Screening Algorithm to Guide Decisions on Whether to Conduct a Health Impact Assessment

EPA Pesticide Factsheets

Provides a visual aid in the form of a decision algorithm that helps guide discussions about whether to proceed with an HIA. The algorithm can help structure, standardize, and document the decision process.

Human Judgment and Decision Making: Models and Applications.

ERIC Educational Resources Information Center

Loke, Wing Hong

This document notes that researchers study the processes involved in judgment and decision making and prescribe theories and models that reflect the behavior of the decision makers. It addresses the various models that are used to represent judgment and decision making, with particular interest in models that more accurately represent human…

30 CFR 761.16 - Submission and processing of requests for valid existing rights determinations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... rights. The decision document must explain how you have or have not satisfied all applicable elements of... appropriate. The agency must then proceed with the decision process under paragraph (e)(2) of this section. (4... statement that the agency will not make a decision on the merits of your request if, by the close of the...

Ten years of the International Patient Decision Aid Standards Collaboration: evolution of the core dimensions for assessing the quality of patient decision aids

PubMed Central

2013-01-01

In 2003, the International Patient Decision Aid Standards (IPDAS) Collaboration was established to enhance the quality and effectiveness of patient decision aids by establishing an evidence-informed framework for improving their content, development, implementation, and evaluation. Over this 10 year period, the Collaboration has established: a) the background document on 12 core dimensions to inform the original modified Delphi process to establish the IPDAS checklist (74 items); b) the valid and reliable IPDAS instrument (47 items); and c) the IPDAS qualifying (6 items), certifying (6 items + 4 items for screening), and quality criteria (28 items). The objective of this paper is to describe the evolution of the IPDAS Collaboration and discuss the standardized process used to update the background documents on the theoretical rationales, evidence and emerging issues underlying the 12 core dimensions for assessing the quality of patient decision aids. PMID:24624947

Information Retrieval: A Sequential Learning Process.

ERIC Educational Resources Information Center

Bookstein, Abraham

1983-01-01

Presents decision-theoretic models which intrinsically include retrieval of multiple documents whereby system responds to request by presenting documents to patron in sequence, gathering feedback, and using information to modify future retrievals. Document independence model, set retrieval model, sequential retrieval model, learning model,…

Relevance Judging, Evaluation, and Decision Making in Virtual Libraries: A Descriptive Study.

ERIC Educational Resources Information Center

Fitzgerald, Mary Ann; Galloway, Chad

2001-01-01

Describes a study that investigated the cognitive processes undergraduates used to select information while using a virtual library, GALILEO (Georgia Library Learning Online). Discusses higher order thinking processes, relevance judging, evaluation (critical thinking), decision making, reasoning involving documents, relevance-related reasoning,…

Situation awareness and documentation of changes that affect patient outcomes in progress notes.

PubMed

Tower, Marion; Chaboyer, Wendy

2014-05-01

To report on registered nurses' situation awareness as a precursor to decision-making when recording changes in patients' conditions. Progress notes are important to communicate patients' progress and detail changes in patients' conditions. However, documentation is often poorly completed. There is little work that examines nurses' decision-making during documentation. This study focused on describing situation awareness as a precursor to decision-making during documentation. This study used Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) work on situation awareness to guide and conceptualise information. The study was situated in a naturalistic paradigm to provide an interpretation of nurses' decision-making. Think-aloud research methods and semi-structured interviews were employed to illuminate decision-making processes. Audio recordings and interview texts were individually examined for evidence of cues, informed by Endsley's (Situation Awareness Analysis and Measurement, 2000, Lawrence Erlbaum Associates, NJ) descriptions of situation awareness. As patients' conditions changed, nurses used complex mental models and pattern-matching of information, drawing on all 3 levels of situation awareness during documentation. Level 1 situation awareness provided context, level 2 situation awareness signified a change in condition and its significance for the patient, and level 3 situation awareness was evident when nurses thought aloud about what this information indicated. Three themes associated with changes in patients' conditions emerged: deterioration in condition, not responding to prescribed treatments as expected and issues related to professional practice that impacted on patients' conditions. Nurses used a complex mental model for decision-making, drawing on 3 levels of situation awareness. Hamm's cognitive continuum theory, when related to situation awareness, is a useful decision-making theory to provide a platform on which to draw together components of situation awareness and provide a framework on which to base decision-making regarding documentation. Understanding how RNs employ situation awareness and providing a framework for decision-making during documentation may assist effective documentation about changes in patients' conditions. © 2013 John Wiley & Sons Ltd.

Incentivizing shared decision making in the USA--where are we now?

PubMed

Durand, Marie-Anne; Barr, Paul J; Walsh, Thom; Elwyn, Glyn

2015-06-01

The Affordable Care Act raised significant interest in the process of shared decision making, the role of patient decision aids, and incentivizing their utilization. However, it has not been clear how best to put incentives into practice, and how the implementation of shared decision making and the use of patient decision aids would be measured. Our goal was to review developments and proposals put forward. We performed a qualitative document analysis following a pragmatic search of Medline, Google, Google Scholar, Business Source Complete (Ebscohost), and LexisNexis from 2009-2013 using the following key words: "Patient Protection and Affordable Care Act", "Decision Making", "Affordable Care Act", "Shared Decision Making", "measurement", "incentives", and "payment." We observed a lack of clarity about how to measure shared decision making, about how best to reward the use of patient decisions aids, and therefore how best to incentivize the process. Many documents clearly imply that providing and disseminating patient decision aids might be equivalent to shared decision making. However, there is little evidence that these tools, when used by patients in advance of clinical encounters, lead to significant change in patient-provider communication. The assessment of shared decision making for performance management remains challenging. Efforts to incentivize shared decision making are at risk of being limited to the promotion of patient decision aids, passing over the opportunity to influence the communication processes between patients and providers. Copyright © 2014 Elsevier Inc. All rights reserved.

Creation of structured documentation templates using Natural Language Processing techniques.

PubMed

Kashyap, Vipul; Turchin, Alexander; Morin, Laura; Chang, Frank; Li, Qi; Hongsermeier, Tonya

2006-01-01

Structured Clinical Documentation is a fundamental component of the healthcare enterprise, linking both clinical (e.g., electronic health record, clinical decision support) and administrative functions (e.g., evaluation and management coding, billing). One of the challenges in creating good quality documentation templates has been the inability to address specialized clinical disciplines and adapt to local clinical practices. A one-size-fits-all approach leads to poor adoption and inefficiencies in the documentation process. On the other hand, the cost associated with manual generation of documentation templates is significant. Consequently there is a need for at least partial automation of the template generation process. We propose an approach and methodology for the creation of structured documentation templates for diabetes using Natural Language Processing (NLP).

44 CFR 10.12 - Pre-implementation actions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... decision-making process. Because of the diversity of FEMA, it is not feasible to describe in this part the... shall provide further guidance, commensurate with their programs and organization, for integration of... the decision. Rather it is a concise document that sets forth the decision and describes the...

32 CFR Appendix F to Part 651 - Glossary

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental documentation and its thorough consideration in the decision-making process. Major Federal Action... necessary to coordinate and staff analyses or present the results of the analyses to the public or decision.... Headquarters, Department of the Army proponent As the principal planner, implementer, and decision authority...

76 FR 56466 - Notice of Intent to Prepare an Environmental Document and Proposed Plan Amendment for the West...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-13

... Vehicle Access Element of the CDCA Plan for the WEMO area; and (2) Alternative processes for designating.... Identification of the process and decision criteria that should be used to designate routes in the sub-regional... analysis, and guide the entire process from plan decision-making to route designation review in order to...

Planning and Evaluation Framework: A Five Year Program for the Department of Libraries, Commonwealth of Kentucky.

ERIC Educational Resources Information Center

Kentucky State Dept. of Libraries, Frankfort.

This document is the beginning of a process. The objects of the process are to improve decisions between alternate choices in the development of statewide library services. Secondary functions are to develop the tools for providing information relevant to decisions, to measure and monitor services, and to aid in the communication process. The…

Feasibility study on the use of groupware support for NASA source evaluation boards

NASA Technical Reports Server (NTRS)

Bishop, Peter C.; Yoes, Cissy

1991-01-01

Groupware is a class of computer based systems that support groups engaged in a common task (or goal) and that provide an interface to a shared environment. A potential application for groupware is the source evaluation board (SEB) process used in the procurement of government contracts. This study was undertaken to (1) identify parts of the SEB process which are candidates for groupware supports; and (2) identify tools which could be used to support the candidate process. Two processes of the SEB were identified as good candidates for groupware support: (1) document generation - a coordination and communication process required to present and document the findings of an SEB; and (2) group decision making - a highly analytical and integrative decision process requiring a clear and supportable outcome.

77 FR 4319 - Notification of Two Public Teleconferences of the Science Advisory Board Ecological Processes and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-27

..., ``Integrating Ecological Assessment and Decision-Making at EPA, 2011 RAF Ecological Assessment Action Plan... the EPA Risk Assessment Forum (RAF) document, ``Integrating Ecological Assessment and Decision-Making... Ecological Risk Assessment in Environmental Decision-Making'' (EPA-SAB-08-002), the EPA Risk Assessment Forum...

Teacher's Guide to Canal. The Middlesex Canal: A Role Playing Exercise.

ERIC Educational Resources Information Center

Holmes, Cary W.; Tedesco, Paul H.

The document consists of a role-playing game and related teacher's guide designed to illustrate decision-making processes leading to the building of the Middlesex Canal in Massachusetts in 1793. The primary educational objective is to involve students in the decision-making process through role play. The game is designed to facilitate…

20 CFR 10.13 - What process is used by a person who wants to correct FECA-related documents?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false What process is used by a person who wants to correct FECA-related documents? 10.13 Section 10.13 Employees' Benefits OFFICE OF WORKERS' COMPENSATION... to OWCP for review and decision. Rights and Penalties ...

Data Quality Objectives for Tank Farms Waste Compatibility Program

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

BANNING, D.L.

1999-07-02

There are 177 waste storage tanks containing over 210,000 m{sup 3} (55 million gal) of mixed waste at the Hanford Site. The River Protection Project (RPP) has adopted the data quality objective (DQO) process used by the U.S. Environmental Protection Agency (EPA) (EPA 1994a) and implemented by RPP internal procedure (Banning 1999a) to identify the information and data needed to address safety issues. This DQO document is based on several documents that provide the technical basis for inputs and decision/action levels used to develop the decision rules that evaluate the transfer of wastes. A number of these documents are presentlymore » in the process of being revised. This document will need to be revised if there are changes to the technical criteria in these supporting documents. This DQO process supports various documents, such as sampling and analysis plans and double-shell tank (DST) waste analysis plans. This document identifies the type, quality, and quantity of data needed to determine whether transfer of supernatant can be performed safely. The requirements in this document are designed to prevent the mixing of incompatible waste as defined in Washington Administrative Code (WAC) 173-303-040. Waste transfers which meet the requirements contained in this document and the Double-Shell Tank Waste Analysis Plan (Mulkey 1998) are considered to be compatible, and prevent the mixing of incompatible waste.« less

EPA Region 9 Guidance for Quality Assurance Program Plans - R9qa/03.2

EPA Pesticide Factsheets

In order for decision makers to have confidence in the quality of environmental data used to support their decisions, the organization must have structured and documented process for quality in place.

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

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2016-01-01

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

Professional Development to Improve Accommodations Decisions--A Review of the Literature. Synthesis Report 84

ERIC Educational Resources Information Center

Hodgson, Jennifer R.; Lazarus, Sheryl S.; Thurlow, Martha L.

2011-01-01

Teachers play an important role in making decisions about students' accommodations for instruction and assessment. Although teachers are a significant part of the decision-making process, "gaps" in teachers' accommodations knowledge are well documented. Some of these gaps may be due to challenges in providing teacher professional…

Scientific Literacy for Democratic Decision-Making

ERIC Educational Resources Information Center

Yacoubian, Hagop A.

2018-01-01

Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the…

Documenting the decision structure in software development

NASA Technical Reports Server (NTRS)

Wild, J. Christian; Maly, Kurt; Shen, Stewart N.

1990-01-01

Current software development paradigms focus on the products of the development process. Much of the decision making process which produces these products is outside the scope of these paradigms. The Decision-Based Software Development (DBSD) paradigm views the design process as a series of interrelated decisions which involve the identification and articulation of problems, alternates, solutions and justifications. Decisions made by programmers and analysts are recorded in a project data base. Unresolved problems are also recorded and resources for their resolution are allocated by management according to the overall development strategy. This decision structure is linked to the products affected by the relevant decision and provides a process oriented view of the resulted system. Software maintenance uses this decision view of the system to understand the rationale behind the decisions affecting the part of the system to be modified. D-HyperCase, a prototype Decision-Based Hypermedia System is described and results of applying the DBSD approach during its development are presented.

Scientific literacy for democratic decision-making

NASA Astrophysics Data System (ADS)

Yacoubian, Hagop A.

2018-02-01

Scientifically literate citizens must be able to engage in making decisions on science-based social issues. In this paper, I start by showing examples of science curricula and policy documents that capitalise the importance of engaging future citizens in decision-making processes whether at the personal or at the societal levels. I elucidate the ideological underpinnings behind a number of the statements within those documents that have defined the trajectory of scientific literacy and have shaped what ought to be considered as personal and societal benefits. I argue that science curricula and policy documents can truly endorse scientific literacy when they embed principles of democratic education at their core. The latter entails fostering learning experiences where some of the underlying assumptions and political ideologies are brought to the conscious level and future citizens encouraged to reflect upon them critically and explicitly. Such a proposal empowers the future citizens to engage in critical deliberation on science-based social issues without taking the underlying status quo for granted. I end up the paper by situating the preparation of scientifically literate citizens within a framework of democratic education, discuss conditions through which a curriculum for scientific literacy can serve democratic decision-making processes, and provide modest recommendations.

Comparison of not for resuscitation (NFR) forms across five Victorian health services.

PubMed

Levinson, M; Mills, A; Hutchinson, A M; Heriot, G; Stephenson, G; Gellie, A

2014-07-01

Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation. To examine the consistency of policies and documentation for withholding in-hospital resuscitation across health services. An observational, qualitative review of hospital policy and documentation was conducted in June 2013 in three public and two private sector hospitals in metropolitan Melbourne. Not for resuscitation (NFR) forms were evaluated for physical characteristics, content, authorisation and decision-making. Hospital policies were coded for alerts, definition of futility and burden of treatment and management of discussions and dissent. There was a lack of standardisation, with each site using its own unique NFR form and accompanying site-specific policies. Differences were found in who could authorise the decision, what was included on the form, the role of patients and families, and how discussions were managed and dissent resolved. Futility and burden of treatment were not defined independently. These inconsistencies across sites contribute to a lack of clarity regarding the decision to withhold resuscitation, and have implications for staff employed across multiple hospitals. NFR forms should be reviewed and standardised so as to be clear, uniform and consistent with the legislative framework. We propose a two-stage process of documentation. Stage 1 facilitates discussion of patient-specific goals of care and consideration of limitations of treatment. Stage 2 serves to communicate a NFR order. Decisions to withhold resuscitation are inherently complex but could be aided by separating the decision-making process from the communication of the decision, resulting in improved end-of-life care. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Actual and Ideal Decision-Making Processes Utilized in Senior High Schools That Individualize Instruction. Technical Report No. 460.

ERIC Educational Resources Information Center

Watkins, Arthur Noel

The purpose of this study was to identify and describe the decision-making processes in senior high schools that were implementing programs of individualized schooling. Field methodology, including interviews, observations, and analysis of documents, was used to gather data in six senior high schools of varying size located throughout the country,…

The Governance and Decision Making Processes of the Arizona Board of Regents and Universities.

ERIC Educational Resources Information Center

Schneider, Jacqueline; Johnson, Edward

One of the working papers in the final report of the Arizona Board of Regents' (ABOR) Task Force on Excellence, Efficiency and Competitiveness, this document looks at ABOR and at the governance and decision making processes of Arizona's three public universities. ABOR is a body corporate charged with the governance of the three universities, which…

New care home admission following hospitalisation: How do older people, families and professionals make decisions about discharge destination? A case study narrative analysis.

PubMed

Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet

2018-03-24

To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.

Applying language technology to nursing documents: pros and cons with a focus on ethics.

PubMed

Suominen, Hanna; Lehtikunnas, Tuija; Back, Barbro; Karsten, Helena; Salakoski, Tapio; Salanterä, Sanna

2007-10-01

The present study discusses ethics in building and using applications based on natural language processing in electronic nursing documentation. Specifically, we first focus on the question of how patient confidentiality can be ensured in developing language technology for the nursing documentation domain. Then, we identify and theoretically analyze the ethical outcomes which arise when using natural language processing to support clinical judgement and decision-making. In total, we put forward and justify 10 claims related to ethics in applying language technology to nursing documents. A review of recent scientific articles related to ethics in electronic patient records or in the utilization of large databases was conducted. Then, the results were compared with ethical guidelines for nurses and the Finnish legislation covering health care and processing of personal data. Finally, the practical experiences of the authors in applying the methods of natural language processing to nursing documents were appended. Patient records supplemented with natural language processing capabilities may help nurses give better, more efficient and more individualized care for their patients. In addition, language technology may facilitate patients' possibility to receive truthful information about their health and improve the nature of narratives. Because of these benefits, research about the use of language technology in narratives should be encouraged. In contrast, privacy-sensitive health care documentation brings specific ethical concerns and difficulties to the natural language processing of nursing documents. Therefore, when developing natural language processing tools, patient confidentiality must be ensured. While using the tools, health care personnel should always be responsible for the clinical judgement and decision-making. One should also consider that the use of language technology in nursing narratives may threaten patients' rights by using documentation collected for other purposes. Applying language technology to nursing documents may, on the one hand, contribute to the quality of care, but, on the other hand, threaten patient confidentiality. As an overall conclusion, natural language processing of nursing documents holds the promise of great benefits if the potential risks are taken into consideration.

Future of electronic health records: implications for decision support.

PubMed

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

2012-01-01

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

42 CFR 488.9 - Onsite observation of accreditation organization operations.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the application review process, the validation review process, or the continuing oversight of an... limited to, the review of documents, auditing meetings concerning the accreditation process, the evaluation of survey results or the accreditation decision-making process, and interviews with the...

42 CFR 488.9 - Onsite observation of accreditation organization operations.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the application review process, the validation review process, or the continuing oversight of an... limited to, the review of documents, auditing meetings concerning the accreditation process, the evaluation of survey results or the accreditation decision-making process, and interviews with the...

42 CFR 488.9 - Onsite observation of accreditation organization operations.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the application review process, the validation review process, or the continuing oversight of an... limited to, the review of documents, auditing meetings concerning the accreditation process, the evaluation of survey results or the accreditation decision-making process, and interviews with the...

42 CFR 488.9 - Onsite observation of accreditation organization operations.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the application review process, the validation review process, or the continuing oversight of an... limited to, the review of documents, auditing meetings concerning the accreditation process, the evaluation of survey results or the accreditation decision-making process, and interviews with the...

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

Decision support for the integrated restoration and protection strategy of the Forest Service, Northern Region

Treesearch

Keith Reynolds; Barry Bollenbacher; Chip Fisher; Melissa Hart; Mary Manning; Eric Henderson; Bruce Sims

2016-01-01

This report documents a decision-support process developed in the U.S. Department of Agriculture, Forest Service, Northern Region to assess management opportunities as part of an ecosystem-based approach to management that emphasizes ecological resilience. The decision-support system described in this work implements what is known as the Integrated Restoration and...

ENVIRONMENTAL PLANNING FOR COMMUNITIES: A GUIDE TO THE ENVIRONMENTAL VISIONING PROCESS UTILIZING A GEOGRAPHIC INFORMATION SYSTEM (GIS)

EPA Science Inventory

This document emphasizes the local stakeholder's role in addressing community-wide environmental issues, especially with respect to the preferred "green" community development. The document is intended to help communities made decisions about alternative land uses and landscape ...

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

An Internationally Consented Standard for Nursing Process-Clinical Decision Support Systems in Electronic Health Records.

PubMed

Müller-Staub, Maria; de Graaf-Waar, Helen; Paans, Wolter

2016-11-01

Nurses are accountable to apply the nursing process, which is key for patient care: It is a problem-solving process providing the structure for care plans and documentation. The state-of-the art nursing process is based on classifications that contain standardized concepts, and therefore, it is named Advanced Nursing Process. It contains valid assessments, nursing diagnoses, interventions, and nursing-sensitive patient outcomes. Electronic decision support systems can assist nurses to apply the Advanced Nursing Process. However, nursing decision support systems are missing, and no "gold standard" is available. The study aim is to develop a valid Nursing Process-Clinical Decision Support System Standard to guide future developments of clinical decision support systems. In a multistep approach, a Nursing Process-Clinical Decision Support System Standard with 28 criteria was developed. After pilot testing (N = 29 nurses), the criteria were reduced to 25. The Nursing Process-Clinical Decision Support System Standard was then presented to eight internationally known experts, who performed qualitative interviews according to Mayring. Fourteen categories demonstrate expert consensus on the Nursing Process-Clinical Decision Support System Standard and its content validity. All experts agreed the Advanced Nursing Process should be the centerpiece for the Nursing Process-Clinical Decision Support System and should suggest research-based, predefined nursing diagnoses and correct linkages between diagnoses, evidence-based interventions, and patient outcomes.

Systematic documentation of new vaccine introduction in selected countries of the Latin American Region.

PubMed

de Oliveira, Lúcia H; Toscano, Cristiana M; Sanwogou, N Jennifer; Ruiz-Matus, Cuauhtémoc; Tambini, Gina; Roses-Periago, Mirta; Andrus, Jon K

2013-07-02

Countries in Latin America were among the first developing countries to introduce new vaccines, particularly rotavirus (RV) and pneumococcal conjugate vaccines (PCVs), into their national immunization schedules. Experiences and lessons learned from these countries are valuable to donors, immunization partners, and policy makers in other countries wishing to make informed decisions on vaccine introduction. In order to enhance knowledge and promote understanding of the process of new vaccine introduction in the Latin American Region, with particular focus on RV and PCV, we conducted a systematic qualitative assessment. We evaluated the decision-making process, documented the structure in place, and reviewed key factors pertaining to new vaccine introduction. These include country morbidity and mortality data available prior to vaccine introduction, funding sources and mechanisms for vaccine introduction, challenges of implementation, and assessment of vaccine impact. From March 2010 to April 2011, we evaluated a subset of countries that had introduced RV and/or PCV in the past five years through interviews with key informants at the country level and through a systematic review of published data, gray literature, official technical documents, and country-specific health indicators. Countries evaluated were Bolivia, Brazil, Nicaragua, Peru, and Venezuela. In all countries, the potential of new vaccines to reduce mortality, as established by Millennium Development Goal 4, was an important consideration leading to vaccine introduction. Several factors-the availability of funds, the existence of sufficient evidence for vaccine introduction, and the feasibility of sustainable financing-were identified as crucial components of the decision-making process in the countries evaluated. The decision making process regarding new vaccine introduction in the countries evaluated does not follow a systematic approach. Nonetheless, existing evidence on efficacy, potential impact, and cost-effectiveness of vaccine introduction, even if not local data, was important in the decision making process for vaccine introduction. Copyright © 2013 Elsevier Ltd. All rights reserved.

Consumer Decision Making in a Global Context.

ERIC Educational Resources Information Center

Lusby, Linda A.

This document examines the underlying rationale for the development of a global approach in consumer studies. The concept of consumer ethics is discussed and the consumer decision-making process is placed within an ecosystem perspective of the marketplace. The model developed introduces educators, marketers, and consumers to a more global…

Using Decision Support to Address Racial Disparities in Mental Health Service Utilization

ERIC Educational Resources Information Center

Rawal, Purva H.; Anderson, Tanya R.; Romansky, Jill R.; Lyons, John S.

2008-01-01

Unfortunately, racial disparities are well documented in the delivery of behavioral health services. This study examines the effects of implementing a decision support process, integrating clinical information into the administration of mental health services, on racial disparities in psychiatric hospital admissions for children in state custody.…

Exploratory Honors Students: Academic Major and Career Decision Making

ERIC Educational Resources Information Center

Carduner, Jessie; Padak, Gary M.; Reynolds, Jamie

2011-01-01

In this qualitative study, we investigated the academic major and career decision-making processes of honors college students who were declared as "exploratory" students in their freshman year at a large, public, midwestern university. We used semistandardized interviews and document analysis as primary data collection methods to answer…

Inside the Black Box: Tracking Decision-Making in an Action Research Study

ERIC Educational Resources Information Center

Smith, Cathryn

2017-01-01

Action research has been described as "designing the plane while flying it" (Herr & Anderson, 2005, p. 69). A black box documented the researcher's decisions while facilitating leadership development sessions with teacher leaders. Ten process folio steps informed the study through six iterations. Planning steps included a design…

Building Stakeholder Trust: Defensible Government Decisions - 13110

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

Franklin, Victor A.

Administrative decisions must be grounded in reasonable expectations, founded on sound principles, and bounded by societal norms. Without these first principles, attaining and retaining public trust is a Herculean task. Decisions made by governmental administrators must be both transparent and defensible: without the former the agency will lose the public's trust and support (possibly prompting a legal challenge to the decision) and without the latter the decision may fail to withstand judicial scrutiny. This presentation and accompanying paper delves into the process by which governmental decisions can achieve both defensibility and openness through building stakeholder trust with transparency. Achieving andmore » maintaining stakeholder trust is crucial, especially in the environs of nuclear waste management. Proving confidence, stability, and security to the surrounding citizenry as well as those throughout the country is the goal of governmental nuclear waste remediation. Guiding administrative decision-making processes and maintaining a broad bandwidth of communication are of incalculable importance to all those charged with serving the public, but are especially essential to those whose decisional impacts will be felt for millennia. A strong, clear, and concise administrative record documenting discrete decisions and overarching policy choices is the strongest defense to a decisional challenge. However, this can be accomplished using transparency as the fundamental building block. This documentation allows the decision-makers to demonstrate the synthesis of legal and technical challenges and fortifies the ground from which challenges will be defended when necessary. Further, administrative actions which capture the public's interest and captivate that interest throughout the process will result in a better-informed, more deeply-involved, and more heavily-invested group of interested parties. Management of information, involvement, and investment on the front-end of the process reaps rewards far more efficiently than attempts to assuage and mitigate the concerns of those parties after the fact and there are a number of tools Savannah River Remediation (SRR) has deployed that render transparency an ally in this context. The makers, applicators, and beneficiaries of policies and decisions will all benefit from strong administrative records which document decisional choices in an open and transparent manner and from timely, up-front management of concerns of interested parties. The strongest defense to decisional challenges is an ability to demonstrate the basis of the decision and the reason(s) that the decision was chosen over other alternatives. Providing a sound basis for defending challenges rather than avoiding or fighting over them allows the deciding entity the greatest opportunity to produce value for its customer. Often, a transparent process that invites public participation and is open for public review and comment will thwart challenge genesis. An entity that has to devote resources to defending its choices obviously cannot utilize those resources to further its mission. (authors)« less

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

Development and evaluation of a web-based application for digital findings and documentation in physiotherapy education.

PubMed

Spieler, Bernadette; Burgsteiner, Harald; Messer-Misak, Karin; Gödl-Purrer, Barbara; Salchinger, Beate

2015-01-01

Findings in physiotherapy have standardized approaches in treatment, but there is also a significant margin of differences in how to implement these standards. Clinical decisions require experience and continuous learning processes to consolidate personal values and opinions and studies suggest that lecturers can influence students positively. Recently, the study course of Physiotherapy at the University of Applied Science in Graz has offered a paper based finding document. This document supported decisions through the adaption of the clinical reasoning process. The document was the starting point for our learning application called "EasyAssess", a Java based web-application for a digital findings documentation. A central point of our work was to ensure efficiency, effectiveness and usability of the web-application through usability tests utilized by both students and lecturers. Results show that our application fulfills the previously defined requirements and can be efficiently used in daily routine largely because of its simple user interface and its modest design. Due to the close cooperation with the study course Physiotherapy, the application has incorporated the various needs of the target audiences and confirmed the usefulness of our application.

How Expert Pilots Think Cognitive Processes in Expert Decision Making

DTIC Science & Technology

1993-02-01

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

Responding to Nonwords in the Lexical Decision Task: Insights from the English Lexicon Project

ERIC Educational Resources Information Center

Yap, Melvin J.; Sibley, Daragh E.; Balota, David A.; Ratcliff, Roger; Rueckl, Jay

2015-01-01

Researchers have extensively documented how various statistical properties of words (e.g., word frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, because a better specification of the mechanisms driving nonword responses may provide…

Government: The Decision-Making Process. A Resource Manual for Teachers and Students. Revised Edition.

ERIC Educational Resources Information Center

Khanlian, John F.; Wallin, Katherine L.

This guide for high school political science teachers focuses on political decision making. The program emphasizes experiential learning through utilizing community and state resources and implementing field study and internships for students. The document is presented in eight sections. The introduction includes a values survey and suggestions…

78 FR 39233 - Data Practices, Computer III Further Remand: BOC Provision of Enhanced Services

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-01

... additional information on the rulemaking process, see the SUPPLEMENTARY INFORMATION section of this document....702 of the Commission's rules and regulations (Computer II Final Decision), 77 FCC 2d 384 (1980... Commission's decision to lift structural separation in Computer III and the implementation of ONA. In light...

[Benefit Assessment for Examination and Treatment Methods with Medical Devices of High Hisk: Trade-off between Patient Benefit, Evidence and Access].

PubMed

Mühlbacher, Axel C; Juhnke, Christin

2018-03-01

The lately inured § 137 h SGB V aims to assess the benefit of new examination and treatment methods with medical devices of class IIb and III. In the future, the decision on the reimbursement eligibility will be marked by high requirements in terms of documentation of benefits and harm. The objective of benefit assessment is the operationalization of benefit to patients. A comparative determination of benefit enables rational decision by regulatory authorities. The process of benefit assessment should guarantee transparent decision-making, and the underlying medical and health economic fundamentals should be documented. In principle, benefit assessment can be divided into 3 phases: measuring causal effects of an intervention, assessment of the measured effects and decision on reimbursement based on the aggregation of an overall benefit. To address the peculiarities of medical devices in this process, adaptive study designs, MCDA and adaptive benefit assessment provide a sustainable concept for rapid access by patients to innovative treatments of high quality and safety. © Georg Thieme Verlag KG Stuttgart · New York.

32 CFR 651.35 - Decision process.

Code of Federal Regulations, 2011 CFR

2011-07-01

... as soon as possible. (b) The FNSI is a document (40 CFR 1508.13) that briefly states why an action... be prepared. It summarizes the EA, noting any NEPA documents that are related to, but are not part of... two typewritten pages in length. (e) The draft FNSI will be made available to the public prior to...

Documenting Evaluation Use: Guided Evaluation Decisionmaking. Evaluation Productivity Project.

ERIC Educational Resources Information Center

Burry, James

This paper documents the evaluation use process among districts using the Guide for Evaluation Decision Makers, published by the Center for the Study of Evaluation (CSE) during the 1984-85 school year. Included are the following: (1) a discussion of research that led to conclusions concerning the administrator's role in evaluation use; (2) a…

Performance Assessment for Pump-and-Treat Closure or Transition

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

Truex, Michael J.; Johnson, Christian D.; Becker, Dave J.

2015-09-29

A structured performance assessment approach is useful to evaluate pump-and-treat (P&T) groundwater remediation, which has been applied at numerous sites. Consistent with the U.S. Environmental Protection Agency’s Groundwater Road Map, performance assessment during remedy implementation may be needed, and should consider remedy optimization, transition to alternative remedies, or remedy closure. In addition, a recent National Research Council study examined groundwater remediation at complex contaminated sites and concluded that it may be beneficial to evaluate remedy performance and the potential need for transition to alternative approaches at these sites. The intent of this document is to provide a structured approach formore » assessing P&T performance to support a decision to optimize, transition, or close a P&T remedy. The process presented in this document for gathering information and performing evaluations to support P&T remedy decisions includes use of decision elements to distinguish between potential outcomes of a remedy decision. Case studies are used to augment descriptions of decision elements and to illustrate each type of outcome identified in the performance assessment approach. The document provides references to resources for tools and other guidance relevant to conducting the P&T assessment.« less

Implementation of a scalable, web-based, automated clinical decision support risk-prediction tool for chronic kidney disease using C-CDA and application programming interfaces.

PubMed

Samal, Lipika; D'Amore, John D; Bates, David W; Wright, Adam

2017-11-01

Clinical decision support tools for risk prediction are readily available, but typically require workflow interruptions and manual data entry so are rarely used. Due to new data interoperability standards for electronic health records (EHRs), other options are available. As a clinical case study, we sought to build a scalable, web-based system that would automate calculation of kidney failure risk and display clinical decision support to users in primary care practices. We developed a single-page application, web server, database, and application programming interface to calculate and display kidney failure risk. Data were extracted from the EHR using the Consolidated Clinical Document Architecture interoperability standard for Continuity of Care Documents (CCDs). EHR users were presented with a noninterruptive alert on the patient's summary screen and a hyperlink to details and recommendations provided through a web application. Clinic schedules and CCDs were retrieved using existing application programming interfaces to the EHR, and we provided a clinical decision support hyperlink to the EHR as a service. We debugged a series of terminology and technical issues. The application was validated with data from 255 patients and subsequently deployed to 10 primary care clinics where, over the course of 1 year, 569 533 CCD documents were processed. We validated the use of interoperable documents and open-source components to develop a low-cost tool for automated clinical decision support. Since Consolidated Clinical Document Architecture-based data extraction extends to any certified EHR, this demonstrates a successful modular approach to clinical decision support. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.

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

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

Greitzer, Frank L.; Podmore, Robin

2008-11-17

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

Analytical control test plan and microbiological methods for the water recovery test

NASA Technical Reports Server (NTRS)

Traweek, M. S. (Editor); Tatara, J. D. (Editor)

1994-01-01

Qualitative and quantitative laboratory results are important to the decision-making process. In some cases, they may represent the only basis for deciding between two or more given options or processes. Therefore, it is essential that handling of laboratory samples and analytical operations employed are performed at a deliberate level of conscientious effort. Reporting erroneous results can lead to faulty interpretations and result in misinformed decisions. This document provides analytical control specifications which will govern future test procedures related to all Water Recovery Test (WRT) Phase 3 activities to be conducted at the National Aeronautics and Space Administration/Marshall Space Flight Center (NASA/MSFC). This document addresses the process which will be used to verify analytical data generated throughout the test period, and to identify responsibilities of key personnel and participating laboratories, the chains of communication to be followed, and ensure that approved methodology and procedures are used during WRT activities. This document does not outline specifics, but provides a minimum guideline by which sampling protocols, analysis methodologies, test site operations, and laboratory operations should be developed.

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

Zining, Jin, E-mail: jinzn@pkusz.edu.cn

The article explores the practices of Environmental Impact Assessment (EIA) Law in China's courts by examining 107 judicial decisions. Each of the 107 judicial decisions has been analyzed to determine the time/location of the decision, what type of EIA document was referred to, what specific claim was made by the plaintiffs, and what the court's ruling was on the case. The results indicate that: unlike in Germany or Japan, all kinds of EIA decisions made by environment protect bureaus (EPBs) in China were widely taken as justiciable, and China's courts generally allowed local residents to have standing and thus challengemore » the EPBs' decisions made during the EIA process. On the other hand, the research also shows the EPBs overwhelmingly prevailed in those EIA lawsuits. It is also found that China's reviewing judges were highly self-restrained, giving obvious deference to the technocrat with the substantial contents of EIA documents. Also, the concept of “flaw” was created when it came to procedural issues. These two factors, among others, were both helping the EPBs' prevailing successes. - Highlights: • 107 judicial decisions referring to China's EIA law are examined. • The justiciability of EPB's EIA decisions were taken for granted. • The defenders overwhelmingly prevailed in those EIA lawsuits. • The reviewing judges were highly self-restrained, defering to the technocrat with the EIA documents. • A functional concept, “flaw”, was created by reviewing judges when it came to procedural issues.« less

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

USGS Publications Warehouse

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

2010-01-01

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

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

23 CFR 450.316 - Interested parties, participation, and consultation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... public transportation employees, freight shippers, providers of freight transportation services, private... at key decision points, including but not limited to a reasonable opportunity to comment on the... extent practicable, develop a documented process(es) that outlines roles, responsibilities, and key...

Medical decision-making during the guardianship process for incapacitated, hospitalized adults: a descriptive cohort study.

PubMed

Bandy, Robin J; Helft, Paul R; Bandy, Robert W; Torke, Alexia M

2010-10-01

It is sometimes necessary for courts to appoint guardians for adult, incapacitated patients. There are few data describing how medical decisions are made for such patients before and during the guardianship process. To describe the process of medical decision-making for incapacitated, hospitalized adults for whom court-appointed guardians are requested. Retrospective, descriptive cohort study. Patients were identified from the legal files of a public, urban hospital. Medical and legal records were reviewed for demographic data, code status, diagnoses, code status orders and invasive procedures and person authorizing the order or procedure, dates of incapacitation and appointment of temporary guardian, reason for guardianship, and documentation of communication with a guardian. A total of 79 patients met inclusion criteria; 68.4% were male and 56.2% African-American. The median age was 65 years. Of the 71 patients with medical records available 89% of patients had a temporary guardianship petitioned because of the need for placement only. Seventeen patients had a new DNR order written during hospitalization, eight of which were ordered by physicians without consultation with a surrogate decision maker. Overall, 32 patients underwent a total of 81 documented invasive procedures, 16 of which were authorized by the patient, 15 by family or friend, and 11 by a guardian; consent was not required for 39 of the procedures because of emergency conditions or because a procedure was medically necessary and no surrogate decision maker was available. Although most of the guardianships were requested for placement purposes, important medical decisions were made while patients were awaiting appointment of a guardian. Hospitalized, incapacitated adults awaiting guardianship may lack a surrogate decision maker when serious decisions must be made about their medical care.

Reasoning Processes Used by Paramedics to Solve Clinical Problems

ERIC Educational Resources Information Center

Alexander, Melissa

2009-01-01

The purpose of this exploratory qualitative study was to determine the reasoning processes used by paramedics to solve clinical problems. Existing research documents concern over the accuracy of paramedics' clinical decision-making, but no research was found that examines the cognitive processes by which paramedics make either faulty or accurate…

Decision making in a human population living sustainably.

PubMed

Hicks, John S; Burgman, Mark A; Marewski, Julian N; Fidler, Fiona; Gigerenzer, Gerd

2012-10-01

The Tiwi people of northern Australia have managed natural resources continuously for 6000-8000 years. Tiwi management objectives and outcomes may reflect how they gather information about the environment. We qualitatively analyzed Tiwi documents and management techniques to examine the relation between the social and physical environment of decision makers and their decision-making strategies. We hypothesized that principles of bounded rationality, namely, the use of efficient rules to navigate complex decision problems, explain how Tiwi managers use simple decision strategies (i.e., heuristics) to make robust decisions. Tiwi natural resource managers reduced complexity in decision making through a process that gathers incomplete and uncertain information to quickly guide decisions toward effective outcomes. They used management feedback to validate decisions through an information loop that resulted in long-term sustainability of environmental use. We examined the Tiwi decision-making processes relative to management of barramundi (Lates calcarifer) fisheries and contrasted their management with the state government's management of barramundi. Decisions that enhanced the status of individual people and their attainment of aspiration levels resulted in reliable resource availability for Tiwi consumers. Different decision processes adopted by the state for management of barramundi may not secure similarly sustainable outcomes. ©2012 Society for Conservation Biology.

Key Decision Record Creation and Approval Module

NASA Technical Reports Server (NTRS)

Hebert, Barrt; Messer, Elizabeth A.; Albasini, Colby; Le, Thang; ORourke, William, Sr.; Stiglets, Tim; Strain, Ted

2012-01-01

Retaining good key decision records is critical to ensuring the success of a project or operation. Having adequately documented decisions with supporting documents and rationale can greatly reduce the amount of rework or reinvention over a project's, vehicle's, or facility's lifecycle. Stennis Space Center developed and uses a software tool that automates the Key Decision Record (KDR) process for its engineering and test projects. It provides the ability for a user to log key decisions that are made during the course of a project. By customizing Parametric Technology Corporation's (PTC) Windchill product, the team was able to log all information about a decision, and electronically route that information for approval. Customizing the Windchill product allowed the team to directly connect these decisions to the engineering data that it might affect and notify data owners of the decision. The user interface was created in JSP and Javascript, within the OOTB (Out of the Box) Windchill product, allowing users to create KDRs. Not only does this interface allow users to create and track KDRs, but it also plugs directly into the OOTB ability to associate these decision records with other relevant engineering data such as drawings, designs, models, requirements, or specifications

How to Overcome Information Anxiety: Assignment and Use of DoD Distribution Statements for Technical Documents. Volume 1. Facilitor Guide

DTIC Science & Technology

1998-05-01

distribution limitations recommended if public release is not approved. The ASD(PA) shall also process appeals when public release denial is based upon...Rules of Evidence, and all other applicable laws. An interlocutory appeal by the United States shall lie from a decision or order of a district court... limitations ; document markings; document preparation; scientific and technical information; STINFO; information security; security training

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

PubMed

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

2012-04-01

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

Factors influencing line officers' decisions about National Environmental Policy Act project design and development.

Treesearch

Donald G. MacGregor; David N. Seesholtz

2008-01-01

Prior to the existence of the National Environmental Policy Act (NEPA), Forest Service district rangers had considerable latitude to make resource management decisions and execute management plans with relatively little encumbrance by documentation and process requirements. Today there appear to be differences not only in the district ranger population, but in the...

How social cognition can inform social decision making.

PubMed

Lee, Victoria K; Harris, Lasana T

2013-12-25

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures-while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context-and examine the benefits of integrating social psychological theory with behavioral economic theory.

How social cognition can inform social decision making

PubMed Central

Lee, Victoria K.; Harris, Lasana T.

2013-01-01

Social decision-making is often complex, requiring the decision-maker to make inferences of others' mental states in addition to engaging traditional decision-making processes like valuation and reward processing. A growing body of research in neuroeconomics has examined decision-making involving social and non-social stimuli to explore activity in brain regions such as the striatum and prefrontal cortex, largely ignoring the power of the social context. Perhaps more complex processes may influence decision-making in social vs. non-social contexts. Years of social psychology and social neuroscience research have documented a multitude of processes (e.g., mental state inferences, impression formation, spontaneous trait inferences) that occur upon viewing another person. These processes rely on a network of brain regions including medial prefrontal cortex (MPFC), superior temporal sulcus (STS), temporal parietal junction, and precuneus among others. Undoubtedly, these social cognition processes affect social decision-making since mental state inferences occur spontaneously and automatically. Few studies have looked at how these social inference processes affect decision-making in a social context despite the capability of these inferences to serve as predictions that can guide future decision-making. Here we review and integrate the person perception and decision-making literatures to understand how social cognition can inform the study of social decision-making in a way that is consistent with both literatures. We identify gaps in both literatures—while behavioral economics largely ignores social processes that spontaneously occur upon viewing another person, social psychology has largely failed to talk about the implications of social cognition processes in an economic decision-making context—and examine the benefits of integrating social psychological theory with behavioral economic theory. PMID:24399928

Analytical group decision making in natural resources: Methodology and application

USGS Publications Warehouse

Schmoldt, D.L.; Peterson, D.L.

2000-01-01

Group decision making is becoming increasingly important in natural resource management and associated scientific applications, because multiple values are treated coincidentally in time and space, multiple resource specialists are needed, and multiple stakeholders must be included in the decision process. Decades of social science research on decision making in groups have provided insights into the impediments to effective group processes and on techniques that can be applied in a group context. Nevertheless, little integration and few applications of these results have occurred in resource management decision processes, where formal groups are integral, either directly or indirectly. A group decision-making methodology is introduced as an effective approach for temporary, formal groups (e.g., workshops). It combines the following three components: (1) brainstorming to generate ideas; (2) the analytic hierarchy process to produce judgments, manage conflict, enable consensus, and plan for implementation; and (3) a discussion template (straw document). Resulting numerical assessments of alternative decision priorities can be analyzed statistically to indicate where group member agreement occurs and where priority values are significantly different. An application of this group process to fire research program development in a workshop setting indicates that the process helps focus group deliberations; mitigates groupthink, nondecision, and social loafing pitfalls; encourages individual interaction; identifies irrational judgments; and provides a large amount of useful quantitative information about group preferences. This approach can help facilitate scientific assessments and other decision-making processes in resource management.

The effects of the application of SIMPRO on the completeness and time efficiency of nursing documentation in the outpatient instalation at Dompet Dhuafa Hospital Parung

NASA Astrophysics Data System (ADS)

Dwisatyadini, M.; Hariyati, R. T. S.; Afifah, E.

2018-03-01

Nursing documentation is clinical information that has a vital role in nursing services. The nursing process includes assessment, diagnosis, intervention, implementation, and evaluation. The purpose of this study was to determine the effects of the application of SIMPRO on the completeness and the efficiency of nursing documentation in the outpatient installation at Dompet Dhuafa Hospital Parung. This study used quantitative method with pre experimental (pre and posttest without control group) design. The mean of the documentation completeness marks before the application of SIMPRO was 1.87 (SD 0.922), and after SIMPRO was applied increased to 3.61 (0.588). This increase indicated an improvement of the nursing documentation completeness after the implementation of SIMPRO. The mean of time needed by nurses in documenting the nursing care before the application of SIMPRO was 476.13 seconds (SD 78.896). The mean of documenting time decreased more than a half after the application of SIMPRO which was 202.52 seconds (SD 196.723). SIMPRO made a nurse easier to take a decision analysis and decision support system to nursing care plan and documentation.

32 CFR 989.3 - Responsibilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.3 Responsibilities. (a) Office of the Secretary of the Air... documentation in making decisions about proposed actions and programs within their commands or areas of... the process, and potential conflicts are precluded. (2) Notifying the EPF of a pending action and...

Patient Preferences and Surrogate Decision Making in Neuroscience Intensive Care Units

PubMed Central

Cai, Xuemei; Robinson, Jennifer; Muehlschlegel, Susanne; White, Douglas B.; Holloway, Robert G.; Sheth, Kevin N.; Fraenkel, Liana; Hwang, David Y.

2016-01-01

In the neuroscience intensive care unit (NICU), most patients lack the capacity to make their own preferences known. This fact leads to situations where surrogate decision makers must fill the role of the patient in terms of making preference-based treatment decisions, oftentimes in challenging situations where prognosis is uncertain. The neurointensivist has a large responsibility and role to play in this shared decision making process. This review covers how NICU patient preferences are determined through existing advance care documentation or surrogate decision makers and how the optimum roles of the physician and surrogate decision maker are addressed. We outline the process of reaching a shared decision between family and care team and describe a practice for conducting optimum family meetings based on studies of ICU families in crisis. We review challenges in the decision making process between surrogate decision makers and medical teams in neurocritical care settings, as well as methods to ameliorate conflicts. Ultimately, the goal of shared decision making is to increase knowledge amongst surrogates and care providers, decrease decisional conflict, promote realistic expectations and preference-centered treatment strategies, and lift the emotional burden on families of neurocritical care patients. PMID:25990137

Facing the Challenge of Technology Integration. A Portfolio of Processes. Facilitator's Manual.

ERIC Educational Resources Information Center

Technology & Innovations in Education, Rapid City, SD.

The overall goal of this technology integration work is to identify the content and processes vital to decision making as schools transform education through technology integration. This guide includes a collection of content and process strategies to start the learner on this path. This document contains the following sections: (1) Professional…

78 FR 78462 - Open Government: Use of Genetic Information in Documenting and Evaluating Disability; Extension...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... information within the disability decision process. Under our current, long-standing policy, we do not... disability determination process via an online forum. We stated that the forum would be open until December... genetic information in the disability determination process via an online forum that would be open until...

Participants' recall and understanding of genomic research and large-scale data sharing.

