decision limit ccalpha: Topics by Science.gov

Sample records for decision limit ccalpha

Development and validation of a liquid chromatography-UV detection method for the determination of sulfonamides in fish muscle and shrimp according to European Union Decision 2002/657/EC.

PubMed

Granja, Rodrigo H M M; De Lima, Andreia C; Salerno, Alessandro G; Wanschel, Amarylis C B A

2013-01-01

Sulfonamides are one class of antimicrobial agents used in aquaculture production. Sulfonamides are often overused because they are inexpensive and readily available. Their presence at a concentration above the legal limits is a potential hazard to human health. Brazilian authorities have included in the National Regulatory Monitoring Program the control of the three most widely used sulfonamides in aquaculture production, i.e., sulfathiazole, sulfamethazine, and sulfadimethoxine. An LC method with UV detection for the determination of residual sulfonamides in fish muscle, using sulfapyridine as an internal standard has been developed and validated. The validation was performed according to the Brazilian Regulation 24/2009 (equivalent to European Union Decision 2002/657/EC). The method meets the Brazilian regulatory requirement that establishes criteria and procedures for determination of parameters such as decision limit (CCalpha), detection capability (CCbeta), precision, and recovery. For fish muscle, CCalpha was determined at 3.63, 2.91, and 7.46 microg/kg for sulfathiazole, sulfamethazine, and sulfadimethoxine, respectively. CCbeta was 9.39, 14.54, and 9.39 microg/kg for sulfathiazole, sulfamethazine, and sulfadimethoxine, respectively. For shrimp, CCalpha was 11.5, 8.67, and 4.46 microg/kg for sulfathiazole, sulfamethazine, and sulfadimethoxine, respectively. CCbeta was 18, 11.93, and 5.24 microg/kg for sulfathiazole, sulfamethazine, and sulfadimethoxine, respectively. A complete statistical analysis was performed on the results obtained. The results indicate that the method is robust when subjected to day-to-day analytical variations.
Residue analysis of tetracyclines in poultry muscle: shortcomings revealed by a proficiency test.

PubMed

Berendsen, B J A; Van Rhijn, J A

2006-11-01

A proficiency test for tetracycline drug residues in poultry muscle was organized according to the guidelines of International Laboratory Accreditation Cooperation (ILAC) ILAC-G13:2000 (2000). For the proficiency test, three test materials were prepared. The homogeneity and stability of the materials during the study were demonstrated. Sixteen laboratories accepted the invitation to participate in the proficiency test; 11 laboratories reported results within the time frame of the study. Most notably, only four of the participating laboratories complied with the definition of the maximum residue limit (MRL) concerning the inclusion of 4-epimers as stated in European Commission Regulation 281/96 (1996). Most participants reported values for the decision limit (CCalpha) and detection capability (CCbeta) and hence were already in compliance with European Commission 2002/657/EC (2002) for this aspect of method validation. However, some CCalpha and CCbeta values were not in agreement with the actual within-laboratory reproducibility calculated from the results reported in this proficiency test. Although most laboratories obtained satisfactory results, it is clear that an effort is needed to include 4-epiOTC, 4-epiTC and 4-epiCTC in the analytical methods. Moreover, reconsideration of values determined for CCalpha and CCbeta with respect to their accuracy may be necessary in some cases.
Validated method for determination of eight banned nitroimidazole residues in natural casings by LC/MS/MS with solid-phase extraction.

PubMed

Sun, Hanwen; Wang, Fengchi; Ai, Lianfeng; Guo, Chunhai; Chen, Ruichun

2009-01-01

A sensitive method based on solid-phase extraction-liquid chromatography-tandem mass spectrometry interfaced with electrospray ionization (SPE-LC-MS/MS-ESI) was developed for the simultaneous determination of 8 banned nitroimidazole (NOZ) drugs including metronidazole (MNZ), ronidazole (RNZ), dimetridazole (DMZ), tinidazole, ornidazole, secnidazole, metronidazole-OH (MNZOH, the metabolite of MNZ), and 2-hydroxymethyl-1-methyl-5-nitroimidazole (HMMNI, the metabolite of RNZ and DMZ) in natural casings. After extraction with ethyl acetate and evaporation, the NOZs were reconstituted in ethyl acetate and purified on a strong cation-exchange SPE column, and then LC/MS/MS analysis was performed by positive ESI applying multiple reaction monitoring of 2 transition reactions for each compound. The method was validated according to the European Union requirements (Commission Decision 2002/657/EC). Specificity, linearity, decision limit (CCalpha), detection capability (CCbeta), accuracy, and precision were determined. Average recoveries of the 8 NOZs from natural animal casing fortified at 3 levels (0.1, 0.5, and 1 microg/kg) ranged from 87.3 to 116.5%. The calculated CCalpha for NOZs ranged from 0.029 to 0.049 microg/kg, and CCbeta ranged from 0.049 to 0.083 microg/kg. Repeatability was in the range of 3.35-10.1%, and within-laboratory reproducibility was <10.3%.
Determination of the hormonal growth promoter 17alpha-methyltestosterone in food-producing animals: bovine hair analysis by HPLC-MS/MS.

PubMed

Regal, P; Nebot, C; Vázquez, B I; Cepeda, A; Fente, C A

2010-01-01

This paper describes the development, validation and application of a confirmatory method to detect 17alpha-methyltestosterone (MT) in bovine hair, to aid in controlling the administration of this growth promoter in meat-producing animals. After cryogenic grinding, MT was removed from the hair matrix using a single step extraction procedure with acetonitrile. Hydroxylamine derivatisation was used to enhance analyte determination with an electrospray ionisation (ESI) source. Determination was carried out using a triple quadrupole liquid chromatography tandem mass spectrometer (LC-MS/MS) in multiple reaction monitoring mode (MRM). The method was validated in accordance with the criteria defined in Commission Decision 2002/657/EC and using deuterated testosterone (T-d(3)) as the internal standard. The decision limit (CCalpha) was 0.07 ng g(-1) and the detection capability (CCbeta) was 0.12 ng g(-1). Repeatability was CV% (7%), within-laboratory reproducibility was CV% (11.0%), and trueness was (87%). Applicability of the method was demonstrated in an animal study. Samples obtained from animal experiments were analyzed and the presence of MT was confirmed.
Determination of chloramphenicol residues in meat, seafood, egg, honey, milk, plasma and urine with liquid chromatography-tandem mass spectrometry, and the validation of the method based on 2002/657/EC.

PubMed

Rønning, Helene Thorsen; Einarsen, Kristin; Asp, Tone Normann

2006-06-23

A simple and rapid method for the determination and confirmation of chloramphenicol in several food matrices with LC-MS/MS was developed. Following addition of d5-chloramphenicol as internal standard, meat, seafood, egg, honey and milk samples were extracted with acetonitrile. Chloroform was then added to remove water. After evaporation, the residues were reconstituted in methanol/water (3+4) before injection. The urine and plasma samples were after addition of internal standard applied to a Chem Elut extraction cartridge, eluted with ethyl acetate, and hexane washed. Also these samples were reconstituted in methanol/water (3+4) after evaporation. By using an MRM acquisition method in negative ionization mode, the transitions 321-->152, 321-->194 and 326-->157 were used for quantification, confirmation and internal standard, respectively. Quantification of chloramphenicol positive samples regardless of matrix could be achieved with a common water based calibration curve. The validation of the method was based on EU-decision 2002/657 and different ways of calculating CCalpha and CCbeta were evaluated. The common CCalpha and CCbeta for all matrices were 0.02 and 0.04 microg/kg for the 321-->152 ion transition, and 0.02 and 0.03 microg/kg for the 321-->194 ion transition. At fortification level 0.1 microg/kg the within-laboratory reproducibility is below 25%.
Confirmation of hormones in animal serum by liquid chromatography/tandem mass spectrometry according to European Commission Decision 2002/657.

PubMed

McDonald, Mark; Malone, Edward; McBride, John

2010-01-01

A novel and rapid method was developed and validated for the confirmation of endogenous and synthetic hormones in animal serum using LC/MS/MS. Detection of 17 beta-estradiol and beta-testosterone below the respective European Union-recommended levels of 0.1 and 0.5 microg/L was achieved, as was a required performance level of 0.1 microg/L for 17 alpha-estradiol and 0.5 microg/L for 17 alpha-testosterone, medroxyprogesterone-17-acetate, and progesterone. The method was established with dilution of serum followed by ion-exchange SPE, LC separation and MS detection with electrospray ionization, selected reaction monitoring, and positivelnegative switching. Two characteristic transitions were monitored for each analyte. The method was applied to bovine, ovine, porcine, equine, and avian samples and validated according to European Commission Decision 2002/657/EC and accepted for ISO/IEC 17025:2005 accreditation. An extended calibration curve allows naturally occurring levels of endogenous hormones to be quantified. Recoveries ranged from 97.3% for 17 alpha-testosterone to 102.0% for 17 alpha-estradiol. The decision limit CCalpha ranged from 0.02 microg/L for 17 alpha- and beta-estradiol to 0.12 microg/L for progesterone. Detection capability CCbeta ranged from 0.03 microg/L for 17 a-estradiol to 0.20 microg/L for progesterone.
Determination of anthelmintic drug residues in milk using ultra high performance liquid chromatography-tandem mass spectrometry with rapid polarity switching.

PubMed

Whelan, Michelle; Kinsella, Brian; Furey, Ambrose; Moloney, Mary; Cantwell, Helen; Lehotay, Steven J; Danaher, Martin

2010-07-02

A new UHPLC-MS/MS (ultra high performance liquid chromatography coupled to tandem mass spectrometry) method was developed and validated to detect 38 anthelmintic drug residues, consisting of benzimidazoles, avermectins and flukicides. A modified QuEChERS-type extraction method was developed with an added concentration step to detect most of the analytes at <1 microg kg(-1) levels in milk. Anthelmintic residues were extracted into acetonitrile using magnesium sulphate and sodium chloride to induce liquid-liquid partitioning followed by dispersive solid phase extraction for cleanup. The extract was concentrated into dimethyl sulphoxide, which was used as a keeper to ensure analytes remain in solution. Using rapid polarity switching in electrospray ionisation, a single injection was capable of detecting both positively and negatively charged ions in a 13 min run time. The method was validated at two levels: the unapproved use level and at the maximum residue level (MRL) according to Commission Decision (CD) 2002/657/EC criteria. The decision limit (CCalpha) of the method was in the range of 0.14-1.9 and 11-123 microg kg(-1) for drugs validated at unapproved and MRL levels, respectively. The performance of the method was successfully verified for benzimidazoles and levamisole by participating in a proficiency study.
Development and validation of a solid-phase extraction method coupled to liquid chromatography with fluorescence detection for the determination of fluoroquinolone residues in powdered infant formulae. Application to the analysis of samples from the Spanish and Latin American market.

PubMed

Rodriguez, E; Moreno-Bondi, M C; Marazuela, M D

2008-10-31

This paper describes a new method for the effective extraction, clean-up and chromatographic analysis of residues of four fluoroquinolones (ciprofloxacin, enrofloxacin, danofloxacin and sarafloxacin) in powdered infant formulae and follow-on preparations. Samples were reconstituted following the manufacturer's recommendations and treated with trichloroacetic acid in methanol 10% (w/v) for deproteinization. Two solid-phase extraction cartridges have been evaluated for sample clean-up and preconcentration, Strata Screen A and Strata X and the later provided the best recoveries for all the analytes tested. Chromatographic analysis has been carried out using a polar endcapped column (AQUA C(18)) and fluorescence detection, with lomefloxacin (LOME) as internal standard. Method validation has been performed according to European Commission Decision 2002/657/EC criteria, in terms of linearity, recovery, precision, specificity, decision limit (CC(alpha)) and detection capability (CC(beta)). Typical recoveries ranged between 70 and 110% at levels below and above the maximum residue limits of the target analytes in bovine milk, with an excellent intralab reproducibility (RSDs<7%). Matrix effects did not significantly affect method accuracy, as evidenced by analyzing different brands of milk. The method has been successfully applied to the analysis of 100 samples of infant and follow-on formulae of the Spanish and Latin American market, using LC-MS/MS as confirmatory technique.
Validation of a confirmatory method for the determination of residues of four nitrofurans in egg by liquid chromatography-tandem mass spectrometry with the software InterVal.

PubMed

Bock, C; Stachel, C; Gowik, P

2007-03-14

A method for the detection and determination of nitrofuran derivatives in egg by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was validated with the software InterVal and can be applied for the confirmation of nitrofuran metabolites in fresh or lyophilised eggs. The validation study comprises variations in operator, storage condition, breeding, equipment and duration of sample preparation. A comprehensive overview of the robustness of the method is obtained by analysing eight samples at six concentration levels. First results of short- and medium-term investigations for stability of analytes in solution show that standard solutions of nitrofuran metabolites are stable for at least 1 year when stored at +4 degrees C in the dark. The decision limit CCalpha expressed for the underivatised metabolite is 0.05 microg kg(-1) for 3-amino-5-methyl-morpholino-2-oxazolidinone, 0.03 microg kg(-1) for 3-amino-2-oxazolidinone, 0.20 microg kg(-1) for semicarbazide and 0.22 microg kg(-1) for 1-amino-hydantoin.
Development and validation of a liquid chromatography-tandem mass spectrometry method for the separation of conjugated and unconjugated 17alpha- and 17beta-boldenone in urine sample.

PubMed

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

2007-03-14

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

PubMed

Delatour, Thierry; Périsset, Adrienne; Goldmann, Till; Riediker, Sonja; Stadler, Richard H

2004-07-28

An improved sample preparation (extraction and cleanup) is presented that enables the quantification of low levels of acrylamide in difficult matrixes, including soluble chocolate powder, cocoa, coffee, and coffee surrogate. Final analysis is done by isotope-dilution liquid chromatography-electrospray ionization tandem mass spectrometry (LC-MS/MS) using d3-acrylamide as internal standard. Sample pretreatment essentially encompasses (a) protein precipitation with Carrez I and II solutions, (b) extraction of the analyte into ethyl acetate, and (c) solid-phase extraction on a Multimode cartridge. The stability of acrylamide in final extracts and in certain commercial foods and beverages is also reported. This approach provided good performance in terms of linearity, accuracy and precision. Full validation was conducted in soluble chocolate powder, achieving a decision limit (CCalpha) and detection capability (CCbeta) of 9.2 and 12.5 microg/kg, respectively. The method was extended to the analysis of acrylamide in various foodstuffs such as mashed potatoes, crisp bread, and butter biscuit and cookies. Furthermore, the accuracy of the method is demonstrated by the results obtained in three inter-laboratory proficiency tests. Copyright 2004 American Chemical Society
Quantitative determination of four nitrofuran metabolites in meat by isotope dilution liquid chromatography-electrospray ionisation-tandem mass spectrometry.

PubMed

Mottier, Pascal; Khong, Seu-Ping; Gremaud, Eric; Richoz, Janique; Delatour, Thierry; Goldmann, Till; Guy, Philippe A

2005-03-04

A confirmatory method based on isotope dilution liquid chromatography-tandem mass spectrometry (LC-MS/MS) has been developed for the low-level determination of residues of four nitrofuran veterinary drugs in meat, e.g., furazolidone, furaltadone, nitrofurantoin, and nitrofurazone. The procedure entails an acid-catalysed release of protein-bound metabolites, followed by their in situ conversion into the 2-nitrobenzaldehyde (NBA) imine-type derivatives. Liquid-liquid extraction and clean-up on a polymeric solid phase extraction cartridge are then performed before LC-MS/MS analysis by positive electrospray ionisation (ESI) applying multiple reaction monitoring of three transition reactions for each compound. Reliable quantitation is obtained by using one deuterated analogue per analyte (d4-NBA derivative) as internal standard (IS). Validation of the method in chicken meat was conducted following the European Union (EU) criteria for the analysis of veterinary drug residues in foods. The decision limits (CCalpha) were 0.11-0.21 microg/kg, and the detection capabilities (CCbeta) 0.19-0.36 microg/kg, thus below the minimum required performance limit (MRPL) set at 1 microg/kg by the EU. The method is robust and suitable for routine quality control operations, and more than 200 sample injections were performed without excessive pollution of the mass spectrometer or loss of LC column performance.
Validation of a liquid chromatography-tandem mass spectrometry method for the identification and quantification of 5-nitroimidazole drugs and their corresponding hydroxy metabolites in lyophilised pork meat.

PubMed

Zeleny, Reinhard; Harbeck, Stefan; Schimmel, Heinz

2009-01-09

A liquid chromatography-electrospray ionisation tandem mass spectrometry method for the simultaneous detection and quantitation of 5-nitroimidazole veterinary drugs in lyophilised pork meat, the chosen format of a candidate certified reference material, has been developed and validated. Six analytes have been included in the scope of validation, i.e. dimetridazole (DMZ), metronidazole (MNZ), ronidazole (RNZ), hydroxymetronidazole (MNZOH), hydroxyipronidazole (IPZOH), and 2-hydroxymethyl-1-methyl-5-nitroimidazole (HMMNI). The analytes were extracted from the sample with ethyl acetate, chromatographically separated on a C(18) column, and finally identified and quantified by tandem mass spectrometry in the multiple reaction monitoring mode (MRM) using matrix-matched calibration and (2)H(3)-labelled analogues of the analytes (except for MNZOH, where [(2)H(3)]MNZ was used). The method was validated in accordance with Commission Decision 2002/657/EC, by determining selectivity, linearity, matrix effect, apparent recovery, repeatability and intermediate precision, decision limits and detection capabilities, robustness of sample preparation method, and stability of extracts. Recovery at 1 microg/kg level was at 100% (estimates in the range of 101-107%) for all analytes, repeatabilities and intermediate precisions at this level were in the range of 4-12% and 2-9%, respectively. Linearity of calibration curves in the working range 0.5-10 microg/kg was confirmed, with r values typically >0.99. Decision limits (CCalpha) and detection capabilities (CCbeta) according to ISO 11843-2 (calibration curve approach) were 0.29-0.44 and 0.36-0.54 microg/kg, respectively. The method reliably identifies and quantifies the selected nitroimidazoles in the reconstituted pork meat in the low and sub-microg/kg range and will be applied in an interlaboratory comparison for determining the mass fraction of the selected nitroimidazoles in the candidate reference material currently developed at IRMM.
A confirmatory method for the simultaneous extraction, separation, identification and quantification of Tetracycline, Sulphonamide, Trimethoprim and Dapsone residues in muscle by ultra-high-performance liquid chromatography-tandem mass spectrometry according to Commission Decision 2002/657/EC.

PubMed

McDonald, Mark; Mannion, Celine; Rafter, Paul

2009-11-13

A rapid confirmatory multi-residue method for the analysis of tetracyclines, sulphonamides, trimethoprim and dapsone by UPLC-MS/MS is described. The method is able to quantify and confirm the following 19 compounds, oxytetracycline, tetracycline, chlortetracycline, doxycycline, sulfadiazine, sulfathiazole, sulfapyridine, trimethoprim, sulfamerazine, sulfamethizole, sulfamethazine, sulfamethoxypyridazine, sulfamonomethoxine, sulfachlorpyridazine, dapsone, sulfamethoxazole, sulfisoxazole, sulfaquinoxaline and sulfadimethoxine. Samples are extracted with 0.1M EDTA and acetonitrile, which is then evaporated under a stream of nitrogen and reconstituted in water. Following centrifugation and filtering, an aliquot is analysed by UPLC-MS/MS using positive electrospray ionisation and multiple reaction monitoring. The method is deemed rapid as all analytes are extracted by a single extraction technique, with no solid-phase extraction clean up required. Validation is according to Commission Decision 2002/657/EC and was carried out for bovine, porcine, ovine and poultry species. Specificity, recovery, repeatability, reproducibility, CCalpha and CCbeta data is presented.
Development and validation of a method for fipronil residue determination in ovine plasma using 96-well plate solid-phase extraction and gas chromatography-tandem mass spectrometry.

