from experts, decision-makers, and stakeholders (defined here as "decision participants"). The basic problem here can be framed as: “What is the best strategy to manage risk associated with NEOs?” Some high-level objectives might be to minimize: mortality and injuries, damage to critical infrastructure (e.g., power, communications and food distribution), ecosystem damage, property damage, ungrounded media and public speculation, resources expended, and overall cost. Another valuable objective would be to maximize inter-agency/government coordination. Some of these objectives (e.g., “minimize mortality”) are readily quantified (e.g., deaths and injuries averted). Others are less so (e.g., “maximize inter-agency/government coordination”), but these can be scaled. Objectives may be inversely related: e.g., a strategy that minimizes mortality may cost more. They are also unlikely to be weighted equally. Defining objectives and assessing their relative weight and interactions requires early engagement with decision participants. High-level decisions include whether to deflect a NEO, when to deflect, what is the best alternative for deflection/destruction, and disaster management strategies if an impact occurs. Important influences include, for example: NEO characteristics (orbital characteristics, diameter, mass, spin and composition), impact probability and location, interval between discovery and projected impact date, interval between discovery and deflection target date, costs of information collection, costs and technological feasibility of deflection alternatives, risks of deflection campaigns, requirements for inter-agency and international cooperation, and timing of informing the public. The analytical aspects of decision analysis center on estimation of the expected value (i.e. utility) of different alternatives. The expected value of an alternative is a function of the probability-weighted consequences, estimated using Bayesian calculations in a decision tree or influence diagram model. The result is a set of expected-value estimates for all alternatives evaluated that enables a ranking; the higher the expected value, the more preferred the alternative. A common way to include resource limitations is by framing the decision analysis in the context of economics (e.g., cost-effectiveness analysis). An important aspect of decision analysis in the NEO risk management case is the ability, known as sensitivity analysis, to examine the effect of parameter uncertainty upon decisions. The simplest way to evaluate uncertainty associated with the information used in a decision analysis is to adjust the input values one at a time (or simultaneously) to examine how the results change. Monte Carlo simulations can be used to adjust the inputs over ranges or distributions of values; statistical means then are used to determine the most influential variables. These techniques yield a measure known as the expected value of imperfect information. This value is highly informative, because it allows the decision-maker with imperfect information to evaluate the impact of using experiments, tests, or data collection (e.g. Earth-based observations, space-based remote sensing, etc.) to refine judgments; and indeed to estimate how much should be spent to reduce uncertainty.

Computer network for improving quality and efficiency of children's primary health care

NASA Astrophysics Data System (ADS)

Deutsch, Larry

1995-10-01

Health care is at its best when both the practitioner and patient are well-informed. In many central urban and remote rural areas, however, health care is characterized by a lack of continuity and coordination among providers. In these areas, a local information infrastructure and a patient-centered system of primary care are missing. Decision-making and ability to follow through is hampered, with limited involvement of patients in planning care and insufficient aggregate data for cost analysis, outcome research, community health planning, and other purposes. A Children's Health Network has been designed to extend current information technology to these underserved areas. Our approach to improving quality of individual care and controlling costs emphasizes use of computerized clinical information networks for better decision making and continuity, and secondarily through data aggregation for financial, research, and public health functions. This is in distinction to information systems centered on billing and administrative needs and to cost-control efforts which rely on fiscal and managerial ('gatekeeper') mechanisms. A uniform data base among sites serving the same population will answer several clinical and public health needs.

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

PubMed

Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

2016-02-01

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

Data Mining Techniques for Customer Relationship Management

NASA Astrophysics Data System (ADS)

Guo, Feng; Qin, Huilin

2017-10-01

Data mining have made customer relationship management (CRM) a new area where firms can gain a competitive advantage, and play a key role in the firms’ management decision. In this paper, we first analyze the value and application fields of data mining techniques for CRM, and further explore how data mining applied to Customer churn analysis. A new business culture is developing today. The conventional production centered and sales purposed market strategy is gradually shifting to customer centered and service purposed. Customers’ value orientation is increasingly affecting the firms’. And customer resource has become one of the most important strategic resources. Therefore, understanding customers’ needs and discriminating the most contributed customers has become the driving force of most modern business.

Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care.

PubMed

Matthews, Veronica; Burgess, Christopher P; Connors, Christine; Moore, Elizabeth; Peiris, David; Scrimgeour, David; Thompson, Sandra C; Larkins, Sarah; Bailie, Ross

2017-01-01

Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded. We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded. Approximately 23% ( n  = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p  < 0.001). Eleven percent ( n  = 53) of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years ( n  = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood lipid or glucose levels had follow-up management plans recorded. There was wide variation in CVRA between jurisdictions and between PHC centers. Learnings from successful interventions to educate and support centers in CVRA provision should be shared with stakeholders more widely. Where risk has been identified, further improvement in follow-up management is required to prevent CVD onset and reduce future burden in Australia's Indigenous population.

13 CFR 130.430 - Application decisions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Application decisions. 130.430 Section 130.430 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION SMALL BUSINESS DEVELOPMENT CENTERS § 130.430 Application decisions. (a) The AA/SBDCs may approve, conditionally approve, or reject...

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

PubMed Central

Wright, Brad; Martin, Graham P.

2017-01-01

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

Multimorbidity and Decision-Making Preferences Among Older Adults.

PubMed

Chi, Winnie C; Wolff, Jennifer; Greer, Raquel; Dy, Sydney

2017-11-01

Understanding individuals' preferences for participating in health care decisions is foundational to delivering person-centered care. We aimed to (1) explore preferences for health care decision making among older adults, and (2) identify multimorbidity profiles associated with preferring less active, ie, passive, participation among older US adults. Ours was a cross-sectional, nationally representative study of 2,017 National Health and Aging Trends Study respondents. Passive decision-making preference was defined as preferring to leave decisions to physicians. Multimorbidity profiles, based on 13 prevalent chronic conditions, were examined as (1) presence of 2 or more conditions, (2) a simple conditions count, and (3) a condition clusters count. Multiple logistic regression was used with adjustment for age, sex, education, English proficiency, and mobility limitation. Most older adults preferred to participate actively in making health care decisions. Older adults with 4 or more conditions, however, and those with multiple condition clusters are relatively less likely to prefer active decision making. Primary care physicians should initiate a shared decision-making process with older adults with 4 or more conditions or multiple condition clusters. Physicians should anticipate variation in decision-making preferences among older adults and adapt a decision-making process that suits individuals' preferences for participation to ensure person-centered care delivery. © 2017 Annals of Family Medicine, Inc.

A Study of Flood Evacuation Center Using GIS and Remote Sensing Technique

NASA Astrophysics Data System (ADS)

Mustaffa, A. A.; Rosli, M. F.; Abustan, M. S.; Adib, R.; Rosli, M. I.; Masiri, K.; Saifullizan, B.

2016-07-01

This research demonstrated the use of Remote Sensing technique and GIS to determine the suitability of an evacuation center. This study was conducted in Batu Pahat areas that always hit by a series of flood. The data of Digital Elevation Model (DEM) was obtained by ASTER database that has been used to delineate extract contour line and elevation. Landsat 8 image was used for classification purposes such as land use map. Remote Sensing incorporate with GIS techniques was used to determined the suitability location of the evacuation center from contour map of flood affected areas in Batu Pahat. GIS will calculate the elevation of the area and information about the country of the area, the road access and percentage of the affected area. The flood affected area map may provide the suitability of the flood evacuation center during the several levels of flood. The suitability of evacuation centers can be determined based on several criteria and the existing data of the evacuation center will be analysed. From the analysis among 16 evacuation center listed, there are only 8 evacuation center suitable for the usage during emergency situation. The suitability analysis was based on the location and the road access of the evacuation center toward the flood affected area. There are 10 new locations with suitable criteria of evacuation center proposed on the study area to facilitate the process of rescue and evacuating flood victims to much safer and suitable locations. The results of this study will help in decision making processes and indirectly will help organization such as fire-fighter and the Department of Social Welfare in their work. Thus, this study can contribute more towards the society.

Implementing health management information systems: measuring success in Korea's health centers.

PubMed

Chae, Y M; Kim, S I; Lee, B H; Choi, S H; Kim, I S

1994-01-01

This article analyses the effects that the introduction and adoption of a health management information system (HMIS) can have on both the productivity of health center staff as well as on user-satisfaction. The focus is upon the service provided by the Kwonsun Health Center located in Suwon City, Korea. Two surveys were conducted to measure the changes in productivity and adoption (knowledge, persuasion, decision, implementation and confirmation) of health center staff over time. In addition, a third survey was conducted to measure the effects of HMIS on the level of satisfaction perceived by the visitors, by comparing the satisfaction level between the study health center and a similar health center identified as a control. The results suggest that HMIS increased the productivity and satisfaction of the staff but did not increase their persuasion and decision levels; and, that is also succeeded in increasing the levels of visitors' satisfaction with the services provided.

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

DTIC Science & Technology

1996-05-01

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

Decisive Action Training Environment at the Joint Multinational Readiness Center, Volume 3: Multinational Interoperability

DTIC Science & Technology

2016-09-01

training in the decisive action training environment, with rotations routinely featuring several thousand participants from many nations and operating in...teams work with exercise participants before they arrive at the training center. The goal is to ensure all formations understand — and are able to...capabilities, location, and extensive experience working with NATO and partner countries, the JMTC is uniquely positioned to implement NATO training

Conjoint analysis: using a market-based research model for healthcare decision making.

PubMed

Mele, Nancy L

2008-01-01

Conjoint analysis is a market-based research model that has been used by businesses for more than 35 years to predict consumer preferences in product design and purchasing. Researchers in medicine, healthcare economics, and health policy have discovered the value of this methodology in determining treatment preferences, resource allocation, and willingness to pay. To describe the conjoint analysis methodology and explore value-added applications in nursing research. Conjoint analysis methodology is described, using examples from the healthcare and business literature, and personal experience with the method. Nurses are called upon to increase interdisciplinary research, provide an evidence base for nursing practice, create patient-centered treatments, and revise nursing education. Other disciplines have met challenges like these using conjoint analysis and discrete choice modeling.

Understanding clinical work practices for cross-boundary decision support in e-health.

PubMed

Tawfik, Hissam; Anya, Obinna; Nagar, Atulya K

2012-07-01

One of the major concerns of research in integrated healthcare information systems is to enable decision support among clinicians across boundaries of organizations and regional workgroups. A necessary precursor, however, is to facilitate the construction of appropriate awareness of local clinical practices, including a clinician's actual cognitive capabilities, peculiar workplace circumstances, and specific patient-centered needs based on real-world clinical contexts across work settings. In this paper, a user-centered study aimed to investigate clinical practices across three different geographical areas-the U.K., the UAE and Nigeria-is presented. The findings indicate that differences in clinical practices among clinicians are associated with differences in local work contexts across work settings, but are moderated by adherence to best practice guidelines and the need for patient-centered care. The study further reveals that an awareness especially of the ontological, stereotypical, and situated practices plays a crucial role in adapting knowledge for cross-boundary decision support. The paper then outlines a set of design guidelines for the development of enterprise information systems for e-health. Based on the guidelines, the paper proposes the conceptual design of CaDHealth, a practice-centered framework for making sense of clinical practices across work settings for effective cross-boundary e-health decision support.

Patient Decision Control and the Use of Cardiac Catheterization

PubMed Central

Paasche-Orlow, Michael K.; Orner, Michelle B.; Stewart, Sabrina K.; Kressin, Nancy R.

2015-01-01

Background: Shared decision-making is a key determinant of patient-centered care. A lack of patient involvement in treatment decisions may explain persistent racial disparities in rates of cardiac catheterization (CCATH). To date, limited evidence exists to demonstrate whether patients who engage in shared decision-makingare more or less likely to undergo non-emergency CCATH. Objective: To assess the relationship between participation in the decision to undergo a CCATH and the use of CCATH. We also examined whether preference for or actual engagement in decision-making varied by patient race. Methods: We analyzed data from 826 male Veterans Administration patients for whom CCATH was indicated and who participated in the Cardiac Decision Making Study. Results: After controlling for confounders, patients reporting any degree of decision control were more likely to receive CCATH compared with those reporting no control (doctor made decision without patient input) (54% vs 39%, P<.0001). Across racial groups, patients were equally likely to report a preference for control over decision-making (P=.53) as well as to experience discordance between their preference for control and their perception of the actual decision-making process (P=.59). Therefore, these factors did not mediate racial disparities in rates of CCATH use. Conclusion: Shared decision-making is an essential feature of whole-person care. While participation in decision-making may not explain disparities in CCATH rates, further work is required to identify strategies to improve congruence between patients' desire for and actual control over decision-making to actualize patient-centered care. PMID:26331101

Psychometrics of Shared Decision Making and Communication as Patient Centered Measures for Two Language Groups

PubMed Central

Alvarez, Kiara; Wang, Ye; Alegria, Margarita; Ault-Brutus, Andrea; Ramanayake, Natasha; Yeh, Yi-Hui; Jeffries, Julia R.; Shrout, Patrick E.

2017-01-01

Shared decision-making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient’s perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of two patient-centered outcome measures, the Shared Decision Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication Subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the two language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the two groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. PMID:27537002

Effects of Newly Designed Hospital Buildings on Staff Perceptions: A Pre-Post Study to Validate Design Decisions.

PubMed

Schreuder, Eliane; van Heel, Liesbeth; Goedhart, Rien; Dusseldorp, Elise; Schraagen, Jan Maarten; Burdorf, Alex

2015-01-01

This study investigates effects of the newly built nonpatient-related buildings of a large university medical center on staff perceptions and whether the design objectives were achieved. The medical center is gradually renewing its hospital building area of 200,000 m.(2) This redevelopment is carefully planned and because lessons learned can guide design decisions of the next phase, the medical center is keen to evaluate the performance of the new buildings. A pre- and post-study with a control group was conducted. Prior to the move to the new buildings an occupancy evaluation was carried out in the old setting (n = 729) (pre-study). Post occupation of the new buildings another occupancy evaluation (post-study) was carried out in the new setting (intervention group) and again in some old settings (control group) (n = 664). The occupancy evaluation consisted of an online survey that measured the perceived performance of different aspects of the building. Longitudinal multilevel analysis was used to compare the performance of the old buildings with the new buildings. Significant improvements were found in indoor climate, perceived safety, working environment, well-being, facilities, sustainability, and overall satisfaction. Commitment to the employer, working atmosphere, orientation, work performance, and knowledge sharing did not improve. The results were interpreted by relating them to specific design choices. We showed that it is possible to measure the performance improvements of a complex intervention being a new building design and validate design decisions. A focused design process aiming for a safe, pleasant and sustainable building resulted in actual improvements in some of the related performance measures. © The Author(s) 2015.

Psychometrics of shared decision making and communication as patient centered measures for two language groups.

PubMed

Alvarez, Kiara; Wang, Ye; Alegria, Margarita; Ault-Brutus, Andrea; Ramanayake, Natasha; Yeh, Yi-Hui; Jeffries, Julia R; Shrout, Patrick E

2016-09-01

Shared decision making (SDM) and effective patient-provider communication are key and interrelated elements of patient-centered care that impact health and behavioral health outcomes. Measurement of SDM and communication from the patient's perspective is necessary in order to ensure that health care systems and individual providers are responsive to patient views. However, there is a void of research addressing the psychometric properties of these measures with diverse patients, including non-English speakers, and in the context of behavioral health encounters. This study evaluated the psychometric properties of 2 patient-centered outcome measures, the Shared Decision-Making Questionnaire-9 (SDM-Q) and the Kim Alliance Scale-Communication subscale (KAS-CM), in a sample of 239 English and Spanish-speaking behavioral health patients. One dominant factor was found for each scale and this structure was used to examine whether there was measurement invariance across the 2 language groups. One SDM-Q item was inconsistent with the configural invariance comparison and was removed. The remaining SDM-Q items exhibited strong invariance, meaning that item loadings and item means were similar across the 2 groups. The KAS-CM items had limited variability, with most respondents indicating high communication levels, and the invariance analysis was done on binary versions of the items. These had metric invariance (loadings the same over groups) but several items violated the strong invariance test. In both groups, the SDM-Q had high internal consistency, whereas the KAS-CM was only adequate. These findings help interpret results for individual patients, taking into account cultural and linguistic differences in how patients perceive SDM and patient-provider communication. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The analysis of rapidly developing fog at the Kennedy Space Center

NASA Technical Reports Server (NTRS)

Wheeler, Mark M.; Atchison, Michael K.; Schumann, Robin; Taylor, Greg E.; Yersavich, Ann; Warburton, John D.

1994-01-01

This report documents fog precursors and fog climatology at Kennedy Space Center (KSC) Florida from 1986 to 1990. The major emphasis of this report focuses on rapidly developing fog events that would affect the less than 7-statute mile visibility rule for End-Of-Mission (EOM) Shuttle landing at KSC (Rule 4-64(A)). The Applied Meteorology Unit's (AMU's) work is to: develop a data base for study of fog associated weather conditions relating to violations of this landing constraint; develop forecast techniques or rules-of-thumb to determine whether or not current conditions are likely to result in an acceptable condition at landing; validate the forecast techniques; and transition techniques to operational use. As part of the analysis the fog events were categorized as either advection, pre-frontal or radiation. As a result of these analyses, the AMU developed a fog climatological data base, identified fog precursors and developed forecaster tools and decision trees. The fog climatological analysis indicates that during the fog season (October to April) there is a higher risk for a visibility violation at KSC during the early morning hours (0700 to 1200 UTC), while 95 percent of all fog events have dissipated by 1600 UTC. A high number of fog events are characterized by a westerly component to the surface wind at KSC (92 percent) and 83 percent of the fog events had fog develop west of KSC first (up to 2 hours). The AMU developed fog decision trees and forecaster tools that would help the forecaster identify fog precursors up to 12 hours in advance. Using the decision trees as process tools ensures the important meteorological data are not overlooked in the forecast process. With these tools and a better understanding of fog formation in the local KSC area, the Shuttle weather support forecaster should be able to give the Launch and Flight Directors a better KSC fog forecast with more confidence.

Effective follow-up consultations: the importance of patient-centered communication and shared decision making.

PubMed

Brand, Paul L P; Stiggelbout, Anne M

2013-12-01

Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice. Copyright © 2013 Elsevier Ltd. All rights reserved.

Earth Observations to Assess Impact of Hurricane Katrina on John C. Stennis Space Center

NASA Technical Reports Server (NTRS)

Graham, William D.; Ross, Kenton W.

2007-01-01

The peril from hurricanes to Space Operations Centers is real and is forecast to continue; Katrina, Rita, and Wilma of 2005 and Charley, Frances, Ivan, and Jeanne of 2004 are sufficient motivation for NASA to develop a multi-Center plan for preparedness and response. As was demonstrated at SSC (Stennis Space Center) in response to Hurricane Katrina, NASA Centers are efficiently activated as local command centers, playing host to Federal and State agencies and first responders to coordinate and provide evacuation, relocation, response, and recovery activities. Remote sensing decision support provides critical insight for managing NASA infrastructure and for assisting Center decision makers. Managers require geospatial information to manage the federal city. Immediately following Katrina, SSC s power and network connections were disabled, hardware was inoperative, technical staff was displaced and/or out of contact, and graphical decision support tools were non-existent or less than fully effective. Despite this circumstance, SSC EOC (Emergency Operations Center) implemented response operations to assess damage and to activate recovery plans. To assist Center Managers, the NASA ASP (Applied Sciences Program) made its archive of high-resolution data over the site available. In the weeks and months after the immediate crisis, NASA supplemented this data with high-resolution, post-Katrina imagery over SSC and much of the affected coastal areas. Much of the high-resolution imagery was made available through the Department of Defense Clear View contract and was distributed through U.S. Geological Survey Center for Earth Resources Observation and Science "Hurricane Katrina Disaster Response" Web site. By integrating multiple image data types with other information sources, ASP applied an all-source solutions approach to develop decision support tools that enabled managers to respond to critical issues, such as expedient access to infrastructure and deployment of resources, provision of temporary shelter, logistical control of critical supplies, and the mobilization and coordination of assets from ground crews to aircraft/airspace management. Furthermore, ASP developed information products that illustrate risks to SSC's infrastructure from surge, inundation, and flood. Current plans include developing wind-risk prototype products for refinement and adoption into EOC plans.

Using a voice-centered relational method of data analysis in a feminist study exploring the working world of nursing unit managers.

PubMed

Paliadelis, Penny; Cruickshank, Mary

2008-10-01

In this article, we discuss the application of a data analysis method used in a feminist study that explored the working world of nursing unit managers in Australia. The decision to use a voice-centered relational approach to the data was based on a desire to delve into the working world of nursing unit managers and uncover the layers within the narratives that specifically related to their perceptions of themselves, their world, and the context in which they work. Throughout this article, the focus is on how this method was applied to uncover multiple layers of meaning within the data, rather than on the researchers' and participants' roles in the coconstruction of interview data. An excerpt from an interview transcript is used to illustrate how the stories of the participants were explored using this method.

A qualitative analysis of how advanced practice nurses use clinical decision support systems.

PubMed

Weber, Scott

2007-12-01

The purpose of this study was to generate a grounded theory that will reflect the experiences of advanced practice nurses (APNs) working as critical care nurse practitioners (NPs) and clinical nurse specialists (CNS) with computer-based decision-making systems. A study design using grounded theory qualitative research methods and convenience sampling was employed in this study. Twenty-three APNs (13 CNS and 10 NPs) were recruited from 16 critical care units located in six large urban medical centers in the U.S. Midwest. Single-structured in-depth interviews with open-ended audio-taped questions were conducted with each APN. Through this process, APNs defined what they consider to be relevant themes and patterns of clinical decision system use in their critical care practices, and they identified the interrelatedness of the conceptual categories that emerged from the results. Data were analyzed using the constant comparative analysis method of qualitative research. APN participants were predominantly female, white/non-Hispanic, had a history of access to the clinical decision system used in their critical care settings for an average of 14 months, and had attended a formal training program to learn how to use clinical decision systems. "Forecasting decision outcomes," which was defined as the voluntary process employed to forecast the outcomes of patient care decisions in critical care prior to actual decision making, was the core variable describing system use that emerged from the responses. This variable consisted of four user constructs or components: (a) users' perceptions of their initial system learning experience, (b) users' sense of how well they understand how system technology works, (c) users' understanding of how system inferences are created or derived, and (d) users' relative trust of system-derived data. Each of these categories was further described through the grounded theory research process, and the relationships between the categories were identified. The findings of this study suggest that the main reason critical care APNs choose to integrate clinical decision systems into their practices is to provide an objective, scientifically derived, technology-based backup for human forecasting of the outcomes of patient care decisions prior to their actual decision making. Implications for nursing, health care, and technology research are presented.

Do neonatologists limit parental decision-making authority? A Canadian perspective.

PubMed

Albersheim, Susan G; Lavoie, Pascal M; Keidar, Yaron D

2010-12-01

According to the principles of family-centered care, fully informed parents and health care professionals are partners in the care of sick neonates. The aim of this study was to assess the attitudes of Canadian neonatologists towards the authority of parents to make life-and-death decisions for their babies. We interviewed 121 (74%) of the 164 practicing neonatologists in Canada (June 2004-March 2005), using scripted open-ended questions and common clinical scenarios. Data analysis employed interpretive description methodology. The main outcome measure was the intention of neonatologists to limit parental life-and-death decision-making authority, when they disagree with parental decisions. Neonatologists' self-rated respect for parental decision-making authority was 8/10. Most neonatologists thought that parents should be either primary decision-makers or part of the decision-making team. Fifty-six percent of neonatologists would limit parental decision-making authority if the parents' decision is not in the baby's "best interest". In response to common neonatal severe illness scenarios, up to 18% of neonatologists said they would limit parental decision-making, even if the chance of intact survival is very poor. For clinical scenarios with equally poor long-term outcomes, neonatologists were more likely to comply with parental wishes early in the life of a baby, particularly with documented brain injury. Canadian neonatologists espouse high regard for parental decision-making authority, but are prepared to limit parental authority if the parents' decision is not thought to be in the baby's best interest. Although neonatologists advise parents that treatment can be started at birth, and stopped later, this was only for early severe brain injury. Copyright © 2010 Elsevier Ltd. All rights reserved.

The impact of decision aids to enhance shared decision making for diabetes (the DAD study): protocol of a cluster randomized trial.

PubMed

LeBlanc, Annie; Ruud, Kari L; Branda, Megan E; Tiedje, Kristina; Boehmer, Kasey R; Pencille, Laurie J; Van Houten, Holly; Matthews, Marc; Shah, Nilay D; May, Carl R; Yawn, Barbara P; Montori, Victor M

2012-05-28

Shared decision making contributes to high quality healthcare by promoting a patient-centered approach. Patient involvement in selecting the components of a diabetes medication program that best match the patient's values and preferences may also enhance medication adherence and improve outcomes. Decision aids are tools designed to involve patients in shared decision making, but their adoption in practice has been limited. In this study, we propose to obtain a preliminary estimate of the impact of patient decision aids vs. usual care on measures of patient involvement in decision making, diabetes care processes, medication adherence, glycemic and cardiovascular risk factor control, and resource utilization. In addition, we propose to identify, describe, and explain factors that promote or inhibit the routine embedding of decision aids in practice. We will be conducting a mixed-methods study comprised of a cluster-randomized, practical, multicentered trial enrolling clinicians and their patients (n = 240) with type 2 diabetes from rural and suburban primary care practices (n = 8), with an embedded qualitative study to examine factors that influence the incorporation of decision aids into routine practice. The intervention will consist of the use of a decision aid (Statin Choice and Aspirin Choice, or Diabetes Medication Choice) during the clinical encounter. The qualitative study will include analysis of video recordings of clinical encounters and in-depth, semi-structured interviews with participating patients, clinicians, and clinic support staff, in both trial arms. Upon completion of this trial, we will have new knowledge about the effectiveness of diabetes decision aids in these practices. We will also better understand the factors that promote or inhibit the successful implementation and normalization of medication choice decision aids in the care of chronic patients in primary care practices. NCT00388050.

An Interoperable, Agricultural Information System Based on Satellite Remote Sensing Data

NASA Technical Reports Server (NTRS)

Teng, William; Chiu, Long; Doraiswamy, Paul; Kempler, Steven; Liu, Zhong; Pham, Long; Rui, Hualan

2005-01-01

Monitoring global agricultural crop conditions during the growing season and estimating potential seasonal production are critically important for market development of US. agricultural products and for global food security. The Goddard Space Flight Center Earth Sciences Data and Information Services Center Distributed Active Archive Center (GES DISC DAAC) is developing an Agricultural Information System (AIS), evolved from an existing TRMM Online Visualization and Analysis System (TOVAS), which will operationally provide satellite remote sensing data products (e.g., rainfall) and services. The data products will include crop condition and yield prediction maps, generated from a crop growth model with satellite data inputs, in collaboration with the USDA Agricultural Research Service. The AIS will enable the remote, interoperable access to distributed data, by using the GrADS-DODS Server (GDS) and by being compliant with Open GIS Consortium standards. Users will be able to download individual files, perform interactive online analysis, as well as receive operational data flows. AIS outputs will be integrated into existing operational decision support systems for global crop monitoring, such as those of the USDA Foreign Agricultural Service and the U.N. World Food Program.