PubMed

Robinson, Jill Oliver; Slashinski, Melody J; Wang, Tao; Hilsenbeck, Susan G; McGuire, Amy L

2013-10-01

As genomic researchers are urged to openly share generated sequence data with other researchers, it is important to examine the utility of informed consent documents and processes, particularly as these relate to participants' engagement with and recall of the information presented to them, their objective or subjective understanding of the key elements of genomic research (e.g., data sharing), as well as how these factors influence or mediate the decisions they make. We conducted a randomized trial of three experimental informed consent documents (ICDs) with participants (n = 229) being recruited to genomic research studies; each document afforded varying control over breadth of release of genetic information. Recall and understanding, their impact on data sharing decisions, and comfort in decision making were assessed in a follow-up structured interview. Over 25% did not remember signing an ICD to participate in a genomic study, and the majority (54%) could not correctly identify with whom they had agreed to share their genomic data. However, participants felt that they understood enough to make an informed decision, and lack of recall did not impact final data sharing decisions or satisfaction with participation. These findings raise questions about the types of information participants need in order to provide valid informed consent, and whether subjective understanding and comfort with decision making are sufficient to satisfy the ethical principle of respect for persons.

Oh, Garbage! Decisions about Waste Disposal. Creative Role-Playing Exercises in Science and Technology Series.

ERIC Educational Resources Information Center

Parisi, Lynn; Pearson, Janice

This document is one of a series of role plays that focus on science-related social issues of concern in contemporary public policy formation. The role plays are designed to help students develop information-processing and decision making skills needed to deal effectively with such issues. The role plays guide students in analyzing science related…

Moderation of Assessment: An Introduction for National Standards Bodies. Developing a Qualifications Framework for New Zealand.

ERIC Educational Resources Information Center

New Zealand Qualifications Authority, Wellington.

This document provides a decision tree to guide the thinking of the staff of New Zealand agencies developing national education and certification standards. It is intended to help them make decisions about moderation of assessment--a process of sampling assessments to ensure that they are consistent with the required standard. After an…

Laying the Groundwork for Enterprise-Wide Medical Language Processing Services: Architecture and Process

PubMed Central

Chen, Elizabeth S.; Maloney, Francine L.; Shilmayster, Eugene; Goldberg, Howard S.

2009-01-01

A systematic and standard process for capturing information within free-text clinical documents could facilitate opportunities for improving quality and safety of patient care, enhancing decision support, and advancing data warehousing across an enterprise setting. At Partners HealthCare System, the Medical Language Processing (MLP) services project was initiated to establish a component-based architectural model and processes to facilitate putting MLP functionality into production for enterprise consumption, promote sharing of components, and encourage reuse. Key objectives included exploring the use of an open-source framework called the Unstructured Information Management Architecture (UIMA) and leveraging existing MLP-related efforts, terminology, and document standards. This paper describes early experiences in defining the infrastructure and standards for extracting, encoding, and structuring clinical observations from a variety of clinical documents to serve enterprise-wide needs. PMID:20351830

Laying the groundwork for enterprise-wide medical language processing services: architecture and process.

PubMed

Chen, Elizabeth S; Maloney, Francine L; Shilmayster, Eugene; Goldberg, Howard S

2009-11-14

A systematic and standard process for capturing information within free-text clinical documents could facilitate opportunities for improving quality and safety of patient care, enhancing decision support, and advancing data warehousing across an enterprise setting. At Partners HealthCare System, the Medical Language Processing (MLP) services project was initiated to establish a component-based architectural model and processes to facilitate putting MLP functionality into production for enterprise consumption, promote sharing of components, and encourage reuse. Key objectives included exploring the use of an open-source framework called the Unstructured Information Management Architecture (UIMA) and leveraging existing MLP-related efforts, terminology, and document standards. This paper describes early experiences in defining the infrastructure and standards for extracting, encoding, and structuring clinical observations from a variety of clinical documents to serve enterprise-wide needs.

Reducing Operating Costs by Optimizing Space in Facilities

DTIC Science & Technology

2012-03-01

Base level 5 engineering units will provide facility floor plans, furniture layouts, and staffing documentation as necessary. One obstacle...due to the quantity and diverse locations. Base level engineering units provided facility floor plans, furniture layouts, and staffing documentation... furniture purchases and placement 5. Follow a quality systematic process in all decisions The per person costs can be better understood with a real

Prostate Cancer Biorepository Network

DTIC Science & Technology

2017-10-01

Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704...clinical data including pathology and outcome data are annotated with the biospecimens. Specialized processing consists of tissue microarray design ...Months 1- 6): Completed in 1st quarter Task 5. Report on performance metrics: Ongoing (accrual reports are provided on quarterly basis) Task 6

The Australian funding debate on quadrivalent HPV vaccine: a case study for the national pharmaceutical policy.

PubMed

Roughead, Elizabeth Ellen; Gilbert, Andrew L; Vitry, Agnes I

2008-12-01

To analyse the media and political reactions to the initial decision of the Pharmaceutical Benefits Advisory Committee (PBAC) to reject funding of the quadrivalent human papilloma virus (HPV) vaccine in Australia. A case study, informed by media reports and government documents, was utilised to examine the reactions of key stakeholders; PBAC, consumers, consumer organisations, pharmaceutical industry, politicians, health professionals and the media to the initial decision to reject funding of HPV vaccine. The initial decision to reject funding of the HPV vaccine led to unprecedented public response with over 300 newspaper articles and calls by consumers, health professionals and politicians to intervene in the decision making process. Misunderstanding of the decision making process, particularly cost-effectiveness assessments, the need for an independent process, the legislated inability of a timely and transparent response from policy makers and the lack of a risk mitigation strategy all played a role in the public outcry. Despite 15 years of implementation of cost-effectiveness assessments there is still a need for improving stakeholder understanding of the decision making process and for timely transfer of complete information. Risk mitigation strategies should be considered as part of the communication plan for all decisions.

A practical approach to communicating benefit-risk decisions of medicines to stakeholders.

PubMed

Leong, James; Walker, Stuart; Salek, Sam

2015-01-01

The importance of a framework for a systematic structured assessment of the benefits and risks has been established, but in addition, it is necessary that the benefit-risk decisions and the processes to derive those decisions are documented and communicated to various stakeholders for accountability. Hence there is now a need to find appropriate tools to enhance communication between regulators and other stakeholders, in a manner that would uphold transparency, consistency and standards. A retrospective, non-comparative study was conducted to determine the applicability and practicality of a summary template in documenting benefit-risk assessment and communicating benefit-risk balance and conclusions for reviewers to other stakeholders. The benefit-risk (BR) Summary Template and its User Manual was evaluated by 12 reviewers within a regulatory agency in Singapore, the Health Sciences Authority (HSA). The BR Summary Template was found to be adequate in documenting benefits, risks, relevant summaries and conclusions, while the User Manual was useful in guiding the reviewer in completing the template. The BR Summary Template was also considered a useful tool for communicating benefit-risk decisions to a variety of stakeholders. The use of a template may be of value for the communicating benefit-risk assessment of medicines to stakeholders.

SME Acceptability Determination For DWPF Process Control (U)

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

Edwards, T.

2017-06-12

The statistical system described in this document is called the Product Composition Control System (PCCS). K. G. Brown and R. L. Postles were the originators and developers of this system as well as the authors of the first three versions of this technical basis document for PCCS. PCCS has guided acceptability decisions for the processing at the Defense Waste Processing Facility (DWPF) at the Savannah River Site (SRS) since the start of radioactive operations in 1996. The author of this revision to the document gratefully acknowledges the firm technical foundation that Brown and Postles established to support the ongoing successfulmore » operation at the DWPF. Their integration of the glass propertycomposition models, developed under the direction of C. M. Jantzen, into a coherent and robust control system, has served the DWPF well over the last 20+ years, even as new challenges, such as the introduction into the DWPF flowsheet of auxiliary streams from the Actinide Removal Process (ARP) and other processes, were met. The purpose of this revision is to provide a technical basis for modifications to PCCS required to support the introduction of waste streams from the Salt Waste Processing Facility (SWPF) into the DWPF flowsheet. An expanded glass composition region is anticipated by the introduction of waste streams from SWPF, and property-composition studies of that glass region have been conducted. Jantzen, once again, directed the development of glass property-composition models applicable for this expanded composition region. The author gratefully acknowledges the technical contributions of C.M. Jantzen leading to the development of these glass property-composition models. The integration of these models into the PCCS constraints necessary to administer future acceptability decisions for the processing at DWPF is provided by this sixth revision of this document.« less

12 CFR 408.5 - Ensuring environmental documents are actually considered in Agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-01-01

... considered in Agency decision-making. 408.5 Section 408.5 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED... Procedures § 408.5 Ensuring environmental documents are actually considered in Agency decision-making... environmental documents in agency decision-making. To implement these requirements, Eximbank officials will: (a...

50 CFR 530.2 - Ensuring that environmental documents are actually considered in agency decision-making.

Code of Federal Regulations, 2010 CFR

2010-10-01

... actually considered in agency decision-making. 530.2 Section 530.2 Wildlife and Fisheries MARINE MAMMAL... documents are actually considered in agency decision-making. Section 1505.1 of the NEPA regulations contains requirements to ensure adequate consideration of environmental documents in agency decision-making. To...

Offshore Wind Guidance Document: Oceanography and Sediment Stability (Version 1) Development of a Conceptual Site Model.

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

Roberts, Jesse D.; Jason Magalen; Craig Jones

This guidance document provide s the reader with an overview of the key environmental considerations for a typical offshore wind coastal location and the tools to help guide the reader through a thoro ugh planning process. It will enable readers to identify the key coastal processes relevant to their offshore wind site and perform pertinent analysis to guide siting and layout design, with the goal of minimizing costs associated with planning, permitting , and long - ter m maintenance. The document highlight s site characterization and assessment techniques for evaluating spatial patterns of sediment dynamics in the vicinity of amore » wind farm under typical, extreme, and storm conditions. Finally, the document des cribe s the assimilation of all of this information into the conceptual site model (CSM) to aid the decision - making processes.« less

The Use of a Rubric as a Tool to Guide Pre-Service Teachers in the Development of IEPs

ERIC Educational Resources Information Center

Rosas, Clarissa E.; Winterman, Kathleen G.

2012-01-01

The challenge of developing Individualized Education Program documents that are representative of a team decision making process and are in compliance with IDEA 2004 is well documented in the literature. One of the main objectives of IEPs is to serve as the foundation of a child's academic program. Inclusion of children with disabilities in the…

78 FR 66660 - Potential Changes to Interlocutory Appeals Process for Adjudicatory Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-06

... issuance of a final Environmental Impact Statement (or other NEPA document) or, alternatively, b) after a... NRC received a single response during the public comment period, from the Nuclear Energy Institute...

Mental Status Documentation: Information Quality and Data Processes

PubMed Central

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses’ assessment, documentation, decisionmaking and communication regarding patients’ mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm. PMID:28269919

Mental Status Documentation: Information Quality and Data Processes.

PubMed

Weir, Charlene; Gibson, Bryan; Taft, Teresa; Slager, Stacey; Lewis, Lacey; Staggers, Nancy

2016-01-01

Delirium is a fluctuating disturbance of cognition and/or consciousness associated with poor outcomes. Caring for patients with delirium requires integration of disparate information across clinicians, settings and time. The goal of this project was to characterize the information processes involved in nurses' assessment, documentation, decisionmaking and communication regarding patients' mental status in the inpatient setting. VA nurse managers of medical wards (n=18) were systematically selected across the US. A semi-structured telephone interview focused on current assessment, documentation, and communication processes, as well as clinical and administrative decision-making was conducted, audio-recorded and transcribed. A thematic analytic approach was used. Five themes emerged: 1) Fuzzy Concepts, 2) Grey Data, 3) Process Variability 4) Context is Critical and 5) Goal Conflict. This project describes the vague and variable information processes related to delirium and mental status that undermine effective risk, prevention, identification, communication and mitigation of harm.

A quantitative method for evaluating alternatives. [aid to decision making

NASA Technical Reports Server (NTRS)

Forthofer, M. J.

1981-01-01

When faced with choosing between alternatives, people tend to use a number of criteria (often subjective, rather than objective) to decide which is the best alternative for them given their unique situation. The subjectivity inherent in the decision-making process can be reduced by the definition and use of a quantitative method for evaluating alternatives. This type of method can help decision makers achieve degree of uniformity and completeness in the evaluation process, as well as an increased sensitivity to the factors involved. Additional side-effects are better documentation and visibility of the rationale behind the resulting decisions. General guidelines for defining a quantitative method are presented and a particular method (called 'hierarchical weighted average') is defined and applied to the evaluation of design alternatives for a hypothetical computer system capability.

Treatment decision-making by men with localized prostate cancer: the influence of personal factors.

PubMed

Berry, Donna L; Ellis, William J; Woods, Nancy Fugate; Schwien, Christina; Mullen, Kristin H; Yang, Claire

2003-01-01

For many men with localized prostate cancer, there is no definite answer or unequivocal choice regarding treatment modality. This high-stakes treatment decision is made in the context of great uncertainty. The purpose of this study is to systematically document meaningful and relevant aspects of treatment decision-making reported by men with localized prostate cancer. Focus groups and individual interviews were conducted with 44 men who were within 6 months of a diagnosis of localized prostate cancer. Using content analysis and grounded theory analytic techniques, major aspects and processes of men's treatment decision making are identified and described. The participants reported their experiences beginning with influential personal history factors, followed by detailed descriptions of information gathering and the important influence of expected treatment outcomes and other individuals' cancer histories and/or shared opinions. Twenty of the 44 (45%) participants relied heavily on the influence of another's opinion or history to finalize a decision, yet only 10 of the 44 (22.7%) reported this individual to be their physician. A common process, "making the best choice for me" was explicated. Clinicians assume that men are making rational treatment decisions based on reliable information, yet this study documents a different reality. Patient education about medical therapies and the patients' own medical factors is not enough. A clinic visit dialogue that brings personal factors to the conversation along with medical factors can guide a man to making his "best choice" for localized prostate cancer.

Multi-Sector Sustainability Browser (MSSB) User Manual: A ...

EPA Pesticide Factsheets

EPA’s Sustainable and Healthy Communities (SHC) Research Program is developing methodologies, resources, and tools to assist community members and local decision makers in implementing policy choices that facilitate sustainable approaches in managing their resources affecting the built environment, natural environment, and human health. In order to assist communities and decision makers in implementing sustainable practices, EPA is developing computer-based systems including models, databases, web tools, and web browsers to help communities decide upon approaches that support their desired outcomes. Communities need access to resources that will allow them to achieve their sustainability objectives through intelligent decisions in four key sustainability areas: • Land Use • Buildings and Infrastructure • Transportation • Materials Management (i.e., Municipal Solid Waste [MSW] processing and disposal) The Multi-Sector Sustainability Browser (MSSB) is designed to support sustainable decision-making for communities, local and regional planners, and policy and decision makers. Document is an EPA Technical Report, which is the user manual for the Multi-Sector Sustainability Browser (MSSB) tool. The purpose of the document is to provide basic guidance on use of the tool for users

Assessing Patient Participation in Health Policy Decision-Making in Cyprus

PubMed Central

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-01-01

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients’ involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. PMID:27694659

Framework for Human Health Risk Assessment to Inform Decision Making

EPA Pesticide Factsheets

The purpose of this document is to describe a Framework for conducting human health risk assessments that are responsive to the needs of decision‐making processes in the U.S. Environmental Protection Agency (EPA).

Test Guidelines for Pesticides and Toxic Substances

EPA Pesticide Factsheets

Documents that specify methods EPA recommends to generate data submitted to EPA to support the registration of a pesticide, setting of a tolerance or tolerance exemption for pesticide residues, or the decision making process for an industrial chemical.

A Science Framework for Connecticut River Watershed Sustainability

USGS Publications Warehouse

Rideout, Stephen; Nicolson, Craig; Russell-Robinson, Susan L.; Mecray, Ellen L.

2005-01-01

Introduction: This document outlines a research framework for water resource managers and land-use planners in the four-state Connecticut River Watershed (CRW). It specifically focuses on developing the decision-support tools and data needed by managers in the watershed. The purpose of the Science Framework is to identify critical research issues and information required to better equip managers to make decisions on desirable changes in the CRW. This Science Framework is the result of a cooperative project between the U.S. Geological Survey (USGS), the University of Massachusetts at Amherst (UMass-Amherst), and the U.S. Fish and Wildlife Service (FWS). The cooperative project was guided by a Science Steering Committee (SC) and included several focus groups, a 70-person workshop in September 2004, and an open collaborative process by which the workshop outcomes were synthesized, written up, and then progressively refined through peer review. This document is the product of that collaborative process.

Logics of pre-merger decision-making processes: the case of Karolinska University Hospital.

PubMed

Choi, Soki; Brommels, Mats

2009-01-01

The purpose of this paper is to examine how and why a decision to merge two university hospitals in a public context might occur by using an in-depth case study of the pre-merger process of Karolinska University Hospital. Based on extensive document analysis and 35 key informant interviews the paper reconstructed the pre-merger process, searched for empirical patterns, and interpreted those by applying neo-institutional theory. Spanning nearly a decade, the pre-merger process goes from idea generation through transition to decision, and took place on two arenas, political, and scientific. Both research excellence and economic efficiency are stated merger motives. By applying a neo-institutional perspective, the paper finds that the two initial phases are driven by decision rationality, which is typical for political organizations and that the final phase demonstrated action rationality, which is typical for private firms. Critical factors behind this radical change of decision logic are means convergence, uniting key stakeholder groups, and an economic and political crisis, triggering critical incidents, which ultimately legitimized the formal decision. It is evident from the paper that merger decisions in the public sector might not necessarily result from stated and/or economic drivers only. This paper suggests that a change of decision logic from decision to action rationality might promote effective decision making on large and complex issues in a public context. This is the first systematic in-depth study of a university hospital merger employing a decision-making perspective.

Demystifying the Process? A Multi Disciplinary Approach to Assessing Capacity for Adults with a Learning Disability

ERIC Educational Resources Information Center

Skinner, Rachael; Joiner, Chris; Chesters, Liz; Bates, Louise; Scrivener, Louise

2011-01-01

There appears to be some degree of hesitation and lack of confidence among professionals in conducting capacity assessments. This document explains a two-phase process developed and implemented by a multi-disciplinary group of professionals during a pilot project. The first phase in the decision making process is to determine to what extent the…

Health Impact Assessment (HIA) and EnviroAtlas: Integrating Ecosystem Services into the Decision-Making Process-Guide

EPA Science Inventory

This document was created to highlight the many ways that the U.S. EPA EnviroAtlas suite of ecosystem services tools can be used to aid in the Health Impact Assessment (HIA) process. Ecosystems provide numerous services and benefits to individuals, communities, businesses, and ot...

78 FR 70617 - Open Government: Use of Genetic Information in Documenting and Evaluating Disability

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-26

... information in the disability decision process and what issues we should consider. \\1\\ 20 CFR 404.1512-404... genetic information in the disability determination process. The forum is open to all members of the....socialsecurity.gov . SUPPLEMENTARY INFORMATION: Under our current, long-standing policy, we do not purchase...

Mentor judgements and decision-making in the assessment of student nurse competence in practice: A mixed-methods study.

PubMed

Burden, Sarah; Topping, Anne Elizabeth; O'Halloran, Catherine

2018-05-01

To investigate how mentors form judgements and reach summative assessment decisions regarding student competence in practice. Competence assessment is a significant component of pre-registration nursing programmes in the United Kingdom. Concerns exist that assessments are subjective, lack consistency and that mentors fail to judge student performance as unsatisfactory. A two-stage sequential embedded mixed-methods design. Data collected 2012-2013. This study involved a whole student cohort completing a UK undergraduate adult nursing programme (N = 41). Stage 1: quantitative data on mentor conduct of assessment interviews and the final decision recorded (N = 330 from 270 mentors) were extracted from student Practice Assessment Documents (PADs). Stage 2: mentor feedback in student PADs was used in Stimulated Recall interviews with a purposive sample of final placement mentors (N = 17). These were thematically analysed. Findings were integrated to develop a theoretically driven model of mentor decision-making. Course assessment strategies and documentation had limited effect in framing mentor judgements and decisions. Rather, mentors amassed impressions, moderated by expectations of an "idealized student" by practice area and programme stage that influenced their management and outcome of the assessment process. These impressions were accumulated and combined into judgements that informed the final decision. This process can best be understood and conceptualized through the Brunswik's lens model of social judgement. Mentor decisions were reasoned and there was a shared understanding of judgement criteria and their importance. This impression-based nature of mentor decision-making questions the reliability and validity of competency-based assessments used in nursing pre-registration programmes. © 2017 John Wiley & Sons Ltd.

The Degree to Which Students and Teachers Are Involved in Second-Level School Processes and Participation in Decision-Making: An Irish Case Study

ERIC Educational Resources Information Center

Harrison, Kathy; Taysum, Alison; McNamara, Gerry; O'Hara, Joe

2016-01-01

The Education Act (1998) is a key policy document in Irish education, emphasising the rights, roles and responsibilities of key stakeholders, including parents, teachers and pupils in schools. Since 1998 the Department of Education and Skills (DES) has stressed the need to introduce an increased role for teachers and pupils in decision-making. It…

Tumor Slice Culture: A New Avatar in Personalized Oncology

DTIC Science & Technology

2017-09-01

of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188...significantly correlated with pathologic assessment of tumor viability/necrosis. We continue to optimize the conditions for TSC by manipulating growth...following exposure to treatments. We are in the process of assessing the pathologic outcome using H&E staining of the treated slices and correlating the

Tumor Slice Culture: A New Avatar in Personalized Oncology

DTIC Science & Technology

2017-09-01

the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public... correlated with pathologic assessment of tumor viability/necrosis. We continue to optimize the conditions for TSC by manipulating growth factors...exposure to treatments. We are in the process of assessing the pathologic outcome using H&E staining of the treated slices and correlating the results

Dietary Lipids, Cell Adhesion and Breast Cancer Metastasis

DTIC Science & Technology

2003-10-01

an official Department of the Army position, policy or decision unless so designated by other documentation. r Form Approved REPORT DOCUMENTATION PAGE...10, or 15 in transendothelial migration of cancer cells during meta- ipM. Similar experimental design was used in our previ- static process, we...Millicell-ERS voltohm- S, Eumn el al. / Eperimental Cell Research 296 (2004) 231-244 233 meter (Millipore, Bedford, MA). The resistance increased

40 CFR 300.700 - Activities by other persons.

Code of Federal Regulations, 2010 CFR

2010-07-01

... action is conducted in accordance with the preauthorization decision document, and costs are reasonable... preauthorization decision document. (8) For a claim to be awarded under section 111 of CERCLA, EPA must certify that the costs were necessary and consistent with the preauthorization decision document. (e) Section...

Reimbursement of biosimilars in Poland: is there a link to health technology assessment?

PubMed

Neumann, Dominika; Jabłecka, Anna

2016-12-01

Due to their complex structures, biosimilars are not generics. The differences between them are considered during market authorization processes but remain unclear during reimbursement decision-making. We analyzed the reimbursement of biopharmaceuticals in Poland with an emphasis on biosimilars and compared the health technology assessment (HTA) process with that defined in other countries. Recommendations provided by the Polish HTA organization and those in other countries were included as source documents. The period of interest covered January 2012 to December 2014. The reimbursement process for biosimilars in Poland is the same as that for generics. In contrast to other countries, a HTA is not involved in decision-making in Poland. The short administrative procedure for reimbursement of biosimilars in Poland accelerates the decision-making process; therefore, therapies can be made available to patients more quickly. However, this procedure can potentially lead to underestimation of aspects concerning the effectiveness and safety of biosimilars.

Do People Experience Cognitive Biases while Searching for Information?

PubMed Central

Lau, Annie Y.S.; Coiera, Enrico W.

2007-01-01

Objective To test whether individuals experience cognitive biases whilst searching using information retrieval systems. Biases investigated are anchoring, order, exposure and reinforcement. Design A retrospective analysis and a prospective experiment were conducted to investigate whether cognitive biases affect the way that documentary evidence is interpreted while searching online. The retrospective analysis was conducted on the search and decision behaviors of 75 clinicians (44 doctors, 31 nurses), answering questions for 8 clinical scenarios within 80 minutes in a controlled setting. The prospective study was conducted on 227 undergraduate students, who used the same search engine to answer two of six randomly assigned consumer health questions. Measurements Frequencies of correct answers pre- and post- search, and confidence in answers were collected. The impact of reading a document on the final decision was measured by the population likelihood ratio (LR) of the frequency of reading the document and the frequency of obtaining a correct answer. Documents with a LR > 1 were most likely to be associated with a correct answer, and those with a LR < 1 were most likely to be associated with an incorrect answer to a question. Agreement between a subject and the evidence they read was estimated by a concurrence rate, which measured the frequency that subjects’ answers agreed with the likelihood ratios of a group of documents, normalized for document order, time exposure or reinforcement through repeated access. Serial position curves were plotted for the relationship between subjects’ pre-search confidence, document order, the number of times and length of time a document was accessed, and concurrence with post-search answers. Chi-square analyses tested for the presence of biases, and the Kolmogorov-Smirnov test checked for equality of distribution of evidence in the comparison populations. Results A person’s prior belief (anchoring) has a significant impact on their post-search answer (retrospective: P < 0.001; prospective: P < 0.001). Documents accessed at different positions in a search session (order effect [retrospective: P = 0.76; prospective: P = 0.026]), and documents processed for different lengths of time (exposure effect [retrospective: P = 0.27; prospective: P = 0.0081]) also influenced decision post-search more than expected in the prospective experiment but not in the retrospective analysis. Reinforcement through repeated exposure to a document did not yield statistical differences in decision outcome post-search (retrospective: P = 0.31; prospective: P = 0.81). Conclusion People may experience anchoring, exposure and order biases while searching for information, and these biases may influence the quality of decision making during and after the use of information retrieval systems. PMID:17600097

FLAMMABLE GAS TECHNICAL BASIS DOCUMENT

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

KRIPPS, L.J.

2005-02-18

This document describes the qualitative evaluation of frequency and consequences for double shell tank (DST) and single shell tank (SST) representative flammable gas accidents and associated hazardous conditions without controls. The evaluation indicated that safety-significant SSCs and/or TSRS were required to prevent or mitigate flammable gas accidents. Discussion on the resulting control decisions is included. This technical basis document was developed to support of the Tank Farms Documented Safety Analysis (DSA) and describes the risk binning process for the flammable gas representative accidents and associated represented hazardous conditions. The purpose of the risk binning process is to determine the needmore » for safety-significant structures, systems, and components (SSC) and technical safety requirement (TSR)-level controls for a given representative accident or represented hazardous condition based on an evaluation of the event frequency and consequence.« less

Governance Challenges in Joint Inter-Jurisdictional Management: The Grand Teton National Park, Wyoming, Elk Case

NASA Astrophysics Data System (ADS)

Clark, Susan G.; Vernon, Marian E.

2015-08-01

The controversial elk reduction program (elk hunt) in Grand Teton National Park, WY, has been a source of conflict since it was legislated in 1950. The hunt is jointly managed by the National Park Service and the Wyoming Game and Fish Department. This forced organizational partnership and the conflicting mandates of these two agencies have led to persistent conflict that seems irresolvable under the current decision-making process. To better understand the decision-making process and participant perspectives, we reviewed management documents, technical literature, and newspaper articles, and interviewed 35 key participants in this case. We used these data to analyze and appraise the adequacy of the decision-making process for the park elk hunt and to ask whether it reflects the common interest. We found deficiencies in all functions of the decision-making process. Neither the decisions made nor the process itself include diverse perspectives, nor do they attend to valid and appropriate participant concerns. Agency officials focus their attention on technical rather than procedural concerns, which largely obfuscates the underlying tension in the joint inter-jurisdictional management arrangement and ultimately contributes to the hunt's annual implementation to the detriment of the common interest. We offer specific yet widely applicable recommendations to better approximate an inclusive and democratic decision-making process that serves the community's common interests.

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing

PubMed Central

Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

2015-01-01

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called “threshold probability” at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today’s clinical practice. PMID:26244571

Dual Processing Model for Medical Decision-Making: An Extension to Diagnostic Testing.

PubMed

Tsalatsanis, Athanasios; Hozo, Iztok; Kumar, Ambuj; Djulbegovic, Benjamin

2015-01-01

Dual Processing Theories (DPT) assume that human cognition is governed by two distinct types of processes typically referred to as type 1 (intuitive) and type 2 (deliberative). Based on DPT we have derived a Dual Processing Model (DPM) to describe and explain therapeutic medical decision-making. The DPM model indicates that doctors decide to treat when treatment benefits outweigh its harms, which occurs when the probability of the disease is greater than the so called "threshold probability" at which treatment benefits are equal to treatment harms. Here we extend our work to include a wider class of decision problems that involve diagnostic testing. We illustrate applicability of the proposed model in a typical clinical scenario considering the management of a patient with prostate cancer. To that end, we calculate and compare two types of decision-thresholds: one that adheres to expected utility theory (EUT) and the second according to DPM. Our results showed that the decisions to administer a diagnostic test could be better explained using the DPM threshold. This is because such decisions depend on objective evidence of test/treatment benefits and harms as well as type 1 cognition of benefits and harms, which are not considered under EUT. Given that type 1 processes are unique to each decision-maker, this means that the DPM threshold will vary among different individuals. We also showed that when type 1 processes exclusively dominate decisions, ordering a diagnostic test does not affect a decision; the decision is based on the assessment of benefits and harms of treatment. These findings could explain variations in the treatment and diagnostic patterns documented in today's clinical practice.

Comprehensive process model of clinical information interaction in primary care: results of a "best-fit" framework synthesis.

PubMed

Veinot, Tiffany C; Senteio, Charles R; Hanauer, David; Lowery, Julie C

2018-06-01

To describe a new, comprehensive process model of clinical information interaction in primary care (Clinical Information Interaction Model, or CIIM) based on a systematic synthesis of published research. We used the "best fit" framework synthesis approach. Searches were performed in PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Library and Information Science Abstracts, Library, Information Science and Technology Abstracts, and Engineering Village. Two authors reviewed articles according to inclusion and exclusion criteria. Data abstraction and content analysis of 443 published papers were used to create a model in which every element was supported by empirical research. The CIIM documents how primary care clinicians interact with information as they make point-of-care clinical decisions. The model highlights 3 major process components: (1) context, (2) activity (usual and contingent), and (3) influence. Usual activities include information processing, source-user interaction, information evaluation, selection of information, information use, clinical reasoning, and clinical decisions. Clinician characteristics, patient behaviors, and other professionals influence the process. The CIIM depicts the complete process of information interaction, enabling a grasp of relationships previously difficult to discern. The CIIM suggests potentially helpful functionality for clinical decision support systems (CDSSs) to support primary care, including a greater focus on information processing and use. The CIIM also documents the role of influence in clinical information interaction; influencers may affect the success of CDSS implementations. The CIIM offers a new framework for achieving CDSS workflow integration and new directions for CDSS design that can support the work of diverse primary care clinicians.

Information Quality in Regulatory Decision Making: Peer Review versus Good Laboratory Practice.

PubMed

McCarty, Lynn S; Borgert, Christopher J; Mihaich, Ellen M

2012-07-01

There is an ongoing discussion on the provenance of toxicity testing data regarding how best to ensure its validity and credibility. A central argument is whether journal peer-review procedures are superior to Good Laboratory Practice (GLP) standards employed for compliance with regulatory mandates. We sought to evaluate the rationale for regulatory decision making based on peer-review procedures versus GLP standards. We examined pertinent published literature regarding how scientific data quality and validity are evaluated for peer review, GLP compliance, and development of regulations. Some contend that peer review is a coherent, consistent evaluative procedure providing quality control for experimental data generation, analysis, and reporting sufficient to reliably establish relative merit, whereas GLP is seen as merely a tracking process designed to thwart investigator corruption. This view is not supported by published analyses pointing to subjectivity and variability in peer-review processes. Although GLP is not designed to establish relative merit, it is an internationally accepted quality assurance, quality control method for documenting experimental conduct and data. Neither process is completely sufficient for establishing relative scientific soundness. However, changes occurring both in peer-review processes and in regulatory guidance resulting in clearer, more transparent communication of scientific information point to an emerging convergence in ensuring information quality. The solution to determining relative merit lies in developing a well-documented, generally accepted weight-of-evidence scheme to evaluate both peer-reviewed and GLP information used in regulatory decision making where both merit and specific relevance inform the process.

Getting ocean acidification on decision makers' to-do lists: dissecting the process through case studies

USGS Publications Warehouse

Cooley, Sarah R.; Jewett, Elizabeth B.; Reichert, Julie; Robbins, Lisa L.; Shrestha, Gyami; Wieczorek, Dan; Weisberg, Stephen B.

2015-01-01

Much of the detailed, incremental knowledge being generated by current scientific research on ocean acidification (OA) does not directly address the needs of decision makers, who are asking broad questions such as: Where will OA harm marine resources next? When will this happen? Who will be affected? And how much will it cost? In this review, we use a series of mainly US-based case studies to explore the needs of local to international-scale groups that are making decisions to address OA concerns. Decisions concerning OA have been made most naturally and easily when information needs were clearly defined and closely aligned with science outputs and initiatives. For decisions requiring more complex information, the process slows dramatically. Decision making about OA is greatly aided (1) when a mixture of specialists participates, including scientists, resource users and managers, and policy and law makers; (2) when goals can be clearly agreed upon at the beginning of the process; (3) when mixed groups of specialists plan and create translational documents explaining the likely outcomes of policy decisions on ecosystems and natural resources; (4) when regional work on OA fits into an existing set of priorities concerning climate or water quality; and (5) when decision making can be reviewed and enhanced.

Considerations for the Systematic Analysis and Use of Single-Case Research

ERIC Educational Resources Information Center

Horner, Robert H.; Swaminathan, Hariharan; Sugai, George; Smolkowski, Keith

2012-01-01

Single-case research designs provide a rigorous research methodology for documenting experimental control. If single-case methods are to gain wider application, however, a need exists to define more clearly (a) the logic of single-case designs, (b) the process and decision rules for visual analysis, and (c) an accepted process for integrating…

78 FR 29140 - Center for Devices and Radiological Health Appeals Processes: Questions and Answers About 517A...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-17

... availability of the draft guidance entitled ``Center for Devices and Radiological Health (CDRH) Appeals Processes: Questions and Answers About 517A.'' This draft document provides CDRH's proposed interpretation... decisions and actions taken by CDRH. This draft guidance is not final nor is it in effect at this time...

76 FR 81511 - Draft Guidance for Industry and Food and Drug Administration Staff; Center for Devices and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-28

... ``Center for Devices and Radiological Health (CDRH) Appeals Processes.'' This document describes the processes available to outside stakeholders to request additional review of decisions and actions by CDRH... submit related requests to CDRH and FDA. This draft guidance is not final nor is it in effect at this...

Modeling Theory of Mind and Cognitive Appraisal with Decision-Theoretic Agents

DTIC Science & Technology

2011-04-07

following key factors: Consistency: People expect, prefer, and are driven to maintain consistency, and avoid cognitive dissonance , be- tween beliefs...Modeling Theory of Mind and Cognitive Appraisal with Decision-Theoretic Agents David V. Pynadath1, Mei Si2, and Stacy C. Marsella1 1Institute for...capacity in appraisal and social emotions, as well as arguing for a uniform process for emotion and cognition . 1 Report Documentation Page Form

[Medical data warehousing as a generator of system component for decision support in health care].

PubMed

Catibusić, Sulejman; Hadzagić-Catibusić, Feriha; Zubcević, Smail

2004-01-01

Growth in role of data warehousing as strategic information for decision makers is significant. Many health institutions have data warehouse implementations in process of development or even in production. This article was made with intention to improve general understanding of data warehousing requirements form the point of view of end-users, and information system as well. For that reason, in this document advantages and arguments for implementation, techniques and methods of data warehousing, data warehouse foundation and exploration of information as final product of data warehousing process have been described.

"What is relevant in a text document?": An interpretable machine learning approach

PubMed Central

Arras, Leila; Horn, Franziska; Montavon, Grégoire; Müller, Klaus-Robert

2017-01-01

Text documents can be described by a number of abstract concepts such as semantic category, writing style, or sentiment. Machine learning (ML) models have been trained to automatically map documents to these abstract concepts, allowing to annotate very large text collections, more than could be processed by a human in a lifetime. Besides predicting the text’s category very accurately, it is also highly desirable to understand how and why the categorization process takes place. In this paper, we demonstrate that such understanding can be achieved by tracing the classification decision back to individual words using layer-wise relevance propagation (LRP), a recently developed technique for explaining predictions of complex non-linear classifiers. We train two word-based ML models, a convolutional neural network (CNN) and a bag-of-words SVM classifier, on a topic categorization task and adapt the LRP method to decompose the predictions of these models onto words. Resulting scores indicate how much individual words contribute to the overall classification decision. This enables one to distill relevant information from text documents without an explicit semantic information extraction step. We further use the word-wise relevance scores for generating novel vector-based document representations which capture semantic information. Based on these document vectors, we introduce a measure of model explanatory power and show that, although the SVM and CNN models perform similarly in terms of classification accuracy, the latter exhibits a higher level of explainability which makes it more comprehensible for humans and potentially more useful for other applications. PMID:28800619

Assessing Patient Participation in Health Policy Decision-Making in Cyprus.

PubMed

Souliotis, Kyriakos; Agapidaki, Eirini; Peppou, Lily Evangelia; Tzavara, Chara; Samoutis, George; Theodorou, Mamas

2016-06-20

Although the importance of patient participation in the design and evaluation of health programs and services is well-documented, there is scarcity of research with regard to patient association (PA) participation in health policy decision-making processes. To this end, the present study aimed to validate further a previously developed instrument as well as to investigate the degree of PA participation in health policy decision-making in Cyprus. A convenient sample of 114 patients-members of patients associations took part in the study. Participants were recruited from an umbrella organization, the Pancyprian Federation of Patient Associations and Friends (PFPA). PA participation in health policy decision-making was assessed with the Health Democracy Index (HDI), an original 8-item tool. To explore its psychometric properties, Cronbach α was computed as regards to its internal consistency, while its convergent validity was tested against a self-rated question enquiring about the degree of PA participation in health policy decision-making. The findings revealed that the HDI has good internal consistency and convergent validity. Furthermore, PAs were found to participate more in consultations in health-related organizations and the Ministry of Health (MoH) as well as in reforms or crucial decisions in health policy. Lower levels were documented with regard to participation in hospital boards, ethics committees in clinical trials and health technology assessment (HTA) procedures. Overall, PA participation levels were found to be lower than the mid-point of the scale. Targeted interventions aiming to facilitate patients' involvement in health policy decision-making processes and to increase its impact are greatly needed in Cyprus. © 2016 by Kerman University of Medical Sciences.

The use of exploratory analyses within the National Institute for Health and Care Excellence single technology appraisal process: an evaluation and qualitative analysis.

PubMed

Kaltenthaler, Eva; Carroll, Christopher; Hill-McManus, Daniel; Scope, Alison; Holmes, Michael; Rice, Stephen; Rose, Micah; Tappenden, Paul; Woolacott, Nerys

2016-04-01

As part of the National Institute for Health and Care Excellence (NICE) single technology appraisal (STA) process, independent Evidence Review Groups (ERGs) critically appraise the company submission. During the critical appraisal process the ERG may undertake analyses to explore uncertainties around the company's model and their implications for decision-making. The ERG reports are a central component of the evidence considered by the NICE Technology Appraisal Committees (ACs) in their deliberations. The aim of this research was to develop an understanding of the number and type of exploratory analyses undertaken by the ERGs within the STA process and to understand how these analyses are used by the NICE ACs in their decision-making. The 100 most recently completed STAs with published guidance were selected for inclusion in the analysis. The documents considered were ERG reports, clarification letters, the first appraisal consultation document and the final appraisal determination. Over 400 documents were assessed in this study. The categories of types of exploratory analyses included fixing errors, fixing violations, addressing matters of judgement and the ERG-preferred base case. A content analysis of documents (documentary analysis) was undertaken to identify and extract relevant data, and narrative synthesis was then used to rationalise and present these data. The level and type of detail in ERG reports and clarification letters varied considerably. The vast majority (93%) of ERG reports reported one or more exploratory analyses. The most frequently reported type of analysis in these 93 ERG reports related to the category 'matters of judgement', which was reported in 83 (89%) reports. The category 'ERG base-case/preferred analysis' was reported in 45 (48%) reports, the category 'fixing errors' was reported in 33 (35%) reports and the category 'fixing violations' was reported in 17 (18%) reports. The exploratory analyses performed were the result of issues raised by an ERG in its critique of the submitted economic evidence. These analyses had more influence on recommendations earlier in the STA process than later on in the process. The descriptions of analyses undertaken were often highly specific to a particular STA and could be inconsistent across ERG reports and thus difficult to interpret. Evidence Review Groups frequently conduct exploratory analyses to test or improve the economic evaluations submitted by companies as part of the STA process. ERG exploratory analyses often have an influence on the recommendations produced by the ACs. More in-depth analysis is needed to understand how ERGs make decisions regarding which exploratory analyses should be undertaken. More research is also needed to fully understand which types of exploratory analyses are most useful to ACs in their decision-making. The National Institute for Health Research Health Technology Assessment programme.

From cure to palliation: staff communication, documentation, and transfer of patient.

PubMed

Löfmark, Rurik; Nilstun, Tore; Bolmsjö, Ingrid Agren

2005-12-01

In the transition from curative treatment to palliative care of a general end-of-life patient population, the internal communication of the acute care staff seems to be less than optimal. The communication had reference to the dialogue within the staff both before and after the decision to concentrate on palliative care, and possible transfer of the patient. This survey of Swedish nurses and physicians showed that most of 780 respondents wanted more internal communication, and a more individualized procedure of decision-making. All staff should be informed about the decision made but full agreement was not seen as realistic. The largest difference of opinion between nurses and physicians concerned the involvement of nurses in the decision-making about the transition. A uniform documentation of the decision to transfer care focus was the ideal. Approximately every fourth patient in acute care is transferred to receive palliative care. Only approximately half of the respondents had any training in palliative care and the majority wanted more training. There seems to be a need for more palliative care training, perhaps somewhat different for each specialty. Furthermore, a common language to enable nurses and physicians to communicate more easily may improve the transition process.

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

Mediator assessment, documentation, and disposition of child custody cases involving intimate partner abuse: a naturalistic evaluation of one county's practices.

PubMed

Beck, Connie J A; Walsh, Michele E; Mechanic, Mindy B; Taylor, Caitilin S

2010-06-01

The contentious and costly nature of the adversarial process for resolving child custody disputes has prompted scholars, practitioners, and policy makers to advocate for the development and implementation of less divisive forms of dispute resolution, notably, mediation. Mediation has been championed for its potential to resolve disputes with less acrimony among disputants, reduced economic costs, increased satisfaction with outcomes, and fewer adverse consequences for family members. Despite the increasing popularity, arguments have cautioned against the use of mandated mediation when intimate partner abuse (IPA) is alleged. This research documents a mediation screening process and models mediators' decision-making process as instantiated, naturally, in one jurisdiction.

A systematic approach to baseline assessment of nursing documentation and enterprise-wide prioritization for electronic conversion.

PubMed

Dykes, Patricia C; Spurr, Cindy; Gallagher, Joan; Li, Qi; Ives Erickson, Jeanette

2006-01-01

An important challenge associated with making the transition from paper to electronic documentation systems is achieving consensus regarding priorities for electronic conversion across diverse groups. In our work we focus on applying a systematic approach to evaluating the baseline state of nursing documentation across a large healthcare system and establishing a unified vision for electronic conversion. A review of the current state of nursing documentation across PHS was conducted using structured tools. Data from this assessment was employed to facilitate an evidence-based approach to decision-making regarding conversion to electronic documentation at local and PHS levels. In this paper we present highlights of the assessment process and the outcomes of this multi-site collaboration.

Decision-making in schizophrenia: A predictive-coding perspective.

PubMed

Sterzer, Philipp; Voss, Martin; Schlagenhauf, Florian; Heinz, Andreas

2018-05-31

Dysfunctional decision-making has been implicated in the positive and negative symptoms of schizophrenia. Decision-making can be conceptualized within the framework of hierarchical predictive coding as the result of a Bayesian inference process that uses prior beliefs to infer states of the world. According to this idea, prior beliefs encoded at higher levels in the brain are fed back as predictive signals to lower levels. Whenever these predictions are violated by the incoming sensory data, a prediction error is generated and fed forward to update beliefs encoded at higher levels. Well-documented impairments in cognitive decision-making support the view that these neural inference mechanisms are altered in schizophrenia. There is also extensive evidence relating the symptoms of schizophrenia to aberrant signaling of prediction errors, especially in the domain of reward and value-based decision-making. Moreover, the idea of altered predictive coding is supported by evidence for impaired low-level sensory mechanisms and motor processes. We review behavioral and neural findings from these research areas and provide an integrated view suggesting that schizophrenia may be related to a pervasive alteration in predictive coding at multiple hierarchical levels, including cognitive and value-based decision-making processes as well as sensory and motor systems. We relate these findings to decision-making processes and propose that varying degrees of impairment in the implicated brain areas contribute to the variety of psychotic experiences. Copyright © 2018 Elsevier Inc. All rights reserved.

7 CFR 1486.303 - What specific contracting procedures must be adhered to?

Code of Federal Regulations, 2010 CFR

2010-01-01

... MARKETS PROGRAM Program Operations § 1486.303 What specific contracting procedures must be adhered to? (a...) Perform some form of fee, price, or cost analysis, such as a comparison of price quotations to market...) Document the decision-making process. ...

Bridging the guideline implementation gap: a systematic, document-centered approach to guideline implementation.

PubMed

Shiffman, Richard N; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge.

Automation Bias: Decision Making and Performance in High-Tech Cockpits

NASA Technical Reports Server (NTRS)

Mosier, Kathleen L.; Skitka, Linda J.; Heers, Susan; Burdick, Mark; Rosekind, Mark R. (Technical Monitor)

1997-01-01

Automated aids and decision support tools are rapidly becoming indispensible tools in high-technology cockpits, and are assuming increasing control of "cognitive" flight tasks, such as calculating fuel-efficient routes, navigating, or detecting and diagnosing system malfunctions and abnormalities. This study was designed to investigate "automation bias," a recently documented factor in the use of automated aids and decision support systems. The term refers to omission and commission errors resulting from the use of automated cues as a heuristic replacement for vigilant information seeking and processing. Glass-cockpit pilots flew flight scenarios involving automation "events," or opportunities for automation-related omission and commission errors. Pilots who perceived themselves as "accountable" for their performance and strategies of interaction with the automation were more likely to double-check automated functioning against other cues, and less likely to commit errors. Pilots were also likely to erroneously "remember" the presence of expected cues when describing their decision-making processes.

Using the Situated Clinical Decision-Making framework to guide analysis of nurses' clinical decision-making.

PubMed

Gillespie, Mary

2010-11-01

Nurses' clinical decision-making is a complex process that holds potential to influence the quality of care provided and patient outcomes. The evolution of nurses' decision-making that occurs with experience has been well documented. In addition, literature includes numerous strategies and approaches purported to support development of nurses' clinical decision-making. There has been, however, significantly less attention given to the process of assessing nurses' clinical decision-making and novice clinical educators are often challenged with knowing how to best support nurses and nursing students in developing their clinical decision-making capacity. The Situated Clinical Decision-Making framework is presented for use by clinical educators: it provides a structured approach to analyzing nursing students' and novice nurses' decision-making in clinical nursing practice, assists educators in identifying specific issues within nurses' clinical decision-making, and guides selection of relevant strategies to support development of clinical decision-making. A series of questions is offered as a guide for clinical educators when assessing nurses' clinical decision-making. The discussion presents key considerations related to analysis of various decision-making components, including common sources of challenge and errors that may occur within nurses' clinical decision-making. An exemplar illustrates use of the framework and guiding questions. Implications of this approach for selection of strategies that support development of clinical decision-making are highlighted. Copyright © 2010 Elsevier Ltd. All rights reserved.

"Leaky" Rationality: How Research on Behavioral Decision Making Challenges Normative Standards of Rationality.