PubMed

Bichon, E; Richard, C A; Le Bizec, B

2008-08-01

Fipronil, a phenylpyrazole insecticide introduced for pest control on a broad range of crops, undergoes a reinforcement of the regulation within the European Union (2007/52/EC directive) due to its potential effects on environment and human health. In order to assess the plasmatic concentrations of fipronil residues (sulfone, sulfide, fipronil, desulfinyl and amide) in ovine, a methodology based on gas chromatography coupled with tandem mass spectrometry (GC-MS/MS) was developed and validated according to the European standard (2002/657/EC). The proposed method allows a large number of samples to be treated concurrently (n=80) using a reduced sample amounts (0.2 mL), and consents to reach a level of quantification of 0.1 pg microL(-1). The sample preparation consisted of a single solid-phase extraction (SPE) purification on a 96-well plate filled with a styrene-divinyl-benzene phase. Linearity was demonstrated all along the investigated range of concentrations, i.e. from 0.25 to 2000 pg microL(-1), with coefficient of determination (R(2)) from 0.977 to 0.994, depending on target analytes. Calculated decision limit (CCalpha) and detection capability (CCbeta) for fipronil, sulfone and sulphide were in the range 0.05-0.16 and 0.28-0.73 pg microL(-1) respectively.
Determination of nifursol metabolites in poultry muscle and liver tissue. Development and validation of a confirmatory method.

PubMed

Mulder, P P J; Zuidema, T; Keestra, N G M; Kooij, P J F; Elbers, I J W; van Rhijn, J A

2005-05-01

A method is described for the identification and quantitative determination of 3,5-dinitrosalicylic acid hydrazide (DSH), the marker residue of nifursol metabolites in poultry (turkey, broiler) muscle and liver tissue. The method is based on the acid-catalysed hydrolysis of tissue-bound metabolites to free DSH and in situ derivatisation with 2-nitrobenzaldehyde to the corresponding nitrophenyl derivative NPDSH. A structural analogue of DSH, 4-hydroxy-3,5-dinitrobenzoic acid hydrazide (HBH) was synthesised to serve as an internal standard. The analytes were isolated from the matrix by liquid-liquid extraction with ethyl acetate. Determination was performed by LC-MS/MS with negative electrospray ionisation. The [M - H](+) ions of NPDSH and NPHBH at m/z 374 were fragmented by collision induced dissociation (CID) producing transition ions at m/z 182, 183 and 226. The transition ions at m/z 182 and 226 were selected for monitoring of NPDSH while the transition ion at m/z 183 was selected for NPHBH. The method has been validated according to the EU criteria of Commission Decision 2002/657/EC at 0.5, 1.0 and 1.5 microg kg(-1) in muscle and liver tissue. A decision limit (CC(alpha)) was obtained of 0.04 and 0.025 microg kg(-1) in muscle and liver, respectively. Similarly a detection capability (CC(beta)) was obtained of 0.10 and 0.05 microg kg(-1) in muscle and liver, respectively. The introduction of HBH as an internal standard did not lead to a significant improvement of the quantitative performance of the method. In fact for liver better performance characteristics were obtained when the IS was not taken into account. Nevertheless, as a qualitative marker for recovery, HBH could still be very useful in the analysis of unknown samples.
Criteria to distinguish between natural situations and illegal use of boldenone, boldenone esters and boldione in cattle 2. Direct measurement of 17beta-boldenone sulpho-conjugate in calf urine by liquid chromatography--high resolution and tandem mass spectrometry.

PubMed

Destrez, Blandine; Bichon, Emmanuelle; Rambaud, Lauriane; Courant, Frédérique; Monteau, Fabrice; Pinel, Gaud; Antignac, Jean-Philippe; Le Bizec, Bruno

2009-10-01

Boldenone is banned in the European Union (Directive 96/22/EC) as growth promoter for meat producing animals. Boldione (ADD), boldenone and boldenone esters (mainly the undecylenate form) are commercially available as anabolic preparations, either to the destination of human, horse or cattle. Since the late 90s, the natural occurrence of boldenone metabolites has been reported in cattle. According to EU regulation, the unambiguous demonstration of boldenone administration in bovine urine should be provided on the basis of boldenone identification in the corresponding conjugate fraction. An analytical method has been developed and validated according to current standards with main concern to the measurement of intact 17beta-boldenone-sulphate. The analytical procedure included direct extraction-purification of target analyte on octadecylsilyl cartridges and direct detection of phase II metabolite by liquid chromatography (negative electrospray), tandem mass spectrometry (QqQ) or high resolution mass spectrometry (Orbitrap). Decision limit (CCalpha) and detection capability (CCbeta) were respectively 0.2 microg L(-1) and 0.4 microg L(-1) on triple quadrupole and 0.1 microg L(-1) and 0.2 microg L(-1) on hybrid system. The method was successfully applied to the analysis of incurred samples collected in different experiments. 17beta-Boldenone-sulphate was measurable up to 36h after oral administration of boldione, and 30 days after 17beta-boldenone undecylenate intra-muscular injection. This conjugate form was never detected in non-treated animals, confirming its status of definitive candidate marker for boldenone administration in calf.
Validation of an off line solid phase extraction liquid chromatography-tandem mass spectrometry method for the determination of systemic insecticide residues in honey and pollen samples collected in apiaries from NW Spain.

PubMed

García-Chao, María; Agruña, María Jesús; Flores Calvete, Gonzalo; Sakkas, Vasilis; Llompart, María; Dagnac, Thierry

2010-07-05

The use of pesticides to protect crops against plagues and insects is one of the most important ways to assure agricultural quality and productivity. However, bad application practices may cause the contamination of different environmental compartments and animal species, as a consequence of migration or accumulation of those compounds. Fipronil, imidacloprid and thiametoxam are systemic or systemic-like insecticides widely used in maize crops. Their heavy action in the nervous system of target insects also means a high toxicity to non-target pollinator insects such as honey bees which can get in touch with them through pollen and nectar during foraging activities. These insecticides have even been suspected to cause a significant decrease of honeybee colonies that has been observed in many countries since the past decade. Since September 1st 2008, the European Commission set new MRLs in food and feed of plant and animal origin. The pesticides included in this study have MRLs in honey and pollen between 10 and 50 ng g(-1). In the present work, an analytical method was developed with the aim of determining residues of fipronil and some of its metabolites (fipronil sulfone, fipronil sulfide, fipronil desulfinyl and fipronil carboxamide), thiamethoxam and imidacloprid in honey and pollen samples. The extraction optimization was performed using a Doehlert experimental design by studying two factors, the mixture and the ratio of solvents used. Prior to the extraction procedure, raw hive samples containing honey, pollen and wax were centrifuged at 4000 rpm. The upper solid material was removed, and 1 g of the lower phase was mixed with 3 mL of the optimized mixture of methanol/water (10/90). The extract was passed through a florisil cartridge and the target compounds were eluted with methanol and analysed by LC-MS/MS in selective reaction monitoring (SRM) mode. The method was validated according to the guidelines included in the SANCO/10684/2009 document and the ISO 11843 standard for the following parameters: decision limit (CCalpha), detection capability (CCbeta), recovery, repeatability and reproducibility at 0.5, 1 and 1.5 folds the MRLs. Ion suppression/enhancement effects into the ion source were also assessed. The CCbeta values were included between 0.83 and 4.83 ng g(-1), well below the current MRLs. The validated method was applied to the determination of the target pesticides in 91 samples collected in colonies from 73 apiaries of NW Spain (two sampling campaigns during 2008). None of the target insecticides were detected among all the collected samples. Copyright 2010 Elsevier B.V. All rights reserved.
A MDMP for All Seasons: Modifying the MDMP for Success

DTIC Science & Technology

2004-05-26

4 Rational Decision - Making Theory ............................................................................. 5 Limited Rationality ... making instead of using the MDMP, which is an analytical decision - making process. Limited rationality and analytical decision - making will be discussed...limited rationality decision - making theories. FM 5.0 defines fundamentals of planning, such as commander’s involvement and developing creative plans
28 CFR 40.7 - Operation and decision.

Code of Federal Regulations, 2010 CFR

2010-07-01

... review. (e) Fixed time limits. Responses shall be made within fixed time limits at each level of decision. Time limits may vary between institutions, but expeditious processing of grievances at each level of..., written responses. Each grievance shall be answered in writing at each level of decision and review. The...

42 CFR 456.126 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.126 Time limits for final... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...
42 CFR 456.137 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Continued Stay § 456.137 Time limits for final... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...
42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for final decision and notification of...
42 CFR 456.137 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Continued Stay § 456.137 Time limits for final... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for final decision and notification of...
42 CFR 456.126 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Ur Plan: Review of Need for Admission 1 § 456.126 Time limits for final... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for final decision and notification of...
Satisficing in Split-Second Decision Making Is Characterized by Strategic Cue Discounting

ERIC Educational Resources Information Center

Oh, Hanna; Beck, Jeffrey M.; Zhu, Pingping; Sommer, Marc A.; Ferrari, Silvia; Egner, Tobias

2016-01-01

Much of our real-life decision making is bounded by uncertain information, limitations in cognitive resources, and a lack of time to allocate to the decision process. It is thought that humans overcome these limitations through "satisficing," fast but "good-enough" heuristic decision making that prioritizes some sources of…
Do neonatologists limit parental decision-making authority? A Canadian perspective.

PubMed

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

2010-12-01

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

PubMed

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

2018-03-17

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

PubMed

Darby, R Ryan; Dickerson, Bradford C

After participating in this activity, learners should be better able to:• Assess the neuropsychological literature on decision making and the medical and legal assessment of capacity in patients with dementia• Identify the limitations of integrating findings from decision-making research into capacity assessments for patients with dementia ABSTRACT: Medical and legal professionals face the challenge of assessing capacity and competency to make medical, legal, and financial decisions in dementia patients with impaired decision making. While such assessments have classically focused on the capacity for complex reasoning and executive functions, research in decision making has revealed that motivational and metacognitive processes are also important. We first briefly review the neuropsychological literature on decision making and on the medical and legal assessment of capacity. Next, we discuss the limitations of integrating findings from decision-making research into capacity assessments, including the group-to-individual inference problem, the unclear role of neuroimaging in capacity assessments, and the lack of capacity measures that integrate important facets of decision making. Finally, we present several case examples where we attempt to demonstrate the potential benefits and important limitations of using decision-making research to aid in capacity determinations.
Confirmatory analysis of 17beta-boldenone, 17alpha-boldenone and androsta-1,4-diene-3,17-dione in bovine urine, faeces, feed and skin swab samples by liquid chromatography-electrospray ionisation tandem mass spectrometry.

PubMed

Nielen, Michel W F; Rutgers, Paula; van Bennekom, Eric O; Lasaroms, Johan J P; van Rhijn, J A Hans

2004-03-05

The origin, i.e. natural occurrence or illegal treatment, of findings of 17alpha-boldenone (alpha-Bol) and 17beta-boldenone (beta-Bol) in urine and faeces of cattle is under debate within the European Union. A liquid chromatographic positive ion electrospray tandem mass spectrometric method is presented for the confirmatory analysis of 17beta-boldenone, 17alpha-boldenone and an important metabolite/precursor androsta-1,4-diene-3,17-dione (ADD), using deuterium-labelled 17beta-boldenone (beta-Bol-d3) as internal standard. Detailed sample preparation procedures were developed for a variety of sample matrices such as bovine urine, faeces, feed and skin swab samples. The method was validated as a quantitative confirmatory method according to the latest EU guidelines and shows good precision, linearity and accuracy data, and CCalpha and CCbeta values of 0.1-0.3 and 0.4-1.0 ng/ml, respectively. Currently, the method has been successfully applied to suspect urine samples for more than a year, and occasionally to faeces, feed and swab samples as well. Results obtained from untreated and treated animals are given and their impact on the debate about the origin of residues of 17beta-boldenone is critically discussed. Finally, preliminary data about the degree of conjugation of boldenone residues are presented and a simple procedure for discrimination between residues from abuse versus natural origin is proposed.
The limits of parental responsibility regarding medical treatment decisions.

PubMed

Woolley, Sarah L

2011-11-01

Parental responsibility (PR) was a concept introduced by the Children Act (CA) 1989 which aimed to replace the outdated notion of parental rights and duties which regarded children as parental possessions. Section 3(1) CA 1989 defines PR as 'all the rights, duties, powers, responsibilities and authority which by law a parent of a child has in relation to the child'. In exercising PR, individuals may make medical treatment decisions on children's behalf. Medical decision-making is one area of law where both children and the state can intercede and limit parental decision-making. Competent children can consent to treatment and the state can interfere if parental decisions are not seemingly in the child's 'best interests'. This article examines the concept, and limitations, of PR in relation to medical treatment decision-making.
42 CFR 405.1875 - Administrator review.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Appeals § 405.1875 Administrator review. (a) Basic rule: Time limit for rendering Administrator decisions... after the date the party making the request received the Board's decision or other reviewable action... decision or other reviewable matter. (ii) Any submission must be limited to the issues accepted for...
20 CFR 260.7 - Time limits for issuing a decision when a hearing is not held.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 1 2011-04-01 2011-04-01 false Time limits for issuing a decision when a hearing is not held. 260.7 Section 260.7 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT REQUESTS FOR RECONSIDERATION AND APPEALS WITHIN THE BOARD § 260.7 Time limits for issuing a decision when a hearing is...
20 CFR 260.7 - Time limits for issuing a decision when a hearing is not held.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 1 2012-04-01 2012-04-01 false Time limits for issuing a decision when a hearing is not held. 260.7 Section 260.7 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT REQUESTS FOR RECONSIDERATION AND APPEALS WITHIN THE BOARD § 260.7 Time limits for issuing a decision when a hearing is...
20 CFR 260.7 - Time limits for issuing a decision when a hearing is not held.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Time limits for issuing a decision when a hearing is not held. 260.7 Section 260.7 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT REQUESTS FOR RECONSIDERATION AND APPEALS WITHIN THE BOARD § 260.7 Time limits for issuing a decision when a hearing is...
Role of Technology in Decision Making: Exploring Land-Use Decisions

ERIC Educational Resources Information Center

Zaino, Maureen A.

2012-01-01

Increases in population, climatic changes, and other environmental issues are current challenges affecting the U.S. Geological Survey's (USGS) decision to examine land-use trends and emphasize efficient use and reuse of limited resources. Because of global concerns involving limited natural resources, researchers recognize land-use decision…
50 CFR 665.801 - Permits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... qualifying for, or renewing, limited access permits. In making such decision, the Administrator will review... American Samoa longline limited access permit initial permit decision, the Regional Administrator will... Hawaii longline limited access permit if that vessel is used: (1) To fish for western Pacific pelagic MUS...
Analysis of the decision-making process of nurse managers: a collective reflection.

PubMed

Eduardo, Elizabete Araujo; Peres, Aida Maris; de Almeida, Maria de Lourdes; Roglio, Karina de Dea; Bernardino, Elizabeth

2015-01-01

to analyze the decision-making model adopted by nurses from the perspective of some decision-making process theories. qualitative approach, based on action research. Semi-structured questionnaires and seminars were conducted from April to June 2012 in order to understand the nature of decisions and the decision-making process of nine nurses in position of managers at a public hospital in Southern Brazil. Data were subjected to content analysis. data were classified in two categories: the current situation of decision-making, which showed a lack of systematization; the construction and collective decision-making, which emphasizes the need to develop a decision-making model. the decision-making model used by nurses is limited because it does not consider two important factors: the limits of human rationality, and the external and internal organizational environments that influence and determine right decisions.
Reproductive Information and Reproductive Decision-Making.

PubMed

Mehlman, Maxwell J

2015-01-01

Opponents of reproductive choice are attempting to limit reproductive decisions based on certain underlying reasons. This commentary explores the rationales for these limitations and the objections to them. It concludes that reasoned-based limitations are unsupportable and unenforceable. © 2015 American Society of Law, Medicine & Ethics, Inc.
The effect of statutory limitations on the authority of substitute decision makers on the care of patients in the intensive care unit: case examples and review of state laws affecting withdrawing or withholding life-sustaining treatment.

PubMed

Venkat, Arvind; Becker, Julianna

2014-01-01

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

Decentralisation of Health Services in Fiji: A Decision Space Analysis.

PubMed

Mohammed, Jalal; North, Nicola; Ashton, Toni

2015-11-15

Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision. Using a modified decision space approach developed by Bossert, this study measures decision space created in five broad categories (finance, service organisation, human resources, access rules, and governance rules) within the decentralised services. Fiji's centrally managed historical-based allocation of financial resources and management of human resources resulted in no decision space for decentralised agents. Narrow decision space was created in the service organisation category where, with limited decision space created over access rules, Fiji has seen greater usage of its decentralised health centres. There remains limited decision space in governance. The current wave of decentralisation reveals that, whilst the workload has shifted from the tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative authority, suggesting that Fiji's deconcentration reflects the transfer of workload only with decision-making in the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and providers are likely to be limited. © 2016 by Kerman University of Medical Sciences.
The application of system dynamics modelling to environmental health decision-making and policy - a scoping review.

PubMed

Currie, Danielle J; Smith, Carl; Jagals, Paul

2018-03-27

Policy and decision-making processes are routinely challenged by the complex and dynamic nature of environmental health problems. System dynamics modelling has demonstrated considerable value across a number of different fields to help decision-makers understand and predict the dynamic behaviour of complex systems in support the development of effective policy actions. In this scoping review we investigate if, and in what contexts, system dynamics modelling is being used to inform policy or decision-making processes related to environmental health. Four electronic databases and the grey literature were systematically searched to identify studies that intersect the areas environmental health, system dynamics modelling, and decision-making. Studies identified in the initial screening were further screened for their contextual, methodological and application-related relevancy. Studies deemed 'relevant' or 'highly relevant' according to all three criteria were included in this review. Key themes related to the rationale, impact and limitation of using system dynamics in the context of environmental health decision-making and policy were analysed. We identified a limited number of relevant studies (n = 15), two-thirds of which were conducted between 2011 and 2016. The majority of applications occurred in non-health related sectors (n = 9) including transportation, public utilities, water, housing, food, agriculture, and urban and regional planning. Applications were primarily targeted at micro-level (local, community or grassroots) decision-making processes (n = 9), with macro-level (national or international) decision-making to a lesser degree. There was significant heterogeneity in the stated rationales for using system dynamics and the intended impact of the system dynamics model on decision-making processes. A series of user-related, technical and application-related limitations and challenges were identified. None of the reported limitations or challenges appeared unique to the application of system dynamics within the context of environmental health problems, but rather to the use of system dynamics in general. This review reveals that while system dynamics modelling is increasingly being used to inform decision-making related to environmental health, applications are currently limited. Greater application of system dynamics within this context is needed before its benefits and limitations can be fully understood.
42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...
42 CFR 456.438 - Time limits for notification of adverse decision.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 4 2011-10-01 2011-10-01 false Time limits for notification of adverse decision... AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Ur Plan: Review of Need for Continued Stay § 456.438 Time limits for notification...
78 FR 77450 - Fannie Mae and Freddie Mac Loan Purchase Limits: Request for Public Input on Implementation Issues

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-23

... reductions in Freddie Mac's and Fannie Mae's loan purchase limits. In short, no final decision on loan... decision to direct the setting of new and lower loan purchase limits by the Enterprises. A Plan for Setting... FEDERAL HOUSING FINANCE AGENCY [No. 2013-N-18] Fannie Mae and Freddie Mac Loan Purchase Limits...
10 CFR 2.649 - Partial decisions on limited work authorization.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Certain Utilization Facilities; and Advance Issuance of Limited Work Authorizations Phased Applications... same time as in the case of a full decision relating to the issuance of a construction permit or...
Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study.

PubMed

Aladangady, Narendra; Shaw, Chloe; Gallagher, Katie; Stokoe, Elizabeth; Marlow, Neil

2017-03-01

To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST). Prospective multicentre observational study. Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network. A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit. Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies. Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST. A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Use of structured decision-making to explicitly incorporate environmental process understanding in management of coastal restoration projects: Case study on barrier islands of the northern Gulf of Mexico.