Faults Discovery By Using Mined Data

NASA Technical Reports Server (NTRS)

Lee, Charles

2005-01-01

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

Ground and Range Operations for a Heavy-Lift Vehicle: Preliminary Thoughts

NASA Technical Reports Server (NTRS)

Rabelo, Luis; Zhu, Yanshen; Compton, Jeppie; Bardina, Jorge

2011-01-01

This paper discusses the ground and range operations for a Shuttle derived Heavy-Lift Vehicle being launched from the Kennedy Space Center on the Eastern range. Comparisons will be made between the Shuttle and a heavy lift configuration (SLS-ETF MPCV April 2011) by contrasting their subsystems. The analysis will also describe a simulation configuration with the potential to be utilized for heavy lift vehicle processing/range simulation modeling and the development of decision-making systems utilized by the range. In addition, a simple simulation model is used to provide the required critical thinking foundations for this preliminary analysis.

Tactical Decision Aids High Bandwidth Links Using Autonomous Vehicles

DTIC Science & Technology

2004-01-01

1 Tactical Decision Aids (High Bandwidth Links Using Autonomous Vehicles ) A. J. Healey, D. P. Horner, Center for Autonomous Underwater Vehicle...SUBTITLE Tactical Decision Aids (High Bandwidth Links Using Autonomous Vehicles ) 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Promoting Maintenance and Generalization through Cognitive Decision Making Training

ERIC Educational Resources Information Center

Fore, Cecil, III; Riser, Susan E.

2005-01-01

This article investigates issues in the areas of work outcomes, self-determination, career decision-making skills, person centered planning, and transitional planning for students with disabilities. In particular, training in cognitive decision-making is suggested for students with mild disabilities. Educators and schools are charged with…

Supporting Informed Decision Making - Center for Research Strategy

Cancer.gov

CRS conducts portfolio analyses and collects data on scientific topics, funding mechanisms, and investigator characteristics to help NCI leadership make data-driven decisions about the scientific research enterprise.

Intelligent data analysis: the best approach for chronic heart failure (CHF) follow up management.

PubMed

Mohammadzadeh, Niloofar; Safdari, Reza; Baraani, Alireza; Mohammadzadeh, Farshid

2014-08-01

Intelligent data analysis has ability to prepare and present complex relations between symptoms and diseases, medical and treatment consequences and definitely has significant role in improving follow-up management of chronic heart failure (CHF) patients, increasing speed ​​and accuracy in diagnosis and treatments; reducing costs, designing and implementation of clinical guidelines. The aim of this article is to describe intelligent data analysis methods in order to improve patient monitoring in follow and treatment of chronic heart failure patients as the best approach for CHF follow up management. Minimum data set (MDS) requirements for monitoring and follow up of CHF patient designed in checklist with six main parts. All CHF patients that discharged in 2013 from Tehran heart center have been selected. The MDS for monitoring CHF patient status were collected during 5 months in three different times of follow up. Gathered data was imported in RAPIDMINER 5 software. Modeling was based on decision trees methods such as C4.5, CHAID, ID3 and k-Nearest Neighbors algorithm (K-NN) with k=1. Final analysis was based on voting method. Decision trees and K-NN evaluate according to Cross-Validation. Creating and using standard terminologies and databases consistent with these terminologies help to meet the challenges related to data collection from various places and data application in intelligent data analysis. It should be noted that intelligent analysis of health data and intelligent system can never replace cardiologists. It can only act as a helpful tool for the cardiologist's decisions making.

[Giving up life in the labyrinth].

PubMed

Portera Sánchez, A

2001-01-01

A brief historic survey of the labyrinth, from prehistoric images carved in stone, to gardens, Renaissance drawings and architectonic constructions will presented. The metaphor of the labyrinths, which began with Theseus killing the Minotaur with the help of Ariadne, can be applied to all: scientific investigation, artistic creation, wickedness, theology ... to life. In these eculiar and chaotic designs, structural simplicity and functional complexity coincide and therefore may produce repeated erroneous decisions. To wander successfully through these labyrinths, caution and repeated decision-makings are required to enable the traveller to reach the desired and elusive center. In each instant, decisions are made in our mind as a consequence of complex cerebral systems, activated by stimuli which originate in the intimate regions of the mind, the most complex labyrinth of all. These types of mental labyrinths are immaterial, without paths or walks, where each successive decision made facing multiple bifurcations, causes the mental traveller to advance until reaching the center. This center deceptively becomes the entrance to another of the innumerable and unknown mental labyrinths that the intimate life proposes.

The Voice of the Patient Methodology: A Novel Mixed-Methods Approach to Identifying Treatment Goals for Men with Prostate Cancer.

PubMed

Saigal, Christopher S; Lambrechts, Sylvia I; Seenu Srinivasan, V; Dahan, Ely

2017-06-01

Many guidelines advocate the use of shared decision making for men with newly diagnosed prostate cancer. Decision aids can facilitate the process of shared decision making. Implicit in this approach is the idea that physicians understand which elements of treatment matter to patients. Little formal work exists to guide physicians or developers of decision aids in identifying these attributes. We use a mixed-methods technique adapted from marketing science, the 'Voice of the Patient', to describe and identify treatment elements of value for men with localized prostate cancer. We conducted semi-structured interviews with 30 men treated for prostate cancer in the urology clinic of the West Los Angeles Veteran Affairs Medical Center. We used a qualitative analysis to generate themes in patient narratives, and a quantitative approach, agglomerative hierarchical clustering, to identify attributes of treatment that were most relevant to patients making decisions about prostate cancer. We identified five 'traditional' prostate cancer treatment attributes: sexual dysfunction, bowel problems, urinary problems, lifespan, and others' opinions. We further identified two novel treatment attributes: a treatment's ability to validate a sense of proactivity and the need for an incision (separate from risks of surgery). Application of a successful marketing technique, the 'Voice of the Customer', in a clinical setting elicits non-obvious attributes that highlight unique patient decision-making concerns. Use of this method in the development of decision aids may result in more effective decision support.

Mapping analysis and planning system for the John F. Kennedy Space Center

NASA Technical Reports Server (NTRS)

Hall, C. R.; Barkaszi, M. J.; Provancha, M. J.; Reddick, N. A.; Hinkle, C. R.; Engel, B. A.; Summerfield, B. R.

1994-01-01

Environmental management, impact assessment, research and monitoring are multidisciplinary activities which are ideally suited to incorporate a multi-media approach to environmental problem solving. Geographic information systems (GIS), simulation models, neural networks and expert-system software are some of the advancing technologies being used for data management, query, analysis and display. At the 140,000 acre John F. Kennedy Space Center, the Advanced Software Technology group has been supporting development and implementation of a program that integrates these and other rapidly evolving hardware and software capabilities into a comprehensive Mapping, Analysis and Planning System (MAPS) based in a workstation/local are network environment. An expert-system shell is being developed to link the various databases to guide users through the numerous stages of a facility siting and environmental assessment. The expert-system shell approach is appealing for its ease of data access by management-level decision makers while maintaining the involvement of the data specialists. This, as well as increased efficiency and accuracy in data analysis and report preparation, can benefit any organization involved in natural resources management.

Starting a sleep center.

PubMed

Epstein, Lawrence J; Valentine, Paul S

2010-05-01

The demand for sleep medicine services has grown tremendously during the last decade and will likely continue. To date, growth in demand has been met by growth in the number of new sleep centers. The need for more new centers will be dependent on market drivers that include increasing regulatory requirements, personnel shortages, integration of home sleep testing, changes in reimbursement, a shift in emphasis from diagnostics to treatment, and an increased consumer focus on sleep. The decision to open a new center should be based on understanding the market dynamics, completing a market analysis, and developing a business plan. The business plan should include an overview of the facility, a personnel and organizational structure, an evaluation of the business environment, a financial plan, a description of services provided, and a strategy for obtaining, managing, and extending a referral base. Implementation of the business plan and successful operation require ongoing planning and monitoring of operational parameters. The need for new sleep centers will likely continue, but the shifting market dynamics indicate a greater need for understanding the marketplace and careful planning.

Application of Fault Management Theory to the Quantitive Selection of a Launch Vehicle Abort Trigger Suite

NASA Technical Reports Server (NTRS)

Lo, Yunnhon; Johnson, Stephen B.; Breckenridge, Jonathan T.

2014-01-01

SHM/FM theory has been successfully applied to the selection of the baseline set Abort Triggers for the NASA SLS center dot Quantitative assessment played a useful role in the decision process ? M&FM, which is new within NASA MSFC, required the most "new" work, as this quantitative analysis had never been done before center dot Required development of the methodology and tool to mechanize the process center dot Established new relationships to the other groups ? The process is now an accepted part of the SLS design process, and will likely be applied to similar programs in the future at NASA MSFC ? Future improvements center dot Improve technical accuracy ?Differentiate crew survivability due to an abort, vs. survivability even no immediate abort occurs (small explosion with little debris) ?Account for contingent dependence of secondary triggers on primary triggers ?Allocate "? LOC Benefit" of each trigger when added to the previously selected triggers. center dot Reduce future costs through the development of a specialized tool ? Methodology can be applied to any manned/unmanned vehicle, in space or terrestrial

BA07PRO103: Modeling Warfighter Physical and Cognitive Performance While Wearing CB Protective Equipment: A Trade-Space Analysis Tool

DTIC Science & Technology

2012-10-31

Development and Engineering Center 15 Kansas St., Natick, MA 01760 Telephone: (508) 233-5597 Email : thaddeus.t.brunye.civ@mail.mil Submitted to: Mr...Salvatore Clementi 8725 John J. Kingman Road Stop 6201 Fort Belvoir, Virginia 22060-6201 Telephone: (703) 767-6275 Email : salvatore.clementi...detection, memory, attention/vigilance, and multitasking /decision-making. A non-linear dynamical systems approach was developed that described Soldier

Alternative Fuels Data Center: Telework

Science.gov Websites

for vehicle fleet managers and corporate decision makers to work with employees to conserve fuel . Telecommute Resources These resources can help corporate decision makers develop and support telework

Workshop: Community Based Environmental Decision Making, Proceedings of the Fifth Workshop in the Environmental Policy and Economics Workshop Series (2000)

EPA Pesticide Factsheets

Proceedings from a one-day workshop cosponsored by US EPA Office of Economy and Environment and National Center for Environmental Research and the National Science Foundation Decision, Risk,and Management Science Program on community-based decision making

Recent Church-State Litigation.

ERIC Educational Resources Information Center

Bryson, Joseph E.

After a brief synopsis of the 1974 legal activity centering on the church-state relationship, the speaker examines three particular cases: the United States Supreme Court decision in Wheeler v. Barrera, a Missouri district court decision in Luetkemeyer v. Kaufmann, and the Supreme Court decision in Franchise Tax Board of California v. United…

42 CFR 423.1092 - Revision of reopened decision.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Revision of reopened decision. 423.1092 Section 423.1092 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Civil Money Penalties § 423.1092 Revision of reopened decision. (a) Revision based on new evidence. If a...

Examining the Forces That Guide Teaching Decisions

ERIC Educational Resources Information Center

Griffith, Robin; Massey, Dixie; Atkinson, Terry S.

2013-01-01

This study of two successful first grade teachers examines the forces that guide their instructional decisions. Findings reveal the complexities of forces that influence the moment-to-moment decisions made by these teachers. Teachers repeatedly attempted to balance their desires to be student-centered while addressing state standards and…

77 FR 71776 - Ohio University, et al.; Notice of Consolidated Decision on Applications for Duty-Free Entry of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-04

... Consolidated Decision on Applications for Duty-Free Entry of Electron Microscope This is a decision... Stocker Center, Athens, OH 45701. Instrument: Electron Microscope. Manufacturer: JEOL Ltd., Japan... North Carolina Wilmington, 601 South College Road, Wilmington, NC 28403-5915. Instrument: Electron...

42 CFR 498.102 - Revision of reopened decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Revision of reopened decision. 498.102 Section 498.102 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... IN THE MEDICAID PROGRAM Reopening of Decisions Made by Administrative Law Judges or the Departmental...

42 CFR 426.560 - Effect of the Board's decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Effect of the Board's decision. 426.560 Section 426.560 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... Within 30 days, CMS implements the Board decision. Any change in policy is applied prospectively to...

42 CFR 426.560 - Effect of the Board's decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of the Board's decision. 426.560 Section 426.560 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES.... Within 30 days, CMS implements the Board decision. Any change in policy is applied prospectively to...

Exploring differences in the use of the statin choice decision aid and diabetes medication choice decision aid in primary care.

PubMed

Ballard, Aimee Yu; Kessler, Maya; Scheitel, Marianne; Montori, Victor M; Chaudhry, Rajeev

2017-08-10

Shared decision making is essential to patient centered care, but can be difficult for busy clinicians to implement into practice. Tools have been developed to aid in shared decision making and embedded in electronic medical records (EMRs) to facilitate use. This study was undertaken to explore the patterns of use and barriers and facilitators to use of two decision aids, the Statin Choice Decision Aid (SCDA) and the Diabetes Medication Choice Decision Aid (DMCDA), in primary care practices where the decision aids are embedded in the EMR. A survey exploring factors that influenced use of each decision aid was sent to eligible primary care clinicians affiliated with the Mayo Clinic in Rochester, MN. Survey data was collected and clinician use of each decision aid via links from the EMR was tracked. The survey response rate was 40% (105/262). Log file data indicated 51% of clinicians used the SCDA and 9% of clinicians used the DMCDA. Reasons for lack of use included lack of knowledge of the EMR link, not finding the decision aids helpful, and time constraints. Survey responses indicated that use of the tool as intended was low, with many clinicians only discussing decision aid topics that they found relevant. Although guidelines for both the treatment of blood cholesterol with a statin and for the treatment of hyperglycemia in type 2 diabetes recommend shared decision making, tools that facilitate shared decision making are not routinely used even when embedded in the EMR. Even when decision aids are used, their use may not reflect patient centered care.

No Further Action Decision Under CERCLA, Study Area 43B, Historic Gas Station Sites, Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

I U.S. Army EnvironmentalCenter NO FURTHER ACTION DECISION UNDER CERCLA * STUDY AREA 43B HISTORIC GAS STATION SITES U FORT DEVENS , MASSACHUSETTS I I... FORT DEVENS , MASSACHUSETTS I I i * Prepared for: U.S. Army Environmental Center Aberdeen Proving Ground, Maryland Contract DAAA15-91-0008 I Prepared...HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS TABLE OF CONTENTS Section Title Page No. EXECUTIVE SUMMARY

Superfund record of decision (EPA Region 3): Langley AFB/NASA Langley Center, Area E Warehouse Operable Unit, Hampton, VA, September 28, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents the selected remedial action for the Area E Warehouse Operable Unit (OU) at the NASA Langley Research Center (LaRC) in Hampton, Virginia (the Site). This actions addresses the principle threat at the OU by imposing land use restrictions that will prevent any non-industrial activities to take place on the OU.

Experiences in Bridging the Gap Between Science and Decision Making at NASAs GSFC Earth Sciences Data and Information Services Center (GES DISC)

NASA Astrophysics Data System (ADS)

Kempler, S.; Teng, W.; Friedl, L.; Lynnes, C.

2008-12-01

In recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet's natural environment, NASA has implemented the 'Decision Support Through Earth Science Research Results' program to solicit "proposals that develop and demonstrate innovative and practicable applications of NASA Earth science observations and research"that focus on improving decision making activities", as stated in the NASA ROSES-2008, A.18 solicitation. This very successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations in the areas of agriculture, air quality, disaster management, ecosystems, public health, water resources, and aviation weather. The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. Coupling this experience with the GES DISC's total understanding and vast experience regarding Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, the GES DISC is in the unique position to more readily identify challenges that come with bringing science data to decision makers. These challenges consist of those that can be met within typical science data usage frameworks, as well as those challenges that arise when utilizing science data for previously unplanned applications, such as decision support systems. The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding how decisions are made, which leads to the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that 'really' evaluate success will be exemplified.

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.

A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design

PubMed Central

Zheng, Hua; Rosal, Milagros C; Li, Wenjun; Borg, Amy; Yang, Wenyun; Ayers, David C

2018-01-01

Background Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants’ responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra “next page” click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients’ use. PMID:29712620

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.

Does Patient Preference Measurement in Decision Aids Improve Decisional Conflict? A Randomized Trial in Men with Prostate Cancer.

PubMed

Shirk, Joseph D; Crespi, Catherine M; Saucedo, Josemanuel D; Lambrechts, Sylvia; Dahan, Ely; Kaplan, Robert; Saigal, Christopher

2017-12-01

Shared decision making (SDM) has been advocated as an approach to medical decision making that can improve decisional quality. Decision aids are tools that facilitate SDM in the context of limited physician time; however, many decision aids do not incorporate preference measurement. We aim to understand whether adding preference measurement to a standard patient educational intervention improves decisional quality and is feasible in a busy clinical setting. Men with incident localized prostate cancer (n = 122) were recruited from the Greater Los Angeles Veterans Affairs (VA) Medical Center urology clinic, Olive View UCLA Medical Center, and Harbor UCLA Medical Center from January 2011 to May 2015 and randomized to education with a brochure about prostate cancer treatment or software-based preference assessment in addition to the brochure. Men undergoing preference assessment received a report detailing the relative strength of their preferences for treatment outcomes used in review with their doctor. Participants completed instruments measuring decisional conflict, knowledge, SDM, and patient satisfaction with care before and/or after their cancer consultation. Baseline knowledge scores were low (mean 62%). The baseline mean total score on the Decisional Conflict Scale was 2.3 (±0.9), signifying moderate decisional conflict. Men undergoing preference assessment had a significantly larger decrease in decisional conflict total score (p = 0.023) and the Perceived Effective Decision Making subscale (p = 0.003) post consult compared with those receiving education only. Improvements in satisfaction with care, SDM, and knowledge were similar between groups. Individual-level preference assessment is feasible in the clinic setting. Patients with prostate cancer who undergo preference assessment are more certain about their treatment decisions and report decreased levels of decisional conflict when making these decisions.

Introduction of the Tools for Economic Analysis of Patient Management Interventions in Heart Failure Costing Tool: a user-friendly spreadsheet program to estimate costs of providing patient-centered interventions.

PubMed

Reed, Shelby D; Li, Yanhong; Kamble, Shital; Polsky, Daniel; Graham, Felicia L; Bowers, Margaret T; Samsa, Gregory P; Paul, Sara; Schulman, Kevin A; Whellan, David J; Riegel, Barbara J

2012-01-01

Patient-centered health care interventions, such as heart failure disease management programs, are under increasing pressure to demonstrate good value. Variability in costing methods and assumptions in economic evaluations of such interventions limit the comparability of cost estimates across studies. Valid cost estimation is critical to conducting economic evaluations and for program budgeting and reimbursement negotiations. Using sound economic principles, we developed the Tools for Economic Analysis of Patient Management Interventions in Heart Failure (TEAM-HF) Costing Tool, a spreadsheet program that can be used by researchers and health care managers to systematically generate cost estimates for economic evaluations and to inform budgetary decisions. The tool guides users on data collection and cost assignment for associated personnel, facilities, equipment, supplies, patient incentives, miscellaneous items, and start-up activities. The tool generates estimates of total program costs, cost per patient, and cost per week and presents results using both standardized and customized unit costs for side-by-side comparisons. Results from pilot testing indicated that the tool was well-formatted, easy to use, and followed a logical order. Cost estimates of a 12-week exercise training program in patients with heart failure were generated with the costing tool and were found to be consistent with estimates published in a recent study. The TEAM-HF Costing Tool could prove to be a valuable resource for researchers and health care managers to generate comprehensive cost estimates of patient-centered interventions in heart failure or other conditions for conducting high-quality economic evaluations and making well-informed health care management decisions.

Mergers involving academic health centers: a formidable challenge.

PubMed

Pellegrini, V D

2001-10-01

Escalating economic pressures on the clinical enterprise threaten the missions of education and research in many of the most prestigious academic health centers. Following the model of industry, mergers of the healthcare delivery systems of teaching hospitals and clinics held promise for economies of scale and an improved operating margin. Failure to follow business principles in constructing the merged entity, differences in organizational governance and culture, and inability of physician leadership to prioritize, downsize, and consolidate clinical programs to optimize operational efficiencies all compromise the success of such mergers in academic medicine. Academic institutions and their respective governing boards need to exercise greater discipline in financial analysis and a willingness to make difficult decisions that show favor to one parent institution over another if mergers are to be effective in this setting. To date, an example of a vibrant and successful merger of academic health centers remains to be found.

A Comparison of a Machine Learning Model with EuroSCORE II in Predicting Mortality after Elective Cardiac Surgery: A Decision Curve Analysis

PubMed Central

Allyn, Jérôme; Allou, Nicolas; Augustin, Pascal; Philip, Ivan; Martinet, Olivier; Belghiti, Myriem; Provenchere, Sophie; Montravers, Philippe; Ferdynus, Cyril

2017-01-01

Background The benefits of cardiac surgery are sometimes difficult to predict and the decision to operate on a given individual is complex. Machine Learning and Decision Curve Analysis (DCA) are recent methods developed to create and evaluate prediction models. Methods and finding We conducted a retrospective cohort study using a prospective collected database from December 2005 to December 2012, from a cardiac surgical center at University Hospital. The different models of prediction of mortality in-hospital after elective cardiac surgery, including EuroSCORE II, a logistic regression model and a machine learning model, were compared by ROC and DCA. Of the 6,520 patients having elective cardiac surgery with cardiopulmonary bypass, 6.3% died. Mean age was 63.4 years old (standard deviation 14.4), and mean EuroSCORE II was 3.7 (4.8) %. The area under ROC curve (IC95%) for the machine learning model (0.795 (0.755–0.834)) was significantly higher than EuroSCORE II or the logistic regression model (respectively, 0.737 (0.691–0.783) and 0.742 (0.698–0.785), p < 0.0001). Decision Curve Analysis showed that the machine learning model, in this monocentric study, has a greater benefit whatever the probability threshold. Conclusions According to ROC and DCA, machine learning model is more accurate in predicting mortality after elective cardiac surgery than EuroSCORE II. These results confirm the use of machine learning methods in the field of medical prediction. PMID:28060903

Informing the design of clinical decision support services for evaluation of children with minor blunt head trauma in the emergency department: a sociotechnical analysis.

PubMed

Sheehan, Barbara; Nigrovic, Lise E; Dayan, Peter S; Kuppermann, Nathan; Ballard, Dustin W; Alessandrini, Evaline; Bajaj, Lalit; Goldberg, Howard; Hoffman, Jeffrey; Offerman, Steven R; Mark, Dustin G; Swietlik, Marguerite; Tham, Eric; Tzimenatos, Leah; Vinson, David R; Jones, Grant S; Bakken, Suzanne

2013-10-01

Integration of clinical decision support services (CDSS) into electronic health records (EHRs) may be integral to widespread dissemination and use of clinical prediction rules in the emergency department (ED). However, the best way to design such services to maximize their usefulness in such a complex setting is poorly understood. We conducted a multi-site cross-sectional qualitative study whose aim was to describe the sociotechnical environment in the ED to inform the design of a CDSS intervention to implement the Pediatric Emergency Care Applied Research Network (PECARN) clinical prediction rules for children with minor blunt head trauma. Informed by a sociotechnical model consisting of eight dimensions, we conducted focus groups, individual interviews and workflow observations in 11 EDs, of which 5 were located in academic medical centers and 6 were in community hospitals. A total of 126 ED clinicians, information technology specialists, and administrators participated. We clustered data into 19 categories of sociotechnical factors through a process of thematic analysis and subsequently organized the categories into a sociotechnical matrix consisting of three high-level sociotechnical dimensions (workflow and communication, organizational factors, human factors) and three themes (interdisciplinary assessment processes, clinical practices related to prediction rules, EHR as a decision support tool). Design challenges that emerged from the analysis included the need to use structured data fields to support data capture and re-use while maintaining efficient care processes, supporting interdisciplinary communication, and facilitating family-clinician interaction for decision-making. Copyright © 2013 Elsevier Inc. All rights reserved.

Percutaneous Trigger Finger Release: A Cost-effectiveness Analysis.

PubMed

Gancarczyk, Stephanie M; Jang, Eugene S; Swart, Eric P; Makhni, Eric C; Kadiyala, Rajendra Kumar

2016-07-01

Percutaneous trigger finger releases (TFRs) performed in the office setting are becoming more prevalent. This study compares the costs of in-hospital open TFRs, open TFRs performed in ambulatory surgical centers (ASCs), and in-office percutaneous releases. An expected-value decision-analysis model was constructed from the payer perspective to estimate total costs of the three competing treatment strategies for TFR. Model parameters were estimated based on the best available literature and were tested using multiway sensitivity analysis. Percutaneous TFR performed in the office and then, if needed, revised open TFR performed in the ASC, was the most cost-effective strategy, with an attributed cost of $603. The cost associated with an initial open TFR performed in the ASC was approximately 7% higher. Initial open TFR performed in the hospital was the least cost-effective, with an attributed cost nearly twice that of primary percutaneous TFR. An initial attempt at percutaneous TFR is more cost-effective than an open TFR. Currently, only about 5% of TFRs are performed in the office; therefore, a substantial opportunity exists for cost savings in the future. Decision model level II.

Development of a decision aid for cardiopulmonary resuscitation and invasive mechanical ventilation in the intensive care unit employing user-centered design and a wiki platform for rapid prototyping

PubMed Central

Witteman, Holly O.; LeBlanc, Annie; Kryworuchko, Jennifer; Heyland, Daren Keith; Ebell, Mark H.; Blair, Louisa; Tapp, Diane; Dupuis, Audrey; Lavoie-Bérard, Carole-Anne; McGinn, Carrie Anna; Légaré, France; Archambault, Patrick Michel

2018-01-01

Background Upon admission to an intensive care unit (ICU), all patients should discuss their goals of care and express their wishes concerning life-sustaining interventions (e.g., cardiopulmonary resuscitation (CPR)). Without such discussions, interventions that prolong life at the cost of decreasing its quality may be used without appropriate guidance from patients. Objectives To adapt an existing decision aid about CPR to create a wiki-based decision aid individually adapted to each patient’s risk factors; and to document the use of a wiki platform for this purpose. Methods We conducted three weeks of ethnographic observation in our ICU to observe intensivists and patients discussing goals of care and to identify their needs regarding decision making. We interviewed intensivists individually. Then we conducted three rounds of rapid prototyping involving 15 patients and 11 health professionals. We recorded and analyzed all discussions, interviews and comments, and collected sociodemographic data. Using a wiki, a website that allows multiple users to contribute or edit content, we adapted the decision aid accordingly and added the Good Outcome Following Attempted Resuscitation (GO-FAR) prediction rule calculator. Results We added discussion of invasive mechanical ventilation. The final decision aid comprises values clarification, risks and benefits of CPR and invasive mechanical ventilation, statistics about CPR, and a synthesis section. We added the GO-FAR prediction calculator as an online adjunct to the decision aid. Although three rounds of rapid prototyping simplified the information in the decision aid, 60% (n = 3/5) of the patients involved in the last cycle still did not understand its purpose. Conclusions Wikis and user-centered design can be used to adapt decision aids to users’ needs and local contexts. Our wiki platform allows other centers to adapt our tools, reducing duplication and accelerating scale-up. Physicians need training in shared decision making skills about goals of care and in using the decision aid. A video version of the decision aid could clarify its purpose. PMID:29447297

Alternative Fuels Data Center: Mass Transit

Science.gov Websites

traveled and fuel used by private vehicles. Vehicle fleet managers, corporate decision makers, and public effective incentives for fleet managers and corporate decision makers to build mass transit ridership

Alternative Fuels Data Center: Transportation System Efficiency

Science.gov Websites

energy use. Transportation planners and corporate decision makers can implement combinations of these corporate decision makers can help employees telework to conserve fuel. Maps & Data Average Annual Fuel

[Logistic and production process in a regional blood center: modeling and analysis].