PubMed

Keys, Daniel J; Schwartz, Barry

2007-06-01

For more than 30 years, decision-making research has documented that people often violate various principles of rationality, some of which are so fundamental that theorists of rationality rarely bother to state them. We take these characteristics of decision making as a given but argue that it is problematic to conclude that they typically represent departures from rationality. The very psychological processes that lead to "irrational" decisions (e.g., framing, mental accounting) continue to exert their influence when one experiences the results of the decisions. That is, psychological processes that affect decisions may be said also to "leak" into one's experience. The implication is that formal principles of rationality do not provide a good enough normative standard against which to assess decision making. Instead, what is needed is a substantive theory of rationality-one that takes subjective experience seriously, considers both direct and indirect consequences of particular decisions, considers how particular decisions fit into life as a whole, and considers the effects of decisions on others. Formal principles may play a role as approximations of the substantive theory that can be used by theorists and decision makers in cases in which the formal principles can capture most of the relevant considerations and leakage into experience is negligible. © 2007 Association for Psychological Science.

Cognitive influences on self-care decision making in persons with heart failure.

PubMed

Dickson, Victoria V; Tkacs, Nancy; Riegel, Barbara

2007-09-01

Despite advances in management, heart failure is associated with high rates of hospitalization, poor quality of life, and early death. Education intended to improve patients' abilities to care for themselves is an integral component of disease management programs. True self-care requires that patients make decisions about symptoms, but the cognitive deficits documented in 30% to 50% of the heart failure population may make daily decision making challenging. After describing heart failure self-care as a naturalistic decision making process, we explore cognitive deficits known to exist in persons with heart failure. Problems in heart failure self-care are analyzed in relation to neural alterations associated with heart failure. As a neural process, decision making has been traced to regions of the prefrontal cortex, the same areas that are affected by ischemia, infarction, and hypoxemia in heart failure. Resulting deficits in memory, attention, and executive function may impair the perception and interpretation of early symptoms and reasoning and, thereby, delay early treatment implementation. There is compelling evidence that the neural processes critical to decision making are located in the same structures that are affected by heart failure. Because self-care requires the cognitive ability to learn, perceive, interpret, and respond, research is needed to discern how neural deficits affects these abilities, decision-making, and self-care behaviors.

A Decision Tree for Nonmetric Sex Assessment from the Skull.

PubMed

Langley, Natalie R; Dudzik, Beatrix; Cloutier, Alesia

2018-01-01

This study uses five well-documented cranial nonmetric traits (glabella, mastoid process, mental eminence, supraorbital margin, and nuchal crest) and one additional trait (zygomatic extension) to develop a validated decision tree for sex assessment. The decision tree was built and cross-validated on a sample of 293 U.S. White individuals from the William M. Bass Donated Skeletal Collection. Ordinal scores from the six traits were analyzed using the partition modeling option in JMP Pro 12. A holdout sample of 50 skulls was used to test the model. The most accurate decision tree includes three variables: glabella, zygomatic extension, and mastoid process. This decision tree yielded 93.5% accuracy on the training sample, 94% on the cross-validated sample, and 96% on a holdout validation sample. Linear weighted kappa statistics indicate acceptable agreement among observers for these variables. Mental eminence should be avoided, and definitions and figures should be referenced carefully to score nonmetric traits. © 2017 American Academy of Forensic Sciences.

An Overview of NASA's Program of Future M&S VV&A Outreach and Training Activities

NASA Technical Reports Server (NTRS)

Caine, Lisa; Hale, Joseph P.

2006-01-01

NASA's Exploration Systems Mission Directorate (ESMD) is implementing a management approach for modeling and simulation (M&S) that will provide decision-makers information on the model s fidelity, credibility, and quality. The Integrated Modeling & Simulation Verification, Validation and Accreditation (IM&S W&A) process will allow the decision-maker to understand the risks involved in using a model s results for mission-critical decisions. The W&A Technical Working Group (W&A TWG) has been identified to communicate this process throughout the agency. As the W&A experts, the W&A NVG will be the central resource for support of W&A policy, procedures, training and templates for documentation. This presentation will discuss the W&A Technical Working Group s outreach approach aimed at educating M&S program managers, developers, users and proponents on the W&A process, beginning at MSFC with the CLV program.

Software Tools for In-Situ Documentation of Built Heritage

NASA Astrophysics Data System (ADS)

Smars, P.

2013-07-01

The paper presents open source software tools developed by the author to facilitate in-situ documentation of architectural and archæological heritage. The design choices are exposed and related to a general issue in conservation and documentation: taking decisions about a valuable object under threat . The questions of level of objectivity is central to the three steps of this process. It is our belief that in-situ documentation has to be favoured in this demanding context, full of potential discoveries. The very powerful surveying techniques in rapid development nowadays enhance our vision but often tend to bring back a critical part of the documentation process to the office. The software presented facilitate a direct treatment of the data on the site. Emphasis is given to flexibility, interoperability and simplicity. Key features of the software are listed and illustrated with examples (3D model of Gothic vaults, analysis of the shape of a column, deformation of a wall, direct interaction with AutoCAD).

Instructional Systems Design and Preservice Teachers' Processes of Thinking, Teaching and Planning: What Do They Learn and How Do They Change?

ERIC Educational Resources Information Center

Moallem, Mahnaz; Applefield, James

This study explored the development and processes of thinking, planning, and decision making of two preservice teachers as they progressed through their teacher education program. The effects of training in the systems approach on two preservice teachers' thinking about instruction and on their actual instructional planning documents were…

78 FR 25758 - Amended Notice of Intent To Clarify the Scope of Analysis of the Environmental Document and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-02

... influence the scope of the environmental analysis, and guide the entire process from plan decision-making to... Amendment in the West Mojave Planning Area, to the Motorized Vehicle Access Element of the California Desert... focused scoping process to solicit public comments and identify issues related to the clarified scope of...

Dual processing model of medical decision-making.

PubMed

Djulbegovic, Benjamin; Hozo, Iztok; Beckstead, Jason; Tsalatsanis, Athanasios; Pauker, Stephen G

2012-09-03

Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. We show that physician's beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker's threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories).

An Introspective Critique of Past, Present, and Future USGS Decision Support

NASA Astrophysics Data System (ADS)

Neff, B. P.; Pavlick, M.

2017-12-01

In response to increasing scrutiny of publicly funded science, the Water Mission Area of USGS is shifting its approach for informing decisions that affect the country. Historically, USGS has focused on providing sound science on cutting edge, societally relevant issues with the expectation that decision makers will take action on this information. In practice, scientists often do not understand or focus on the needs of decision makers and decision makers often cannot or do not utilize information produced by scientists. The Water Mission Area of USGS has recognized that it can better serve the taxpayer by delivering information more relevant to decision making in a form more conducive to its use. To this end, the Water Mission Area of USGS is seeking greater integration with the decision making process to better inform what information it produces. In addition, recognizing that the transfer of scientific knowledge to decision making is fundamentally a social process, USGS is embracing the use of social science to better inform how it delivers scientific information and facilitates its use. This study utilizes qualitative methods to document the evolution of decision support at USGS and provide a rationale for a shift in direction. Challenges to implementation are identified and collaborative opportunities to improve decision making are discussed.

External audit of clinical practice and medical decision making in a new Asian oncology center: Results and implications for both developing and developed nations

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

Shakespeare, Thomas P.; Back, Michael F.; Lu, Jiade J.

2006-03-01

Purpose: The external audit of oncologist clinical practice is increasingly important because of the incorporation of audits into national maintenance of certification (MOC) programs. However, there are few reports of external audits of oncology practice or decision making. Our institution (The Cancer Institute, Singapore) was asked to externally audit an oncology department in a developing Asian nation, providing a unique opportunity to explore the feasibility of such a process. Methods and Materials: We audited 100 randomly selected patients simulated for radiotherapy in 2003, using a previously reported audit instrument assessing clinical documentation/quality assurance and medical decision making. Results: Clinical documentation/qualitymore » assurance, decision making, and overall performance criteria were adequate 74.4%, 88.3%, and 80.2% of the time, respectively. Overall 52.0% of cases received suboptimal management. Multivariate analysis revealed palliative intent was associated with improved documentation/clinical quality assurance (p = 0.07), decision making (p 0.007), overall performance (p = 0.003), and optimal treatment rates (p 0.07); non-small-cell lung cancer or central nervous system primary sites were associated with better decision making (p = 0.001), overall performance (p = 0.03), and optimal treatment rates (p = 0.002). Conclusions: Despite the poor results, the external audit had several benefits. It identified learning needs for future targeting, and the auditor provided facilitating feedback to address systematic errors identified. Our experience was also helpful in refining our national revalidation audit instrument. The feasibility of the external audit supports the consideration of including audit in national MOC programs.« less

Conformance Testing: Measurement Decision Rules

NASA Technical Reports Server (NTRS)

Mimbs, Scott M.

2010-01-01

The goal of a Quality Management System (QMS) as specified in ISO 9001 and AS9100 is to provide assurance to the customer that end products meet specifications. Measuring devices, often called measuring and test equipment (MTE), are used to provide the evidence of product conformity to specified requirements. Unfortunately, processes that employ MTE can become a weak link to the overall QMS if proper attention is not given to the measurement process design, capability, and implementation. Documented "decision rules" establish the requirements to ensure measurement processes provide the measurement data that supports the needs of the QMS. Measurement data are used to make the decisions that impact all areas of technology. Whether measurements support research, design, production, or maintenance, ensuring the data supports the decision is crucial. Measurement data quality can be critical to the resulting consequences of measurement-based decisions. Historically, most industries required simplistic, one-size-fits-all decision rules for measurements. One-size-fits-all rules in some cases are not rigorous enough to provide adequate measurement results, while in other cases are overly conservative and too costly to implement. Ideally, decision rules should be rigorous enough to match the criticality of the parameter being measured, while being flexible enough to be cost effective. The goal of a decision rule is to ensure that measurement processes provide data with a sufficient level of quality to support the decisions being made - no more, no less. This paper discusses the basic concepts of providing measurement-based evidence that end products meet specifications. Although relevant to all measurement-based conformance tests, the target audience is the MTE end-user, which is anyone using MTE other than calibration service providers. Topics include measurement fundamentals, the associated decision risks, verifying conformance to specifications, and basic measurement decisions rules.

A framework for ecological decision support systems: Building the right systems and building the systems right

USGS Publications Warehouse

D'Erchia, Frank; Korschgen, Carl E.; Nyquist, M.; Root, Ralph; Sojda, Richard S.; Stine, Peter

2001-01-01

Workshops in the late 1990's launched the commitment of the U.S. Geological Survey's Biological Resources Division (BRD) to develop and implement decision support systems (DSS) applications. One of the primary goals of this framework document is to provide sufficient background and information for Department of the Interior (DOI) bureau stakeholders and other clients to determine the potential for DSS development. Such an understanding can assist them in carrying out effective land planning and management practices. This document provides a definition of DSS and its characteristics and capabilities. It proceeds to describe issues related to meeting resource managers needs, such as the needs for specific applications, customer requirements, information and technology transfer, user support, and institutionalization. Using the decision process as a means to guide DSS development and determine users needs is also discussed. We conclude with information on method to evaluate DSS development efforts and recommended procedures for verification and validation. 

A Review of Computerized Team Performance Measures to Identify Military-Relevant, Low-to-Medium Fidelity Tests of Small Group Effectiveness during Shared Information Processing

DTIC Science & Technology

2012-05-01

Alexandria, Virginia 22314. Orders will be expedited if placed through the librarian or other person designated to request documents from DTIC...an official Department of the Army position, policy, or decision, unless so designated by other official documentation. Citation of trade names in...teamwork and evaluate the effectiveness of team training methods (Baker and Salas, 1997). Additionally, good measures of team performance should aid the

Vocabulary Development and Maintenance--Descriptors. ERIC Processing Manual, Section VIII (Part 1).

ERIC Educational Resources Information Center

Houston, Jim, Ed.

Comprehensive rules, guidelines, and examples are provided for use by ERIC indexers and lexicographers in developing and maintaining the "Thesaurus of ERIC Descriptors." Evaluation and decision criteria, research procedures, and inputting details for adding new Descriptors are documented. Instructions for modifying existing Thesaurus…

28 CFR 2.56 - Disclosure of Parole Commission file.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Chairman's decision on appeal. (i) Expedited processing of Requests. (1) The Commission will provide... permissible under the Freedom of Information Act or the Privacy Act of 1974. (b) Scope of disclosure. Disclosure under this section shall extend to Commission documents concerning the prisoner or parolee making...

7 CFR 1940.301 - Purpose.

Code of Federal Regulations, 2013 CFR

2013-01-01

... environmental policies of the Farmers Home Administration (FmHA) or its successor agency under Public Law 103... required for a series of Federal laws, regulations, and Executive orders within one environmental document... Law 103-354 decision-making process is also outlined. (b) This subpart is intended to be consistent...

7 CFR 1940.301 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-01-01

... environmental policies of the Farmers Home Administration (FmHA) or its successor agency under Public Law 103... required for a series of Federal laws, regulations, and Executive orders within one environmental document... Law 103-354 decision-making process is also outlined. (b) This subpart is intended to be consistent...

Improving Recruiting of the 6th Recruiting Brigade Through Statistical Analysis and Efficiency Measures

DTIC Science & Technology

2014-12-01

example of maximizing or minimizing decision variables within a model. Carol Stoker and Stephen Mehay present a comparative analysis of marketing and advertising strategies...strategy development process; documenting various recruiting, marketing , and advertising initiatives in each nation; and examining efforts to

100-N Area Decision Unit Target Analyte List Development for Soil

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

Ovink, R.

2012-09-18

This report documents the process used to identify source area target analytes in support of the 100-N Area remedial investigation/feasibility study (RI/FS) addendum to the Integrated 100 Area Remedial Investigation/Feasibility Study Work Plan (DOE/RL-2008-46, Rev. 0).

Evaluate Yourself. Evaluation: Research-Based Decision Making Series, Number 9304.

ERIC Educational Resources Information Center

Fetterman, David M.

This document considers both self-examination and external evaluation of gifted and talented education programs. Principles of the self-examination process are offered, noting similarities to external evaluation models. Principles of self-evaluation efforts include the importance of maintaining a nonjudgmental orientation, soliciting views from…

GRADE equity guidelines 4: considering health equity in GRADE guideline development: evidence to decision process.

PubMed

Pottie, Kevin; Welch, Vivian; Morton, Rachael; Akl, Elie A; Eslava-Schmalbach, Javier H; Katikireddi, Vittal; Singh, Jasvinder; Moja, Lorenzo; Lang, Eddy; Magrini, Nicola; Thabane, Lehana; Stanev, Roger; Matovinovic, Elizabeth; Snellman, Alexandra; Briel, Matthias; Shea, Beverly; Tugwell, Peter; Schunemann, Holger; Guyatt, Gordon; Alonso-Coello, Pablo

2017-10-01

The aim of this paper is to provide detailed guidance on how to incorporate health equity within the GRADE (Grading Recommendations Assessment and Development Evidence) evidence to decision process. We developed this guidance based on the GRADE evidence to decision framework, iteratively reviewing and modifying draft documents, in person discussion of project group members and input from other GRADE members. Considering the impact on health equity may be required, both in general guidelines and guidelines that focus on disadvantaged populations. We suggest two approaches to incorporate equity considerations: (1) assessing the potential impact of interventions on equity and (2) incorporating equity considerations when judging or weighing each of the evidence to decision criteria. We provide guidance and include illustrative examples. Guideline panels should consider the impact of recommendations on health equity with attention to remote and underserviced settings and disadvantaged populations. Guideline panels may wish to incorporate equity judgments across the evidence to decision framework. This is the fourth and final paper in a series about considering equity in the GRADE guideline development process. This series is coming from the GRADE equity subgroup. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing an Advanced Environment for Collaborative Computing

NASA Technical Reports Server (NTRS)

Becerra-Fernandez, Irma; Stewart, Helen; DelAlto, Martha; DelAlto, Martha; Knight, Chris

1999-01-01

Knowledge management in general tries to organize and make available important know-how, whenever and where ever is needed. Today, organizations rely on decision-makers to produce "mission critical" decisions that am based on inputs from multiple domains. The ideal decision-maker has a profound understanding of specific domains that influence the decision-making process coupled with the experience that allows them to act quickly and decisively on the information. In addition, learning companies benefit by not repeating costly mistakes, and by reducing time-to-market in Research & Development projects. Group-decision making tools can help companies make better decisions by capturing the knowledge from groups of experts. Furthermore, companies that capture their customers preferences can improve their customer service, which translates to larger profits. Therefore collaborative computing provides a common communication space, improves sharing of knowledge, provides a mechanism for real-time feedback on the tasks being performed, helps to optimize processes, and results in a centralized knowledge warehouse. This paper presents the research directions. of a project which seeks to augment an advanced collaborative web-based environment called Postdoc, with workflow capabilities. Postdoc is a "government-off-the-shelf" document management software developed at NASA-Ames Research Center (ARC).

Development of a robust space power system decision model

NASA Astrophysics Data System (ADS)

Chew, Gilbert; Pelaccio, Dennis G.; Jacobs, Mark; Stancati, Michael; Cataldo, Robert

2001-02-01

NASA continues to evaluate power systems to support human exploration of the Moon and Mars. The system(s) would address all power needs of surface bases and on-board power for space transfer vehicles. Prior studies have examined both solar and nuclear-based alternatives with respect to individual issues such as sizing or cost. What has not been addressed is a comprehensive look at the risks and benefits of the options that could serve as the analytical framework to support a system choice that best serves the needs of the exploration program. This paper describes the SAIC developed Space Power System Decision Model, which uses a formal Two-step Analytical Hierarchy Process (TAHP) methodology that is used in the decision-making process to clearly distinguish candidate power systems in terms of benefits, safety, and risk. TAHP is a decision making process based on the Analytical Hierarchy Process, which employs a hierarchic approach of structuring decision factors by weights, and relatively ranks system design options on a consistent basis. This decision process also includes a level of data gathering and organization that produces a consistent, well-documented assessment, from which the capability of each power system option to meet top-level goals can be prioritized. The model defined on this effort focuses on the comparative assessment candidate power system options for Mars surface application(s). This paper describes the principles of this approach, the assessment criteria and weighting procedures, and the tools to capture and assess the expert knowledge associated with space power system evaluation. .

Evaluation of Nursing Documentation Completion of Stroke Patients in the Emergency Department: A Pre-Post Analysis Using Flowsheet Templates and Clinical Decision Support.

PubMed

Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance

2016-02-01

The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.

The decision-making process in Brazil's ratification of the World Health Organization Framework Convention on Tobacco Control.

PubMed

Rangel, Erica Cavalcanti; Pereira, Andre; Cavalcante, Tania Maria; Oliveira, Egléubia Andrade; Silva, Vera Luiza da Costa E

2017-09-21

Tobacco consumption is a leading cause of various types of cancer and other tobacco-related diseases. In 2003, the World Health Assembly adopted the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC), which aims to protect citizens from the health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke. The Convention was to be ratified by the Member States of the WHO; in Brazil's case, ratification involved the National Congress, which held public hearings in the country's leading tobacco growing communities (municipalities). The current study analyzes this decision-making process according to the different interests, positions, and stakeholders. In methodological terms, this is a qualitative study based on document research, drawing primarily on the shorthand notes from the public hearings. We analyze the interests and arguments for and against ratification. The article shows that although preceded by intense debates, the final decision in favor of ratification was made by a limited group of government stakeholders, characterizing a decision-making process similar to a funnel.

Mapping Process to Pattern in the Landscape Change of the Amazonian Frontier

NASA Technical Reports Server (NTRS)

Walker, Robert

2003-01-01

Changes in land use and land cover are dynamic processes reflecting a sequence of decisions made by individual land managers. In developing economies, these decisions may be embedded in the evolution of individual households, as is often the case in indigenous areas and agricultural frontiers. One goal of the present article is to address the land use and land-cover decisions of colonist farmers in the Amazon Basin as a function, in part, of household characteristics. Another goal is to generalize the issue of tropical deforestation into a broader discussion on forest dynamics. The extent of secondary forest in tropical areas has been well documented in South America and Africa. Agricultural-plot abandonment often occurs in tandem with primary forest clearance and as part of the same decision-making calculus. Consequently, tropical deforestation and forest succession are not independent processes in the landscape. This article presents a framework that integrates them into a model of forest dynamics at household level, and in so doing provides an account of the spatial pattern of deforestation that has been observed in the Amazon's colonization frontiers.

Bridging the Guideline Implementation Gap: A Systematic, Document-Centered Approach to Guideline Implementation

PubMed Central

Shiffman, Richard N.; Michel, George; Essaihi, Abdelwaheb; Thornquist, Elizabeth

2004-01-01

Objective: A gap exists between the information contained in published clinical practice guidelines and the knowledge and information that are necessary to implement them. This work describes a process to systematize and make explicit the translation of document-based knowledge into workflow-integrated clinical decision support systems. Design: This approach uses the Guideline Elements Model (GEM) to represent the guideline knowledge. Implementation requires a number of steps to translate the knowledge contained in guideline text into a computable format and to integrate the information into clinical workflow. The steps include: (1) selection of a guideline and specific recommendations for implementation, (2) markup of the guideline text, (3) atomization, (4) deabstraction and (5) disambiguation of recommendation concepts, (6) verification of rule set completeness, (7) addition of explanations, (8) building executable statements, (9) specification of origins of decision variables and insertions of recommended actions, (10) definition of action types and selection of associated beneficial services, (11) choice of interface components, and (12) creation of requirement specification. Results: The authors illustrate these component processes using examples drawn from recent experience translating recommendations from the National Heart, Lung, and Blood Institute's guideline on management of chronic asthma into a workflow-integrated decision support system that operates within the Logician electronic health record system. Conclusion: Using the guideline document as a knowledge source promotes authentic translation of domain knowledge and reduces the overall complexity of the implementation task. From this framework, we believe that a better understanding of activities involved in guideline implementation will emerge. PMID:15187061

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program.

PubMed

Gouin, Marie-Michelle; Coutu, Marie-France; Durand, Marie-José

2017-11-12

Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders. This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively. The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders' concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers' diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker's capacities were essential for return-to-work success. These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions. Implications for rehabilitation Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker's capacities, is important for return-to-work success. Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities. Rehabilitation professionals should also be constantly watching for workers' and employers' return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

A Unified Electronic Tool for CPR and Emergency Treatment Escalation Plans Improves Communication and Early Collaborative Decision Making for Acute Hospital Admissions.

PubMed

Johnson, Mae; Whyte, Martin; Loveridge, Robert; Yorke, Richard; Naleem, Shairana

2017-01-01

The National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report 'Time to Intervene' (2012) stated that in a substantial number of cases, resuscitation is attempted when it was thought a 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision should have been in place. Early decisions about CPR status and advance planning about limits of care now form part of national recommendations by the UK Resuscitation Council (2016). Treatment escalation plans (TEP) document what level of treatment intervention would be appropriate if a patient were to become acutely unwell and were not previously formally in place at King's College Hospital. A unifying paper based form was successfully piloted in the Acute Medical Unit, introducing the TEP and bringing together decision making around both treatment escalation and CPR status. Subsequently an electronic order-set for CPR status and treatment escalation was launched in April 2015 which led to a highly visible CPR and escalation status banner on the main screen at the top of the patient's electronic record. Ultimately due to further iterations in the electronic process by December 2016, all escalation decisions for acutely admitted patients now have high quality supporting, explanatory documentation with 100% having TEPs in place. There is now widespread multidisciplinary engagement in the process of defining limits of care for acutely admitted medical patients within the first 14 hours of admission and a strategy for rolling this process out across all the divisions of the hospital through our Deteriorating Patient Group (DPG). The collaborative design with acute medical, palliative and intensive care teams and the high visibility provided by the electronic process in the Electronic Patient Record (EPR) has enhanced communication with these teams, patients, nursing staff and the multidisciplinary team by ensuring clarity through a universally understood process about escalation and CPR. Clarity and openness about these discussions have been welcomed by patient focus groups facilitated via our acute medicine patient experience committee. There has been a shift in medical culture where transparency about limits of care has contributed to improving patient safety and quality of care through reducing unnecessary CPR supported by focus groups of staff.

Analysis of the policymaking process in Burkina Faso's health sector: case studies of the creation of two health system support units.

PubMed

Zida, Andre; Lavis, John N; Sewankambo, Nelson K; Kouyate, Bocar; Moat, Kaelan; Shearer, Jessica

2017-02-13

Burkina Faso has made a number of health system policy decisions to improve performance on health indicators and strengthen responsiveness to health-related challenges. These included the creation of a General Directorate of Health Information and Statistics (DGISS) and a technical unit to coordinate performance-based financing (CT-FBR). We analysed the policymaking processes associated with the establishment of these units, and documented the factors that influenced this process. We used a multiple-case study design based on Kingdon's agenda-setting model to investigate the DGISS and CT-FBR policymaking processes. Data were collected from interviews with key informants (n = 28), published literature, policy documents (including two strategic and 230 action plans), and 55 legal/regulatory texts. Interviews were analysed using thematic qualitative analysis. Data from the documentary analysis were triangulated with the qualitative interview data. Key factors influencing the policymaking processes associated with the two units involved the 'problem' (problem identification), 'policy' (formation of policy proposals), and 'politics' (political climate/change) streams, which came together in a way that resulted in proposals being placed on the decision agenda. A number of problems with Burkina Faso's health information and financing systems were identified. Policy proposals for the DGISS and CT-FBR units were developed in response to these problems, emerging from several sources including development partners. Changes in political and public service administrations (specifically the 2008 appointment of a new Minister of Health and the establishment of a new budget allocation system), with corresponding changes in the actors and interests involved, appeared key in elevating the proposals to the decision agenda. Efforts to improve performance on health indicators and strengthen responsiveness to health-related challenges need focus on the need for a compelling problem, a viable policy, and conducive politics in order to make it to the decision agenda.

75 FR 5331 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-02

... decision concerning the collection of information between 30 and 60 days after publication of this document... who are delinquent in making child support payments. Respondents: State IV-D Agencies. Annual Burden... 0.14 393.12 Certification Letter 54 1 0.40 21.60 Federal Offset Processing Menu Screens--State 176...

Here's Another Nice Mess: Using Video in Reflective Dialogue Research Method

ERIC Educational Resources Information Center

Hepplewhite, K.

2014-01-01

This account discusses "reflective dialogues", a process utilising video to re-examine in-action decision-making with theatre practitioners who operate in community contexts. The reflexive discussions combine with observation, text and digital documentation to offer a sometimes "messy" (from Schön 1987) dynamic to the research…

Alternative Schools. An Analysis of Their Impact on Administrators: Part II

ERIC Educational Resources Information Center

Sachs, David; Codding, Judy

1976-01-01

Extensive interviews with school personnel of alternative programs reveal that it is in the process of defining their essence with regard to decision-making, admissions, policies, responsibility, freedom, calendars, and programs vs. school identity that planning problems arise. (A related document is EA 507 273.) (Author/MLF)

Creating a Shared Formulary in 7 Critical Access Hospitals

ERIC Educational Resources Information Center

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

2010-01-01

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

76 FR 45300 - Notice of Issuance of Materials License SUA-1597 and Record of Decision for Uranerz Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... considered but eliminated from detailed analysis include conventional uranium mining and milling, conventional mining and heap leach processing, alternative site location, alternate lixiviants, and alternate...'s Agencywide Document Access and Management System (ADAMS), which provides text and image files of...

The Arkansas Lottery Scholarship Act: An Examination of the Policy Design Process

ERIC Educational Resources Information Center

Copeland, Kristopher D.; Mamiseishvili, Ketevan

2017-01-01

State lottery policies have been created to generate additional funds to support public initiatives, such as higher education scholarships. Through 18 participant interviews and document analysis, this study examined how decision makers in Arkansas socially constructed citizens while forming lottery policy. The social construction of target…

32 CFR 989.26 - Classified actions (40 CFR 1507.3(c)).

Code of Federal Regulations, 2010 CFR

2010-07-01

... relieve the requirement of complying with NEPA. In classified matters, the Air Force must prepare and make available normal NEPA environmental analysis documents to aid in the decision-making process; however, Air... Section 989.26 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE...

Nutzwertanalyse

Treesearch

A. Henne

1978-01-01

Nutzwertanalyse (NUWA) is a psychometric instrument for finding the test compromise in the multiple use planning of forestry, when the multiple objectives cannot be expressed in the same physical or monetary unit. It insures a systematic assessment of the consequences of proposed alternatives and thoroughly documents the decision process. The method leads to a ranking...

Mid-USA, Making Informed Decisions: Using Student Activities.

ERIC Educational Resources Information Center

Scovel, Donald A.; Nelson, Phillip J.

This document presents a series of learning activities focusing on the role of state government in American society. It is intended for senior or junior high school students. Six objectives are: to identify information sources about state government; to increase knowledge about its organization, processes, services, and costs; to compare these…

Installation restoration program. Decision document for soil and groundwater at the storage area at the USMC Subleased Area, Site 3. 144th Fighter Wing, California Air National Guard, Fresno Air Terminal, California

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

NONE

1996-01-01

Decision Document for IRP Site No. 3 - Storage Area at the USMC Sublease Area, California Air National Guard, 144th Fighter Wing, Fresno Air Terminal, Fresno, California. This report documents the data, conclusion, and recommendation to support a No Further Remedial Action Planned decision at Site 3 under the IRP.

Introduction to cognitive processes of expert pilots.

PubMed

Adams, R J; Ericsson, A E

2000-10-01

This report addresses the historical problem that a very high percentage of accidents have been classified as involving "pilot error." Through extensive research since 1977, the Federal Aviation Administration determined that the predominant underlying cause of these types of accidents involved decisional problems or cognitive information processing. To attack these problems, Aeronautical Decision Making (ADM) training materials were developed and tested for ten years. Since the publication of the ADM training manuals in 1987, significant reductions in human performance error (HPE) accidents have been documented both in the U.S. and world wide. However, shortcomings have been observed in the use of these materials for recurrency training and in their relevance to more experienced pilots. The following discussion defines the differences between expert and novice decision makers from a cognitive information processing perspective, correlates the development of expert pilot cognitive processes with training and experience, and reviews accident scenarios which exemplify those processes. This introductory material is a necessary prerequisite to an understanding of how to formulate expert pilot decision making training innovations; and, to continue the record of improved safety through ADM training.

Towards a Transparent, Credible, Evidence-Based Decision-Making Process of New Drug Listing on the Hong Kong Hospital Authority Drug Formulary: Challenges and Suggestions.

PubMed

Wong, Carlos King Ho; Wu, Olivia; Cheung, Bernard M Y

2018-02-01

The aim of this article is to describe the process, evaluation criteria, and possible outcomes of decision-making for new drugs listed in the Hong Kong Hospital Authority Drug Formulary in comparison to the health technology assessment (HTA) policy overseas. Details of decision-making processes including the new drug listing submission, Drug Advisory Committee (DAC) meeting, and procedures prior to and following the meeting, were extracted from the official Hong Kong Hospital Authority drug formulary management website and manual. Publicly-available information related to the new drug decision-making process for five HTA agencies [the National Institute of Health and Care Excellence (NICE), the Scottish Medicines Consortium (SMC), the Australia Pharmaceutical Benefits Advisory Committee (PBAC), the Canadian Agency for Drugs and Technologies in Health (CADTH), and the New Zealand Pharmaceutical Management Agency (PHARMAC)] were reviewed and retrieved from official documents from public domains. The DAC is in charge of systemically and critically appraising new drugs before they are listed on the formulary, reviewing submitted applications, and making the decision to list the drug based on scientific evidence to which safety, efficacy, and cost-effectiveness are the primary considerations. When compared with other HTA agencies, transparency of the decision-making process of the DAC, the relevance of clinical and health economic evidence, and the lack of health economic and methodological input of submissions are the major challenges to the new-drug listing policy in Hong Kong. Despite these challenges, this review provides suggestions for the establishment of a more transparent, credible, and evidence-based decision-making process in the Hong Kong Hospital Authority Drug Formulary. Proposals for improvement in the listing of new drugs in the formulary should be a priority of healthcare reforms.

Framing of task performance strategies: effects on performance in a multiattribute dynamic decision making environment.

PubMed

Nygren, T E

1997-09-01

It is well documented that the way a static choice task is "framed" can dramatically alter choice behavior, often leading to observable preference reversals. This framing effect appears to result from perceived changes in the nature or location of a person's initial reference point, but it is not clear how framing effects might generalize to performance on dynamic decision making tasks that are characterized by high workload, time constraints, risk, or stress. A study was conducted to examine the hypothesis that framing can introduce affective components to the decision making process and can influence, either favorably (positive frame) or adversely (negative frame), the implementation and use of decision making strategies in dynamic high-workload environments. Results indicated that negative frame participants were significantly impaired in developing and employing a simple optimal decision strategy relative to a positive frame group. Discussion focuses on implications of these results for models of dynamic decision making.

Identifying and assessing the application of ecosystem services approaches in environmental policies and decision making.

PubMed

Van Wensem, Joke; Calow, Peter; Dollacker, Annik; Maltby, Lorraine; Olander, Lydia; Tuvendal, Magnus; Van Houtven, George

2017-01-01

The presumption is that ecosystem services (ES) approaches provide a better basis for environmental decision making than do other approaches because they make explicit the connection between human well-being and ecosystem structures and processes. However, the existing literature does not provide a precise description of ES approaches for environmental policy and decision making, nor does it assess whether these applications will make a difference in terms of changing decisions and improving outcomes. We describe 3 criteria that can be used to identify whether and to what extent ES approaches are being applied: 1) connect impacts all the way from ecosystem changes to human well-being, 2) consider all relevant ES affected by the decision, and 3) consider and compare the changes in well-being of different stakeholders. As a demonstration, we then analyze retrospectively whether and how the criteria were met in different decision-making contexts. For this assessment, we have developed an analysis format that describes the type of policy, the relevant scales, the decisions or questions, the decision maker, and the underlying documents. This format includes a general judgment of how far the 3 ES criteria have been applied. It shows that the criteria can be applied to many different decision-making processes, ranging from the supranational to the local scale and to different parts of decision-making processes. In conclusion we suggest these criteria could be used for assessments of the extent to which ES approaches have been and should be applied, what benefits and challenges arise, and whether using ES approaches made a difference in the decision-making process, decisions made, or outcomes of those decisions. Results from such studies could inform future use and development of ES approaches, draw attention to where the greatest benefits and challenges are, and help to target integration of ES approaches into policies, where they can be most effective. Integr Environ Assess Manag 2017;13:41-51. © 2016 SETAC. © 2016 SETAC.

Patients’ priorities for treatment decision making during periods of incapacity: quantitative survey

PubMed Central

RID, ANNETTE; WESLEY, ROBERT; PAVLICK, MARK; MAYNARD, SHARON; ROTH, KATALIN; WENDLER, DAVID

2017-01-01

Objective Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. Method We employed a self-administered, quantitative survey of patients in a tertiary care center. Results Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Significance of Results Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients’ treatment preferences. Clinicians should also discuss and document patients’ priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making. PMID:25273677

Patients' priorities for treatment decision making during periods of incapacity: quantitative survey.

PubMed

Rid, Annette; Wesley, Robert; Pavlick, Mark; Maynard, Sharon; Roth, Katalin; Wendler, David

2015-10-01

Clinical practice aims to respect patient autonomy by basing treatment decisions for incapacitated patients on their own preferences. Yet many patients do not complete an advance directive, and those who do frequently just designate a family member to make decisions for them. This finding raises the concern that clinical practice may be based on a mistaken understanding of patient priorities. The present study aimed to collect systematic data on how patients prioritize the goals of treatment decision making. We employed a self-administered, quantitative survey of patients in a tertiary care center. Some 80% or more of the 1169 respondents (response rate = 59.8%) ranked six of eight listed goals for treatment decision making as important. When asked which goal was most important, 38.8% identified obtaining desired or avoiding unwanted treatments, 20.0% identified minimizing stress or financial burden on their family, and 14.6% identified having their family help to make treatment decisions. No single goal was designated as most important by 25.0% of participants. Patients endorsed three primary goals with respect to decision making during periods of incapacity: being treated consistent with their own preferences; minimizing the burden on their family; and involving their family in the decision-making process. However, no single goal was prioritized by a clear majority of patients. These findings suggest that advance care planning should not be limited to documenting patients' treatment preferences. Clinicians should also discuss and document patients' priorities for how decisions are to be made. Moreover, future research should evaluate ways to modify current practice to promote all three of patients primary goals for treatment decision making.

Shuttle Transportation System Case-Study Development

NASA Technical Reports Server (NTRS)

Ransom, Khadijah

2012-01-01

A case-study collection was developed for NASA's Space Shuttle Program. Using lessons learned and documented by NASA KSC engineers, analysts, and contractors, decades of information related to processing and launching the Space Shuttle was gathered into a single database. The goal was to provide educators with an alternative means to teach real-world engineering processes and to enhance critical thinking, decision making, and problem solving skills. Suggested formats were created to assist both external educators and internal NASA employees to develop and contribute their own case-study reports to share with other educators and students. Via group project, class discussion, or open-ended research format, students will be introduced to the unique decision making process related to Shuttle missions and development. Teaching notes, images, and related documents will be made accessible to the public for presentation of Space Shuttle reports. Lessons investigated included the engine cutoff (ECO) sensor anomaly which occurred during mission STS-114. Students will be presented with general mission infom1ation as well as an explanation of ECO sensors. The project will conclude with the design of a website that allows for distribution of information to the public as well as case-study report submissions from other educators online.

Glossary

MedlinePlus

... healthcare A document that designates the person you trust to make medical decisions on your behalf if ... healthcare: a document that designates the person you trust to make medical decisions on your behalf if ...

Usability Evaluation of NLP-PIER: A Clinical Document Search Engine for Researchers.

PubMed

Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei; Lindemann, Elizabeth; Skube, Steven; Melton, Genevieve B

2017-01-01

NLP-PIER (Natural Language Processing - Patient Information Extraction for Research) is a self-service platform with a search engine for clinical researchers to perform natural language processing (NLP) queries using clinical notes. We conducted user-centered testing of NLP-PIER's usability to inform future design decisions. Quantitative and qualitative data were analyzed. Our findings will be used to improve the usability of NLP-PIER.

Decision making for breast cancer prevention among women at elevated risk.

PubMed

Padamsee, Tasleem J; Wills, Celia E; Yee, Lisa D; Paskett, Electra D

2017-03-24

Several medical management approaches have been shown to be effective in preventing breast cancer and detecting it early among women at elevated risk: 1) prophylactic mastectomy; 2) prophylactic oophorectomy; 3) chemoprevention; and 4) enhanced screening routines. To varying extents, however, these approaches are substantially underused relative to clinical practice recommendations. This article reviews the existing research on the uptake of these prevention approaches, the characteristics of women who are likely to use various methods, and the decision-making processes that underlie the differing choices of women. It also highlights important areas for future research, detailing the types of studies that are particularly needed in four key areas: documenting women's perspectives on their own perceptions of risk and prevention decisions; explicit comparisons of available prevention pathways and their likely health effects; the psychological, interpersonal, and social processes of prevention decision making; and the dynamics of subgroup variation. Ultimately, this research could support the development of interventions that more fully empower women to make informed and values-consistent decisions, and to move towards favorable health outcomes.

[Who makes decisions--the dilemma of decision-making within the framework of job-sharing in a hospital].

PubMed

Voglmayr, Elisabeth; Widder, Joachim

2006-05-01

By means of a case report on a 44-year-old female patient, we show how, with changing personnel and places of care, decisions as well as the kind of decision-making during illness influence the quality of care. The patient was receiving immunosuppressive therapy after kidney transplantation and then suffered from a carcinomatous ovary. At first she refused postoperative chemotherapy, but then returned with a very advanced state of metastatic growth. The lack of continuity, a missing overall interdisciplinary concept of medical case, as well as the failure to document decision processes and the patient's attitude to life and suffering made it difficult for the caring team to accompany her in the last weeks of life. A possible solution to such a complex problem will be the introduction of ethical case deliberation.

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

36 CFR 219.14 - Decision document and planning records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... planning records. 219.14 Section 219.14 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF... records. (a) Decision document. The responsible official shall record approval of a new plan, plan... (§ 219.15); (4) The documentation of how the best available scientific information was used to inform...

Applying LD Documentation Guidelines at the Postsecondary Level: Decision Making with Sparse or Missing Data

ERIC Educational Resources Information Center

Banerjee, Manju; Madaus, Joseph W.; Gelbar, Nicholas

2015-01-01

A key issue in fostering transition to postsecondary education for students with disabilities is documentation verifying the nature of the disability and supporting the need for services and reasonable accommodations. Documentation guidelines assist postsecondary disability service providers in making decisions about eligibility and reasonable…

76 FR 49526 - Environmental Impact Statement; Saint Louis County, MN

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-10

... environmental impacts of alternatives, including (1) No-build, (2) Purchasing title and possession of the.... The Scoping Document/Draft Scoping Decision Document is anticipated to be published in late 2011. A... Decision Document will be published after the public comment period has closed. A Draft EIS will be...

FEATURES, EVENTS, AND PROCESSES: SYSTEM-LEVEL AND CRITICALITY

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

D.L. McGregor

The primary purpose of this Analysis/Model Report (AMR) is to identify and document the screening analyses for the features, events, and processes (FEPs) that do not easily fit into the existing Process Model Report (PMR) structure. These FEPs include the 3 1 FEPs designated as System-Level Primary FEPs and the 22 FEPs designated as Criticality Primary FEPs. A list of these FEPs is provided in Section 1.1. This AMR (AN-WIS-MD-000019) documents the Screening Decision and Regulatory Basis, Screening Argument, and Total System Performance Assessment (TSPA) Disposition for each of the subject Primary FEPs. This AMR provides screening information and decisionsmore » for the TSPA-SR report and provides the same information for incorporation into a project-specific FEPs database. This AMR may also assist reviewers during the licensing-review process.« less

Inspection of Forrestal parking permit allocation and assignments

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

Not Available

1992-12-16

The purpose of this inspection was to review the process cr allocating and assigning parking permits at the Forrestal building. Specifically, we sought to determine the roles and responsibilities of Department of Energy (DOE) officials involved in the administration of the Forrestal parking permit process during the period June 1, 1991 to February 1, 1992. We also sought to determine if the allocation and assignment of Forrestal building parking spaces was implemented in accordance with Federal and DOE requirements. For our review, we interviewed the Headquarters officials involved in the administration of the parking permit allocation and assignment process. Wemore » also reviewed parking permit files and associated documentation for the period June 1, 1991 through February 1, 1992. In addition, we conducted a limited sampling of parking permits that were revoked during July and August 1991 to assess if they were processed in compliance with applicable regulations. We found no evidence that the actions by the Special Assistant to the Secretary (White House Liaison) and the other members of the parking committee regarding the issuance and revocation of parking permits were for any reason other than a desire to ensure that only individuals having a legitimate basis for a parking permit were issued a permit. However, we found that decisions by the parking committee regarding revocation of permits and appeals of revocation decisions were not always documented, nor were there written guidelines or procedures to govern the activities of the committee. In our view, the lack of written guidelines and procedures resulted in the use of invalidated personal knowledge by the parking committee in making decisions involving the revocation of parking permits and led to inconsistencies in the notification of individuals about the associated appeal process.« less

Understanding the long-term influence of EIA on organisational learning and transformation

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

Jones, Megan, E-mail: 31836179@student.murdoch.edu.au; Morrison-Saunders, Angus, E-mail: a.morrison-saunders@murdoch.edu.au

This research is an attempt to verify the notion postulated by Robert Bartlett and Lynton Caldwell that the full benefits of environmental impact assessment (EIA) would take decades to be realized. While EIA is intended to directly influence decision-making regarding new development proposals, the process is also expected to lead to organisational learning and transformation over time. Our aim was to examine the influence of EIA on a single Western Australian proponent with sustained experience in the process to understand how EIA is used within the organisation and to seek evidence of transformation of the organisation's purpose and mission. Themore » research reviewed literature in order to identify key influences of EIA on organisations, along with semi-structured staff interviews and document analysis for the case study organisation. Ascertaining causality that involvement in EIA processes influences or effects organisational learning and transformation is a challenge in the face of other societal events. Document analysis and interviewee data indicates that the action-forcing nature of EIA did influence proponent behavior through the creation of internal processes seeking to ensure robust design of new projects that would satisfy environmental protection expectations, without the need to trigger formal EIA. Evidence of EIA values and thinking were apparent within internal documentation, including the evolving mission statement. Our research indicates that participation in the EIA process can positively influence organisational learning and transformation by guiding internal change for decision-making. - Highlights: • The long-term influence of EIA on a proponent organisation is investigated. • EIA promotes internal organisational learning and transformation. • Analysis of mission statements can indicate the influence of EIA on organisations. • Organisations aligned with EIA values can reduce the need to engage in formal EIA.« less

Inspection of the Department`s export licensing process for dual-use and munitions commodities

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

Not Available

1993-08-10

The purpose of our inspection was to review the Department of Energy`s (Energy) export licensing process for dual-use and military (munitions) commodities subject to nuclear nonproliferation controls. Specifically, we reviewed Energy`s authorities, procedures, and policies pertaining to the export licensing process and examined procedures for safeguarding data transmitted between Energy and other agencies involved in the export licensing process. We also reviewed Energy`s role as a member of the Subgroup on Nuclear Export Coordination. Our review of the sample of 60 export cases did not find evidence to lead us to believe that Energy`s recommendations for these cases were inappropriatemore » or incorrect. We identified, however, problems regarding management systems associated with the export license review process. We found that without documentation supporting export licensing decisions by the Export Control Operations Division (ECOD), we could not determine whether ECOD analysts considered all required criteria in their review of export cases referred to Energy. For example, we found that the ECOD did not retain records documenting the bases for its advice, recommendations, or decisions regarding its reviews of export license cases or revisions to lists of controlled commodities and, therefore, was not in compliance with certain provisions of the Export Administration Act, as amended, and Energy records management directives. Additionally, we found that the degree of compliance by Energy with the export licensing review criteria contained in the Export Administration Regulations and the Nuclear Non-Proliferation Act of 1978 could not be determined because ECOD did not retain records documenting the bases for its advice and recommendations on export cases.« less

SLUDGE TREATMENT PROJECT KOP CONCEPTUAL DESIGN CONTROL DECISION REPORT

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

CARRO CA

2010-03-09

This control decision addresses the Knock-Out Pot (KOP) Disposition KOP Processing System (KPS) conceptual design. The KPS functions to (1) retrieve KOP material from canisters, (2) remove particles less than 600 {micro}m in size and low density materials from the KOP material, (3) load the KOP material into Multi-Canister Overpack (MCO) baskets, and (4) stage the MCO baskets for subsequent loading into MCOs. Hazard and accident analyses of the KPS conceptual design have been performed to incorporate safety into the design process. The hazard analysis is documented in PRC-STP-00098, Knock-Out Pot Disposition Project Conceptual Design Hazard Analysis. The accident analysismore » is documented in PRC-STP-CN-N-00167, Knock-Out Pot Disposition Sub-Project Canister Over Lift Accident Analysis. Based on the results of these analyses, and analyses performed in support of MCO transportation and MCO processing and storage activities at the Cold Vacuum Drying Facility (CVDF) and Canister Storage Building (CSB), control decision meetings were held to determine the controls required to protect onsite and offsite receptors and facility workers. At the conceptual design stage, these controls are primarily defined by their safety functions. Safety significant structures, systems, and components (SSCs) that could provide the identified safety functions have been selected for the conceptual design. It is anticipated that some safety SSCs identified herein will be reclassified based on hazard and accident analyses performed in support of preliminary and detailed design.« less

Gendered negotiations for research participation in community-based studies: implications for health research policy and practice

PubMed Central

Kamuya, Dorcas M; Molyneux, Catherine, S; Theobald, Sally

2017-01-01

There is a growing literature documenting the complex realities of consent processes in the field, and the negotiations and ethical dilemmas involved. Much has also been written about how gender and power shape household decision-making processes. However, these bodies of literature have rarely been brought together to inform research theory and practice in low-income settings. In this paper, qualitative research (observation, focus group discussions and interviews) were used alongside large clinical community-based studies conducted on the Kenyan Coast to explore how gender and power relations within households and communities and between fieldworkers and communities shape consent processes and interactions. This exploration is embedded in relevant literature and the implications for community-based health research policy and practice are considered. Across diverse forms of households, we observed significant consultation on whether or not to participate in research. Although men are typically described as household decision-makers, in practice, decision-making processes are often far more nuanced, with many women using their agency to control, sometimes subtly, the decisions made. Where decisions are made without adequately consulting women, many find strategies to exercise their choice, in ways that safeguard important relationships within households in the longer term. We also found that the gender of field staff who typically conduct research activities in the field, including consent processes, can influence household dynamics and decision-making processes with important implications for the science and ethics of research. It is essential that frontline field staff and their supervisors are aware of the complex and gendered realities of consent processes at household level, and their implications, and that they develop appropriate context-informed approaches that support ethical practice. PMID:29225935

Towards a deeper understanding of parenting on farms: A qualitative study.