PubMed

Dalyander, P Soupy; Meyers, Michelle; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark; Ford, Mark

2016-12-01

Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework. Published by Elsevier Ltd.
Use of structured decision-making to explicitly incorporate environmental process understanding in management of coastal restoration projects: Case study on barrier islands of the northern Gulf of Mexico

USGS Publications Warehouse

Dalyander, P. Soupy; Meyers, Michelle B.; Mattsson, Brady; Steyer, Gregory; Godsey, Elizabeth; McDonald, Justin; Byrnes, Mark R.; Ford, Mark

2016-01-01

Coastal ecosystem management typically relies on subjective interpretation of scientific understanding, with limited methods for explicitly incorporating process knowledge into decisions that must meet multiple, potentially competing stakeholder objectives. Conversely, the scientific community lacks methods for identifying which advancements in system understanding would have the highest value to decision-makers. A case in point is barrier island restoration, where decision-makers lack tools to objectively use system understanding to determine how to optimally use limited contingency funds when project construction in this dynamic environment does not proceed as expected. In this study, collaborative structured decision-making (SDM) was evaluated as an approach to incorporate process understanding into mid-construction decisions and to identify priority gaps in knowledge from a management perspective. The focus was a barrier island restoration project at Ship Island, Mississippi, where sand will be used to close an extensive breach that currently divides the island. SDM was used to estimate damage that may occur during construction, and guide repair decisions within the confines of limited availability of sand and funding to minimize adverse impacts to project objectives. Sand was identified as more limiting than funds, and unrepaired major breaching would negatively impact objectives. Repairing minor damage immediately was determined to be generally more cost effective (depending on the longshore extent) than risking more damage to a weakened project. Key gaps in process-understanding relative to project management were identified as the relationship of island width to breach formation; the amounts of sand lost during breaching, lowering, or narrowing of the berm; the potential for minor breaches to self-heal versus developing into a major breach; and the relationship between upstream nourishment and resiliency of the berm to storms. This application is a prototype for using structured decision-making in support of engineering projects in dynamic environments where mid-construction decisions may arise; highlights uncertainty about barrier island physical processes that limit the ability to make robust decisions; and demonstrates the potential for direct incorporation of process-based models in a formal adaptive management decision framework.
The development of decision limits for the GH-2000 detection methodology using additional insulin-like growth factor-I and amino-terminal pro-peptide of type III collagen assays.

PubMed

Holt, Richard I G; Böhning, Walailuck; Guha, Nishan; Bartlett, Christiaan; Cowan, David A; Giraud, Sylvain; Bassett, E Eryl; Sönksen, Peter H; Böhning, Dankmar

2015-09-01

The GH-2000 and GH-2004 projects have developed a method for detecting GH misuse based on measuring insulin-like growth factor-I (IGF-I) and the amino-terminal pro-peptide of type III collagen (P-III-NP). The objectives were to analyze more samples from elite athletes to improve the reliability of the decision limit estimates, to evaluate whether the existing decision limits needed revision, and to validate further non-radioisotopic assays for these markers. The study included 998 male and 931 female elite athletes. Blood samples were collected according to World Anti-Doping Agency (WADA) guidelines at various sporting events including the 2011 International Association of Athletics Federations (IAAF) World Athletics Championships in Daegu, South Korea. IGF-I was measured by the Immunotech A15729 IGF-I IRMA, the Immunodiagnostic Systems iSYS IGF-I assay and a recently developed mass spectrometry (LC-MS/MS) method. P-III-NP was measured by the Cisbio RIA-gnost P-III-P, Orion UniQ™ PIIINP RIA and Siemens ADVIA Centaur P-III-NP assays. The GH-2000 score decision limits were developed using existing statistical techniques. Decision limits were determined using a specificity of 99.99% and an allowance for uncertainty because of the finite sample size. The revised Immunotech IGF-I - Orion P-III-NP assay combination decision limit did not change significantly following the addition of the new samples. The new decision limits are applied to currently available non-radioisotopic assays to measure IGF-I and P-III-NP in elite athletes, which should allow wider flexibility to implement the GH-2000 marker test for GH misuse while providing some resilience against manufacturer withdrawal or change of assays. Copyright © 2015 John Wiley & Sons, Ltd.
The ultimate veal calf reference experiment: hormone residue analysis data obtained by gas and liquid chromatography tandem mass spectrometry.

PubMed

Nielen, Michel W F; Lasaroms, Johan J P; Essers, Martien L; Sanders, Marieke B; Heskamp, Henri H; Bovee, Toine F H; van Rhijn, J Hans; Groot, Maria J

2007-03-14

A lifetime controlled reference experiment has been performed using 42 veal calves, 21 males and 21 females which were fed and housed according to European regulations and common veterinary practice. During the experiment feed, water, urine and hair were sampled and feed intake and growth were monitored. Thus for the first time residue analysis data were obtained from guaranteed lifetime-untreated animals. The analysis was focused on the natural hormones estradiol and testosterone and their metabolites, on 17beta- and 17alpha-nortestosterone, on 17beta- and 17alpha-boldenone and androsta-1,4-diene-3,17-dione (ADD), and carried out by gas chromatography tandem mass spectrometry (GC/MS/MS), an estrogen bioassay and liquid chromatography (LC) MS/MS. Feed, water and hair samples were negative for the residues tested. Female calf urines showed occasionally low levels of 17alpha-estradiol and 17alpha-testosterone. On one particular sampling day male veal calf urines showed very high levels of 17alpha-testosterone (up to 1000 ng mL(-1)), accompanied by lower levels of estrone and 17beta-testosterone. Despite these extreme levels of natural testosterone, 17beta-boldenone was never detected in the same urine samples; even 17alpha-boldenone and ADD were only occasionally beyond CCalpha (maximum levels 2.7 ng mL(-1)). The data from this unique experiment provide a set of reference values for steroid hormones in calf urine and demonstrate that 17beta-boldenone is not a naturally occurring compound in urine samples.
Memory-based decision-making with heuristics: evidence for a controlled activation of memory representations.

PubMed

Khader, Patrick H; Pachur, Thorsten; Meier, Stefanie; Bien, Siegfried; Jost, Kerstin; Rösler, Frank

2011-11-01

Many of our daily decisions are memory based, that is, the attribute information about the decision alternatives has to be recalled. Behavioral studies suggest that for such decisions we often use simple strategies (heuristics) that rely on controlled and limited information search. It is assumed that these heuristics simplify decision-making by activating long-term memory representations of only those attributes that are necessary for the decision. However, from behavioral studies alone, it is unclear whether using heuristics is indeed associated with limited memory search. The present study tested this assumption by monitoring the activation of specific long-term-memory representations with fMRI while participants made memory-based decisions using the "take-the-best" heuristic. For different decision trials, different numbers and types of information had to be retrieved and processed. The attributes consisted of visual information known to be represented in different parts of the posterior cortex. We found that the amount of information required for a decision was mirrored by a parametric activation of the dorsolateral PFC. Such a parametric pattern was also observed in all posterior areas, suggesting that activation was not limited to those attributes required for a decision. However, the posterior increases were systematically modulated by the relative importance of the information for making a decision. These findings suggest that memory-based decision-making is mediated by the dorsolateral PFC, which selectively controls posterior storage areas. In addition, the systematic modulations of the posterior activations indicate a selective boosting of activation of decision-relevant attributes.
42 CFR 456.238 - Time limits for final decision and notification of adverse decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Ur Plan: Review of Need for Continued Stay § 456.238 Time limits for...
Iowa pavement asset management decision-making framework.

DOT National Transportation Integrated Search

2015-10-01

Most local agencies in Iowa currently make their pavement treatment decisions based on their limited experience due primarily to : lack of a systematic decision-making framework and a decision-aid tool. The lack of objective condition assessment data...
13 CFR 125.10 - Who does SBA consider to control an SDVO SBC?

Code of Federal Regulations, 2010 CFR

2010-01-01

... partners, with control over all partnership decisions. (d) Control over a limited liability company. In the case of a limited liability company, one or more service-disabled veterans (or in the case of a veteran... managing members, with control over all decisions of the limited liability company. (e) Control over a...
Cognitive load reducing in destination decision system

NASA Astrophysics Data System (ADS)

Wu, Chunhua; Wang, Cong; Jiang, Qien; Wang, Jian; Chen, Hong

2007-12-01

With limited cognitive resource, the quantity of information can be processed by a person is limited. If the limitation is broken, the whole cognitive process would be affected, so did the final decision. The research of effective ways to reduce the cognitive load is launched from two aspects: cutting down the number of alternatives and directing the user to allocate his limited attention resource based on the selective visual attention theory. Decision-making is such a complex process that people usually have difficulties to express their requirements completely. An effective method to get user's hidden requirements is put forward in this paper. With more requirements be caught, the destination decision system can filtering more quantity of inappropriate alternatives. Different information piece has different utility, if the information with high utility would get attention easily, the decision might be made more easily. After analyzing the current selective visual attention theory, a new presentation style based on user's visual attention also put forward in this paper. This model arranges information presentation according to the movement of sightline. Through visual attention, the user can put their limited attention resource on the important information. Hidden requirements catching and presenting information based on the selective visual attention are effective ways to reducing the cognitive load.
Deciding to Decide: How Decisions Are Made and How Some Forces Affect the Process.

PubMed

McConnell, Charles R

There is a decision-making pattern that applies in all situations, large or small, although in small decisions, the steps are not especially evident. The steps are gathering information, analyzing information and creating alternatives, selecting and implementing an alternative, and following up on implementation. The amount of effort applied in any decision situation should be consistent with the potential consequences of the decision. Essentially, all decisions are subject to certain limitations or constraints, forces, or circumstances that limit one's range of choices. Follow-up on implementation is the phase of decision making most often neglected, yet it is frequently the phase that determines success or failure. Risk and uncertainty are always present in a decision situation, and the application of human judgment is always necessary. In addition, there are often emotional forces at work that can at times unwittingly steer one away from that which is best or most workable under the circumstances and toward a suboptimal result based largely on the desires of the decision maker.
Human Cognitive Limitations. Broad, Consistent, Clinical Application of Physiological Principles Will Require Decision Support.

PubMed

Morris, Alan H

2018-02-01

Our education system seems to fail to enable clinicians to broadly understand core physiological principles. The emphasis on reductionist science, including "omics" branches of research, has likely contributed to this decrease in understanding. Consequently, clinicians cannot be expected to consistently make clinical decisions linked to best physiological evidence. This is a large-scale problem with multiple determinants, within an even larger clinical decision problem: the failure of clinicians to consistently link their decisions to best evidence. Clinicians, like all human decision-makers, suffer from significant cognitive limitations. Detailed context-sensitive computer protocols can generate personalized medicine instructions that are well matched to individual patient needs over time and can partially resolve this problem.
Analytical and CASE study on Limited Search, ID3, CHAID, C4.5, Improved C4.5 and OVA Decision Tree Algorithms to design Decision Support System

NASA Astrophysics Data System (ADS)

Kaur, Parneet; Singh, Sukhwinder; Garg, Sushil; Harmanpreet

2010-11-01

In this paper we study about classification algorithms for farm DSS. By applying classification algorithms i.e. Limited search, ID3, CHAID, C4.5, Improved C4.5 and One VS all Decision Tree on common data set of crop with specified class, results are obtained. The tool used to derive results is SPINA. The graphical results obtained from tool are compared to suggest best technique to develop farm Decision Support System. This analysis would help to researchers to design effective and fast DSS for farmer to take decision for enhancing their yield.
Patients With Limited Health Literacy Have Similar Preferences but Different Perceptions in Surgical Decision-making for Carpal Tunnel Release.

PubMed

Roh, Young Hak; Koh, Young Do; Kim, Jong Oh; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

2018-04-01

Health literacy is the ability to obtain, process, and understand health information needed to make appropriate health decisions. The proper comprehension by patients regarding a given disease, its treatment, and the physician's instructions plays an important role in shared decision-making. Studies have disagreed over the degree to which differences in health literacy affect patients' preferences for shared decision-making; we therefore sought to evaluate this in the context of shared decision-making about carpal tunnel release. (1) Do patients with limited health literacy have different preferences of shared decision-making for carpal tunnel release than those with greater levels of health literacy? (2) How do patients with limited health literacy retrospectively perceive their role in shared decision-making after carpal tunnel release? Over a 32-month period, one surgeon surgically treated 149 patients for carpal tunnel syndrome. Patients were eligible if they had cognitive and language function to provide informed consent and complete a self-reported questionnaire and were not eligible if they had nerve entrapment other than carpal tunnel release or had workers compensation issues; based on those, 140 (94%) were approached for study. Of those, seven (5%) were lost to followup before 6 months, leaving 133 for analysis here. Their mean age was 55 years (range, 31-76 years), and 83% (111 of 133) were women. Thirty-three percent (44 of 133) of patients had less than a high school education. Health literacy was measured according to the Newest Vital Sign during the initial visit, and a score of ≤ 3 was considered limited health literacy. Forty-four percent of patients had limited health literacy. The Control Preferences Scale was used for patients to indicate their preferred role in surgical decision-making preoperatively and to assess their perceived level of involvement postoperatively. Bivariate and multivariable analyses were performed to determine whether patients' clinical, demographic, and health literacy factors accounted for the preoperative preferences and postoperative assessments of their role in shared decision-making. A total of 133 patients would provide 94% power for a medium effect size for linear regression with five main predictors. We found no differences between patients with lower levels of health literacy and those with greater health literacy in terms of preferences of shared decision-making for carpal tunnel release (3.0 ± 1.6 versus 2.7 ± 1.4; mean difference, 0.3; 95% confidence interval, -0.2 to 0.8; p = 0.25). A history of surgical procedures (coefficient = -0.32, p < 0.01) and a lower Disabilities of the Arm, Shoulder and Hand score (coefficient = 0.17, p = 0.02) were independently associated with a preference for an active role in shared decision-making. However, patients with limited health literacy (coefficient = -0.31, p = 0.01) and an absence of a caregiver (coefficient = -0.28, p = 0.03) perceived a more passive role in actual decision-making. Physicians should be aware of the discrepancy between preferences and perceptions of shared decision-making among patients with limited health literacy, and physicians should consider providing a decision aid tailored to basic levels of health literacy to help patients achieve their preferred role in decision-making. Level II, prognostic study.

How Should Physicians Respond When the Best Treatment for an Individual Patient Conflicts with Practice Guidelines about the Use of a Limited Resource?

PubMed

Howe, Edmund G

2017-06-01

The case presents a physician's ethical conflict, due to limited resources, between his obligations to meet the needs of a community and those of his patient. Elements of the decision-making process (and who should make the decision) are discussed, including the limitations of what ethical reasoning can offer and risks of arbitrary outcomes. Additionally, potential benefits to physicians and their patients of discussing these conflicts, including reducing the physician's moral distress, are noted. I argue that physicians' abilities to make "right" decisions in such situations are limited, and I suggest ways in which physicians can try to preserve their relationships with patients. © 2017 American Medical Association. All Rights Reserved.
Limits of detection and decision. Part 4

NASA Astrophysics Data System (ADS)

Voigtman, E.

2008-02-01

Probability density functions (PDFs) have been derived for a number of commonly used limit of detection definitions, including several variants of the Relative Standard Deviation of the Background-Background Equivalent Concentration (RSDB-BEC) method, for a simple linear chemical measurement system (CMS) having homoscedastic, Gaussian measurement noise and using ordinary least squares (OLS) processing. All of these detection limit definitions serve as both decision and detection limits, thereby implicitly resulting in 50% rates of Type 2 errors. It has been demonstrated that these are closely related to Currie decision limits, if the coverage factor, k, is properly defined, and that all of the PDFs are scaled reciprocals of noncentral t variates. All of the detection limits have well-defined upper and lower limits, thereby resulting in finite moments and confidence limits, and the problem of estimating the noncentrality parameter has been addressed. As in Parts 1-3, extensive Monte Carlo simulations were performed and all the simulation results were found to be in excellent agreement with the derived theoretical expressions. Specific recommendations for harmonization of detection limit methodology have also been made.
Developing Guidelines for Disclosure or Non-Disclosure of Bad News around Life-Limiting Illness and Death to People with Intellectual Disabilities

ERIC Educational Resources Information Center

Tuffrey-Wijne, Irene; Giatras, Nikoletta; Butler, Gary; Cresswell, Amanda; Manners, Paula; Bernal, Jane

2013-01-01

Background: There is insufficient evidence to guide decisions around (non-)disclosure of bad news of life-limiting illness and death to people with intellectual disabilities. Aim: The aim of this study was to develop guidelines for decisions about (non-)disclosure of bad news around life-limiting illness and death to people with intellectual…
41 CFR 102-118.485 - Is there a time limit for my agency to issue a decision on disputed claims?

Code of Federal Regulations, 2010 CFR

2010-07-01

... and Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Is there a time limit... Information for All Claims § 102-118.485 Is there a time limit for my agency to issue a decision on disputed...
22 CFR 224.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... limited to any advantage, preference, privilege, license, permit, favorable decision, ruling, status, or... United States Government. Individual means a natural person. Initial decision means the written decision of the ALJ required by § 224.10 or § 224.37, and includes a revised initial decision issued following...
76 FR 24463 - Caribbean Fishery Management Council; Public Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-02

.... Magnuson-Stevens Reauthorization Act (MSRA)/Annual Catch Limit (ACL) review of language--Overfishing Limit... decisions/motions get treated at Council level. 2. Review of decisions/logic behind 2010 amendment. a. Brief... accessible to people with disabilities. For more information or request for sign language interpretation and...
Applicability of risk-based management and the need for risk-based economic decision analysis at hazardous waste contaminated sites.

PubMed

Khadam, Ibrahim; Kaluarachchi, Jagath J

2003-07-01

Decision analysis in subsurface contamination management is generally carried out through a traditional engineering economic viewpoint. However, new advances in human health risk assessment, namely, the probabilistic risk assessment, and the growing awareness of the importance of soft data in the decision-making process, require decision analysis methodologies that are capable of accommodating non-technical and politically biased qualitative information. In this work, we discuss the major limitations of the currently practiced decision analysis framework, which evolves around the definition of risk and cost of risk, and its poor ability to communicate risk-related information. A demonstration using a numerical example was conducted to provide insight on these limitations of the current decision analysis framework. The results from this simple ground water contamination and remediation scenario were identical to those obtained from studies carried out on existing Superfund sites, which suggests serious flaws in the current risk management framework. In order to provide a perspective on how these limitations may be avoided in future formulation of the management framework, more matured and well-accepted approaches to decision analysis in dam safety and the utility industry, where public health and public investment are of great concern, are presented and their applicability in subsurface remediation management is discussed. Finally, in light of the success of the application of risk-based decision analysis in dam safety and the utility industry, potential options for decision analysis in subsurface contamination management are discussed.
Memory-Based Decision-Making with Heuristics: Evidence for a Controlled Activation of Memory Representations

ERIC Educational Resources Information Center

Khader, Patrick H.; Pachur, Thorsten; Meier, Stefanie; Bien, Siegfried; Jost, Kerstin; Rosler, Frank

2011-01-01

Many of our daily decisions are memory based, that is, the attribute information about the decision alternatives has to be recalled. Behavioral studies suggest that for such decisions we often use simple strategies (heuristics) that rely on controlled and limited information search. It is assumed that these heuristics simplify decision-making by…
The Rational Patient and Beyond: Implications for Treatment Adherence in People with Psychiatric Disabilities

PubMed Central

Corrigan, Patrick W.; Rüsch, Nicolas; Ben-Zeev, Dror; Sher, Tamara

2014-01-01

Purpose/Objective Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a “rational patient;” namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. Design The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Results Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person’s health decisions. Conclusions/Implications Old models of rational decision making need to be supplanted by multi-process models that explain supra-deliberative factors in health decisions and behaviors. PMID:24446671
The rational patient and beyond: implications for treatment adherence in people with psychiatric disabilities.