PubMed

Baesler, Felipe; Martínez, Cristina; Yaksic, Eduardo; Herrera, Claudia

2011-09-01

The blood supply chain is a complex system that considers different interconnected elements that have to be synchronized correctly to satisfy in quality and quantity the final patient requirements. To determine the blood center maximum production capacity, as well as the determination of the necessary changes for a future production capacity expansion. This work was developed in the Blood Center of Concepción, Chile, operations management tools were applied to model it and to propose improvement alternatives for the production process. The use of simulation is highlighted, which permitted the replication of the center behavior and the evaluation of expansion alternatives. It is possible to absorb a 100% increment in blood demand, without making major changes or investments in the production process. Also it was possible to determine the subsequent steps in terms of investments in equipment and human resources for a future expansion of the center coverage. The techniques used to model the production process of the blood center of Concepción, Chile, allowed us to analyze how it operates, to detect "bottle necks", and to support the decision making process for a future expansion of its capacity.

Perspectives on Cybersecurity Information Sharing among Multiple Stakeholders Using a Decision-Theoretic Approach.

PubMed

He, Meilin; Devine, Laura; Zhuang, Jun

2018-02-01

The government, private sectors, and others users of the Internet are increasingly faced with the risk of cyber incidents. Damage to computer systems and theft of sensitive data caused by cyber attacks have the potential to result in lasting harm to entities under attack, or to society as a whole. The effects of cyber attacks are not always obvious, and detecting them is not a simple proposition. As the U.S. federal government believes that information sharing on cybersecurity issues among organizations is essential to safety, security, and resilience, the importance of trusted information exchange has been emphasized to support public and private decision making by encouraging the creation of the Information Sharing and Analysis Center (ISAC). Through a decision-theoretic approach, this article provides new perspectives on ISAC, and the advent of the new Information Sharing and Analysis Organizations (ISAOs), which are intended to provide similar benefits to organizations that cannot fit easily into the ISAC structure. To help understand the processes of information sharing against cyber threats, this article illustrates 15 representative information sharing structures between ISAC, government, and other participating entities, and provide discussions on the strategic interactions between different stakeholders. This article also identifies the costs of information sharing and information security borne by different parties in this public-private partnership both before and after cyber attacks, as well as the two main benefits. This article provides perspectives on the mechanism of information sharing and some detailed cost-benefit analysis. © 2017 Society for Risk Analysis.

Simpler ISS Flight Control Communications and Log Keeping via Social Tools and Techniques

NASA Technical Reports Server (NTRS)

Scott, David W.; Cowart, Hugh; Stevens, Dan

2012-01-01

The heart of flight operations control involves a) communicating effectively in real time with other controllers in the room and/or in remote locations and b) tracking significant events, decisions, and rationale to support the next set of decisions, provide a thorough shift handover, and troubleshoot/improve operations. International Space Station (ISS) flight controllers speak with each other via multiple voice circuits or loops, each with a particular purpose and constituency. Controllers monitor and/or respond to several loops concurrently. The primary tracking tools are console logs, typically kept by a single operator and not visible to others in real-time. Information from telemetry, commanding, and planning systems also plays into decision-making. Email is very secondary/tertiary due to timing and archival considerations. Voice communications and log entries supporting ISS operations have increased by orders of magnitude because the number of control centers, flight crew, and payload operations have grown. This paper explores three developmental ground system concepts under development at Johnson Space Center s (JSC) Mission Control Center Houston (MCC-H) and Marshall Space Flight Center s (MSFC) Payload Operations Integration Center (POIC). These concepts could reduce ISS control center voice traffic and console logging yet increase the efficiency and effectiveness of both. The goal of this paper is to kindle further discussion, exploration, and tool development.

Integrating primary care with occupational health services: a success story.

PubMed

Griffith, Karen; Strasser, Patricia B

2010-12-01

This article describes the process used by a large U.S. manufacturing company to successfully integrate full-service primary care centers at two locations. The company believed that by providing employees with health promotion and disease prevention services, including screening, early diagnosis, and uncomplicated illness treatment, its health care costs could be significantly reduced while saving employees money. To accurately demonstrate the cost-effectiveness of adding primary care to existing occupational health services, a thorough financial analysis projected the return on investment (ROI) of the program. Decisions were made about center size, the scope of services, and staffing. A critical part of the ROI analysis involved evaluating employee health claim data to identify the actual cost of health care services for each center and the projected costs if the services were provided on-site. The pilot initiative included constructing two on-site health center facilities staffed with primary care physicians, nurse practitioners, physical therapists, and other health care professionals. Key outcome metrics from the pilot clinics exceeded goals in three of four categories. In addition, clinic use after 12 months far exceeded benchmarks for similar clinics. Most importantly, the pilot clinics were operating with a positive cash flow within the first year and demonstrated an increasingly positive ROI. Copyright 2010, SLACK Incorporated.

Analysis of Convective Weather Impact on Pre-Departure Routing of Flights from Fort Worth Center to New York Center

NASA Technical Reports Server (NTRS)

Arneson, Heather; Bombelli, Alessandro; Segarra-Torne, Adria; Tse, Elmer

2017-01-01

In response to severe weather conditions, Traffic Managers specify flow constraints and reroutes to route air traffic around affected regions of airspace. Providing analysis and recommendations of available reroute options and associated airspace capacities would assist Traffic Managers in making more efficient decisions in response to convective weather. These recommendations can be developed by examining historical data to determine which previous reroute options were used in similar weather and traffic conditions. This paper describes the initial steps and methodology used towards this goal. The focus of this work is flights departing from Fort Worth Center destined for New York Center. Dominant routing structures used in the absence of convective weather are identified. A method to extract relevant features from the large volume of weather data available to quantify the impact of convective weather on this routing structure over a given time range is presented. Finally, a method of estimating flow rate capacity along commonly used routes during convective weather events is described. Results show that the flow rates drop exponentially as a function of the values of the proposed feature and that convective weather on the final third of the route was found to have a greater impact on the flow rate restriction than other portions of the route.

A Person-Centered Approach to Financial Capacity Assessment: Preliminary Development of a New Rating Scale

PubMed Central

Lichtenberg, Peter A.; Stoltman, Jonathan; Ficker, Lisa J.; Iris, Madelyn; Mast, Benjamin

2014-01-01

Financial exploitation and financial capacity issues often overlap when a gerontologist assesses whether an older adult’s financial decision is an autonomous, capable choice. Our goal is to describe a new conceptual model for assessing financial decisions using principles of person-centered approaches and to introduce a new instrument, the Lichtenberg Financial Decision Rating Scale (LFDRS). We created a conceptual model, convened meetings of experts from various disciplines to critique the model and provide input on content and structure, and select final items. We then videotaped administration of the LFDRS to five older adults and had 10 experts provide independent ratings. The LFDRS demonstrated good to excellent inter-rater agreement. The LFDRS is a new tool that allows gerontologists to systematically gather information about a specific financial decision and the decisional abilities in question. PMID:25866438

A Person-Centered Approach to Financial Capacity Assessment: Preliminary Development of a New Rating Scale.

PubMed

Lichtenberg, Peter A; Stoltman, Jonathan; Ficker, Lisa J; Iris, Madelyn; Mast, Benjamin

2015-01-01

Financial exploitation and financial capacity issues often overlap when a gerontologist assesses whether an older adult's financial decision is an autonomous, capable choice. Our goal is to describe a new conceptual model for assessing financial decisions using principles of person-centered approaches and to introduce a new instrument, the Lichtenberg Financial Decision Rating Scale (LFDRS). We created a conceptual model, convened meetings of experts from various disciplines to critique the model and provide input on content and structure, and select final items. We then videotaped administration of the LFDRS to five older adults and had 10 experts provide independent ratings. The LFDRS demonstrated good to excellent inter-rater agreement. The LFDRS is a new tool that allows gerontologists to systematically gather information about a specific financial decision and the decisional abilities in question.

Accounting for treatment by center interaction in sample size determinations and the use of surrogate outcomes in the pessary for the prevention of preterm birth trial: a simulation study.

PubMed

Willan, Andrew R

2016-07-05

The Pessary for the Prevention of Preterm Birth Study (PS3) is an international, multicenter, randomized clinical trial designed to examine the effectiveness of the Arabin pessary in preventing preterm birth in pregnant women with a short cervix. During the design of the study two methodological issues regarding power and sample size were raised. Since treatment in the Standard Arm will vary between centers, it is anticipated that so too will the probability of preterm birth in that arm. This will likely result in a treatment by center interaction, and the issue of how this will affect the sample size requirements was raised. The sample size requirements to examine the effect of the pessary on the baby's clinical outcome was prohibitively high, so the second issue is how best to examine the effect on clinical outcome. The approaches taken to address these issues are presented. Simulation and sensitivity analysis were used to address the sample size issue. The probability of preterm birth in the Standard Arm was assumed to vary between centers following a Beta distribution with a mean of 0.3 and a coefficient of variation of 0.3. To address the second issue a Bayesian decision model is proposed that combines the information regarding the between-treatment difference in the probability of preterm birth from PS3 with the data from the Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study that relate preterm birth and perinatal mortality/morbidity. The approach provides a between-treatment comparison with respect to the probability of a bad clinical outcome. The performance of the approach was assessed using simulation and sensitivity analysis. Accounting for a possible treatment by center interaction increased the sample size from 540 to 700 patients per arm for the base case. The sample size requirements increase with the coefficient of variation and decrease with the number of centers. Under the same assumptions used for determining the sample size requirements, the simulated mean probability that pessary reduces the risk of perinatal mortality/morbidity is 0.98. The simulated mean decreased with coefficient of variation and increased with the number of clinical sites. Employing simulation and sensitivity analysis is a useful approach for determining sample size requirements while accounting for the additional uncertainty due to a treatment by center interaction. Using a surrogate outcome in conjunction with a Bayesian decision model is an efficient way to compare important clinical outcomes in a randomized clinical trial in situations where the direct approach requires a prohibitively high sample size.

Virtual Small Business Emergency Operations Center (VSBEOC): Shared Awareness and Decision Making for Small Business

DTIC Science & Technology

2011-06-01

Shared Awareness and Decision Making for Small Business Topic(s) 2. Topic 1: Concepts, Theory , and Policy 1. Topic 5: Collaboration, Shared...emergencies do not have the time or the resources to collaborate on a continual basis with a large number of organizations. 3. A primary Crisis Management...Center (CMC) should be identified in advance. This is the initial site used by the Crisis Management Team and Response Teams for directing and

No Further Action Decision Under CERCLA Study Area 43N Historic Gas Station Sites Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

SITES FORT DEVENS , MASSACHUSETTS CONTRACT DAAA15-91-0008 U.S. ARMY ENVIRONMENTAL CENTER ABERDEEN PROVING GROUND, MARYLAND JANUARY 1995 PRINTED ON...HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS I . Prepared for: U.S. Army Environmental Center Aberdeen Proving Ground, Maryland Contract DAAA15-91...DECISION UNDER CERCLA STUDY AREA 43N HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS 3 TABLE OF CONTENTS U Section Title Page No. EXECUTIVE SUMMARY

No Further Action Decision Under CERCLA Study 43R Historic Gas Station Sites Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

in accordance with the same. E Date RAC Environmental Coordinator m U.S. ENVIRONMENTAL PROTECTION AGENCY JAMES P. BYRý% Date Fort Devens Remedial...CERCLA STUDY AREA 43R HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS CONTRACT DAAA15-91-D-0008 U.S. ARMY ENVIRONMENTAL CENTER ABERDEEN PROVING...ACTION DECISION UNDER CERCLA STUDY AREA 43R HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS I * Prepared for: U.S. Army Environmental Center

Outcome based state budget allocation for diabetes prevention programs using multi-criteria optimization with robust weights.

PubMed

Mehrotra, Sanjay; Kim, Kibaek

2011-12-01

We consider the problem of outcomes based budget allocations to chronic disease prevention programs across the United States (US) to achieve greater geographical healthcare equity. We use Diabetes Prevention and Control Programs (DPCP) by the Center for Disease Control and Prevention (CDC) as an example. We present a multi-criteria robust weighted sum model for such multi-criteria decision making in a group decision setting. The principal component analysis and an inverse linear programming techniques are presented and used to study the actual 2009 budget allocation by CDC. Our results show that the CDC budget allocation process for the DPCPs is not likely model based. In our empirical study, the relative weights for different prevalence and comorbidity factors and the corresponding budgets obtained under different weight regions are discussed. Parametric analysis suggests that money should be allocated to states to promote diabetes education and to increase patient-healthcare provider interactions to reduce disparity across the US.

42 CFR 423.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Notice and effect of revised decision. 423.1094 Section 423.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Procedures for Civil Money Penalties § 423.1094 Notice and effect of revised decision. (a) Notice. The notice...

42 CFR 423.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Notice and effect of revised decision. 423.1094 Section 423.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Civil Money Penalties § 423.1094 Notice and effect of revised decision. (a) Notice. The notice mailed to...

42 CFR 423.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Notice and effect of revised decision. 423.1094 Section 423.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Civil Money Penalties § 423.1094 Notice and effect of revised decision. (a) Notice. The notice mailed to...

42 CFR 423.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Notice and effect of revised decision. 423.1094 Section 423.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Procedures for Civil Money Penalties § 423.1094 Notice and effect of revised decision. (a) Notice. The notice...

42 CFR 423.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Notice and effect of revised decision. 423.1094 Section 423.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Procedures for Civil Money Penalties § 423.1094 Notice and effect of revised decision. (a) Notice. The notice...

42 CFR 426.460 - Effect of an ALJ's decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of an ALJ's decision. 426.460 Section 426.460 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... decision within 30 days. Any change in policy applies prospectively to requests for service or claims filed...

42 CFR 426.460 - Effect of an ALJ's decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Effect of an ALJ's decision. 426.460 Section 426.460 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... decision within 30 days. Any change in policy applies prospectively to requests for service or claims filed...

Towards a systems approach to risk considerations for concurrent design

NASA Technical Reports Server (NTRS)

Meshkat, Leila; Oberto, Robert E.

2004-01-01

This paper describes the new process used by the Project Design Center at NASA's Jet Propulsion Laboratory for the identification, assessment and communication of risk elements throughout the lifecycle of a mission design. This process includes a software tool, 'RAP' that collects and communicates risk information between the various designers and a 'risk expert' who mediates this process. The establishment of this process is an attempt towards the systematic consideration of risk in the design decision making process. Using this process, we are able to better keep track of the risks associated with the design decisions. Furthermore, it helps us develop better risk profiles for the studies under consideration. We aim to refine and expand the current process to enable more thorough risk analysis capabilities in the future.

Cost-Effectiveness Analysis of Health Care Waste Treatment Facilities in Iran Hospitals; a Provider Perspective

PubMed Central

RASHIDIAN, Arash; ALINIA, Cyrus; MAJDZADEH, Reza

2015-01-01

Background: Our aim was to make right and informative decision about choosing the most cost-effectiveness heterogeneous infectious waste treatment methods and devices. Methods: In this descriptive study, decision tree analysis, with 10-yr time horizon in bottom-up approach was used to estimate the costs and effectiveness criteria of the employed devices at provider perspective in Iranian hospitals. We used the one-way and scenario sensitivity analysis to measure the effects of variables with uncertainty. The resources of data were national Environmental and Occupational Health Center Survey (EOHCS) in 2012, field observation and completing questionnaire by relevant authorities in mentioned centers. Results: Devices called Saray 2, Autoclave based, and Newster 10, Hydroclave based, with 92032.4 (±12005) and 6786322.9 (±826453) Dollars had the lowest and highest costs respectively in studied time period and given the 5–10% discount rate. Depending on effectiveness factor type, Newster 10 with Ecodas products and Saray products respectively had the highest and lowest effectiveness. In most considered scenarios, Caspian-Alborz device was the most cost-effectiveness alternative, so for the treatment of each adjusted unit of volume and weight of infectious waste in a 10 year period and in different conditions, between 39.4 (±5.1) to 915 (±111.4) dollars must be spent. Conclusion: The findings indicate the inefficiency and waste of resources, so in order to efficient resource allocation and to encourage further cost containment in infectious waste management we introduce policy recommendation that be taken in three levels. PMID:25905078

Vista goes online: Decision-analytic systems for real-time decision-making in mission control

NASA Technical Reports Server (NTRS)

Barry, Matthew; Horvitz, Eric; Ruokangas, Corinne; Srinivas, Sampath

1994-01-01

The Vista project has centered on the use of decision-theoretic approaches for managing the display of critical information relevant to real-time operations decisions. The Vista-I project originally developed a prototype of these approaches for managing flight control displays in the Space Shuttle Mission Control Center (MCC). The follow-on Vista-II project integrated these approaches in a workstation program which currently is being certified for use in the MCC. To our knowledge, this will be the first application of automated decision-theoretic reasoning techniques for real-time spacecraft operations. We shall describe the development and capabilities of the Vista-II system, and provide an overview of the use of decision-theoretic reasoning techniques to the problems of managing the complexity of flight controller displays. We discuss the relevance of the Vista techniques within the MCC decision-making environment, focusing on the problems of detecting and diagnosing spacecraft electromechanical subsystems component failures with limited information, and the problem of determining what control actions should be taken in high-stakes, time-critical situations in response to a diagnosis performed under uncertainty. Finally, we shall outline our current research directions for follow-on projects.

Cost Benefit of Comprehensive Primary and Preventive School-Based Health Care.

PubMed

Padula, William V; Connor, Katherine A; Mueller, Josiah M; Hong, Jonathan C; Velazquez, Gabriela Calderon; Johnson, Sara B

2018-01-01

The Rales Health Center is a comprehensive school-based health center at an urban elementary/middle school. Rales Health Center provides a full range of pediatric services using an enriched staffing model consisting of pediatrician, nurse practitioner, registered nurses, and medical office assistant. This staffing model provides greater care but costs more than traditional school-based health centers staffed by part-time nurses. The objective was to analyze the cost benefit of Rales Health Center enhanced staffing model compared with a traditional school-based health center (standard care), focusing on asthma care, which is among the most prevalent chronic conditions of childhood. In 2016, cost-benefit analysis using a decision tree determined the net social benefit of Rales Health Center compared with standard care from the U.S. societal perspective based on the 2015-2016 academic year. It was assumed that Rales Health Center could handle greater patient throughput related to asthma, decreased prescription costs, reduced parental resources in terms of missed work time, and improved student attendance. Univariate and multivariate probabilistic sensitivity analyses were conducted. The expected cost to operate Rales Health Center was $409,120, compared with standard care cost of $172,643. Total monetized incremental benefits of Rales Health Center were estimated to be $993,414. The expected net social benefit for Rales Health Center was $756,937, which demonstrated substantial societal benefit at a return of $4.20 for every dollar invested. This net social benefit estimate was robust to sensitivity analyses. Despite the greater cost associated with the Rales Health Center's enhanced staffing model, the results of this analysis highlight the cost benefit of providing comprehensive, high-quality pediatric care in schools, particularly schools with a large proportion of underserved students. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Neuropsychological Markers of Suicidal Risk in the Context of Medical Rehabilitation.

PubMed

Pustilnik, Alexandra; Elkana, Odelia; Vatine, Jean-Jacques; Franko, Motty; Hamdan, Sami

2017-01-01

While great strides have been made to advance the understanding of the neurobiology of suicidal behavior (SB), the neural and neuropsychological mechanisms associated with SB are not well understood. The purpose of the current study is to identify neurocognitive markers of SB in the context of medical rehabilitation. The performances of 39 patients at a medical rehabilitation center, aged 21-78, were examined on a series of neurocognitive executive tasks-decision-making (Iowa Gambling Task - IGT), mental flexibility (WCST), response inhibition (SST) and working memory (digit span). Self-report questionnaires were administered, for Suicidal behaviors, depression, Anxiety, and PTSD as well as perceived social support. Suicidal participants performed more poorly on the IGT. A mediation analysis presented a significant direct effect of decision making on suicidal risk (p < 0.14) as well as significant indirect effect of decision making on suicidal risk that was mediated by the depressive symptoms (95% BCa CI [-0.15, -0.018]) with a medium effect size (κ 2  = 0.20, 95% BCa CI [0.067, 0.381]). Despite the complexity of relationship between decision-making and suicidal risk, these results suggest that clinicians should routinely assess decision-making abilities in adults at risk for suicide due to the fact that impaired decision-making may increase suicidal risk above and beyond that conferred by depression.

Preferences for autonomy in end-of-life decision making in modern Korean society.

PubMed

Kim, Su Hyun

2015-03-01

The demand for autonomy in medical decision making is increasing among Korean people, but it is not well known why some people prefer autonomy in decision making but others do not. The aim of this study was to determine the extent to which Korean adults wished to exercise autonomy in the process of decision making regarding end-of-life treatment and to determine whether economic issues and family functioning, in particular, were associated with preferences for participation in decision making in Korean people. This study was a cross-sectional correlational study using a survey. Data were collected using structured questionnaires from 354 patients or their families who visited ambulatory departments at two general hospitals in South Korea, recruited by the proportionate quota sampling method. Data analysis was performed using multinomial logistic regression analyses. The study was approved by the hospitals' directors and the ethics committee of Kyungpook National University Hospital. Written informed consent was given by all participants. A majority of Korean people wanted to make autonomous decisions regarding treatment at the end of life. Preferences for autonomous decision making regarding end-of-life treatment, rather than relying on family, showed a significant increase in association with poor family functioning and low income. Results of this study suggested the necessity for development of alternatives to a dominant traditional "family-centered" approach in Korean people, in order to enhance end-of-life decision making for people who wish to take an active role in the decision-making process. Healthcare providers need to examine not only patients' preferred decision-making style but also any reasons for their choice, in particular, family conflict and financial burden. © The Author(s) 2014.

Patterns of out-of-home placement decision-making in child welfare.

PubMed

Chor, Ka Ho Brian; McClelland, Gary M; Weiner, Dana A; Jordan, Neil; Lyons, John S

2013-10-01

Out-of-home placement decision-making in child welfare is founded on the best interest of the child in the least restrictive setting. After a child is removed from home, however, little is known about the mechanism of placement decision-making. This study aims to systematically examine the patterns of out-of-home placement decisions made in a state's child welfare system by comparing two models of placement decision-making: a multidisciplinary team decision-making model and a clinically based decision support algorithm. Based on records of 7816 placement decisions representing 6096 children over a 4-year period, hierarchical log-linear modeling characterized concordance or agreement, and discordance or disagreement when comparing the two models and accounting for age-appropriate placement options. Children aged below 16 had an overall concordance rate of 55.7%, most apparent in the least restrictive (20.4%) and the most restrictive placement (18.4%). Older youth showed greater discordant distributions (62.9%). Log-linear analysis confirmed the overall robustness of concordance (odd ratios [ORs] range: 2.9-442.0), though discordance was most evident from small deviations from the decision support algorithm, such as one-level under-placement in group home (OR=5.3) and one-level over-placement in residential treatment center (OR=4.8). Concordance should be further explored using child-level clinical and placement stability outcomes. Discordance might be explained by dynamic factors such as availability of placements, caregiver preferences, or policy changes and could be justified by positive child-level outcomes. Empirical placement decision-making is critical to a child's journey in child welfare and should be continuously improved to effect positive child welfare outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Peer-Led Decision Support Intervention Improves Decision Outcomes in Black Women with Breast Cancer

PubMed Central

Wallington, Sherrie F.; Willey, Shawna C.; Hampton, Regina M.; Lucas, W.; Jennings, Y.; Horton, S.; Muzeck, N.; Cocilovo, C.; Isaacs, C.

2013-01-01

Previous reports suggest that Black breast cancer patients receive less patient-centered cancer care than their White counterparts. Interventions to improve patient-centered care (PCC) in Black breast cancer patients are lacking. Seventy-six women with histologically confirmed breast cancer were recruited from the Washington, DC area. After a baseline telephone interview, women received an in-person decision support educational session led by a trained survivor coach. The coach used a culturally appropriate guidebook and decision-making model—TALK Back!© A follow-up assessment assessed participants’ acceptability of the intervention and intermediate outcomes. After the intervention, participants reported increased: self-efficacy in communicating with providers (70 %) and self-efficacy in making treatment decisions (70 %). Compared to baseline scores, post-intervention communication with providers significantly increased (p=.000). This is the first outcome report of an intervention to facilitate PCC in Black breast cancer patients. Testing this intervention using RCTs or similar designs will be important next steps. PMID:23576067

Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings

PubMed Central

Kuntz, Jennifer L.; Safford, Monika M.; Singh, Jasvinder A.; Phansalkar, Shobha; Slight, Sarah P.; Her, Qoua Liang; Lapointe, Nancy Allen; Mathews, Robin; O’Brien, Emily; Brinkman, William B.; Hommel, Kevin; Farmer, Kevin C.; Klinger, Elissa; Maniam, Nivethietha; Sobko, Heather J.; Bailey, Stacy C.; Cho, Insook; Rumptz, Maureen H.; Vandermeer, Meredith L.; Hornbrook, Mark C.

2018-01-01

Objective Patient-centered approaches to improving medication adherence hold promise, but evidence of their effectiveness is unclear. This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains: shared decision-making, methods to enhance effective prescribing, systems for eliciting and acting on patient feedback about medication use and treatment goals, and medication-taking behavior. Methods We reviewed literature on interventions that fell into these domains and were published between January 2007 and May 2013. Two reviewers abstracted information and categorized studies by intervention type. Results We identified 60 studies, of which 40% focused on patient education. Other intervention types included augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. Medication adherence was an outcome in most (70%) of the studies, although 50% also examined patient-centered outcomes. Conclusions We identified a large number of medication management interventions that incorporated patient-centered care and improved patient outcomes. We were unable to determine whether these interventions are more effective than traditional medication adherence interventions. Practice Implications Additional research is needed to identify effective and feasible approaches to incorporate patient-centeredness into the medication management processes of the current health care system, if appropriate. PMID:25264309

Systems Design and Pilot Operation of a Regional Center for Technical Processing for the Libraries of the New England State Universities. NELINET, New England Library Information Network. Progress Report, July 1, 1967 - March 30, 1968, Volume II, Appendices.

ERIC Educational Resources Information Center

Agenbroad, James E.; And Others

Included in this volume of appendices to LI 000 979 are acquisitions flow charts; a current operations questionnaire; an algorithm for splitting the Library of Congress call number; analysis of the Machine-Readable Cataloging (MARC II) format; production problems and decisions; operating procedures for information transmittal in the New England…

Annual Faculty Research Report of the Department of Systems Engineering and the Operations Research Center for the Academic Year 2006

DTIC Science & Technology

2006-10-01

Senior Investigators: COL Darrall Henderson, Ph.D. LTC Simon R. Goerger, Ph.D. Points of Contact: NAME ADDRESS PHONE OTHER LTC Eric R. Keller...revision. Non-Refereed Publications LTC Tim Trainor*, Dr. Greg Parnell*, LTC Brigitte Kwinn*, MAJ John Brence*, CPT Eric Tollefson*, Ms. Robin Burk*, MAJ...Parnell, Brigitte Kwinn, John Brence, Eric Tollefson, Pat Downes. The US Army Uses Decision Analysis in Designing Its US Installation Regions

The Internet and Care Initiation by People Living with HIV

PubMed Central

Perazzo, Joseph; Haas, Stephen; Webel, Allison; Voss, Joachim

2017-01-01

Over the past 20 years, people increasingly use the Internet to obtain information, including information about health. Yet, we lack understanding of how people living with HIV (PLHIV) use the Internet in their care and treatment decisions. Interviews with 23 individuals who initiated HIV care at an urban, Midwestern medical center were analyzed to explore how they used the Internet during the process of initiating HIV care. The time frame of initiation of HIV care ranged from less than one month to a delay of three years post-diagnosis. Qualitative content analysis was conducted and revealed that the participants discussed the Internet as a source of information about their diagnosis that influenced their care and treatment decisions. Five predominate themes emerged: 1) The Internet Alerted me to the Possibility of HIV, 2) The Internet Showed me a Solution is Available, 3) The Internet Influenced my Decisions about Care, 4) The Internet Empowered me to Participate in my Treatment Decisions, and 5) The Internet Gave me Hope for my Future. The results suggest that the Internet has the potential to provide information that can profoundly influence PLHIVs acceptance of care and treatment decisions. Clinicians face a new reality in which patients use Internet resources to obtain information and shape opinions about HIV treatment and care initiation decision-making. Guiding PLHIV in their selection of online resources needs to be adopted as one approach to educating and empowering individuals as they cope with their diagnosis and contemplate decisions regarding HIV care and treatment. PMID:27686871

U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?