PubMed

Elliot, Valerie; Cammer, Allison; Pickett, William; Marlenga, Barbara; Lawson, Joshua; Dosman, James; Hagel, Louise; Koehncke, Niels; Trask, Catherine

2018-01-01

Children living on farms experience exceptionally high risks for traumatic injury. There is a large body of epidemiological research documenting this phenomenon, yet few complementary studies that have explored the deep underlying reasons for such trends. Fundamental to this is understanding the decision-making processes of parents surrounding their choice to bring children, or not, into the farm worksite. To (1) document farm parent views of the risks and benefits of raising children on a family farm, and, (2) understand more deeply why children are brought into the farm worksite. Interviews were conducted as part of a larger cohort study, The Saskatchewan Farm Injury Cohort. Subsequent to an initial mail-out question focused on parental decision-making, 11 semi-structured telephone interviews were conducted with rural Saskatchewan farm parents. Interviews were digitally recorded and transcribed verbatim, then thematically analyzed using interpretive description methodology. This parental decision-making process on farms fundamentally involves weighing the risks vs. benefits of bringing children into the worksite, as if on a balance scale. One side of this scale holds potential risks such as exposure to physical and chemical farm hazards, in the absence of full supervision. The other side holds potential benefits such as meeting family needs for childcare, labour, and family time; building work ethic and pride; and the positive impacts of involvement and responsibility. Decision-making 'tips the scales', in part dependent upon parental perceptions of the risk-benefit trade-off. This 'perceptual lens' is influenced by factors such as: the agricultural way of life, parents' prior knowledge and past experience, characteristics of children, and safety norms. This novel qualitative study provides deep insight into how Saskatchewan farm parents approach a fundamental decision-making process associated with their parenting. The proposed model provides insight into the etiology of pediatric farm injuries as well as their prevention.

Towards a deeper understanding of parenting on farms: A qualitative study

PubMed Central

Elliot, Valerie; Cammer, Allison; Pickett, William; Marlenga, Barbara; Lawson, Joshua; Dosman, James; Hagel, Louise; Koehncke, Niels

2018-01-01

Background Children living on farms experience exceptionally high risks for traumatic injury. There is a large body of epidemiological research documenting this phenomenon, yet few complementary studies that have explored the deep underlying reasons for such trends. Fundamental to this is understanding the decision-making processes of parents surrounding their choice to bring children, or not, into the farm worksite. Objectives To (1) document farm parent views of the risks and benefits of raising children on a family farm, and, (2) understand more deeply why children are brought into the farm worksite. Methods Interviews were conducted as part of a larger cohort study, The Saskatchewan Farm Injury Cohort. Subsequent to an initial mail-out question focused on parental decision-making, 11 semi-structured telephone interviews were conducted with rural Saskatchewan farm parents. Interviews were digitally recorded and transcribed verbatim, then thematically analyzed using interpretive description methodology. Findings This parental decision-making process on farms fundamentally involves weighing the risks vs. benefits of bringing children into the worksite, as if on a balance scale. One side of this scale holds potential risks such as exposure to physical and chemical farm hazards, in the absence of full supervision. The other side holds potential benefits such as meeting family needs for childcare, labour, and family time; building work ethic and pride; and the positive impacts of involvement and responsibility. Decision-making 'tips the scales', in part dependent upon parental perceptions of the risk-benefit trade-off. This 'perceptual lens' is influenced by factors such as: the agricultural way of life, parents' prior knowledge and past experience, characteristics of children, and safety norms. Conclusions This novel qualitative study provides deep insight into how Saskatchewan farm parents approach a fundamental decision-making process associated with their parenting. The proposed model provides insight into the etiology of pediatric farm injuries as well as their prevention. PMID:29897960

ACOG Committee Opinion No. 306. Informed refusal.

PubMed

2004-12-01

Informed refusal is a fundamental component of the informed consent process. Informed consent laws have evolved to the "materiality or patient viewpoint" standard. A physician must disclose to the patient the risks, benefits, and alternatives that a reasonable person in the patient's position would want to know to make an informed decision. Throughout this process, the patient's autonomy, level of health literacy, and cultural background should be respected. The subsequent election by the patient to forgo an intervention that has been recommended by the physician constitutes informed refusal. Documentation of the informed refusal process is essential. It should include a notation that the need for the intervention, as well as risks, benefits, and alternatives to the intervention, and possible consequences of refusal, have been explained. The patient's reason for refusal also should be documented.

Web-based document and content management with off-the-shelf software

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

Schuster, J

1999-03-18

This, then, is the current status of the project: Since we made the switch to Intradoc, we are now treating the project as a document and image management system. In reality, it could be considered a document and content management system since we can manage almost any file input to the system such as video or audio. At present, however, we are concentrating on images. As mentioned above, my CRADA funding was only targeted at including thumbnails of images in Intradoc. We still had to modify Intradoc so that it would compress images submitted to the system. All processing ofmore » files submitted to Intradoc is handled in what is called the Document Refinery. Even though MrSID created thumbnails in the process of compressing an image, work needed to be done to somehow build this capability into the Document Refinery. Therefore we made the decision to contract the Intradoc Engineering Team to perform this custom development work. To make Intradoc even more capable of handling images, we have also contracted for customization of the Document Refinery to accept Adobe PhotoShop and Illustrator file in their native format.« less

Superfund record of decision (EPA Region 3): Ohio River Park Site, Operable Unit 3, Neville Island, PA, September 17, 1998

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

NONE

1998-10-01

This Record of Decision (ROD) presents the selected remedial action plan for the Ohio River Park Superfund Site (the Site) in Allegheny County, Pennsylvania. The remedial action plan in this document is presented as the permanent remedy for controlling the groundwater at the Site. This remedy is comprised of: monitoring of natural attenuation processes to measure changes in contaminant concentrations in groundwater plume at the Site until the cleanup levels are achieved; deed restriction preventing residential use of groundwater at the Site.

Dual processing model of medical decision-making

PubMed Central

2012-01-01

Background Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. Methods We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. Results We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. Conclusions We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories). PMID:22943520

Complex Development Report: Moanalua High School.

ERIC Educational Resources Information Center

Anbe, Aruga and Ishizu, Architects, Inc., Honolulu, HI.

This report documents the planning process and the decisions involved in master planning a proposed Honolulu high school, and it provides guidance for the implementation of those increments remaining after phase one of the first increment had been completed in September 1972. Phase two of the first increment and the second increment are now under…

76 FR 13652 - Agency Information Collection Activities: Proposed Collection; Comment Request, 1660-0104; Severe...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-14

... information collection outlines the process by which any owner of a severe repetitive loss of property may appeal a FEMA decision that would increase the chargeable insurance premium rate on the property. This... SRL grant funds, the property owner may submit any additional documentation that supports their appeal...

The Assessment of Business Knowledge and Integration for Assurance of Learning: An Application

ERIC Educational Resources Information Center

Hawkins, Alfred G., Jr.

2010-01-01

AACSB has mandated that the documentation of student learning will become increasingly important in decisions regarding initial accreditation and reaffirmation. Assurance of learning is a major part of the accreditation and reaffirmation process. All universities will need to develop a set of learning goals for all their programs. These learning…

38 CFR 17.904 - Review and appeal process.

Code of Federal Regulations, 2010 CFR

2010-07-01

... submitted in writing (by facsimile, mail, or hand delivery) within one year of the date of the initial..., including any relevant supporting documentation, a benefits advisor will issue a written determination (with... dissatisfied, within 90 days of the date of the decision he or she may submit in writing (by facsimile, mail...

The Design of an Intelligent Decision Support Tool for Submarine Commanders

DTIC Science & Technology

2009-06-01

for public release, distribution unlimited 13. SUPPLEMENTARY NOTES The original document contains color images . 14. ABSTRACT 15. SUBJECT TERMS 16...with research supporting the advancement of military technology. Thank you again for your support throughout this process . To Dave Silvia and Carl...26 2.1.3 Voyage Management System

Effective Crisis Management at the Smaller Campus.

ERIC Educational Resources Information Center

DeWitt, Robert C.

Pennsylvania State University Beaver Campus developed crisis guidelines and a formal working relationship with a local community mental health center in order to be able to deal with on-campus crises and their followup. The guidelines provide each employee with a single, easy-to-follow document that outlines the decision making process to be…

76 FR 58807 - An Assessment of Decision-Making Processes: Evaluation of Where Land Protection Planning Can...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-22

...: Evaluation of Where Land Protection Planning Can Incorporate Climate Change Information-- Release of Final... Protection Planning can Incorporate Climate Change Information, (EPA/600/R-09/142F). The document was... goal of this report is to evaluate where land protection planning can incorporate climate change...

Developing a Markup Language for Encoding Graphic Content in Plan Documents

ERIC Educational Resources Information Center

Li, Jinghuan

2009-01-01

While deliberating and making decisions, participants in urban development processes need easy access to the pertinent content scattered among different plans. A Planning Markup Language (PML) has been proposed to represent the underlying structure of plans in an XML-compliant way. However, PML currently covers only textual information and lacks…

Morphological Effects in Auditory Word Recognition: Evidence from Danish

ERIC Educational Resources Information Center

Balling, Laura Winther; Baayen, R. Harald

2008-01-01

In this study, we investigate the processing of morphologically complex words in Danish using auditory lexical decision. We document a second critical point in auditory comprehension in addition to the Uniqueness Point (UP), namely the point at which competing morphological continuation forms of the base cease to be compatible with the input,…

The Use of Computer Networks in Data Gathering and Data Analysis.

ERIC Educational Resources Information Center

Yost, Michael; Bremner, Fred

This document describes the review, analysis, and decision-making process that Trinity University, Texas, went through to develop the three-part computer network that they use to gather and analyze EEG (electroencephalography) and EKG (electrocardiogram) data. The data are gathered in the laboratory on a PDP-1124, an analog minicomputer. Once…

Information as An Important Production Factor.

ERIC Educational Resources Information Center

Ljungberg, Sixten

This paper focuses on the importance of information and documentation (I&D) as one of the essential production factors in pharmaceutical industrial activities. The need for and use of I&D services depends far more on such factors as product profile, decision making processes within the organization, and ownership than on the size of the…

76 FR 47271 - Implementation of Scientific Integrity Principles: Draft Plan for Public Comment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... Communications The Office of Legislative and Public Affairs (OLPA) is the authorized news media liaison for NSF... follows: Media Policy: Purpose This document establishes NSF's media policy governing media communications... conduct our merit review process and make funding decisions to adhere to the highest standards of ethical...

A National Approach to Reimbursement Decision-Making on Drugs for Rare Diseases in Canada? Insights from Across the Ponds.

PubMed

Short, Hilary; Stafinski, Tania; Menon, Devidas

2015-05-01

Regardless of the type of health system or payer, coverage decisions on drugs for rare diseases (DRDs) are challenging. While these drugs typically represent the only active treatment option for a progressive and/or life-threatening condition, evidence of clinical benefit is often limited because of small patient populations and the costs are high. Thus, decisions come with considerable uncertainty and risk. In Canada, interest in developing a pan-Canadian decision-making approach informed by international experiences exists. To develop an inventory of existing policies and processes for making coverage decisions on DRDs around the world. A systematic review of published and unpublished documents describing current policies and processes in the top 20 gross domestic product countries was conducted. Bibliographic databases, the Internet and government/health technology assessment organization websites in each country were searched. Two researchers independently extracted information and tabulated it to facilitate qualitative comparative analyses. Policy experts from each country were contacted and asked to review the information collected for accuracy and completeness. Almost all countries have multiple mechanisms through which coverage for a DRD may be sought. However, they typically begin with a review that follows the same process as drugs for more common conditions (i.e., the centralized review process), although specific submission requirements could differ (e.g., no need to submit a cost-effectiveness analysis). When drugs fail to receive a positive recommendation/decision, they are reconsidered by "safety net"-type programs. Eligibility criteria vary across countries, as do the decision options, which may be applied to individual patients or patient groups. With few exceptions, countries have not created separate centralized review processes for DRDs. Instead, they have modified components of existing mechanisms and added safety nets. Copyright © 2015 Longwoods Publishing.

Regulation in work and decision-making in the activity of public prosecutors in Santa Catarina, Brazil.

PubMed

de Azevedo, Beatriz Marcondes; Cruz, Roberto Moraes

2012-01-01

Was to characterize the relationship between regulation at work and decision processes in the activity of Prosecutors in SC. To this end, it starts with the assumption that the decision-making and regulation are complex phenomena of conduct at work, since the worker makes continuously micro and macro decisions, based on a set of regulations, influenced by contingency and personal variables. Four Prosecutors participated in this study. This was a case study, descriptive and exploratory. For data collection, documents were analyzed, observing the workplace and interviewed key personnel of the institution in order to identify macro and micro organizational factors. Also as a technique for data collection an Ergonomic Analysis of Work. It was found that the work of the Prosecutor presents a set of activities that take place on the basis of coordination and cooperation in a dynamic and unstable environment. The prosecutor's activity, in addition to being the full expression of basic psychological processes of service work, is embedded in a context which, in part, depends and, therefore, encourages and requires choices and referrals by employees, demanding the demonstration of skills and modulating its operative mode. Processing depends on the idiosyncrasies and the force of circumstances, thus creating a brand, a unique personal style in the work. It is inferred that they are dialectical processes, since they regulate to decide and decide because they are regulated. However, the regular employee builds micro decisions that subsidize an effective decision. Thus, the better the variability of regulation, the greater the variability of decisions.

30 CFR 746.13 - Decision document and recommendation on mining plan.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Decision document and recommendation on mining plan. 746.13 Section 746.13 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR FEDERAL LANDS PROGRAM REVIEW AND APPROVAL OF MINING PLANS § 746.13 Decision...

Process quality of decision-making in multidisciplinary cancer team meetings: a structured observational study.

PubMed

Hahlweg, Pola; Didi, Sarah; Kriston, Levente; Härter, Martin; Nestoriuc, Yvonne; Scholl, Isabelle

2017-11-17

The quality of decision-making in multidisciplinary team meetings (MDTMs) depends on the quality of information presented and the quality of team processes. Few studies have examined these factors using a standardized approach. The aim of this study was to objectively document the processes involved in decision-making in MDTMs, document the outcomes in terms of whether a treatment recommendation was given (none vs. singular vs. multiple), and to identify factors related to type of treatment recommendation. An adaptation of the observer rating scale Multidisciplinary Tumor Board Metric for the Observation of Decision-Making (MDT-MODe) was used to assess the quality of the presented information and team processes in MDTMs. Data was analyzed using descriptive statistics and mixed logistic regression analysis. N = 249 cases were observed in N = 29 MDTMs. While cancer-specific medical information was judged to be of high quality, psychosocial information and information regarding patient views were considered to be of low quality. In 25% of the cases no, in 64% one, and in 10% more than one treatment recommendations were given (1% missing data). Giving no treatment recommendation was associated with duration of case discussion, duration of the MDTM session, quality of case history, quality of radiological information, and specialization of the MDTM. Higher levels of medical and treatment uncertainty during discussions were found to be associated with a higher probability for more than one treatment recommendation. The quality of different aspects of information was observed to differ greatly. In general, we did not find MDTMs to be in line with the principles of patient-centered care. Recommendation outcome varied substantially between different specializations of MDTMs. The quality of certain information was associated with the recommendation outcome. Uncertainty during discussions was related to more than one recommendation being considered. Time constraints were found to play an important role. Some of those aspects seem modifiable, which offers possibilities for the reorganization of MDTMs.

43 CFR 46.315 - How to format an environmental assessment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... planning, decision-making, and appropriate public participation. (b) An environmental assessment may be accompanied by any other planning or decision-making document. The portion of the document that analyzes the...

Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making.

PubMed

Ricci, Karen A; Griffin, Anne R; Heslin, Kevin C; Kranke, Derrick; Dobalian, Aram

2015-06-01

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

Concordance Between Veterans' Self-Report and Documentation of Surrogate Decision Makers: Implications for Quality Measurement.

PubMed

Garner, Kimberly K; Dubbert, Patricia; Lensing, Shelly; Sullivan, Dennis H

2017-01-01

The Measuring What Matters initiative of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association identified documentation of a surrogate decision maker as one of the top 10 quality indicators in the acute hospital and hospice settings. To better understand the potential implementation of this Measuring What Matters quality measure #8, Documentation of Surrogate in outpatient primary care settings by describing primary care patients' self-reported identification and documentation of a surrogate decision maker. Examination of patient responses to self-assessment questions from advance health care planning educational groups conducted in one medical center primary care clinic and seven community-based outpatient primary care clinics. We assessed the concordance between patient reports of identifying and naming a surrogate decision maker and having completed an advance directive (AD) with presence of an AD in the electronic medical record. Of veterans without a documented AD on file, more than half (66%) reported that they had talked with someone they trusted and nearly half (52%) reported that they had named someone to communicate their preferences. Our clinical project data suggest that many more veterans may have initiated communications with surrogate decision makers than is evident in the electronic medical record. System changes are needed to close the gap between veterans' plans for a surrogate decision maker and the documentation available to acute care health care providers. Published by Elsevier Inc.

Expertise Development With Different Types of Automation: A Function of Different Cognitive Abilities.

PubMed

Jipp, Meike

2016-02-01

I explored whether different cognitive abilities (information-processing ability, working-memory capacity) are needed for expertise development when different types of automation (information vs. decision automation) are employed. It is well documented that expertise development and the employment of automation lead to improved performance. Here, it is argued that a learner's ability to reason about an activity may be hindered by the employment of information automation. Additional feedback needs to be processed, thus increasing the load on working memory and decelerating expertise development. By contrast, the employment of decision automation may stimulate reasoning, increase the initial load on information-processing ability, and accelerate expertise development. Authors of past research have not investigated the interrelations between automation assistance, individual differences, and expertise development. Sixty-one naive learners controlled simulated air traffic with two types of automation: information automation and decision automation. Their performance was captured across 16 trials. Well-established tests were used to assess information-processing ability and working-memory capacity. As expected, learners' performance benefited from expertise development and decision automation. Furthermore, individual differences moderated the effect of the type of automation on expertise development: The employment of only information automation increased the load on working memory during later expertise development. The employment of decision automation initially increased the need to process information. These findings highlight the importance of considering individual differences and expertise development when investigating human-automation interaction. The results are relevant for selecting automation configurations for expertise development. © 2015, Human Factors and Ergonomics Society.

Linking Acquisition Decisionmaking With National Military Strategy

DTIC Science & Technology

1990-10-01

DTIC CONTAINED A SIGNIFICANT NUMBER OF COLOR PAGES WHICH DO NOT REPRODUCE LEGIBLY ON BLACK AND WHITE MICROFICHE, L i REPORT DOCUMENTATION PAGE Form...objectives I within the planning process. A fourth issue was the pace of change in enchancing the joint role in the acquisition g process. The former CJCS...goals, the roadmap, and PPOs. Hence, the DPG provides a VI-22 5 I systematic institutional memory , incorporating decisions as they are made, and thus

75 FR 18205 - Notice of Peer Review Meeting for the External Peer Review Drafts of Two Documents on Using...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

... Role of Risk Analysis in Decision-Making AGENCY: Environmental Protection Agency (EPA). ACTION: Notice... documents entitled, ``Using Probabilistic Methods to Enhance the Role of Risk Analysis in Decision- Making... Probabilistic Methods to Enhance the Role of Risk Analysis in Decision-Making, with Case Study Examples'' and...

Power, Authority and Decision Making in Teacher Education. Yearbook 1971.

ERIC Educational Resources Information Center

American Association of Colleges for Teacher Education, Washington, DC.

This document is a collection of reports of the American Association of Colleges for Teacher Education (AACTE) for 1971. The title of the document reflects much of the association's concern for that year and is close to the theme of the association's 1971 annual meeting, "Power and Decision Making in Teacher Education." The document is divided…

Testing of Triggers by Data Mining of Epilepsy Patients' Structured Nursing Records.

PubMed

Kinnunen, Ulla-Mari; Kivekäs, Eija; Paananen, Pekka; Kälviäinen, Reetta; Saranto, Kaija

2016-01-01

Epilepsies are neurological disorders with many different etiologies, symptoms and prognoses. Care for epilepsy patients should be uniform, homogeneous and optimized to avoid unnecessary hospitalizations or even worse outcomes. FinCC-based structured nursing documentation facilitates analyzing patient profiles and populations, developing care processes, nursing documentation, decision-making, and data reuse. This research aimed to determine the potential for finding possible risks for epilepsy patients' health and well-being from the structured nursing data with defined triggers for epilepsy patients. The research data included structured documentation of nursing diagnoses of and interventions for adult epilepsy patients (n = 100) at one neurological ward in a university hospital in 2009-2013. The results showed that nurses documented abundantly, and all triggers were mostly found. The study results will be reviewed by the neurological ward nurses to assess the FinCC and highlight the importance of documentation.

Combining computational analyses and interactive visualization for document exploration and sensemaking in jigsaw.

PubMed

Görg, Carsten; Liu, Zhicheng; Kihm, Jaeyeon; Choo, Jaegul; Park, Haesun; Stasko, John

2013-10-01

Investigators across many disciplines and organizations must sift through large collections of text documents to understand and piece together information. Whether they are fighting crime, curing diseases, deciding what car to buy, or researching a new field, inevitably investigators will encounter text documents. Taking a visual analytics approach, we integrate multiple text analysis algorithms with a suite of interactive visualizations to provide a flexible and powerful environment that allows analysts to explore collections of documents while sensemaking. Our particular focus is on the process of integrating automated analyses with interactive visualizations in a smooth and fluid manner. We illustrate this integration through two example scenarios: an academic researcher examining InfoVis and VAST conference papers and a consumer exploring car reviews while pondering a purchase decision. Finally, we provide lessons learned toward the design and implementation of visual analytics systems for document exploration and understanding.

Report on the remedial investigation of Bear Creek Valley at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Volume 5: Appendix F -- Baseline human health risk assessment report

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

NONE

1996-09-01

This Remedial Investigation (RI) Report characterizes the nature and extent of contamination, evaluates the fate and transport of contaminants, and assesses risk to human health and the environment resulting from waste disposal and other US Department of Energy (DOE) operations in Bear Creek Valley (BCV). BCV, which is located within the DOE Oak Ridge Reservation (ORR) encompasses multiple waste units containing hazardous and radioactive wastes arising from operations at the adjacent Oak Ridge Y-12 Plant. The primary waste units discussed in this RI Report are the S-3 Site, Oil Landfarm (OLF), Boneyard/Burnyard (BYBY), Sanitary Landfill 1 (SL 1), and Bearmore » Creek Burial Grounds (BCBG). These waste units, plus the contaminated media resulting from environmental transport of the wastes from these units, are the subject of this RI. This BCV RI Report represents the first major step in the decision-making process for the BCV watershed. The RI results, in concert with the follow-on FS will form the basis for the Proposed Plan and Record of Decision for all BCV sites. This comprehensive decision document process will meet the objectives of the watershed approach for BCV. Appendix F documents potential risks and provides information necessary for making remediation decisions. A quantitative analysis of the inorganic, organic, and radiological site-related contaminants found in various media is used to characterize the potential risks to human health associated with exposure to these contaminants.« less

Semantic-Web Architecture for Electronic Discharge Summary Based on OWL 2.0 Standard.

PubMed

Tahmasebian, Shahram; Langarizadeh, Mostafa; Ghazisaeidi, Marjan; Safdari, Reza

2016-06-01

Patients' electronic medical record contains all information related to treatment processes during hospitalization. One of the most important documents in this record is the record summary. In this document, summary of the whole treatment process is presented which is used for subsequent treatments and other issues pertaining to the treatment. Using suitable architecture for this document, apart from the aforementioned points we can use it in other fields such as data mining or decision making based on the cases. In this study, at first, a model for patient's medical record summary has been suggested using semantic web-based architecture. Then, based on service-oriented architecture and using Java programming language, a software solution was designed and run in a way to generate medical record summary with this structure and at the end, new uses of this structure was explained. in this study a structure for medical record summaries along with corrective points within semantic web has been offered and a software running within Java along with special ontologies are provided. After discussing the project with the experts of medical/health data management and medical informatics as well as clinical experts, it became clear that suggested design for medical record summary apart from covering many issues currently faced in the medical records has also many advantages including its uses in research projects, decision making based on the cases etc.

A prospective multiple case study of the impact of emerging scientific evidence on established colorectal cancer screening programs: a study protocol.

PubMed

Geddie, Hannah; Dobrow, Mark J; Hoch, Jeffrey S; Rabeneck, Linda

2012-06-01

Health-policy decision making is a complex and dynamic process, for which strong evidentiary support is required. This includes scientifically produced research, as well as information that relates to the context in which the decision takes place. Unlike scientific evidence, this "contextual evidence" is highly variable and often includes information that is not scientifically produced, drawn from sources such as political judgement, program management experience and knowledge, or public values. As the policy decision-making process is variable and difficult to evaluate, it is often unclear how this heterogeneous evidence is identified and incorporated into "evidence-based policy" decisions. Population-based colorectal cancer screening poses an ideal context in which to examine these issues. In Canada, colorectal cancer screening programs have been established in several provinces over the past five years, based on the fecal occult blood test (FOBT) or the fecal immunochemical test. However, as these programs develop, new scientific evidence for screening continues to emerge. Recently published randomized controlled trials suggest that the use of flexible sigmoidoscopy for population-based screening may pose a greater reduction in mortality than the FOBT. This raises the important question of how policy makers will address this evidence, given that screening programs are being established or are already in place. This study will examine these issues prospectively and will focus on how policy makers monitor emerging scientific evidence and how both scientific and contextual evidence are identified and applied for decisions about health system improvement. This study will employ a prospective multiple case study design, involving participants from Ontario, Alberta, Manitoba, Nova Scotia, and Quebec. In each province, data will be collected via document analysis and key informant interviews. Documents will include policy briefs, reports, meeting minutes, media releases, and correspondence. Interviews will be conducted in person with senior administrative leaders, government officials, screening experts, and high-level cancer system stakeholders. The proposed study comprises the third and final phase of an Emerging Team grant to address the challenges of health-policy decision making and colorectal cancer screening decisions in Canada. This study will contribute a unique prospective look at how policy makers address new, emerging scientific evidence in several different policy environments and at different stages of program planning and implementation. Findings will provide important insight into the various approaches that are or should be used to monitor emerging evidence, the relative importance of scientific versus contextual evidence for decision making, and the tools and processes that may be important to support challenging health-policy decisions.

"The Right of Every Child": The Story of the Washington, D.C. Program of School Integration.

ERIC Educational Resources Information Center

American Friends Service Committee, Washington, DC.

Described in this 1955 document is the initiation of school integration in the District of Columbia immediately following the 1954 Supreme Court school desegregation decision. The report presents information about the desegregation process in terms of pupil assignment and extent of interracial classes, teacher and administrator integration, parent…

Mississippi Curriculum Structure: Philosophy, Goals, Skills, and Concepts for Curriculum Development and Instructional Planning in Mississippi.

ERIC Educational Resources Information Center

Mississippi State Dept. of Education, Jackson. Bureau of School Improvement.

This document is a decision-making tool on the instructional process in Mississippi. It attempts to standardize curriculum content by identifying core skills that must be included in subject areas in kindergarten through grade 12. Subjects covered are reading, English/language arts, mathematics, art, computer education, foreign languages, health…

Towards a More Telling Way of Understanding Early School Leaving

ERIC Educational Resources Information Center

Hodgson, David

2007-01-01

This paper is concerned with research into early school leaving. A narrative interview approach was used to document and analyse the experiences, processes and decisions that a small sample of boys made prior to leaving school, in this case, before completing year 10 and 11. Data collected in 2004 indicate that schools along with students…

Replace or Modernize? The Future of the District of Columbia's Endangered Old and Historic Public Schools.

ERIC Educational Resources Information Center

Twenty-First Century School Fund, Washington, DC.

This report addresses the decision-making process for replacing or modernizing the District of Columbia Public Schools (DCPS) as proposed in the DCPS facility master plan. The three-section document discusses old and historic schools and their future; the schools' historical and architectural value; cost of replacement and modernization; design;…

From Assessment to Annual Goal: Engaging a Decision-Making Process in Writing Measurable IEPs

ERIC Educational Resources Information Center

Capizzi, Andrea M.

2008-01-01

Despite federal regulations requiring measurable individualized education programs (IEPs), IEPs are often vague and unfocused, making them difficult to use in guiding instructional planning. Although a well-written IEP can be time consuming and labor intensive, a clearly written IEP, based on documented student needs, can and should be a guidepost…

76 FR 10781 - Amendments to Adjudicatory Process Rules and Related Requirements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-28

... documents created or received at the NRC are available electronically at the NRC's Electronic Reading Room at http://www.nrc.gov/reading-rm/adams.html . From this page, the public can gain entry into ADAMS... make faster and better-reasoned decisions. The NRC is therefore proposing to extend the time to file an...

Educational Documentation, Research and Decision-Making: National Case Studies. Studies in Comparative Education.

ERIC Educational Resources Information Center

Rokicka, Wanda, Ed.

In 1997, The International Bureau of Education (IBE) launched a series of case studies on the processes involved in the use of educational information and research. These studies describe how recent educational research has been disseminated and how educational reforms may have benefited, or not benefited, from insights gained through research.…

Technical Guidance for Assessing Environmental Justice in ...

EPA Pesticide Factsheets

The Technical Guidance for Assessing Environmental Justice in Regulatory Analysis (also referred to as the Environmental Justice Technical Guidance or EJTG) is intended for use by Agency analysts, including risk assessors, economists, and other analytic staff that conduct analyses to evaluate EJ concerns in the context of regulatory actions. Senior EPA managers and decision makers also may find this document useful to understand analytic expectations and to ensure that EJ concerns are appropriately considered in the development of analyses to support regulatory actions under EPA’s action development process. Specifically, the document outlines approaches and methods to help Agency analysts evaluate EJ concerns. The document provides overarching direction to analysts by outlining a series of questions that will ensure the decision maker has appropriate information about baseline risks across population groups, and how those risks are distributed under the options being considered. In addition, the document provides a set of recommendations and requirements as well as best practices for use in analyzing and reporting results from consideration of EJ concerns. These principles will help ensure consistency, quality, and transparency across regulatory actions, while allowing for flexibility needed across different regulatory actions. The purpose of the EJTG is ensure consistency, quality, and transparency in considering environmental justice, while allowing f

Coastal processes study at Ocean Beach, San Francisco, CA: summary of data collection 2004-2006

USGS Publications Warehouse

Barnard, Patrick L.; Eshleman, Jodi; Erikson, Li H.; Hanes, Daniel M.

2007-01-01

Ocean Beach in San Francisco, California, contains a persistent erosional section in the shadow of the San Francisco ebb tidal delta and south of Sloat Boulevard that threatens valuable public infrastructure as well as the safe recreational use of the beach. Coastal managers have been discussing potential mediation measures for over a decade, with little scientific research available to aid in decision making. The United States Geological Survey (USGS) initiated the Ocean Beach Coastal Processes Study in April 2004 to provide the scientific knowledge necessary for coastal managers to make informed management decisions. This study integrates a wide range of field data collection and numerical modeling techniques to document nearshore sediment transport processes at the mouth of San Francisco Bay, with emphasis on how these processes relate to erosion at Ocean Beach. The Ocean Beach Coastal Processes Study is the first comprehensive study of coastal processes at the mouth of San Francisco Bay.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 541: Small Boy Nevada National Security Site and Nevada Test and Training Range, Nevada, Revision 0 with ROTC-1

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

Kidman, Raymond; Matthews, Patrick

The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supporting the recommendation that no further corrective action is needed for CAU 541 based on the no further action alternative listed in Table ES-1.

25 CFR 1000.69 - How can a Tribe/Consortium obtain comments or selection documents received or utilized after OSG...

Code of Federal Regulations, 2010 CFR

2010-04-01

...-DETERMINATION AND EDUCATION ACT Other Financial Assistance for Planning and Negotiation Grants for Non-BIA... documents received or utilized after OSG has made a decision on a planning grant application? 1000.69... selection documents received or utilized after OSG has made a decision on a planning grant application? A...

An interdisciplinary framework for participatory modeling design and evaluation—What makes models effective participatory decision tools?

NASA Astrophysics Data System (ADS)

Falconi, Stefanie M.; Palmer, Richard N.

2017-02-01

Increased requirements for public involvement in water resources management (WRM) over the past century have stimulated the development of more collaborative decision-making methods. Participatory modeling (PM) uses computer models to inform and engage stakeholders in the planning process in order to influence collaborative decisions in WRM. Past evaluations of participatory models focused on process and final outcomes, yet, were hindered by diversity of purpose and inconsistent documentation. This paper presents a two-stage framework for evaluating PM based on mechanisms for improving model effectiveness as participatory tools. The five dimensions characterize the "who, when, how, and why" of each participatory effort (stage 1). Models are evaluated as "boundary objects," a concept used to describe tools that bridge understanding and translate different bodies of knowledge to improve credibility, salience, and legitimacy (stage 2). This evaluation framework is applied to five existing case studies from the literature. Though the goals of participation can be diverse, the novel contribution of the two-stage proposed framework is the flexibility it has to evaluate a wide range of cases that differ in scope, modeling approach, and participatory context. Also, the evaluation criteria provide a structured vocabulary based on clear mechanisms that extend beyond previous process-based and outcome-based evaluations. Effective models are those that take advantage of mechanisms that facilitate dialogue and resolution and improve the accessibility and applicability of technical knowledge. Furthermore, the framework can help build more complete records and systematic documentation of evidence to help standardize the field of PM.

Incremental development and prototyping in current laboratory software development projects: Preliminary analysis

NASA Technical Reports Server (NTRS)

Griesel, Martha Ann

1988-01-01

Several Laboratory software development projects that followed nonstandard development processes, which were hybrids of incremental development and prototyping, are being studied. Factors in the project environment leading to the decision to use a nonstandard development process and affecting its success are analyzed. A simple characterization of project environment based on this analysis is proposed, together with software development approaches which have been found effective for each category. These approaches include both documentation and review requirements.

Implementing Base Realignment and Closure Decisions in Compliance with the National Environmental Policy Act

DTIC Science & Technology

1991-05-01

February, 1991) Environmental Impact Statement Completion Date Fort Dix Jul 90 (A) Fort Devens - Fort Huachuca On Hold *Presidio of San Francisco May...the signing of the ROD in the NEPA process, documents must be revised, extending the environmental analysis process. As noted in the Fort Belvoir...91 Fort Sheridan Feb 91 (A) Fort Douglas Mar 91 Fort Meade Jul 91 Army Material Technology Laboratory Sep 91 Jefferson Proving Ground Sep 91 Cameron

The Role of Evidence in the Decision-Making Process of Selecting Essential Medicines in Developing Countries: The Case of Tanzania

PubMed Central

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Background Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. Methods This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. Findings The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Conclusions Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence. PMID:24416293

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

PubMed

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

2014-10-01

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

The role of evidence in the decision-making process of selecting essential medicines in developing countries: the case of Tanzania.

PubMed

Mori, Amani Thomas; Kaale, Eliangiringa Amos; Ngalesoni, Frida; Norheim, Ole Frithjof; Robberstad, Bjarne

2014-01-01

Insufficient access to essential medicines is a major health challenge in developing countries. Despite the importance of Standard Treatment Guidelines and National Essential Medicine Lists in facilitating access to medicines, little is known about how they are updated. This study aims to describe the process of updating the Standard Treatment Guidelines and National Essential Medicine List in Tanzania and further examines the criteria and the underlying evidence used in decision-making. This is a qualitative study in which data were collected by in-depth interviews and document reviews. Interviews were conducted with 18 key informants who were involved in updating the Standard Treatment Guidelines and National Essential Medicine List. We used a thematic content approach to analyse the data. The Standard Treatment Guidelines and National Essential Medicine List was updated by committees of experts who were recruited mostly from referral hospitals and the Ministry of Health and Social Welfare. Efficacy, safety, availability and affordability were the most frequently utilised criteria in decision-making, although these were largely based on experience rather than evidence. In addition, recommendations from international guidelines and medicine promotions also influenced decision-making. Cost-effectiveness, despite being an important criterion for formulary decisions, was not utilised. Recent decisions about the selection of essential medicines in Tanzania were made by committees of experts who largely used experience and discretionary judgement, leaving evidence with only a limited role in decision-making process. There may be several reasons for the current limited use of evidence in decision-making, but one hypothesis that remains to be explored is whether training experts in evidence-based decision-making would lead to a better and more explicit use of evidence.

Extensions to regret-based decision curve analysis: an application to hospice referral for terminal patients.

PubMed

Tsalatsanis, Athanasios; Barnes, Laura E; Hozo, Iztok; Djulbegovic, Benjamin

2011-12-23

Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned.

Extensions to Regret-based Decision Curve Analysis: An application to hospice referral for terminal patients

PubMed Central

2011-01-01

Background Despite the well documented advantages of hospice care, most terminally ill patients do not reap the maximum benefit from hospice services, with the majority of them receiving hospice care either prematurely or delayed. Decision systems to improve the hospice referral process are sorely needed. Methods We present a novel theoretical framework that is based on well-established methodologies of prognostication and decision analysis to assist with the hospice referral process for terminally ill patients. We linked the SUPPORT statistical model, widely regarded as one of the most accurate models for prognostication of terminally ill patients, with the recently developed regret based decision curve analysis (regret DCA). We extend the regret DCA methodology to consider harms associated with the prognostication test as well as harms and effects of the management strategies. In order to enable patients and physicians in making these complex decisions in real-time, we developed an easily accessible web-based decision support system available at the point of care. Results The web-based decision support system facilitates the hospice referral process in three steps. First, the patient or surrogate is interviewed to elicit his/her personal preferences regarding the continuation of life-sustaining treatment vs. palliative care. Then, regret DCA is employed to identify the best strategy for the particular patient in terms of threshold probability at which he/she is indifferent between continuation of treatment and of hospice referral. Finally, if necessary, the probabilities of survival and death for the particular patient are computed based on the SUPPORT prognostication model and contrasted with the patient's threshold probability. The web-based design of the CDSS enables patients, physicians, and family members to participate in the decision process from anywhere internet access is available. Conclusions We present a theoretical framework to facilitate the hospice referral process. Further rigorous clinical evaluation including testing in a prospective randomized controlled trial is required and planned. PMID:22196308

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders.

PubMed

Loisel, Patrick; Falardeau, Marlène; Baril, Raymond; José-Durand, Marie; Langley, Ann; Sauvé, Sandrine; Gervais, Julie

2005-05-20

This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital. In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members. Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them. This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.

Health Information Technology, Patient Safety, and Professional Nursing Care Documentation in Acute Care Settings.

PubMed

Lavin, Mary Ann; Harper, Ellen; Barr, Nancy

2015-04-14

The electronic health record (EHR) is a documentation tool that yields data useful in enhancing patient safety, evaluating care quality, maximizing efficiency, and measuring staffing needs. Although nurses applaud the EHR, they also indicate dissatisfaction with its design and cumbersome electronic processes. This article describes the views of nurses shared by members of the Nursing Practice Committee of the Missouri Nurses Association; it encourages nurses to share their EHR concerns with Information Technology (IT) staff and vendors and to take their place at the table when nursing-related IT decisions are made. In this article, we describe the experiential-reflective reasoning and action model used to understand staff nurses' perspectives, share committee reflections and recommendations for improving both documentation and documentation technology, and conclude by encouraging nurses to develop their documentation and informatics skills. Nursing issues include medication safety, documentation and standards of practice, and EHR efficiency. IT concerns include interoperability, vendors, innovation, nursing voice, education, and collaboration.

Drug pricing and reimbursement decision making systems in Mongolia.

PubMed

Dorj, Gereltuya; Sunderland, Bruce; Sanjjav, Tsetsegmaa; Dorj, Gantuya; Gendenragchaa, Byambatsogt

2017-01-01

It is essential to allocate available resources equitably in order to ensure accessibility and affordability of essential medicines, especially in less fortunate nations with limited health funding. Currently, transparent and evidence based research is required to evaluate decision making regarding drug registration, drug pricing and reimbursement processes in Mongolia. To assess the drug reimbursement system and discuss challenges faced by policy-makers and stakeholders. The study has examined Mongolian administrative documents and directives for stakeholders and analysed published statistics. Experts and decision-makers were interviewed about the drug pricing and reimbursement processes in Mongolia. Decisions regarding Mongolian drug registration were based on commonly used criteria of quality, safety, efficacy plus some economic considerations. A total of 11.32 billion Mongolian National Tugrugs (MNT) [5.6 million United States Dollars (USD)] or 12.1% of total health expenditure was spent on patient reimbursement of essential drugs. The highest reimbursed drugs with respect to cost in 2014 were the cardiovascular drug group. Health insurance is compulsory for all citizens; in addition all insured patients have access to reimbursed drugs. However, the decision making process, in particular the level of reimbursement was limited by various barriers, including lack of evidence based data regarding efficacy and comparative cost-effectiveness analysis of drugs and decisions regarding reimbursement. Drug registration, pricing and reimbursement process in Mongolia show an increasing trend of drug registration and reimbursement rates, along with lack of transparency. Limited available data indicate that more evidence-based research studies are required in Mongolia to evaluate and improve the effectiveness of drug pricing and reimbursement policies.

Introduction of New Vaccines: Decision-making Process in Bangladesh

PubMed Central

Sarma, Haribondhu; Bari, Tajul I.; Koehlmoos, Tracey P.

2013-01-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country. PMID:23930339

Introduction of new vaccines: decision-making process in Bangladesh.

PubMed

Uddin, Jasim; Sarma, Haribondhu; Bari, Tajul I; Koehlmoos, Tracey P

2013-06-01

The understanding of the decision-making process in the introduction of new vaccines helps establish why vaccines are adopted or not. It also contributes to building a sustainable demand for vaccines in a country. The purpose of the study was to map and analyze the formal decision-making process in relation to the introduction of new vaccines within the context of health policy and health systems and identify the ways of making decisions to introduce new vaccines in Bangladesh. During February-April 2011, a qualitative assessment was made at the national level to evaluate the decision-making process around the adoption of new vaccines in Bangladesh. The study population included: policy-level people, programme heads or associates, and key decision-makers of the Government, private sector, non-governmental organizations, and international agencies at the national level. In total, 13 key informants were purposively selected. Data were collected by interviewing key informants and reviewing documents. Data were analyzed thematically. The findings revealed that the actors from different sectors at the policy level were involved in the decision-making process in the introduction of new vaccines. They included policy-makers from the ministries of health and family welfare, finance, and local government and rural development; academicians; researchers; representatives from professional associations; development partners; and members of different committees on EPI. They contributed to the introduction of new vaccines in their own capacity. The burden of disease, research findings on vaccine-preventable diseases, political issues relating to outbreaks of certain diseases, initiatives of international and local stakeholders, pressure of development partners, the Global Alliance for Vaccines and Immunization (GAVI) support, and financial matters were the key factors in the introduction of new vaccines in Bangladesh. The slow introduction and uptake of new vaccines is a concern in the country. Rapid action on the application of GAVI support and less time taken by the Government in processing the implementation and administrative work may expedite the introduction of new vaccines in future in this country.

Automation bias: decision making and performance in high-tech cockpits.

PubMed

Mosier, K L; Skitka, L J; Heers, S; Burdick, M

1997-01-01

Automated aids and decision support tools are rapidly becoming indispensable tools in high-technology cockpits and are assuming increasing control of"cognitive" flight tasks, such as calculating fuel-efficient routes, navigating, or detecting and diagnosing system malfunctions and abnormalities. This study was designed to investigate automation bias, a recently documented factor in the use of automated aids and decision support systems. The term refers to omission and commission errors resulting from the use of automated cues as a heuristic replacement for vigilant information seeking and processing. Glass-cockpit pilots flew flight scenarios involving automation events or opportunities for automation-related omission and commission errors. Although experimentally manipulated accountability demands did not significantly impact performance, post hoc analyses revealed that those pilots who reported an internalized perception of "accountability" for their performance and strategies of interaction with the automation were significantly more likely to double-check automated functioning against other cues and less likely to commit errors than those who did not share this perception. Pilots were also lilkely to erroneously "remember" the presence of expected cues when describing their decision-making processes.

Integrating multi-criteria techniques with geographical information systems in waste facility location to enhance public participation.

PubMed

Higgs, Gary

2006-04-01

Despite recent U.K. Government commitments' to encourage public participation in environmental decision making, those exercises conducted to date have been largely confined to 'traditional' modes of participation such as the dissemination of information and in encouraging feedback on proposals through, for example, questionnaires or surveys. It is the premise of this paper that participative approaches that use IT-based methods, based on combined geographical information systems (GIS) and multi-criteria evaluation techniques that could involve the public in the decision-making process, have the potential to build consensus and reduce disputes and conflicts such as those arising from the siting of different types of waste facilities. The potential of these techniques are documented through a review of the existing literature in order to highlight the opportunities and challenges facing decision makers in increasing the involvement of the public at different stages of the waste facility management process. It is concluded that there are important lessons to be learned by researchers, consultants, managers and decision makers if barriers hindering the wider use of such techniques are to be overcome.

[Technology and progress in the use of information systems in the dental office].

PubMed

Walther, K

1989-09-01

The numerous DP systems used in dental offices are designed for administrative work. Data storage and management is limited to accountancy applications, and the advantages of the flow of information are restricted to operational purposes. Data of medical use are available only to a moderate extent. It should be possible, however, to use these information systems for processing purely medical data, for the structured input of comprehensive diagnostic information, and to have these data available for specific decisions. The use of a "decision-supporting system" has been tested in the documentation of dental diagnostic findings.

Evaluating the impact of an educational intervention on documentation of decision-making capacity in an emergency medical services system.

PubMed

Riley, Jennifer; Burgess, Rob; Schwartz, Brian

2004-07-01

To compare the documentation of decision-making capacity by advanced life support (ALS) providers and signature acquisition before, one month after, and one year after an educational intervention. The intervention comprised a one-and-a-half-hour module on assessment and documentation of decision-making capacity. Ambulance call reports were reviewed for all ALS calls occurring during three two-month periods, and refusals of transport were recorded. Provider compliance with documentation of decision-making capacity and signature acquisition were determined from a convenience sample of 75 reports from each period. Reviewers were blinded to study period. Twenty-percent double data entry was undertaken to evaluate accuracy. Ninety-five percent confidence intervals were calculated to compare frequencies of cancelled calls and documentation. From the emergency medical services database, 7,744 calls before the intervention, 7,444 immediately after, and 7,604 one year later were identified. Documentation rates in the second and third periods did not differ from that prior to the intervention (1.3% vs. 0.0% and 0.0% in subsequent periods), nor did the rates of signature acquisition differ (85.3% vs. 85.3% and 78.6%). The accuracy of data entry was 92.6%. However, the frequency of call refusals decreased significantly after the intervention (from 9.0% to 2.0% and 6.6% in the respective periods). An educational intervention resulted in no change in the rate of decision-making capacity documentation or signature acquisition by ALS providers for refusal of transport. There was a temporary increase in the number of transported patients.

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

PubMed

Dando, Coral J; Ormerod, Thomas C

2017-12-01

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

The Drug Reimbursement Decision-Making System in Iran.

PubMed

Ansaripour, Amir; Uyl-de Groot, Carin A; Steenhoek, Adri; Redekop, William K

2014-05-01

Previous studies of health policies in Iran have not focused exclusively on the drug reimbursement process. The aim of this study was to describe the entire drug reimbursement process and the stakeholders, and discuss issues faced by policymakers. Review of documents describing the administrative rules and directives of stakeholders, supplemented by published statistics and interviews with experts and policymakers. Iran has a systematic process for the assessment, appraisal, and judgment of drug reimbursements. The two most important organizations in this process are the Food and Drug Organization, which considers clinical effectiveness, safety, and economic issues, and the Supreme Council of Health Insurance, which considers various criteria, including budget impact and cost-effectiveness. Ultimately, the Iranian Cabinet approves a drug and recommends its use to all health insurance organizations. Reimbursed drugs account for about 53.5% of all available drugs and 77.3% of drug expenditures. Despite its strengths, the system faces various issues, including conflicting stakeholder aims, lengthy decision-making duration, limited access to decision-making details, and rigidity in the assessment process. The Iranian drug reimbursement system uses decision-making criteria and a structured approach similar to those in other countries. Important shortcomings in the system include out-of-pocket contributions due to lengthy decision making, lack of transparency, and conflicting interests among stakeholders. Iranian policymakers should consider a number of ways to remedy these problems, such as case studies of individual drugs and closer examination of experiences in other countries. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Beyond the lab: observations on the process by which science successfully informs management and policy decisions

NASA Astrophysics Data System (ADS)

Flores, S.