PubMed

Corrigan, Patrick W; Rüsch, Nicolas; Ben-Zeev, Dror; Sher, Tamara

2014-02-01

Many people with psychiatric disabilities do not benefit from evidence-based practices because they often do not seek out or fully adhere to them. One way psychologists have made sense of this rehabilitation and health decision process and subsequent behaviors (of which adherence might be viewed as one) is by proposing a "rational patient"; namely, that decisions are made deliberatively by weighing perceived costs and benefits of intervention options. Social psychological research, however, suggests limitations to a rational patient theory that impact models of health decision making. The research literature was reviewed for studies of rational patient models and alternative theories with empirical support. Special focus was on models specifically related to decisions about rehabilitation strategies for psychiatric disability. Notions of the rational patient evolved out of several psychological models including the health belief model, protection motivation theory, and theory of planned behavior. A variety of practice strategies evolved to promote rational decision making. However, research also suggests limitations to rational deliberations of health. (1) Rather than carefully and consciously considered, many health decisions are implicit, potentially occurring outside awareness. (2) Decisions are not always planful; often it is the immediate exigencies of a context rather than an earlier balance of costs and benefits that has the greatest effects. (3) Cool cognitions often do not dictate the process; emotional factors have an important role in health decisions. Each of these limitations suggests additional practice strategies that facilitate a person's health decisions. Old models of rational decision making need to be supplanted by multiprocess models that explain supradeliberative factors in health decisions and behaviors. PsycINFO Database Record (c) 2014 APA, all rights reserved.
19 CFR 172.21 - Decisions effective for limited time.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Decisions effective for limited time. 172.21 Section 172.21 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... liquidated damages will be deemed applicable and will be enforced by promptly transmitting the matter, after...
19 CFR 172.21 - Decisions effective for limited time.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 2 2014-04-01 2014-04-01 false Decisions effective for limited time. 172.21 Section 172.21 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... liquidated damages will be deemed applicable and will be enforced by promptly transmitting the matter, after...
19 CFR 171.22 - Decisions effective for limited time.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 2 2013-04-01 2013-04-01 false Decisions effective for limited time. 171.22 Section 171.22 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... deemed applicable and will be enforced by promptly referring the matter, after required collection action...
19 CFR 171.22 - Decisions effective for limited time.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 2 2014-04-01 2014-04-01 false Decisions effective for limited time. 171.22 Section 171.22 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... deemed applicable and will be enforced by promptly referring the matter, after required collection action...
19 CFR 172.21 - Decisions effective for limited time.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Decisions effective for limited time. 172.21 Section 172.21 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... liquidated damages will be deemed applicable and will be enforced by promptly transmitting the matter, after...
19 CFR 172.21 - Decisions effective for limited time.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Decisions effective for limited time. 172.21 Section 172.21 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... liquidated damages will be deemed applicable and will be enforced by promptly transmitting the matter, after...
19 CFR 171.22 - Decisions effective for limited time.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Decisions effective for limited time. 171.22 Section 171.22 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... deemed applicable and will be enforced by promptly referring the matter, after required collection action...
19 CFR 172.21 - Decisions effective for limited time.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 2 2013-04-01 2013-04-01 false Decisions effective for limited time. 172.21 Section 172.21 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... liquidated damages will be deemed applicable and will be enforced by promptly transmitting the matter, after...
19 CFR 171.22 - Decisions effective for limited time.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 2 2012-04-01 2012-04-01 false Decisions effective for limited time. 171.22 Section 171.22 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... deemed applicable and will be enforced by promptly referring the matter, after required collection action...
19 CFR 171.22 - Decisions effective for limited time.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 2 2011-04-01 2011-04-01 false Decisions effective for limited time. 171.22 Section 171.22 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... deemed applicable and will be enforced by promptly referring the matter, after required collection action...

Multiple-Reason Decision Making Based on Automatic Processing

ERIC Educational Resources Information Center

Glockner, Andreas; Betsch, Tilmann

2008-01-01

It has been repeatedly shown that in decisions under time constraints, individuals predominantly use noncompensatory strategies rather than complex compensatory ones. The authors argue that these findings might be due not to limitations of cognitive capacity but instead to limitations of information search imposed by the commonly used experimental…
Keys to success for data-driven decision making: Lessons from participatory monitoring and collaborative adaptive management

USDA-ARS?s Scientific Manuscript database

Recent years have witnessed a call for evidence-based decisions in conservation and natural resource management, including data-driven decision-making. Adaptive management (AM) is one prevalent model for integrating scientific data into decision-making, yet AM has faced numerous challenges and limit...
25 CFR 16.6 - Authority of attorneys in State court litigation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... or decision against exercise of a preferential right to purchase property subject to sale, the removal or decision against removal of actions to Federal courts, and the waiver or decision against... his official capacity as counsel therein, including but not limited to the filing or decision against...
Economic evaluations of health technologies in Dutch healthcare decision-making: a qualitative study of the current and potential use, barriers, and facilitators.

PubMed

Roseboom, Kitty J; van Dongen, Johanna M; Tompa, Emile; van Tulder, Maurits W; Bosmans, Judith E

2017-01-26

The use of economic evaluations in healthcare decision-making can potentially help decision-makers in allocating scarce resources as efficiently as possible. Over a decade ago, the use of such studies was found to be limited in Dutch healthcare decision-making, but their current use is unknown. Therefore, this study aimed to provide insight into the current and potential use of economic evaluations in Dutch healthcare decision-making and to identify barriers and facilitators to the use of such studies. Interviews containing semi-structured and structured questions were conducted among Dutch healthcare decision-makers. Participants were purposefully selected and special efforts were made to include decision-makers working at the macro- (national), meso- (local/regional), and micro-level (patient setting). During the interviews, a topic list was used that was based on the research questions and a literature search, and was developed in consultation with the Dutch National Healthcare Institute. Responses to the semi-structured questions were analyzed using a constant comparative approach. As for the structured questions, participants' definitions of various economic evaluation concepts were scored as either being "correct" or "incorrect" by two researchers, and summary statistics were prepared. Sixteen healthcare decision-makers were interviewed and two health economists. Decision-makers' knowledge of economic evaluations was only modest, and their current use appeared to be limited. Nonetheless, decision-makers recognized the importance of economic evaluations and saw several opportunities for extending their use at the macro- and meso-level, but not at the micro-level. The disparity between the limited use and recognition of the importance of economic evaluations is likely due to the many barriers decision-makers experience preventing their use (e.g. lack of resources, lack of formal willingness-to-pay threshold). Possible facilitators for extending the use of economic evaluations include, amongst others, educating decision-makers and the general population about economic evaluations and presenting economic evaluation results in a clearer and more understandable way. This study demonstrated that the current use and impact of economic evaluations in Dutch healthcare decision-making is limited at best. Therefore, strategies are needed to overcome the barriers that currently prevent economic evaluations from being used extensively.
[Decisions on limiting treatment in critically-ill neonates: a multicenter study].

PubMed

2002-12-01

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

PubMed

Shrier, Ian

2015-10-01

The sport medicine clinician is faced with return-to-play (RTP) decisions for every patient who wants to return to activity. The complex interaction of factors related to history, physical examination, testing, activity and baseline characteristics can make RTP decision-making challenging. Further, when reasoning is not explicit, unnecessary conflict can arise among clinicians themselves, or among clinicians and patients. This conflict can have negative health consequences for the patient. In 2010, a transparent framework for RTP decisions was proposed. However, some have identified limitations to the framework and found difficulties in its implementation. This paper presents a revised framework that addresses the limitations, and provides concrete examples of how to apply it in simple and complex cases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
The ethical and legal aspects of palliative sedation in severely brain-injured patients: a French perspective

PubMed Central

2011-01-01

To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made. PMID:21303504
Constitutional and Legal Protection for Life Support Limitation in India

PubMed Central

Mani, RK

2015-01-01

Appropriate treatment limitations towards the end of life to reduce unwanted burdens require ethical clarity that is supported by appropriate legislation. The lack of knowledge of enabling legal provisions, physicians feel vulnerable to legal misinterpretation of treatment limiting decisions. In India the lack of societal awareness, inadequate exploration of the gray areas of bio-ethics and unambiguous legal position relating to terminal illness have resulted in poor quality end of life care. Much of the perceived vulnerability by the physician is attributable to insufficient knowledge and understanding of existing constitutional and legal position in India. While we await informed legal and legislative opinion, this paper highlights possible legal liabilities arising from treatment limitation decisions with available defense. It is hoped that such clarity would lead to more confident ethical decisions and improved end of life care for patients. PMID:26600691
75 FR 20358 - Intra-Agency Appeal Process: Guidelines for Appeals of Material Supervisory Determinations and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-19

... decisional deadline for written decisions by the SARC. Also, both the SARC Guidelines and the AAC Guidelines have been amended to make additional, limited technical clarifying and conforming amendments. Both sets... action or decision, and to make limited technical amendments. (73 FR 54822 (Sept. 23, 2008)). Although...
23 CFR 771.139 - Limitations on actions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 23 Highways 1 2010-04-01 2010-04-01 false Limitations on actions. 771.139 Section 771.139 Highways... indicating that such decisions are final within the meaning of 23 U.S.C. 139(l). Claims arising under Federal law seeking judicial review of any such decisions are barred unless filed within 180 days after...
Comparing the Financial Literacy of Public School, Christian School, and Homeschooled Students

ERIC Educational Resources Information Center

Wright, Tricia

2016-01-01

The 2008 recession underscored public concern that financial illiteracy has costs that are not limited to the individual who makes poor financial decisions. Considering that college students with limited financial experience are making legally binding decisions, this study explored the personal finance literacy and behavior of Christian college…
25 CFR 700.291 - Petitions for amendment: Time limits for processing.

Code of Federal Regulations, 2010 CFR

2010-04-01

... decision on a petition may be extended if the official responsible for making a decision on the petition... collected from facilities other than the facility at which the official responsible for making the decision is located. (2) If the official responsible for making a decision on the petition determines that an...
43 CFR 2.73 - Petitions for amendments: Time limits for processing.

Code of Federal Regulations, 2010 CFR

2010-10-01

... processing the request. (2) If the official responsible for making a decision on the petition determines that... decision on a petition may be extended if the official responsible for making a decision on the petition... collected from facilities other than the facility at which the official responsible for making the decision...
The Wildland Fire Decision Support System: Integrating science, technology, and fire management

Treesearch

Morgan Pence; Tom Zimmerman

2011-01-01

Federal agency policy requires documentation and analysis of all wildland fire response decisions. In the past, planning and decision documentation for fires were completed using multiple unconnected processes, yielding many limitations. In response, interagency fire management executives chartered the development of the Wildland Fire Decision Support System (WFDSS)....
Multiple-reason decision making based on automatic processing.

PubMed

Glöckner, Andreas; Betsch, Tilmann

2008-09-01

It has been repeatedly shown that in decisions under time constraints, individuals predominantly use noncompensatory strategies rather than complex compensatory ones. The authors argue that these findings might be due not to limitations of cognitive capacity but instead to limitations of information search imposed by the commonly used experimental tool Mouselab (J. W. Payne, J. R. Bettman, & E. J. Johnson, 1988). The authors tested this assumption in 3 experiments. In the 1st experiment, information was openly presented, whereas in the 2nd experiment, the standard Mouselab program was used under different time limits. The results indicate that individuals are able to compute weighted additive decision strategies extremely quickly if information search is not restricted by the experimental procedure. In a 3rd experiment, these results were replicated using more complex decision tasks, and the major alternative explanations that individuals use more complex heuristics or that they merely encode the constellation of cues were ruled out. In sum, the findings challenge the fundaments of bounded rationality and highlight the importance of automatic processes in decision making. (c) 2008 APA, all rights reserved.
U.S. infrastructure : funding trends and opportunities to improve investment decisions

DOT National Transportation Integrated Search

2000-02-01

Given the profound economic and social importance of the public infrastructure, it is crucial that federal, state, and local governments make prudent decisions on how to invest limited available resources. In making these decisions, governments will ...
Factors that contribute to physician variability in decisions to limit life support in the ICU: a qualitative study.

PubMed

Wilson, Michael E; Rhudy, Lori M; Ballinger, Beth A; Tescher, Ann N; Pickering, Brian W; Gajic, Ognjen

2013-06-01

Our aim was to explore reasons for physician variability in decisions to limit life support in the intensive care unit (ICU) utilizing qualitative methodology. Single center study consisting of semi-structured interviews with experienced physicians and nurses. Seventeen intensivists from medical (n = 7), surgical (n = 5), and anesthesia (n = 5) critical care backgrounds, and ten nurses from medical (n = 5) and surgical (n = 5) ICU backgrounds were interviewed. Principles of grounded theory were used to analyze the interview transcripts. Eleven factors within four categories were identified that influenced physician variability in decisions to limit life support: (1) physician work environment-workload and competing priorities, shift changes and handoffs, and incorporation of nursing input; (2) physician experiences-of unexpected patient survival, and of limiting life support in physician's family; (3) physician attitudes-investment in a good surgical outcome, specialty perspective, values and beliefs; and (4) physician relationship with patient and family-hearing the patient's wishes firsthand, engagement in family communication, and family negotiation. We identified several factors which physicians and nurses perceived were important sources of physician variability in decisions to limit life support. Ways to raise awareness and ameliorate the potentially adverse effects of factors such as workload, competing priorities, shift changes, and handoffs should be explored. Exposing intensivists to long term patient outcomes, formalizing nursing input, providing additional training, and emphasizing firsthand knowledge of patient wishes may improve decision making.
Farmer Decision-Making for Climate Adaptation

NASA Astrophysics Data System (ADS)

Lubell, M.; Niles, M.; Salerno, J.

2015-12-01

This talk will provide an overview of several studies of how farmers make decisions about climate change adaptation and mitigation. A particular focus will be the "limiting factors hypothesis", which argues that farmers will respond to the climate variables that usually have the largest impact on their crop productivity. For example, the most limiting factor in California is usually water so how climate change affects water will be the largest drive of climate adaptation decisions. This basic idea is drawn from the broader theory of "psychological distance", which argue that human decisions are more attuned to ideas that are psychologically closer in space, time, or other factors. Empirical examples come from California, New Zealand, and Africa.
Visualising Uncertainty for Decision Support

DTIC Science & Technology

2016-12-01

25 4.2.7 The perceived trust level of information in decision making ......... 26 4.3 User issues...crucial to understanding the “reliability” of information , and consequently affect decision making (Deitrick, 2007). Olston and Mackinlay (2002...have long been regarded as a difficult topic since the commander has to make decisions in a limited time frame with information that comes from
13 CFR 125.6 - Prime contractor performance requirements (limitations on subcontracting).

Code of Federal Regulations, 2010 CFR

2010-01-01

... Register notice. (4) Decision. SBA will render its decision after the close of the comment period. If SBA decides against a change, SBA will publish notice of its decision in the Federal Register. Concurrent with the notice, SBA will advise the requester of its decision in writing. If SBA decides in favor of a...

Decision-Making and the Interface between Human Intelligence and Artificial Intelligence. AIR 1987 Annual Forum Paper.

ERIC Educational Resources Information Center

Henard, Ralph E.

Possible future developments in artificial intelligence (AI) as well as its limitations are considered that have implications for institutional research in higher education, and especially decision making and decision support systems. It is noted that computer software programs have been developed that store knowledge and mimic the decision-making…
Decision-Theoretic Control of Planetary Rovers

NASA Technical Reports Server (NTRS)

Zilberstein, Shlomo; Washington, Richard; Bernstein, Daniel S.; Mouaddib, Abdel-Illah; Morris, Robert (Technical Monitor)

2003-01-01

Planetary rovers are small unmanned vehicles equipped with cameras and a variety of sensors used for scientific experiments. They must operate under tight constraints over such resources as operation time, power, storage capacity, and communication bandwidth. Moreover, the limited computational resources of the rover limit the complexity of on-line planning and scheduling. We describe two decision-theoretic approaches to maximize the productivity of planetary rovers: one based on adaptive planning and the other on hierarchical reinforcement learning. Both approaches map the problem into a Markov decision problem and attempt to solve a large part of the problem off-line, exploiting the structure of the plan and independence between plan components. We examine the advantages and limitations of these techniques and their scalability.
Adaptive Strategy Selection in Decision Making.

DTIC Science & Technology

1986-07-31

information processing capabilities of a decision maker, given any " reasonable " time limit for making the decision. If use of a more normative rule...DECISION MAKING JOHN W. PAYNE DTIC DUKE UNIVERSITY L.CT E AUG 13 JAMES R. BETTMAN DUKE. UNIVERSITY ERIC J. JOHNSON CARNEGIE-MELLON UNIVERSITY...REPORT & PERIOD COVERED ADAPTIVE STRATEGY SELECTION IN DECISION MAKING Research 6. PERFORMING ORO. REPORT NUMSER 7. AUTNORfe) e. CONTRACT ON GRANT
The impact of regional culture on intensive care end of life decision making: an Israeli perspective from the ETHICUS study.

PubMed

Ganz, F D; Benbenishty, J; Hersch, M; Fischer, A; Gurman, G; Sprung, C L

2006-04-01

Decisions of patients, families, and health care providers about medical care at the end of life depend on many factors, including the societal culture. A pan-European study was conducted to determine the frequency and types of end of life practices in European intensive care units (ICUs), including those in Israel. Several results of the Israeli subsample were different to those of the overall sample. The objective of this article was to explore these differences and provide a possible explanation based on the impact of culture on end of life decision making. All adult patients admitted consecutively to three Israeli ICUs (n = 2778) who died or underwent any limitation of life saving interventions between 1 January 1999 and 30 June 2000 were studied prospectively (n = 363). These patients were compared with a similar sample taken from the larger study (ethics in European intensive care units: ETHICUS) carried out in 37 European ICUs. Patients were followed until discharge, death, or 2 months from the decision to limit therapy. End of life decisions were prospectively organised into one of five mutually exclusive categories: cardiopulmonary resuscitation (CPR), brain death, withholding treatment, withdrawing treatment, and active shortening of the dying process (SDP). The data also included patient characteristics (gender, age, ICU admission diagnosis, chronic disorders, date of hospital admission, date and time of decision to limit therapy, date of hospital discharge, date and time of death in hospital), specific therapies limited, and the method of SDP. The majority of patients (n = 252, 69%) had treatment withheld, none underwent SDP, 62 received CPR (17%), 31 had brain death (9%), and 18 underwent withdrawal of treatment (5%). The primary reason given for limiting treatment was that the patient was unresponsive to therapy (n = 187). End of life discussions were held with 132 families (36%), the vast majority of which revolved around withholding treatment (91% of the discussions) and the remainder concerned withdrawing treatment (n = 11, 9%). There was a statistically significant association (chi2 = 830.93, df = 12, p < 0.0001) between the type of end of life decision and region-that is, the northern region of Europe, the central region, the southern region, and Israel. Regional culture plays an important part in end of life decision making. Differences relating to end of life decision making exist between regions and these differences can often be attributed to cultural factors. Such cultures not only affect patients and their families but also the health care workers who make and carry out such decisions.
Neuroanatomical basis for recognition primed decision making.

PubMed

Hudson, Darren

2013-01-01

Effective decision making under time constraints is often overlooked in medical decision making. The recognition primed decision making (RPDM) model was developed by Gary Klein based on previous recognized situations to develop a satisfactory solution to the current problem. Bayes Theorem is the most popular decision making model in medicine but is limited by the need for adequate time to consider all probabilities. Unlike other decision making models, there is a potential neurobiological basis for RPDM. This model has significant implication for health informatics and medical education.
Withdrawal of anticancer therapy in advanced disease: a systematic literature review.

PubMed

Clarke, G; Johnston, S; Corrie, P; Kuhn, I; Barclay, S

2015-11-11

Current guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop. A systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed. Forty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced 'professional role dissonance' between their self-perception as 'treaters', and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians' personal experience, values, emotions. Some patients continued treatment to maintain 'hope', often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients' decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction. Oncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments.
Relational autonomy: moving beyond the limits of isolated individualism.