PubMed Central

Bustamante, Arturo Vargas

2016-01-01

For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization. PMID:27694684

Why doesn't a family member of a person with advanced dementia use a substituted judgment when making a decision for that person?

PubMed

Hirschman, Karen B; Kapo, Jennifer M; Karlawish, Jason H T

2006-08-01

The objective of this study was to identify what standard of decision making a family member uses when making medical decisions for their relative with advanced dementia. Thirty family members of patients with advanced dementia from an Alzheimer disease center and a suburban long-term care facility were interviewed using a semistructured interview. All interviews were audiotaped, transcribed, and analyzed using qualitative data analysis techniques. Family members were split almost evenly in the standard they used when making medical decisions for their relative: substituted judgment (43%) or best interests (57%). However, few who used the substituted judgment standard viewed it as distinct from best interests. Instead, both standards were taken into consideration when making medical decisions. In addition to not having discussions about healthcare preferences, the reasons for not using a substituted judgment included: the need for family consensus, unrealistic expectations of the patient, the need to incorporate their relative's quality of life into the decision, and the influence of healthcare professionals. Family members who did not have discussions about healthcare preferences identified various barriers to the discussion, including waiting too long, avoiding the topic, and the patient's denial of dementia. These data suggest several reasons why surrogate decision-makers for persons with advanced dementia do not use the substituted judgment standard and the potential value of interventions that would allow patients with early-stage dementia and their family members to discuss healthcare preferences.

Critical care physicians’ approaches to negotiating with surrogate decision makers: a qualitative study

PubMed Central

Brush, David R.; Brown, Crystal E.; Alexander, G. Caleb

2013-01-01

Objective To describe how critical care physicians manage conflicts with surrogates about withdrawing or withholding patients’ life support. Design Qualitative analysis of key informant interviews with critical care physicians during 2010. We transcribed interviews verbatim and used grounded theory to code and revise a taxonomy of themes and to identify illustrative quotes. Setting 3 academic medical centers, 1 academic-affiliated medical center and 4 private practice groups or private hospitals in a large Midwestern city Subjects 14 critical care physicians Measurements and main results Physicians reported tailoring their approach to address specific reasons for disagreement with surrogates. Five common approaches were identified: (1) building trust, (2) educating and informing, (3) providing surrogates more time, (4) adjusting surrogate and physician roles, and (5) highlighting specific values. When mistrust was an issue, physicians endeavored to build a more trusting relationship with the surrogate before re-addressing decision making. Physicians also reported correcting misunderstandings by providing targeted education, and some reported highlighting specific patient, surrogate, or physician values that they hoped would guide surrogates to agree with them. When surrogates struggled with decision making roles, physicians attempted to reinforce the concept of substituted judgment. Physicians noted that some surrogates needed time to “come to terms” with the patent’s illness before agreeing with physicians. Many physicians had witnessed colleagues negotiate in ways they found objectionable, such as providing misleading information, injecting their own values into the negotiation, or behaving unprofessionally towards surrogates. While some physicians viewed their efforts to encourage surrogates’ agreement as persuasive, others strongly denied persuading surrogates and described their actions as “guiding” or “negotiating.” Conclusions Physicians reported using a tailored approach to resolve decisional conflicts about life support; and attempted to change surrogates’ decisions in accordance with what the physician thought was in the patients’ best interests. While physicians acknowledged their efforts to change surrogate’s decisions, many physicians did not perceive these as persuasive. PMID:22080645

Engineering Technical Support Center (ETSC)

EPA Pesticide Factsheets

ETSC is EPA’s technical support and resource centers responsible for providing specialized scientific and engineering support to decision-makers in the Agency’s ten regional offices, states, communities, and local businesses.

The contribution of multidimensional spatial analysis to a waste management policy: implementation of the ELECTRE method for characterizing transfer centers in the region of Oran

NASA Astrophysics Data System (ADS)

Saidi, A.; Trache, M. A.; Khelfi, M. F.

2016-08-01

The social and economic activity steadily growing in our cities creates a significant waste production in constantly evolving. The management of this waste is problematic because it is the center of many issues and interests. Indeed, any action or decision to the collection, transportation, treatment and disposal of waste should be considered in the economic, social, political and especially environmental aspect. A global Geomatic solution requires implementing a GIS with powerful multidimensional spatial analysis tools that support really waste management problem. Algeria has adopted a solution of waste landfill for all urban cities. In the Oran region, it exists three Centers Controlled landfill (CET) which the most important is that of Hassi-Bounif. This center currently meeting the needs of the region is unsustainable solution at the long-term because of its rapid saturation and its geographic location, which is still far from city centers (20-30 km) implying a negative impact on the vehicle park collecting such frequent breakdowns, the rapid degradation, slow delivery time and especially the high cost of the maintenance operation. This phenomenon is aggravated by the absence of real and actual initiatives targeting the recycling and recovery of waste, which makes the CET an endpoint for all types of waste. We present in this study, the use of the ELECTRE method (Multicriteria Analysis) integrated into a GIS to characterize the impact of the implementation of transfers centers at Oran region. The results of this study will accentuate the advantages of the activation of waste warehouse closer to the city, and relieving considerably the volume of transfer towards CET. The objective of our presentation is to show the leading role of the new Geomatics tools and the multidimensional spatial analysis in the apprehension of an environmental problem such the waste management and more generally in the urban management.

Characteristics of service requests and service processes of fire and rescue service dispatch centers: analysis of real world data and the underlying probability distributions.

PubMed

Krueger, Ute; Schimmelpfeng, Katja

2013-03-01

A sufficient staffing level in fire and rescue dispatch centers is crucial for saving lives. Therefore, it is important to estimate the expected workload properly. For this purpose, we analyzed whether a dispatch center can be considered as a call center. Current call center publications very often model call arrivals as a non-homogeneous Poisson process. This bases on the underlying assumption of the caller's independent decision to call or not to call. In case of an emergency, however, there are often calls from more than one person reporting the same incident and thus, these calls are not independent. Therefore, this paper focuses on the dependency of calls in a fire and rescue dispatch center. We analyzed and evaluated several distributions in this setting. Results are illustrated using real-world data collected from a typical German dispatch center in Cottbus ("Leitstelle Lausitz"). We identified the Pólya distribution as being superior to the Poisson distribution in describing the call arrival rate and the Weibull distribution to be more suitable than the exponential distribution for interarrival times and service times. However, the commonly used distributions offer acceptable approximations. This is important for estimating a sufficient staffing level in practice using, e.g., the Erlang-C model.

Neurostimulation options for failed back surgery syndrome: The need for rational and objective measurements. Proposal of an international clinical network using an integrated database and health economic analysis: the PROBACK network.

PubMed

Rigoard, P; Slavin, K

2015-03-01

In the context of failed back surgery syndrome (FBSS) treatment, the current practice in neurostimulation varies from center-to-center and most clinical decisions are based on an individual diagnosis. Neurostimulation evaluation tools and pain relief assessment are of major concern, as they now constitute one of the main biases of clinical trials. Moreover, the proliferation of technological devices, in a fertile and unsatisfied market, fosters and only furthers the confusion. There are three options available to apply scientific debates to our daily neurostimulation practice: intentional ignorance, standardized evidence-based practice or alternative data mining approach. In view of the impossibility of conducting multiple randomized clinical trials comparing various devices, one by one, the proposed concept would be to redefine the indications and the respective roles of the various spinal cord and peripheral nerve stimulation devices with large-scale computational modeling/data mining approach, by conducting a multicenter prospective database registry, supported by a clinician's global network called "PROBACK". We chose to specifically analyze 6 parameters: device coverage performance/coverage selectivity/persistence of the long-term electrical response (technical criteria) and comparative mapping of patient pain relief/persistence of the long-term clinical response/safety and complications occurrence (clinical criteria). Two types of analysis will be performed: immediate analysis (including cost analysis) and computational analysis, i.e. demonstration of the robustness of certain correlations of variables, in order to extract response predictors. By creating an international prospective database, the purpose of the PROBACK project was to set up a process of extraction and comparative analysis of data derived from the selection, implantation and follow-up of FBSS patients candidates for implanted neurostimulation. This evaluation strategy should help to change the opinions of each implanter and each health system towards a more rational decision-making approach subtended by mathematical reality. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

No Further Action Decision Under CERCLA Study Area 43Q Historic Gas Station Sites Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

the same. ,J ES C. CHAMBERS Date RAC Environmental Coordinator I U.S. ENVIRONMENTAL PROTECTION AGENCY -t JAMES P. BYR4 Date3 Fort Devens Refiedial...CERCLA STUDY AREA 43Q HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS , CONTRACT DAAA15-91-D-0008 U.S. ARMY ENVIRONMENTAL CENTER ABERDEEN PROVING...ACTION DECISION UNDER CERCLA STUDY AREA 43Q HISTORIC GAS STATION SITES 5 FORT DEVENS , MASSACHUSETTS V a I i Prepared for: U.S. Army Environmental Center

No Further Action Decision Under CERCLA Study Area 43K Historic Gas Station Sites Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

with the same. AMES C. CHAMBERS Date RAC Environmental Coordinator U.S. ENVIRONMENTAL PROTECTION AGENCY JAMES P. BYRNE Date Fort Devens l(emedial...STATION SITES FORT DEVENS , MASSACHUSETTS CONTRACT DAAA15-91-D-0008 U.S. ARMY ENVIRONMENTAL CENTER ABERDEEN PROVING GROUND, MARYLAND JANUARY 1995 PRINTED ON...Distribution Unlimited U.S. ArmyEnvironmentalCenter NO FURTHER ACTION DECISION UNDER CERCLA STUDY AREA 43K HISTORIC GAS STATION SITES FORT DEVENS ,9

No Further Action Decision Under CERCLA Study Area 43L Historic Gas Station Sites Fort Devens, Massachusetts

DTIC Science & Technology

1995-01-01

AES C. CHAMBERS Date RAC Environmental Coordinator U.S. ENVIRONMENTAL PROTECTION AGENCY JAMES P. BY/NE ) Date Fort Devens Remedial Project Manager...CERCLA STUDY AREA 43L HISTORIC GAS STATION SITES FORT DEVENS , MASSACHUSETTS CONTRACT DAAA15-91-D-0008 U.S. ARMY ENVIRONMENTAL CENTER ABERDEEN PROVING...DECISION UNDER CERCLA STUDY AREA 43L HISTORIC GAS STATION SITES ! FORT DEVENS , MASSACHUSETTS I I I 5 Prepared for: U.S. Army Environmental Center I

A peer review process as part of the implementation of clinical pathways in radiation oncology: Does it improve compliance?

PubMed

Gebhardt, Brian J; Heron, Dwight E; Beriwal, Sushil

Clinical pathways are patient management plans that standardize evidence-based practices to ensure high-quality and cost-effective medical care. Implementation of a pathway is a collaborative process in our network, requiring the active involvement of physicians. This approach promotes acceptance of pathway recommendations, although a peer review process is necessary to ensure compliance and to capture and approve off-pathway selections. We investigated the peer review process and factors associated with time to completion of peer review. Our cancer center implemented radiation oncology pathways for every disease site throughout a large, integrated network. Recommendations are written based upon national guidelines, published literature, and institutional experience with evidence evaluated hierarchically in order of efficacy, toxicity, and then cost. Physicians enter decisions into an online, menu-driven decision support tool that integrates with medical records. Data were collected from the support tool and included the rate of on- and off-pathway selections, peer review decisions performed by disease site directors, and time to complete peer review. A total of 6965 treatment decisions were entered in 2015, and 605 (8.7%) were made off-pathway and were subject to peer review. The median time to peer review decision was 2 days (interquartile range, 0.2-6.8). Factors associated with time to peer review decision >48 hours on univariate analysis include disease site (P < .0001) with a trend toward significance (P = .066) for radiation therapy modality. There was no difference between recurrent and non-recurrent disease (P = .267). Multivariable analysis revealed disease site was associated with time to peer review (P < .001), with lymphoma and skin/sarcoma most strongly influencing decision time >48 hours. Clinical pathways are an integral tool for standardizing evidence-based care throughout our large, integrated network, with 91.3% of all treatment decisions being made as per pathway. The peer review process was feasible, with <1% selections ultimately rejected, suggesting that awareness of peer review of treatment decisions encourages compliance with clinical pathway recommendations. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Implications of Contingency Planning Support for Weather and Icing Information

NASA Technical Reports Server (NTRS)

Vigeant-Langlois, Laurence; Hansman, R. John, Jr.

2003-01-01

A human-centered systems analysis was applied to the adverse aircraft weather encounter problem in order to identify desirable functions of weather and icing information. The importance of contingency planning was identified as emerging from a system safety design methodology as well as from results of other aviation decision-making studies. The relationship between contingency planning support and information on regions clear of adverse weather was investigated in a scenario- based analysis. A rapid prototype example of the key elements in the depiction of icing conditions was developed in a case study, and the implications for the components of the icing information system were articulated.

Statistical innovations in the medical device world sparked by the FDA.

PubMed

Campbell, Gregory; Yue, Lilly Q

2016-01-01

The world of medical devices while highly diverse is extremely innovative, and this facilitates the adoption of innovative statistical techniques. Statisticians in the Center for Devices and Radiological Health (CDRH) at the Food and Drug Administration (FDA) have provided leadership in implementing statistical innovations. The innovations discussed include: the incorporation of Bayesian methods in clinical trials, adaptive designs, the use and development of propensity score methodology in the design and analysis of non-randomized observational studies, the use of tipping-point analysis for missing data, techniques for diagnostic test evaluation, bridging studies for companion diagnostic tests, quantitative benefit-risk decisions, and patient preference studies.

A prospective cohort study of treatment decision-making for prostate cancer following participation in a multidisciplinary clinic.

PubMed

Hurwitz, Lauren M; Cullen, Jennifer; Elsamanoudi, Sally; Kim, Daniel J; Hudak, Jane; Colston, Maryellen; Travis, Judith; Kuo, Huai-Ching; Porter, Christopher R; Rosner, Inger L

2016-05-01

Patients diagnosed with prostate cancer (PCa) are presented with several treatment options of similar efficacy but varying side effects. Understanding how and why patients make their treatment decisions, as well as the effect of treatment choice on long-term outcomes, is critical to ensuring effective, patient-centered care. This study examined treatment decision-making in a racially diverse, equal-access, contemporary cohort of patients with PCa counseled on treatment options at a multidisciplinary clinic. A prospective cohort study was initiated at the Walter Reed National Military Medical Center (formerly Walter Reed Army Medical Center) in 2006. Newly diagnosed patients with PCa were enrolled before attending a multidisciplinary clinic. Patients completed surveys preclinic and postclinic to assess treatment preferences, reasons for treatment choice, and decisional regret. As of January 2014, 925 patients with PCa enrolled in this study. Surgery (54%), external radiation (20%), and active surveillance (12%) were the most common primary treatments for patients with low- and intermediate-risk PCa, whereas patients with high-risk PCa chose surgery (34%) or external radiation with neoadjuvant hormones (57%). Treatment choice differed by age at diagnosis, race, comorbidity status, and calendar year in both univariable and multivariable analyses. Patients preferred to play an active role in the decision-making process and cited doctors at the clinic as the most helpful source of treatment-related information. Almost all patients reported satisfaction with their decision. This is one of the first prospective cohort studies to examine treatment decision-making in an equal-access, multidisciplinary clinic setting. Studies of this cohort would aid in understanding and improving the PCa decision-making process. Published by Elsevier Inc.

The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.

PubMed

Grudzen, Corita R; Anderson, Jana R; Carpenter, Christopher R; Hess, Erik P

2016-12-01

Shared decision making in emergency medicine has the potential to improve the quality, safety, and outcomes of emergency department (ED) patients. Given that the ED is the gateway to care for patients with a variety of illnesses and injuries and the safety net for patients otherwise unable to access care, shared decision making in the ED is relevant to numerous disciplines and the interests of the United States (U.S.) public. On May 10, 2016 the 16th annual Academic Emergency Medicine (AEM) consensus conference, "Shared Decision Making: Development of a Policy-Relevant Patient-Centered Research Agenda" was held in New Orleans, Louisiana. During this one-day conference clinicians, researchers, policy-makers, patient and caregiver representatives, funding agency representatives, trainees, and content experts across many areas of medicine interacted to define high priority areas for research in 1 of 6 domains: 1) diagnostic testing; 2) policy, 3) dissemination/implementation and education, 4) development and testing of shared decision making approaches and tools in practice, 5) palliative care and geriatrics, and 6) vulnerable populations and limited health literacy. This manuscript describes the current state of shared decision making in the ED context, provides an overview of the conference planning process, the aims of the conference, the focus of each respective breakout session, the roles of patient and caregiver representatives and an overview of the conference agenda. The results of this conference published in this issue of AEM provide an essential summary of the future research priorities for shared decision making to increase quality of care and patient-centered outcomes. © 2016 by the Society for Academic Emergency Medicine.

"Paying the price to get there": Motherhood and the dynamics of pregnancy deliberations among women with disabilities.

PubMed

LaPierre, Tracey A; Zimmerman, Mary K; Hall, Jean P

2017-07-01

Women with disabilities report fewer pregnancies than those without disabilities. To explore the range of factors involved in pregnancy decision-making among women with disabilities, and give insight into the decision making process. Data were obtained from 4 focus groups conducted with 22 women of child-bearing age, who had a chronic physical or mental health condition or disability that influenced their pregnancy decisions. Group transcripts were analyzed using conventional content analysis to identify the types of factors that influence pregnancy decisions and themes related to pregnancy decision-making. Most had a strong desire for motherhood, although there were varied decisions and some ambivalence over whether or not to attempt pregnancy. Decisions were influenced by an interplay of biomedical, social and personal factors that shaped assessments of three key areas of consideration: importance, feasibility, and costs of pregnancy/motherhood. It is not just the 'biomedical facts' of health conditions that are relevant, but rather the meaning attributed to these facts and how they are weighed in relation to other significant non-medical factors. By moving beyond the medical model of disability to recognize the importance of social and personal factors, and engaging in patient-centered communication, healthcare providers can facilitate pregnancy decision-making that is consistent with the values and preferences of women with disabilities and improve quality of care and support. In order to make motherhood a more viable option for women with disabilities, societal attitudes and a lack of role models for these women also need to be addressed. Copyright © 2017 Elsevier Inc. All rights reserved.

Gender Differences in Bladder Cancer Treatment Decision Making.

PubMed

Pozzar, Rachel A; Berry, Donna L

2017-03-01

To explore gender differences in bladder cancer treatment decision making.
. Secondary qualitative analysis of interview transcripts.
. One multidisciplinary genitourinary oncology clinic (Dana-Farber Cancer Institute) and two urology clinics (Brigham and Women's Hospital and Beth Israel Deaconess Medical Center) in Boston, MA.
. As part of the original study, 45 men and 15 women with bladder cancer participated in individual interviews. Participants were primarily Caucasian, and most had at least some college education.
. Word frequency reports were used to identify thematic differences between the men's and women's statements. Line-by-line coding of constructs prevalent among women was then performed on all participants in NVivo 9. Coding results were compared between genders using matrix coding queries.
. The role of family in the decision-making process was found to be a dominant theme for women but not for men. Women primarily described family members as facilitators of bladder cancer treatment-related decisions, but men were more likely to describe family in a nonsupportive role.
. The results suggest that influences on the decision-making process are different for men and women with bladder cancer. Family may play a particularly important role for women faced with bladder cancer treatment-related decisions.
. Clinical nurses who care for individuals with bladder cancer should routinely assess patients' support systems and desired level of family participation in decision making. For some people with bladder cancer, family may serve as a stressor. Nurses should support the decision-making processes of all patients and be familiar with resources that can provide support to patients who do not receive it from family.

Caregivers’ perspectives on decision making about lung transplantation in cystic fibrosis

PubMed Central

Dellon, Elisabeth P.; Shores, Mitchell D.; Nelson, Katherine I.; Wolfe, Joanne; Noah, Terry L.; Hanson, Laura C.

2013-01-01

Context Lung transplantation extends survival for some patients with advanced cystic fibrosis, but it is complicated, has many potential risks, and its outcomes are difficult to predict. No standards exist for informed decision making about transplantation. Objective To assess decision making from the perspective of caregivers of patients who faced the transplant decision before dying of cystic fibrosis or transplant complications. Design Semistructured interviews with descriptive and qualitative content analysis. Participants Twenty-eight caregivers of patients with cystic fibrosis who received care at our center and died between 1996 and 2006. Results Of 28 patients who considered lung transplantation, 19 (68%) received transplants, 6 (21%) died while waiting for transplant, and 3 (11%) declined transplant. Three caregivers (11%) thought that the patient did not fully understand the reason for transplant referral. Five (18%) thought that the patient did not fully understand potential risks. Ten (36%) thought that alternatives were not fully understood. The only alternatives to transplant identified, progressive illness and the possibility of earlier death without transplant, were unacceptable to most. Thirteen caregivers (46%) reported that the patient thought that declining transplant was not an option. Caregivers described the decision as “easy” for 19 (68%), often expressing a sentiment of “do or die.” Those who described the decision as “easy” recalled fewer elements of informed decision making. Conclusions From caregivers’ reports, patients with cystic fibrosis may not fully understand risks of and alternatives to lung transplantation. Because a strong desire to prolong life necessitates honest communication about potential outcomes, interventions are needed to facilitate high-quality decision making. PMID:20050454

Measuring Command Post Operations in a Decisive Action Training Environment

DTIC Science & Technology

2017-05-01

Research Report 2001 Measuring Command Post Operations in a Decisive Action Training Environment Michelle N...September 2014 - September 2015 4. TITLE AND SUBTITLE Measuring Command Post Operations in a Decisive Action Training Environment 5a...Readiness Training Center Warrior Leadership Council, we explored whether a guide on Command Post (CP) Operations could improve performance during

Decision Support Systems Project. Design Review Conference, October 14-15, 1984. Summary Report of Findings.

ERIC Educational Resources Information Center

Tetlow, William L.

Findings of a conference that reviewed and evaluated design decisions concerning the Decision Support System (DSS) Demonstrator are summarized. The DSS Demonstrator was designed by the National Center for Higher Education Management Systems as an example of the way in which microcomputer technology can support and make more effective planning and…

Data Decision-Making and Program-Wide Implementation of the Pyramid Model. Roadmap to Effective Intervention Practices #7

ERIC Educational Resources Information Center

Fox, Lise; Veguilla, Myrna; Perez Binder, Denise

2014-01-01

The Technical Assistance Center on Social Emotional Intervention for Young Children (TACSEI) Roadmap on "Data Decision-Making and Program-Wide Implementation of the Pyramid Model" provides programs with guidance on how to collect and use data to ensure the implementation of the Pyramid Model with fidelity and decision-making that…

Aid-Assisted Decision-Making and Colorectal Cancer Screening

PubMed Central

Schroy, Paul C.; Emmons, Karen M.; Peters, Ellen; Glick, Julie T.; Robinson, Patricia A.; Lydotes, Maria A.; Mylvaganam, Shamini R.; Coe, Alison M.; Chen, Clara A.; Chaisson, Christine E.; Pignone, Michael P.; Prout, Marianne N.; Davidson, Peter K.; Heeren, Timothy C.

2014-01-01

Background Shared decision-making (SDM) is a widely recommended yet unproven strategy for increasing colorectal cancer (CRC) screening uptake. Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results. Purpose To assess the impact of decision aid–assisted SDM on CRC screening uptake. Design RCT. Setting/participants The study was conducted at an urban, academic safety-net hospital and community health center between 2005 and 2010. Participants were asymptomatic, average-risk patients aged 50–75 years due for CRC screening. Intervention Study participants (n=825) were randomized to one of two intervention arms (decision aid plus personalized risk assessment or decision aid alone) or control arm. The interventions took place just prior to a routine office visit with their primary care providers. Main outcome measures The primary outcome was completion of a CRC screening test within 12 months of the study visit. Logistic regression was used to identify predictors of test completion and mediators of the intervention effect. Analysis was completed in 2011. Results Patients in the decision-aid group were more likely to complete a screening test than control patients (43.1% vs 34.8%; p=0.046) within 12 months of the study visit; conversely, test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar (43.1% vs 37.1%; p=0.15). Assignment to the decision-aid arm (AOR 1.48; 95% CI=1.04, 2.10), black race (AOR 1.52, 95% CI=1.12, 2.06) and a preference for a patient-dominant decisionmaking approach (AOR, 1.55; 95% CI=1.02, 2.35) were independent determinants of test completion. Activation of the screening discussion and enhanced screening intentions mediated the intervention effect. Conclusions Decision aid–assisted SDM has a modest impact on CRC screening uptake. A decision aid plus personalized risk assessment tool is no more effective than a decision aid alone. PMID:23159252

Balance Sheets Versus Decision Dashboards to Support Patient Treatment Choices: A Comparative Analysis.

PubMed

Dolan, James G; Veazie, Peter J

2015-12-01

Growing recognition of the importance of involving patients in preference-driven healthcare decisions has highlighted the need to develop practical strategies to implement patient-centered shared decision-making. The use of tabular balance sheets to support clinical decision-making is well established. More recent evidence suggests that graphic, interactive decision dashboards can help people derive deeper a understanding of information within a specific decision context. We therefore conducted a non-randomized trial comparing the effects of adding an interactive dashboard to a static tabular balance sheet on patient decision-making. The study population consisted of members of the ResearchMatch registry who volunteered to participate in a study of medical decision-making. Two separate surveys were conducted: one in the control group and one in the intervention group. All participants were instructed to imagine they were newly diagnosed with a chronic illness and were asked to choose between three hypothetical drug treatments, which varied with regard to effectiveness, side effects, and out-of-pocket cost. Both groups made an initial treatment choice after reviewing a balance sheet. After a brief "washout" period, members of the control group made a second treatment choice after reviewing the balance sheet again, while intervention group members made a second treatment choice after reviewing an interactive decision dashboard containing the same information. After both choices, participants rated their degree of confidence in their choice on a 1 to 10 scale. Members of the dashboard intervention group were more likely to change their choice of preferred drug (10.2 versus 7.5%; p = 0.054) and had a larger increase in decision confidence than the control group (0.67 versus 0.075; p < 0.03). There were no statistically significant between-group differences in decisional conflict or decision aid acceptability. These findings suggest that clinical decision dashboards may be an effective point-of-care decision-support tool. Further research to explore this possibility is warranted.

Developing Evidence to Inform Decisions about Effectiveness (DeCIDE) Network

Cancer.gov

The Developing Evidence to Inform Decisions about Effectiveness Network is a network of research centers that the Agency for Healthcare Research and Quality created to conduct practical studies about health care items and services.