2012-12-01

Scientific findings inform management decisions and policy products through various ways, these include: synthesis reports, white papers, in-person and web-based seminars (webinars), communication from specialized staff, and seminal peer-reviewed journal articles. Scientists are often told that if they want their science to inform management decisions and policy products that they must: clearly and simply articulate discreet pieces of scientific information and avoid attaching advocacy messages to the science; however, solely relying on these tenants does not ensure that scientific products will infuse the realms of management and policy. The process by which science successfully informs management decisions and policy products rarely begins at the time the results come out of the lab, but rather, before the research is carried out. Having an understanding of the political climate, management needs, agency research agendas, and funding limitations, as well as developing a working relationship with the intended managers and policy makers are key elements to developing the kind of science results and products that often make an impact in the management and policy world. In my presentation I will provide case-studies from California (USA) to highlight the type of coastal, ocean and climate science that has been successful in informing management decisions and policy documents, as well as provide a state-level agency perspective on the process by which this occurs.

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

Tiradani, Tiradani,Anthony; Altunay, Mine; Dagenhart, David

The Decision Engine is a critical component of the HEP Cloud Facility. It provides the functionality of resource scheduling for disparate resource providers, including those which may have a cost or a restricted allocation of cycles. Along with the architecture, design, and requirements for the Decision Engine, this document will provide the rationale and explanations for various design decisions. In some cases, requirements and interfaces for a limited subset of external services will be included in this document. This document is intended to be a high level design. The design represented in this document is not complete and does notmore » break everything down in detail. The class structures and pseudo-code exist for example purposes to illustrate desired behaviors, and as such, should not be taken literally. The protocols and behaviors are the important items to take from this document. This project is still in prototyping mode so flaws and inconsistencies may exist and should be noted and treated as failures.« less

Creating Your Life's Work Portfolio. An Interactive Career and Life Planning Workbook.

ERIC Educational Resources Information Center

1998

Designed for those beginning a working life or with years of experience, this book leads the user through collecting records that document work history and affirm successes. It provides a step-by-step process to help plan one's life's work, make career decisions, and develop plans for new career directions and a structure to learn career planning…

The Impact of Professional Development on the Quality of the Transition Components of IEPs

ERIC Educational Resources Information Center

Flannery, K. Brigid; Lombardi, Allison; Kato, Mimi McGrath

2015-01-01

Under the Individuals With Disabilities Education Act (IDEA), transition needs and services are to be discussed as part of the Individual Education Program (IEP) planning process, and decisions based on students' future goals are to be documented in the IEP. These transition requirements were included in IDEA in order to plan with the student,…

INDIVIDUALIZING UNIVERSITY INSTRUCTION, EXPLORING COMPUTER POTENTIAL TO AID COLLEGE TEACHERS BY DIRECTING THE LEARNING PROCESS. INTER-UNIVERSITY PROJECT ONE, PUBLICATIONS SERIES.

ERIC Educational Resources Information Center

FALL, CHARLES R.

THIS DOCUMENT CONCLUDES THAT INSTRUCTION BY COMPUTER-BASED RESOURCE UNITS CAN FACILITATE LEARNING AND PROVIDE THE INSTRUCTOR WITH VALUABLE ASSISTANCE. BY PRE-PLANNING THE TEACHING-LEARNING SITUATION, RESOURCE UNITS CAN FREE THE INSTRUCTOR FOR DECISION-MAKING TASKS. RESOURCE UNITS CAN ALSO PROVIDE APPROPRIATE LEARNING GOALS AND STUDY GUIDES TO EACH…

Application of a Dynamic Programming Algorithm for Weapon Target Assignment

DTIC Science & Technology

2016-02-01

25] A . Turan , “Techniques for the Allocation of Resources Under Uncertainty,” Middle Eastern Technical University, Ankara, Turkey, 2012. [26] K...UNCLASSIFIED UNCLASSIFIED Application of a Dynamic Programming Algorithm for Weapon Target Assignment Lloyd Hammond Weapons and...optimisation techniques to support the decision making process. This report documents the methodology used to identify, develop and assess a

Supplemental knowledge acquisition through external product interface for CLIPS

NASA Technical Reports Server (NTRS)

Saito, Tim; Ebaud, Stephen; Loftin, Bowen R.

1990-01-01

Traditionally, the acquisition of knowledge for expert systems consisted of the interview process with the domain or subject matter expert (SME), observation of domain environment, and information gathering and research which constituted a direct form of knowledge acquisition (KA). The knowledge engineer would be responsible for accumulating pertinent information and/or knowledge from the SME(s) for input into the appropriate expert system development tool. The direct KA process may (or may not) have included forms of data or documentation to incorporate from the SME's surroundings. The differentiation between direct KA and supplemental KA (indirect) would be the difference in the use of data. In acquiring supplemental knowledge, the knowledge engineer would access other types of evidence (manuals, documents, data files, spreadsheets, etc.) that would support the reasoning or premises of the SME. When an expert makes a decision in a particular task, one tool that may have been used to justify a recommendation, would have been a spreadsheet total or column figure. Locating specific decision points from that data within the SME's framework would constitute supplemental KA. Data used for a specific purpose in one system or environment would be used as supplemental knowledge for another, specifically a CLIPS project.

Regret and the rationality of choices.

PubMed

Bourgeois-Gironde, Sacha

2010-01-27

Regret helps to optimize decision behaviour. It can be defined as a rational emotion. Several recent neurobiological studies have confirmed the interface between emotion and cognition at which regret is located and documented its role in decision behaviour. These data give credibility to the incorporation of regret in decision theory that had been proposed by economists in the 1980s. However, finer distinctions are required in order to get a better grasp of how regret and behaviour influence each other. Regret can be defined as a predictive error signal but this signal does not necessarily transpose into a decision-weight influencing behaviour. Clinical studies on several types of patients show that the processing of an error signal and its influence on subsequent behaviour can be dissociated. We propose a general understanding of how regret and decision-making are connected in terms of regret being modulated by rational antecedents of choice. Regret and the modification of behaviour on its basis will depend on the criteria of rationality involved in decision-making. We indicate current and prospective lines of research in order to refine our views on how regret contributes to optimal decision-making.

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

Kinzey, Bruce R.

The City of Detroit is undertaking a comprehensive restoration of its street lighting system that includes transitioning the existing high-pressure sodium (HPS) sources to light-emitting diode (LED). Detroit’s well-publicized financial troubles over the last several years have added many hurdles and constraints to this process. Strategies to overcome these issues have largely been successful, but have also brought some mixed results. This document provides an objective review of the circumstances surrounding the system restoration, the processes undertaken and decisions made, and the results so far.

[Shared decision-making and individualized goal setting - a pilot trial using PRISM (Pictorial Representation of Illness and Self Measure) in psychiatric inpatients].

PubMed

Büchi, S; Straub, S; Schwager, U

2010-12-01

Although there is much talk about shared decision making and individualized goal setting, there is a lack of knowledge and knowhow in their realization in daily clinical practice. There is a lack in tools for easy applicable tools to ameliorate person-centred individualized goal setting processes. In three selected psychiatric inpatients the semistructured, theory driven use of PRISM (Pictorial Representation of Illness and Self Measure) in patients with complex psychiatric problems is presented and discussed. PRISM sustains a person-centred individualized process of goal setting and treatment and reinforces the active participation of patients. The process of visualisation and synchronous documentation is validated positively by patients and clinicians. The visual goal setting requires 30 to 45 minutes. In patients with complex psychiatric illness PRISM was used successfully to ameliorate individual goal setting. Specific effects of PRISM-visualisation are actually evaluated in a randomized controlled trial.

[Development and clinical evaluation of an anesthesia information management system].

PubMed

Feng, Jing-yi; Chen, Hua; Zhu, Sheng-mei

2010-09-21

To study the design, implementation and clinical evaluation of an anesthesia information management system. To record, process and store peri-operative patient data automatically, all kinds of bedside monitoring equipments are connected into the system based on information integrating technology; after a statistical analysis of those patient data by data mining technology, patient status can be evaluated automatically based on risk prediction standard and decision support system, and then anesthetist could perform reasonable and safe clinical processes; with clinical processes electronically recorded, standard record tables could be generated, and clinical workflow is optimized, as well. With the system, kinds of patient data could be collected, stored, analyzed and archived, kinds of anesthesia documents could be generated, and patient status could be evaluated to support clinic decision. The anesthesia information management system is useful for improving anesthesia quality, decreasing risk of patient and clinician, and aiding to provide clinical proof.

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 6 2010-10-01 2010-10-01 false How is the decision made to issue or deny..., PURCHASE, BARTER, EXPORTATION, AND IMPORTATION OF WILDLIFE AND PLANTS (CONTINUED) CONVENTION ON... Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

No Further Remedial Action Planned Decision Document for Site 3.

DTIC Science & Technology

1998-04-01

INSTALLATION RESTORATION PROGRAM No FURTHER REMEDIAL ACTION PLANNED DECISION DOCUMENT FOR SITE 3 FINAL MICHIGAN AIR NATIONAL GUARD ALPENA ...COMBAT READINESS TRAINING CENTER ALPENA , MICHIGAN April 1998 Air National Guard Andrews AFB, Maryland &nc QUALITY IMSmm«^ 19980519 204 XA REPORT...Document for Site 3 at Alpena CRTC, Alpena , MI. 6. AUTHOR(S) N/A 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Montgomery

Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery.

PubMed

Catanuto, Giuseppe; Pappalardo, Francesco; Rocco, Nicola; Leotta, Marco; Ursino, Venera; Chiodini, Paolo; Buggi, Federico; Folli, Secondo; Catalano, Francesca; Nava, Maurizio B

2016-10-01

The increased complexity of the decisional process in breast cancer surgery is well documented. With this study we aimed to create a software tool able to assist patients and surgeons in taking proper decisions. We hypothesized that the endpoints of breast cancer surgery could be addressed combining a set of decisional drivers. We created a decision support system software tool (DSS) and an interactive decision tree. A formal analysis estimated the information gain derived from each feature in the process. We tested the DSS on 52 patients and we analyzed the concordance of decisions obtained by different users and between the DSS suggestions and the actual surgery. We also tested the ability of the system to prevent post breast conservation deformities. The information gain revealed that patients preferences are the root of our decision tree. An observed concordance respectively of 0.98 and 0.88 was reported when the DSS was used twice by an expert operator or by a newly trained operator vs. an expert one. The observed concordance between the DSS suggestion and the actual decision was 0.69. A significantly higher incidence of post breast conservation defects was reported among patients who did not follow the DSS decision (Type III of Fitoussi, N = 4; 33.3%, p = 0.004). The DSS decisions can be reproduced by operators with different experience. The concordance between suggestions and actual decision is quite low, however the DSS is able to prevent post- breast conservation deformities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Problems caused by regulatory delays and lack of regulation

NASA Astrophysics Data System (ADS)

Reamer, Lynne A.

1994-12-01

An FDA perspective on some of the problems encountered during the device review process is described. Emphasis is placed on the need for communication and teamwork among all parties to make the system work. Manufacturers are encouraged to `Do it right the first time.' Pertinent questions are asked of the manufacturers and proposed solutions are presented. Day to day reality at FDA is described and document workload is revealed. Lack of regulation, or more appropriately, when less regulation is appropriate is discussed. FDA has distributed to manufacturers a new draft guidance document to help in the decisionmaking process and when to submit a 510(k) when modifications are made to a device. This and other mechanisms are in place at the FDA to streamline the review process. Manufacturers are cautioned about their decisions and to seek advice from qualified persons. FDA emphasizes that help is available and that when in doubt, call.

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

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

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

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

Implementation of Improvements in an Electronic Documentation Nursing Process System Structured on NANDA-I, NOC and NIC (NNN) Classification.

PubMed

Peres, Heloísa; Cruz, Diná; Tellez, Michelle; de Cássia Gengo E Silva, Rita; Ortiz, Diley; Diogo, Regina; Ortiz, Dóris R

2016-01-01

The aim of this study was to present the experience of a teaching hospital with the implementation of improvements to an electronic documentation system of the nursing process (PROCEnf-USP®). The improvements were based on functional performance and technical quality of the system. It was adopted Scrum^™ method for version control PROCEnf-USP® by enabling agility, flexibility and possibility of integration between development and users. The PROCEnf-USP® has been used since 2009 and has professional and academic environments. The current version lets you generate reports and supports decisions about diagnoses, outcomes and interventions. It is provided the use of indicators to monitor results and registration at the point of care. The establishment of important.

Ubiquitous computing in shared-care environments.

PubMed

Koch, S

2006-07-01

In light of future challenges, such as growing numbers of elderly, increase in chronic diseases, insufficient health care budgets and problems with staff recruitment for the health-care sector, information and communication technology (ICT) becomes a possible means to meet these challenges. Organizational changes such as the decentralization of the health-care system lead to a shift from in-hospital to both advanced and basic home health care. Advanced medical technologies provide solutions for distant home care in form of specialist consultations and home monitoring. Furthermore, the shift towards home health care will increase mobile work and the establishment of shared care teams which require ICT-based solutions that support ubiquitous information access and cooperative work. Clinical documentation and decision support systems are the main ICT-based solutions of interest in the context of ubiquitous computing for shared care environments. This paper therefore describes the prerequisites for clinical documentation and decision support at the point of care, the impact of mobility on the documentation process, and how the introduction of ICT-based solutions will influence organizations and people. Furthermore, the role of dentistry in shared-care environments is discussed and illustrated in the form of a future scenario.

A short history of health technology assessment in Germany.

PubMed

Perleth, Matthias; Gibis, Bernhard; Göhlen, Britta

2009-07-01

To provide an overview of the development of health technology assessment (HTA) in Germany since the 1990s. Analysis of key documents (e.g. literature, laws, and other official documentation) and personal experiences. Health technology assessment (HTA) entered the political agenda in Germany only in the mid-1990s, basically as the result of a top-down approach toward more efficiency in health care, but with a strong impetus of an evidence-based medicine movement. Accordingly, HTA became part of several healthcare reform laws since 1997, which led to the establishment of the Federal Joint Committee (G-BA) and the Institute for Quality and Efficiency in Health Care (IQWiG) in 2004. This tandem construction aims at using evidence in decision-making processes for coverage and other decisions. These developments have led to a considerable impact of HTA in Germany. In addition, a broad spectrum of activities at universities and in other organizations, such as the German Institute for Medical Documentation and Information (DIMDI), can be observed that contribute to both teaching and research in HTA. German researchers in the field of HTA are actively involved in international projects, such as EUNetHTA, and contribute to scientific conferences and journals.

Guideline Adherence Regarding the Use of Expensive Drugs in Daily Practice: The Examples of Trastuzumab in Breast Cancer and Bortezomib in Multiple Myeloma.

PubMed

Boons, Christel C L M; Wagner, Cordula; Hugtenburg, Jacqueline G

2016-01-01

The present study was designed to obtain insights into guideline adherence regarding the use of expensive drugs in The Netherlands in daily practice and into the patients' perspective on the decision-making process. A retrospective review of medical charts regarding the use of trastuzumab in early and metastatic breast cancer (EBC/MBC) and bortezomib in multiple myeloma (MM) was conducted. Prescription according to clinical practice guidelines was assessed. The review was supplemented with patient interviews. Of 702 adjuvant-treated EBC patients, 97% had a documented human epidermal growth factor receptor 2 (HER2) testing (23% HER2 positive). 92% (147/160) of the HER2-positive EBC patients were treated with trastuzumab. Of 594 MBC patients, 81% had a documented HER2 testing (19% HER2 positive). 82% (75/91) of the HER2-positive MBC patients were treated with trastuzumab. Of 68 MM patients, 50% were treated with bortezomib. Reasons not to treat were consistent with the guidelines. Patients were generally satisfied with the decision-making process; improvements in patient education were suggested (e.g., repeating the information given, adding information on side effects). Guidelines were generally well followed with respect to trastuzumab and bortezomib, indicating that funding did not influence the treatment decisions of physicians. In view of the growing numbers of both cancer patients and expensive new anticancer drugs, and increasing budget constraints, it is unclear whether the present-day policies will guarantee a similar level of guideline adherence. Patient involvement in decision-making could be increased by improving the patient education on treatment. © 2016 S. Karger GmbH, Freiburg.

Sustainability in health care by allocating resources effectively (SHARE) 3: examining how resource allocation decisions are made, implemented and evaluated in a local healthcare setting.

PubMed

Harris, Claire; Allen, Kelly; Waller, Cara; Brooke, Vanessa

2017-05-09

This is the third in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. Leaders in a large Australian health service planned to establish an organisation-wide, systematic, integrated, evidence-based approach to disinvestment. In order to introduce new systems and processes for disinvestment into existing decision-making infrastructure, we aimed to understand where, how and by whom resource allocation decisions were made, implemented and evaluated. We also sought the knowledge and experience of staff regarding previous disinvestment activities. Structured interviews, workshops and document analysis were used to collect information from multiple sources in an environmental scan of decision-making systems and processes. Findings were synthesised using a theoretical framework. Sixty-eight respondents participated in interviews and workshops. Eight components in the process of resource allocation were identified: Governance, Administration, Stakeholder engagement, Resources, Decision-making, Implementation, Evaluation and, where appropriate, Reinvestment of savings. Elements of structure and practice for each component are described and a new framework was developed to capture the relationships between them. A range of decision-makers, decision-making settings, type and scope of decisions, criteria used, and strengths, weaknesses, barriers and enablers are outlined. The term 'disinvestment' was not used in health service decision-making. Previous projects that involved removal, reduction or restriction of current practices were driven by quality and safety issues, evidence-based practice or a need to find resource savings and not by initiatives where the primary aim was to disinvest. Measuring resource savings is difficult, in some situations impossible. Savings are often only theoretical as resources released may be utilised immediately by patients waiting for beds, clinic appointments or surgery. Decision-making systems and processes for resource allocation are more complex than assumed in previous studies. There is a wide range of decision-makers, settings, scope and type of decisions, and criteria used for allocating resources within a single institution. To our knowledge, this is the first paper to report this level of detail and to introduce eight components of the resource allocation process identified within a local health service.

Expectations Do Not Alter Early Sensory Processing during Perceptual Decision-Making.

PubMed

Rungratsameetaweemana, Nuttida; Itthipuripat, Sirawaj; Salazar, Annalisa; Serences, John T

2018-06-13

Two factors play important roles in shaping perception: the allocation of selective attention to behaviorally relevant sensory features, and prior expectations about regularities in the environment. Signal detection theory proposes distinct roles of attention and expectation on decision-making such that attention modulates early sensory processing, whereas expectation influences the selection and execution of motor responses. Challenging this classic framework, recent studies suggest that expectations about sensory regularities enhance the encoding and accumulation of sensory evidence during decision-making. However, it is possible, that these findings reflect well documented attentional modulations in visual cortex. Here, we tested this framework in a group of male and female human participants by examining how expectations about stimulus features (orientation and color) and expectations about motor responses impacted electroencephalography (EEG) markers of early sensory processing and the accumulation of sensory evidence during decision-making (the early visual negative potential and the centro-parietal positive potential, respectively). We first demonstrate that these markers are sensitive to changes in the amount of sensory evidence in the display. Then we show, counter to recent findings, that neither marker is modulated by either feature or motor expectations, despite a robust effect of expectations on behavior. Instead, violating expectations about likely sensory features and motor responses impacts posterior alpha and frontal theta oscillations, signals thought to index overall processing time and cognitive conflict. These findings are inconsistent with recent theoretical accounts and suggest instead that expectations primarily influence decisions by modulating post-perceptual stages of information processing. SIGNIFICANCE STATEMENT Expectations about likely features or motor responses play an important role in shaping behavior. Classic theoretical frameworks posit that expectations modulate decision-making by biasing late stages of decision-making including the selection and execution of motor responses. In contrast, recent accounts suggest that expectations also modulate decisions by improving the quality of early sensory processing. However, these effects could instead reflect the influence of selective attention. Here we examine the effect of expectations about sensory features and motor responses on a set of electroencephalography (EEG) markers that index early sensory processing and later post-perceptual processing. Counter to recent empirical results, expectations have little effect on early sensory processing but instead modulate EEG markers of time-on-task and cognitive conflict. Copyright © 2018 the authors 0270-6474/18/385632-17$15.00/0.

DATA QUALITY OBJECTIVE SUMMARY REPORT FOR THE 105 K EAST ION EXCHANGE COLUMN MONOLITH

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

JOCHEN, R.M.

2007-08-02

The 105-K East (KE) Basin Ion Exchange Column (IXC) cells, lead caves, and the surrounding vault are to be removed as necessary components in implementing ''Hanford Federal Facility Agreement and Consent Order'' (Ecology et al. 2003) milestone M-034-32 (Complete Removal of the K East Basin Structure). The IXCs consist of six units located in the KE Basin, three in operating positions in cells and three stored in a lead cave. Methods to remove the IXCs from the KE Basin were evaluated in KBC-28343, ''Disposal of K East Basin Ion Exchange Column Evaluation''. The method selected for removal was grouting themore » six IXCs into a single monolith for disposal at the Environmental Restoration Disposal Facility (ERDF). Grout will be added to the IXC cells, IXC lead caves containing spent IXCs, and in the spaces between the lead cave walls and metal skin, to immobilize the contaminants, provide self-shielding, minimize void space, and provide a structurally stable waste form. The waste to be offered for disposal is the encapsulated monolith defined by the exterior surfaces of the vault and the lower surface of the underlying slab. This document presents summary of the data quality objective (DQO) process establishing the decisions and data required to support decision-making activities for the disposition of the IXC monolith. The DQO process is completed in accordance with the seven-step planning process described in EPA QA/G-4, ''Guidance for the Data Quality Objectives Process'', which is used to clarify and study objectives; define the appropriate type, quantity, and quality of data; and support defensible decision-making. The DQO process involves the following steps: (1) state the problem; (2) identify the decision; (3) identify the inputs to the decision; (4) define the boundaries of the study; (5) develop a decision rule (DR); (6) specify tolerable limits on decision errors; and (7) optimize the design for obtaining data.« less

Independence and interdependence in collective decision making: an agent-based model of nest-site choice by honeybee swarms

PubMed Central

List, Christian; Elsholtz, Christian; Seeley, Thomas D.

2008-01-01

Condorcet's jury theorem shows that when the members of a group have noisy but independent information about what is best for the group as a whole, majority decisions tend to outperform dictatorial ones. When voting is supplemented by communication, however, the resulting interdependencies between decision makers can strengthen or undermine this effect: they can facilitate information pooling, but also amplify errors. We consider an intriguing non-human case of independent information pooling combined with communication: the case of nest-site choice by honeybee (Apis mellifera) swarms. It is empirically well documented that when there are different nest sites that vary in quality, the bees usually choose the best one. We develop a new agent-based model of the bees' decision process and show that its remarkable reliability stems from a particular interplay of independence and interdependence between the bees. PMID:19073474

Evaluating a Clinical Decision Support Interface for End-of-Life Nurse Care.

PubMed

Febretti, Alessandro; Stifter, Janet; Keenan, Gail M; Lopez, Karen D; Johnson, Andrew; Wilkie, Diana J

2014-01-01

Clinical Decision Support Systems (CDSS) are tools that assist healthcare personnel in the decision-making process for patient care. Although CDSSs have been successfully deployed in the clinical setting to assist physicians, few CDSS have been targeted at professional nurses, the largest group of health providers. We present our experience in designing and testing a CDSS interface embedded within a nurse care planning and documentation tool. We developed four prototypes based on different CDSS feature designs, and tested them in simulated end-of-life patient handoff sessions with a group of 40 nurse clinicians. We show how our prototypes directed nurses towards an optimal care decision that was rarely performed in unassisted practice. We also discuss the effect of CDSS layout and interface navigation in a nurse's acceptance of suggested actions. These findings provide insights into effective nursing CDSS design that are generalizable to care scenarios different than end-of-life.

Decision analysis framing study; in-valley drainage management strategies for the western San Joaquin Valley, California

USGS Publications Warehouse

Presser, Theresa S.; Jenni, Karen E.; Nieman, Timothy; Coleman, James

2010-01-01

Constraints on drainage management in the western San Joaquin Valley and implications of proposed approaches to management were recently evaluated by the U.S. Geological Survey (USGS). The USGS found that a significant amount of data for relevant technical issues was available and that a structured, analytical decision support tool could help optimize combinations of specific in-valley drainage management strategies, address uncertainties, and document underlying data analysis for future use. To follow-up on USGS's technical analysis and to help define a scientific basis for decisionmaking in implementing in-valley drainage management strategies, this report describes the first step (that is, a framing study) in a Decision Analysis process. In general, a Decision Analysis process includes four steps: (1) problem framing to establish the scope of the decision problem(s) and a set of fundamental objectives to evaluate potential solutions, (2) generation of strategies to address identified decision problem(s), (3) identification of uncertainties and their relationships, and (4) construction of a decision support model. Participation in such a systematic approach can help to promote consensus and to build a record of qualified supporting data for planning and implementation. In December 2008, a Decision Analysis framing study was initiated with a series of meetings designed to obtain preliminary input from key stakeholder groups on the scope of decisions relevant to drainage management that were of interest to them, and on the fundamental objectives each group considered relevant to those decisions. Two key findings of this framing study are: (1) participating stakeholders have many drainage management objectives in common; and (2) understanding the links between drainage management and water management is necessary both for sound science-based decisionmaking and for resolving stakeholder differences about the value of proposed drainage management solutions. Citing ongoing legal processes associated with drainage management in the western San Joaquin Valley, the U.S. Bureau of Reclamation (USBR) withdrew from the Decision Analysis process early in the proceedings. Without the involvement of the USBR, the USGS discontinued further development of this study.

How can the use of data within the immunisation programme be increased in order to improve data quality and ensure greater accountability in the health system? A protocol for implementation science study.

PubMed

Tilahun, Binyam; Teklu, Alemayehu; Mancuso, Arielle; Abebaw, Zeleke; Dessie, Kassahun; Zegeye, Desalegn

2018-05-03

Immunisation remains one of the most important and cost-effective interventions to reduce vaccine-preventable child morbidity, disability and mortality. Health programmes like the Expanded Program of Immunization rely on complex decision-making and strong local level evidence is important to effectively and efficiently utilise limited resources. Lack of data use for decision-making at each level of the health system remains the main challenge in most developing countries. While there is much evidence on data quality and how to improve it, there is a lack of sufficient evidence on why the use of data for decision-making at each level of the health system is low. Herein, we describe a comprehensive implementation science study that will be conducted to identify organisational, technical and individual level factors affecting local data use at each level of the Ethiopian health system. We will apply a mixed methods approach using key informant interviews and document reviews. The qualitative data will be gathered through key informant interviews using a semi-structured guide with open- and closed-ended questions with four categories of respondents, namely decision-makers, data producers, data users and community representatives at the federal, regional, zonal, woreda and community levels of the health system. The document review will be conducted on selected reports and feedback documented at different levels of the health system. Data will be collected from July 2017 to March 2018. Descriptive statistics will be analysed for the quantitative study using SPSS version 20 software and thematic content analysis will be performed for the qualitative part using NVivo software. Appropriate and timely use of health and health-related information for decision-making is an essential element in the process of transforming the health sector. The findings of the study will inform stakeholders at different levels on the institutionalisation of evidence-based practice in immunisation programmes.

Structured vs. Unstructured: Factors Affecting Adverse Drug Reaction Documentation in an EMR Repository

PubMed Central

Skentzos, Stephen; Shubina, Maria; Plutzky, Jorge; Turchin, Alexander

2011-01-01

Adverse reactions to medications to which the patient was known to be intolerant are common. Electronic decision support can prevent them but only if history of adverse reactions to medications is recorded in structured format. We have conducted a retrospective study of 31,531 patients with adverse reactions to statins documented in the notes, as identified with natural language processing. The software identified statin adverse reactions with sensitivity of 86.5% and precision of 91.9%. Only 9020 of these patients had an adverse reaction to a statin recorded in structured format. In multivariable analysis the strongest predictor of structured documentation was utilization of EMR functionality that integrated the medication list with the structured medication adverse reaction repository (odds ratio 48.6, p < 0.0001). Integration of information flow between EMR modules can help improve documentation and potentially prevent adverse drug events. PMID:22195188

Alternative control technology document for bakery oven emissions. Final report

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

Sanford, C.W.

The document was produced in response to a request by the baking industry for Federal guidance to assist in providing a more uniform information base for State decision-making with regard to control of bakery oven emissions. The information in the document pertains to bakeries that produce yeast-leavened bread, rolls, buns, and similar products but not crackers, sweet goods, or baked foodstuffs that are not yeast leavened. Information on the baking processes, equipment, operating parameters, potential emissions from baking, and potential emission control options are presented. Catalytic and regenerative oxidation are identified as the most appropriate existing control technologies applicable tomore » VOC emissions from bakery ovens. Cost analyses for catalytic and regenerative oxidation are included. A predictive formula for use in estimating oven emissions has been derived from source tests done in junction with the development of the document. Its use and applicability are described.« less

Automation of Design Engineering Processes

NASA Technical Reports Server (NTRS)

Torrey, Glenn; Sawasky, Gerald; Courey, Karim

2004-01-01

A method, and a computer program that helps to implement the method, have been developed to automate and systematize the retention and retrieval of all the written records generated during the process of designing a complex engineering system. It cannot be emphasized strongly enough that all the written records as used here is meant to be taken literally: it signifies not only final drawings and final engineering calculations but also such ancillary documents as minutes of meetings, memoranda, requests for design changes, approval and review documents, and reports of tests. One important purpose served by the method is to make the records readily available to all involved users via their computer workstations from one computer archive while eliminating the need for voluminous paper files stored in different places. Another important purpose served by the method is to facilitate the work of engineers who are charged with sustaining the system and were not involved in the original design decisions. The method helps the sustaining engineers to retrieve information that enables them to retrace the reasoning that led to the original design decisions, thereby helping them to understand the system better and to make informed engineering choices pertaining to maintenance and/or modifications of the system. The software used to implement the method is written in Microsoft Access. All of the documents pertaining to the design of a given system are stored in one relational database in such a manner that they can be related to each other via a single tracking number.

49 CFR 219.901 - Retention of alcohol testing records.

Code of Federal Regulations, 2010 CFR

2010-10-01

... test results; and (2) A copy of the annual report summarizing the results of its alcohol misuse... connection with decisions to administer reasonable suspicion alcohol tests. (iv) Documents generated in connection with decisions on post-accident testing. (v) Documents verifying the existence of a medical...

15 CFR 764.5 - Voluntary self-disclosure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... retained by the person making the disclosure until OEE requests them, or until a final decision on the disclosed information has been made. After a final decision, the documents should be maintained in... account and supporting documentation. If the person making the disclosure believes otherwise, a request...

Region-to-area screening methodology for the Crystalline Repository Project

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

None

1985-04-01

The purpose of this document is to describe the Crystalline Repository Project's (CRP) process for region-to-area screening of exposed and near-surface crystalline rock bodies in the three regions of the conterminous United States where crystalline rock is being evaluated as a potential host for the second nuclear waste repository (i.e., in the North Central, Northeastern, and Southeastern Regions). This document indicates how the US Department of Energy's (DOE) General Guidelines for the Recommendation of Sites for Nuclear Waste Repositories (10 CFR 960) were used to select and apply factors and variables for the region-to-area screening, explains how these factors andmore » variable are to be applied in the region-to-area screening, and indicates how this methodology relates to the decision process leading to the selection of candidate areas. A brief general discussion of the screening process from the national survey through area screening and site recommendation is presented. This discussion sets the scene for detailed discussions which follow concerning the region-to-area screening process, the guidance provided by the DOE Siting Guidelines for establishing disqualifying factors and variables for screening, and application of the disqualifying factors and variables in the screening process. This document is complementary to the regional geologic and environmental characterization reports to be issued in the summer of 1985 as final documents. These reports will contain the geologic and environmental data base that will be used in conjunction with the methodology to conduct region-to-area screening.« less

How strongly do word reading times and lexical decision times correlate? Combining data from eye movement corpora and megastudies.

PubMed

Kuperman, Victor; Drieghe, Denis; Keuleers, Emmanuel; Brysbaert, Marc

2013-01-01

We assess the amount of shared variance between three measures of visual word recognition latencies: eye movement latencies, lexical decision times, and naming times. After partialling out the effects of word frequency and word length, two well-documented predictors of word recognition latencies, we see that 7-44% of the variance is uniquely shared between lexical decision times and naming times, depending on the frequency range of the words used. A similar analysis of eye movement latencies shows that the percentage of variance they uniquely share either with lexical decision times or with naming times is much lower. It is 5-17% for gaze durations and lexical decision times in studies with target words presented in neutral sentences, but drops to 0.2% for corpus studies in which eye movements to all words are analysed. Correlations between gaze durations and naming latencies are lower still. These findings suggest that processing times in isolated word processing and continuous text reading are affected by specific task demands and presentation format, and that lexical decision times and naming times are not very informative in predicting eye movement latencies in text reading once the effect of word frequency and word length are taken into account. The difference between controlled experiments and natural reading suggests that reading strategies and stimulus materials may determine the degree to which the immediacy-of-processing assumption and the eye-mind assumption apply. Fixation times are more likely to exclusively reflect the lexical processing of the currently fixated word in controlled studies with unpredictable target words rather than in natural reading of sentences or texts.

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 9 2014-10-01 2014-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 9 2013-10-01 2013-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 9 2012-10-01 2012-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

50 CFR 23.33 - How is the decision made to issue or deny a request for a U.S. CITES document?

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 8 2011-10-01 2011-10-01 false How is the decision made to issue or deny... INTERNATIONAL TRADE IN ENDANGERED SPECIES OF WILD FAUNA AND FLORA (CITES) Application Procedures, Criteria, and Conditions § 23.33 How is the decision made to issue or deny a request for a U.S. CITES document? (a) Upon...

Development and Validation of a Natural Language Processing Tool to Identify Patients Treated for Pneumonia across VA Emergency Departments.

PubMed

Jones, B E; South, B R; Shao, Y; Lu, C C; Leng, J; Sauer, B C; Gundlapalli, A V; Samore, M H; Zeng, Q

2018-01-01

Identifying pneumonia using diagnosis codes alone may be insufficient for research on clinical decision making. Natural language processing (NLP) may enable the inclusion of cases missed by diagnosis codes. This article (1) develops a NLP tool that identifies the clinical assertion of pneumonia from physician emergency department (ED) notes, and (2) compares classification methods using diagnosis codes versus NLP against a gold standard of manual chart review to identify patients initially treated for pneumonia. Among a national population of ED visits occurring between 2006 and 2012 across the Veterans Affairs health system, we extracted 811 physician documents containing search terms for pneumonia for training, and 100 random documents for validation. Two reviewers annotated span- and document-level classifications of the clinical assertion of pneumonia. An NLP tool using a support vector machine was trained on the enriched documents. We extracted diagnosis codes assigned in the ED and upon hospital discharge and calculated performance characteristics for diagnosis codes, NLP, and NLP plus diagnosis codes against manual review in training and validation sets. Among the training documents, 51% contained clinical assertions of pneumonia; in the validation set, 9% were classified with pneumonia, of which 100% contained pneumonia search terms. After enriching with search terms, the NLP system alone demonstrated a recall/sensitivity of 0.72 (training) and 0.55 (validation), and a precision/positive predictive value (PPV) of 0.89 (training) and 0.71 (validation). ED-assigned diagnostic codes demonstrated lower recall/sensitivity (0.48 and 0.44) but higher precision/PPV (0.95 in training, 1.0 in validation); the NLP system identified more "possible-treated" cases than diagnostic coding. An approach combining NLP and ED-assigned diagnostic coding classification achieved the best performance (sensitivity 0.89 and PPV 0.80). System-wide application of NLP to clinical text can increase capture of initial diagnostic hypotheses, an important inclusion when studying diagnosis and clinical decision-making under uncertainty. Schattauer GmbH Stuttgart.

A systematic review of near real-time and point-of-care clinical decision support in anesthesia information management systems.

PubMed

Simpao, Allan F; Tan, Jonathan M; Lingappan, Arul M; Gálvez, Jorge A; Morgan, Sherry E; Krall, Michael A

2017-10-01

Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies were identified by searches of the electronic databases Medline and EMBASE. Two reviewers screened studies based on title, abstract, and full text. Studies that were similar in intervention and desired outcome were grouped into CDS categories. Three reviewers graded the evidence within each category. The final analysis included 25 articles on CDS as implemented within AIMS. CDS categories included perioperative antibiotic prophylaxis, post-operative nausea and vomiting prophylaxis, vital sign monitors and alarms, glucose management, blood pressure management, ventilator management, clinical documentation, and resource utilization. Of these categories, the reviewers graded perioperative antibiotic prophylaxis and clinical documentation as having strong evidence per the peer reviewed literature. There is strong evidence for the inclusion of near real-time and point-of-care CDS in AIMS to enhance compliance with perioperative antibiotic prophylaxis and clinical documentation. Additional research is needed in many other areas of AIMS-based CDS.

Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya

PubMed Central

Cleary, Susan; Molyneux, Sassy; English, Mike

2017-01-01

Abstract This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions. PMID:27679522

Setting healthcare priorities: a description and evaluation of the budgeting and planning process in county hospitals in Kenya.

PubMed

Barasa, Edwine W; Cleary, Susan; Molyneux, Sassy; English, Mike

2017-04-01

This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes. The budgeting and planning process in the case study hospitals was characterized by lack of alignment, inadequate role clarity and the use of informal priority-setting criteria. With regard to consequentialist conditions, the hospitals incorporated economic criteria by considering the affordability of alternatives, but rarely considered the equity of allocative decisions. In the first hospital, stakeholders were aware of - and somewhat satisfied with - the budgeting and planning process, while in the second hospital they were not. Decision making in both hospitals did not result in reallocation of resources. With regard to proceduralist conditions, the budgeting and planning process in the first hospital was more inclusive and transparent, with the stakeholders more empowered compared to the second hospital. In both hospitals, decisions were not based on evidence, implementation of decisions was poor and the community was not included. There were no mechanisms for appeals or to ensure that the proceduralist conditions were met in both hospitals. Public hospitals in Kenya could improve their budgeting and planning processes by harmonizing these processes, improving role clarity, using explicit priority-setting criteria, and by incorporating both consequentialist (efficiency, equity, stakeholder satisfaction and understanding, shifted priorities, implementation of decisions), and proceduralist (stakeholder engagement and empowerment, transparency, use of evidence, revisions, enforcement, and incorporating community values) conditions. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Risk-based decision making for terrorism applications.

PubMed

Dillon, Robin L; Liebe, Robert M; Bestafka, Thomas

2009-03-01

This article describes the anti-terrorism risk-based decision aid (ARDA), a risk-based decision-making approach for prioritizing anti-terrorism measures. The ARDA model was developed as part of a larger effort to assess investments for protecting U.S. Navy assets at risk and determine whether the most effective anti-terrorism alternatives are being used to reduce the risk to the facilities and war-fighting assets. With ARDA and some support from subject matter experts, we examine thousands of scenarios composed of 15 attack modes against 160 facility types on two installations and hundreds of portfolios of 22 mitigation alternatives. ARDA uses multiattribute utility theory to solve some of the commonly identified challenges in security risk analysis. This article describes the process and documents lessons learned from applying the ARDA model for this application.

Optimized model tuning in medical systems.

PubMed

Kléma, Jirí; Kubalík, Jirí; Lhotská, Lenka

2005-12-01

In medical systems it is often advantageous to utilize specific problem situations (cases) in addition to or instead of a general model. Decisions are then based on relevant past cases retrieved from a case memory. The reliability of such decisions depends directly on the ability to identify cases of practical relevance to the current situation. This paper discusses issues of automated tuning in order to obtain a proper definition of mutual case similarity in a specific medical domain. The main focus is on a reasonably time-consuming optimization of the parameters that determine case retrieval and further utilization in decision making/ prediction. The two case studies - mortality prediction after cardiological intervention, and resource allocation at a spa - document that the optimization process is influenced by various characteristics of the problem domain.

Clinical decision support improves quality of telephone triage documentation - an analysis of triage documentation before and after computerized clinical decision support

PubMed Central

2014-01-01

Background Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. Methods We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Results Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). Conclusions CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care. PMID:24645674

Clinical decision support improves quality of telephone triage documentation--an analysis of triage documentation before and after computerized clinical decision support.

PubMed

North, Frederick; Richards, Debra D; Bremseth, Kimberly A; Lee, Mary R; Cox, Debra L; Varkey, Prathibha; Stroebel, Robert J

2014-03-20

Clinical decision support (CDS) has been shown to be effective in improving medical safety and quality but there is little information on how telephone triage benefits from CDS. The aim of our study was to compare triage documentation quality associated with the use of a clinical decision support tool, ExpertRN©. We examined 50 triage documents before and after a CDS tool was used in nursing triage. To control for the effects of CDS training we had an additional control group of triage documents created by nurses who were trained in the CDS tool, but who did not use it in selected notes. The CDS intervention cohort of triage notes was compared to both the pre-CDS notes and the CDS trained (but not using CDS) cohort. Cohorts were compared using the documentation standards of the American Academy of Ambulatory Care Nursing (AAACN). We also compared triage note content (documentation of associated positive and negative features relating to the symptoms, self-care instructions, and warning signs to watch for), and documentation defects pertinent to triage safety. Three of five AAACN documentation standards were significantly improved with CDS. There was a mean of 36.7 symptom features documented in triage notes for the CDS group but only 10.7 symptom features in the pre-CDS cohort (p < 0.0001) and 10.2 for the cohort that was CDS-trained but not using CDS (p < 0.0001). The difference between the mean of 10.2 symptom features documented in the pre-CDS and the mean of 10.7 symptom features documented in the CDS-trained but not using was not statistically significant (p = 0.68). CDS significantly improves triage note documentation quality. CDS-aided triage notes had significantly more information about symptoms, warning signs and self-care. The changes in triage documentation appeared to be the result of the CDS alone and not due to any CDS training that came with the CDS intervention. Although this study shows that CDS can improve documentation, further study is needed to determine if it results in improved care.

Difficult decisions: Migration from Small Island Developing States under climate change

NASA Astrophysics Data System (ADS)

Kelman, Ilan

2015-04-01

The impacts of climate change on Small Island Developing States (SIDS) are leading to discussions regarding decision-making about the potential need to migrate. Despite the situation being well-documented, with many SIDS aiming to raise the topic to prominence and to take action for themselves, limited support and interest has been forthcoming from external sources. This paper presents, analyzes, and critiques a decision-making flowchart to support actions for SIDS dealing with climate change-linked migration. The flowchart contributes to identifying the pertinent topics to consider and the potential support needed to implement decision-making. The flowchart has significant limitations and there are topics which it cannot resolve. On-the-ground considerations include who decides, finances, implements, monitors, and enforces each decision. Additionally, views within communities differ, hence mechanisms are needed for dealing with differences, while issues to address include moral and legal blame for any climate change-linked migration, the ultimate goal of the decision-making process, the wider role of migration in SIDS communities and the right to judge decision-making and decisions. The conclusions summarize the paper, emphasizing the importance of considering contexts beyond climate change and multiple SIDS voices.

The System of Objectified Judgement Analysis (SOJA). A tool in rational drug selection for formulary inclusion.

PubMed

Janknegt, R; Steenhoek, A

1997-04-01

Rational drug selection for formulary purposes is important. Besides rational selection criteria, other factors play a role in drug decision making, such as emotional, personal financial and even unconscious criteria. It is agreed that these factors should be excluded as much as possible in the decision making process. A model for drug decision making for formulary purposes is described, the System of Objectified Judgement Analysis (SOJA). In the SOJA method, selection criteria for a given group of drugs are prospectively defined and the extent to which each drug fulfils the requirements for each criterion is determined. Each criterion is given a relative weight, i.e. the more important a given selection criterion is considered, the higher the relative weight. Both the relative scores for each drug per selection criterion and the relative weight of each criterion are determined by a panel of experts in this field. The following selection criteria are applied in all SOJA scores: clinical efficacy, incidence and severity of adverse effects, dosage frequency, drug interactions, acquisition cost, documentation, pharmacokinetics and pharmaceutical aspects. Besides these criteria, group specific criteria are also used, such as development of resistance when a SOJA score was made for antimicrobial agents. The relative weight that is assigned to each criterion will always be a subject of discussion. Therefore, interactive software programs for use on a personal computer have been developed, in which the user of the system may enter their own personal relative weight to each selection criterion and make their own personal SOJA score. The main advantage of the SOJA method is that all nonrational selection criteria are excluded and that drug decision making is based solely on rational criteria. The use of the interactive SOJA discs makes the decision process fully transparent as it becomes clear on which criteria and weighting decisions are based. We have seen that the use of this method for drug decision making greatly aids the discussion in the formulary committee, as discussion becomes much more concrete. The SOJA method is time dependent. Documentation on most products is still increasing and the score for this criterion will therefore change continuously. New products are introduced and prices are also subject to change. To overcome the time-dependence of the SOJA method, regular updates of interactive software programs are being made, in which changes in acquisition cost, documentation or a different weighting of criteria are included, as well as newly introduced products. The possibility of changing the official acquisition cost into the actual purchasing costs for the hospital in question provides a tailor-made interactive program.

The effectiveness of health impact assessment in influencing decision-making in Australia and New Zealand 2005–2009

PubMed Central

2013-01-01

Background Health Impact Assessment (HIA) involves assessing how proposals may alter the determinants of health prior to implementation and recommends changes to enhance positive and mitigate negative impacts. HIAs growing use needs to be supported by a strong evidence base, both to validate the value of its application and to make its application more robust. We have carried out the first systematic empirical study of the influence of HIA on decision-making and implementation of proposals in Australia and New Zealand. This paper focuses on identifying whether and how HIAs changed decision-making and implementation and impacts that participants report following involvement in HIAs. Methods We used a two-step process first surveying 55 HIAs followed by 11 in-depth case studies. Data gathering methods included questionnaires with follow-up interview, semi-structured interviews and document collation. We carried out deductive and inductive qualitative content analyses of interview transcripts and documents as well as simple descriptive statistics. Results We found that most HIAs are effective in some way. HIAs are often directly effective in changing, influencing, broadening areas considered and in some cases having immediate impact on decisions. Even when HIAs are reported to have no direct effect on a decision they are often still effective in influencing decision-making processes and the stakeholders involved in them. HIA participants identify changes in relationships, improved understanding of the determinants of health and positive working relationships as major and sustainable impacts of their involvement. Conclusions This study clearly demonstrates direct and indirect effectiveness of HIA influencing decision making in Australia and New Zealand. We recommend that public health leaders and policy makers should be confident in promoting the use of HIA and investing in building capacity to undertake high quality HIAs. New findings about the value HIA stakeholders put on indirect impacts such as learning and relationship building suggest HIA has a role both as a technical tool that makes predictions of potential impacts of a policy, program or project and as a mechanism for developing relationships with and influencing other sectors. Accordingly when evaluating the effectiveness of HIAs we need to look beyond the direct impacts on decisions. PMID:24341545

Scientific information and the Tongass land management plan: key findings derived from the scientific literature, species assessments, resource analyses, workshops, and risk assessment panels.

Treesearch

Douglas N. Swanston; Charles G. Shaw; Winston P. Smith; Kent R. Julin; Guy A. Cellier; Fred H. Everest

1996-01-01

This document highlights key items of information obtained from the published literature and from specific assessments, workshops, resource analyses, and various risk assessment panels conducted as part of the Tongass land management planning process. None of this information dictates any particular decision; however, it is important to consider during decisionmaking...