PubMed

Walter, Jennifer K; Ross, Lainie Friedman

2014-02-01

Although clinicians may value respecting a patient's or surrogate's autonomy in decision-making, it is not always clear how to proceed in clinical practice. The confusion results, in part, from which conception of autonomy is used to guide ethical practice. Reliance on an individualistic conception such as the "in-control agent" model prioritizes self-sufficiency in decision-making and highlights a decision-maker's capacity to have reason transcend one's emotional experience. An alternative model of autonomy, relational autonomy, highlights the social context within which all individuals exist and acknowledges the emotional and embodied aspects of decision-makers. These 2 conceptions of autonomy lead to different interpretations of several aspects of ethical decision-making. The in-control agent model believes patients or surrogates should avoid both the influence of others and emotional persuasion in decision-making. As a result, providers have a limited role to play and are expected to provide medical expertise but not interfere with the individual's decision-making process. In contrast, a relational autonomy approach acknowledges the central role of others in decision-making, including clinicians, who have a responsibility to engage patients' and surrogates' emotional experiences and offer clear guidance when patients are confronting serious illness. In the pediatric setting, in which decision-making is complicated by having a surrogate decision-maker in addition to a patient, these conceptions of autonomy also may influence expectations about the role that adolescents can play in decision-making.
Informed decision making before initiating screening mammography: does it occur and does it make a difference?

PubMed

Nekhlyudov, Larissa; Li, Rong; Fletcher, Suzanne W

2008-12-01

Informed decision making regarding screening mammography is recommended for women under age 50. To what extent it occurs in clinical settings is unclear. Using a mailed instrument, we surveyed women aged 40-44 prior to their first screening mammogram. All women were members of a large health maintenance organization and received care at a large medical practice in the Greater Boston area. The survey measured informed decision making, decisional conflict, satisfaction, and screening mammography knowledge and intentions to undergo screening. Ninety-six women responded to the survey (response rate 47%). Overall, women reported limited informed decision making regarding screening mammography, both with respect to information exchange and involvement in the decision process. Less than half (47%) reported discussing the benefits of screening; 23% the uncertainties; and only 7% the harms. About 30% reported discussing the nature of the decision or clinical issue; and 29% reported their provider elicited their preferred role in the decision; 38% their preferences; and 24% their understanding of the information. Women who were uninformed had higher decisional conflict (2.37 vs. 1.83, P=0.005) about screening mammography and were more likely to be dissatisfied with the information and involvement. Women's screening mammography knowledge was limited in most areas; however being presented with information did not diminish their intentions to undergo screening. Informed decision making before initiating screening mammography is limited in this setting. There appears to be little indication that information about the benefits and harms decreases women's intentions to undergo screening. Methods to communicate information to women before initiating screening mammography are needed.
75 FR 68783 - Clean Water Act Section 303(d): Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-09

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9223-5] Clean Water Act Section 303(d): Availability of List Decisions AGENCY: Environmental Protection Agency (EPA). ACTION: Notice of availability. SUMMARY: This action announces the availability of EPA decisions identifying water quality limited segments and...
In Favour of Medical Dissensus: Why We Should Agree to Disagree About End‐of‐Life Decisions

PubMed Central

Truog, Robert; Savulescu, Julian

2015-01-01

Abstract End‐of‐life decision‐making is controversial. There are different views about when it is appropriate to limit life‐sustaining treatment, and about what palliative options are permissible. One approach to decisions of this nature sees consensus as crucial. Decisions to limit treatment are made only if all or a majority of caregivers agree. We argue, however, that it is a mistake to require professional consensus in end‐of‐life decisions. In the first part of the article we explore practical, ethical, and legal factors that support agreement. We analyse subjective and objective accounts of moral reasoning: accord is neither necessary nor sufficient for decisions. We propose an alternative norm for decisions – that of ‘professional dissensus’. In the final part of the article we address the role of agreement in end‐of‐life policy. Such guidelines can ethically be based on dissensus rather than consensus. Disagreement is not always a bad thing. PMID:25908398
Do laboratories follow heart failure recommendations and guidelines and did we improve? The CARdiac MArker Guideline Uptake in Europe (CARMAGUE).

PubMed

Hammerer-Lercher, Angelika; Collinson, Paul; van Dieijen-Visser, Marja P; Pulkki, Kari; Suvisaari, Janne; Ravkilde, Jan; Stavljenic-Rukavina, Ana; Baum, Hannsjörg; Laitinen, Päivi

2013-06-01

Natriuretic peptides (NP) are well-established markers of heart failure (HF). During the past 5 years, analytical and clinical recommendations for measurement of these biomarkers have been published in guidelines. The aim of this follow-up survey was to investigate how well these guidelines for measurement of NP have been implemented in laboratory practice in Europe. Member societies of the European Federation of Clinical Chemistry and Laboratory Medicine were invited in 2009 to participate in a web-based audit questionnaire. The questionnaire requested information on type of tests performed, decision limits for HF, turn-around time and frequency of testing. There was a moderate increase (12%) of laboratories measuring NP compared to the initial survey in 2006. The most frequently used HF decision limits for B-type NP (BNP) and N-terminal BNP (NT-proBNP) were, respectively, 100 ng/L and 125 ng/L, derived from the package inserts in 55%. Fifty laboratories used a second decision limit. Age or gender dependent decision limits were applied in 10% (8.5% in 2006). The vast majority of laboratories (80%) did not have any criteria regarding frequency of testing, compared to 33% in 2006. The implementation of NP measurement for HF management was a slow process between 2006 and 2009 at a time when guidelines had just been established. The decision limits were derived from package insert information and literature. There was great uncertainty concerning frequency of testing which may reflect the debate about the biological variability which was not published for most of the assays in 2009.
Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

PubMed

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.
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.
Ethics of End of Life Decisions in Pediatrics: A Narrative Review of the Roles of Caregivers, Shared Decision-Making, and Patient Centered Values.

PubMed

Santoro, Jonathan D; Bennett, Mariko

2018-04-26

Background: This manuscript reviews unique aspects of end of life decision-making in pediatrics. Methods: A narrative literature review of pediatric end of life issues was performed in the English language. Results: While a paternalistic approach is typically applied to children with life-limiting medical prognoses, the cognitive, language, and physical variability in this patient population is wide and worthy of review. In end of life discussions in pediatrics, the consideration of a child’s input is often not reviewed in depth, although a shared decision-making model is ideal for use, even for children with presumed limitations due to age. This narrative review of end of life decision-making in pediatric care explores nomenclature, the introduction of the concept of death, relevant historical studies, limitations to the shared decision-making model, the current state of end of life autonomy in pediatrics, and future directions and needs. Although progress is being made toward a more uniform and standardized approach to care, few non-institutional protocols exist. Complicating factors in the lack of guidelines include the unique facets of pediatric end of life care, including physical age, paternalism, the cognitive and language capacity of patients, subconscious influencers of parents, and normative values of death in pediatrics. Conclusions: Although there have been strides in end of life decision-making in pediatrics, further investigation and research is needed in this field.
Incorporating uncertainty in watershed management decision-making: A mercury TMDL case study

USGS Publications Warehouse

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

2005-01-01

Water quality impairment due to high mercury fish tissue concentrations and high mercury aqueous concentrations is a widespread problem in several sub-watersheds that are major sources of mercury to the San Francisco Bay. Several mercury Total Maximum Daily Load regulations are currently being developed to address this problem. Decisions about control strategies are being made despite very large uncertainties about current mercury loading behavior, relationships between total mercury loading and methyl mercury formation, and relationships between potential controls and mercury fish tissue levels. To deal with the issues of very large uncertainties, data limitations, knowledge gaps, and very limited State agency resources, this work proposes a decision analytical alternative for mercury TMDL decision support. The proposed probabilistic decision model is Bayesian in nature and is fully compatible with a "learning while doing" adaptive management approach. Strategy evaluation, sensitivity analysis, and information collection prioritization are examples of analyses that can be performed using this approach.
10 CFR 51.103 - Record of decision-general.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Record of decision-general. 51.103 Section 51.103 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) ENVIRONMENTAL PROTECTION REGULATIONS FOR DOMESTIC LICENSING AND... limited work authorization under 10 CFR 50.10 was issued, the Commission's decision on the construction...
Bridge over troubled waters: A Synthesis Session to connect scientific and decision making sectors

EPA Science Inventory

Lack of access to relevant scientific data has limited decision makers from incorporating scientific information into their management and policy schemes. Yet, there is increasing interest among decision makers and scientists to integrate coastal and marine science into the polic...
Common decision limits --The need for harmonised immunoassays.

PubMed

Sturgeon, Catharine M

2014-05-15

The main aim of clinical guidelines is to encourage the best clinical outcome for patients and the best use of resources, no matter where patients are investigated or managed. Where guidelines incorporate decision limits based on levels of analytes in serum, plasma or urine these may determine whether or not to treat or may be used to tailor further treatment. Consideration should be given to the effect of method-related differences in results when implementing common decision limits. Available evidence suggests that for some analytes the implications for the patient may be serious, e.g. in terms of missed biopsies or unnecessary prostatic biopsies when prostate specific antigen is measured. Major causes of between-method differences are reviewed and means of addressing them considered. Copyright © 2013 Elsevier B.V. All rights reserved.
Assessment of Characteristic Function Modulus of Vibroacoustic Signal Given a Limit State Parameter of Diagnosed Equipment

NASA Astrophysics Data System (ADS)

Kostyukov, V. N.; Naumenko, A. P.; Kudryavtseva, I. S.

2018-01-01

Improvement of distinguishing criteria, determining defects of machinery and mechanisms, by vibroacoustic signals is a recent problem for technical diagnostics. The work objective is assessment of instantaneous values by methods of statistical decision making theory and risk of regulatory values of characteristic function modulus. The modulus of the characteristic function is determined given a fixed parameter of the characteristic function. It is possible to determine the limits of the modulus, which correspond to different machine’s condition. The data of the modulus values are used as diagnostic features in the vibration diagnostics and monitoring systems. Using such static decision-making methods as: minimum number of wrong decisions, maximum likelihood, minimax, Neumann-Pearson characteristic function modulus limits are determined, separating conditions of a diagnosed object.
Satisficing in split-second decision making is characterized by strategic cue discounting.

PubMed

Oh, Hanna; Beck, Jeffrey M; Zhu, Pingping; Sommer, Marc A; Ferrari, Silvia; Egner, Tobias

2016-12-01

Much of our real-life decision making is bounded by uncertain information, limitations in cognitive resources, and a lack of time to allocate to the decision process. It is thought that humans overcome these limitations through satisficing, fast but "good-enough" heuristic decision making that prioritizes some sources of information (cues) while ignoring others. However, the decision-making strategies we adopt under uncertainty and time pressure, for example during emergencies that demand split-second choices, are presently unknown. To characterize these decision strategies quantitatively, the present study examined how people solve a novel multicue probabilistic classification task under varying time pressure, by tracking shifts in decision strategies using variational Bayesian inference. We found that under low time pressure, participants correctly weighted and integrated all available cues to arrive at near-optimal decisions. With increasingly demanding, subsecond time pressures, however, participants systematically discounted a subset of the cue information by dropping the least informative cue(s) from their decision making process. Thus, the human cognitive apparatus copes with uncertainty and severe time pressure by adopting a "drop-the-worst" cue decision making strategy that minimizes cognitive time and effort investment while preserving the consideration of the most diagnostic cue information, thus maintaining "good-enough" accuracy. This advance in our understanding of satisficing strategies could form the basis of predicting human choices in high time pressure scenarios. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

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

PubMed

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

NASA Astrophysics Data System (ADS)

Allen, Will; Cruz, Jennyffer; Warburton, Bruce

2017-06-01

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

PubMed

Halvorsen, K; Førde, R; Nortvedt, P

2009-01-01

To shed light on the values and considerations that affect the decision-making processes and the decisions to limit intensive care treatment. Qualitative methodology with participant observation and in-depth interviews, with an emphasis on eliciting the underlying rationale of the clinicians' actions and choices when limiting treatment. Informants perceived over-treatment in intensive care medicine as a dilemma. One explanation was that the decision-making base was somewhat uncertain, complex and difficult. The informants claimed that those responsible for taking decisions from the admitting ward prolonged futile treatment because they may bear guilt or responsibility for something that had gone wrong during the course of treatment. The assessments of the patient's situation made by physicians from the admitting ward were often more organ-oriented and the expectations were less realistic than those of clinicians in the intensive care unit who frequently had a more balanced and overall perspective. Aspects such as the personality and the speciality of those involved, the culture of the unit and the degree of interdisciplinary cooperation were important issues in the decision-making processes. Under-communicated considerations jeopardise the principle of equal treatment. If intensive care patients are to be ensured equal treatment, strategies for interdisciplinary, transparent and appropriate decision-making processes must be developed in which open and hidden values are rendered visible, power structures disclosed, employees respected and the various perspectives of the treatment given their legitimate place.
Decision Science Challenges for C2 Agility

DTIC Science & Technology

2014-06-01

decision -making effectiveness , but also the adaptive capacities needed to assure the resilience of the decision -making process itself. New methods are... effectiveness , but also the adaptive capacities needed to assure the resilience of the decision -making process itself. New methods are needed to help...of the literature on human biases and limitations, and hence it has been formative of entire programs of resarch and development on
LECTURES ON DECISION THEORY,

DTIC Science & Technology

These lecture notes deal with the mathematical theory of decision - making , i.e., wihematical models of situations in which there is a set of...individual and group decision - making as a quantitative science, in contrast with a field such as physics, suggests that mathematical theorizing on...phenomena of decision - making is very much an exploratory enterprise and that ex isting models have limited generality and appli cability. The purpose is to
77 FR 15368 - Clean Water Act; Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-15

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9646-9] Clean Water Act; Availability of List Decisions...) proposed decision identifying water quality limited segments and associated pollutants in Oregon to be listed pursuant to section 303(d)(2) of the Clean Water Act (CWA). EPA is proposing to add 1004 water...
77 FR 54909 - Clean Water Act: Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9724-6] Clean Water Act: Availability of List Decisions... notice announces EPA's decision to identify certain water quality limited waters and the associated pollutant to be listed pursuant to the Clean Water Act Section 303(d)(2) on New York's list of impaired...
45 CFR 1630.8 - Recovery of disallowed costs and other corrective action.

Code of Federal Regulations, 2011 CFR

2011-10-01

... giving rise to a questioned cost. (c) In the event of an appeal of the Corporation's management decision... limits and conditions set forth in the Corporation's management decision. Recovery of the disallowed... conditions set forth in the Corporation's management decision. The recipient shall have taken final action...
40 CFR 86.1851-01 - Application of good engineering judgment to manufacturers' decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 19 2010-07-01 2010-07-01 false Application of good engineering... Application of good engineering judgment to manufacturers' decisions. (a) The manufacturer shall exercise good engineering judgment in making all decisions called for under this subpart, including but not limited to...
40 CFR 86.1851-01 - Application of good engineering judgment to manufacturers' decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 19 2011-07-01 2011-07-01 false Application of good engineering... Application of good engineering judgment to manufacturers' decisions. (a) The manufacturer shall exercise good engineering judgment in making all decisions called for under this subpart, including but not limited to...
40 CFR 86.1851-01 - Application of good engineering judgment to manufacturers' decisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 19 2014-07-01 2014-07-01 false Application of good engineering... of good engineering judgment to manufacturers' decisions. (a) The manufacturer shall exercise good engineering judgment in making all decisions called for under this subpart, including but not limited to...
40 CFR 86.1851-01 - Application of good engineering judgment to manufacturers' decisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 20 2012-07-01 2012-07-01 false Application of good engineering... Application of good engineering judgment to manufacturers' decisions. (a) The manufacturer shall exercise good engineering judgment in making all decisions called for under this subpart, including but not limited to...
40 CFR 86.1851-01 - Application of good engineering judgment to manufacturers' decisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 20 2013-07-01 2013-07-01 false Application of good engineering... Application of good engineering judgment to manufacturers' decisions. (a) The manufacturer shall exercise good engineering judgment in making all decisions called for under this subpart, including but not limited to...
45 CFR 1630.8 - Recovery of disallowed costs and other corrective action.

Code of Federal Regulations, 2010 CFR

2010-10-01

... giving rise to a questioned cost. (c) In the event of an appeal of the Corporation's management decision... limits and conditions set forth in the Corporation's management decision. Recovery of the disallowed... conditions set forth in the Corporation's management decision. The recipient shall have taken final action...
A Contingency Model for Ethical Decision-Making by Educational Leaders

ERIC Educational Resources Information Center

Green, James; Walker, Keith

2009-01-01

While numerous philosophical essays offer speculative explanations of how persons should make ethical decisions, empirical investigations of the phenomenon of ethical decision-making are limited to just a few studies in the discipline of business management. This investigation focused on the ethical dilemmas confronted by educators, with emphasis…
48 CFR 1652.204-72 - Filing health benefit claims/court review of disputed claims.

Code of Federal Regulations, 2010 CFR

2010-10-01

... beyond his or her control from making the request within the time limit. (2) The Carrier has 30 days... information is required to make a decision on the claim; (iii) Specify the time limit (60 days after the date... that time and give a written notice of its decision to the covered individual and to the Carrier. (f...
Ecological relevance of the Iowa gambling task in patients with Alzheimer's disease and mild cognitive impairment.

PubMed

Jacus, J-P; Gély-Nargeot, M-C; Bayard, S

2018-05-01

In spite of their extensive use, the ecological relevance of tasks dedicated to assessing real-world decision-making in a laboratory setting remains unclear. Our study aimed to evaluate the relationship between decision-making and behavioral competency and awareness of limitations. A total of 20 patients with Alzheimer's disease (AD), 20 with amnestic mild cognitive impairment (aMCI) and 20 healthy controls (HC) were assessed for decision-making using the Iowa Gambling Task (IGT). Behavioral competency was evaluated by the Patient Competency Rating Scale (PCRS), which requires each participant and a relative to answer the same 30 questions on participant's competency and to rate each item, while awareness of limitations was evaluated by subtracting the self-rated score from the relative-rated score. Using the median-split approach, the proportion of disadvantageous decision-makers was higher in both the MCI and AD groups than in HC (P=0.02 and P=0.03, respectively), with no differences between clinical groups. The percentage of participants with poorer behavioral competency was also higher in the MCI and AD than in the HC (self-rated: P=0.025 and P=0.01, respectively; relative-rated: P=0.008 and P=0.008, respectively), again with no differences between MCI and AD. All groups were comparable in awareness. For all participants, disadvantageous decision-making was associated with both reduced behavioral competency and poor awareness of limitations (OR: 3.47, P=0.03 and OR: 5.4, P=0.004, respectively). Our findings support the ecological relevance of the IGT. Behavioral competency integrity and awareness of limitations are both associated with advantageous decision-making profiles. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
Scaling Up Decision Theoretic Planning to Planetary Rover Problems

NASA Technical Reports Server (NTRS)

Meuleau, Nicolas; Dearden, Richard; Washington, Rich

2004-01-01

Because of communication limits, planetary rovers must operate autonomously during consequent durations. The ability to plan under uncertainty is one of the main components of autonomy. Previous approaches to planning under uncertainty in NASA applications are not able to address the challenges of future missions, because of several apparent limits. On another side, decision theory provides a solid principle framework for reasoning about uncertainty and rewards. Unfortunately, there are several obstacles to a direct application of decision-theoretic techniques to the rover domain. This paper focuses on the issues of structure and concurrency, and continuous state variables. We describes two techniques currently under development that address specifically these issues and allow scaling-up decision theoretic solution techniques to planetary rover planning problems involving a small number of goals.
Influence of analytical bias and imprecision on the number of false positive results using Guideline-Driven Medical Decision Limits.