Software Products

NASA Technical Reports Server (NTRS)

1993-01-01

MAST is a decision support system to help in the management of dairy herds. Data is collected on dairy herds around the country and processed at regional centers. One center is Cornell University, where Dr. Lawrence Jones and his team developed MAST. The system draws conclusions from the data and summarizes it graphically. CLIPS, which is embedded in MAST, gives the system the ability to make decisions without user interaction. With this technique, dairy managers can identify herd problems quickly, resulting in improved animal health and higher milk quality. CLIPS (C Language Integrated Production System) was developed by NASA's Johnson Space Center. It is a shell for developing expert systems designed to permit research, development and delivery on conventional computers.

Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice.

PubMed

Krauss, J K; Halve, B

2004-04-01

There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH. Standardized questionnaires with sections on the incidence of NPH and the frequency of shunting, evaluation of clinical symptoms, and signs, diagnostic studies, therapeutic decision-making and operative techniques, postoperative outcome and complications, and the profiles of different centers, were sent to 82 neurosurgical centers in Germany known to participate in the care of patients with NPH. Data were analyzed from 49 of 53 centers which responded to the survey (65%). The estimated annual incidence of NPH was 1.8 cases/100.000 inhabitants. Gait disturbance was defined as the most important sign of NPH (61%). There was a wide variety in the choice of diagnostic tests. Cisternography was performed routinely only in single centers. Diagnostic CSF removal was used with varying frequency by all centers except one, but the amount of CSF removed by lumbar puncture differed markedly between centers. There was poor agreement on criteria for evaluation of continuous intracranial pressure recordings regarding both the amplitude and the relative frequency of B-waves. Both periventricular and deep white matter lesions were present in about 50% of patients being shunted, indicating that vascular comorbidity in NPH patients has gained more acceptance. Programmable shunts were used by more than half of the centers, and newer valve types such as gravitational valves have become more popular. According to the present survey, new diagnostic and therapeutic concepts on NPH have penetrated daily routine to a certain extent. Wide variability, however, still exists among different neurosurgical centers.

Learning from the Past, Looking to the Future: Modeling Social Unrest in Karachi, Pakistan

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

Olson, Jarrod; Kurzrok, Andrew J.; Hund, Gretchen

Social unrest represents a major challenge for policy makers around the globe, as it can quickly escalate from small scale disturbances to highly public protests, riots and even civil war. This research was motivated by a need to understand social instability and to unpack the comments made during a spring 2013 conference hosted by Pacific Northwest National Laboratory’s Center for Global Security and the U.S. Institute for Peace, where policymakers noted that models considering social instability are often not suitable for decision-making. This analysis shows that existing state level models of instability could be improved in spatial scale to themore » city level, even without significantly improved data access. Better data would make this analysis more complete and likely improve the quality of the model. Another challenge with incorporating modeling into decision-making is the need to understand uncertainty in a model. Policy makers are frequently tasked with making decisions without a clear outcome, so characterization of uncertainty is critical. This report describes the work and findings of the project. It took place in three phases: a literature review of social stability research, a “hindsight scan” that looked at historical data, and a “foresight scan” looking at future scenarios.« less

Parent Child Center Program Management Information System. User's Manual.

ERIC Educational Resources Information Center

Warner, Donna D.; And Others

This manual describes procedures for collecting, recording, and reporting in a uniform, timely manner critical information necessary to the making of key management decisions for parent child centers as well as for the parent child center program. The first section describes recommended data collection and recordkeeping procedures for such…

Family-centered end-of-life care in the ICU.

PubMed

Wiegand, Debra L; Grant, Marian S; Cheon, Jooyoung; Gergis, Mary A

2013-08-01

Families of older adults are intricately involved in the end-of-life decision-making process for a family member with a serious illness in the intensive care unit (ICU) setting. However, families are not always as involved and as informed as they would like to be. Creating a culture that assesses family needs and supports families is an important component of family-centered care. There are several strategies that nurses and other members of the interdisciplinary team can use to promote family-centered end-of-life care in the ICU. Nurses can get to know the family by spending time talking with them, assessing them, seeking to understand their perspectives on their family member's condition, and discussing previously verbalized patient wishes for care. This article offers strategies nurses can use to help guide the family through the end-of-life decision-making process, support families as difficult and complex decisions are made in collaboration with the health care team, and prepare families for the dying process. Copyright 2013, SLACK Incorporated.

Patient perspectives on informed decision-making surrounding dialysis initiation

PubMed Central

Song, Mi-Kyung; Lin, Feng-Chang; Gilet, Constance A.; Arnold, Robert M.; Bridgman, Jessica C.; Ward, Sandra E.

2013-01-01

Background Careful patient–clinician shared decision-making about dialysis initiation has been promoted, but few studies have addressed patient perspectives on the extent of information provided and how decisions to start dialysis are made. Methods Ninety-nine maintenance dialysis patients recruited from 15 outpatient dialysis centers in North Carolina completed semistructured interviews on information provision and communication about the initiation of dialysis. These data were examined with content analysis. In addition, informed decision-making (IDM) scores were created by summing patient responses (yes/no) to 10 questions about the decision-making. Results The mean IDM score was 4.4 (of 10; SD = 2.0); 67% scored 5 or lower. Age at the time of decision-making (r = −0.27, P = 0.006), years of education (r = 0.24, P = 0.02) and presence of a warning about progressing to end-stage kidney disease (t = 2.9, P = 0.005) were significantly associated with IDM scores. Nearly 70% said that the risks and burdens of dialysis were not mentioned at all, and only one patient recalled that the doctor offered the option of not starting dialysis. While a majority (67%) said that they felt they had no choice about starting dialysis (because the alternative would be death) or about dialysis modality, only 21.2% said that they had felt rushed to make a decision. About one-third of the patients perceived that the decision to start dialysis and modality was already made by the doctor. Conclusions A majority of patients felt unprepared and ill-informed about the initiation of dialysis. Improving the extent of IDM about dialysis may optimize patient preparation prior to starting treatment and their perceptions about the decision-making process. PMID:23901048

Development of coverage with evidence development for medical technologies in Switzerland from 1996 to 2012.

PubMed

Brügger, Urs; Ruckstuhl, Andreas; Horisberger, Bruno; Gratwohl, Alois

2014-07-01

The aim of this study was to assess incidence, time frame, and outcome of "Coverage with Evidence Development" (CED) decisions in the Swiss Basic Health Insurance scheme. Analysis of all controversial medical technologies submitted to review by the Swiss Federal Office of Public Health (FOPH) from 1996 to 2012 with focus on decisions with constraints. Description of types of technology, type of initial decision, duration of evaluation period, final decision, and search for potential factors associated with changes over time. Forty-five (37.5 percent) of 120 controversial health technologies were classified as "yes, in evaluation, reimbursed" for a certain period of time and thirty-five (29.2 percent) as "no, in evaluation, not reimbursed" by the Federal Department of Home Affairs from 1996 to 2012. The rate of CED decisions ranged between zero and nine per year and was influenced by type of technology and calendar year. Forty-four of forty-five decisions were subject to further restrictions, to a "center or a specialist" (76 percent), "indications" (49 percent), "registry" (31 percent), or "other" (49 percent). The time to a final decision ranged from 1.5 to 11 years (median, 6 years). No factors associated with initial decision and final outcome could be identified. CED as a reality in Switzerland might have enabled patients to obtain access to promising technologies early in their life cycle. CED might have acted as a trigger to a successful implementation of a comprehensive national registry. The lack of qualitative data stresses the urgent need for evaluation of the HTA decisions and their impact on patient outcome and costs.

Pattern analysis of community health center location in Surabaya using spatial Poisson point process

NASA Astrophysics Data System (ADS)

Kusumaningrum, Choriah Margareta; Iriawan, Nur; Winahju, Wiwiek Setya

2017-11-01

Community health center (puskesmas) is one of the closest health service facilities for the community, which provide healthcare for population on sub-district level as one of the government-mandated community health clinics located across Indonesia. The increasing number of this puskesmas does not directly comply the fulfillment of basic health services needed in such region. Ideally, a puskesmas has to cover up to maximum 30,000 people. The number of puskesmas in Surabaya indicates an unbalance spread in all of the area. This research aims to analyze the spread of puskesmas in Surabaya using spatial Poisson point process model in order to get the effective location of Surabaya's puskesmas which based on their location. The results of the analysis showed that the distribution pattern of puskesmas in Surabaya is non-homogeneous Poisson process and is approched by mixture Poisson model. Based on the estimated model obtained by using Bayesian mixture model couple with MCMC process, some characteristics of each puskesmas have no significant influence as factors to decide the addition of health center in such location. Some factors related to the areas of sub-districts have to be considered as covariate to make a decision adding the puskesmas in Surabaya.

Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.

PubMed

Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

2014-06-01

As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.

Detecting Suspended Sediments from Remote Sensed Data in the Northern Gulf of Mexico

NASA Astrophysics Data System (ADS)

Hardin, D. M.; Graves, S. J.; Hawkins, L.; He, M.; Smith, T.; Drewry, M.; Ebersole, S.; Travis, A.; Thorn, J.; Brown, B.

2012-12-01

The Sediment Analysis Network for Decision Support (SANDS) project utilized remotely sensed data from Landsat and MODIS, both prior and following landfall, to investigate suspended sediment and sediment redistribution. The satellite imagery was enhanced by applying a combination of cluster busting and classification techniques to color and infrared bands. Results from the process show patterns associated with sediment transport and deposition related to coastal processes, storm-related sediment transport, post-storm pollutant transport, and sediment-current interactions. Imagery prior to landfall and following landfall are shown to the left for Landsat and to the right for MODIS. Scientific analysis and production of enhanced imagery was conducted by the Geological Survey of Alabama. The Information Technology and Systems Center at the University of Alabama in Huntsville was responsible for data acquisition, development of the SANDS data portal and the archive and distribution through the Global Hydrology Resource Center, one of NASA's Earth Science Data Centers . SANDs data may be obtained from the GHRC at ghrc.nsstc.nasa.gov and from the SANDS data portal at sands.itsc.uah.edu. This project was funded by the NASA Applied Sciences Division

Merging Air Quality and Public Health Decision Support Systems

NASA Astrophysics Data System (ADS)

Hudspeth, W. B.; Bales, C. L.

2003-12-01

The New Mexico Air Quality Mapper (NMAQM) is a Web-based, open source GIS prototype application that Earth Data Analysis Center is developing under a NASA Cooperative Agreement. NMAQM enhances and extends existing data and imagery delivery systems with an existing Public Health system called the Rapid Syndrome Validation Project (RSVP). RSVP is a decision support system operating in several medical and public health arenas. It is evolving to ingest remote sensing data as input to provide early warning of human health threats, especially those related to anthropogenic atmospheric pollutants and airborne pathogens. The NMAQM project applies measurements of these atmospheric pollutants, derived from both remotely sensed data as well as from in-situ air quality networks, to both forecasting and retrospective analyses that influence human respiratory health. NMAQM provides a user-friendly interface for visualizing and interpreting environmentally-linked epidemiological phenomena. The results, and the systems made to provide the information, will be applicable not only to decision-makers in the public health realm, but also to air quality organizations, demographers, community planners, and other professionals in information technology, and social and engineering sciences. As an accessible and interactive mapping and analysis application, it allows environment and health personnel to study historic data for hypothesis generation and trend analysis, and then, potentially, to predict air quality conditions from daily data acquisitions. Additional spin off benefits to such users include the identification of gaps in the distribution of in-situ monitoring stations, the dissemination of air quality data to the public, and the discrimination of local vs. more regional sources of air pollutants that may bear on decisions relating to public health and public policy.

Shared decision-making in end-stage renal disease: a protocol for a multi-center study of a communication intervention to improve end-of-life care for dialysis patients.

PubMed

Eneanya, Nwamaka D; Goff, Sarah L; Martinez, Talaya; Gutierrez, Natalie; Klingensmith, Jamie; Griffith, John L; Garvey, Casey; Kitsen, Jenny; Germain, Michael J; Marr, Lisa; Berzoff, Joan; Unruh, Mark; Cohen, Lewis M

2015-06-12

End-stage renal disease carries a prognosis similar to cancer yet only 20 % of end-stage renal disease patients are referred to hospice. Furthermore, conversations between dialysis team members and patients about end-of-life planning are uncommon. Lack of provider training about how to communicate prognostic data may contribute to the limited number of end-of-life care discussions that take place with this chronically ill population. In this study, we will test the Shared Decision-Making Renal Supportive Care communication intervention to systematically elicit patient and caretaker preferences for end-of-life care so that care concordant with patients' goals can be provided. This multi-center study will deploy an intervention to improve end-of-life communication for hemodialysis patients who are at high risk of death in the ensuing six months. The intervention will be carried out as a prospective cohort with a retrospective cohort serving as the comparison group. Patients will be recruited from 16 dialysis units associated with two large academic centers in Springfield, Massachusetts and Albuquerque, New Mexico. Critical input from patient advisory boards, a stakeholder panel, and initial qualitative analysis of patient and caretaker experiences with advance care planning have informed the communication intervention. Rigorous communication training for hemodialysis social workers and providers will ensure that standardized study procedures are performed at each dialysis unit. Nephrologists and social workers will communicate prognosis and provide advance care planning in face-to-face encounters with patients and families using a social work-centered algorithm. Study outcomes including frequency and timing of hospice referrals, patient and caretaker satisfaction, quality of end-of-life discussions, and quality of death will be assessed over an 18 month period. The Shared Decision-Making Renal Supportive Care Communication intervention intends to improve discussions about prognosis and end-of-life care with end-stage renal disease patients. We anticipate that the intervention will help guide hemodialysis staff and providers to effectively participate in advance care planning for patients and caretakers to establish preferences and goals at the end of life. NCT02405312.

Integrated system dynamics toolbox for water resources planning.

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

Reno, Marissa Devan; Passell, Howard David; Malczynski, Leonard A.

2006-12-01

Public mediated resource planning is quickly becoming the norm rather than the exception. Unfortunately, supporting tools are lacking that interactively engage the public in the decision-making process and integrate over the myriad values that influence water policy. In the pages of this report we document the first steps toward developing a specialized decision framework to meet this need; specifically, a modular and generic resource-planning ''toolbox''. The technical challenge lies in the integration of the disparate systems of hydrology, ecology, climate, demographics, economics, policy and law, each of which influence the supply and demand for water. Specifically, these systems, their associatedmore » processes, and most importantly the constitutive relations that link them must be identified, abstracted, and quantified. For this reason, the toolbox forms a collection of process modules and constitutive relations that the analyst can ''swap'' in and out to model the physical and social systems unique to their problem. This toolbox with all of its modules is developed within the common computational platform of system dynamics linked to a Geographical Information System (GIS). Development of this resource-planning toolbox represents an important foundational element of the proposed interagency center for Computer Aided Dispute Resolution (CADRe). The Center's mission is to manage water conflict through the application of computer-aided collaborative decision-making methods. The Center will promote the use of decision-support technologies within collaborative stakeholder processes to help stakeholders find common ground and create mutually beneficial water management solutions. The Center will also serve to develop new methods and technologies to help federal, state and local water managers find innovative and balanced solutions to the nation's most vexing water problems. The toolbox is an important step toward achieving the technology development goals of this center.« less

PACS for imaging centers.

PubMed

Farnsworth, T J

2003-01-01

PACS can be a difficult and confusing decision for any radiology provider, but it can be an even more dynamic question for an outpatient imaging center. Every center represents a unique situation and requires a specialized solution. Typically, most of what is said and discussed about PACS concentrates on solutions and requirements for hospital radiology facilities. Administrators of imaging centers have different problems from hospital administrators, and they need different answers. For imaging centers, the financial justification for PACS may be less immediate than for hospitals. The first thing that must be understood is that no PAC system can make a typical imaging center completely filmless, at least not for quite a while. A hospital has the ability to dictate to its internal referring physicians how a radiological study is delivered, whereas in an imaging center environment, the roles are very much reversed. Once the justification are made for the financial viability of PACS in an imaging center, the next question is how to finance the acquisition of PACS. The decision will depend on how you cost justify your PACS, as well as the shape of your business model, and it will come to a decision between capital purchase or contracting with an application service provider, or ASP. Historically, in the hospital-dominated marketplace, PAC systems have been treated as capital acquisitions. However, for most imaging center, owning the system is more of a problem than a benefit. ASPs increasingly represent a successful alternative for imaging centers. One of the biggest things to consider with PACS is how to store all of those images. There are typically two options, on-site and off-site, with a new "hybrid" option surfacing more recently. Each option has benefits for the user, but the benefits of off-site storage are increasing as the technology advances. Some of the benefits are data security and access. Other issues to address are HIPAA compliance, standardized interfaces such as HL-7, Web access and the choice of view stations.

Research centers and institutes in U.S. medical schools: a descriptive analysis.

PubMed

Mallon, William T; Bunton, Sarah A

2005-11-01

Research centers and institutes are a common mechanism to organize and facilitate biomedical research at medical schools and universities. The authors report the results of a study on the size, scope, and range of activities of 604 research centers and institutes at research-intensive U.S. medical schools and their parent universities. Centers and institutes with primary missions of patient care, education, or outreach were not included. The findings indicate that, in addition to research, centers and institutes are involved in a range of activities, including education, service, and technology transfer. The centers and institutes the authors studied were more interdisciplinary than those included in previous studies on this topic. Most research centers and institutes did not have authority comparable to academic departments. Only 22% of centers directly appointed faculty members, and most center directors reported to a medical school dean or a department chair. A small group of centers and institutes ("power centers"), however, reported to a university president or provost, and may have considerable power and influence in academic decision making and resource allocation. Two main types of centers and institutes emerge from this research. The first type, which includes the vast of majority of centers, is modest in its scope and marginal in its influence. The second type--with greater amounts of funding, larger staffs, and direct access to institutional decisionmakers--may have a more significant role in the organization and governance of the medical school and university and in the ways that researchers interact within and across academic divisions.

Fort Collins Science Center- Policy Analysis and Science Assistance Branch : Integrating social, behavioral, economic and biological sciences

USGS Publications Warehouse

2010-01-01

The Fort Collins Science Center's Policy Analysis and Science Assistance (PASA) Branch is a team of approximately 22 scientists, technicians, and graduate student researchers. PASA provides unique capabilities in the U.S. Geological Survey by leading projects that integrate social, behavioral, economic, and biological analyses in the context of human-natural resource interactions. Resource planners, managers, and policymakers in the U.S. Departments of the Interior (DOI) and Agriculture (USDA), State and local agencies, as well as international agencies use information from PASA studies to make informed natural resource management and policy decisions. PASA scientists' primary functions are to conduct both theoretical and applied social science research, provide technical assistance, and offer training to advance performance in policy relevant research areas. Management and research issues associated with human-resource interactions typically occur in a unique context, involve difficult to access populations, require knowledge of both natural/biological science in addition to social science, and require the skill to integrate multiple science disciplines. In response to these difficult contexts, PASA researchers apply traditional and state-of-the-art social science methods drawing from the fields of sociology, demography, economics, political science, communications, social-psychology, and applied industrial organization psychology. Social science methods work in concert with our rangeland/agricultural management, wildlife, ecology, and biology capabilities. The goal of PASA's research is to enhance natural resource management, agency functions, policies, and decision-making. Our research is organized into four broad areas of study.

What Does a Shoulder MRI Cost the Consumer?

PubMed

Westermann, Robert W; Schick, Cameron; Graves, Christopher M; Duchman, Kyle R; Weinstein, Stuart L

2017-03-01

More than 100 MRIs per 1000 inhabitants are performed in the United States annually, more than almost every other country. Little is known regarding the cost of obtaining an MRI and factors associated with differences in cost. By surveying all hospital-owned and independent imaging centers in Iowa, we wished to determine (1) the cost to the consumer of obtaining a noncontrast shoulder MRI, (2) the frequency and magnitude of discounts provided, and (3) factors associated with differences in cost including location (hospital-owned or independent) and Centers for Medicare & Medicaid Services designation (rural, urban, and critical access). There were 71 hospitals and 26 independent imaging centers that offered MRI services in Iowa. Each site was contacted via telephone and posed a scripted request for the cost of the technical component of a noncontrast shoulder MRI. Radiologists' reading fees were not considered. Statistical analysis was performed using standard methods and significance was defined as a probability less than 0.05. The mean technical component cost to consumers for an MRI was USD 1874 ± USD 694 (range, USD 500-USD 4000). Discounts were offered by 49% of imaging centers, with a mean savings of 21%. Factors associated with increased cost include hospital-owned imaging centers (USD 2062 ± USD 664 versus USD 1400 ± USD 441 at independent imaging centers; p < 0.001; mean difference, USD 662; 95% CI, USD 351-USD 893) and rural imaging centers, unless designated as a critical access hospital (USD 2213 ± USD 668 versus USD 1794 ± USD 680; p = 0.0202; mean difference, USD 419; 95% CI, USD 66-USD 772). In Iowa, the cost to the consumer of a shoulder MRI is significantly less at independent imaging centers compared with hospital-owned centers. Referring physicians and healthcare consumers should be aware that there may be substantial price discrepancies between centers that provide advanced imaging services. Level IV, Economic and decision analysis.

A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design.

PubMed

Zheng, Hua; Rosal, Milagros C; Li, Wenjun; Borg, Amy; Yang, Wenyun; Ayers, David C; Franklin, Patricia D

2018-04-30

Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants' responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra "next page" click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients' use. ©Hua Zheng, Milagros C Rosal, Wenjun Li, Amy Borg, Wenyun Yang, David C Ayers, Patricia D Franklin. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 30.04.2018.

Water Planning in Phoenix: Managing Risk in the Face of Climatic Uncertainty

NASA Astrophysics Data System (ADS)

Gober, P.

2009-12-01

The Decision Center for a Desert City (DCDC) was founded in 2004 to develop scientifically-credible support tools to improve water management decisions in the face of growing climatic uncertainty and rapid urbanization in metropolitan Phoenix. At the center of DCDC's effort is WaterSim, a model that integrates information about water supply from groundwater, the Colorado River, and upstream watersheds and water demand from land use change and population growth. Decision levers enable users to manipulate model outcomes in response to climate change scenarios, drought conditions, population growth rates, technology innovations, lifestyle changes, and policy decisions. WaterSim allows users to examine the risks of water shortage from global climate change, the tradeoffs between groundwater sustainability and lifestyle choices, the effects of various policy decisions, and the consequences of delaying policy for the exposure to risk. WaterSim is an important point of contact for DCDC’s relationships with local decision makers. Knowledge, tools, and visualizations are co-produced—by scientists and policy makers, and the Center’s social scientists mine this co-production process for new insights about model development and application. WaterSim is less a static scientific product and more a dynamic process of engagement between decision makers and scientists.

Aging and consumer decision making

PubMed Central

Carpenter, Stephanie M.; Yoon, Carolyn

2013-01-01

Research on consumer decision making and aging is especially important for fostering a better understanding of ways to maintain consumer satisfaction and high decision quality across the life span. We provide a review of extant research on the effects of normal aging on cognition and decision processes and how these age-related processes are influenced by task environment, meaningfulness of the task, and consumer expertise. We consider how research centered on these topics generates insights about changes in consumption decisions that occur with aging and identify a number of gaps and directions for future research. PMID:22360794

Decision Aids for Naval Air ASW

DTIC Science & Technology

1980-03-15

Algorithm for Zone Optimization Investigation) NADC Developing Sonobuoy Pattern for Air ASW Search DAISY (Decision Aiding Information System) Wharton...sion making behavior. 0 Artificial intelligence sequential pattern recognition algorithm for reconstructing the decision maker’s utility functions. 0...display presenting the uncertainty area of the target. 3.1.5 Algorithm for Zone Optimization Investigation (AZOI) -- Naval Air Development Center 0 A

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 2 2012-10-01 2012-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 2 2013-10-01 2013-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 2 2014-10-01 2014-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

42 CFR 405.1889 - Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Effect of a revision; issue-specific nature of appeals of revised determinations and decisions. 405.1889 Section 405.1889 Public Health CENTERS FOR... revision; issue-specific nature of appeals of revised determinations and decisions. (a) If a revision is...

Community Coordinated Modeling Center: Paving the Way for Progress in Space Science Research to Operational Space Weather Forecasting

NASA Astrophysics Data System (ADS)

Kuznetsova, M. M.; Maddox, M. M.; Mays, M. L.; Mullinix, R.; MacNeice, P. J.; Pulkkinen, A. A.; Rastaetter, L.; Shim, J.; Taktakishvili, A.; Zheng, Y.; Wiegand, C.

2013-12-01

Community Coordinated Modeling Center (CCMC) was established at the dawn of the millennium as an essential element on the National Space Weather Program. One of the CCMC goals was to pave the way for progress in space science research to operational space weather forecasting. Over the years the CCMC acquired the unique experience in preparing complex models and model chains for operational environment, in developing and maintaining powerful web-based tools and systems ready to be used by space weather service providers and decision makers as well as in space weather prediction capabilities assessments. The presentation will showcase latest innovative solutions for space weather research, analysis, forecasting and validation and review on-going community-wide initiatives enabled by CCMC applications.

Integrating software architectures for distributed simulations and simulation analysis communities.

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

Goldsby, Michael E.; Fellig, Daniel; Linebarger, John Michael

2005-10-01

The one-year Software Architecture LDRD (No.79819) was a cross-site effort between Sandia California and Sandia New Mexico. The purpose of this research was to further develop and demonstrate integrating software architecture frameworks for distributed simulation and distributed collaboration in the homeland security domain. The integrated frameworks were initially developed through the Weapons of Mass Destruction Decision Analysis Center (WMD-DAC), sited at SNL/CA, and the National Infrastructure Simulation & Analysis Center (NISAC), sited at SNL/NM. The primary deliverable was a demonstration of both a federation of distributed simulations and a federation of distributed collaborative simulation analysis communities in the context ofmore » the same integrated scenario, which was the release of smallpox in San Diego, California. To our knowledge this was the first time such a combination of federations under a single scenario has ever been demonstrated. A secondary deliverable was the creation of the standalone GroupMeld{trademark} collaboration client, which uses the GroupMeld{trademark} synchronous collaboration framework. In addition, a small pilot experiment that used both integrating frameworks allowed a greater range of crisis management options to be performed and evaluated than would have been possible without the use of the frameworks.« less

Cost-effectiveness analysis of a patient-centered care model for management of psoriasis.

PubMed

Parsi, Kory; Chambers, Cindy J; Armstrong, April W

2012-04-01

Cost-effectiveness analyses help policymakers make informed decisions regarding funding allocation of health care resources. Cost-effectiveness analysis of technology-enabled models of health care delivery is necessary to assess sustainability of novel online, patient-centered health care models. We sought to compare cost-effectiveness of conventional in-office care with a patient-centered, online model for follow-up treatment of patients with psoriasis. Cost-effectiveness analysis was performed from a societal perspective on a randomized controlled trial comparing a patient-centered online model with in-office visits for treatment of patients with psoriasis during a 24-week period. Quality-adjusted life expectancy was calculated using the life table method. Costs were generated from the original study parameters and national averages for salaries and services. No significant difference existed in the mean change in Dermatology Life Quality Index scores between the two groups (online: 3.51 ± 4.48 and in-office: 3.88 ± 6.65, P value = .79). Mean improvement in quality-adjusted life expectancy was not significantly different between the groups (P value = .93), with a gain of 0.447 ± 0.48 quality-adjusted life years for the online group and a gain of 0.463 ± 0.815 quality-adjusted life years for the in-office group. The cost of follow-up psoriasis care with online visits was 1.7 times less than the cost of in-person visits ($315 vs $576). Variations in travel time existed among patients depending on their distance from the dermatologist's office. From a societal perspective, the patient-centered online care model appears to be cost saving, while maintaining similar effectiveness to standard in-office care. Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

A data dictionary approach to multilingual documentation and decision support for the diagnosis of acute abdominal pain. (COPERNICUS 555, an European concerted action).