49 CFR 40.131 - How does the MRO or DER notify an employee of the verification process after receiving laboratory...

Code of Federal Regulations, 2010 CFR

2010-10-01

... result. In making this contact, you must explain to the employee that, if he or she declines to discuss... staff person must document the employee's decision, including the date and time. (2) A staff person must... numbers listed on the CCF. If you or your staff cannot reach the employee directly after making these...

Response to Intervention A Systematic Process to Increase Learning Outcomes for All Students. Guidance Document for New Mexico Schools

ERIC Educational Resources Information Center

New Mexico Public Education Department, 2006

2006-01-01

Response to Intervention (RtI) is the practice of providing high-quality instruction and interventions to meet student needs and monitor progress in order to ensure effectiveness of instruction and/or interventions. RtI is an integrated service delivery approach for all students and should be applied to decisions in general, remedial, and special…

Using Option Grids: steps toward shared decision-making for neonatal circumcision.

PubMed

Fay, Mary; Grande, Stuart W; Donnelly, Kyla; Elwyn, Glyn

2016-02-01

To assess the impact, acceptability and feasibility of a short encounter tool designed to enhance the process of shared decision-making and parental engagement. We analyzed video-recordings of clinical encounters, half undertaken before and half after a brief intervention that trained four clinicians how to use Option Grids, using an observer-based measure of shared decision-making. We also analyzed semi-structured interviews conducted with the clinicians four weeks after their exposure to the intervention. Observer OPTION(5) scores were higher at post-intervention, with a mean of 33.9 (SD=23.5) compared to a mean of 16.1 (SD=7.1) for pre-intervention, a significant difference of 17.8 (95% CI: 2.4, 33.2). Prior to using the intervention, clinicians used a consent document to frame circumcision as a default practice. Encounters with the Option Grid conferred agency to both parents and clinicians, and facilitated shared decision-making. Clinician reported recognizing the tool's positive effect on their communication process. Tools such as Option Grids have the potential to make it easier for clinicians to achieve shared decision-making. Encounter tools have the potential to change practice. More research is needed to test their feasibility in routine practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Responding to Nonwords in the Lexical Decision Task: Insights from the English Lexicon Project

PubMed Central

Yap, Melvin J.; Sibley, Daragh E.; Balota, David A.; Ratcliff, Roger; Rueckl, Jay

2014-01-01

Researchers have extensively documented how various statistical properties of words (e.g., word-frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, since a better specification of the mechanisms driving nonword responses may provide valuable insights into early lexical processes. In the present study, item-level and participant-level analyses were conducted on the trial-level lexical decision data for almost 37,000 nonwords in the English Lexicon Project in order to identify the influence of different psycholinguistic variables on nonword lexical decision performance, and to explore individual differences in how participants respond to nonwords. Item-level regression analyses reveal that nonword response time was positively correlated with number of letters, number of orthographic neighbors, number of affixes, and baseword number of syllables, and negatively correlated with Levenshtein orthographic distance and baseword frequency. Participant-level analyses also point to within- and between-session stability in nonword responses across distinct sets of items, and intriguingly reveal that higher vocabulary knowledge is associated with less sensitivity to some dimensions (e.g., number of letters) but more sensitivity to others (e.g., baseword frequency). The present findings provide well-specified and interesting new constraints for informing models of word recognition and lexical decision. PMID:25329078

An approach to the language discrimination in different scripts using adjacent local binary pattern

NASA Astrophysics Data System (ADS)

Brodić, D.; Amelio, A.; Milivojević, Z. N.

2017-09-01

The paper proposes a language discrimination method of documents. First, each letter is encoded with the certain script type according to its status in baseline area. Such a cipher text is subjected to a feature extraction process. Accordingly, the local binary pattern as well as its expanded version called adjacent local binary pattern are extracted. Because of the difference in the language characteristics, the above analysis shows significant diversity. This type of diversity is a key aspect in the decision-making differentiation of the languages. Proposed method is tested on an example of documents. The experiments give encouraging results.

[Allocation decisions of health insurance rehabilitation managers--An explorative case study concerning stroke rehabilitation].

PubMed

Hasenbein, U; Wallesch, C-W

2003-12-01

We investigated processes of and subjective reasons for resource allocation in three out of four rehabilitation specialists of a regional office of a major health insurance. Decisions of health insurance personnel include approval of and duration of rehabilitation treatment and choice of clinical provider. Insurance specialists are mainly involved in documentation and coordination, whereas decisions mainly follow expert recommendations, mainly of the medical service. Allocation is based primarily on somatic impairment and disability, psychosocial function, motivation and rehabilitation potential are regarded as secondary. Goals and expected results of rehabilitation are neither individually defined nor their achievement evaluated. Decision processes are dominated by routines and agreements. Only exceptionally, defined rules and procedures are applied. Active case management is hampered by a highly specialized internal structure of the investigated insurance fund. The optimal fulfillment of individual requirements for a limited-time rehabilitation treatment is the central criterion for decision making. However, the specialists lack detailed information concerning appropriateness, quality and efficacy of rehabilitation providers, especially when taking patient-related variables into account. Instead, they trust that only high-quality institutions are contracted. Systematic control and feedback of rehabilitation results is not available. The surveyed rehabilitation managers do not include cost aspects in their decision-making. They would regard this as alien to a member- and patient-oriented policy. Improvement potentials with respect to rehabilitation case management are being reviewed.

Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

PubMed

Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

2010-08-01

Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process. (c) 2010 Elsevier Ltd. All rights reserved.

Safety of clinical and non-clinical decision makers in telephone triage: a narrative review.

PubMed

Wheeler, Sheila Q; Greenberg, Mary E; Mahlmeister, Laura; Wolfe, Nicole

2015-09-01

Patient safety is a persistent problem in telephone triage research; however, studies have not differentiated between clinicians' and non-clinicians' respective safety. Currently, four groups of decision makers perform aspects of telephone triage: clinicians (physicians, nurses), and non-clinicians (emergency medical dispatchers (EMD) and clerical staff). Using studies published between 2002-2012, we applied Donabedian's structure-process-outcome model to examine groups' systems for evidence of system completeness (a minimum measure of structure and quality). We defined system completeness as the presence of a decision maker and four additional components: guidelines, documentation, training, and standards. Defining safety as appropriate referrals (AR) - (right time, right place with the right person), we measured each groups' corresponding AR rate percentages (outcomes). We analyzed each group's respective decision-making process as a safe match to the telephone triage task, based on each group's system structure completeness, process and AR rates (outcome). Studies uniformly noted system component presence: nurses (2-4), physicians (1), EMDs (2), clerical staff (1). Nurses had the highest average appropriate referral (AR) rates (91%), physicians' AR (82% average). Clerical staff had no system and did not perform telephone triage by standard definitions; EMDs may represent the use of the wrong system. Telephone triage appears least safe after hours when decision makers with the least complete systems (physicians, clerical staff) typically manage calls. At minimum, telephone triage decision makers should be clinicians; however, clinicians' safety calls for improvement. With improved training, standards and CDSS quality, the 24/7 clinical call center has potential to represent the national standard. © The Author(s) 2015.

Superfund record of decision (EPA Region 9): Riverbank Army Ammunition Plant Site, Riverbank, CA, March 1994

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

Not Available

1994-07-01

This decision document presents the selected remedial actions for the Riverbank Army Ammunition Plant (RBAAP) in Riverbank, California. This sitewide ROD contains two response actions that address the media of concern at RBAAP. This ROD also documents the decision that no further action is warranted at the Evaporation/Percolation (E/P) ponds. The two response actions for this ROD are a groundwater response action and a landfill response action.

[Potential of Information and Communications Technology to Improve Intersectoral Processes of Care: A Case Study of the Specialised Outpatient Palliative Care].

PubMed

Meyer-Delpho, C; Schubert, H-J

2015-09-01

The added value of information and communications technologies should be demonstrated precisely in such areas of care in which the importance of intersectoral and interdisciplinary cooperation is particularly high. In the context of the accompanying research of a supply concept for palliative care patients, the potential of a digital documentation process was comparatively analysed with the conventional paper-based workflow. Data were collected in the form of a multi-methodological approach and processed for the project in 3 stages: (1) Development and analysis of a palliative care process with the focus on all relevant steps of documentation. (2) Questionnaire design and the comparative mapping of specific process times. (3) Sampling, selection, and analysis of patient records and their derivable insights of process iterations. With the use of ICT, the treatment time per patient is reduced by up to 53% and achieves a reduction in costs and workload by up to 901 min. The result of an up to 213% increase in the number of patient contacts allows a higher continuity of care. Although the 16% increase in documentation loyalty improves the usability of cross-team documented information, it partially extends the workload on the level of individual actors. By using a digital health record around 31% more patients could be treated with the same staffing ratio. The multi-stage analysis of the palliative care process showed that ICT has a decisive influence on the process dimension of intersectoral cooperation. Due to favourable organisational conditions the pioneering work of palliative care also provides important guidance for a successful use of ICT technologies in the context of innovative forms of care. © Georg Thieme Verlag KG Stuttgart · New York.

Decision-making contexts involving Earth observations in federal and state government agencies

NASA Astrophysics Data System (ADS)

Kuwayama, Y.; Thompson, A.

2017-12-01

National and international organizations are placing greater emphasis on the societal and economic benefits that can be derived from applications of Earth observations, yet improvements are needed to connect to the decision processes that produce actions with direct societal benefits. The Consortium for the Valuation of Applications Benefits Linked with Earth Science (VALUABLES), a cooperative agreement between Resources for the Future (RFF) and the National Aeronautics and Space Administration (NASA), has the goal of advancing methods for the valuation and communication of the applied benefits linked with Earth observations. One of the Consortium's activities is a set of Policy Briefs that document the use of Earth observations for decision making in federal and state government agencies. In developing these Policy Briefs, we pay special attention to documenting the entire information value chain associated with the use of Earth observations in government decision making, namely (a) the specific data product, modeling capability, or information system used by the agency, (b) the decision context that employs the Earth observation information and translates it into an agency action, (c) the outcomes that are realized as a result of the action, and (d) the beneficiaries associated with the outcomes of the decision. Two key examples include the use of satellite data for informing the US Drought Monitor (USDM), which is used to determine the eligibility of agricultural communities for drought disaster assistance programs housed at the US Department of Agriculture (USDA), and the use of satellite data by the Florida Department of Environmental Protection to develop numeric nutrient water quality standards and monitoring methods for chlorophyll-a, which is codified in Florida state code (62-302.532).

Internal NASA Study: NASAs Protoflight Research Initiative

NASA Technical Reports Server (NTRS)

Coan, Mary R.; Hirshorn, Steven R.; Moreland, Robert

2015-01-01

The NASA Protoflight Research Initiative is an internal NASA study conducted within the Office of the Chief Engineer to better understand the use of Protoflight within NASA. Extensive literature reviews and interviews with key NASA members with experience in both robotic and human spaceflight missions has resulted in three main conclusions and two observations. The first conclusion is that NASA's Protoflight method is not considered to be "prescriptive." The current policies and guidance allows each Program/Project to tailor the Protoflight approach to better meet their needs, goals and objectives. Second, Risk Management plays a key role in implementation of the Protoflight approach. Any deviations from full qualification will be based on the level of acceptable risk with guidance found in NPR 8705.4. Finally, over the past decade (2004 - 2014) only 6% of NASA's Protoflight missions and 6% of NASA's Full qualification missions experienced a publicly disclosed mission failure. In other words, the data indicates that the Protoflight approach, in and of it itself, does not increase the mission risk of in-flight failure. The first observation is that it would be beneficial to document the decision making process on the implementation and use of Protoflight. The second observation is that If a Project/Program chooses to use the Protoflight approach with relevant heritage, it is extremely important that the Program/Project Manager ensures that the current project's requirements falls within the heritage design, component, instrument and/or subsystem's requirements for both the planned and operational use, and that the documentation of the relevant heritage is comprehensive, sufficient and the decision well documented. To further benefit/inform this study, a recommendation to perform a deep dive into 30 missions with accessible data on their testing/verification methodology and decision process to research the differences between Protoflight and Full Qualification missions' Design Requirements and Verification & Validation (V&V) (without any impact or special request directly to the project).

Implications of Climate Change for State Bioassessment ...

EPA Pesticide Factsheets

This draft report uses biological data collected by four states in wadeable rivers and streams to examine the components of state and tribal bioassessment and biomonitoring programs that may be vulnerable to climate change. The study investigates the potential to identify biological response signals to climate change within existing bioassessment data sets; analyzes how biological responses can be categorized and interpreted; and assesses how they may influence decision-making processes. The analyses suggest that several biological indicators may be used to detect climate change effects and such indicators can be used by state bioassessment programs to document changes at high-quality reference sites. The study investigates the potential to identify biological response signals to climate change within existing bioassessment data sets; analyzes how biological responses can be categorized and interpreted; and assesses how they may influence decision-making processes.

A service oriented approach for guidelines-based clinical decision support using BPMN.

PubMed

Rodriguez-Loya, Salvador; Aziz, Ayesha; Chatwin, Chris

2014-01-01

Evidence-based medical practice requires that clinical guidelines need to be documented in such a way that they represent a clinical workflow in its most accessible form. In order to optimize clinical processes to improve clinical outcomes, we propose a Service Oriented Architecture (SOA) based approach for implementing clinical guidelines that can be accessed from an Electronic Health Record (EHR) application with a Web Services enabled communication mechanism with the Enterprise Service Bus. We have used Business Process Modelling Notation (BPMN) for modelling and presenting the clinical pathway in the form of a workflow. The aim of this study is to produce spontaneous alerts in the healthcare workflow in the diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The use of BPMN as a tool to automate clinical guidelines has not been previously employed for providing Clinical Decision Support (CDS).

The Effect of Structured Decision-Making Techniques and Gender on Student Reaction and Quality of Written Documents.

ERIC Educational Resources Information Center

Neal, Joan; Echternacht, Lonnie

1995-01-01

Experimental groups used four decision-making techniques--reverse brainstorming (RS), dialectical inquiry (DI), devil's advocacy (DA), and consensus--in evaluating writing assignments. Control group produced a better quality document. Student reaction to negative features of RS, DI, and DA were not significant. (SK)

Report: Administrative Leave Decisions for EPA Employee Disciplinary Actions Should Be Better Documented, and Parameters on Use of Such Leave Should Be Established

EPA Pesticide Factsheets

Report #16-P-0036, November 9, 2015. EPA’s use of extended administrative leave can result in unnecessary and excessive payroll costs, and lack of documentation and justification can lead others to second guess the agency’s decisions.

Corrective Action Decision Document for Corrective Action Unit 340: Pesticide Release sites, Nevada Test Site, Nevada

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

DOE /NV

This Corrective Action Decision Document has been prepared for Corrective Action Unit 340, the NTS Pesticide Release Sites, in accordance with the Federal Facility Agreement and Consent Order of 1996 (FFACO, 1996). Corrective Action Unit 340 is located at the Nevada Test Site, Nevada, and is comprised of the following Corrective Action Sites: 23-21-01, Area 23 Quonset Hut 800 Pesticide Release Ditch; 23-18-03, Area 23 Skid Huts Pesticide Storage; and 15-18-02, Area 15 Quonset Hut 15-11 Pesticide Storage. The purpose of this Corrective Action Decision Document is to identify and provide a rationale for the selection of a recommended correctivemore » action alternative for each Corrective Action Site. The scope of this Corrective Action Decision Document consists of the following tasks: Develop corrective action objectives; Identify corrective action alternative screening criteria; Develop corrective action alternatives; Perform detailed and comparative evaluations of the corrective action alternatives in relation to the corrective action objectives and screening criteria; and Recommend and justify a preferred corrective action alternative for each Corrective Action Site.« less

Towards Automatic Classification of Wikipedia Content

NASA Astrophysics Data System (ADS)

Szymański, Julian

Wikipedia - the Free Encyclopedia encounters the problem of proper classification of new articles everyday. The process of assignment of articles to categories is performed manually and it is a time consuming task. It requires knowledge about Wikipedia structure, which is beyond typical editor competence, which leads to human-caused mistakes - omitting or wrong assignments of articles to categories. The article presents application of SVM classifier for automatic classification of documents from The Free Encyclopedia. The classifier application has been tested while using two text representations: inter-documents connections (hyperlinks) and word content. The results of the performed experiments evaluated on hand crafted data show that the Wikipedia classification process can be partially automated. The proposed approach can be used for building a decision support system which suggests editors the best categories that fit new content entered to Wikipedia.

Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV).

PubMed

Moreno-Ramírez, D; Ruiz-Villaverde, R; de Troya, M; Reyes-Alcázar, V; Alcalde, M; Galán, M; García-Lora, E; García, E I; Linares, M; Martínez, L; Pulpillo, Á; Suárez, C; Vélez, A; Torres, A

2016-06-01

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type. Copyright © 2016. Published by Elsevier España, S.L.U.

Shuttle Case Study Collection Website Development

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2012-01-01

As a continuation from summer 2012, the Shuttle Case Study Collection has been developed using lessons learned documented by NASA engineers, analysts, and contractors. Decades of information related to processing and launching the Space Shuttle is gathered into a single database to provide educators with an alternative means to teach real-world engineering processes. The goal is to provide additional engineering materials that enhance critical thinking, decision making, and problem solving skills. During this second phase of the project, the Shuttle Case Study Collection website was developed. Extensive HTML coding to link downloadable documents, videos, and images was required, as was training to learn NASA's Content Management System (CMS) for website design. As the final stage of the collection development, the website is designed to allow for distribution of information to the public as well as for case study report submissions from other educators online.

Nevada National Security Site Industrial Sites Project Closeout - 12498

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

Cabble, Kevin; Krauss, Mark; Matthews, Pat

The U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office is responsible for environmental restoration (ER) at the Nevada National Security Site (NNSS). This includes remediation at Industrial Sites where past nuclear testing activities and activities that supported nuclear testing may have or are known to have resulted in the release of contaminants into the environment. Industrial Sites at the NNSS have included nuclear facilities that supported the nuclear rocket/missile development programs, gas stations, landfills, spill sites, ordnance sites, and numerous other waste disposal and release sites. The NNSS Industrial Sites activities neared completion at the endmore » of fiscal year 2011 while other activities required under the Federal Facility Agreement and Consent Order (FFACO) and part of the same NNSS ER Project are forecasted to extend to 2027 or beyond. With the majority of Industrial Sites corrective action units (CAUs) completed (more than 250 CAUs and over 1,800 corrective action sites), it was determined that an activity closeout process should be implemented to ensure that the work completed over the past 15 years is well documented in a comprehensive and concise summary. While the process used to close each individual CAU is described in approved documents, no single document describes in summary fashion the work completed to close the many individual Industrial Sites. The activity closeout process will be used to develop an Industrial Sites closeout document that describes these years of work. This document will summarize the number of Industrial Sites closed under the FFACO and provide general descriptions of projects, contaminants removed, and sites closed in place with corresponding Use Restrictions. Other pertinent information related to Industrial Sites work such as the project history, closure decisions, historical declarations, remediation strategies, and final CAU status will be included in the closeout document, along with a table listing each CAU and corresponding corrective action sites within each CAU. Using this process of conducting the activity closeout and developing a closeout document may prove useful for other ER projects within the DOE complex in describing how a long period of ER can be summarized in a single document. The NNSS Industrial Sites activities were completed over the span of 15 years and involved the investigation, cleanup or Use Restriction, and closure of more than 260 CAUs and over 1,800 sites. These activities will conclude in FY 2012 (with the exception of one CAU). In order to capture the work completed over this length of time and document decisions made during the activities, a closeout effort was initiated. The closeout will review the work conducted during the Industrial Sites activities and produce a single document that summarizes Industrial Sites activities. This closeout is being conducted at an interim stage in the overall NNSA/NSO ER Project since the Soils and UGTA activities will continue for a number of years, but the completion of the Industrial Sites project warrants conducting a closeout now while personnel are available and information is still current. The process followed by NNSA/NSO in conducing project closeout for the Industrial Sites portion of the ER program may prove useful within the DOE complex in demonstrating how a large ER project can be summarized. (authors)« less

24 CFR 5.502 - Requirements concerning documents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Requirements concerning documents... § 5.502 Requirements concerning documents. For any notice or document (decision, declaration, consent... regulations for requirements concerning communications with persons with disabilities.) ...

Providing Greater Protection for Environmental Audits: A Proposal for a Self-Evaluative Privilege

DTIC Science & Technology

1993-04-01

make the government more accountable to the people. It also intended to encourage governmental responsibility. FOIA provides, in part, that any person ...document is exempt.84 Pre- decisional documents lose their exempt status if the documents are incorporated by reference in the agency’s final decision .85 E...the employee making the communication, of whatever rank he may be, is in a position to control or even to take a substantial part in a decision about

Comprehensible knowledge model creation for cancer treatment decision making.

PubMed

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

2017-03-01

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

Model performance evaluation (validation and calibration) in model-based studies of therapeutic interventions for cardiovascular diseases : a review and suggested reporting framework.

PubMed

Haji Ali Afzali, Hossein; Gray, Jodi; Karnon, Jonathan

2013-04-01

Decision analytic models play an increasingly important role in the economic evaluation of health technologies. Given uncertainties around the assumptions used to develop such models, several guidelines have been published to identify and assess 'best practice' in the model development process, including general modelling approach (e.g., time horizon), model structure, input data and model performance evaluation. This paper focuses on model performance evaluation. In the absence of a sufficient level of detail around model performance evaluation, concerns regarding the accuracy of model outputs, and hence the credibility of such models, are frequently raised. Following presentation of its components, a review of the application and reporting of model performance evaluation is presented. Taking cardiovascular disease as an illustrative example, the review investigates the use of face validity, internal validity, external validity, and cross model validity. As a part of the performance evaluation process, model calibration is also discussed and its use in applied studies investigated. The review found that the application and reporting of model performance evaluation across 81 studies of treatment for cardiovascular disease was variable. Cross-model validation was reported in 55 % of the reviewed studies, though the level of detail provided varied considerably. We found that very few studies documented other types of validity, and only 6 % of the reviewed articles reported a calibration process. Considering the above findings, we propose a comprehensive model performance evaluation framework (checklist), informed by a review of best-practice guidelines. This framework provides a basis for more accurate and consistent documentation of model performance evaluation. This will improve the peer review process and the comparability of modelling studies. Recognising the fundamental role of decision analytic models in informing public funding decisions, the proposed framework should usefully inform guidelines for preparing submissions to reimbursement bodies.

Study types and reliability of Real World Evidence compared with experimental evidence used in Polish reimbursement decision-making processes.

PubMed

Wilk, N; Wierzbicka, N; Skrzekowska-Baran, I; Moćko, P; Tomassy, J; Kloc, K

2017-04-01

The aim of this study was to identify the relationship and impact between Real World Evidence (RWE) and experimental evidence (EE) in Polish decision-making processes for the drugs from selected Anatomical Therapeutic Chemical (ATC) groups. Descriptive study. A detailed analysis was performed for 58 processes from five ATC code groups in which RWE for effectiveness, or effectiveness and safety were cited in Agency for Health Technology Assessment and Tariff System's (AOTMiT) documents published between January 2012 and September 2015: Verification Analysis of AOTMiT, Statement of the Transparency Council of AOTMiT, and Recommendation of the President of AOTMiT. In 62% of the cases, RWE supported the EE and confirmed its main conclusions. The majority of studies in the EE group showed to be RCTs (97%), and the RWE group included mainly cohort studies (89%). There were more studies without a control group within RWE compared with the EE group (10% vs 1%). Our results showed that EE are more often assessed using Jadad, NICE or NOS scale by AOTMiT compared with RWE (93% vs 48%). When the best evidence within a given decision-making process is analysed, half of RWE and two-thirds of EE are considered high quality evidence. RWE plays an important role in the decision-making processes on public funding of drugs in Poland, contributing to nearly half (45%) of all the evidence considered. There exist such processes in which the proportion of RWE is dominant, with one process showing RWE as the only evidence presented. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Assessment for Operator Confidence in Automated Space Situational Awareness and Satellite Control Systems

NASA Astrophysics Data System (ADS)

Gorman, J.; Voshell, M.; Sliva, A.

2016-09-01

The United States is highly dependent on space resources to support military, government, commercial, and research activities. Satellites operate at great distances, observation capacity is limited, and operator actions and observations can be significantly delayed. Safe operations require support systems that provide situational understanding, enhance decision making, and facilitate collaboration between human operators and system automation both in-the-loop, and on-the-loop. Joint cognitive systems engineering (JCSE) provides a rich set of methods for analyzing and informing the design of complex systems that include both human decision-makers and autonomous elements as coordinating teammates. While, JCSE-based systems can enhance a system analysts' understanding of both existing and new system processes, JCSE activities typically occur outside of traditional systems engineering (SE) methods, providing sparse guidance about how systems should be implemented. In contrast, the Joint Director's Laboratory (JDL) information fusion model and extensions, such as the Dual Node Network (DNN) technical architecture, provide the means to divide and conquer such engineering and implementation complexity, but are loosely coupled to specialized organizational contexts and needs. We previously describe how Dual Node Decision Wheels (DNDW) extend the DNN to integrate JCSE analysis and design with the practicalities of system engineering and implementation using the DNN. Insights from Rasmussen's JCSE Decision Ladders align system implementation with organizational structures and processes. In the current work, we present a novel approach to assessing system performance based on patterns occurring in operational decisions that are documented by JCSE processes as traces in a decision ladder. In this way, system assessment is closely tied not just to system design, but the design of the joint cognitive system that includes human operators, decision-makers, information systems, and automated processes. Such operationally relevant and integrated testing provides a sound foundation for operator trust in system automation that is required to safely operate satellite systems.

Nystagmus Assessments Documented by Emergency Physicians in Acute Dizziness Presentations: A Target for Decision Support?

PubMed Central

Kerber, Kevin A.; Morgenstern, Lewis B.; Meurer, William J.; McLaughlin, Thomas; Hall, Pamela A.; Forman, Jane; Fendrick, A. Mark; Newman-Toker, David E.

2011-01-01

Objectives Dizziness is a common presenting complaint to the emergency department (ED), and emergency physicians (EPs) consider these presentations a priority for decision support. Assessing for nystagmus and defining its features are important steps for any acute dizziness decision algorithm. The authors sought to describe nystagmus documentation in routine ED care to determine if nystagmus assessments might be an important target in decision support efforts. Methods Medical records from ED visits for dizziness were captured as part of a surveillance study embedded within an ongoing population-based cohort study. Visits with documentation of a nystagmus assessment were reviewed and coded for presence or absence of nystagmus, ability to draw a meaningful inference from the description, and coherence with the final EP diagnosis when a peripheral vestibular diagnosis was made. Results Of 1,091 visits for dizziness, 887 (81.3%) documented a nystagmus assessment. Nystagmus was present in 185 out of 887 (20.9%) visits. When nystagmus was present, no further characteristics were recorded in 48 of the 185 visits (26%). The documentation of nystagmus (including all descriptors recorded) enabled a meaningful inference about the localization or cause in only 10 of the 185 (5.4%) visits. The nystagmus description conflicted with the EP diagnosis in 113 (80.7%) of the 140 visits that received a peripheral vestibular diagnosis. Conclusions Nystagmus assessments are frequently documented in acute dizziness presentations, but details do not generally enable a meaningful inference. Recorded descriptions usually conflict with the diagnosis when a peripheral vestibular diagnosis is rendered. Nystagmus assessments might be an important target in developing decision support for dizziness presentations. PMID:21676060

Regret and the rationality of choices

PubMed Central

Bourgeois-Gironde, Sacha

2010-01-01

Regret helps to optimize decision behaviour. It can be defined as a rational emotion. Several recent neurobiological studies have confirmed the interface between emotion and cognition at which regret is located and documented its role in decision behaviour. These data give credibility to the incorporation of regret in decision theory that had been proposed by economists in the 1980s. However, finer distinctions are required in order to get a better grasp of how regret and behaviour influence each other. Regret can be defined as a predictive error signal but this signal does not necessarily transpose into a decision-weight influencing behaviour. Clinical studies on several types of patients show that the processing of an error signal and its influence on subsequent behaviour can be dissociated. We propose a general understanding of how regret and decision-making are connected in terms of regret being modulated by rational antecedents of choice. Regret and the modification of behaviour on its basis will depend on the criteria of rationality involved in decision-making. We indicate current and prospective lines of research in order to refine our views on how regret contributes to optimal decision-making. PMID:20026463

The advance care planning PREPARE study among older Veterans with serious and chronic illness: study protocol for a randomized controlled trial.

PubMed

Sudore, Rebecca; Le, Gem M; McMahan, Ryan; McMahon, Ryan; Feuz, Mariko; Katen, Mary; Barnes, Deborah E

2015-12-12

Advance care planning (ACP) is a process whereby patients prepare for medical decision-making. The traditional objective of ACP has focused on the completion of advance directives. We have developed a new paradigm of ACP focused on preparing patients and their loved ones for communication and informed medical decision-making. To operationalize this new paradigm of ACP, we created an interactive, patient-centered website called PREPARE ( www.prepareforyourcare.org ) designed for diverse older adults. This randomized controlled trial with blinded outcome assessment is designed to determine the efficacy of PREPARE to engage older Veterans in the ACP process. Veterans who are ≥ 60 years of age, have ≥ two medical conditions, and have seen a primary care physician ≥ two times in the last year are being randomized to one of two study arms. The PREPARE study arm reviews the PREPARE website and an easy-to-read advance directive. The control arm only reviews the advance directive. The primary outcome is documentation of an advance directive and ACP discussions. Other clinically important outcomes using validated surveys include ACP behavior change process measures (knowledge, contemplation, self-efficacy, and readiness) and a full range of ACP action measures (identifying a surrogate, identifying values and goals, choosing leeway or flexibility for the surrogate, communicating with clinicians and surrogates, and documenting one's wishes). We will also assess satisfaction with decision-making and Veteran activation within primary care visits by direct audio recording. To examine the outcomes at 1 week, 3 months, and 6 months between the two study arms, we will use mixed effects linear, Poisson, or negative binomial regression and mixed effects logistic regression. This study will determine whether PREPARE increases advance directive completion rates and engagement with the ACP process. If PREPARE is efficacious, it could prove to be an easy and effective intervention to help older adults engage in the ACP process within or outside of the medical environment. PREPARE may also help older adults communicate their medical wishes and goals to their loved ones and clinicians, improve medical decision-making, and ensure their wishes are honored over the life course. ClinicalTrials.gov NCT01550731 . Registered on 8 December 2011.

Beyond Rhetoric: Assuring a Child's Right to Two Parents. Presentations at the Children's Rights Council National Conference (7th, Bethesda, Maryland, April 28-May 2, 1993).

ERIC Educational Resources Information Center

National Council for Children's Rights, Washington, DC.

This document contains papers presented at the Seventh National Conference of the Children's Rights Council, also known as the National Council for Children's Rights. The papers presented were: (1) "Alternatives to the Adversarial Process for Resolution of Child Custody Cases" (Hugh McIsaac); (2) "New Decision Making Models in Child…

Proceedings of the Second Joint Technology Workshop on Neural Networks and Fuzzy Logic, volume 2

NASA Technical Reports Server (NTRS)

Lea, Robert N. (Editor); Villarreal, James A. (Editor)

1991-01-01

Documented here are papers presented at the Neural Networks and Fuzzy Logic Workshop sponsored by NASA and the University of Texas, Houston. Topics addressed included adaptive systems, learning algorithms, network architectures, vision, robotics, neurobiological connections, speech recognition and synthesis, fuzzy set theory and application, control and dynamics processing, space applications, fuzzy logic and neural network computers, approximate reasoning, and multiobject decision making.

UCLA High Speed, High Volume Laboratory Network for Infectious Diseases. Addendum

DTIC Science & Technology

2009-08-01

s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation... Design : Because of current public health and national security threats, influenza surveillance and analysis will be the initial focus. In the upcoming...throughput and automated systems will enable processing of tens of thousands of samples and provide critical laboratory capacity. Its overall design and

20 CFR 30.301 - May subpoenas be issued for witnesses and documents in connection with a claim under Part B of...

Code of Federal Regulations, 2010 CFR

2010-04-01

... adjudication of a claim under Part B of EEOICPA, an OWCP district office and/or a FAB reviewer may, at their... a FAB reviewer. No subpoenas will be issued at the request of the claimant under any other portion of the claims process. The decision to grant or deny such request is within the discretion of the FAB...

Aligning Infrastructure Decisions with Strategic Vision

DTIC Science & Technology

2012-03-22

last ten years and produced several documents such as: Global Defense Posture Review ( GDPR ), Overseas Basing Commission Report, Base Realignment and...significant force structure changes in the form of GDPR , Army Modular Force, and the ARFORGEN process. These concurrent demands forced a holistic...returning to domestic bases as part of the GDPR and the reduction of leased space in the DoD portfolio.26 BRAC 2005 demonstrated failures in cost

Army General Fund Adjustments Not Adequately Documented or Supported

DTIC Science & Technology

2016-07-26

compilation process. Finding The Office of the Assistant Secretary of the Army (Financial Management & Comptroller) (OASA[FM&C]) and the Defense Finance and...statements were unreliable and lacked an adequate audit trail. Furthermore, DoD and Army managers could not rely on the data in their accounting...systems when making management and resource decisions. Until the Army and DFAS Indianapolis correct these control deficiencies, there is considerable

Evaluability Assessment of an immunization improvement strategy in rural Burkina Faso: intervention theory versus reality, information need and evaluations.

PubMed

Sanou, Aboubakary; Kouyaté, Bocar; Bibeau, Gilles; Nguyen, Vinh-Kim

2011-08-01

An innovative immunization improvement strategy was proposed by the CRSN (Centre de Recherche en Santé de Nouna) to improve the low coverage rate for children aged 0-11 months in the health district of Nouna in Burkina Faso. This article reports on the Evaluability Assessment (EA) study that aimed to orient decisions for its evaluation in close relationship with the information needs of the stakeholders. Various methods were used, including document reviews, individual interviews, focus group discussions, meetings, literature reviews and site visits. A description of the intervention theory and philosophy is provided with its logic models and its reality documented. Lessons on the procedure include the importance of the position of the evaluability assessor, the value of replicating some steps of the assessment and the relationships between EA and process evaluation. The evaluability study concludes that the intervention had some evaluable components. To satisfy the stakeholders' needs, the initially planned community randomized controlled trial can be maintained and complemented with a process evaluation. There is a need to provide sufficient information on the cost of the intervention. This will inform decision makers on the possibility of replicating the intervention in other contexts. Copyright © 2010 Elsevier Ltd. All rights reserved.

36 CFR 220.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... environmental impact statement (EIS) or environmental assessment (EA). Decision notice. A concise written record... ENVIRONMENTAL POLICY ACT (NEPA) COMPLIANCE § 220.3 Definitions. The following definitions supplement, by adding... about natural resource systems is sometimes uncertain. Decision document. A record of decision, decision...

Solid waste projection model: Model version 1. 0 technical reference manual

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

Wilkins, M.L.; Crow, V.L.; Buska, D.E.

1990-11-01

The Solid Waste Projection Model (SWPM) system is an analytical tool developed by Pacific Northwest Laboratory (PNL) for Westinghouse Hanford Company (WHC). The SWPM system provides a modeling and analysis environment that supports decisions in the process of evaluating various solid waste management alternatives. This document, one of a series describing the SWPM system, contains detailed information regarding the software utilized in developing Version 1.0 of the modeling unit of SWPM. This document is intended for use by experienced software engineers and supports programming, code maintenance, and model enhancement. Those interested in using SWPM should refer to the SWPM Modelmore » User's Guide. This document is available from either the PNL project manager (D. L. Stiles, 509-376-4154) or the WHC program monitor (B. C. Anderson, 509-373-2796). 8 figs.« less

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.

Facsimile Transmission of Microforms.

DTIC Science & Technology

1983-12-30

display terminals, high speed printers, conventional facsimile receivers, and/or graphics COM recorders. Microforms designed for storage, retrieval...author and Whould not be construed as an official Department of the Army position, policy, or decision, unless so designated by other documentation...beconstrued as an official Department of the Army position, policy, or decision, unless so designated by other documentation. ,, -- UNCLASSIFIED SECURITY

Logic-Based Retrieval: Technology for Content-Oriented and Analytical Querying of Patent Data

NASA Astrophysics Data System (ADS)

Klampanos, Iraklis Angelos; Wu, Hengzhi; Roelleke, Thomas; Azzam, Hany

Patent searching is a complex retrieval task. An initial document search is only the starting point of a chain of searches and decisions that need to be made by patent searchers. Keyword-based retrieval is adequate for document searching, but it is not suitable for modelling comprehensive retrieval strategies. DB-like and logical approaches are the state-of-the-art techniques to model strategies, reasoning and decision making. In this paper we present the application of logical retrieval to patent searching. The two grand challenges are expressiveness and scalability, where high degree of expressiveness usually means a loss in scalability. In this paper we report how to maintain scalability while offering the expressiveness of logical retrieval required for solving patent search tasks. We present logical retrieval background, and how to model data-source selection and results' fusion. Moreover, we demonstrate the modelling of a retrieval strategy, a technique by which patent professionals are able to express, store and exchange their strategies and rationales when searching patents or when making decisions. An overview of the architecture and technical details complement the paper, while the evaluation reports preliminary results on how query processing times can be guaranteed, and how quality is affected by trading off responsiveness.

The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

PubMed Central

Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

2009-01-01

Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes introduced by the participants. We will conduct within-case and cross-case analyses of the data. Discussion The question of the role of economic evaluation in FPs' decision-making is of great interest to scientists, health care practitioners, managers and policy-makers, as well as to consultants, industry, and society. It is believed that the proposed research approach will make an original contribution to the development of knowledge, both empirical and theoretical. PMID:19210787

Making Information Useful: Engagement in the Sustained National Climate Assessment Process

NASA Astrophysics Data System (ADS)

Lough, G. C.; Cloyd, E.

2015-12-01

Creation of actionable information requires that the producers of that information understand the needs of the intended users and decision makers. To that end, the U.S. Global Change Research Program's sustained National Climate Assessment process includes a focus on engaging users through an inclusive, broad-based, and ongoing process. Such a process provides opportunities for scientific experts and decision makers to share knowledge about the climate-related issues, impacts, and potential response actions that are most important in a particular region or sector. Such a process is also highly transparent in order to produce results that are credible, salient, and legitimate for both scientists and decision makers, ultimately making the results extremely useful. To implement these principles, USGCRP implements a broad-based engagement strategy that invites participation from users and stakeholder communities and considers methods for communicating with potential users at every step. The strategy elicits contributions to help shape the framing of the assessment process and products, improve the transparency of the process, and increase the utility of the final information. Specific user inputs are gathered through workshops, public comment opportunities, town hall meetings, presentations, requests for information, submitted documents, and open meetings. Further, a network of contributors self-organizes around topics of interest to extend assessment activities to a wider range of user groups. Here, we describe the outcomes of these innovations in assessment engagement and identify clear successes, notable surprises, future evaluation needs, and areas for new ideas.

The Application of Recognition-Primed Decision Theory to Decisions Made in an Outdoor Education Context

ERIC Educational Resources Information Center

Boyes, Mike; Potter, Tom

2015-01-01

This research examined the decisions that highly experienced outdoor leaders made on backpacking expeditions conducted by a tertiary institution in the Southern Alps of New Zealand. The purpose of the research was to document decision problems and explore them as Recognition-Primed Decisions (RPD) within naturalistic decision making (NDM)…

Sustaining a Mature Risk Management Process: Ensuring the International Space Station for a Vibrant Future

NASA Technical Reports Server (NTRS)

Raftery, Michael; Carter-Journet, Katrina

2013-01-01

The International Space Station (ISS) risk management methodology is an example of a mature and sustainable process. Risk management is a systematic approach used to proactively identify, analyze, plan, track, control, communicate, and document risks to help management make risk-informed decisions that increase the likelihood of achieving program objectives. The ISS has been operating in space for over 14 years and permanently crewed for over 12 years. It is the longest surviving habitable vehicle in low Earth orbit history. Without a mature and proven risk management plan, it would be increasingly difficult to achieve mission success throughout the life of the ISS Program. A successful risk management process must be able to adapt to a dynamic program. As ISS program-level decision processes have evolved, so too has the ISS risk management process continued to innovate, improve, and adapt. Constant adaptation of risk management tools and an ever-improving process is essential to the continued success of the ISS Program. Above all, sustained support from program management is vital to risk management continued effectiveness. Risk management is valued and stressed as an important process by the ISS Program.

What makes health impact assessments successful? Factors contributing to effectiveness in Australia and New Zealand.

PubMed

Haigh, Fiona; Harris, Elizabeth; Harris-Roxas, Ben; Baum, Fran; Dannenberg, Andrew L; Harris, Mark F; Keleher, Helen; Kemp, Lynn; Morgan, Richard; Ng Chok, Harrison; Spickett, Jeff

2015-10-03

While many guidelines explain how to conduct Health Impact Assessments (HIAs), less is known about the factors that determine the extent to which HIAs affect health considerations in the decision making process. We investigated which factors are associated with increased or reduced effectiveness of HIAs in changing decisions and in the implementation of policies, programs or projects. This study builds on and tests the Harris and Harris-Roxas' conceptual framework for evaluating HIA effectiveness, which emphasises context, process and output as key domains. We reviewed 55 HIA reports in Australia and New Zealand from 2005 to 2009 and conducted surveys and interviews for 48 of these HIAs. Eleven detailed case studies were undertaken using document review and stakeholder interviews. Case study participants were selected through purposeful and snowball sampling. The data were analysed by thematic content analysis. Findings were synthesised and mapped against the conceptual framework. A stakeholder forum was utilised to test face validity and practical adequacy of the findings. We found that some features of HIA are essential, such as the stepwise but flexible process, and evidence based approach. Non-essential features that can enhance the impact of HIAs include capacity and experience; 'right person right level'; involvement of decision-makers and communities; and relationships and partnerships. There are contextual factors outside of HIA such as fit with planning and decision making context, broader global context and unanticipated events, and shared values and goals that may influence a HIA. Crosscutting factors include proactive positioning, and time and timeliness. These all operate within complex open systems, involving multiple decision-makers, levels of decision-making, and points of influence. The Harris and Harris-Roxas framework was generally supported. We have confirmed previously identified factors influencing effectiveness of HIA and identified new factors such as proactive positioning. Our findings challenge some presumptions about 'right' timing for HIA and the rationality and linearity of decision-making processes. The influence of right timing on decision making needs to be seen within the context of other factors such as proactive positioning. This research can help HIA practitioners and researchers understand and identify what can be enhanced within the HIA process. Practitioners can adapt the flexible HIA process to accommodate the external contextual factors identified in this report.

Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review.

PubMed

Hemens, Brian J; Holbrook, Anne; Tonkin, Marita; Mackay, Jean A; Weise-Kelly, Lorraine; Navarro, Tamara; Wilczynski, Nancy L; Haynes, R Brian

2011-08-03

Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit. We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements. CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.

Expert communities and interest-formation in the Brazilian AIDS program.

PubMed

Lago, Regina Ferro do; Costa, Nilson do Rosário

2017-05-01

This paper examines the role of the Technical Advisory Committee for antiretroviral therapy of the Brazilian AIDS program in mediating the decision-making process of including new antiretroviral (ARV) drugs in the Unified Health System services by the end of the 2000s. We conducted documental analysis and interviews with key informants from the governmental sphere and professionals. The work features the Technical Advisory Committee as an "expert community", defined as a network of individuals with expertise and competence in a particular sphere and whose knowledge is relevant in critical public policy decision areas. It also indicates that the decision-making process for inclusion of antiretroviral drugs in the Brazilian program was incremental, considering the expectations of the innovative leader companies of pharmaceutical market. The work describes thus the results of the interaction of government interests, pharmaceutical industry and experts in the implementation of a relevant international policy. It provides arguments and evidence for understanding the role of expert communities on a sectorial public policy so far analyzed predominantly from the perspective of social movements.

The Space Station decision - Incremental politics and technological choice

NASA Technical Reports Server (NTRS)

Mccurdy, Howard E.

1990-01-01

Using primary documents and interviews with participants, this book describes the events that led up to the 1984 decision that NASA should build a permanently occupied, international space station in low earth orbit. The role that civil servants in NASA played in initiating the program is highlighted. The trail of the Space Station proposal as its advocates devised strategies to push it through the White House policy review process is followed. The critical analysis focuses on the way in which 'incrementalism' (the tendency of policy makers to introduce incremental changes once projects are under way) operated in connection with the Space Station program. The book calls for a commitment to a long-range space policy.

Atrium building study

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

Not Available

1990-01-01

The CIGNA design team was faced with creating a new 500,000 square foot office building on a pastoral 610 acre corporate campus in Bloomfield, Connecticut, just outside of Hartford. Challenges abounded during the design process, from the selection of a specific building site on the sprawling campus to the evolution of a building form incorporating an atrium, to the selection of building systems and materials, to the design to the office interiors and atrium landscape. This document summarizes the original design problem, focusing on design criteria and performance standards that led to the decision to design an atrium building asmore » well as decision concerning its function, its form, its building systems and materials, and its passive energy strategies.« less

Contextual information influences diagnosis accuracy and decision making in simulated emergency medicine emergencies.

PubMed

McRobert, Allistair Paul; Causer, Joe; Vassiliadis, John; Watterson, Leonie; Kwan, James; Williams, Mark A

2013-06-01

It is well documented that adaptations in cognitive processes with increasing skill levels support decision making in multiple domains. We examined skill-based differences in cognitive processes in emergency medicine physicians, and whether performance was significantly influenced by the removal of contextual information related to a patient's medical history. Skilled (n=9) and less skilled (n=9) emergency medicine physicians responded to high-fidelity simulated scenarios under high- and low-context information conditions. Skilled physicians demonstrated higher diagnostic accuracy irrespective of condition, and were less affected by the removal of context-specific information compared with less skilled physicians. The skilled physicians generated more options, and selected better quality options during diagnostic reasoning compared with less skilled counterparts. These cognitive processes were active irrespective of the level of context-specific information presented, although high-context information enhanced understanding of the patients' symptoms resulting in higher diagnostic accuracy. Our findings have implications for scenario design and the manipulation of contextual information during simulation training.

Knowledge-based processing for aircraft flight control

NASA Technical Reports Server (NTRS)

Painter, John H.; Glass, Emily; Economides, Gregory; Russell, Paul

1994-01-01

This Contractor Report documents research in Intelligent Control using knowledge-based processing in a manner dual to methods found in the classic stochastic decision, estimation, and control discipline. Such knowledge-based control has also been called Declarative, and Hybid. Software architectures were sought, employing the parallelism inherent in modern object-oriented modeling and programming. The viewpoint adopted was that Intelligent Control employs a class of domain-specific software architectures having features common over a broad variety of implementations, such as management of aircraft flight, power distribution, etc. As much attention was paid to software engineering issues as to artificial intelligence and control issues. This research considered that particular processing methods from the stochastic and knowledge-based worlds are duals, that is, similar in a broad context. They provide architectural design concepts which serve as bridges between the disparate disciplines of decision, estimation, control, and artificial intelligence. This research was applied to the control of a subsonic transport aircraft in the airport terminal area.

ADESSA: A Real-Time Decision Support Service for Delivery of Semantically Coded Adverse Drug Event Data

PubMed Central

Duke, Jon D.; Friedlin, Jeff

2010-01-01

Evaluating medications for potential adverse events is a time-consuming process, typically involving manual lookup of information by physicians. This process can be expedited by CDS systems that support dynamic retrieval and filtering of adverse drug events (ADE’s), but such systems require a source of semantically-coded ADE data. We created a two-component system that addresses this need. First we created a natural language processing application which extracts adverse events from Structured Product Labels and generates a standardized ADE knowledge base. We then built a decision support service that consumes a Continuity of Care Document and returns a list of patient-specific ADE’s. Our database currently contains 534,125 ADE’s from 5602 product labels. An NLP evaluation of 9529 ADE’s showed recall of 93% and precision of 95%. On a trial set of 30 CCD’s, the system provided adverse event data for 88% of drugs and returned these results in an average of 620ms. PMID:21346964

Method for Examination and Documentation of Basic Information and Metadata from Published Reports Relevant to the Study of Stormwater Runoff Quality

USGS Publications Warehouse

Dionne, Shannon G.; Granato, Gregory E.; Tana, Cameron K.