PubMed

Hyltoft Petersen, Per; Klee, George G

2014-03-20

Diagnostic decisions based on decision limits according to medical guidelines are different from the majority of clinical decisions due to the strict dichotomization of patients into diseased and non-diseased. Consequently, the influence of analytical performance is more critical than for other diagnostic decisions where much other information is included. The aim of this opinion paper is to investigate consequences of analytical quality and other circumstances for the outcome of "Guideline-Driven Medical Decision Limits". Effects of analytical bias and imprecision should be investigated separately and analytical quality specifications should be estimated accordingly. Use of sharp decision limits doesn't consider biological variation and effects of this variation are closely connected with the effects of analytical performance. Such relationships are investigated for the guidelines for HbA1c in diagnosis of diabetes and in risk of coronary heart disease based on serum cholesterol. The effects of a second sampling in diagnosis give dramatic reduction in the effects of analytical quality showing minimal influence of imprecision up to 3 to 5% for two independent samplings, whereas the reduction in bias is more moderate and a 2% increase in concentration doubles the percentage of false positive diagnoses, both for HbA1c and cholesterol. An alternative approach comes from the current application of guidelines for follow-up laboratory tests according to clinical procedure orders, e.g. frequency of parathyroid hormone requests as a function of serum calcium concentrations. Here, the specifications for bias can be evaluated from the functional increase in requests for increasing serum calcium concentrations. In consequence of the difficulties with biological variation and the practical utilization of concentration dependence of frequency of follow-up laboratory tests already in use, a kind of probability function for diagnosis as function of the key-analyte is proposed. Copyright © 2013 Elsevier B.V. All rights reserved.
Reprint of "Influence of analytical bias and imprecision on the number of false positive results using Guideline-Driven Medical Decision Limits".

PubMed

Hyltoft Petersen, Per; Klee, George G

2014-05-15

Diagnostic decisions based on decision limits according to medical guidelines are different from the majority of clinical decisions due to the strict dichotomization of patients into diseased and non-diseased. Consequently, the influence of analytical performance is more critical than for other diagnostic decisions where much other information is included. The aim of this opinion paper is to investigate consequences of analytical quality and other circumstances for the outcome of "Guideline-Driven Medical Decision Limits". Effects of analytical bias and imprecision should be investigated separately and analytical quality specifications should be estimated accordingly. Use of sharp decision limits doesn't consider biological variation and effects of this variation are closely connected with the effects of analytical performance. Such relationships are investigated for the guidelines for HbA1c in diagnosis of diabetes and in risk of coronary heart disease based on serum cholesterol. The effects of a second sampling in diagnosis give dramatic reduction in the effects of analytical quality showing minimal influence of imprecision up to 3 to 5% for two independent samplings, whereas the reduction in bias is more moderate and a 2% increase in concentration doubles the percentage of false positive diagnoses, both for HbA1c and cholesterol. An alternative approach comes from the current application of guidelines for follow-up laboratory tests according to clinical procedure orders, e.g. frequency of parathyroid hormone requests as a function of serum calcium concentrations. Here, the specifications for bias can be evaluated from the functional increase in requests for increasing serum calcium concentrations. In consequence of the difficulties with biological variation and the practical utilization of concentration dependence of frequency of follow-up laboratory tests already in use, a kind of probability function for diagnosis as function of the key-analyte is proposed. Copyright © 2014. Published by Elsevier B.V.

Decision making in urological surgery.

PubMed

Abboudi, Hamid; Ahmed, Kamran; Normahani, Pasha; Abboudi, May; Kirby, Roger; Challacombe, Ben; Khan, Mohammed Shamim; Dasgupta, Prokar

2012-06-01

Non-technical skills are important behavioural aspects that a urologist must be fully competent at to minimise harm to patients. The majority of surgical errors are now known to be due to errors in judgment and decision making as opposed to the technical aspects of the craft. The authors reviewed the published literature regarding decision-making theory and in practice related to urology as well as the current tools available to assess decision-making skills. Limitations include limited number of studies, and the available studies are of low quality. Decision making is the psychological process of choosing between alternative courses of action. In the surgical environment, this can often be a complex balance of benefit and risk within a variable time frame and dynamic setting. In recent years, the emphasis of new surgical curriculums has shifted towards non-technical surgical skills; however, the assessment tools in place are far from objective, reliable and valid. Surgical simulators and video-assisted questionnaires are useful methods for appraisal of trainees. Well-designed, robust and validated tools need to be implemented in training and assessment of decision-making skills in urology. Patient safety can only be ensured when safe and effective decisions are made.
Decision-making in crisis: Applying a healthcare triage methodology to business continuity management.

PubMed

Moore, Bethany; Bone, Eric A

2017-01-01

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

PubMed

Malec, James F; Mandrekar, Jayawant N; Brown, Allen W; Moessner, Anne M

2009-01-01

To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.
17 CFR 201.360 - Initial decision of hearing officer.

Code of Federal Regulations, 2010 CFR

2010-04-01

... with the Secretary, as well as any other time limits established in orders issued by the hearing... include: Findings and conclusions, and the reasons or basis therefor, as to all the material issues of... decision, except for good cause shown, within which a petition for review of the initial decision may be...
Curriculum: Big Decisions--Making Healthy, Informed Choices about Sex

ERIC Educational Resources Information Center

Davis, Melanie

2009-01-01

Big Decisions is a 10-lesson abstinence-plus curriculum for ages 12-18 that emphasizes sex as a big decision, abstinence as the healthiest choice, and the mandate that sexually active teens use condoms and be tested for sexually transmitted diseases. This program can be implemented with limited resources and facilitator training when abstinence…
Three Cases of Adolescent Childbearing Decision-Making: The Importance of Ambivalence

ERIC Educational Resources Information Center

Bender, Soley S.

2008-01-01

Limited information is available about the childbearing decision-making experience by the pregnant adolescent. The purpose of this case study was to explore this experience with three pregnant teenagers. The study is based on nine qualitative interviews. Within-case descriptions applying the theoretical model of decision-making regarding unwanted…
Decision Making and Health Education.

ERIC Educational Resources Information Center

Duryea, Elias J.

1983-01-01

A position statement is offered that clarifies the function, role, and emphasis of decision making within the field of health education, and a rationale that proposes that health decision-making efforts be limited to areas where evidence links a health behavior (i.e., smoking) to a health problem (i.e., lung cancer) is presented. (Author/CJ)
18 CFR 385.704 - Rights of participants before initial decision (Rule 704).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Rights of participants... PROCEDURE Decisions § 385.704 Rights of participants before initial decision (Rule 704). After testimony is... good cause, deny opportunity for reply or limit the issues which may be addressed in any reply. ...
24 CFR 115.204 - Criteria for adequacy of law.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the agency's decision-making authority to be contracted out or delegated to a non-governmental authority. For the purposes of this paragraph, “decision-making authority” includes but is not limited to...; (4) Any action specified in § 115.204(a)(2)(iii) or (b)(1); and (5) Any decision-making regarding...
Decision-Making Difficulties Experienced by Adults with Autism Spectrum Conditions

ERIC Educational Resources Information Center

Luke, Lydia; Clare, Isabel C. H.; Ring, Howard; Redley, Marcus; Watson, Peter

2012-01-01

Autobiographical and clinical accounts, as well as a limited neuropsychological research literature, suggest that, in some situations, men and women with autism spectrum conditions (ASCs) may have difficulty making decisions. Little is known, however, about how people with ASCs experience decision-making or how they might best be supported to make…
The Development and Validation of a Novice Nurse Decision-Making Skills Education Curriculum

ERIC Educational Resources Information Center

Simmons, Joanne

2017-01-01

Novice nurses (NNs) are entering critical care environments with limited knowledge, skills, and decision-making expertise. They are expected to care for complex patients in a dynamic healthcare setting. The research question for this project examined whether NNs improve their knowledge and skills by participating in a nursing decision-making…
Accepting uncertainty, assessing risk: decision quality in managing wildfire, forest resource values, and new technology

Treesearch

Jeffrey G. Borchers

2005-01-01

The risks, uncertainties, and social conflicts surrounding uncharacteristic wildfire and forest resource values have defied conventional approaches to planning and decision-making. Paradoxically, the adoption of technological innovations such as risk assessment, decision analysis, and landscape simulation models by land management organizations has been limited. The...
Capacity of noncoherent MFSK channels

NASA Technical Reports Server (NTRS)

Bar-David, I.; Butman, S. A.; Klass, M. J.; Levitt, B. K.; Lyon, R. F.

1974-01-01

Performance limits theoretically achievable over noncoherent channels perturbed by additive Gaussian noise in hard decision, optimal, and soft decision receivers are computed as functions of the number of orthogonal signals and the predetection signal-to-noise ratio. Equations are derived for orthogonal signal capacity, the ultimate MFSK capacity, and the convolutional coding and decoding limit. It is shown that performance improves as the signal-to-noise ratio increases, provided the bandwidth can be increased, that the optimum number of signals is not infinite (except for the optimal receiver), and that the optimum number decreases as the signal-to-noise ratio decreases, but is never less than 7 for even the hard decision receiver.
Treatment limitation decisions under uncertainty: the value of subsequent euthanasia.

PubMed

Savulescu, Julian

1994-01-01

This paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires life-supporting treatment. However, his life may be not worth living. If active euthanasia of 'non-terminal' conditions is prohibited, the option of dying will no longer be available. Taking a rational 'wait and see' course may result in being trapped within an unbearable life. On the other hand, sometimes present practice 'lets nature take its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty.
Collaborative Manufacturing for Small-Medium Enterprises

NASA Astrophysics Data System (ADS)

Irianto, D.

2016-02-01

Manufacturing systems involve decisions concerning production processes, capacity, planning, and control. In a MTO manufacturing systems, strategic decisions concerning fulfilment of customer requirement, manufacturing cost, and due date of delivery are the most important. In order to accelerate the decision making process, research on decision making structure when receiving order and sequencing activities under limited capacity is required. An effective decision making process is typically required by small-medium components and tools maker as supporting industries to large industries. On one side, metal small-medium enterprises are expected to produce parts, components or tools (i.e. jigs, fixture, mold, and dies) with high precision, low cost, and exact delivery time. On the other side, a metal small- medium enterprise may have weak bargaining position due to aspects such as low production capacity, limited budget for material procurement, and limited high precision machine and equipment. Instead of receiving order exclusively, a small-medium enterprise can collaborate with other small-medium enterprise in order to fulfill requirements high quality, low manufacturing cost, and just in time delivery. Small-medium enterprises can share their best capabilities to form effective supporting industries. Independent body such as community service at university can take a role as a collaboration manager. The Laboratory of Production Systems at Bandung Institute of Technology has implemented shared manufacturing systems for small-medium enterprise collaboration.
Considering Risk and Resilience in Decision-Making

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

2015-01-01

This paper examines the concepts of decision-making, risk analysis, uncertainty and resilience analysis. The relation between risk, vulnerability, and resilience is analyzed. The paper describes how complexity, uncertainty, and ambiguity are the most critical factors in the definition of the approach and criteria for decision-making. Uncertainty in its various forms is what limits our ability to offer definitive answers to questions about the outcomes of alternatives in a decision-making process. It is shown that, although resilience-informed decision-making would seem fundamentally different from risk-informed decision-making, this is not the case as resilience-analysis can be easily incorporated within existing analytic-deliberative decision-making frameworks.
Decision-making theories and their usefulness to the midwifery profession both in terms of midwifery practice and the education of midwives.

PubMed

Jefford, Elaine; Fahy, Kathleen; Sundin, Deborah

2011-06-01

What are the strengths and limitations of existing Decision-Making Theories as a basis for guiding best practice clinical decision-making within a framework of midwifery philosophy? Each theory is compared in relation with how well they provide a teachable framework for midwifery clinical reasoning that is consistent with midwifery philosophy. Hypothetico-Deductive Theory, from which medical clinical reasoning is based; intuitive decision-making; Dual Processing Theory; The International Confederation of Midwives Clinical Decision-Making Framework; Australian Nursing and Midwifery Council Midwifery Practice Decisions Flowchart and Midwifery Practice. Best practice midwifery clinical Decision-Making Theory needs to give guidance about: (i) effective use of cognitive reasoning processes; (ii) how to include contextual and emotional factors; (iii) how to include the interests of the baby as an integral part of the woman; (iv) decision-making in partnership with woman; and (v) how to recognize/respond to clinical situations outside the midwife's legal/personal scope of practice. No existing Decision-Making Theory meets the needs of midwifery. Medical clinical reasoning has a good contribution to make in terms of cognitive reasoning processes. Two limitations of medical clinical reasoning are its reductionistic focus and privileging of reason to the exclusion of emotional and contextual factors. Hypothetico-deductive clinical reasoning is a necessary but insufficient condition for best practice clinical decision-making in midwifery. © 2011 Blackwell Publishing Asia Pty Ltd.
Are patient decision aids the best way to improve clinical decision making? Report of the IPDAS Symposium.

PubMed

Holmes-Rovner, Margaret; Nelson, Wendy L; Pignone, Michael; Elwyn, Glyn; Rovner, David R; O'Connor, Annette M; Coulter, Angela; Correa-de-Araujo, Rosaly

2007-01-01

This article reports on the International Patient Decision Aid Standards Symposium held in 2006 at the annual meeting of the Society for Medical Decision Making in Cambridge, Massachusetts. The symposium featured a debate regarding the proposition that "decision aids are the best way to improve clinical decision making.'' The formal debate addressed the theoretical problem of the appropriate gold standard for an improved decision, efficacy of decision aids, and prospects for implementation. Audience comments and questions focused on both theory and practice: the often unacknowledged roots of decision aids in expected utility theory and the practical problems of limited patient decision aid implementation in health care. The participants' vote on the proposition was approximately half for and half against.
A decision-analytic approach to the optimal allocation of resources for endangered species consultation

USGS Publications Warehouse

Converse, Sarah J.; Shelley, Kevin J.; Morey, Steve; Chan, Jeffrey; LaTier, Andrea; Scafidi, Carolyn; Crouse, Deborah T.; Runge, Michael C.

2011-01-01

The resources available to support conservation work, whether time or money, are limited. Decision makers need methods to help them identify the optimal allocation of limited resources to meet conservation goals, and decision analysis is uniquely suited to assist with the development of such methods. In recent years, a number of case studies have been described that examine optimal conservation decisions under fiscal constraints; here we develop methods to look at other types of constraints, including limited staff and regulatory deadlines. In the US, Section Seven consultation, an important component of protection under the federal Endangered Species Act, requires that federal agencies overseeing projects consult with federal biologists to avoid jeopardizing species. A benefit of consultation is negotiation of project modifications that lessen impacts on species, so staff time allocated to consultation supports conservation. However, some offices have experienced declining staff, potentially reducing the efficacy of consultation. This is true of the US Fish and Wildlife Service's Washington Fish and Wildlife Office (WFWO) and its consultation work on federally-threatened bull trout (Salvelinus confluentus). To improve effectiveness, WFWO managers needed a tool to help allocate this work to maximize conservation benefits. We used a decision-analytic approach to score projects based on the value of staff time investment, and then identified an optimal decision rule for how scored projects would be allocated across bins, where projects in different bins received different time investments. We found that, given current staff, the optimal decision rule placed 80% of informal consultations (those where expected effects are beneficial, insignificant, or discountable) in a short bin where they would be completed without negotiating changes. The remaining 20% would be placed in a long bin, warranting an investment of seven days, including time for negotiation. For formal consultations (those where expected effects are significant), 82% of projects would be placed in a long bin, with an average time investment of 15. days. The WFWO is using this decision-support tool to help allocate staff time. Because workload allocation decisions are iterative, we describe a monitoring plan designed to increase the tool's efficacy over time. This work has general application beyond Section Seven consultation, in that it provides a framework for efficient investment of staff time in conservation when such time is limited and when regulatory deadlines prevent an unconstrained approach. ?? 2010.
33 CFR 154.1075 - Appeal process.

Code of Federal Regulations, 2011 CFR

2011-07-01

... are not limited to, those listed in § 154.1016(b). After considering all relevant material presented... making his or her decision on reconsideration. (c) Within 10 days of the COTP's decision under paragraph...

33 CFR 154.1075 - Appeal process.

Code of Federal Regulations, 2010 CFR

2010-07-01

... are not limited to, those listed in § 154.1016(b). After considering all relevant material presented... making his or her decision on reconsideration. (c) Within 10 days of the COTP's decision under paragraph...
Knowledge bases, clinical decision support systems, and rapid learning in oncology.

PubMed

Yu, Peter Paul

2015-03-01

One of the most important benefits of health information technology is to assist the cognitive process of the human mind in the face of vast amounts of health data, limited time for decision making, and the complexity of the patient with cancer. Clinical decision support tools are frequently cited as a technologic solution to this problem, but to date useful clinical decision support systems (CDSS) have been limited in utility and implementation. This article describes three unique sources of health data that underlie fundamentally different types of knowledge bases which feed into CDSS. CDSS themselves comprise a variety of models which are discussed. The relationship of knowledge bases and CDSS to rapid learning health systems design is critical as CDSS are essential drivers of rapid learning in clinical care. Copyright © 2015 by American Society of Clinical Oncology.
KNOW ESSENTIALS: a tool for informed decisions in the absence of formal HTA systems.

PubMed

Mathew, Joseph L

2011-04-01

Most developing countries and resource-limited settings lack robust health technology assessment (HTA) systems. Because the development of locally relevant HTA is not immediately viable, and the extrapolation of external HTA is inappropriate, a new model for evaluating health technologies is required. The aim of this study was to describe the development and application of KNOW ESSENTIALS, a tool facilitating evidence-based decisions on health technologies by stakeholders in settings lacking formal HTA systems. Current HTA methodology was examined through literature search. Additional issues relevant to resource-limited settings, but not adequately addressed in current methodology, were identified through further literature search, appraisal of contextually relevant issues, discussion with healthcare professionals familiar with the local context, and personal experience. A set of thirteen elements important for evidence-based decisions was identified, selected and combined into a tool with the mnemonic KNOW ESSENTIALS. Detailed definitions for each element, coding for the elements, and a system to evaluate a given health technology using the tool were developed. Developing countries and resource-limited settings face several challenges to informed decision making. Models that are relevant and applicable in high-income countries are unlikely in such settings. KNOW ESSENTIALS is an alternative that facilitates evidence-based decision making by stakeholders without formal expertise in HTA. The tool could be particularly useful, as an interim measure, in healthcare systems that are developing HTA capacity. It could also be useful anywhere when rapid evidence-based decisions on health technologies are required.
Shared decision-making in epilepsy management.

PubMed

Pickrell, W O; Elwyn, G; Smith, P E M

2015-06-01

Policy makers, clinicians, and patients increasingly recognize the need for greater patient involvement in clinical decision-making. Shared decision-making helps address these concerns by providing a framework for clinicians and patients to make decisions together using the best evidence. Shared decision-making is applicable to situations where several acceptable options exist (clinical equipoise). Such situations occur commonly in epilepsy, for example, in decisions regarding the choice of medication, treatment in pregnancy, and medication withdrawal. A talk model is a way of implementing shared decision-making during consultations, and decision aids are useful tools to assist in the process. Although there is limited evidence available for shared decision-making in epilepsy, there are several benefits of shared decision-making in general including improved decision quality, more informed choices, and better treatment concordance. Copyright © 2015 Elsevier Inc. All rights reserved.
Individual responsibility as ground for priority setting in shared decision-making.

PubMed

Sandman, Lars; Gustavsson, Erik; Munthe, Christian

2016-10-01

Given healthcare resource constraints, voices are being raised to hold patients responsible for their health choices. In parallel, there is a growing trend towards shared decision-making, aiming to empower patients and give them more control over healthcare decisions. More power and control over decisions is usually taken to mean more responsibility for them. The trend of shared decision-making would therefore seem to strengthen the case for invoking individual responsibility in the healthcare priority setting. To analyse whether the implementation of shared decision-making would strengthen the argument for invoking individual responsibility in the healthcare priority setting using normative analysis. Shared decision-making does not constitute an independent argument in favour of employing individual responsibility since these notions rest on different underlying values. However, if a health system employs shared decision-making, individual responsibility may be used to limit resource implications of accommodating patient preferences outside professional standards and goals. If a healthcare system employs individual responsibility, high level dynamic shared decision-making implying a joint deliberation resulting in a decision where both parties are willing to revise initial standpoints may disarm common objections to the applicability of individual responsibility by virtue of making patients more likely to exercise adequate control of their own actions. However, if communication strategies applied in the shared decision-making are misaligned to the patient's initial capacities, arguments against individual responsibility might, on the other hand, gain strength. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
DOE Office of Scientific and Technical Information (OSTI.GOV)

Edwards, Timothy S.