PubMed

Ohmann, C; Eich, H P; Sippel, H

1998-01-01

This paper describes the design and development of a multilingual documentation and decision support system for the diagnosis of acute abdominal pain. The work was performed within a multi-national COPERNICUS European concerted action dealing with information technology for quality assurance in acute abdominal pain in Europe (EURO-AAP, 555). The software engineering was based on object-oriented analysis design and programming. The program cover three modules: a data dictionary, a documentation program and a knowledge based system. National versions of the software were provided and introduced into 16 centers from Central and Eastern Europe. A prospective data collection was performed in which 4020 patients were recruited. The software design has been proven to be very efficient and useful for the development of multilingual software.

Patient Understanding of the Risks and Benefits of Biologic Therapies in Inflammatory Bowel Disease: Insights from a Large-scale Analysis of Social Media Platforms.

PubMed

Martinez, Bibiana; Dailey, Francis; Almario, Christopher V; Keller, Michelle S; Desai, Mansee; Dupuy, Taylor; Mosadeghi, Sasan; Whitman, Cynthia; Lasch, Karen; Ursos, Lyann; Spiegel, Brennan M R

2017-07-01

Few studies have examined inflammatory bowel disease (IBD) patients' knowledge and understanding of biologic therapies outside traditional surveys. Here, we used social media data to examine IBD patients' understanding of the risks and benefits associated with biologic therapies and how this affects decision-making. We collected posts from Twitter and e-forum discussions from >3000 social media sites posted between June 27, 2012 and June 27, 2015. Guided by natural language processing, we identified posts with specific IBD keywords that discussed the risks and/or benefits of biologics. We then manually coded the resulting posts and performed qualitative analysis using ATLAS.ti software. A hierarchical coding structure was developed based on the keyword list and relevant themes were identified through manual coding. We examined 1598 IBD-related posts, of which 452 (28.3%) centered on the risks and/or benefits of biologics. There were 5 main themes: negative experiences and concerns with biologics (n = 247; 54.6%), decision-making surrounding biologic use (n = 169; 37.4%), positive experiences with biologics (n = 168; 37.2%), information seeking from peers (n = 125; 27.7%), and cost (n = 38; 8.4%). Posts describing negative experiences primarily commented on side effects from biologics, concerns about potential side effects and increased cancer risk, and pregnancy safety concerns. Posts on decision-making focused on nonbiologic treatment options, hesitation to initiate biologics, and concerns about changing or discontinuing regimens. Social media reveals a wide range of themes governing patients' experience and choice with IBD biologics. The complexity of navigating their risk-benefit profiles suggests merit in creating online tailored decision tools to support IBD patients' decision-making with biologic therapies.

Incorporating geodiversity into conservation decisions.

PubMed

Comer, Patrick J; Pressey, Robert L; Hunter, Malcolm L; Schloss, Carrie A; Buttrick, Steven C; Heller, Nicole E; Tirpak, John M; Faith, Daniel P; Cross, Molly S; Shaffer, Mark L

2015-06-01

In a rapidly changing climate, conservation practitioners could better use geodiversity in a broad range of conservation decisions. We explored selected avenues through which this integration might improve decision making and organized them within the adaptive management cycle of assessment, planning, implementation, and monitoring. Geodiversity is seldom referenced in predominant environmental law and policy. With most natural resource agencies mandated to conserve certain categories of species, agency personnel are challenged to find ways to practically implement new directives aimed at coping with climate change while retaining their species-centered mandate. Ecoregions and ecological classifications provide clear mechanisms to consider geodiversity in plans or decisions, the inclusion of which will help foster the resilience of conservation to climate change. Methods for biodiversity assessment, such as gap analysis, climate change vulnerability analysis, and ecological process modeling, can readily accommodate inclusion of a geophysical component. We adapted others' approaches for characterizing landscapes along a continuum of climate change vulnerability for the biota they support from resistant, to resilient, to susceptible, and to sensitive and then summarized options for integrating geodiversity into planning in each landscape type. In landscapes that are relatively resistant to climate change, options exist to fully represent geodiversity while ensuring that dynamic ecological processes can change over time. In more susceptible landscapes, strategies aiming to maintain or restore ecosystem resilience and connectivity are paramount. Implementing actions on the ground requires understanding of geophysical constraints on species and an increasingly nimble approach to establishing management and restoration goals. Because decisions that are implemented today will be revisited and amended into the future, increasingly sophisticated forms of monitoring and adaptation will be required to ensure that conservation efforts fully consider the value of geodiversity for supporting biodiversity in the face of a changing climate. © 2015 Society for Conservation Biology.

Volume and outcome relation in German liver transplant centers: what lessons can be learned?

PubMed Central

2014-01-01

Background The volume and outcome relationship for transplant procedures has become one of the major topics during discussions about consequences following the organ transplantation scandal of wait-list manipulations in Germany during the past year. Proponents of reducing the number of centers argue in favor of increasing quality at highly specialized transplant centers while disregarding the wish of patients for regionally available medical service. Methods The homepage of the German Organ Procurement Organization (DSO) was screened for the annual reports of transplant programs for the years 2007 to 2010. Results were extracted from these reports. Additionally, an analysis of volume per million people per number of transplant centers for each German federal state was made to give an overview of the density of transplant programs for the years 2009 to 2011. Results In-house mortality (R2 = 0.005, P = 0.518), 3-year survival (R2 = 0.068, P = 0.085), and a ROC analysis for in-house mortality (AUC 0.55, CI: 0.41; 0.68, P = 0.53), did not show volume-outcome relation. Definition of a threshold for good centers was impossible. One-year survival indicated better outcome in high volume centers. R2 = 0.106, P = 0.009. Outcome data in Germany, as provided by Institute für angewandte Qualitätsförderung und Forschung im Gesundheitswesen (AQUA) or the DSO, are not risk adapted for the investigated time period. The factor of transplants per year per million people per transplant centers is 0.6 for Germany. Some Federal States (for example, Bavaria and Northrhine Westfalia) have an oversupply of transplant centers, which means that the average number transplanted per center and year is very low. Discussion and conclusion We propose a risk-adapted prospective analysis of outcome and definition of a quality catalogue for liver transplant centers. Volume and outcome relation is not conclusive for liver transplantation in Germany. Data should be collected, for example, for a time period of 3 to 5 years, and decisions influencing the regulation of numbers of transplant centers should be based upon the findings, weighing federal state sovereignty and regional medical requirements against an optimal patient supply while respecting a plausible risk adaption for each center. PMID:24513057

EPA CENTER FOR EXPOSURE ASSESSMENT MODELING (CEAM)

EPA Science Inventory

The EPA Center for Exposure Assessment Modeling (CEAM) supports the Agency and professional community in environmental, risk-based decision-making by expanding their applications expertise for quantitatively assessing pollutant exposure via aquatic, terrestrial, and multimedia pa...

Living Wills and Advance Directives for Medical Decisions

MedlinePlus

... the Conversation Project and the Center for Practical Bioethics. You should address a number of possible end- ... Making your healthcare wishes known. Center for Practical Bioethics. http://www.practicalbioethics.org/resources/caring-conversations. Accessed ...

Mobility Data Analytics Center.

DOT National Transportation Integrated Search

2016-01-01

Mobility Data Analytics Center aims at building a centralized data engine to efficiently manipulate : large-scale data for smart decision making. Integrating and learning the massive data are the key to : the data engine. The ultimate goal of underst...

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

NASA Astrophysics Data System (ADS)

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

2017-12-01

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

Decision support tools to support the operations of traffic management centers (TMC)

DOT National Transportation Integrated Search

2011-01-31

The goal of this project is to develop decision support tools to support traffic management operations based on collected intelligent transportation system (ITS) data. The project developments are in accordance with the needs of traffic management ce...

Decision support automation research in the en route air traffic control environment

DOT National Transportation Integrated Search

2002-01-01

This study examined the effect of automated decision support on Certified Professional Controller (CPC) behavior. : Sixteen CPCs from Air Route Traffic Control Centers participated in human-in-the-loop simulations. CPCs controlled : two levels of tra...

Sustaining the edge: factors influencing strategy selection in academic health centers.

PubMed

Walsh, Anne M; Szabat, Kathryn

2002-01-01

Competition within the acute care sector as well as increased penetration by managed care organizations has influenced the structure and role of academic health centers during the past decade. The market factors confronting academic health centers are not dissimilar from conditions that confront other organizations competing in mature industries characterized by declining profitability and intense rivalry for market share. When confronted with intense competition or adverse external events, organizations in other industries have responded to potential threats by forming alliances, developing joint ventures, or merging with another firm to maintain their competitive advantage. Although mergers and acquisitions dominated the strategic landscape in the healthcare industry during the past decade, recent evidence suggests that other types of strategic ventures may offer similar economic and contracting benefits to member organizations. Academic health centers have traditionally been involved in network relationships with multiple partners via their shared technology, collaborative research, and joint educational endeavors. These quasi-organizational relationships appear to have provided a framework for strategic decisions and allowed executives of academic health centers to select strategies that were competitive yet closely aligned with their organizational mission. The analysis of factors that influenced strategy selection by executives of academic health centers suggests a deliberate and methodical approach to achieving market share objectives, expanding managed care contracts, and developing physician networks.

Experiences of surgical continence management approaches for cloacal anomalies: a qualitative analysis based on 6 women.

PubMed

Liao, L-M; Baker, E; Boyle, M E; Woodhouse, C R J; Creighton, S M

2014-10-01

The aim of this qualitative study was to gain insight into health care experiences of young women diagnosed with cloacal anomalies, with a special focus on continence management. Qualitative analysis of one-to-one interviews. A tertiary center for congenital anomalies of the urogenital tract in London. Six women aged 16 to 24 with cloacal anomalies. Tape-recorded one-to-one semi-stuctured interviews with a skilled interviewer. The taped interviews were transcribed and analyzed verbatim using interpretative phenomenological analysis according to the research question. Organizing themes across all of the accounts were identified. Two organizing themes concerning our research interests are summarized. The first theme Personal Agency in the Hands of Experts focuses on the interviewees' appreciation of their life-saving surgical care and their involvement in treatment decisions. The second theme Compromises and Trade-Offs focuses on what it was like to live with the more traditional versus the more advanced continence methods. Reliability emerged as a key priority in terms of continence treatment outcome. Gratitude may have interfered with the women's honest communications during treatment decision and evaluation consultations. A more developed approach to communication about the complex interventions proposed, founded on a nuanced understanding of users perspectives, can enhance informed decision making about continence management approaches. Despite these specific gaps, the interviewees were appreciative of their care and optimistic about life. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Comparison of Three Instructional Approaches to Enhance Tactical Knowledge in Volleyball among University Students

ERIC Educational Resources Information Center

Vande Broek, Gert; Boen, Filip; Claessens, Manu; Feys, Jos; Ceux, Tanja

2011-01-01

This study investigated the decision-making process of three instructional groups (i.e., teacher-centered, student-centered with tactical questioning and student-centered without tactical questioning) in practical courses in volleyball among university students. All students (N = 122) performed a Tactical Awareness task on the correctness of the…

Developing a New Graduate Program in Healthcare Management: Embracing the Transformation of Healthcare Management Education on a Pathway to Success

ERIC Educational Resources Information Center

Dominguez, Daniel G.; Garcia, Chris; LaFrance, Kevin G.

2013-01-01

Within a sea change in the structure and process of providing health services, the field of health administration education has moved decisively and concretely from a teaching-centered model of education based on the assumption that knowledge equals competency to a learning-centered model. The learning-centered, or student-centered, model is based…

Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives

PubMed Central

Gwede, Clement K.; Davis, Stacy N.; Wilson, Shaenelle; Patel, Mitul; Vadaparampil, Susan T.; Meade, Cathy D.; Rivers, Brian M.; Yu, Daohai; Torres-Roca, Javier; Heysek, Randy; Spiess, Philippe E.; Pow-Sang, Julio; Jacobsen, Paul

2014-01-01

Purpose First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity. Design A cross-sectional, qualitative Setting Study setting was a cancer center in southwest Florida. Participants The study comprised 44 participants (24 PC patients and 20 unaffected FDRs). Method Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods. Results Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM. Conclusion Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway. PMID:24968183

A clinical decision rule to prioritize polysomnography in patients with suspected sleep apnea.

PubMed

Rodsutti, Julvit; Hensley, Michael; Thakkinstian, Ammarin; D'Este, Catherine; Attia, John

2004-06-15

To derive and validate a clinical decision rule that can help to prioritize patients who are on waiting lists for polysomnography, Prospective data collection on consecutive patients referred to a sleep center. The Newcastle Sleep Disorders Centre, University of Newcastle, NSW, Australia. Consecutive adult patients who had been scheduled for initial diagnostic polysomnography. Eight hundred and thirty-seven patients were used for derivation of the decision rule. An apnea-hypopnoea index of at least 5 was used as the cutoff point to diagnose sleep apnea. Fifteen clinical features were included in the analyses using logistic regression to construct a model from the derivation data set. Only 5 variables--age, sex, body mass index, snoring, and stopping breathing during sleep--were significantly associated with sleep apnea. A scoring scheme based on regression coefficients was developed, and the total score was trichotomized into low-, moderate-, and high-risk groups with prevalence of sleep apnea of 8%, 51%, and 82%, respectively. Color-coded tables were developed for ease of use. The clinical decision rule was validated on a separate set of 243 patients. Receiver operating characteristic analysis confirmed that the decision rule performed well, with the area under the curve being similar for both the derivation and validation sets: 0.81 and 0.79, P =.612. We conclude that this decision rule was able to accurately classify the risk of sleep apnea and will be useful for prioritizing patients with suspected sleep apnea who are on waiting lists for polysomnography.

Shared clinical decision making

PubMed Central

AlHaqwi, Ali I.; AlDrees, Turki M.; AlRumayyan, Ahmad; AlFarhan, Ali I.; Alotaibi, Sultan S.; AlKhashan, Hesham I.; Badri, Motasim

2015-01-01

Objectives: To determine preferences of patients regarding their involvement in the clinical decision making process and the related factors in Saudi Arabia. Methods: This cross-sectional study was conducted in a major family practice center in King Abdulaziz Medical City, Riyadh, Saudi Arabia, between March and May 2012. Multivariate multinomial regression models were fitted to identify factors associated with patients preferences. Results: The study included 236 participants. The most preferred decision-making style was shared decision-making (57%), followed by paternalistic (28%), and informed consumerism (14%). The preference for shared clinical decision making was significantly higher among male patients and those with higher level of education, whereas paternalism was significantly higher among older patients and those with chronic health conditions, and consumerism was significantly higher in younger age groups. In multivariate multinomial regression analysis, compared with the shared group, the consumerism group were more likely to be female [adjusted odds ratio (AOR) =2.87, 95% confidence interval [CI] 1.31-6.27, p=0.008] and non-dyslipidemic (AOR=2.90, 95% CI: 1.03-8.09, p=0.04), and the paternalism group were more likely to be older (AOR=1.03, 95% CI: 1.01-1.05, p=0.04), and female (AOR=2.47, 95% CI: 1.32-4.06, p=0.008). Conclusion: Preferences of patients for involvement in the clinical decision-making varied considerably. In our setting, underlying factors that influence these preferences identified in this study should be considered and tailored individually to achieve optimal treatment outcomes. PMID:26620990

Assessment and forecasting of lightning potential and its effect on launch operations at Cape Canaveral Air Force Station and John F. Kennedy Space Center

NASA Technical Reports Server (NTRS)

Weems, J.; Wyse, N.; Madura, J.; Secrist, M.; Pinder, C.

1991-01-01

Lightning plays a pivotal role in the operation decision process for space and ballistic launches at Cape Canaveral Air Force Station and Kennedy Space Center. Lightning forecasts are the responsibility of Detachment 11, 4th Weather Wing's Cape Canaveral Forecast Facility. These forecasts are important to daily ground processing as well as launch countdown decisions. The methodology and equipment used to forecast lightning are discussed. Impact on a recent mission is summarized.

REACT Real-Time Emergency Action Coordination Tool

NASA Technical Reports Server (NTRS)

2004-01-01

Recently the Emergency Management Operations Center (EMOC) of St. Tammany Parish turned to the Technology Development and Transfer Office (TDTO) of NASA's Stennis Space Center (SSC) for help in combating the problems associated with water inundation. Working through a Dual-Use Development Agreement the Technology Development and Transfer Office, EMOC and a small geospatial applications company named Nvision provided the parish with a new front-line defense. REACT, Real-time Emergency Action coordination Tool is a decision support system that integrates disparate information to enable more efficient decision making by emergency management personnel.

Superfund record of decision (EPA Region 3): US Defense General Supply Center (DLA), operable unit 3, Chesterfield County, Richmond, VA, September 29, 1995

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

NONE

This decision document presents the selected remedial action for the National Guard Source Area (NGA), Operable Unit (OU3) at the Defense General Supply Center (DGSC) in Richmond, Virginia. Operable Unit 3 addresses the contaminated soils at the National Guard . The selected alternative requires that institutional controls, including access restriction, property transfer restriction, and preconstruction assessment, be implemented or continued at the site. Also, contaminated soils posing human health risks will be excavated and disposed of.

A Model for NASA-KSC's Privatization Transition

NASA Technical Reports Server (NTRS)

Lavelle, Jerome P.; Krumwiede, Dennis W.; Flowers, Jean

1996-01-01

This paper describes a model for government agencies that are considering privatization of all or part of their functions. Privatization encompasses the transitioning of government functions from government run to contractor run. The model developed in this paper is used to analyze the National Aeronautics and Space Administration's (NASA) decision to privatize space shuttle operations at the Kennedy Space Center (KSC). Several specific recommendations are given to KSC as they attempt to operationalize this privatization decision at the Center and to transition to a new relationship with their contractors.

The decision-making process of young adult women with cancer who considered fertility cryopreservation.

PubMed

Hershberger, Patricia E; Finnegan, Lorna; Pierce, Penny F; Scoccia, Bert

2013-01-01

To provide an in-depth description of the decision-making process that women who are diagnosed with cancer undergo as they decide whether to accept or decline fertility cryopreservation. A qualitative, grounded theory approach. Twenty-seven women (mean age = 29 years) who were diagnosed with cancer and were eligible for egg, embryo, or ovarian tissue cryopreservation were recruited from the Internet and two university centers. Each woman participated in a semistructured interview by phone (n = 21) or e-mail (n = 6). Data were analyzed using the constant-comparative method to inductively ascertain the women's decision-making process. NVivo 8 software was used to assist with data retrieval and analysis. The decision-making process consists of four major phases that women experience to actively formulate a decision: identify, contemplate, resolve, and engage. In the identify phase, women acquire knowledge and experience a "double hit" scenario that is often devastating. Within the contemplate phase, five interrelated dimensions emerged including constructing and/or endorsing preferences and values and undergoing decisional debriefing sessions. A decision is reached in the resolve phase and carried out in the engage phase. Among the participants, 14 declined fertility cryopreservation and 13 accepted egg and/or embryo cryopreservation. The descriptive theoretical framework clarifies the underlying processes that women with cancer undergo to decide about fertility cryopreservation. Quality of care for women with cancer can be improved by implementing appropriately timed information and tailored developmental and contextual counseling to support decision making. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Nudge or Grudge? Choice Architecture and Parental Decision-Making.

PubMed

Blumenthal-Barby, Jennifer; Opel, Douglas J

2018-03-01

Richard Thaler and Cass Sunstein define a nudge as "any aspect of the choice architecture that alters people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives." Much has been written about the ethics of nudging competent adult patients. Less has been written about the ethics of nudging surrogates' decision-making and how the ethical considerations and arguments in that context might differ. Even less has been written about nudging surrogate decision-making in the context of pediatrics, despite fundamental differences that exist between the pediatric and adult contexts. Yet, as the field of behavioral economics matures and its insights become more established and well-known, nudges will become more crafted, sophisticated, intentional, and targeted. Thus, the time is now for reflection and ethical analysis regarding the appropriateness of nudges in pediatrics. We argue that there is an even stronger ethical justification for nudging in parental decision-making than with competent adult patients deciding for themselves. We give three main reasons in support of this: (1) child patients do not have autonomy that can be violated (a concern with some nudges), and nudging need not violate parental decision-making authority; (2) nudging can help fulfill pediatric clinicians' obligations to ensure parental decisions are in the child's interests, particularly in contexts where there is high certainty that a recommended intervention is low risk and of high benefit; and (3) nudging can relieve parents' decisional burden regarding what is best for their child, particularly with decisions that have implications for public health. © 2018 The Hastings Center.

Parent perspectives on information about late effects of childhood cancer treatment and their role in initial treatment decision making.

PubMed

Greenzang, Katie A; Dauti, Angela; Mack, Jennifer W

2018-06-01

Though most childhood cancer survivors experience late effects of treatment, we know little about parent preferences for late effects information during therapy, or how parents weigh late effects when making treatment decisions. Our objective was to explore how parents of children with cancer consider late effects in initial treatment decision making and during active cancer treatment. Semistructured interviews were conducted with 12 parents of children with cancer who were actively receiving treatment at Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Interviews were audio-recorded, transcribed verbatim, and qualitatively analyzed using thematic analysis. Ten of 12 parents reported that they had to decide between two or more treatment options for their child's cancer. Of those, 50% (5/10) considered late effects to be an important factor in their decision making. Most parents wanted early and detailed information about their child's risk of late effects to make treatment decisions and to feel prepared for the future. However, a few parents felt too overwhelmed to focus on late effects at diagnosis. While many recalled extensive late effects information in informed consent discussions, some parents felt these issues were minimally addressed. Parents desire detailed information about late effects to make informed treatment decisions and prepare for the future. Despite the role of late effects in treatment decision making, some parents feel that late effects are either inadequately addressed or too overwhelming to process at diagnosis. Parents may benefit from early assessment of their information needs and a return to these issues over time. © 2018 Wiley Periodicals, Inc.

The Burden of Cystoscopic Bladder Cancer Surveillance: Anxiety, Discomfort, and Patient Preferences for Decision Making.

PubMed

Koo, Kevin; Zubkoff, Lisa; Sirovich, Brenda E; Goodney, Philip P; Robertson, Douglas J; Seigne, John D; Schroeck, Florian R

2017-10-01

To examine discomfort, anxiety, and preferences for decision making in patients undergoing surveillance cystoscopy for non-muscle-invasive bladder cancer (NMIBC). Veterans with a prior diagnosis of NMIBC completed validated survey instruments assessing procedural discomfort, worry, and satisfaction, and were invited to participate in semistructured focus groups about their experience and desire to be involved in surveillance decision making. Focus group transcripts were analyzed qualitatively, using (1) systematic iterative coding, (2) triangulation involving multiple perspectives from urologists and an implementation scientist, and (3) searching and accounting for disconfirming evidence. Twelve patients participated in 3 focus groups. Median number of lifetime cystoscopy procedures was 6.5 (interquartile range 4-10). Based on survey responses, two-thirds of participants (64%) experienced some degree of procedural discomfort or worry, and all participants reported improvement in at least 2 dimensions of overall well-being following cystoscopy. Qualitative analysis of the focus groups indicated that participants experience preprocedural anxiety and worry about their disease. Although many participants did not perceive themselves as having a defined role in decision making surrounding their surveillance care, their preferences to be involved in decision making varied widely, ranging from acceptance of the physician's recommendation, to uncertainty, to dissatisfaction with not being involved more in determining the intensity of surveillance care. Many patients with NMIBC experience discomfort, anxiety, and worry related to disease progression and not only cystoscopy. Although some patients are content to defer surveillance decisions to their physicians, others prefer to be more involved. Future work should focus on defining patient-centered approaches to surveillance decision making. Published by Elsevier Inc.

Patient-centered communication, ratings of care, and concordance of patient and physician race.

PubMed

Cooper, Lisa A; Roter, Debra L; Johnson, Rachel L; Ford, Daniel E; Steinwachs, Donald M; Powe, Neil R

2003-12-02

African-American patients who visit physicians of the same race rate their medical visits as more satisfying and participatory than do those who see physicians of other races. Little research has investigated the communication process in race-concordant and race-discordant medical visits. To compare patient-physician communication in race-concordant and race-discordant visits and examine whether communication behaviors explain differences in patient ratings of satisfaction and participatory decision making. Cohort study with follow-up using previsit and postvisit surveys and audiotape analysis. 16 urban primary care practices. 252 adults (142 African-American patients and 110 white patients) receiving care from 31 physicians (of whom 18 were African-American and 13 were white). Audiotape measures of patient-centeredness, patient ratings of physicians' participatory decision-making styles, and overall satisfaction. Race-concordant visits were longer (2.15 minutes [95% CI, 0.60 to 3.71]) and had higher ratings of patient positive affect (0.55 point, [95% CI, 0.04 to 1.05]) compared with race-discordant visits. Patients in race-concordant visits were more satisfied and rated their physicians as more participatory (8.42 points [95% CI, 3.23 to 13.60]). Audiotape measures of patient-centered communication behaviors did not explain differences in participatory decision making or satisfaction between race-concordant and race-discordant visits. Race-concordant visits are longer and characterized by more patient positive affect. Previous studies link similar communication findings to continuity of care. The association between race concordance and higher patient ratings of care is independent of patient-centered communication, suggesting that other factors, such as patient and physician attitudes, may mediate the relationship. Until more evidence is available regarding the mechanisms of this relationship and the effectiveness of intercultural communication skills programs, increasing ethnic diversity among physicians may be the most direct strategy to improve health care experiences for members of ethnic minority groups.

Restating a Client-Centered Approach to Career Counseling.

ERIC Educational Resources Information Center

Miller, Mark J.

1988-01-01

Asserts career counseling too often is associated with objective test scores and rational decision making. Reiterates the importance of considering the client's developing self-concept in career counseling. Provides sample client centered career counseling session. (Author/ABL)

Relationship between Physicians' Uncertainty about Clinical Assessments and Patient-Centered Recommendations for Colorectal Cancer Screening in the Elderly.

PubMed

Dalton, Alexandra F; Golin, Carol E; Esserman, Denise; Pignone, Michael P; Pathman, Donald E; Lewis, Carmen L

2015-05-01

The goal of this study was to examine associations between physicians' clinical assessments, their certainty in these assessments, and the likelihood of a patient-centered recommendation about colorectal cancer (CRC) screening in the elderly. Two hundred seventy-six primary care physicians in the United States read 3 vignettes about an 80-year-old female patient and answered questions about her life expectancy, their confidence in their life expectancy estimate, the balance of benefits/downsides of CRC screening, their certainty in their benefit/downside assessment, and the best course of action regarding CRC screening. We used logistic regression to determine the relationship between these variables and patient-centered recommendations about CRC screening. In bivariate analyses, physicians had higher odds of making a patient-centered recommendation about CRC screening when their clinical assessments did not lead to a clear screening recommendation or when they experienced uncertainty in their clinical assessments. However, in a multivariate regression model, only benefit/downside assessment and best course of action remained statistically significant predictors of a patient-centered recommendation. Our findings demonstrate that when the results of clinical assessments do not lead to obvious screening decisions or when physicians feel uncertain about their clinical assessments, they are more likely to make patient-centered recommendations. Existing uncertainty frameworks do not adequately describe the uncertainty associated with patient-centered recommendations found in this study. Adapting or modifying these frameworks to better reflect the constructs associated with uncertainty and the interactions between uncertainty and the complexity inherent in clinical decisions will facilitate a more complete understanding of how and when physicians choose to include patients in clinical decisions. © The Author(s) 2015.

Quality assurance past and present in Canada

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

Bush, R.S.