1999-01-01

A readily accessible archive of information that is valid, current, and technically defensible is needed to make informed highway-planning, design, and management decisions. The National Highway Runoff Water-Quality Data and Methodology Synthesis (NDAMS) is a cataloging and assessment of the documentation of information relevant to highway-runoff water quality available in published reports. The report review process is based on the NDAMS review sheet, which was designed by the USGS with input from the FHWA, State transportation agencies, and the regulatory community. The report-review process is designed to determine the technical merit of the existing literature in terms of current requirements for data documentation, data quality, quality assurance and quality control (QA/QC), and technical issues that may affect the use of historical data. To facilitate the review process, the NDAMS review sheet is divided into 12 sections: (1) administrative review information, (2) investigation and report information, (3) temporal information, (4) location information (5) water-quality-monitoring information, (6) sample-handling methods, (7) constituent information, (8) sampling focus and matrix, (9) flow monitoring methods, (10) field QA/QC, (11) laboratory, and (12) uncertainty/error analysis. This report describes the NDAMS report reviews and metadata documentation methods and provides an overview of the approach and of the quality-assurance and quality-control program used to implement the review process. Detailed information, including a glossary of relevant terms, a copy of the report-review sheets, and reportreview instructions are completely documented in a series of three appendixes included with this report. Therefore the reviews are repeatable and the methods can be used by transportation research organizations to catalog new reports as they are published.

NASA-STD-7009 Guidance Document for Human Health and Performance Models and Simulations

NASA Technical Reports Server (NTRS)

Walton, Marlei; Mulugeta, Lealem; Nelson, Emily S.; Myers, Jerry G.

2014-01-01

Rigorous verification, validation, and credibility (VVC) processes are imperative to ensure that models and simulations (MS) are sufficiently reliable to address issues within their intended scope. The NASA standard for MS, NASA-STD-7009 (7009) [1] was a resultant outcome of the Columbia Accident Investigation Board (CAIB) to ensure MS are developed, applied, and interpreted appropriately for making decisions that may impact crew or mission safety. Because the 7009 focus is engineering systems, a NASA-STD-7009 Guidance Document is being developed to augment the 7009 and provide information, tools, and techniques applicable to the probabilistic and deterministic biological MS more prevalent in human health and performance (HHP) and space biomedical research and operations.

Reaching beyond the review of research evidence: a qualitative study of decision making during the development of clinical practice guidelines for disease prevention in healthcare.

PubMed

Richter Sundberg, Linda; Garvare, Rickard; Nyström, Monica Elisabeth

2017-05-11

The judgment and decision making process during guideline development is central for producing high-quality clinical practice guidelines, but the topic is relatively underexplored in the guideline research literature. We have studied the development process of national guidelines with a disease-prevention scope produced by the National board of Health and Welfare (NBHW) in Sweden. The NBHW formal guideline development model states that guideline recommendations should be based on five decision-criteria: research evidence; curative/preventive effect size, severity of the condition; cost-effectiveness; and ethical considerations. A group of health profession representatives (i.e. a prioritization group) was assigned the task of ranking condition-intervention pairs for guideline recommendations, taking into consideration the multiple decision criteria. The aim of this study was to investigate the decision making process during the two-year development of national guidelines for methods of preventing disease. A qualitative inductive longitudinal case study approach was used to investigate the decision making process. Questionnaires, non-participant observations of nine two-day group meetings, and documents provided data for the analysis. Conventional and summative qualitative content analysis was used to analyse data. The guideline development model was modified ad-hoc as the group encountered three main types of dilemmas: high quality evidence vs. low adoptability of recommendation; insufficient evidence vs. high urgency to act; and incoherence in assessment and prioritization within and between four different lifestyle areas. The formal guideline development model guided the decision-criteria used, but three new or revised criteria were added by the group: 'clinical knowledge and experience', 'potential guideline consequences' and 'needs of vulnerable groups'. The frequency of the use of various criteria in discussions varied over time. Gender, professional status, and interpersonal skills were perceived to affect individuals' relative influence on group discussions. The study shows that guideline development groups make compromises between rigour and pragmatism. The formal guideline development model incorporated multiple aspects, but offered few details on how the different criteria should be handled. The guideline development model devoted little attention to the role of the decision-model and group-related factors. Guideline development models could benefit from clarifying the role of the group-related factors and non-research evidence, such as clinical experience and ethical considerations, in decision-processes during guideline development.

Measuring research influence on drug policy: a case example of two epidemiological monitoring systems.

PubMed

Ritter, Alison; Lancaster, Kari

2013-01-01

Assessing the extent to which drug research influences and impacts upon policy decision-making needs to go beyond bibliometric analysis of academic citations. Policy makers do not necessarily access the academic literature, and policy processes are largely iterative and rely on interactions and relationships. Furthermore, media representation of research contributes to public opinion and can influence policy uptake. In this context, assessing research influence involves examining the extent to which a research project is taken up in policy documents, used within policy processes, and disseminated via the media. This three component approach is demonstrated using a case example of two ongoing illicit drug monitoring systems: the Illicit Drug Reporting System (IDRS) and the Ecstasy and related Drugs Reporting System (EDRS). Systematic searches for reference to the IDRS and/or EDRS within policy documents, across multiple policy processes (such as parliamentary inquiries) and in the media, in conjunction with analysis of the types of mentions in these three sources, enables an analysis of policy influence. The context for the research is also described as the foundation for the approach. The application of the three component approach to the case study demonstrates a practical and systematic retrospective approach to measure drug research influence. For example, the ways in which the IDRS and EDRS were mentioned in policy documents demonstrated research utilisation. Policy processes were inclusive of IDRS and EDRS findings, while the media analysis revealed only a small contribution in the context of wider media reporting. Consistent with theories of policy processes, assessing the extent of research influence requires a systematic analysis of policy documents and processes. Development of such analyses and associated methods will better equip researchers to evaluate the impact of research. Copyright © 2012 Elsevier B.V. All rights reserved.

Naturalistic Decision Making for Power System Operators

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

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

2010-02-01

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

Design and implementation of the standards-based personal intelligent self-management system (PICS).

PubMed

von Bargen, Tobias; Gietzelt, Matthias; Britten, Matthias; Song, Bianying; Wolf, Klaus-Hendrik; Kohlmann, Martin; Marschollek, Michael; Haux, Reinhold

2013-01-01

Against the background of demographic change and a diminishing care workforce there is a growing need for personalized decision support. The aim of this paper is to describe the design and implementation of the standards-based personal intelligent care systems (PICS). PICS makes consistent use of internationally accepted standards such as the Health Level 7 (HL7) Arden syntax for the representation of the decision logic, HL7 Clinical Document Architecture for information representation and is based on a open-source service-oriented architecture framework and a business process management system. Its functionality is exemplified for the application scenario of a patient suffering from congestive heart failure. Several vital signs sensors provide data for the decision support system, and a number of flexible communication channels are available for interaction with patient or caregiver. PICS is a standards-based, open and flexible system enabling personalized decision support. Further development will include the implementation of components on small computers and sensor nodes.

Documenting moral agency: a qualitative analysis of abortion decision making for fetal indications.

PubMed

Gawron, Lori M; Watson, Katie

2017-02-01

We explored whether the decision-making process of women aborting a pregnancy for a fetal indication fit common medical ethical frameworks. We applied three ethical frameworks (principlism, care ethics, and narrative ethics) in a secondary analysis of 30 qualitative interviews from women choosing 2nd trimester abortion for fetal indications. All 30 women offered reasoning consistent with one or more ethical frameworks. Principlism themes included avoidance of personal suffering (autonomy), and sparing a child a poor quality of life and painful medical interventions (beneficence/non-maleficence). Care ethics reasoning included relational considerations of family needs and resources, and narrative ethics reasoning contextualized this experience into the patient's life story. This population's universal application of commonly accepted medical ethical frameworks supports the position that patients choosing fetal indication abortions should be treated as moral decision-makers and given the same respect as patients making decisions about other medical procedures. These findings suggest recent political efforts blocking abortion access should be reframed as attempts to undermine the moral decision-making of women. Published by Elsevier Inc.

[Mechanisms for allocating financial resources after decentralization in the state of Jalisco].

PubMed

Pérez-Núñez, Ricardo; Arredondo-López, Armando; Pelcastre, Blanca

2006-01-01

To analyze, from the decision maker's perspective, the financial resource allocation process of the health services of the state of Jalisco (SSJ, per its abbreviation in spanish), within the context of decentralization. Through a qualitative approximation using semi-structured individual interviews of key personnel in managerial positions as the method for compiling information, the experience of the SSJ in financial resource allocation was documented. From September to November 2003, the perception of managers and administrators regarding their level of autonomy in decision-making was explored as well as the process they follow for the allocation of financial resources, in order to identify the criteria they use and their justifications. From the point of view of decision-makers, autonomy of the SSJ has increased considerably since decentralization was implemented, although the degree of decision-making freedom remains limited due mainly to high adminstrative costs associated with salaries. In this sense, the implications attributable to labor situations that are still centralized are evident. Some innovative systems for financial resource allocation have been established in the SSJ for the sanitary regions and hospitals based upon administrative-managerial and productivity incentives. Adjustments were also made for degree of marginalization and population lag, under the equity criterion. General work conditions and decision-making autonomy of the sanitary regions constitute outstanding aspects pending decentralization. Although decentralization has granted more autonomy to the SSJ, the level of decision-making freedom for allocating financial resources has been held within the highest hierarchical levels.

Progressive Learning of Topic Modeling Parameters: A Visual Analytics Framework.

PubMed

El-Assady, Mennatallah; Sevastjanova, Rita; Sperrle, Fabian; Keim, Daniel; Collins, Christopher

2018-01-01

Topic modeling algorithms are widely used to analyze the thematic composition of text corpora but remain difficult to interpret and adjust. Addressing these limitations, we present a modular visual analytics framework, tackling the understandability and adaptability of topic models through a user-driven reinforcement learning process which does not require a deep understanding of the underlying topic modeling algorithms. Given a document corpus, our approach initializes two algorithm configurations based on a parameter space analysis that enhances document separability. We abstract the model complexity in an interactive visual workspace for exploring the automatic matching results of two models, investigating topic summaries, analyzing parameter distributions, and reviewing documents. The main contribution of our work is an iterative decision-making technique in which users provide a document-based relevance feedback that allows the framework to converge to a user-endorsed topic distribution. We also report feedback from a two-stage study which shows that our technique results in topic model quality improvements on two independent measures.

Launch Vehicle Design Process: Characterization, Technical Integration, and Lessons Learned

NASA Technical Reports Server (NTRS)

Blair, J. C.; Ryan, R. S.; Schutzenhofer, L. A.; Humphries, W. R.

2001-01-01

Engineering design is a challenging activity for any product. Since launch vehicles are highly complex and interconnected and have extreme energy densities, their design represents a challenge of the highest order. The purpose of this document is to delineate and clarify the design process associated with the launch vehicle for space flight transportation. The goal is to define and characterize a baseline for the space transportation design process. This baseline can be used as a basis for improving effectiveness and efficiency of the design process. The baseline characterization is achieved via compartmentalization and technical integration of subsystems, design functions, and discipline functions. First, a global design process overview is provided in order to show responsibility, interactions, and connectivity of overall aspects of the design process. Then design essentials are delineated in order to emphasize necessary features of the design process that are sometimes overlooked. Finally the design process characterization is presented. This is accomplished by considering project technical framework, technical integration, process description (technical integration model, subsystem tree, design/discipline planes, decision gates, and tasks), and the design sequence. Also included in the document are a snapshot relating to process improvements, illustrations of the process, a survey of recommendations from experienced practitioners in aerospace, lessons learned, references, and a bibliography.

Responding to nonwords in the lexical decision task: Insights from the English Lexicon Project.

PubMed

Yap, Melvin J; Sibley, Daragh E; Balota, David A; Ratcliff, Roger; Rueckl, Jay

2015-05-01

Researchers have extensively documented how various statistical properties of words (e.g., word frequency) influence lexical processing. However, the impact of lexical variables on nonword decision-making performance is less clear. This gap is surprising, because a better specification of the mechanisms driving nonword responses may provide valuable insights into early lexical processes. In the present study, item-level and participant-level analyses were conducted on the trial-level lexical decision data for almost 37,000 nonwords in the English Lexicon Project in order to identify the influence of different psycholinguistic variables on nonword lexical decision performance and to explore individual differences in how participants respond to nonwords. Item-level regression analyses reveal that nonword response time was positively correlated with number of letters, number of orthographic neighbors, number of affixes, and base-word number of syllables, and negatively correlated with Levenshtein orthographic distance and base-word frequency. Participant-level analyses also point to within- and between-session stability in nonword responses across distinct sets of items, and intriguingly reveal that higher vocabulary knowledge is associated with less sensitivity to some dimensions (e.g., number of letters) but more sensitivity to others (e.g., base-word frequency). The present findings provide well-specified and interesting new constraints for informing models of word recognition and lexical decision. (c) 2015 APA, all rights reserved).

77 FR 20688 - 29th Meeting: RTCA Special Committee 206, Aeronautical Information and Meteorological Data Link...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-05

.... SC-206 Related Work in SESAR--Progress Status. Discuss previously proposed TOR changes and DO-252 Revision. [cir] Discuss TOR changes for the June PMC meeting. PMC decision on OSED document. ConUse FRAC... dates. Decision to approve the ConUse document for release to the PMC. Agree upon TOR changes for June...

Issues in Peer Review of the Scientific Basis for Regulatory Decisions.

ERIC Educational Resources Information Center

American Chemical Society, Washington, DC.

This document is intended to provide a discussion of the issues that need to be addressed in the development of peer review guidelines, the options for addressing the issues, and a range of views about such options. The document focuses on peer review with regard to regulatory decisions and contains major sections which deal with: (1) what should…

[Evaluating the maturity of IT-supported clinical imaging and diagnosis using the Digital Imaging Adoption Model : Are your clinical imaging processes ready for the digital era?

PubMed

Studzinski, J

2017-06-01

The Digital Imaging Adoption Model (DIAM) has been jointly developed by HIMSS Analytics and the European Society of Radiology (ESR). It helps evaluate the maturity of IT-supported processes in medical imaging, particularly in radiology. This eight-stage maturity model drives your organisational, strategic and tactical alignment towards imaging-IT planning. The key audience for the model comprises hospitals with imaging centers, as well as external imaging centers that collaborate with hospitals. The assessment focuses on different dimensions relevant to digital imaging, such as software infrastructure and usage, workflow security, clinical documentation and decision support, data exchange and analytical capabilities. With its standardised approach, it enables regional, national and international benchmarking. All DIAM participants receive a structured report that can be used as a basis for presenting, e.g. budget planning and investment decisions at management level.

A multi-agent system for monitoring patient flow.

PubMed

Rosati, Samanta; Tralli, Augusta; Balestra, Gabriella

2013-01-01

Patient flow within a healthcare facility may follow different and, sometimes, complicated paths. Each path phase is associated with the documentation of the activities carried out during it and may require the consultation of clinical guidelines, medical literature and the use of specific software and decision aid systems. In this study we present the design of a Patient Flow Management System (PFMS) based on Multi Agent Systems (MAS) methodology. System requirements were identified by means of process modeling tools and a MAS consisting of six agents was designed and is under construction. Its main goal is to support both the medical staff during the health care process and the hospital managers in assuring that all the required documentation is completed and available. Moreover, such a tool can be used for the assessment and comparison of different clinical pathways, in order to identify possible improvementsand the optimum patient flow.

Integrated information systems for electronic chemotherapy medication administration.

PubMed

Levy, Mia A; Giuse, Dario A; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K

2011-07-01

Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations.

Systematic review of interventions to improve appropriate use and outcomes associated with do-not-attempt-cardiopulmonary-resuscitation decisions.

PubMed

Field, Richard A; Fritz, Zoë; Baker, Annalie; Grove, Amy; Perkins, Gavin D

2014-11-01

The treatment for a cardiac arrest, cardiopulmonary resuscitation (CPR), may be lifesaving following an acute, potentially reversible illness. Yet this treatment is unlikely to be effective if cardiac arrest occurs as part of the dying process towards the end of a person's natural life. Do not attempt CPR (DNACPR) decisions allow resuscitation to be withheld when it has little chance of success, or where the patient, or those close to the patient, indicate the burdens of CPR outweigh the benefits. This review sought to identify evidence for systems that improve the appropriate use of DNACPR decisions. Electronic databases were searched (Medline, CINAHL and Embase) for English language articles from 2001 to 2014. 4090 citations were identified of which 37 studies were relevant. The overall quality of evidence was moderate to poor. Thematic synthesis identified key interventions which may improve DNACPR decision making. The most promising interventions involved structured discussion at the time of acute admission to hospital and review by specialist teams at the point of an acute deterioration. Linking DNACPR decisions to discussions about overall treatment plans provided greater clarity about goals of care, aided communication between clinicians and reduced harms. Standardised documentation proved helpful for improving the frequency and quality of recording DNACPR decisions. Patient and clinician education in isolation were associated with limited or no effects. Relatively simple process changes may enhance the appropriate use of and outcomes associated with DNACPR decisions. Systematic review registration number: PROSPERO2012:CRD42012002669. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Operator models for delivering municipal solid waste management services in developing countries: Part B: Decision support.

PubMed

Soós, Reka; Whiteman, Andrew D; Wilson, David C; Briciu, Cosmin; Nürnberger, Sofia; Oelz, Barbara; Gunsilius, Ellen; Schwehn, Ekkehard

2017-08-01

This is the second of two papers reporting the results of a major study considering 'operator models' for municipal solid waste management (MSWM) in emerging and developing countries. Part A documents the evidence base, while Part B presents a four-step decision support system for selecting an appropriate operator model in a particular local situation. Step 1 focuses on understanding local problems and framework conditions; Step 2 on formulating and prioritising local objectives; and Step 3 on assessing capacities and conditions, and thus identifying strengths and weaknesses, which underpin selection of the operator model. Step 4A addresses three generic questions, including public versus private operation, inter-municipal co-operation and integration of services. For steps 1-4A, checklists have been developed as decision support tools. Step 4B helps choose locally appropriate models from an evidence-based set of 42 common operator models ( coms); decision support tools here are a detailed catalogue of the coms, setting out advantages and disadvantages of each, and a decision-making flowchart. The decision-making process is iterative, repeating steps 2-4 as required. The advantages of a more formal process include avoiding pre-selection of a particular com known to and favoured by one decision maker, and also its assistance in identifying the possible weaknesses and aspects to consider in the selection and design of operator models. To make the best of whichever operator models are selected, key issues which need to be addressed include the capacity of the public authority as 'client', management in general and financial management in particular.

A judgment and decision-making model for plant behavior.

PubMed

Karban, Richard; Orrock, John L

2018-06-12

Recently plant biologists have documented that plants, like animals, engage in many activities that can be considered as behaviors, although plant biologists currently lack a conceptual framework to understand these processes. Borrowing the well-established framework developed by psychologists, we propose that plant behaviors can be constructively modeled by identifying four distinct components: 1) a cue or stimulus that provides information, 2) a judgment whereby the plant perceives and processes this informative cue, 3) a decision whereby the plant chooses among several options based on their relative costs and benefits, and 4) action. Judgment for plants can be determined empirically by monitoring signaling associated with electrical, calcium, or hormonal fluxes. Decision-making can be evaluated empirically by monitoring gene expression or differential allocation of resources. We provide examples of the utility of this judgment and decision-making framework by considering cases in which plants either successfully or unsuccessfully induced resistance against attacking herbivores. Separating judgment from decision-making suggests new analytical paradigms (i.e., Bayesian methods for judgment and economic utility models for decision-making). Following this framework, we propose an experimental approach to plant behavior that explicitly manipulates the stimuli provided to plants, uses plants that vary in sensory abilities, and examines how environmental context affects plant responses. The concepts and approaches that follow from the judgment and decision-making framework can shape how we study and understand plant-herbivore interactions, biological invasions, plant responses to climate change, and the susceptibility of plants to evolutionary traps. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Planning Protective Action Decision-Making: Evacuate or Shelter-in-Place

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

Sorensen, J.H.

Appropriate protective action recommendations or decisions (PARs/PADs) are needed to achieve maximum protection of a population at risk. The factors that affect protective action decisions are complex but fairly well documented. Protective action decisions take into account population distributions, projected or actual exposure to a chemical substance, availability of adequate shelters, evacuation time estimates, and other relevant factors. To choose in-place sheltering, there should be a reasonable assurance that the movement of people beyond their residence, workplace, or school will endanger the health and safety of the public more so than allowing them to remain in place. The decision tomore » evacuate the public should be based on the reasonable assurance that the movement of people to an area outside of an affected area is in the best interest of their health and safety, and is of minimal risk to them. In reality, an evacuation decision is also a resource-dependent decision. The availability of transportation and other resources, including shelters, may factor heavily in the protective action decision-making process. All strategies to protect the health and safety of the public from a release of hazardous chemicals are explicitly considered during emergency decision making. Each institutional facility (such as hospitals, schools, day care centers, correctional facilities, assisted living facilities or nursing homes) in the community should be considered separately to determine what special protective actions may be necessary. Deciding whether to evacuate or to shelter-in-place is one of the most important questions facing local emergency planners responding to a toxic chemical release. That such a complex decision with such important potential consequences must be made with such urgency places tremendous responsibility on the planners and officials involved. Researchers have devoted considerable attention to the evacuation/shelter-in-place protection decision. While several decision aids have been developed, no single approach has achieved widespread acceptance based on validity, utility, and effectiveness (Ujihara 1989, Mannan and Kilpatrick 2000). In the absence of an agreed-upon methodology for making this decision, the best strategy for local emergency planners and officials is a thorough understanding of all the components affecting the decision. This paper summarizes what is currently known about the evacuation/shelter-in-place protection decision and points to available literature that more thoroughly explores the individual components of the decision. The next section summarizes the major issues in protective action decision process. This is followed by a discussion of all the factors that may bear on the protective action decision process. The final section address how to make a protective action decision.« less

Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.

PubMed

Johnson, Claire E; Chong, Jeffrey C; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas

2017-07-01

Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR. To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients. A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer. When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03). An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care. © 2017 Royal Australasian College of Physicians.

How IRBs View and Make Decisions About Consent Forms

PubMed Central

Klitzman, Robert L.

2013-01-01

IRBs have been criticized for long and complicated consent forms, but how IRBs make decisions about these issues hasn’t been examined. I contacted leaders of 60 IRBs, and interviewed IRB leaders from 34 (response rate = 55%), and 13 members and administrators. IRBs confront challenges and dilemmas regarding these documents: what and how much these forms should include (e.g., how “perfect” forms should be). While IRBs generally seek to decrease the length and complexity, institutions and industry funders often want these forms to be legal documents. IRBs may also “nitpick” these documents without realizing the costs. This study, the first to explore how IRBs view and make decisions about consent forms, suggests underlying tensions, ambiguities, and subjectivities that have important implications for future policy, practice, education, and research. PMID:23485667

Applied Robotics for Installations and Base Operations: User Perceptions of a Driverless Vehicle at Fort Bragg

DTIC Science & Technology

2018-01-03

position unless so designated by other authorized documents. Citation of manufacturer’s or trade names does not constitute an official endorsement or...trust and acceptability of the vehicle autonomy, as well as design recommendations for increasing future passenger and pedestrian comfort and trust...of design features and capabilities to better communicate its decision-making processes and intent to passengers, pedestrians, and other road users

Cost and Training Effectiveness Analysis in the Army Life Cycle Systems Management Model

DTIC Science & Technology

1980-07-23

Sugarman et al., 1975). The Training Developer’s Decision Aid (Pieper et al., 1979) method was de - veloped for the Army and it is generally... de - veloped, acquired, tested, and deployed in conjunction with the materiel acqui- sition process. Personnel resources include the number and...concerning personnel and training. An early training requirements document is the Task and Skill Analysis ( TASA ) that describes roughly what the people

Analysis of return on investment for Naval air station fallon energy project Alternatives

DTIC Science & Technology

2017-06-01

Second Reader: Daniel Nussbaum THIS PAGE INTENTIONALLY LEFT BLANK i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704–0188 Public reporting...Standard Form 298 (Rev. 2–89) Prescribed by ANSI Std. 239–18 ii THIS PAGE INTENTIONALLY LEFT BLANK iii Approved for public release...be awarded in its current form as an Energy Savings Performance Contract (ESPC). This analysis can support the decision- making process for similar

Integrated Software Development System/Higher Order Software Conceptual Description (ISDS/HOS)

DTIC Science & Technology

1976-11-01

Structured Flowchart Conventions 270 6.3.5.3 Design Diagram Notation 273 xii HIGHER ORDER SOFTWARE, INC. 843 MASSACHUSETTS AVENUE. CAMBRIDGE, MASSACHUSETTS...associated with the process steps. They also reference other HIPO diagrams as well an non-HIPO documentation such as flowcharts or decision tables of...syntax that is easy to learn and must provide the novice with some prompting to help him avoid classic beginner errors. Desirable editing capabilities

Metal Vapor Arcing Risk Assessment Tool

NASA Technical Reports Server (NTRS)

Hill, Monika C.; Leidecker, Henning W.

2010-01-01

The Tin Whisker Metal Vapor Arcing Risk Assessment Tool has been designed to evaluate the risk of metal vapor arcing and to help facilitate a decision toward a researched risk disposition. Users can evaluate a system without having to open up the hardware. This process allows for investigating components at risk rather than spending time and money analyzing every component. The tool points to a risk level and provides direction for appropriate action and documentation.

Ethical issues in a pediatric private practice.

PubMed

Jakubowitz, Melissa

2011-11-01

Building a successful pediatric private practice requires clinical expertise and an understanding of the business process, as well as familiarity with the American Speech-Language-Hearing Association Code of Ethics. This article provides an overview of the ethical issues that may be encountered when building a practice, including a look at marketing and advertising, financial management, privacy, and documentation. Ethically sound decision making is a key to a successful business. © Thieme Medical Publishers.

Simulated Engineer Assessment of the Communications Zone Model (SEAC) (Documentation and Users Manual)

DTIC Science & Technology

1988-06-01

became apparent. ESC originally planned to confect a dedicated model, i.e., one specifically designed to address Korea. However, it reconsidered the...s) and should not be construed as an official US Department of the Army position, policy, or decision unless so designated by other official...model based on object-oriented programming design techniques, and uses the process view of simulation to achieve its purpose. As a direct con

HELIOS Third Joint Working Group Meeting

NASA Technical Reports Server (NTRS)

Ousley, Gilbert; Kutzer, Ants

1970-01-01

During the past six months since the Second Helios Joint Working Group Meeting held 27-30 April 1970 at Goddard Space Flight Center, the TDS Sub-Group supported the Helios Project Office and the other Sub-Groups in the timely disposition of action items and the dissemination of information pertinent to the development of interface documentation. Of particular importance during this time period was the Project's decision to incorporate a single-channel telemetry system design aboard the spacecraft. The TDS Sub-Group participated actively in the process that led to this decision. Still under active study with TDS participation is the pending Project Office decision regarding the incorporation of a ranging capability within the telecommunications design. The TDS Sub-Group assisted the Mission Analysis and Operations Sub-Group in establishment of a study effort concerning the Near-Earth Sequence of Events from launch to launch plus 8 hours. This study, which will provide valuable data for the spacecraft telecommunications design, will include participation by the Experiment, Launch Vehicle, Spacecraft, as well as the TDS and MA&O Sub-Groups. Also during the past 6-month period, the TDS, in conjunction with the Spacecraft Sub-Group, initiated activity to develop the Helios Spacecraft/TDS Compatibility Test Plans and Procedures. Activity concerning the foregoing interface discussions has been and will continue to be based upon the "TDS Estimated Capabilities Document for the Helios Missions" (613-1), and the "DSN/Flight Project Interface Design Handbook" (810-5). These will continue to be considered TDS controlling documents until specific Helios Project/TDS interface documentation is generated and signed off by the respective parties. In addition to the above, the DSN continued the Helios Trainee Program with seven GfW/DFVLR trainees in residence at JPL. Two trainees will complete their year's residency concurrent with the Third Helios Joint Working Group Meeting, while four new trainees are expected to arrive following the Third Helios Joint Working Group Meeting. These and other activities are reported in detail in the paragraphs that follow.

Documentary analysis of risk-assessment and safety-planning policies and tools in a mental health context.

PubMed

Higgins, Agnes; Doyle, Louise; Morrissey, Jean; Downes, Carmel; Gill, Ailish; Bailey, Sive

2016-08-01

Despite the articulated need for policies and processes to guide risk assessment and safety planning, limited guidance exists on the processes or procedures to be used to develop such policies, and there is no body of research that examines the quality or content of the risk-management policies developed. The aim of the present study was to analyse the policies of risk and safety management used to guide mental health nursing practice in Ireland. A documentary analysis was performed on 123 documents received from 22 of the 23 directors of nursing contacted. Findings from the analysis revealed a wide variation in how risk, risk assessment, and risk management were defined. Emphasis within the risk documentation submitted was on risk related to self and others, with minimal attention paid to other types of risks. In addition, there was limited evidence of recovery-focused approaches to positive risk taking that involved service users and their families within the risk-related documentation. Many of the risk-assessment tools had not been validated, and lacked consistency or guidance in relation to how they were to be used or applied. The tick-box approach and absence of space for commentary within documentation have the potential to impact severely on the quality of information collected and documented, and subsequent clinical decision-making. Managers, and those tasked with ensuring safety and quality, need to ensure that policies and processes are, where possible, informed by best evidence and are in line with national mental health policy on recovery. © 2016 Australian College of Mental Health Nurses Inc.

Resurrecting Legacy Code Using Ontosoft Knowledge-Sharing and Digital Object Management to Revitalize and Reproduce Software for Groundwater Management Research

NASA Astrophysics Data System (ADS)

Kwon, N.; Gentle, J.; Pierce, S. A.

2015-12-01

Software code developed for research is often used for a relatively short period of time before it is abandoned, lost, or becomes outdated. This unintentional abandonment of code is a valid problem in the 21st century scientific process, hindering widespread reusability and increasing the effort needed to develop research software. Potentially important assets, these legacy codes may be resurrected and documented digitally for long-term reuse, often with modest effort. Furthermore, the revived code may be openly accessible in a public repository for researchers to reuse or improve. For this study, the research team has begun to revive the codebase for Groundwater Decision Support System (GWDSS), originally developed for participatory decision making to aid urban planning and groundwater management, though it may serve multiple use cases beyond those originally envisioned. GWDSS was designed as a java-based wrapper with loosely federated commercial and open source components. If successfully revitalized, GWDSS will be useful for both practical applications as a teaching tool and case study for groundwater management, as well as informing theoretical research. Using the knowledge-sharing approaches documented by the NSF-funded Ontosoft project, digital documentation of GWDSS is underway, from conception to development, deployment, characterization, integration, composition, and dissemination through open source communities and geosciences modeling frameworks. Information assets, documentation, and examples are shared using open platforms for data sharing and assigned digital object identifiers. Two instances of GWDSS version 3.0 are being created: 1) a virtual machine instance for the original case study to serve as a live demonstration of the decision support tool, assuring the original version is usable, and 2) an open version of the codebase, executable installation files, and developer guide available via an open repository, assuring the source for the application is accessible with version control and potential for new branch developments. Finally, metadata about the software has been completed within the OntoSoft portal to provide descriptive curation, make GWDSS searchable, and complete documentation of the scientific software lifecycle.

36 CFR 220.4 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... agency decisionmaking by: (1) Completing the environmental document review before making a decision on...(s) before rendering a decision on the proposal; and (5) Making a decision encompassed within the... preparing to make a decision on one or more alternative means of accomplishing that goal and the effects can...

Documenting Employee Conduct

ERIC Educational Resources Information Center

Dalton, Jason

2009-01-01

One of the best ways for a child care program to lose an employment-related lawsuit is failure to document the performance of its employees. Documentation of an employee's performance can provide evidence of an employment-related decision such as discipline, promotion, or discharge. When properly implemented, documentation of employee performance…

Semantic Metadata for Heterogeneous Spatial Planning Documents

NASA Astrophysics Data System (ADS)

Iwaniak, A.; Kaczmarek, I.; Łukowicz, J.; Strzelecki, M.; Coetzee, S.; Paluszyński, W.

2016-09-01

Spatial planning documents contain information about the principles and rights of land use in different zones of a local authority. They are the basis for administrative decision making in support of sustainable development. In Poland these documents are published on the Web according to a prescribed non-extendable XML schema, designed for optimum presentation to humans in HTML web pages. There is no document standard, and limited functionality exists for adding references to external resources. The text in these documents is discoverable and searchable by general-purpose web search engines, but the semantics of the content cannot be discovered or queried. The spatial information in these documents is geographically referenced but not machine-readable. Major manual efforts are required to integrate such heterogeneous spatial planning documents from various local authorities for analysis, scenario planning and decision support. This article presents results of an implementation using machine-readable semantic metadata to identify relationships among regulations in the text, spatial objects in the drawings and links to external resources. A spatial planning ontology was used to annotate different sections of spatial planning documents with semantic metadata in the Resource Description Framework in Attributes (RDFa). The semantic interpretation of the content, links between document elements and links to external resources were embedded in XHTML pages. An example and use case from the spatial planning domain in Poland is presented to evaluate its efficiency and applicability. The solution enables the automated integration of spatial planning documents from multiple local authorities to assist decision makers with understanding and interpreting spatial planning information. The approach is equally applicable to legal documents from other countries and domains, such as cultural heritage and environmental management.

Advanced decision support for winter road maintenance

DOT National Transportation Integrated Search

2008-01-01

This document provides an overview of the Federal Highway Administration's winter Maintenance Decision Support System (MDSS). The MDSS is a decision support tool that has the ability to provide weather predictions focused toward the road surface. The...

Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.

PubMed

Schicktanz, Silke

2009-06-01

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

Large resource development projects as markets for passive solar technologies. Final report

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

Roze-Benson, R V

1980-12-01

A basic premise of this study is that large resource development projects provide a major market opportunity for passive solar manufactured buildings. The primary objectives of the work are to document selected resource development projects and identify their potential housing needs and development schedules, to contact resource industry representatives and assess some of the processes and motivations behind their involvement in housing decisions, and to provide passive solar manufactured buildings producers with results of these steps as early initial market intelligence. The intent is to identify not only the industries, location of their planned projects, and their likely worker housingmore » needs, but also the individuals involved in making housing-related decisions. The 56 identified projects are located within 18 states and cover 11 types of resources. The report documents individual projects, provides protections of total worker-related housing needs, and presents overviews of resource development company involvement in the new construction market. In addition, the report profiles three organizations that expressed a strong interest in implementing the use of low-cost passive solar manufactured buildings in resource-development-related activities.« less

Thoughtflow: Standards and Tools for Provenance Capture and Workflow Definition to Support Model‐Informed Drug Discovery and Development

PubMed Central

Wilkins, JJ; Chan, PLS; Chard, J; Smith, G; Smith, MK; Beer, M; Dunn, A; Flandorfer, C; Franklin, C; Gomeni, R; Harnisch, L; Kaye, R; Moodie, S; Sardu, ML; Wang, E; Watson, E; Wolstencroft, K

2017-01-01

Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error‐prone, and time‐consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model‐informed drug discovery and development (MID3), as well as to support reproducibility: “Thoughtflow.” A prototype software implementation is provided. PMID:28504472

An Overview of R in Health Decision Sciences.

PubMed

Jalal, Hawre; Pechlivanoglou, Petros; Krijkamp, Eline; Alarid-Escudero, Fernando; Enns, Eva; Hunink, M G Myriam

2017-10-01

As the complexity of health decision science applications increases, high-level programming languages are increasingly adopted for statistical analyses and numerical computations. These programming languages facilitate sophisticated modeling, model documentation, and analysis reproducibility. Among the high-level programming languages, the statistical programming framework R is gaining increased recognition. R is freely available, cross-platform compatible, and open source. A large community of users who have generated an extensive collection of well-documented packages and functions supports it. These functions facilitate applications of health decision science methodology as well as the visualization and communication of results. Although R's popularity is increasing among health decision scientists, methodological extensions of R in the field of decision analysis remain isolated. The purpose of this article is to provide an overview of existing R functionality that is applicable to the various stages of decision analysis, including model design, input parameter estimation, and analysis of model outputs.

Quality Document Examples (Record of Decision of the Year Contest)

EPA Pesticide Factsheets

This page provides document examples with clear documentation that are consistent with the Superfund Program's policy and regulations. The examples provided here are the winners of the Superfund ROD of the Year Contest (1999-2004)

The History of a Decision: A Standard Vibration Test Method for Qualification

DOE PAGES

Rizzo, Davinia; Blackburn, Mark

2017-01-01

As Mil-Std-810G and subsequent versions have included multiple degree of freedom vibration test methodologies, it is important to understand the history and factors that drove the original decision in Mil-Std-810 to focus on single degree of freedom (SDOF) vibration testing. By assessing the factors and thought process of early Mil-Std-810 vibration test methods, it enables one to better consider the use of multiple degree of freedom testing now that it is feasible with today’s technology and documented in Mil-Std-810. This paper delves into the details of the decision made in the 1960s for the SDOF vibration testing standards in Mil-Std-810more » beyond the limitations of technology at the time. We also consider the implications for effective test planning today considering the advances in test capabilities and improvements in understanding of the operational environment.« less

The History of a Decision: A Standard Vibration Test Method for Qualification

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

Rizzo, Davinia; Blackburn, Mark

As Mil-Std-810G and subsequent versions have included multiple degree of freedom vibration test methodologies, it is important to understand the history and factors that drove the original decision in Mil-Std-810 to focus on single degree of freedom (SDOF) vibration testing. By assessing the factors and thought process of early Mil-Std-810 vibration test methods, it enables one to better consider the use of multiple degree of freedom testing now that it is feasible with today’s technology and documented in Mil-Std-810. This paper delves into the details of the decision made in the 1960s for the SDOF vibration testing standards in Mil-Std-810more » beyond the limitations of technology at the time. We also consider the implications for effective test planning today considering the advances in test capabilities and improvements in understanding of the operational environment.« less

Evidence for top-down control of eye movements during visual decision making.

PubMed

Glaholt, Mackenzie G; Wu, Mei-Chun; Reingold, Eyal M

2010-05-01

Participants' eye movements were monitored while they viewed displays containing 6 exemplars from one of several categories of everyday items (belts, sunglasses, shirts, shoes), with a column of 3 items presented on the left and another column of 3 items presented on the right side of the display. Participants were either required to choose which of the two sets of 3 items was the most expensive (2-AFC) or which of the 6 items was the most expensive (6-AFC). Importantly, the stimulus display, and the relevant stimulus dimension, were held constant across conditions. Consistent with the hypothesis of top-down control of eye movements during visual decision making, we documented greater selectivity in the processing of stimulus information in the 6-AFC than the 2-AFC decision. In addition, strong spatial biases in looking behavior were demonstrated, but these biases were largely insensitive to the instructional manipulation, and did not substantially influence participants' choices.

Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents1

PubMed Central

Silva, Kenya de Lima; Évora, Yolanda Dora Martinez; Cintra, Camila Santana Justo

2015-01-01

Objective: to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba. Method: a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development. Result: the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan. Conclusion: the development of this tool used to document the nursing actions will contribute to decision-making and quality of care. PMID:26487144

Software development to support decision making in the selection of nursing diagnoses and interventions for children and adolescents.

PubMed

Silva, Kenya de Lima; Évora, Yolanda Dora Martinez; Cintra, Camila Santana Justo

2015-01-01

to report the development of a software to support decision-making for the selection of nursing diagnoses and interventions for children and adolescents, based on the nomenclature of nursing diagnoses, outcomes and interventions of a university hospital in Paraiba. a methodological applied study based on software engineering, as proposed by Pressman, developed in three cycles, namely: flow chart construction, development of the navigation interface, and construction of functional expressions and programming development. the software consists of administrative and nursing process screens. The assessment is automatically selected according to age group, the nursing diagnoses are suggested by the system after information is inserted, and can be indicated by the nurse. The interventions for the chosen diagnosis are selected by structuring the care plan. the development of this tool used to document the nursing actions will contribute to decision-making and quality of care.

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

O'Malley, Daniel; Vesselinov, Velimir V.

MADSpython (Model analysis and decision support tools in Python) is a code in Python that streamlines the process of using data and models for analysis and decision support using the code MADS. MADS is open-source code developed at LANL and written in C/C++ (MADS; http://mads.lanl.gov; LA-CC-11-035). MADS can work with external models of arbitrary complexity as well as built-in models of flow and transport in porous media. The Python scripts in MADSpython facilitate the generation of input and output file needed by MADS as wells as the external simulators which include FEHM and PFLOTRAN. MADSpython enables a number of data-more » and model-based analyses including model calibration, sensitivity analysis, uncertainty quantification, and decision analysis. MADSpython will be released under GPL V3 license. MADSpython will be distributed as a Git repo at gitlab.com and github.com. MADSpython manual and documentation will be posted at http://madspy.lanl.gov.« less

Sequential Probability Ratio Test for Spacecraft Collision Avoidance Maneuver Decisions

NASA Technical Reports Server (NTRS)

Carpenter, J. Russell; Markley, F. Landis

2013-01-01

A document discusses sequential probability ratio tests that explicitly allow decision-makers to incorporate false alarm and missed detection risks, and are potentially less sensitive to modeling errors than a procedure that relies solely on a probability of collision threshold. Recent work on constrained Kalman filtering has suggested an approach to formulating such a test for collision avoidance maneuver decisions: a filter bank with two norm-inequality-constrained epoch-state extended Kalman filters. One filter models the null hypotheses that the miss distance is inside the combined hard body radius at the predicted time of closest approach, and one filter models the alternative hypothesis. The epoch-state filter developed for this method explicitly accounts for any process noise present in the system. The method appears to work well using a realistic example based on an upcoming, highly elliptical orbit formation flying mission.

TREC 2010 legal track: method and results of the ELK collaboration

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

Spearing, Shelly; Roman, Jorge; Mc Kay, Bain

The ELK team ([E]WA-IIT, [L]os Alamos National laboratory (LANL), and [K]ayvium Corporation (ELK)) used the legal Track task 302 as an opportunity to compare and integrate advanced semantic-automation strategies. The team members believe that enabling parties to discover, consume, analyze, and make decisions in a noisy and information-overloaded environment requires new tools. Together, as well as independently, they are actively developing these tools and view the TREC exercise as an opportunity to test, compare, and complement tools and approaches. Our collaboration is new to TREC, brought together by a shared interest in document relevance, concept-in-context identification and annotation, and themore » recognition that words out-of-context do not a match make. The team's intent was to lay the foundation for automating the mining and analysis of large volumes of electronic information by litigants and their lawyers, not only in the context of document discovery, but also to support litigation strategy, motion practice, deposition, trial tactics, etc. The premise was that a Subject Matter Expert- (SME-) built model can be automatically mapped onto various search engines for document retrieval, organization, relevance scoring, analysis and decision support. In the end, we ran nearly a dozen models, mostly, but not exclusively, with Kayvium Corporation's knowledge automation technology. The Sal Database Search Engine we used had a bug in its proximity feature, requiring that we develop a workaround. While the work-around was successful, it left us with insufficient time to converge the models to achieve expected quality. However, with optimized proximity processing in place, we would be able to run the model many more times, and believe repeatable quality would be a matter of working through a few requests to get the approach right. We believe that with more time, the results we would achieve might point towards a new way of processing documents for litigation support, so litigators can be confident that results are complete but not overly inclusive.« less

A data management life-cycle

USGS Publications Warehouse

Ferderer, David A.

2001-01-01

Documented, reliable, and accessible data and information are essential building blocks supporting scientific research and applications that enhance society's knowledge base (fig. 1). The U.S. Geological Survey (USGS), a leading provider of science data, information, and knowledge, is uniquely positioned to integrate science and natural resource information to address societal needs. The USGS Central Energy Resources Team (USGS-CERT) provides critical information and knowledge on the quantity, quality, and distribution of the Nation's and the world's oil, gas, and coal resources. By using a life-cycle model, the USGS-CERT Data Management Project is developing an integrated data management system to (1) promote access to energy data and information, (2) increase data documentation, and (3) streamline product delivery to the public, scientists, and decision makers. The project incorporates web-based technology, data cataloging systems, data processing routines, and metadata documentation tools to improve data access, enhance data consistency, and increase office efficiency

[The electronic health record: computerised provider order entry and the electronic instruction document as new functionalities].

PubMed

Derikx, Joep P M; Erdkamp, Frans L G; Hoofwijk, A G M

2013-01-01

An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.

Multispectral Photogrammetric Data Acquisition and Processing Forwall Paintings Studies

NASA Astrophysics Data System (ADS)

Pamart, A.; Guillon, O.; Faraci, S.; Gattet, E.; Genevois, M.; Vallet, J. M.; De Luca, L.

2017-02-01

In the field of wall paintings studies different imaging techniques are commonly used for the documentation and the decision making in term of conservation and restoration. There is nowadays some challenging issues to merge scientific imaging techniques in a multimodal context (i.e. multi-sensors, multi-dimensions, multi-spectral and multi-temporal approaches). For decades those CH objects has been widely documented with Technical Photography (TP) which gives precious information to understand or retrieve the painting layouts and history. More recently there is an increasing demand of the use of digital photogrammetry in order to provide, as one of the possible output, an orthophotomosaic which brings a possibility for metrical quantification of conservators/restorators observations and actions planning. This paper presents some ongoing experimentations of the LabCom MAP-CICRP relying on the assumption that those techniques can be merged through a common pipeline to share their own benefits and create a more complete documentation.

Protocol-based care: the standardisation of decision-making?

PubMed

Rycroft-Malone, Jo; Fontenla, Marina; Seers, Kate; Bick, Debra

2009-05-01

To explore how protocol-based care affects clinical decision-making. In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context.

The Role of Documentation Quality in Anesthesia-Related Closed Claims: A Descriptive Qualitative Study.

PubMed

Wilbanks, Bryan A; Geisz-Everson, Marjorie; Boust, Rebecca R

2016-09-01

Clinical documentation is a critical tool in supporting care provided to patients. Sound documentation provides a picture of clinical events that can be used to improve patient care. However, many other uses for clinical documentation are equally important. Such documentation informs clinical decision support tools, creates a legal record of patient care, assists in financial reimbursement of services, and serves as a repository for secondary data analysis. Conversely, poor documentation can impair patient safety and increase malpractice risk exposure by reflecting poor or inaccurate information that ultimately may guide patient care decisions.Through an examination of anesthesia-related closed claims, a descriptive qualitative study emerged, which explored the antecedents and consequences of documentation quality in the claims reviewed. A secondary data analysis utilized a database generated by the American Association of Nurse Anesthetists Foundation closed claim review team. Four major themes emerged from the analysis. Themes 1, 2, and 4 primarily describe how poor documentation quality can have negative consequences for clinicians. The third theme primarily describes how poor documentation quality that can negatively affect patient safety.

Superfund record of decision amendment (EPA Region 5): Arrowhead Refinery Company, Hermantown, MN, February 9, 1994

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

NONE

This decision document amends the selected remedial action for the Arrowhead Refinery Superfund Site (Arrowhead). This AROD does not make `fundamental changes` to the groundwater remedy selected in the ROD. Therefore, this AROD does not constitute an amendment of the groundwater remedy. However, this AROD does document minor differences in the groundwater remedy which the Agency intends to implement.

Reconstructing the Prostate Cancer Transcriptional Regulatory Network

DTIC Science & Technology

2010-07-01

the Medical Scientist Training Program. The funders had no role in study design , data collection and analysis , decision to publish, or preparation of...reverse analysis , building a cell line subtype classifier to classify 86 breast tumors (from the original Stanford/Norway study defining the five tumor...Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public

Econ's optimal decision model of wheat production and distribution-documentation

NASA Technical Reports Server (NTRS)

1977-01-01

The report documents the computer programs written to implement the ECON optical decision model. The programs were written in APL, an extremely compact and powerful language particularly well suited to this model, which makes extensive use of matrix manipulations. The algorithms used are presented and listings of and descriptive information on the APL programs used are given. Possible changes in input data are also given.

25 CFR 162.588 - What happens if BIA does not meet a deadline for issuing a decision on a lease document?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false What happens if BIA does not meet a deadline for issuing a decision on a lease document? 162.588 Section 162.588 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease...

25 CFR 162.588 - What happens if BIA does not meet a deadline for issuing a decision on a lease document?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false What happens if BIA does not meet a deadline for issuing a decision on a lease document? 162.588 Section 162.588 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease...