Normal tolerance limits are frequently used in dynamic environments specifications of aerospace systems as a method to account for aleatory variability in the environments. Upper tolerance limits, when used in this way, are computed from records of the environment and used to enforce conservatism in the specification by describing upper extreme values the environment may take in the future. Components and systems are designed to withstand these extreme loads to ensure they do not fail under normal use conditions. The degree of conservatism in the upper tolerance limits is controlled by specifying the coverage and confidence level (usually written inmore » “coverage/confidence” form). Moreover, in high-consequence systems it is common to specify tolerance limits at 95% or 99% coverage and confidence at the 50% or 90% level. Despite the ubiquity of upper tolerance limits in the aerospace community, analysts and decision-makers frequently misinterpret their meaning. The misinterpretation extends into the standards that govern much of the acceptance and qualification of commercial and government aerospace systems. As a result, the risk of a future observation of the environment exceeding the upper tolerance limit is sometimes significantly underestimated by decision makers. This note explains the meaning of upper tolerance limits and a related measure, the upper prediction limit. So, the objective of this work is to clarify the probability of exceeding these limits in flight so that decision-makers can better understand the risk associated with exceeding design and test levels during flight and balance the cost of design and development with that of mission failure.« less
In Light of the Limitations of Data-Driven Decision Making

ERIC Educational Resources Information Center

Loeb, Susanna

2012-01-01

Students' experiences and the opportunities they have to learn rest on the quality of education decisions made in each classroom, in each school, in each district, and in each state, federal legislature, and department of education. The role of research and scholarship more broadly in education finance and policy is to inform these decisions for…
12 CFR 516.170 - When will OTS conduct a meeting on an application?

Code of Federal Regulations, 2010 CFR

2010-01-01

... application, or otherwise determines that a meeting will benefit the decision-making process. OTS may limit... inform the applicant and all commenters requesting a meeting of its decision to grant or deny a meeting request, or of its decision to conduct a meeting on its own initiative. (c) If OTS decides to conduct a...
Limits in decision making arise from limits in memory retrieval.

PubMed

Giguère, Gyslain; Love, Bradley C

2013-05-07

Some decisions, such as predicting the winner of a baseball game, are challenging in part because outcomes are probabilistic. When making such decisions, one view is that humans stochastically and selectively retrieve a small set of relevant memories that provides evidence for competing options. We show that optimal performance at test is impossible when retrieving information in this fashion, no matter how extensive training is, because limited retrieval introduces noise into the decision process that cannot be overcome. One implication is that people should be more accurate in predicting future events when trained on idealized rather than on the actual distributions of items. In other words, we predict the best way to convey information to people is to present it in a distorted, idealized form. Idealization of training distributions is predicted to reduce the harmful noise induced by immutable bottlenecks in people's memory retrieval processes. In contrast, machine learning systems that selectively weight (i.e., retrieve) all training examples at test should not benefit from idealization. These conjectures are strongly supported by several studies and supporting analyses. Unlike machine systems, people's test performance on a target distribution is higher when they are trained on an idealized version of the distribution rather than on the actual target distribution. Optimal machine classifiers modified to selectively and stochastically sample from memory match the pattern of human performance. These results suggest firm limits on human rationality and have broad implications for how to train humans tasked with important classification decisions, such as radiologists, baggage screeners, intelligence analysts, and gamblers.
Limits in decision making arise from limits in memory retrieval

PubMed Central

Giguère, Gyslain; Love, Bradley C.

2013-01-01

Some decisions, such as predicting the winner of a baseball game, are challenging in part because outcomes are probabilistic. When making such decisions, one view is that humans stochastically and selectively retrieve a small set of relevant memories that provides evidence for competing options. We show that optimal performance at test is impossible when retrieving information in this fashion, no matter how extensive training is, because limited retrieval introduces noise into the decision process that cannot be overcome. One implication is that people should be more accurate in predicting future events when trained on idealized rather than on the actual distributions of items. In other words, we predict the best way to convey information to people is to present it in a distorted, idealized form. Idealization of training distributions is predicted to reduce the harmful noise induced by immutable bottlenecks in people’s memory retrieval processes. In contrast, machine learning systems that selectively weight (i.e., retrieve) all training examples at test should not benefit from idealization. These conjectures are strongly supported by several studies and supporting analyses. Unlike machine systems, people’s test performance on a target distribution is higher when they are trained on an idealized version of the distribution rather than on the actual target distribution. Optimal machine classifiers modified to selectively and stochastically sample from memory match the pattern of human performance. These results suggest firm limits on human rationality and have broad implications for how to train humans tasked with important classification decisions, such as radiologists, baggage screeners, intelligence analysts, and gamblers. PMID:23610402
Reduction in growth threshold for pulmonary metastases: an opportunity for volumetry and its impact on treatment decisions.

PubMed

Vogel, M N; Schmücker, S; Maksimovic, O; Hartmann, J; Claussen, C D; Horger, M

2012-07-01

This study compares tumour response assessment by automated CT volumetry and standard manual measurements regarding the impact on treatment decisions and patient outcome. 58 consecutive patients with 203 pulmonary metastases undergoing baseline and follow-up multirow detector CT (MDCT) under chemotherapy were assessed for response to chemotherapy. Tumour burden of pulmonary target lesions was quantified in three ways: (1) following response evaluation criteria in solid tumours (RECIST); (2) following the volume equivalents of RECIST (i.e. with a threshold of -65/+73%); and (3) using calculated limits for stable disease (SD). For volumetry, calculated limits had been set at ±38% prior to the study by repeated quantification of nodules scanned twice. Results were compared using non-weighted κ-values and were evaluated for their impact on treatment decisions and patient outcome. In 15 (17%) of the 58 patients, the results of response assessment were inconsistent with 1 of the 3 methods, which would have had an impact on treatment decisions in 8 (13%). Patient outcome regarding therapy response could be verified in 5 (33%) of the 15 patients with inconsistent measurement results and was consistent with both RECIST and volumetry in 1, with calculated limits in 3 and with none in 1. Diagnosis as to the overall response was consistent with RECIST in six patients, with volumetry in six and with calculated limits in eight cases. There is an impact of different methods for therapy response assessment on treatment decisions. A reduction of threshold for SD to ±30-40% of volume change seems reasonable when using volumetry.
Primary Breast Cancer Decision-making Among Chinese American Women: Satisfaction, Regret.

PubMed

Katie Lee, Shiu-Yu C; Knobf, M Tish

2015-01-01

Decision-making for cancer treatment is a complex, informational process. Lower satisfaction, higher decision regret, and poorer quality of life are potential adverse outcomes. The aim of the study was to describe breast cancer treatment decision outcomes and examine factors associated with decision outcomes of satisfaction and regret in Chinese American women. A cross-sectional, correlational design was used. A sample of 123 self-identified Chinese American women with early-stage breast cancer was recruited from the greater New York metropolitan area. The Breast Cancer Decision-Making Questionnaire, Decisional Conflict Scale, and Decisional Regret Scale--that were written in Chinese with equivalence from back-translation--were used to measure the factors in the decision-making process and the decisional outcome. Multiple, linear regression was used to identify predictors for decisional outcomes. The mean age of the subjects was 48.7 years (SD = 9.3 years), the majority of whom were married (80%) and not working (63%), and about half spoke Cantonese or Mandarin as their daily language. The women reported a low to moderate level of decisional conflict, postdecisional dissatisfaction, and regret with their decision. However, the women who had greater decisional conflict, who had more difficulty in communicating with their physician, who had limited English fluency, and who were financially dependent and less involved in decision-making had lower satisfaction and more regret with their treatment decision. Limited English fluency among Chinese American women negatively affected communication during the physician consultation about breast cancer treatment options, and financial barriers were also associated with lower postdecisional satisfaction and higher regret. Culturally sensitive decision support interventions are needed for Asian American women to make an informed, satisfied breast cancer treatment decision.
True detection limits in an experimental linearly heteroscedastic system.. Part 2

NASA Astrophysics Data System (ADS)

Voigtman, Edward; Abraham, Kevin T.

2011-11-01

Despite much different processing of the experimental fluorescence detection data presented in Part 1, essentially the same estimates were obtained for the true theoretical Currie decision levels ( YC and XC) and true Currie detection limits ( YD and XD). The obtained experimental values, for 5% probability of false positives and 5% probability of false negatives, were YC = 56.0 mV, YD = 125. mV, XC = 0.132 μg/mL and XD = 0.293 μg/mL. For 5% probability of false positives and 1% probability of false negatives, the obtained detection limits were YD = 158 . mV and XD = 0.371 μg/mL. Furthermore, by using bootstrapping methodology on the experimental data for the standards and the analytical blank, it was possible to validate previously published experimental domain expressions for the decision levels ( yC and xC) and detection limits ( yD and xD). This was demonstrated by testing the generated decision levels and detection limits for their performance in regard to false positives and false negatives. In every case, the obtained numbers of false negatives and false positives were as specified a priori.
Improving Decision Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial

PubMed Central

Hanson, Laura C.; Carey, Timothy S.; Caprio, Anthony J.; Lee, Tae Joon; Ersek, Mary; Garrett, Joanne; Jackman, Anne; Gilliam, Robin; Wessell, Kathryn; Mitchell, Susan L.

2011-01-01

Background Feeding problems are common in dementia, and decision-makers have limited understanding of treatment options. Objectives To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. Design Cluster randomized controlled trial. Setting 24 nursing homes in North Carolina Participants Residents with advanced dementia and feeding problems and their surrogates. Intervention Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. Measurements Primary outcome was the Decisional Conflict Scale (range 1–5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. Results 256 residents and surrogate decision-makers were recruited. Residents’ average age was 85; 67% were Caucasian and 79% were women. Surrogates’ average age was 59; 67% were Caucasian, and 70% were residents’ children. The intervention improved knowledge scores (16.8 vs 15.1, p<0.001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs. 1.90, p<0.001) and more often discussed feeding options with a health care provider (46% vs. 33%, p=0.04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs.76%, p=0.04), and showed a trend toward increased staff eating assistance (20% vs.10%, p=0.08). Tube feeding was rare in both groups even after 9 months (1 intervention vs. 3 control, p=0.34). Limitations Cluster randomization was necessary to avoid contamination, but limits blinding and may introduce bias by site effect. Conclusion A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. PMID:22091750
Five reasons not to use numerical models in water resource management (Arne Richter Award Lecture for OYS)

NASA Astrophysics Data System (ADS)

Pianosi, Francesca

2015-04-01

Sustainable water resource management in a quickly changing world poses new challenges to hydrology and decision sciences. Systems analysis can contribute to promote sustainable practices by providing the theoretical background and the operational tools for an objective and transparent appraisal of policy options for water resource systems (WRS) management. Traditionally, limited availability of data and computing resources imposed to use oversimplified WRS models, with little consideration of modeling uncertainties and of the non-stationarity and feedbacks between WRS drivers, and a priori aggregation of costs and benefits. Nowadays we increasingly recognize the inadequacy of these simplifications, and consider them among the reasons for the limited use of model-generated information in actual decision-making processes. On the other hand, fast-growing availability of data and computing resources are opening up unprecedented possibilities in the way we build and apply numerical models. In this talk I will discuss my experiences and ideas on how we can exploit this potential to improve model-informed decision-making while facing the challenges of uncertainty, non-stationarity, feedbacks and conflicting objectives. In particular, through practical examples of WRS design and operation problems, my talk will aim at stimulating discussion about the impact of uncertainty on decisions: can inaccurate and imprecise predictions still carry valuable information for decision-making? Does uncertainty in predictions necessarily limit our ability to make 'good' decisions? Or can uncertainty even be of help for decision-making, for instance by reducing the projected conflict between competing water use? Finally, I will also discuss how the traditionally separate disciplines of numerical modelling, optimization, and uncertainty and sensitivity analysis have in my experience been just different facets of the same 'systems approach'.
The Mental Capacity Act 2005: a new framework for healthcare decision making.

PubMed

Johnston, Carolyn; Liddle, Jane

2007-02-01

The Mental Capacity Act received Royal Assent on 7 April 2005, and it will be implemented in 2007. The Act defines when someone lacks capacity and it supports people with limited decision-making ability to make as many decisions as possible for themselves. The Act lays down rules for substitute decision making. Someone taking decisions on behalf of the person lacking capacity must act in the best interests of the person concerned and choose the options least restrictive of his or her rights and freedoms. Decision making will be allowed without any formal procedure unless specific provisions apply, such as a written advance decision, lasting powers of attorney or a decision by the court of protection.
Probability of Future Observations Exceeding One-Sided, Normal, Upper Tolerance Limits

DOE PAGES

Edwards, Timothy S.

2014-10-29

Normal tolerance limits are frequently used in dynamic environments specifications of aerospace systems as a method to account for aleatory variability in the environments. Upper tolerance limits, when used in this way, are computed from records of the environment and used to enforce conservatism in the specification by describing upper extreme values the environment may take in the future. Components and systems are designed to withstand these extreme loads to ensure they do not fail under normal use conditions. The degree of conservatism in the upper tolerance limits is controlled by specifying the coverage and confidence level (usually written inmore » “coverage/confidence” form). Moreover, in high-consequence systems it is common to specify tolerance limits at 95% or 99% coverage and confidence at the 50% or 90% level. Despite the ubiquity of upper tolerance limits in the aerospace community, analysts and decision-makers frequently misinterpret their meaning. The misinterpretation extends into the standards that govern much of the acceptance and qualification of commercial and government aerospace systems. As a result, the risk of a future observation of the environment exceeding the upper tolerance limit is sometimes significantly underestimated by decision makers. This note explains the meaning of upper tolerance limits and a related measure, the upper prediction limit. So, the objective of this work is to clarify the probability of exceeding these limits in flight so that decision-makers can better understand the risk associated with exceeding design and test levels during flight and balance the cost of design and development with that of mission failure.« less
Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit.

PubMed

Guidet, Bertrand; Flaatten, Hans; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Jung, Christian; Marsh, Brian; Moreno, Rui; Oeyen, Sandra; Öhman, Christina Agwald; Pinto, Bernardo Bollen; Soliman, Ivo W; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; De Lange, Dylan W

2018-05-17

To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. ClinicalTrials.gov (ID: NTC03134807).
Know the risk, take the win: how executive functions and probability processing influence advantageous decision making under risk conditions.

PubMed

Brand, Matthias; Schiebener, Johannes; Pertl, Marie-Theres; Delazer, Margarete

2014-01-01

Recent models on decision making under risk conditions have suggested that numerical abilities are important ingredients of advantageous decision-making performance, but empirical evidence is still limited. The results of our first study show that logical reasoning and basic mental calculation capacities predict ratio processing and that ratio processing predicts decision making under risk. In the second study, logical reasoning together with executive functions predicted probability processing (numeracy and probability knowledge), and probability processing predicted decision making under risk. These findings suggest that increasing an individual's understanding of ratios and probabilities should lead to more advantageous decisions under risk conditions.
A qualitative study of professional and client perspectives on information flows and decision aid use.

PubMed

Stirling, Christine; Lloyd, Barbara; Scott, Jenn; Abbey, Jenny; Croft, Toby; Robinson, Andrew

2012-03-29

This paper explores the meanings given by a diverse range of stakeholders to a decision aid aimed at helping carers of people in early to moderate stages of dementia (PWD) to select community based respite services. Decision aids aim to empower clients to share decision making with health professionals. However, the match between health professionals' perspectives on decision support needs and their clients' perspective is an important and often unstudied aspect of decision aid use. A secondary analysis was undertaken of qualitative data collected as part of a larger study. The data included twelve interviews with carers of people with dementia, three interviews with expert advisors, and three focus groups with health professionals. A theoretical analysis was conducted, drawing on theories of 'positioning' and professional identity. Health professionals are seen to hold varying attitudes and beliefs about carers' decision support needs, and these appeared to be grounded in the professional identity of each group. These attitudes and beliefs shaped their attitudes towards decision aids, the information they believed should be offered to dementia carers, and the timing of its offering. Some groups understood carers as needing to be protected from realistic information and consequently saw a need to filter information to carer clients. Health professionals' beliefs may cause them to restrict information flows, which can limit carers' ability to make decisions, and limit health services' ability to improve partnering and shared decision making. In an era where information is freely available to those with the resources to access it, we question whether health professionals should filter information.

Health technology assessment in Saudi Arabia.

PubMed

Al-Aqeel, Sinaa

2018-05-16

The Saudi government, similar to any other government, is committed to making public spending more efficient, using resources more effectively, and limiting waste. Health technology assessment (HTA) is a tool that informs policy and decision makers regarding the formulation of safe and effective policies that are patient-focused and help to achieve efficiency when allocating limited health-care resources. Areas covered: After a brief description of HTA in the international context, this review provides a brief introduction to Saudi Arabia's health-care system, followed by a delineation of the decision maker(s) and influencers and the decision-making process for pricing and reimbursement. The article then discusses the current status of HTA in Saudi Arabia and proposes four strategic objectives that can form the first step in the development of a formal HTA process. Expert commentary: In Saudi Arabia, facilitators for incorporating HTA into the decision-making process exist. Future local research is needed to guide the implementation of full HTA.
Simultaneous analysis of coccidiostats and sulfonamides in non-target feed by HPLC-MS/MS and validation following the Commission Decision 2002/657/EC.

PubMed

Gavilán, Rosa Elvira; Nebot, Carolina; Patyra, Ewelina; Miranda, Jose Manuel; Franco, Carlos Manuel; Cepeda, Alberto

2018-05-02

Taking into consideration the maximum level for coccidiostats included in the European Regulation 574/2011 and the fact that the presence of residues of sulfonamides in non-target feed is forbidden, the aim of this article is to present an analytical method based on HPLC-MS/MS for the identification and quantification of sulfonamides and coccidiostats in non-target feeds. The method was validated following Decision 2002/657/EC and recovery, repeatability, and reproducibility were within the limits stablished in the Decision. For coccidiostats, the decision limit and detection capability were calculated for the different species taking into account the maximum level allowed in Regulation 574/2011. The applicability of the method was investigated in 50 feed samples collected from dairy farms, 50 obtained from feed mills, and 10 interlaboratory feed samples.
Limitations and opportunities for the social cost of carbon (Invited)

NASA Astrophysics Data System (ADS)

Rose, S. K.

2010-12-01

Estimates of the marginal value of carbon dioxide-the social cost of carbon (SCC)-were recently adopted by the U.S. Government in order to satisfy requirements to value estimated GHG changes of new federal regulations. However, the development and use of SCC estimates of avoided climate change impacts comes with significant challenges and controversial decisions. Fortunately, economics can provide some guidance for conceptually appropriate estimates. At the same time, economics defaults to a benefit-cost decision framework to identify socially optimal policies. However, not all current policy decisions are benefit-cost based, nor depend on monetized information, or even have the same threshold for information. While a conceptually appropriate SCC is a useful metric, how far can we take it? This talk discusses potential applications of the SCC, limitations based on the state of research and methods, as well as opportunities for among other things consistency with climate risk management and research and decision-making tools.
The optimal retailer's ordering policies with trade credit financing and limited storage capacity in the supply chain system

NASA Astrophysics Data System (ADS)

Yen, Ghi-Feng; Chung, Kun-Jen; Chen, Tzung-Ching

2012-11-01

The traditional economic order quantity model assumes that the retailer's storage capacity is unlimited. However, as we all know, the capacity of any warehouse is limited. In practice, there usually exist various factors that induce the decision-maker of the inventory system to order more items than can be held in his/her own warehouse. Therefore, for the decision-maker, it is very practical to determine whether or not to rent other warehouses. In this article, we try to incorporate two levels of trade credit and two separate warehouses (own warehouse and rented warehouse) to establish a new inventory model to help the decision-maker to make the decision. Four theorems are provided to determine the optimal cycle time to generalise some existing articles. Finally, the sensitivity analysis is executed to investigate the effects of the various parameters on ordering policies and annual costs of the inventory system.
Variability in visual working memory ability limits the efficiency of perceptual decision making.