Quality assurance in any clinical field must involve the three components of clinical care: (a) diagnosis and evaluation of patients; (b) medical decision making and treatment; and (c) outcome analysis. Nationally, there have been five annual reviews of outcome from all cancer centers following radiation therapy for cancer at various sites. These reviews are voluntary and organized through the Canadian Association of Radiologists. The objective is to determine if there are any major differences in outcome across the country, and if so, can such differences be related to the population treated or technique used. So far no major differences havemore » been noted. There is a National Tumour Reference Center funded by the National Cancer Institute of Canada (NCIC) to provide assistancein establishing diagnostic criteria in pathology. Ontario has been active through the staging and reporting, together with an evaluative program for this staging system. All other quality assurance programs take place at the level of local centers.« less

Use and interest in complementary and alternative medicine among college students seeking healthcare at a university campus student health center.

PubMed

Nguyen, Jannett; Liu, Michael A; Patel, Rohini J; Tahara, Keli; Nguyen, Annie L

2016-08-01

There is growing data on complementary and alternative medicine (CAM) preferences among college students. While several studies have focused on undergraduate students, there is limited data on graduate students. Cross sectional analysis of undergraduate and graduate students seeking medical care at the University of California Irvine's Student Health Center (SHC). The survey assessed previous CAM use and preferences for future CAM use and education. The majority (67.0%) had used CAM within the last year, 27.0% would use CAM for their current health condition, and 51.9% would consider CAM for their current health condition if they were more knowledgeable. Most respondents desired more CAM education and indicated that they would try CAM modalities if covered under insurance. Most college students requested more knowledge to assist in their decisions to use CAM. These findings provide insight for health centers on the preferences of college student patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Nursing Home Stakeholder Views of Resident Involvement in Medical Care Decisions

PubMed Central

Garcia, Theresa J.; Harrison, Tracie C.; Goodwin, James S.

2017-01-01

Demand by nursing home residents for involvement in their medical care, or, patient-centered care, is expected to increase as baby boomers begin seeking long-term care for their chronic illnesses. To explore the needs in meeting this proposed demand, we used a qualitative descriptive method with content analysis to obtain the joint perspective of key stakeholders on the current state of person-centered medical care in the nursing home. We interviewed 31 nursing home stakeholders: 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Our findings revealed constraints placed by the long-term care system limited medical involvement opportunities and created conflicting goals for patient-centered medical care. Resident participation in medical care was perceived as low, but important. The creation of supportive educational programs for all stakeholders to facilitate a common goal for nursing home admission and to provide assistance through the long-term care system was encouraged. PMID:25721717

Next generation terminology infrastructure to support interprofessional care planning.

PubMed

Collins, Sarah; Klinkenberg-Ramirez, Stephanie; Tsivkin, Kira; Mar, Perry L; Iskhakova, Dina; Nandigam, Hari; Samal, Lipika; Rocha, Roberto A

2017-11-01

Develop a prototype of an interprofessional terminology and information model infrastructure that can enable care planning applications to facilitate patient-centered care, learn care plan linkages and associations, provide decision support, and enable automated, prospective analytics. The study steps included a 3 step approach: (1) Process model and clinical scenario development, and (2) Requirements analysis, and (3) Development and validation of information and terminology models. Components of the terminology model include: Health Concerns, Goals, Decisions, Interventions, Assessments, and Evaluations. A terminology infrastructure should: (A) Include discrete care plan concepts; (B) Include sets of profession-specific concerns, decisions, and interventions; (C) Communicate rationales, anticipatory guidance, and guidelines that inform decisions among the care team; (D) Define semantic linkages across clinical events and professions; (E) Define sets of shared patient goals and sub-goals, including patient stated goals; (F) Capture evaluation toward achievement of goals. These requirements were mapped to AHRQ Care Coordination Measures Framework. This study used a constrained set of clinician-validated clinical scenarios. Terminology models for goals and decisions are unavailable in SNOMED CT, limiting the ability to evaluate these aspects of the proposed infrastructure. Defining and linking subsets of care planning concepts appears to be feasible, but also essential to model interprofessional care planning for common co-occurring conditions and chronic diseases. We recommend the creation of goal dynamics and decision concepts in SNOMED CT to further enable the necessary models. Systems with flexible terminology management infrastructure may enable intelligent decision support to identify conflicting and aligned concerns, goals, decisions, and interventions in shared care plans, ultimately decreasing documentation effort and cognitive burden for clinicians and patients. Copyright © 2017 Elsevier Inc. All rights reserved.

"Best Case/Worst Case": Qualitative Evaluation of a Novel Communication Tool for Difficult in-the-Moment Surgical Decisions.

PubMed

Kruser, Jacqueline M; Nabozny, Michael J; Steffens, Nicole M; Brasel, Karen J; Campbell, Toby C; Gaines, Martha E; Schwarze, Margaret L

2015-09-01

To evaluate a communication tool called "Best Case/Worst Case" (BC/WC) based on an established conceptual model of shared decision-making. Focus group study. Older adults (four focus groups) and surgeons (two focus groups) using modified questions from the Decision Aid Acceptability Scale and the Decisional Conflict Scale to evaluate and revise the communication tool. Individuals aged 60 and older recruited from senior centers (n = 37) and surgeons from academic and private practices in Wisconsin (n = 17). Qualitative content analysis was used to explore themes and concepts that focus group respondents identified. Seniors and surgeons praised the tool for the unambiguous illustration of multiple treatment options and the clarity gained from presentation of an array of treatment outcomes. Participants noted that the tool provides an opportunity for in-the-moment, preference-based deliberation about options and a platform for further discussion with other clinicians and loved ones. Older adults worried that the format of the tool was not universally accessible for people with different educational backgrounds, and surgeons had concerns that the tool was vulnerable to physicians' subjective biases. The BC/WC tool is a novel decision support intervention that may help facilitate difficult decision-making for older adults and their physicians when considering invasive, acute medical treatments such as surgery. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Patient perceived participation in decision making on their antipsychotic treatment: Evidence of validity and reliability of the COMRADE scale in a sample of schizophrenia spectrum disorders.

PubMed

Pérez-Revuelta, José; Villagrán-Moreno, José María; Moreno-Sánchez, Luisa; Pascual-Paño, Juan Manuel; González-Saiz, Francisco

2018-03-23

The aim of this paper is to provide evidence of the validity and reliability of the COMRADE scale (Combined Outcome Measure for Risk communication And treatment Decision making Effectiveness) in patients suffering from schizophrenia spectrum disorders. 150 patients recruited at five mental health centers were assessed using a cross-sectional study design. The COMRADE, WAIS-S (therapeutic alliance) and TSQM (satisfaction with medication) scales were used. Exploratory Factor Analysis identified three factors from the COMRADE (F1: "Risk communication"; F2: "Confidence in decision" and F3: "Knowledge of decisional balance") which explain 45.2, 8.5 and 6% of the variance, respectively. Statistically significant correlations were observed between the scores of the COMRADE subscales with the subscales of the WAI-S and the TSQM. The internal consistency observed for each of the factorial scores of the COMRADE were (Cronbach's alpha values) 0.90, 0.89 and 0.74, respectively. The COMRADE scale offers appropriate psychometric properties for its use as a measure of perceived patient involvement in the shared decision making process in antipsychotic treatment. The use of the COMRADE measure in psychiatric clinical practice and in research studies provides an outcome measure of interventions from the shared decision making model. Copyright © 2018 Elsevier B.V. All rights reserved.

42 CFR 456.237 - Notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Notification of adverse decision. 456.237 Section 456.237 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals...

Flu vaccine shortage creates ethical issues, safety challenges.

PubMed

2004-12-01

Decisions may have to be made as to whether staff or patients get priority. Centers for Disease Control and Prevention guidelines help ease choices when it comes to inoculating workers. Quality professionals should be aware of the legal implications of their decisions.

Insect pest management decisions in food processing facilities

USDA-ARS?s Scientific Manuscript database

Pest management decision making in food processing facilities such as flour mills, rice mills, human and pet food manufacturing facilities, distribution centers and warehouses, and retail stores is a challenging undertaking. Insect pest management programs require an understanding of the food facili...

Decision-support systems for natural-hazards and land-management issues

USGS Publications Warehouse

Dinitz, Laura; Forney, William; Byrd, Kristin

2012-01-01

Scientists at the USGS Western Geographic Science Center are developing decision-support systems (DSSs) for natural-hazards and land-management issues. DSSs are interactive computer-based tools that use data and models to help identify and solve problems. These systems can provide crucial support to policymakers, planners, and communities for making better decisions about long-term natural hazards mitigation and land-use planning.

Decision-making Strategies and Performance among Seniors1

PubMed Central

Besedeš, Tibor; Deck, Cary; Sarangi, Sudipta; Shor, Mikhael

2011-01-01

Using paper and pencil experiments administered in senior centers, we examine decision-making performance in multi-attribute decision problems. We differentiate the effects of declining cognitive performance and changing cognitive process on decision-making performance of seniors as they age. We find a significant decline in performance with age due to reduced reliance on common heuristics and increased decision-making randomness among our oldest subjects. However, we find that increasing the number of options in a decision problem increases the number of heuristics brought to the task. This challenges the choice overload view that people give up when confronted with too much choice. PMID:22408282

User-centered design and usability testing of an innovative health-related quality of life module.

PubMed

Nagykaldi, Z J; Jordan, M; Quitoriano, J; Ciro, C A; Mold, J W

2014-01-01

Various computerized health risk appraisals (HRAs) are available, but few of them assess health-related quality of life (HRQoL) in a goal-directed framework. This study describes the user-centered development and usability testing of an innovative HRQoL module that extends a validated HRA tool in primary care settings. Systematic user-centered design, usability testing, and qualitative methods were used to develop the HRQoL module in primary care practices. Twenty two patients and 5 clinicians participated in two rounds of interactive technology think-out-loud sessions (TOLs) and semi-structured interviews (SSIs) to iteratively develop a four-step, computerized process that collects information on patient goals for meaningful life activities and current level of disability and presents a personalized and prioritized list of preventive recommendations linked to online resources. Analysis of TOLs and SSIs generated 5 categories and 11 sub-categories related to facilitators and barriers to usability and human-technology interaction. The categories included: Understanding the Purpose, Usability, Perceived Value, Literacy, and Participant Motivation. Some categories were inter-connected. The technology was continually and iteratively improved between sessions until saturation of positive feedback was achieved in 4 categories (addressing motivation will require more research). Usability of all screen units of the module was improved substantially. Clinician feedback emphasized the importance of the module's ability to translate the patient-centered HRQoL Report into actionable items for clinicians to facilitate shared decision-making. Complete integration of the HRQoL module into the existing HRA will require further development and testing. Systematic application of user-centered design and human factors principles in technology development and testing may significantly improve the usability and clinical value of health information systems. This more sophisticated approach helped us translate complex clinical concepts, goal-setting steps, and decision-support processes into an accepted and value-added technology.

Evaluation and development of potentially better practices for improving family-centered care in neonatal intensive care units.

PubMed

Saunders, Roger P; Abraham, Marie R; Crosby, Mary Jo; Thomas, Karen; Edwards, William H

2003-04-01

Technological and scientific advances have progressively decreased neonatal morbidity and mortality. Less attention has been given to meeting the psychosocial needs of the infant and family than on meeting the infant's physical needs. Parents' participation in making decisions and caring for their child has often been limited. Environments designed for efficient technological care may not be optimal for nurturing the growth and development of sick neonates or their families. Eleven centers collaborating on quality improvement tried to make the care of families better by focusing on understanding and improving family-centered care. Through internal process analysis, review of the evidence, collaborative learning, and benchmarking site visits to centers of excellence in family-centered care, a list of potentially better practices was developed. Choice of which practices to implement and methods of implementation were center specific. Improvement goals were in 3 areas: parent-reported outcomes, staff beliefs and practices, and clinical outcomes in length of stay and feeding practices. Measurement tools for the first 2 areas were developed and pilots were conducted. Length of stay and feeding outcomes were not different before the collaboration (1998) and at the formal end of the collaboration (2000). Prospective parent-reported outcomes are being collected, and the staff beliefs and practices questionnaire will be repeated in all centers to determine the impact of the project in those areas.

Analysis of decision making at a multidisciplinary head and neck tumor board incorporating evidence-based National Cancer Comprehensive Network (NCCN) guidelines.

PubMed

Shah, Bhartesh A; Qureshi, Muhammad M; Jalisi, Scharukh; Grillone, Gregory; Salama, Andrew; Cooley, Timothy; Zaner, Ken; Sakai, Osamu; Truong, Minh Tam

2016-01-01

To evaluate incorporation of National Cancer Comprehensive Network (NCCN) guidelines in decision making at a head and neck cancer (HNC) multidisciplinary tumor board (MDT) at an urban academic medical center. A retrospective study of 176 HNC patients was performed. The extent to which MDT decisions and subsequent patient care incorporate NCCN guidelines was evaluated. A total of 173 (98.3%) HNC patients received MDT recommendations according to NCCN guidelines. Of the 159 patients treated, 153 (96.2%) received treatment according to NCCN guidelines. The MDT recommended the highest available evidence-based NCCN category guideline in 78.0%. Subsequent treatment using the same or higher category MDT recommendation occurred in 87.0% of patients. Evaluation of patients at an MDT using NCCN guidelines incorporates the highest level of evidence in approximately 80% of patients and translates well into subsequent care. Incorporation of the highest available NCCN guideline may be improved, although management should be individualized. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Decision Making Under Uncertainty and Complexity: A Model-Based Scenario Approach to Supporting Integrated Water Resources Management

NASA Astrophysics Data System (ADS)

Liu, Y.; Gupta, H.; Wagener, T.; Stewart, S.; Mahmoud, M.; Hartmann, H.; Springer, E.

2007-12-01

Some of the most challenging issues facing contemporary water resources management are those typified by complex coupled human-environmental systems with poorly characterized uncertainties. In other words, major decisions regarding water resources have to be made in the face of substantial uncertainty and complexity. It has been suggested that integrated models can be used to coherently assemble information from a broad set of domains, and can therefore serve as an effective means for tackling the complexity of environmental systems. Further, well-conceived scenarios can effectively inform decision making, particularly when high complexity and poorly characterized uncertainties make the problem intractable via traditional uncertainty analysis methods. This presentation discusses the integrated modeling framework adopted by SAHRA, an NSF Science & Technology Center, to investigate stakeholder-driven water sustainability issues within the semi-arid southwestern US. The multi-disciplinary, multi-resolution modeling framework incorporates a formal scenario approach to analyze the impacts of plausible (albeit uncertain) alternative futures to support adaptive management of water resources systems. Some of the major challenges involved in, and lessons learned from, this effort will be discussed.

Cloud-Based Data Sharing Connects Emergency Managers

NASA Technical Reports Server (NTRS)

2014-01-01

Under an SBIR contract with Stennis Space Center, Baltimore-based StormCenter Communications Inc. developed an improved interoperable platform for sharing geospatial data over the Internet in real time-information that is critical for decision makers in emergency situations.

American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience.

PubMed

Joseph, Bellal; Azim, Asad; O'Keeffe, Terence; Ibraheem, Kareem; Kulvatunyou, Narong; Tang, Andrew; Vercruysse, Gary; Friese, Randall; Latifi, Rifat; Rhee, Peter

2017-04-01

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance. Retrospective analysis of the latest publicly available HCAHPS data (2014-2015) was performed. American College of Surgeons (ACS) verified Level I trauma centers for each state were identified from the ACS registry and then the following data points were collected for each hospital: HCAHPS linear mean scores regarding cleanliness of the hospital, doctor and nurse communication with the patient, staff responsiveness, pain management, overall hospital rating, and patient willingness to recommend the hospital. Our outcome measure were serious complication scores, failure-to-rescue (FTR) scores and readmission-after-discharge scores. Spearman correlation analysis was performed. A total of 119 ACS verified Level I trauma centers across 46 states were included. The median [IQR] overall hospital rating score for Level I trauma centers was 89 (87-90). The mean ± SD score for serious complication was 0.96 ± 0.266, FTR was 123.06 ± 22.5, and readmission after discharge was 15.71 ± 1.07. The Spearman correlation analysis showed that overall HCAHP-based hospital rating scores did not correlate with serious complications (correlation coefficient = 0.14 p = 0.125), FTR (correlation coefficient = -0.15 p = 0.073), or readmission after discharge (correlation coefficient = -0.18 p = 0.053). The findings of our study suggest that no correlation exists between HCAHPS patient satisfaction scores and hospital performance for Level I trauma centers. Consequently, the Centers of Medicare and Medicaid Services should reconsider hospital reimbursement decisions based on HCAHP patient satisfaction scores. Prognostic/epidemiologic study, level III; therapeutic study, level IV.

NewYork-Presbyterian Hospital: translating innovation into practice.

PubMed

Johnson, Trudy; Currie, Gail; Keill, Patricia; Corwin, Steven J; Pardes, Herbert; Cooper, Mary Reich

2005-10-01

NewYork-Presbyterian (NYP) Hospital, a 2,242-bed not-for-profit academic medical center, was formed by a merger of The New York Hospital and The Presbyterian Hospital in the City of New York. It is also the flagship for the NewYork-Presbyterian Healthcare System, with 37 acute care facilities and 18 others. The hospital embeds safety in the culture through strategic initiatives and enhances service and efficiency using Six Sigma and other techniques to drive adoption of improvements. Goals are selected in alignment with the annual strategic initiatives, which are chosen on the basis of satisfaction surveys, patient and family complaints, community advisory groups, and performance measures, among other sources. A new business intelligence system enables online, dynamic analysis of performance results, replacing static paper reports. Advanced features in the clinical information systems include computerized physician order entry; interactive clinical alerts for decision support; a real-time infection control tracking system; and a clinical data warehouse supporting data mining and analysis for quality improvement, decision making, and education. To achieve clinical, service, and operational excellence, NYP focuses on all Institute of Medicine quality aims.

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

PubMed

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

2015-01-01

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

How To Start a Child Care Center.

ERIC Educational Resources Information Center

Benner, Phylis M., Comp.; Hollestelle, Kay, Comp.

This paper is addressed to those who want to start their own child care center, and provides guidelines for doing so. It identifies the first things to be considered--planning and conducting a community needs assessment to analyze the competition in the area and make the decision of opening a day care center, and gathering information from a…

Evaluation of Automatic Item Generation Utilities in Formative Assessment Application for Korean High School Students

ERIC Educational Resources Information Center

Choi, Jaehwa; Kim, HeeKyoung; Pak, Seohong

2018-01-01

The recent interests in research in the assessment field have been rapidly shifting from decision-maker-centered assessments to learner-centered assessments (i.e., diagnostic and/or formative assessments). In particular, it is a very important research topic in this field to analyze how these learner-centered assessments are developed more…

42 CFR 422.1092 - Revision of reopened decision.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Revision of reopened decision. 422.1092 Section 422.1092 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil Money...

The Way We Learn

ERIC Educational Resources Information Center

Caine, Renate Nummela; Caine, Geoffrey

2006-01-01

Although students' eclecticism can be overwhelming, all students are identical in at least one respect--they are biologically equipped to learn from experiences. Caine and Caine discuss neurological findings about decision-making capacities built into the brain. They describe Elkhonen Goldberg's concept of actor-centered adaptive decision making…

Alternative Fuels Data Center: Workplace Charging Success: Zappos.com

Science.gov Websites

proud to say that Zappos has been very supportive of employees who have made the decision to be more technology. I'm proud to say that Zappos has been very supportive of employees who have made the decision to

Polar body biopsy in the diagnosis of monogenic diseases: the birth of three healthy children.

PubMed

Griesinger, Georg; Bündgen, Nana; Salmen, Diana; Schwinger, Eberhard; Gillessen-Kaesbach, Gabriele; Diedrich, Klaus

2009-08-01

For prospective parents at risk of transmitting a monogenic disease, polar body analysis is an option for pre-conception genetic diagnosis. In Germany, polar body analysis is currently performed in only two centers (Lübeck and Regensburg). The authors present a clinical series of 9 couples at risk for the transmission of a monogenic disease who underwent in vitro fertilization with polar body analysis. Nine couples have undergone in vitro fertilization with polar body analysis at the center in Lübeck since 2004. Three healthy children were born after polar body analysis for mucopolysaccharidosis type I, incontinentia pigmenti, and cystic fibrosis. The decision to undergo in vitro fertilization with polar body analysis is not easy for prospective parents to take, even though it often follows years of emotional suffering. Treatment with the methods of reproductive medicine in general, and with polar body analysis in particular, can cause considerable physical and emotional stress. For prospective parents in Germany at risk of transmitting a monogenic disease, polar body-based preimplantation diagnosis is an alternative to prenatal diagnosis and possible termination of pregnancy. The live birth rate per treatment cycle in this clinical series was 30%, which can be considered satisfactory. Nonetheless, most of the couples who did not achieve pregnancy after a first treatment cycle dropped out of treatment prematurely and did not go on to a second cycle.

Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial.

PubMed

Sung, Vivian W; Borello-France, Diane; Dunivan, Gena; Gantz, Marie; Lukacz, Emily S; Moalli, Pamela; Newman, Diane K; Richter, Holly E; Ridgeway, Beri; Smith, Ariana L; Weidner, Alison C; Meikle, Susan

2016-10-01

Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.

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

PubMed

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

2017-02-01

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

Coronal Mass Ejection Data Clustering and Visualization of Decision Trees

NASA Astrophysics Data System (ADS)

Ma, Ruizhe; Angryk, Rafal A.; Riley, Pete; Filali Boubrahimi, Soukaina

2018-05-01

Coronal mass ejections (CMEs) can be categorized as either “magnetic clouds” (MCs) or non-MCs. Features such as a large magnetic field, low plasma-beta, and low proton temperature suggest that a CME event is also an MC event; however, so far there is neither a definitive method nor an automatic process to distinguish the two. Human labeling is time-consuming, and results can fluctuate owing to the imprecise definition of such events. In this study, we approach the problem of MC and non-MC distinction from a time series data analysis perspective and show how clustering can shed some light on this problem. Although many algorithms exist for traditional data clustering in the Euclidean space, they are not well suited for time series data. Problems such as inadequate distance measure, inaccurate cluster center description, and lack of intuitive cluster representations need to be addressed for effective time series clustering. Our data analysis in this work is twofold: clustering and visualization. For clustering we compared the results from the popular hierarchical agglomerative clustering technique to a distance density clustering heuristic we developed previously for time series data clustering. In both cases, dynamic time warping will be used for similarity measure. For classification as well as visualization, we use decision trees to aggregate single-dimensional clustering results to form a multidimensional time series decision tree, with averaged time series to present each decision. In this study, we achieved modest accuracy and, more importantly, an intuitive interpretation of how different parameters contribute to an MC event.

The Infusion of Dust Model Model Outputs into Public Health Decision Making - an Examination of Differential Adoption of SOAP and Open Geospatial Consortium Service Products into Public Health Decision Support Systems

NASA Astrophysics Data System (ADS)

Benedict, K. K.

2008-12-01

Since 2004 the Earth Data Analysis Center, in collaboration with the researchers at the University of Arizona and George Mason University, with funding from NASA, has been developing a services oriented architecture (SOA) that acquires remote sensing, meteorological forecast, and observed ground level particulate data (EPA AirNow) from NASA, NOAA, and DataFed through a variety of standards-based service interfaces. These acquired data are used to initialize and set boundary conditions for the execution of the Dust Regional Atmospheric Model (DREAM) to generate daily 48-hour dust forecasts, which are then published via a combination of Open Geospatial Consortium (OGC) services (WMS and WCS), basic HTTP request-based services, and SOAP services. The goal of this work has been to develop services that can be integrated into existing public health decision support systems (DSS) to provide enhanced environmental data (i.e. ground surface particulate concentration estimates) for use in epidemiological analysis, public health warning systems, and syndromic surveillance systems. While the project has succeeded in deploying these products into the target systems, there has been differential adoption of the different service interface products, with the simple OGC and HTTP interfaces generating much greater interest by DSS developers and researchers than the more complex SOAP service interfaces. This paper reviews the SOA developed as part of this project and provides insights into how different service models may have a significant impact on the infusion of Earth science products into decision making processes and systems.

A Tentative Career Development Curriculum and Its Implications for the Patterning of Supervisory Responsibilities in the Information System for Vocational Decisions. Information System for Vocational Decisions. Project Report Number 10.

ERIC Educational Resources Information Center

Fletcher, Wallace J.; And Others

The goals of the Information System for Vocational Decisions (ISVD), a computerized vocational development program which emphasized goal setting and purposeful action, are related to a tentative curriculum context called a Career Development Program. This Program is learner centered with process and subject matter a function of individual…

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

The doctor-patient relationship as a toolkit for uncertain clinical decisions.

PubMed

Diamond-Brown, Lauren

2016-06-01

Medical uncertainty is a well-recognized problem in healthcare, yet how doctors make decisions in the face of uncertainty remains to be understood. This article draws on interdisciplinary literature on uncertainty and physician decision-making to examine a specific physician response to uncertainty: using the doctor-patient relationship as a toolkit. Additionally, I ask what happens to this process when the doctor-patient relationship becomes fragmented. I answer these questions by examining obstetrician-gynecologists' narratives regarding how they make decisions when faced with uncertainty in childbirth. Between 2013 and 2014, I performed 21 semi-structured interviews with obstetricians in the United States. Obstetricians were selected to maximize variation in relevant physician, hospital, and practice characteristics. I began with grounded theory and moved to analytical coding of themes in relation to relevant literature. My analysis renders it evident that some physicians use the doctor-patient relationship as a toolkit for dealing with uncertainty. I analyze how this process varies for physicians in different models of care by comparing doctors' experiences in models with continuous versus fragmented doctor-patient relationships. My key findings are that obstetricians in both models appealed to the ideal of patient-centered decision-making to cope with uncertain decisions, but in practice physicians in fragmented care faced a number of challenges to using the doctor-patient relationship as a toolkit for decision-making. These challenges led to additional uncertainties and in some cases to poor outcomes for doctors and/or patients; they also raised concerns about the reproduction of inequality. Thus organization of care delivery mitigates the efficacy of doctors' use of the doctor-patient relationship toolkit for uncertain decisions. These findings have implications for theorizing about decision-making under conditions of medical uncertainty, for understanding how the doctor-patient relationship and model of care affect physician decision-making, and for forming policy on the optimal structure of medical work. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Comparative Evaluation of Public Health Centers with Private Health Training Centers on Primary Healthcare Parameters in India: a Study by Data Envelopment Analysis Technique

PubMed Central

Davey, Sanjeev; Raghav, Santosh Kumar; Singh, Jai Vir; Davey, Anuradha; Singh, Nirankar

2015-01-01

Background: The evaluation of primary healthcare services provided by health training centers of a private medical college has not been studied in comparison with government health facilities in Indian context. Data envelopment analysis (DEA) is one such technique of operations research, which can be used on health facilities for identifying efficient operating practices and strategies for relatively efficient or inefficient health centers by calculating their efficiency scores. Materials and Methods: This study was carried out by DEA technique by using basic radial models (constant ratio to scale (CRS)) in linear programming via DEAOS free online Software among four decision making units (DMUs; by comparing efficiency of two private health centers of a private medical college of India with two public health centers) in district Muzaffarnagar of state Uttar Pradesh. The input and output records of all these health facilities (two from private and two from Government); for 6 months duration from 1st Jan 2014 to 1st July 2014 was taken for deciding their efficiency scores. Results: The efficiency scores of primary healthcare services in presence of doctors (100 vs 30%) and presence of health staff (100 vs 92%) were significantly better from government health facilities as compared to private health facilities (P < 0.0001). Conclusions: The evaluation of primary healthcare services delivery by DEA technique reveals that the government health facilities group were more efficient in delivery of primary healthcare services as compared to private training health facilities group, which can be further clarified in by more in-depth studies in future. PMID:26435598

Quality of pancreatic transplant program assessment using a risk-adjusted cumulative sum chart: experience from a single, small center.