10 CFR 95.37 - Classification and preparation of documents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... classification decisions. (c) Markings required on face of documents. (1) For derivative classification of... to a document must be placed in a conspicuous fashion in letters at the top and bottom of the outside... on the face of the document: Reproduction or Further Dissemination Requires Approval of If any...

10 CFR 95.37 - Classification and preparation of documents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... classification decisions. (c) Markings required on face of documents. (1) For derivative classification of... to a document must be placed in a conspicuous fashion in letters at the top and bottom of the outside... on the face of the document: Reproduction or Further Dissemination Requires Approval of If any...

Pedagogical Documentation as a Lens for Examining Equality in Early Childhood Education

ERIC Educational Resources Information Center

Paananen, Maiju; Lipponen, Lasse

2018-01-01

In this paper, we consider pedagogical quality particularly as equal opportunities for participating in decision-making in preschool. Relying on Ferraris' [2013. "Documentality: Why it is necessary to leave traces." New York: Fordham University Press] theory of Documentality, we demonstrate how pedagogical documentation can contribute to…

Nuclear emergency management procedures in Europe

NASA Astrophysics Data System (ADS)

Carter, Emma

The Chernobyl accident brought to the fore the need for decision-making in nuclear emergency management to be transparent and consistent across Europe. A range of systems to support decision-making in future emergencies have since been developed, but, by and large, with little consultation with potential decision makers and limited understanding of the emergency management procedures across Europe and how they differ. In nuclear emergency management, coordination, communication and information sharing are of paramount importance. There are many key players with their own technical expertise, and several key activities occur in parallel, across different locations. Business process modelling can facilitate understanding through the representation of processes, aid transparency and structure the analysis, comparison and improvement of processes. This work has been conducted as part of a European Fifth Framework Programme project EVATECH, whose aim was to improve decision support methods, models and processes taking into account stakeholder expectations and concerns. It has involved the application of process modelling to document and compare the emergency management processes in four European countries. It has also involved a multidisciplinary approach taking a socio-technical perspective. The use of process modelling did indeed facilitate understanding and provided a common platform, which was not previously available, to consider emergency management processes. This thesis illustrates the structured analysis approach that process modelling enables. Firstly, through an individual analysis for the United Kingdom (UK) model that illustrated the potential benefits for a country. These are for training purposes, to build reflexive shared mental models, to aid coordination and for process improvement. Secondly, through a comparison of the processes in Belgium, Germany, Slovak Republic and the UK. In this comparison of the four processes we observed that the four process models are substantially different in their organisational structure and identified differences in the management of advice, where decisions are made and the communication network style. Another key aspect of this work is that through the structured analysis conducted we were able to develop a framework for the evaluation of DSS from the perspective of process. This work concludes reflecting on the challenges, which the European off-site nuclear emergency community face and suggest direction for future work, with particular reference to a recent conference on the capabilities and challenges of offsite nuclear emergency management, the Salzburg Symposium 2003.

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

NASA Technical Reports Server (NTRS)

Cioletti, Louis

2010-01-01

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

Louhi 2010: Special issue on Text and Data Mining of Health Documents

PubMed Central

2011-01-01

The papers presented in this supplement focus and reflect on computer use in every-day clinical work in hospitals and clinics such as electronic health record systems, pre-processing for computer aided summaries, clinical coding, computer decision systems, as well as related ethical concerns and security. Much of this work concerns itself by necessity with incorporation and development of language processing tools and methods, and as such this supplement aims at providing an arena for reporting on development in a diversity of languages. In the supplement we can read about some of the challenges identified above. PMID:21992545

Funding Based on Needs? A Study on the Use of Needs Assessment Data by a Major Humanitarian Health Assistance Donor in its Decisions to Allocate Funds

PubMed Central

Olin, Emma; von Schreeb, Johan

2014-01-01

Background: International humanitarian assistance is essential for disaster-affected populations, particularly in resource scarce settings. To target such assistance, needs assessments are required. According to internationally endorsed principles, donor governments should provide funding for humanitarian assistance based on need. Aim: The aim of this study is to explore a major donor’s use of needs assessment data in decision-making for allocations of funds for health-related humanitarian assistance contributions. Setting: This is a case study of the Swedish International Development Cooperation Agency (Sida), a major and respected international donor of humanitarian assistance. Methods: To explore Sida’s use of needs assessment data in practice for needs-based allocations, we reviewed all decision documents and assessment memoranda for humanitarian assistance contributions for 2012 using content analysis; this was followed by interviews with key personnel at Sida. Results: Our document analysis found that needs assessment data was not systematically included in Sida’s assessment memoranda and decision documents. In the interviews, we observed various descriptions of the concept of needs assessments, the importance of contextual influences as well as previous collaborations with implementing humanitarian assistance organizations. Our findings indicate that policies guiding funding decisions on humanitarian assistance need to be matched with available needs assessment data and that terminologies and concepts have to be clearly defined. Conclusion: Based on the document analysis and the interviews, it is unclear how well Sida used needs assessment data for decisions to allocate funds. However, although our observations show that needs assessments are seldom used in decision making, Sida’s use of needs assessments has improved compared to a previous study. To improve project funds allocations based on needs assessment data, it will be critical to develop distinct frameworks for allocation distributions based on needs assessment and clear definitions, measurements and interpretations of needs. Key words: Needs assessment, humanitarian assistance, disasters, donor decision-making PMID:24894417

Automatic extraction of numeric strings in unconstrained handwritten document images

NASA Astrophysics Data System (ADS)

Haji, M. Mehdi; Bui, Tien D.; Suen, Ching Y.

2011-01-01

Numeric strings such as identification numbers carry vital pieces of information in documents. In this paper, we present a novel algorithm for automatic extraction of numeric strings in unconstrained handwritten document images. The algorithm has two main phases: pruning and verification. In the pruning phase, the algorithm first performs a new segment-merge procedure on each text line, and then using a new regularity measure, it prunes all sequences of characters that are unlikely to be numeric strings. The segment-merge procedure is composed of two modules: a new explicit character segmentation algorithm which is based on analysis of skeletal graphs and a merging algorithm which is based on graph partitioning. All the candidate sequences that pass the pruning phase are sent to a recognition-based verification phase for the final decision. The recognition is based on a coarse-to-fine approach using probabilistic RBF networks. We developed our algorithm for the processing of real-world documents where letters and digits may be connected or broken in a document. The effectiveness of the proposed approach is shown by extensive experiments done on a real-world database of 607 documents which contains handwritten, machine-printed and mixed documents with different types of layouts and levels of noise.

Nepal's Health Facility Operation and Management Committees: exploring community participation and influence in the Dang district's primary care clinics.

PubMed

Gurung, Gagan; Derrett, Sarah; Hill, Philip C; Gauld, Robin

2018-01-28

Aim To describe community representation in Nepal's Health Facility Operation and Management Committees (HFMCs) and the degree of influence of community representatives in the HFMC decision-making processes. Community participation has been recognised as one of the key components for the successful implementation of primary health care (PHC) strategies, following the 1978 Declaration of Alma-Ata. In low- and middle-income countries (LMICs), HFMCs are now widely considered as a mechanism to increase community participation in health through community representation. There is some research examining the implementation process, impact and factors affecting the effectiveness of HFMCs. Despite the documented evidence of the importance of factors such as adequate representation, links with wider community, and decision-making power, there is limited evidence about the nature of community representation and degree of decision making within HFMCs in the PHC setting, particularly in LMICs. Qualitative interviews with 39 key informants were held to explore different aspects of community representation in HFMCs, and the influence of the HFMC on health facility decision-making processes. In addition, a facility audit at 22 facilities and review of HFMC meeting minutes at six health facilities were conducted. Findings There were Dalit (a marginalised caste) and Janajati (an ethnic group) representations in 77% and 100% of the committees, respectively. Likewise, there were at least two female members in each committee. However, the HFMC member selection process and decision making within the committees were influenced by powerful elites. The degree of participation through HFMCs appeared to be at the 'Manipulation' and 'Informing' stage of Arnstein's ladder of participation. In conclusion, despite representation of the community on HFMCs, the depth of participation seems low. There is a need to ensure a democratic selection process of committee members; and to expand the depth of participation.

Transparency in Canadian public drug advisory committees.

PubMed

Rosenberg-Yunger, Zahava R S; Bayoumi, Ahmed M

2014-11-01

Transparency in health care resource allocation decisions is a criterion of a fair process. We used qualitative methods to explore transparency across 11 Canadian drug advisory committees. We developed seven criteria to assess transparency (disclosure of members' names, disclosure of membership selection criteria, disclosure of conflict of interest guidelines and members' conflicts, public posting of decisions not to fund drugs, public posting of rationales for decisions, stakeholder input, and presence of an appeals mechanism) and two sub-criteria for when rationales were posted (direct website link and readability). We interviewed a purposeful sample of key informants who were conversant in English and a current or past member of either a committee or a stakeholder group. We analyzed data using a thematic approach. Interviewing continued until saturation was reached. We examined documents from 10 committees and conducted 27 interviews. The median number of criteria addressed by committees was 2 (range 0-6). Major interview themes included addressing: (1) accessibility issues, including stakeholders' degree of access to the decision making process and appeal mechanisms; (2) communication issues, including improving internal and external communication and public access to information; and (3) confidentiality issues, including the use of proprietary evidence. Most committees have some mechanisms to address transparency but none had a fully transparent process. The most important ways to improve transparency include creating formal appeal mechanisms, improving communication, and establishing consistent rules about the use of, and public access to, proprietary evidence. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Antibiotic Prescribing Pathway for Presumed Urinary Tract Infections in Nursing Home Residents.

PubMed

Kistler, Christine E; Zimmerman, Sheryl; Scales, Kezia; Ward, Kimberly; Weber, David; Reed, David; McClester, Mallory; Sloane, Philip D

2017-08-01

Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections (UTIs) in nursing home (NH) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship. Chart review of 260 randomly-selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NHs in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work-up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision-making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics. Of 260 cases, 60% had documented signs/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign/symptom (24%). NH providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed UTI cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy-five percent of cultures grew at least one organism with ≥100,000 colony-forming units/milliliter and 12% grew multi-drug resistant organisms; 28% of antibiotics were prescribed for more than 7 days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7 days. Non-specific signs/symptoms appeared to influence prescribing more often than urinary tract-specific signs/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision-making process to reduce antibiotic overuse and antibiotic resistance. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus

PubMed Central

Spat, Stephan; Donsa, Klaus; Beck, Peter; Höll, Bernhard; Mader, Julia K.; Schaupp, Lukas; Augustin, Thomas; Chiarugi, Franco; Lichtenegger, Katharina M.; Plank, Johannes; Pieber, Thomas R.

2016-01-01

Background: Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention. Methods: The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated. Results: Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system. Conclusions: Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system. PMID:27810995

Tactical Approaches for Making a Successful Satellite Passive Microwave ESDR

NASA Astrophysics Data System (ADS)

Hardman, M.; Brodzik, M. J.; Gotberg, J.; Long, D. G.; Paget, A. C.

2014-12-01

Our NASA MEaSUREs project is producing a new, enhanced resolution gridded Earth System Data Record for the entire satellite passive microwave (SMMR, SSM/I-SSMIS and AMSR-E) time series. Our project goals are twofold: to produce a well-documented, consistently processed, high-quality historical record at higher spatial resolutions than have previously been available, and to transition the production software to the NSIDC DAAC for ongoing processing after our project completion. In support of these goals, our distributed team at BYU and NSIDC faces project coordination challenges to produce a high-quality data set that our user community will accept as a replacement for the currently available historical versions of these data. We work closely with our DAAC liaison on format specifications, data and metadata plans, and project progress. In order for the user community to understand and support our project, we have solicited a team of Early Adopters who are reviewing and evaluating a prototype version of the data. Early Adopter feedback will be critical input to our final data content and format decisions. For algorithm transparency and accountability, we have released an Algorithm Theoretical Basis Document (ATBD) and detailed supporting technical documentation, with rationale for all algorithm implementation decisions. For distributed team management, we are using collaborative tools for software revision control and issue tracking. For reliably transitioning a research-quality image reconstruction software system to production-quality software suitable for use at the DAAC, we have adopted continuous integration methods for running automated regression testing. Our presentation will summarize bothadvantages and challenges of each of these tactics in ensuring production of a successful ESDR and an enduring production software system.

Multi-Sensor Documentation of Metric and Qualitative Information of Historic Stone Structures

NASA Astrophysics Data System (ADS)

Adamopoulos, E.; Tsilimantou, E.; Keramidas, V.; Apostolopoulou, M.; Karoglou, M.; Tapinaki, S.; Ioannidis, C.; Georgopoulos, A.; Moropoulou, A.

2017-08-01

This paper focuses on the integration of multi-sensor techniques regarding the acquisition, processing, visualisation and management of data regarding historic stone structures. The interdisciplinary methodology that is carried out here comprises of two parts. In the first part, the acquisition of qualitative and quantitative data concerning the geometry, the materials and the degradation of the tangible heritage asset each time, is discussed. The second part, refers to the analysis, management and visualization of the interrelated data by using spatial information technologies. Through the paradigm of the surveying of the ancient temple of Pythian Apollo at Acropolis of Rhodes, Rhodes Island, Greece, it is aimed to highlight the issues deriving from the separate application of documentation procedures and how the fusion of these methods can contribute effectively to ensure the completeness of the measurements for complex structures. The surveying results are further processed to be compatible and integrated with GIS. Also, the geometric documentation derivatives are combined with environmental data and the results of the application of non-destructive testing and evaluation techniques in situ and analytical techniques in lab after sampling. GIS operations are utilized to document the building materials but also to model and to analyse the decay extent and patterns. Detailed surface measurements and geo-processing analysis are executed. This integrated approach, helps the assessment of past interventions on the monument, identify main causes of damage and decay, and finally assist the decision making on the most compatible materials and techniques for protection and restoration works.

Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews.

PubMed

Mickan, Sharon; Tilson, Julie K; Atherton, Helen; Roberts, Nia Wyn; Heneghan, Carl

2013-10-28

Handheld computers and mobile devices provide instant access to vast amounts and types of useful information for health care professionals. Their reduced size and increased processing speed has led to rapid adoption in health care. Thus, it is important to identify whether handheld computers are actually effective in clinical practice. A scoping review of systematic reviews was designed to provide a quick overview of the documented evidence of effectiveness for health care professionals using handheld computers in their clinical work. A detailed search, sensitive for systematic reviews was applied for Cochrane, Medline, EMBASE, PsycINFO, Allied and Complementary Medicine Database (AMED), Global Health, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. All outcomes that demonstrated effectiveness in clinical practice were included. Classroom learning and patient use of handheld computers were excluded. Quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. A previously published conceptual framework was used as the basis for dual data extraction. Reported outcomes were summarized according to the primary function of the handheld computer. Five systematic reviews met the inclusion and quality criteria. Together, they reviewed 138 unique primary studies. Most reviewed descriptive intervention studies, where physicians, pharmacists, or medical students used personal digital assistants. Effectiveness was demonstrated across four distinct functions of handheld computers: patient documentation, patient care, information seeking, and professional work patterns. Within each of these functions, a range of positive outcomes were reported using both objective and self-report measures. The use of handheld computers improved patient documentation through more complete recording, fewer documentation errors, and increased efficiency. Handheld computers provided easy access to clinical decision support systems and patient management systems, which improved decision making for patient care. Handheld computers saved time and gave earlier access to new information. There were also reports that handheld computers enhanced work patterns and efficiency. This scoping review summarizes the secondary evidence for effectiveness of handheld computers and mhealth. It provides a snapshot of effective use by health care professionals across four key functions. We identified evidence to suggest that handheld computers provide easy and timely access to information and enable accurate and complete documentation. Further, they can give health care professionals instant access to evidence-based decision support and patient management systems to improve clinical decision making. Finally, there is evidence that handheld computers allow health professionals to be more efficient in their work practices. It is anticipated that this evidence will guide clinicians and managers in implementing handheld computers in clinical practice and in designing future research.

Making Information Useful: Engagement in the National Climate Assessment Process

NASA Astrophysics Data System (ADS)

Lough, G. C.; Cloyd, E.

2014-12-01

Creation of actionable information requires that the producers of that information understand the needs of the intended users and decision makers. To that end, development of the Third National Climate Assessment included a focus on engaging users through an inclusive, broad-based, and sustained process. Such a process provides opportunities for scientific experts and decision makers to share knowledge about the climate-related issues, impacts, and potential response actions that are most important in a particular region or sector. Such a process is also highly transparent in order to produce results that are credible, salient, and legitimate for both scientists and decision makers, ultimately making the results extremely useful. To implement these principles for the recent NCA, a broad-based engagement strategy was implemented from the start of the process. The strategy invited participation from users and stakeholder communities at each stage of the process, and considered methods for communicating with potential users at every step. The strategy was designed to elicit contributions to help shape the framing of the assessment, improve the transparency of the process, and increase the utility of the final information. Specific user inputs were gathered through a series of workshops, public comment opportunities, town hall meetings, presentations, requests for information, submitted documents, and open meetings. Further, a network of contributors self-organized around topics of interest to extend the NCA to a wider range of user groups. Here, we describe the outcomes of these innovations in assessment engagement and identify clear successes, notable surprises, future evaluation needs, and areas for new ideas.

The development and implementation of a decision-making capacity assessment model.

PubMed

Parmar, Jasneet; Brémault-Phillips, Suzette; Charles, Lesley

2015-03-01

Decision-making capacity assessment (DMCA) is an issue of increasing importance for older adults. Current challenges need to be explored, and potential processes and strategies considered in order to address issues of DMCA in a more coordinated manner. An iterative process was used to address issues related to DMCA. This began with recognition of challenges associated with capacity assessments (CAs) by staff at Covenant Health (CH). Review of the literature, as well as discussions with and a survey of staff at three CH sites, resulted in determination of issues related to DMCA. Development of a DMCA Model and demonstration of its feasibility followed. A process was proposed with front-end screening/problem- solving, a well-defined standard assessment, and definition of team member roles. A Capacity Assessment Care Map was formulated based on the process. Documentation was developed consisting of a Capacity Assessment Process Worksheet, Capacity Interview Worksheet, and a brochure. Interactive workshops were delivered to familiarize staff with the DMCA Model. A successful demonstration project led to implementation across all sites in the Capital Health region, and eventual provincial endorsement. Concerns identified in the survey and in the literature regarding CA were addressed through the holistic interdisciplinary approach offered by the DMCA Model.

Noninvasive Characterization of Indeterminate Pulmonary Nodules Detected on Chest High-Resolution Computed Tomography

DTIC Science & Technology

2017-10-01

author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation...the LTRC database comprised of nodules with a very high pretest probability of malignancy make these results encouraging as we are in the process of...working with the investigators to design the study, establish and support access to the clinical data and images of NLST and DECAMP, develop database

DURIP: An Ultrafast Testbed for Comprehensive Characterization of Photonics, Electronic, and Optoelectronic Properties of Inegrated Nanophotonic Structures

DTIC Science & Technology

2017-10-14

Department of the Army position, policy or decision , unless so designated by other documentation. 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS (ES...characterization equipment to an al- ready available photonic characterization setup. The following table details of the spent budget and the list of purchased ...measure the response of a high-speed optical signal processing platform. The same architecture also can be used to charac- terize high-speed

Principal/agent theory and decision making in health care.

PubMed

Buchanan, Allen

1988-10-01

Principal/agent theory, an economics concept that defines an agency relationship as "a contract under which one or more persons engage another person (the agent) to perform some service on their behalf which involves delegating some decision-making authority to the agent," is held to be applicable to the patient/physician relationship, in contrast to the view that this is a fiduciary relationship, not a contractual one. The distinction between fiduciary and contractual relationships is illuminated in the process of evaluating objections to the application of the principal/agent theory to the patient/physician relationship. The ability of the principal/agent theory to reveal important features of advance directives, understood as public documents rather than as confidential instructions from patient to physician, is also examined.

PVEX: An expert system for producibility/value engineering

NASA Technical Reports Server (NTRS)

Lam, Chun S.; Moseley, Warren

1991-01-01

PVEX is described as an expert system that solves the problem of selection of the material and process in missile manufacturing. The producibility and the value problem has been deeply studied in the past years, and was written in dBase III and PROLOG before. A new approach is presented in that the solution is achieved by introducing hypothetical reasoning, heuristic criteria integrated with a simple hypertext system and shell programming. PVEX combines KMS with Unix scripts which graphically depicts decision trees. The decision trees convey high level qualitative problem solving knowledge to users, and a stand-alone help facility and technical documentation is available through KMS. The system developed is considerably less development costly than any other comparable expert system.

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

28 CFR 68.3 - Service of complaint, notice of hearing, written orders, and decisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., written orders, and decisions. 68.3 Section 68.3 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... DOCUMENT FRAUD § 68.3 Service of complaint, notice of hearing, written orders, and decisions. (a) Service of complaint, notice of hearing, written orders, and decisions shall be made by the Office of the...

Surface transportation weather decision support requirements : operational concept description : advanced-integrated decision support using weather information for surface transportation decisions makers : draft version 2.0

DOT National Transportation Integrated Search

2000-07-14

This is a draft document for the Surface Transportation Weather Decision Support Requirements (STWDSR) project. The STWDSR project is being conducted for the FHWAs Office of Transportation Operations (HOTO) Road Weather Management Program by Mitre...

8 CFR 103.9 - Availability of decisions and interpretive material under the Freedom of Information Act.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Availability of decisions and interpretive... of decisions and interpretive material under the Freedom of Information Act. (a) Precedent decisions. There may be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington...

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.

Leveraging certified nursing assistant documentation and knowledge to improve clinical decision making: the on-time quality improvement program to prevent pressure ulcers.

PubMed

Sharkey, Siobhan; Hudak, Sandra; Horn, Susan D; Spector, William

2011-04-01

The goal of this article was to enhance understanding of the On-Time Quality Improvement for Long-term Care Program, a practical approach to embed health information technology into quality improvement in nursing homes that leverages certified nursing assistant documentation and knowledge, supports frontline clinical decision making, and establishes proactive intervention for pressure ulcer prevention.

25 CFR 162.569 - Will BIA require an appeal bond for an appeal of a decision on a WSR lease document?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Will BIA require an appeal bond for an appeal of a decision on a WSR lease document? 162.569 Section 162.569 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162...

25 CFR 162.569 - Will BIA require an appeal bond for an appeal of a decision on a WSR lease document?

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Will BIA require an appeal bond for an appeal of a decision on a WSR lease document? 162.569 Section 162.569 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER LEASES AND PERMITS Wind and Solar Resource Leases Wsr Lease Approval § 162...

Reconstructing the Prostate Cancer Transcriptional Regulatory Network

DTIC Science & Technology

2010-09-01

funders had no role in study design , data collection and analysis , decision to publish, or preparation of the manuscript. Competing Interests: The authors...basal-like or ERBB2 tumors (despite that none were ERBB2-positive). We also carried out the reverse analysis , building a cell line subtype classifier to...Department of the Army position, policy or decision unless so designated by other documentation. REPORT DOCUMENTATION PAGE Form Approved OMB No

Trialability, observability and risk reduction accelerating individual innovation adoption decisions.

PubMed

Hayes, Kathryn J; Eljiz, Kathy; Dadich, Ann; Fitzgerald, Janna-Anneke; Sloan, Terry

2015-01-01

The purpose of this paper is to provide a retrospective analysis of computer simulation's role in accelerating individual innovation adoption decisions. The process innovation examined is Lean Systems Thinking, and the organizational context is the imaging department of an Australian public hospital. Intrinsic case study methods including observation, interviews with radiology and emergency personnel about scheduling procedures, mapping patient appointment processes and document analysis were used over three years and then complemented with retrospective interviews with key hospital staff. The multiple data sources and methods were combined in a pragmatic and reflexive manner to explore an extreme case that provides potential to act as an instructive template for effective change. Computer simulation of process change ideas offered by staff to improve patient-flow accelerated the adoption of the process changes, largely because animated computer simulation permitted experimentation (trialability), provided observable predictions of change results (observability) and minimized perceived risk. The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged. This work has implications for policy, practice and theory, particularly for inducing the rapid diffusion of process innovations to address challenges facing health service organizations and national health systems. Originality/value - The research demonstrates the value of animated computer simulation in presenting the need for change, identifying options, and predicting change outcomes and is the first work to indicate the importance of trialability, observability and risk reduction in individual adoption decisions in health services.

[The Glivec® case: the first example of a global debate on the drug patent system].

PubMed

Moital, Inês; Bosch, Fèlix; Farré, Magí; Maddaleno, Mariano; Baños, Josep-E

2014-01-01

To describe the sequence of events involving the Glivec® case in India and to analyze the opinions generated in distinct settings. We performed a systematic search for articles concerning the imatinib (Glivec®) patent in India. We selected those sources that described the events, decisions of the authorities involved, and press and scientific opinions. Dates and arguments presented by the involved parties were clearly identified. Of 886 documents initially obtained, we selected 40 documents published between 2003 and 2013. Most of them were press news and commentaries. The process lasted 7 years, starting in 2006 when the Indian Patent Office rejected the patent application filed by Novartis. It ended in 2013 when the Indian Supreme Court upheld this decision. It was argued that the Indian Patent Law would facilitate access to medicines in the Third World and the final decision has received support by the general population. Although the court's final decision has been supported by several institutions, an objective analysis should also take into account the arguments of the pharmaceutical companies and other entities. The Glivec® case gave rise to an intense debate on the appropriateness of international standards on patents, their applicability and how they should be adopted in each country. This case, as well as other cases, should serve to stimulate reflection on the international patent system and to achieve scenarios in which the health of the poorest populations is protected but also balanced against intellectual property protection and innovation. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

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

Matthews, Patrick K.

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 550: Smoky Contamination Area, Nevada National Security Site, Nevada. CAU 550 includes 19 corrective action sites (CASs), which consist of one weapons-related atmospheric test (Smoky), three safety experiments (Ceres, Oberon, Titania), and 15 debris sites (Table ES-1). The CASs were sorted into the following study groups based on release potential and technical similarities: • Study Group 1, Atmospheric Test • Study Group 2, Safety Experiments • Study Group 3, Washes • Study Group 4, Debris The purpose of this document is to provide justificationmore » and documentation supporting the conclusion that no further corrective action is needed for CAU 550 based on implementation of the corrective actions listed in Table ES-1. Corrective action investigation (CAI) activities were performed between August 2012 and October 2013 as set forth in the Corrective Action Investigation Plan for Corrective Action Unit 550: Smoky Contamination Area; and in accordance with the Soils Activity Quality Assurance Plan. The approach for the CAI was to investigate and make data quality objective (DQO) decisions based on the types of releases present. The purpose of the CAI was to fulfill data needs as defined during the DQO process. The CAU 550 dataset of investigation results was evaluated based on a data quality assessment. This assessment demonstrated the dataset is complete and acceptable for use in fulfilling the DQO data needs.« less

Toward the Computational Representation of Individual Cultural, Cognitive, and Physiological State: The Sensor Shooter Simulation

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

RAYBOURN,ELAINE M.; FORSYTHE,JAMES C.

2001-08-01

This report documents an exploratory FY 00 LDRD project that sought to demonstrate the first steps toward a realistic computational representation of the variability encountered in individual human behavior. Realism, as conceptualized in this project, required that the human representation address the underlying psychological, cultural, physiological, and environmental stressors. The present report outlines the researchers' approach to representing cognitive, cultural, and physiological variability of an individual in an ambiguous situation while faced with a high-consequence decision that would greatly impact subsequent events. The present project was framed around a sensor-shooter scenario as a soldier interacts with an unexpected target (twomore » young Iraqi girls). A software model of the ''Sensor Shooter'' scenario from Desert Storm was developed in which the framework consisted of a computational instantiation of Recognition Primed Decision Making in the context of a Naturalistic Decision Making model [1]. Recognition Primed Decision Making was augmented with an underlying foundation based on our current understanding of human neurophysiology and its relationship to human cognitive processes. While the Gulf War scenario that constitutes the framework for the Sensor Shooter prototype is highly specific, the human decision architecture and the subsequent simulation are applicable to other problems similar in concept, intensity, and degree of uncertainty. The goal was to provide initial steps toward a computational representation of human variability in cultural, cognitive, and physiological state in order to attain a better understanding of the full depth of human decision-making processes in the context of ambiguity, novelty, and heightened arousal.« less

Avoidant decision making in social anxiety: the interaction of angry faces and emotional responses

PubMed Central

Pittig, Andre; Pawlikowski, Mirko; Craske, Michelle G.; Alpers, Georg W.

2014-01-01

Recent research indicates that angry facial expressions are preferentially processed and may facilitate automatic avoidance response, especially in socially anxious individuals. However, few studies have examined whether this bias also expresses itself in more complex cognitive processes and behavior such as decision making. We recently introduced a variation of the Iowa Gambling Task which allowed us to document the influence of task-irrelevant emotional cues on rational decision making. The present study used a modified gambling task to investigate the impact of angry facial expressions on decision making in 38 individuals with a wide range of social anxiety. Participants were to find out which choices were (dis-) advantageous to maximize overall gain. To create a decision conflict between approach of reward and avoidance of fear-relevant angry faces, advantageous choices were associated with angry facial expressions, whereas disadvantageous choices were associated with happy facial expressions. Results indicated that higher social avoidance predicted less advantageous decisions in the beginning of the task, i.e., when contingencies were still uncertain. Interactions with specific skin conductance responses further clarified that this initial avoidance only occurred in combination with elevated responses before choosing an angry facial expressions. In addition, an interaction between high trait anxiety and elevated responses to early losses predicted faster learning of an advantageous strategy. These effects were independent of intelligence, general risky decision-making, self-reported state anxiety, and depression. Thus, socially avoidant individuals who respond emotionally to angry facial expressions are more likely to show avoidance of these faces under uncertainty. This novel laboratory paradigm may be an appropriate analog for central features of social anxiety. PMID:25324792

Clarity versus complexity: land-use modeling as a practical tool for decision-makers

USGS Publications Warehouse

Sohl, Terry L.; Claggett, Peter

2013-01-01

The last decade has seen a remarkable increase in the number of modeling tools available to examine future land-use and land-cover (LULC) change. Integrated modeling frameworks, agent-based models, cellular automata approaches, and other modeling techniques have substantially improved the representation of complex LULC systems, with each method using a different strategy to address complexity. However, despite the development of new and better modeling tools, the use of these tools is limited for actual planning, decision-making, or policy-making purposes. LULC modelers have become very adept at creating tools for modeling LULC change, but complicated models and lack of transparency limit their utility for decision-makers. The complicated nature of many LULC models also makes it impractical or even impossible to perform a rigorous analysis of modeling uncertainty. This paper provides a review of land-cover modeling approaches and the issues causes by the complicated nature of models, and provides suggestions to facilitate the increased use of LULC models by decision-makers and other stakeholders. The utility of LULC models themselves can be improved by 1) providing model code and documentation, 2) through the use of scenario frameworks to frame overall uncertainties, 3) improving methods for generalizing key LULC processes most important to stakeholders, and 4) adopting more rigorous standards for validating models and quantifying uncertainty. Communication with decision-makers and other stakeholders can be improved by increasing stakeholder participation in all stages of the modeling process, increasing the transparency of model structure and uncertainties, and developing user-friendly decision-support systems to bridge the link between LULC science and policy. By considering these options, LULC science will be better positioned to support decision-makers and increase real-world application of LULC modeling results.

Avoidant decision making in social anxiety: the interaction of angry faces and emotional responses.

PubMed

Pittig, Andre; Pawlikowski, Mirko; Craske, Michelle G; Alpers, Georg W

2014-01-01

Recent research indicates that angry facial expressions are preferentially processed and may facilitate automatic avoidance response, especially in socially anxious individuals. However, few studies have examined whether this bias also expresses itself in more complex cognitive processes and behavior such as decision making. We recently introduced a variation of the Iowa Gambling Task which allowed us to document the influence of task-irrelevant emotional cues on rational decision making. The present study used a modified gambling task to investigate the impact of angry facial expressions on decision making in 38 individuals with a wide range of social anxiety. Participants were to find out which choices were (dis-) advantageous to maximize overall gain. To create a decision conflict between approach of reward and avoidance of fear-relevant angry faces, advantageous choices were associated with angry facial expressions, whereas disadvantageous choices were associated with happy facial expressions. Results indicated that higher social avoidance predicted less advantageous decisions in the beginning of the task, i.e., when contingencies were still uncertain. Interactions with specific skin conductance responses further clarified that this initial avoidance only occurred in combination with elevated responses before choosing an angry facial expressions. In addition, an interaction between high trait anxiety and elevated responses to early losses predicted faster learning of an advantageous strategy. These effects were independent of intelligence, general risky decision-making, self-reported state anxiety, and depression. Thus, socially avoidant individuals who respond emotionally to angry facial expressions are more likely to show avoidance of these faces under uncertainty. This novel laboratory paradigm may be an appropriate analog for central features of social anxiety.

Qualitative analysis of national documents on health care services and pharmaceuticals` purchasing challenges: evidence from Iran.

PubMed

Bastani, Peivand; Samadbeik, Mahnaz; Dinarvand, Rassoul; Kashefian-Naeeini, Sara; Vatankhah, Soudabeh

2018-06-05

Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014. In order to retrieve the related documents, we searched the official websites related to the Ministry of Health and Medical Education, four main Iranian insurance organizations, the Health Committee of the Parliament Profile, strategic vice president's site and Supreme Insurance Council. After recognition of documents, their credibility and authenticity were evaluated in terms of their publication or adjustment. For the analysis of documents, the four step-Scott method was used applying MAXQDA version 10. Findings illustrated that health service purchase challenges in the country can be classified in 6 main themes of policy-making, executive, intersectional, natural, legal and informational challenges with 26 subthemes. Furthermore, 5 themes of Basic Benefit Package, Reimbursement,Decision making, Technology and Contract are considered as the main Challenges in pharmaceutical purchasing area containing 13 relevant subthemes. It seems that according to documents, Iran has faced many structural and procedural problems with the purchase of the best health interventions. So it is highly recommended to consider consequences derived from the present challenges and try to use these evidences in their policy making process to decrease the existed problems and move to better procurement of health interventions.

Gold Run Pass - Div. of Mining, Land, and Water

Science.gov Websites

issuing a Final Findings of Fact and Decision for the renewal of the Gold Run Pass Mine permits. Documents : Final Findings and Decision(PDF)(Posted 9/2/2016) Public Notice of Final Findings and Decision (PDF

The contractor`s role in low-level waste disposal facility application review and licensing

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

Serie, P.J.; Dressen, A.L.

1991-12-31

The California Department of Health Services will soon reach a licensing decision on the proposed Ward Valley low-level radioactive waste disposal facility. As the first regulatory agency in the country to address the 10 CFR Part 61 requirements for a new disposal facility, California`s program has broken new ground in its approach. Throughout the review process, the Department has relied on contractor support to augment its technical and administrative staff. A team consisting of Roy F. Weston, Inc., supported by ERM-Program Management Corp., Environmental Issues Management, Inc., and Rogers and Associates Engineering Corporation, has worked closely with the Department inmore » a staff extension role. The authors have been involved with the project in contractor project management roles since 1987, and continue to support the Department`s program as it proceeds to finalize its licensing process. This paper describes the selection process used to identify a contractor team with the needed skills and experience, and the makeup of team capabilities. It outlines the management, communication, and technical approaches used to assure a smooth agency-contractor function and relationship. It describes the techniques used to ensure that decisions and documents represented the Department credibly in its role as the regulatory and licensing agency under the Nuclear Regulatory Commission (NRC) Agreement State program. The paper outlines the license application review process and activities, through preparation of licensing documentation and responses to public comments. Lessons learned in coordination of an agency-contractor team effort to review and license a low-level waste disposal facility are reviewed and suggestions made for approaching a similar license application review and licensing situation.« less

Engineering and Safety Partnership Enhances Safety of the Space Shuttle Program (SSP)

NASA Technical Reports Server (NTRS)

Duarte, Alberto

2007-01-01

Project Management must use the risk assessment documents (RADs) as tools to support their decision making process. Therefore, these documents have to be initiated, developed, and evolved parallel to the life of the project. Technical preparation and safety compliance of these documents require a great deal of resources. Updating these documents after-the-fact not only requires substantial increase in resources - Project Cost -, but this task is also not useful and perhaps an unnecessary expense. Hazard Reports (HRs), Failure Modes and Effects Analysis (FMEAs), Critical Item Lists (CILs), Risk Management process are, among others, within this category. A positive action resulting from a strong partnership between interested parties is one way to get these documents and related processes and requirements, released and updated in useful time. The Space Shuttle Program (SSP) at the Marshall Space Flight Center has implemented a process which is having positive results and gaining acceptance within the Agency. A hybrid Panel, with equal interest and responsibilities for the two larger organizations, Safety and Engineering, is the focal point of this process. Called the Marshall Safety and Engineering Review Panel (MSERP), its charter (Space Shuttle Program Directive 110 F, April 15, 2005), and its Operating Control Plan emphasizes the technical and safety responsibilities over the program risk documents: HRs; FMEA/CILs; Engineering Changes; anomalies/problem resolutions and corrective action implementations, and trend analysis. The MSERP has undertaken its responsibilities with objectivity, assertiveness, dedication, has operated with focus, and has shown significant results and promising perspectives. The MSERP has been deeply involved in propulsion systems and integration, real time technical issues and other relevant reviews, since its conception. These activities have transformed the propulsion MSERP in a truly participative and value added panel, making a difference for the safety of the Space Shuttle Vehicle, its crew, and personnel. Because of the MSERP's valuable contribution to the assessment of safety risk for the SSP, this paper also proposes an enhanced Panel concept that takes this successful partnership concept to a higher level of 'true partnership'. The proposed panel is aimed to be responsible for the review and assessment of all risk relative to Safety for new and future aerospace and related programs.

Consensus Recommendations for Systematic Evaluation of Drug-Drug Interaction Evidence for Clinical Decision Support

PubMed Central

Scheife, Richard T.; Hines, Lisa E.; Boyce, Richard D.; Chung, Sophie P.; Momper, Jeremiah; Sommer, Christine D.; Abernethy, Darrell R.; Horn, John; Sklar, Stephen J.; Wong, Samantha K.; Jones, Gretchen; Brown, Mary; Grizzle, Amy J.; Comes, Susan; Wilkins, Tricia Lee; Borst, Clarissa; Wittie, Michael A.; Rich, Alissa; Malone, Daniel C.

2015-01-01

Background Healthcare organizations, compendia, and drug knowledgebase vendors use varying methods to evaluate and synthesize evidence on drug-drug interactions (DDIs). This situation has a negative effect on electronic prescribing and medication information systems that warn clinicians of potentially harmful medication combinations. Objective To provide recommendations for systematic evaluation of evidence from the scientific literature, drug product labeling, and regulatory documents with respect to DDIs for clinical decision support. Methods A conference series was conducted to develop a structured process to improve the quality of DDI alerting systems. Three expert workgroups were assembled to address the goals of the conference. The Evidence Workgroup consisted of 15 individuals with expertise in pharmacology, drug information, biomedical informatics, and clinical decision support. Workgroup members met via webinar from January 2013 to February 2014. Two in-person meetings were conducted in May and September 2013 to reach consensus on recommendations. Results We developed expert-consensus answers to three key questions: 1) What is the best approach to evaluate DDI evidence?; 2) What evidence is required for a DDI to be applicable to an entire class of drugs?; and 3) How should a structured evaluation process be vetted and validated? Conclusion Evidence-based decision support for DDIs requires consistent application of transparent and systematic methods to evaluate the evidence. Drug information systems that implement these recommendations should be able to provide higher quality information about DDIs in drug compendia and clinical decision support tools. PMID:25556085

Using the IRPA Guiding Principles on Stakeholder Engagement: putting theory into practice.

PubMed

Jones, C Rick

2011-11-01

The International Radiation Protection Association (IRPA) published their Guiding Principles for Radiation Protection Professionals on Stakeholder Engagement in February 2009. The publication of this document is the culmination of four years of work by the Spanish Society for Radiological Protection, the French Society of Radioprotection, the United Kingdom Society of Radiological Protection, and the IRPA organization, with full participation by the Italian Associate Society and the Nuclear Energy Agency's Committee on Radiation Protection and Public Health. The Guiding Principles provide field-tested and sound counsel to the radiation protection profession to aid it in successfully engaging with stakeholders in decision-making processes that result in mutually agreeable and sustainable decisions. Stakeholders in the radiation protection decision making process are now being recognized as a spectrum of individuals and organizations specific to the situation. It is also important to note that stakeholder engagement is not needed or advised in all decision making situations, although it has been shown to be a tool of first choice in dealing with such topics as intervention and chronic exposure situations, as well as situations that have reached an impasse using traditional approaches to decision-making. To enhance the contribution of the radiation protection profession, it is important for radiation protection professionals and their national professional societies to embrace and implement the IRPA Guiding Principles in a sustainable way by making them a cornerstone of their operations and an integral part of day-to-day activities.

Integrated Information Systems for Electronic Chemotherapy Medication Administration

PubMed Central

Levy, Mia A.; Giuse, Dario A.; Eck, Carol; Holder, Gwen; Lippard, Giles; Cartwright, Julia; Rudge, Nancy K.

2011-01-01

Introduction: Chemotherapy administration is a highly complex and distributed task in both the inpatient and outpatient infusion center settings. The American Society of Clinical Oncology and the Oncology Nursing Society (ASCO/ONS) have developed standards that specify procedures and documentation requirements for safe chemotherapy administration. Yet paper-based approaches to medication administration have several disadvantages and do not provide any decision support for patient safety checks. Electronic medication administration that includes bar coding technology may provide additional safety checks, enable consistent documentation structure, and have additional downstream benefits. Methods: We describe the specialized configuration of clinical informatics systems for electronic chemotherapy medication administration. The system integrates the patient registration system, the inpatient order entry system, the pharmacy information system, the nursing documentation system, and the electronic health record. Results: We describe the process of deploying this infrastructure in the adult and pediatric inpatient oncology, hematology, and bone marrow transplant wards at Vanderbilt University Medical Center. We have successfully adapted the system for the oncology-specific documentation requirements detailed in the ASCO/ONS guidelines for chemotherapy administration. However, several limitations remain with regard to recording the day of treatment and dose number. Conclusion: Overall, the configured systems facilitate compliance with the ASCO/ONS guidelines and improve the consistency of documentation and multidisciplinary team communication. Our success has prompted us to deploy this infrastructure in our outpatient chemotherapy infusion centers, a process that is currently underway and that will require a few unique considerations. PMID:22043185

[Written information for patients: From papers to documents].

PubMed

Cortés-Criado, M C

2014-01-01

There is a high variability in the level of information intended for patients, with different content, format and presentation. To determine the perceived safety of the patients treated at the Country Hospital of Melilla (HCML) and to assess the quality of the documents using criteria adapted to the «International Patient Decision Aid Standards» (IPDAS). Descriptive study of the documents given to patients by the HCML. They included questionnaires on perceived safety, classification of the documents, and the level of adherence to the IPDAS criteria. The Information given to patients during their stay in the HCML, their participation in decision-making, and the information about medication, did not exceed the average on the acceptance scale. Only 40 documents were studied (of the 131 collected), on being published in-house, and were classified, following the definitions of the RAE, into instructions (20), recommendations (14) and guidelines (6). Of these, only the 27.5% showed hospital logo. In the content analysis according to the IPDAS criteria, there was an overall adherence rate of 24.1% in instructions, 24.8% in recommendations, and 61.5% in guidelines. The perception of patient safety expressed in the questionnaire, and its assessment according IPDAS criteria, shows there may be a significant improvement within the organization. Furthermore, the quality of patient documentation provided can help decision making. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Corrective Action Decision Document/Closure Report for Corrective Action Unit 569: Area 3 Yucca Flat Atmospheric Test Sites Nevada National Security Site, Nevada with ROTC 1, Revision 0

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

Sloop, Christy

2013-04-01

This Corrective Action Decision Document/Closure Report presents information supporting the closure of Corrective Action Unit (CAU) 569: Area 3 Yucca Flat Atmospheric Test Sites, Nevada National Security Site, Nevada. CAU 569 comprises the following nine corrective action sites (CASs): • 03-23-09, T-3 Contamination Area • 03-23-10, T-3A Contamination Area • 03-23-11, T-3B Contamination Area • 03-23-12, T-3S Contamination Area • 03-23-13, T-3T Contamination Area • 03-23-14, T-3V Contamination Area • 03-23-15, S-3G Contamination Area • 03-23-16, S-3H Contamination Area • 03-23-21, Pike Contamination Area The purpose of this Corrective Action Decision Document/Closure Report is to provide justification and documentation supportingmore » the recommendation that no further corrective action is needed for CAU 569 based on the implementation of the corrective actions listed in Table ES-2.« less

LEEDS Decision Tools for E-Craft

DTIC Science & Technology

2011-02-15

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

Self-Aligned, Extremely High Frequency III-V Metal-Oxide-Semiconductor Field-Effect Transistors on Rigid and Flexible Substrates

DTIC Science & Technology

2012-06-29

resistances, respectively, and gd is the output conductance. The reduced parasitic capacitances and resistances provided by the self-aligned T-gate design ...Department of the Army position, policy or decision, unless so designated by other documentation. 12. DISTRIBUTION AVAILIBILITY STATEMENT Approved for...position, policy or decision, unless so designated by other documentation. Approved for public release; distribution is unlimited. ... 59654.5-MS-DRP Self

Terahertz Photovoltaic Detection of Cyclotron Resonance in the Regime of Radiation-Induced Magnetoresistance Oscillations

DTIC Science & Technology

2013-06-17

should not contrued as an official Department of the Army position, policy or decision, unless so designated by other documentation. 9. SPONSORING...construed as an official Department of the Army position, policy or decision, unless so designated by other documentation. ... PHYSICAL REVIEW B 87, 245308...oscillations in the diagonal magnetoresistance, Rxx , of the 2DES at cryogenic temperatures, T , with oscillatory nodes near integral and half- integral

Rise and Fall of Decentralized School Governance--Decision-Making Practices in Georgia

ERIC Educational Resources Information Center

Gorgodze, Sophia

2016-01-01

The current study investigates educational decision-making in the former Soviet Republic of Georgia. The focus is on decisions concerning issues of school governance decentralization/recentralization in the period of 2003-2012. The research draws on in-depth interviews with over 20 top decision-makers, and an extensive review of legal documents,…

The willingness and actual situation of Chinese cancer patients and their family members participating in medical decision-making.

PubMed

Zhang, Jie; Yang, Dan; Deng, Yaotiao; Wang, Ying; Deng, Lei; Luo, Xinmei; Zhong, Wuning; Liu, Jie; Wang, Yuqing; Jiang, Yu

2015-12-01

In China, not only patients and physicians are involved in medical decision-making (MDM) but also the patients' family members. The objective is to investigate the willingness and actual situation of cancer patients and their family members participating in the MDM process. In this cross-sectional study, questionnaires were administered to 247 pairs of cancer inpatients and their relatives. Information regarding participants' willingness and actual experience during the decision-making process was documented. Eligible participants were cancer inpatients or their relatives, 18 years of age or older, and informed of the cancer diagnosis. All the patients should have received chemotherapy. The effective response rate was 72.9% (180/247). Over half of the patients (53.3%) and family members (57.8%) were willing to be part of the MDM process. In contrast, only 35.0% of patients and 46.1% of family members actually experienced this process (p = 0.001 and p = 0.011, respectively). Fewer family members (42.2%) than patients (53.3%) believed that patients should be involved in the MDM process (p < 0.001). Patients who were the head of their family (odds ratio 2.577, 95% CI 1.198-5.556, p = 0.015) experienced more involvement in MDM. Although more than half of Chinese cancer patients and family members wanted to be part of MDM, the actual participation was below their expectation. Majority of family members do not want the patients to be involved in the process of MDM. Copyright © 2015 John Wiley & Sons, Ltd.

36 CFR 228.102 - Leasing analyses and decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... decisions. 228.102 Section 228.102 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE MINERALS Oil and Gas Resources Leasing § 228.102 Leasing analyses and decisions. (a) Compliance... further planning in Executive Communication 1504, Ninety-Sixth Congress (House Document No. 96-119...