PubMed

Grochowiecki, T; Jakimowicz, T; Grabowska-Derlatka, L; Szmidt, J

2014-10-01

The high rate of complication after pancreas transplantation not only had an impact on recipient quality of life and survival but also had significant financial implications. Thus, monitoring transplant center performance was crucial to indentifying changes in clinical practice that result in quality deterioration. To evaluate retrospectively the quality of the single, small pancreatic transplant program and to establish prospective monitoring of the center using risk-adjusted cumulative sum (CUSUM). From 1988 to 2014, 119 simultaneous pancreas and the kidney transplantations (SPKTx) were performed. The program was divided into 3 eras, based on surgical technique and immunosuppression. Analyses of the 15 fatal outcomes due to complication from pancreatic graft were performed. The risk model was developed using multivariable logistic regression analysis based on retrospective data of 112 SPKTx recipients. The risk-adjusted 1-sided CUSUM chart was plotted for retrospective and prospective events. The upper control limit was set to 2. There were 2 main causes of death: multiorgan failure (73.3%; 11/15) and septic hemorrhage (26.7%; 4/15). Quality analysis using the CUSUM chart revealed that the process was not homogeneous; however, no significant signal of program deterioration was obtained and the performance of the whole program was within the settled control limit. For a single pancreatic transplant center. The risk-adjusted CUSUM chart was a useful tool for quality program assessment. It could support decision making during traditional surgical morbidity and mortality conferences. For small transplant centers, increasing the sensitivity of the CUSUM method by lowering the upper control limit should be considered. However, an individual assessment approach of the for particular centers is recommended.

An Operational Perspective of Total Lightning Information

NASA Technical Reports Server (NTRS)

Nadler, David J.; Darden, Christopher B.; Stano, Geoffrey; Buechler, Dennis E.

2009-01-01

The close and productive collaborations between the NWS Warning and Forecast Office, the Short Term Prediction and Research Transition Center at NASA Marshall Space Flight Center and the University of Alabama in Huntsville have provided a unique opportunity for science sharing and technology transfer. One significant technology transfer that has provided immediate benefits to NWS forecast and warning operations is the use of data from the North Alabama Lightning Mapping Array. This network consists of ten VHF receivers deployed across northern Alabama and a base station located at the National Space Science and Technology Center. Preliminary investigations done at WFO Huntsville, along with other similar total lightning networks across the country, have shown distinct correlations between the time rate-of-change of total lightning and trends in intensity/severity of the parent convective cell. Since May 2003 when WFO HUN began receiving these data - in conjunction with other more traditional remotely sensed data (radar, satellite, and surface observations) -- have improved the situational awareness of the WFO staff. The use of total lightning information, either from current ground based systems or future space borne instrumentation, may substantially contribute to the NWS mission, by enhancing severe weather warning and decision-making processes. Operational use of the data has been maximized at WFO Huntsville through a process that includes forecaster training, product implementation, and post event analysis and assessments. Since receiving these data, over 50 surveys have been completed highlighting the use of total lightning information during significant events across the Tennessee Valley. In addition, around 150 specific cases of interest have been archived for collaborative post storm analysis. From these datasets, detailed trending information from radar and total lightning can be compared to corresponding damage reports. This presentation will emphasize the effective use of total lightning information in warning decision making along with best practices for implementation of new technologies into operations.

Energy-Aware Computation Offloading of IoT Sensors in Cloudlet-Based Mobile Edge Computing.

PubMed

Ma, Xiao; Lin, Chuang; Zhang, Han; Liu, Jianwei

2018-06-15

Mobile edge computing is proposed as a promising computing paradigm to relieve the excessive burden of data centers and mobile networks, which is induced by the rapid growth of Internet of Things (IoT). This work introduces the cloud-assisted multi-cloudlet framework to provision scalable services in cloudlet-based mobile edge computing. Due to the constrained computation resources of cloudlets and limited communication resources of wireless access points (APs), IoT sensors with identical computation offloading decisions interact with each other. To optimize the processing delay and energy consumption of computation tasks, theoretic analysis of the computation offloading decision problem of IoT sensors is presented in this paper. In more detail, the computation offloading decision problem of IoT sensors is formulated as a computation offloading game and the condition of Nash equilibrium is derived by introducing the tool of a potential game. By exploiting the finite improvement property of the game, the Computation Offloading Decision (COD) algorithm is designed to provide decentralized computation offloading strategies for IoT sensors. Simulation results demonstrate that the COD algorithm can significantly reduce the system cost compared with the random-selection algorithm and the cloud-first algorithm. Furthermore, the COD algorithm can scale well with increasing IoT sensors.

An extreme events laboratory to provide network centric collaborative situation assessment and decision making

NASA Astrophysics Data System (ADS)

Panulla, Brian J.; More, Loretta D.; Shumaker, Wade R.; Jones, Michael D.; Hooper, Robert; Vernon, Jeffrey M.; Aungst, Stanley G.

2009-05-01

Rapid improvements in communications infrastructure and sophistication of commercial hand-held devices provide a major new source of information for assessing extreme situations such as environmental crises. In particular, ad hoc collections of humans can act as "soft sensors" to augment data collected by traditional sensors in a net-centric environment (in effect, "crowd-sourcing" observational data). A need exists to understand how to task such soft sensors, characterize their performance and fuse the data with traditional data sources. In order to quantitatively study such situations, as well as study distributed decision-making, we have developed an Extreme Events Laboratory (EEL) at The Pennsylvania State University. This facility provides a network-centric, collaborative situation assessment and decision-making capability by supporting experiments involving human observers, distributed decision making and cognition, and crisis management. The EEL spans the information chain from energy detection via sensors, human observations, signal and image processing, pattern recognition, statistical estimation, multi-sensor data fusion, visualization and analytics, and modeling and simulation. The EEL command center combines COTS and custom collaboration tools in innovative ways, providing capabilities such as geo-spatial visualization and dynamic mash-ups of multiple data sources. This paper describes the EEL and several on-going human-in-the-loop experiments aimed at understanding the new collective observation and analysis landscape.

X-33 Environmental Impact Statement: A Fast Track Approach

NASA Technical Reports Server (NTRS)

McCaleb, Rebecca C.; Holland, Donna L.

1998-01-01

NASA is required by the National Environmental Policy Act (NEPA) to prepare an appropriate level environmental analysis for its major projects. Development of the X-33 Technology Demonstrator and its associated flight test program required an environmental impact statement (EIS) under the NEPA. The EIS process is consists of four parts: the "Notice of Intent" to prepare an EIS and scoping; the draft EIS which is distributed for review and comment; the final ETS; and the "Record of Decision." Completion of this process normally takes from 2 - 3 years, depending on the complexity of the proposed action. Many of the agency's newest fast track, technology demonstration programs require NEPA documentation, but cannot sustain the lengthy time requirement between program concept development to implementation. Marshall Space Flight Center, in cooperation with Kennedy Space Center, accomplished the NEPA process for the X-33 Program in 13 months from Notice of Intent to Record of Decision. In addition, the environmental team implemented an extensive public involvement process, conducting a total of 23 public meetings for scoping and draft EIS comment along with numerous informal meetings with public officials, civic organizations, and Native American Indians. This paper will discuss the fast track approach used to successfully accomplish the NEPA process for X-33 on time.

Genetic counselor perceptions of genetic counseling session goals: a validation study of the reciprocal-engagement model.

PubMed

Hartmann, Julianne E; Veach, Patricia McCarthy; MacFarlane, Ian M; LeRoy, Bonnie S

2015-04-01

Although some researchers have attempted to define genetic counseling practice goals, no study has obtained consensus about the goals from a large sample of genetic counselors. The Reciprocal-Engagement Model (REM; McCarthy Veach, Bartels & LeRoy, 2007) articulates 17 goals of genetic counseling practice. The present study investigated whether these goals could be generalized as a model of practice, as determined by a larger group of clinical genetic counselors. Accordingly, 194 genetic counselors were surveyed regarding their opinions about the importance of each goal and their perceptions of how frequently they achieve each goal. Mean importance ratings suggest they viewed every goal as important. Factor analysis of the 17 goals yielded four factors: Understanding and Appreciation, Support and Guidance, Facilitative Decision-Making, and Patient-Centered Education. Patient-Centered Education and Facilitative Decision-Making goals received the highest mean importance ratings. Mean frequency ratings were consistently lower than importance ratings, suggesting genetic counseling goals may be difficult to achieve and/or not applicable in all situations. A number of respondents provided comments about the REM goals that offer insight into factors related to implementing the goals in clinical practice. This study presents preliminary evidence concerning the validity of the goals component of the REM.

Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.

PubMed

Kataoka, Yaeko; Masuzawa, Yuko; Kato, Chiho; Eto, Hiromi

2018-01-01

In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals. This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes. © 2017 Japan Academy of Nursing Science.

Fitts' Law? a Test of the Relationship Between Information Load and Movement Precision

NASA Technical Reports Server (NTRS)

Zalaski, M.; Sanderson, P.

1984-01-01

The independence of information load (Hick's Law) and movement precision (Fitts' Law) was tested using additive factors methodology. Subjects were required to classify stimuli according to a decision rule with a variable entropy. The stimuli were presented in the center of the CRT screen. In response, subjects had to move a cursor from a starting point near the stimulus to the appropriate target. The precision of the response movement was varied by manipulating the ratio of the radius of the annulus to the width of the target area. The dependent measure was elapsed time between onset of the stimulus and completion of the response movement. Independence of the Hick's Law and Fitts' Law components of the reaction time was tested with an analysis of variance. Presence of an interaction would suggest that a decision stage and a response stage are dependent, and cannot be considered discrete steps in a serial process.

Factors Influencing the Decision to Receive an Influenza Vaccination Among Manufacturing Plant and Day Care Center Employees.

PubMed

McKeirnan, Kimberly C

2016-05-01

To improve influenza immunization rates, it is essential to understand why adults are not immunized and the factors that influence their decisions. This information can be used to tailor educational materials and outreach. © 2016 The Author(s).

42 CFR 423.1092 - Revision of reopened decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Revision of reopened decision. 423.1092 Section 423.1092 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Appeal Procedures for Civil Money...

42 CFR 422.1092 - Revision of reopened decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Revision of reopened decision. 422.1092 Section 422.1092 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil Money Penalties § 422...

Pervasive Agility and Agile Fires in Support of Decisive Action

DTIC Science & Technology

2012-03-29

Pervasive Agility and Agile Fires in Support of Decisive Action FORMAT: Civilian Research Project DATE: 29 March 2012 WORD COUNT : 12,599 PAGES: 54...will face, this pollenization may require creative measures, perhaps virtual or constructive scenarios. The National Training Center at Fort Irwin

32 CFR 1802.26 - Notification of decision and prohibition on adverse action.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NATIONAL COUNTERINTELLIGENCE CENTER CHALLENGES TO CLASSIFICATION OF DOCUMENTS BY AUTHORIZED HOLDERS... regard to the challenge and that an appeal of the decision may be made to the Interagency Security Classification Appeals Panel (ISCAP) established pursuant to § 5.4 of this Order. ...

32 CFR 1802.26 - Notification of decision and prohibition on adverse action.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NATIONAL COUNTERINTELLIGENCE CENTER CHALLENGES TO CLASSIFICATION OF DOCUMENTS BY AUTHORIZED HOLDERS... regard to the challenge and that an appeal of the decision may be made to the Interagency Security Classification Appeals Panel (ISCAP) established pursuant to § 5.4 of this Order. ...

A quantitative analysis of optimal treatment capacity for perinatal asphyxia.

PubMed

Geva, Alon; Gray, James

2012-01-01

In centers electing to offer therapeutic hypothermia for treating hypoxic-ischemic encephalopathy (HIE), determining the optimal number of cooling devices is not straightforward. The authors used computer-based modeling to determine the level of service as a function of local HIE caseload and number of cooling devices available. The authors used discrete event simulation to create a model that varied the number of HIE cases and number of cooling devices available. Outcomes of interest were percentage of HIE-affected infants not cooled, number of infants not cooled, and percentage of time that all cooling devices were in use. With 1 cooling device, even the smallest perinatal center did not achieve a cooling rate of 99% of eligible infants. In contrast, 2 devices ensured 99% service in centers treating as many as 20 infants annually. In centers averaging no more than 1 HIE infant monthly, the addition of a third cooling device did not result in a substantial reduction in the number of infants who would not be cooled. Centers electing to offer therapeutic hypothermia with only a single cooling device are at significant risk of being unable to provide treatment to eligible infants, whereas 2 devices appear to suffice for most institutions treating as many as 20 annual HIE cases. Three devices would rarely be needed given current caseloads seen at individual institutions. The quantitative nature of this analysis allows decision makers to determine the number of devices necessary to ensure adequate availability of therapeutic hypothermia given the HIE caseload of a particular institution.

Superfund record of decision (EPA Region 3): US Defense General Supply Center, Operable Unit 9, Chesterfield County, VA, September 1993

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

Not Available

1993-09-01

The decision document presents the selected interim remedial action for Operable Unit 9 (OU9) at the Defense General Supply Center (DGSC) in Chesterfield County, Virginia near Richmond. OU9 pertains to groundwater beneath Area 50, the Open Storage Area (OSA), and the Naitonal Guard Area (NGA). This operable unit is the third of nine operable units that are currently being addressed at the DGSC. OU9 addresses interim treatment and containment of groundwater in the upper and lower aquifers beneath Area 50, the OSA, and the NGA.

Police Officer, Deal-Maker, or Healthcare Provider? Moving to a Patient-Centered Framework for Chronic Opioid Management

PubMed Central

Nicolaidis, Christina

2016-01-01

How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be non-judgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the APS/AAPM guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This paper discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic non-malignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. PMID:21539703

[Evaluation of multidisciplinary team meeting; the example of gynecological mammary cancers in a tertiary referral center in Morocco].

PubMed

Chaouki, Wahid; Mimouni, Mohsine; Boutayeb, Saber; Hachi, Hafid; Errihani, Hassan; Benjaafar, Noureddine

The multidisciplinary team meeting has become a standard medical practice in oncology. However, no evaluation of this activity was carried out in Morocco. The aim of this study was to evaluate the multidisciplinary team meeting of gynecological mammary cancers in a National Tertiary Referral Center. The study was carried out by retrospective analysis of 207 cases of patients randomly selected among the 1190 cases recruited during the year 2015. Completeness and quality criteria were evaluated. The global completeness rate of passage in multidisciplinary team meeting is 38%. According to the therapeutic specialities, the completeness of passage in multidisciplinary team meeting is 68% of surgery, 35% of medical oncology and 19% of radiotherapy. As far as localizations are concerned, the completeness of passage in multidisciplinary team meeting is 43% for the breast and only 19% for the cervix. A quorum was met 100% of the cases. In 96% of cases the treatment performed is in accordance with the decision of the multidisciplinary team meeting. Eighty-four percent of cases performed multidisciplinary team meeting within less than one month. This analysis shows that the completeness of the transition to multidisciplinary team meeting has not reached the 100% planned by our institution. However, the requirements for conducting the multidisciplinary team meeting were generally met. This study shows an organizational evolution of our structure based on collective and multidisciplinary medical decision. The national obligation measure of multidisciplinary team meeting is necessary. Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database.

PubMed

Bianchi, Lorenzo; Schiavina, Riccardo; Borghesi, Marco; Bianchi, Federico Mineo; Briganti, Alberto; Carini, Marco; Terrone, Carlo; Mottrie, Alex; Gacci, Mauro; Gontero, Paolo; Imbimbo, Ciro; Marchioro, Giansilvio; Milanese, Giulio; Mirone, Vincenzo; Montorsi, Francesco; Morgia, Giuseppe; Novara, Giacomo; Porreca, Angelo; Volpe, Alessandro; Brunocilla, Eugenio

2018-04-06

To assess the predictive accuracy and the clinical value of a recent nomogram predicting cancer-specific mortality-free survival after surgery in pN1 prostate cancer patients through an external validation. We evaluated 518 prostate cancer patients treated with radical prostatectomy and pelvic lymph node dissection with evidence of nodal metastases at final pathology, at 10 tertiary centers. External validation was carried out using regression coefficients of the previously published nomogram. The performance characteristics of the model were assessed by quantifying predictive accuracy, according to the area under the curve in the receiver operating characteristic curve and model calibration. Furthermore, we systematically analyzed the specificity, sensitivity, positive predictive value and negative predictive value for each nomogram-derived probability cut-off. Finally, we implemented decision curve analysis, in order to quantify the nomogram's clinical value in routine practice. External validation showed inferior predictive accuracy as referred to in the internal validation (65.8% vs 83.3%, respectively). The discrimination (area under the curve) of the multivariable model was 66.7% (95% CI 60.1-73.0%) by testing with receiver operating characteristic curve analysis. The calibration plot showed an overestimation throughout the range of predicted cancer-specific mortality-free survival rates probabilities. However, in decision curve analysis, the nomogram's use showed a net benefit when compared with the scenarios of treating all patients or none. In an external setting, the nomogram showed inferior predictive accuracy and suboptimal calibration characteristics as compared to that reported in the original population. However, decision curve analysis showed a clinical net benefit, suggesting a clinical implication to correctly manage pN1 prostate cancer patients after surgery. © 2018 The Japanese Urological Association.

Extending The P4P Agenda, Part 1: How Medicare Can Improve Patient Decision Making And Reduce Unnecessary Care

PubMed Central

Wennberg, John E.; O'Connor, Annette M.; Collins, E. Dale; Weinstein, James N.

2008-01-01

The decision to undergo many discretionary medical treatments should be based on informed patient choice. Shared decision making is an effective strategy for achieving this goal. The Centers for Medicare and Medicaid Services (CMS) should extend its pay-for-performance (P4P) agenda to assure that all Americans have access to a certified shared decision-making process. This paper outlines a strategy to achieve informed patient choice as the standard of practice for preference-sensitive care. PMID:17978377

34 CFR 366.46 - How does the Secretary review a center's appeal of a decision included in a Director's initial...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 366.46 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION CENTERS FOR INDEPENDENT LIVING... 34 Education 2 2011-07-01 2010-07-01 true How does the Secretary review a center's appeal of a...

34 CFR 366.46 - How does the Secretary review a center's appeal of a decision included in a Director's initial...

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 366.46 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION CENTERS FOR INDEPENDENT LIVING... 34 Education 2 2010-07-01 2010-07-01 false How does the Secretary review a center's appeal of a...

Decision support system for health care resources allocation

PubMed Central

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-01-01

Background A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. Aim The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. Methods To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. Results A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. Conclusion In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff. PMID:28848645

Decision support system for health care resources allocation.

PubMed

Sebaa, Abderrazak; Nouicer, Amina; Tari, AbdelKamel; Tarik, Ramtani; Abdellah, Ouhab

2017-06-01

A study about healthcare resources can improve decisions regarding the allotment and mobilization of medical resources and to better guide future investment in the health sector. The aim of this work was to design and implement a decision support system to improve medical resources allocation of Bejaia region. To achieve the retrospective cohort study, we integrated existing clinical databases from different Bejaia department health sector institutions (an Algerian department) to collect information about patients from January 2015 through December 2015. Data integration was performed in a data warehouse using the multi-dimensional model and OLAP cube. During implementation, we used Microsoft SQL server 2012 and Microsoft Excel 2010. A medical decision support platform was introduced, and was implemented during the planning stages allowing the management of different medical orientations, it provides better apportionment and allotment of medical resources, and ensures that the allocation of health care resources has optimal effects on improving health. In this study, we designed and implemented a decision support system which would improve health care in Bejaia department to especially assist in the selection of the optimum location of health center and hospital, the specialty of the health center, the medical equipment and the medical staff.

Integrated System of Structural Health Monitoring and Intelligent Management for a Cable-Stayed Bridge

PubMed Central

Chen, Bin; Wang, Xu; Sun, Dezhang; Xie, Xu

2014-01-01

It is essential to construct structural health monitoring systems for large important bridges. Zhijiang Bridge is a cable-stayed bridge that was built recently over the Hangzhou Qiantang River (the largest river in Zhejiang Province). The length of Zhijiang Bridge is 478 m, which comprises an arched twin-tower space and a twin-cable plane structure. As an example, the present study describes the integrated system of structural health monitoring and intelligent management for Zhijiang Bridge, which comprises an information acquisition system, data management system, evaluation and decision-making system, and application service system. The monitoring components include the working environment of the bridge and various factors that affect bridge safety, such as the stress and strain of the main bridge structure, vibration, cable force, temperature, and wind speed. In addition, the integrated system includes a forecasting and decision-making module for real-time online evaluation, which provides warnings and makes decisions based on the monitoring information. From this, the monitoring information, evaluation results, maintenance decisions, and warning information can be input simultaneously into the bridge monitoring center and traffic emergency center to share the monitoring data, thereby facilitating evaluations and decision making using the system. PMID:25140342

Integrated system of structural health monitoring and intelligent management for a cable-stayed bridge.

PubMed

Chen, Bin; Wang, Xu; Sun, Dezhang; Xie, Xu

2014-01-01

It is essential to construct structural health monitoring systems for large important bridges. Zhijiang Bridge is a cable-stayed bridge that was built recently over the Hangzhou Qiantang River (the largest river in Zhejiang Province). The length of Zhijiang Bridge is 478 m, which comprises an arched twin-tower space and a twin-cable plane structure. As an example, the present study describes the integrated system of structural health monitoring and intelligent management for Zhijiang Bridge, which comprises an information acquisition system, data management system, evaluation and decision-making system, and application service system. The monitoring components include the working environment of the bridge and various factors that affect bridge safety, such as the stress and strain of the main bridge structure, vibration, cable force, temperature, and wind speed. In addition, the integrated system includes a forecasting and decision-making module for real-time online evaluation, which provides warnings and makes decisions based on the monitoring information. From this, the monitoring information, evaluation results, maintenance decisions, and warning information can be input simultaneously into the bridge monitoring center and traffic emergency center to share the monitoring data, thereby facilitating evaluations and decision making using the system.

Building an Information Resource Center for Competitive Intelligence.

ERIC Educational Resources Information Center

Martin, J. Sperling

1992-01-01

Outlines considerations in the design of a Competitive Intelligence Information Resource Center (CIIRC), which is needed by business organizations for effective strategic decision making. Discussed are user needs, user participation, information sources, technology and interface design, operational characteristics, and planning for implementation.…

An Automation Survival Guide for Media Centers.

ERIC Educational Resources Information Center

Whaley, Roger E.

1989-01-01

Reviews factors that should affect the decision to automate a school media center and offers suggestions for the automation process. Topics discussed include getting the library collection ready for automation, deciding what automated functions are needed, evaluating software vendors, selecting software, and budgeting. (CLB)

The NASA Short-term Prediction Research and Transition (SPoRT) Center: A Collaborative Model for Accelerating Research into Operations

NASA Technical Reports Server (NTRS)

Goodman, S. J.; Lapenta, W.; Jedlovec, G.; Dodge, J.; Bradshaw, T.

2003-01-01

The NASA Short-term Prediction Research and Transition (SPoRT) Center in Huntsville, Alabama was created to accelerate the infusion of NASA earth science observations, data assimilation and modeling research into NWS forecast operations and decision-making. The principal focus of experimental products is on the regional scale with an emphasis on forecast improvements on a time scale of 0-24 hours. The SPoRT Center research is aligned with the regional prediction objectives of the US Weather Research Program dealing with 0-1 day forecast issues ranging from convective initiation to 24-hr quantitative precipitation forecasting. The SPoRT Center, together with its other interagency partners, universities, and the NASA/NOAA Joint Center for Satellite Data Assimilation, provides a means and a process to effectively transition NASA Earth Science Enterprise observations and technology to National Weather Service operations and decision makers at both the global/national and regional scales. This paper describes the process for the transition of experimental products into forecast operations, current products undergoing assessment by forecasters, and plans for the future.

42 CFR 422.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Notice and effect of revised decision. 422.1094 Section 422.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil...

42 CFR 422.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Notice and effect of revised decision. 422.1094 Section 422.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil Money...

42 CFR 422.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Notice and effect of revised decision. 422.1094 Section 422.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil...

42 CFR 422.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Notice and effect of revised decision. 422.1094 Section 422.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil Money...

42 CFR 422.1094 - Notice and effect of revised decision.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Notice and effect of revised decision. 422.1094 Section 422.1094 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) MEDICARE ADVANTAGE PROGRAM Appeal procedures for Civil...

42 CFR 423.1086 - Effect of Departmental Appeals Board Decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... an affected party has a right to seek judicial review. (c) Special rules: Civil money penalty... 42 Public Health 3 2011-10-01 2011-10-01 false Effect of Departmental Appeals Board Decision. 423.1086 Section 423.1086 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

42 CFR 423.1086 - Effect of Departmental Appeals Board Decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... an affected party has a right to seek judicial review. (c) Special rules: Civil money penalty... 42 Public Health 3 2010-10-01 2010-10-01 false Effect of Departmental Appeals Board Decision. 423.1086 Section 423.1086 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND...

Crucial Decisions in American Higher Education.

ERIC Educational Resources Information Center

Cowley, W. H.

In an informal address, this David Jacks Professor of Higher Education offers a historical review of decision-making in American higher education. This discussion centers around these milestones: the founding of Harvard in 1636; the first alumni gift in 1648; faculty organization in 1725; annual subventions for state universities in 1805; the…

Euthanasia of Severely Handicapped Infants: Ethical Issues.

ERIC Educational Resources Information Center

Cohen, Libby

Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…

A Statistical Decision Model for Periodical Selection for a Specialized Information Center

ERIC Educational Resources Information Center

Dym, Eleanor D.; Shirey, Donald L.

1973-01-01

An experiment is described which attempts to define a quantitative methodology for the identification and evaluation of all possibly relevant periodical titles containing toxicological-biological information. A statistical decision model was designed and employed, along with yes/no criteria questions, a training technique and a quality control…

13 CFR 130.430 - Application decisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... CENTERS § 130.430 Application decisions. (a) The AA/SBDCs may approve, conditionally approve, or reject any application. In the event of a rejection, the AA/SBDCs shall communicate the reasons for rejection... resolve the specified matters to the AA/SBDCs' satisfaction within the allotted time period, SBA has the...

13 CFR 130.430 - Application decisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... CENTERS § 130.430 Application decisions. (a) The AA/SBDCs may approve, conditionally approve, or reject any application. In the event of a rejection, the AA/SBDCs shall communicate the reasons for rejection... resolve the specified matters to the AA/SBDCs' satisfaction within the allotted time period, SBA has the...

13 CFR 130.430 - Application decisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... CENTERS § 130.430 Application decisions. (a) The AA/SBDCs may approve, conditionally approve, or reject any application. In the event of a rejection, the AA/SBDCs shall communicate the reasons for rejection... resolve the specified matters to the AA/SBDCs' satisfaction within the allotted time period, SBA has the...

OASIS: PARAMETER ESTIMATION SYSTEM FOR AQUIFER RESTORATION MODELS, USER'S MANUAL VERSION 2.0

EPA Science Inventory

OASIS, a decision support system for ground water contaminant modeling, has been developed for the CPA by Rice University, through the National Center for Ground Water Research. As a decision support system, OASIS was designed to provide a set of tools which will help scientists ...

42 CFR 456.136 - Notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Notification of adverse decision. 456.136 Section 456.136 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...) through (h) is sent to— (a) The hospital administrator; (b) The attending physician; (c) The Medicaid...

42 CFR 456.136 - Notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Notification of adverse decision. 456.136 Section 456.136 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...) through (h) is sent to— (a) The hospital administrator; (b) The attending physician; (c) The Medicaid...