PubMed

Ester, Edward F; Ho, Tiffany C; Brown, Scott D; Serences, John T

2014-04-02

The ability to make rapid and accurate decisions based on limited sensory information is a critical component of visual cognition. Available evidence suggests that simple perceptual discriminations are based on the accumulation and integration of sensory evidence over time. However, the memory system(s) mediating this accumulation are unclear. One candidate system is working memory (WM), which enables the temporary maintenance of information in a readily accessible state. Here, we show that individual variability in WM capacity is strongly correlated with the speed of evidence accumulation in speeded two-alternative forced choice tasks. This relationship generalized across different decision-making tasks, and could not be easily explained by variability in general arousal or vigilance. Moreover, we show that performing a difficult discrimination task while maintaining a concurrent memory load has a deleterious effect on the latter, suggesting that WM storage and decision making are directly linked.
Extending the boundaries of the Declaration of Helsinki: a case study of an unethical experiment in a non-medical setting

PubMed Central

Richter, E.; Barach, P.; Berman, T.; Ben-David, G; Weinberger, Z.

2001-01-01

To examine the ethical issues involved in governmental decisions with potential health risks, we review the history of the decision to raise the interurban speed limit in Israel in light of its impact on road death and injury. In 1993, the Israeli Ministry of Transportation initiated an "experiment" to raise the interurban speed limit from 90 to 100 kph. The "experiment" did not include a protocol and did not specify cut-off points for early termination in the case of adverse results. After the raise in the speed limit, the death toll on interurban roads rose as a result of a sudden increase in speeds and case fatality rates. The committee's decision is a case study in unfettered human experimentation and public health risks when the setting is non-medical and lacks a defined ethical framework. The case study states the case for extending Helsinki type safeguards to experimentation in non-medical settings. Key Words: Declaration of Helsinki • human experimentation • speed limit PMID:11314157
Physicians' Perceptions of Shared Decision Making in Chronic Disease and Its Barriers and Facilitators.

PubMed

Dodds, Cassandra M; Britto, Maria T; Denson, Lee A; Lovell, Daniel J; Saeed, Shehzad; Lipstein, Ellen A

2016-04-01

This study assessed pediatric physicians' use of shared decision making (SDM) in 2 chronic conditions. Most physicians indicated that parent and adolescent trust and emotional readiness facilitated SDM, physicians' preferred approach to decision making. At the same time, they perceived few barriers, other than insurance limitations, to using SDM. Copyright © 2016 Elsevier Inc. All rights reserved.
40 CFR 57.702 - Compliance with constant control emission limitation.

Code of Federal Regulations, 2010 CFR

2010-07-01

... with subpart H, pending a final decision on the request under subpart H. If a waiver is requested in... months from a final decision by the issuing agency to deny a waiver under subpart H or disapproval by EPA... decision under subpart H so as to either grant a waiver of any remaining requirements of subpart C, or deny...
Obstacles to comprehensive dental care in patients with sustained limitations of their decision-making abilities: findings from a Delphi study.

PubMed

Blaizot, Alessandra; Catteau, Céline; Delfosse, Caroline; Hamel, Olivier; Trentesaux, Thomas

2018-06-01

The objective of this study was to explore the therapeutic limitations experienced by a panel of special-care dentists in France when treating patients with sustained limitations of their decision-making abilities. We used a Delphi technique conducted in three rounds from 01 June 2014 to 30 September 2015. A first questionnaire comprising open-ended questions was addressed to 72 panellists. A content analysis of the returned questionnaires served to draft a second questionnaire comprising closed-ended questions; this was sent to the 28 panellists who responded in the first round. A third questionnaire was sent to the 20 panellists who responded in the second round to give them an opportunity to reconsider their response in the context of the second-round response group. Sixteen panellists answered the last round. A large majority agreed on the importance of providing comprehensive care, but they encountered obstacles at two time points: (i) when proposing the care; and (ii) when setting it up. The panel put forward recommendations in two main areas: (i) the training of those involved in oral health decisions; and (ii) dental care management and organization of the care system. The study provided a foundation for building future orientations in health care for patients with limited decision-making abilities. © 2018 Eur J Oral Sci.
A Reward-Maximizing Spiking Neuron as a Bounded Rational Decision Maker.

PubMed

Leibfried, Felix; Braun, Daniel A

2015-08-01

Rate distortion theory describes how to communicate relevant information most efficiently over a channel with limited capacity. One of the many applications of rate distortion theory is bounded rational decision making, where decision makers are modeled as information channels that transform sensory input into motor output under the constraint that their channel capacity is limited. Such a bounded rational decision maker can be thought to optimize an objective function that trades off the decision maker's utility or cumulative reward against the information processing cost measured by the mutual information between sensory input and motor output. In this study, we interpret a spiking neuron as a bounded rational decision maker that aims to maximize its expected reward under the computational constraint that the mutual information between the neuron's input and output is upper bounded. This abstract computational constraint translates into a penalization of the deviation between the neuron's instantaneous and average firing behavior. We derive a synaptic weight update rule for such a rate distortion optimizing neuron and show in simulations that the neuron efficiently extracts reward-relevant information from the input by trading off its synaptic strengths against the collected reward.
Representation or reason: consulting the public on the ethics of health policy.

PubMed

Mullen, Caroline

2008-12-01

Consulting the public about the ethical approaches underlying health policies can seem an appealing means of addressing concerns about limited public participation in development of health policy. However ambiguity surrounds questions of whether, or how consultation can really contribute to more defensible decisions about ethical aspects of policy. This paper clarifies the role and limits of public consultation on ethics, beginning by separating different senses of defensibility in decisions on ethics. Defensibility of ethical decisions could be understood either in the sense of legitimacy in virtue of reflecting the opinions of the public whose interests are affected, or in the sense of being able to withstand and respond to challenges presented in ethical debate. The question then is whether there are forms of consultation which have the potential to realise more defensible decisions in either of these senses. Problems of adequately accounting for the views of those affected by policy decisions casts doubt on the plausibility of using consultation as a means of determining the opinions of the public. Consultation can have a role by bringing new ideas and challenges to debate, although it is uncertain whether this will increase the defensibility of any decision on ethics.
Neural integrators for decision making: a favorable tradeoff between robustness and sensitivity

PubMed Central

Cain, Nicholas; Barreiro, Andrea K.; Shadlen, Michael

2013-01-01

A key step in many perceptual decision tasks is the integration of sensory inputs over time, but a fundamental questions remain about how this is accomplished in neural circuits. One possibility is to balance decay modes of membranes and synapses with recurrent excitation. To allow integration over long timescales, however, this balance must be exceedingly precise. The need for fine tuning can be overcome via a “robust integrator” mechanism in which momentary inputs must be above a preset limit to be registered by the circuit. The degree of this limiting embodies a tradeoff between sensitivity to the input stream and robustness against parameter mistuning. Here, we analyze the consequences of this tradeoff for decision-making performance. For concreteness, we focus on the well-studied random dot motion discrimination task and constrain stimulus parameters by experimental data. We show that mistuning feedback in an integrator circuit decreases decision performance but that the robust integrator mechanism can limit this loss. Intriguingly, even for perfectly tuned circuits with no immediate need for a robustness mechanism, including one often does not impose a substantial penalty for decision-making performance. The implication is that robust integrators may be well suited to subserve the basic function of evidence integration in many cognitive tasks. We develop these ideas using simulations of coupled neural units and the mathematics of sequential analysis. PMID:23446688
Assessing the speed--accuracy trade-off effect on the capacity of information processing.

PubMed

Donkin, Chris; Little, Daniel R; Houpt, Joseph W

2014-06-01

The ability to trade accuracy for speed is fundamental to human decision making. The speed-accuracy trade-off (SAT) effect has received decades of study, and is well understood in relatively simple decisions: collecting more evidence before making a decision allows one to be more accurate but also slower. The SAT in more complex paradigms has been given less attention, largely due to limits in the models and statistics that can be applied to such tasks. Here, we have conducted the first analysis of the SAT in multiple signal processing, using recently developed technologies for measuring capacity that take into account both response time and choice probability. We show that the primary influence of caution in our redundant-target experiments is on the threshold amount of evidence required to trigger a response. However, in a departure from the usual SAT effect, we found that participants strategically ignored redundant information when they were forced to respond quickly, but only when the additional stimulus was reliably redundant. Interestingly, because the capacity of the system was severely limited on redundant-target trials, ignoring additional targets meant that processing was more efficient when making fast decisions than when making slow and accurate decisions, where participants' limited resources had to be divided between the 2 stimuli. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Patient and Clinician Perspectives on Shared Decision-making in Early Adopting Lung Cancer Screening Programs: a Qualitative Study.

PubMed

Wiener, Renda Soylemez; Koppelman, Elisa; Bolton, Rendelle; Lasser, Karen E; Borrelli, Belinda; Au, David H; Slatore, Christopher G; Clark, Jack A; Kathuria, Hasmeena

2018-02-21

Guidelines recommend, and Medicare requires, shared decision-making between patients and clinicians before referring individuals at high risk of lung cancer for chest CT screening. However, little is known about the extent to which shared decision-making about lung cancer screening is achieved in real-world settings. To characterize patient and clinician impressions of early experiences with communication and decision-making about lung cancer screening and perceived barriers to achieving shared decision-making. Qualitative study entailing semi-structured interviews and focus groups. We enrolled 36 clinicians who refer patients for lung cancer screening and 49 patients who had undergone lung cancer screening in the prior year. Participants were recruited from lung cancer screening programs at four hospitals (three Veterans Health Administration, one urban safety net). Using content analysis, we analyzed transcripts to characterize communication and decision-making about lung cancer screening. Our analysis focused on the recommended components of shared decision-making (information sharing, deliberation, and decision aid use) and barriers to achieving shared decision-making. Clinicians varied in the information shared with patients, and did not consistently incorporate decision aids. Clinicians believed they explained the rationale and gave some (often purposely limited) information about the trade-offs of lung cancer screening. By contrast, some patients reported receiving little information about screening or its trade-offs and did not realize the CT was intended as a screening test for lung cancer. Clinicians and patients alike did not perceive that significant deliberation typically occurred. Clinicians perceived insufficient time, competing priorities, difficulty accessing decision aids, limited patient comprehension, and anticipated patient emotions as barriers to realizing shared decision-making. Due to multiple perceived barriers, patient-clinician conversations about lung cancer screening may fall short of guideline-recommended shared decision-making supported by a decision aid. Consequently, patients may be left uncertain about lung cancer screening's rationale, trade-offs, and process.
A timely account of the role of duration in decision making.

PubMed

Ariely, D; Zakay, D

2001-09-01

The current work takes a general perspective on the role of time in decision making. There are many different relationships and interactions between time and decision making, and no single summary can do justice to this topic. In this paper we will describe a few of the aspects in which time and decision making are interleaved: (a) temporal perspectives of decisions--the various temporal orientations that decision-makers may adopt while making decisions, and the impact of such temporal orientations on the decision process and its outcomes; (b) time as a medium within which decisions take place--the nature of decision processes that occur along time; (c) time as a resource and as a contextual factor--the implications of shortage in time resources and the impact of time limits on decision making processes and performance; (d) time as a commodity--time as the subject matter of decision making. The paper ends with a few general questions on the role of duration in decision making.
Heuristics in Managing Complex Clinical Decision Tasks in Experts’ Decision Making

PubMed Central

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2016-01-01

Background Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. Objective The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. Method After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. Results We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Conclusion Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Application Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design. PMID:27275019
Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making.

PubMed

Islam, Roosan; Weir, Charlene; Del Fiol, Guilherme

2014-09-01

Clinical decision support is a tool to help experts make optimal and efficient decisions. However, little is known about the high level of abstractions in the thinking process for the experts. The objective of the study is to understand how clinicians manage complexity while dealing with complex clinical decision tasks. After approval from the Institutional Review Board (IRB), three clinical experts were interviewed the transcripts from these interviews were analyzed. We found five broad categories of strategies by experts for managing complex clinical decision tasks: decision conflict, mental projection, decision trade-offs, managing uncertainty and generating rule of thumb. Complexity is created by decision conflicts, mental projection, limited options and treatment uncertainty. Experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes and focusing on only the most relevant information. Understanding complex decision making processes can help design allocation based on the complexity of task for clinical decision support design.
Environmental change challenges decision-making during post-market environmental monitoring of transgenic crops.

PubMed

Sanvido, Olivier; Romeis, Jörg; Bigler, Franz

2011-12-01

The ability to decide what kind of environmental changes observed during post-market environmental monitoring of genetically modified (GM) crops represent environmental harm is an essential part of most legal frameworks regulating the commercial release of GM crops into the environment. Among others, such decisions are necessary to initiate remedial measures or to sustain claims of redress linked to environmental liability. Given that consensus on criteria to evaluate 'environmental harm' has not yet been found, there are a number of challenges for risk managers when interpreting GM crop monitoring data for environmental decision-making. In the present paper, we argue that the challenges in decision-making have four main causes. The first three causes relate to scientific data collection and analysis, which have methodological limits. The forth cause concerns scientific data evaluation, which is controversial among the different stakeholders involved in the debate on potential impacts of GM crops on the environment. This results in controversy how the effects of GM crops should be valued and what constitutes environmental harm. This controversy may influence decision-making about triggering corrective actions by regulators. We analyse all four challenges and propose potential strategies for addressing them. We conclude that environmental monitoring has its limits in reducing uncertainties remaining from the environmental risk assessment prior to market approval. We argue that remaining uncertainties related to adverse environmental effects of GM crops would probably be assessed in a more efficient and rigorous way during pre-market risk assessment. Risk managers should acknowledge the limits of environmental monitoring programmes as a tool for decision-making.
Decision-Making in Management of the Complex Trauma Patient: Changing the Mindset of the non-trauma Surgeon.

PubMed

Sonesson, Linda; Boffard, Kenneth; Lundberg, Lars; Rydmark, Martin; Karlgren, Klas

2018-01-16

European surgeons are frequently subspecialized and trained primarily in elective surgical techniques. As trauma leaders, they may occasionally have to deal with complex polytrauma, advanced management techniques, differing priorities, and the need for multidisciplinary care. There is a lack of expertise, experience, and a low trauma volume, as well as a lack of research, with limited support as to the decision-making and teaching challenges present. We studied what experienced trauma experts describe as the challenges that are specific to the advanced surgical decision-making required, whether civilian, humanitarian, or military. Design-based research using combined methods including interviews, reviews of authentic trauma cases, and video-recorded resuscitations performed at a high-volume civilian academic trauma center. Several educational dilemmas were identified: (1) thinking physiologically, (2) the application of damage control resuscitation and surgery, (3) differing priorities and time management, (4) impact of environment, (5) managing limited resources, (6) lack of general surgical skills, (7) different cultural behavior, and (8) ethical issues. The challenges presented, and the educational domains identified, constitute a basis for improved development of education and training in complex surgical decision-making. This study contributes new knowledge about the mindset required for decision-making in patients with complex multisystem trauma and competing priorities of care. This is, especially important in countries having a low intensity of trauma in both military and civilian environments, and consequential limited skills, and lack of expertise. Guidelines focused on the same decision-making process, using virtual patients and blended learning, can be developed.
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.

Health Technology Assessment and Private Payers' Coverage of Personalized Medicine

PubMed Central

Trosman, Julia R.; Van Bebber, Stephanie L.; Phillips, Kathryn A.

2011-01-01

Purpose: Health technology assessment (HTA) plays an increasing role in translating emerging technologies into clinical practice and policy. Private payers are important users of HTA whose decisions impact adoption and use of new technologies. We examine the current use of HTA by private payers in coverage decisions for personalized medicine, a field that is increasingly impacting oncology practice. Study Design: Literature review and semistructured interviews. Methods: We reviewed seven HTA organizations used by private payers in decision making and explored how HTA is used by major US private payers (n = 11) for coverage of personalized medicine. Results: All payers used HTA in coverage decisions, but the number of HTA organizations used by an individual payer ranged from one (n = 1) to all seven (n = 1), with the majority of payers (n = 8) using three or more. Payers relied more extensively on HTAs for reviews of personalized medicine (64%) than for other technologies. Most payers (82%) equally valued expertise of reviewers and rigor of evaluation as HTA strengths, whereas genomic-specific methodology was less important. Key reported shortcomings were limited availability of reviews (73%) and limited inclusion of nonclinical factors (91%), such as cost-effectiveness or adoption of technology in clinical practice. Conclusion: Payers use a range of HTAs in their coverage decisions related to personalized medicine, but the current state of HTA to comprehensively guide those decisions is limited. HTA organizations should address current gaps to improve their relevance to payers and clinicians. Current HTA shortcomings may also inform the national HTA agenda. PMID:21886515
Moral Fiber?

ERIC Educational Resources Information Center

Zirkel, Perry A.

2000-01-01

Discusses a 2000 federal trial court decision upholding a Kentucky district's termination of a tenured teacher who presented a curricular segment on industrial hemp as part of a "save-the-trees" unit. The decision underscores teachers' severely limited constitutional rights in the curricular context. (MLH)
A rough set approach for determining weights of decision makers in group decision making.

PubMed

Yang, Qiang; Du, Ping-An; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs' decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member' decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs' evaluations and selections.
Inertia and Decision Making.

PubMed

Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Li, Jiahui

2016-01-01

Decision inertia is the tendency to repeat previous choices independently of the outcome, which can give rise to perseveration in suboptimal choices. We investigate this tendency in probability-updating tasks. Study 1 shows that, whenever decision inertia conflicts with normatively optimal behavior (Bayesian updating), error rates are larger and decisions are slower. This is consistent with a dual-process view of decision inertia as an automatic process conflicting with a more rational, controlled one. We find evidence of decision inertia in both required and autonomous decisions, but the effect of inertia is more clear in the latter. Study 2 considers more complex decision situations where further conflict arises due to reinforcement processes. We find the same effects of decision inertia when reinforcement is aligned with Bayesian updating, but if the two latter processes conflict, the effects are limited to autonomous choices. Additionally, both studies show that the tendency to rely on decision inertia is positively associated with preference for consistency.
Inertia and Decision Making

PubMed Central

Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Li, Jiahui

2016-01-01

Decision inertia is the tendency to repeat previous choices independently of the outcome, which can give rise to perseveration in suboptimal choices. We investigate this tendency in probability-updating tasks. Study 1 shows that, whenever decision inertia conflicts with normatively optimal behavior (Bayesian updating), error rates are larger and decisions are slower. This is consistent with a dual-process view of decision inertia as an automatic process conflicting with a more rational, controlled one. We find evidence of decision inertia in both required and autonomous decisions, but the effect of inertia is more clear in the latter. Study 2 considers more complex decision situations where further conflict arises due to reinforcement processes. We find the same effects of decision inertia when reinforcement is aligned with Bayesian updating, but if the two latter processes conflict, the effects are limited to autonomous choices. Additionally, both studies show that the tendency to rely on decision inertia is positively associated with preference for consistency. PMID:26909061
Reduction in growth threshold for pulmonary metastases: an opportunity for volumetry and its impact on treatment decisions

PubMed Central

Vogel, M N; Schmücker, S; Maksimovic, O; Hartmann, J; Claussen, C D; Horger, M

2012-01-01

Objectives This study compares tumour response assessment by automated CT volumetry and standard manual measurements regarding the impact on treatment decisions and patient outcome. Methods 58 consecutive patients with 203 pulmonary metastases undergoing baseline and follow-up multirow detector CT (MDCT) under chemotherapy were assessed for response to chemotherapy. Tumour burden of pulmonary target lesions was quantified in three ways: (1) following response evaluation criteria in solid tumours (RECIST); (2) following the volume equivalents of RECIST (i.e. with a threshold of −65/+73%); and (3) using calculated limits for stable disease (SD). For volumetry, calculated limits had been set at ±38% prior to the study by repeated quantification of nodules scanned twice. Results were compared using non-weighted κ-values and were evaluated for their impact on treatment decisions and patient outcome. Results In 15 (17%) of the 58 patients, the results of response assessment were inconsistent with 1 of the 3 methods, which would have had an impact on treatment decisions in 8 (13%). Patient outcome regarding therapy response could be verified in 5 (33%) of the 15 patients with inconsistent measurement results and was consistent with both RECIST and volumetry in 1, with calculated limits in 3 and with none in 1. Diagnosis as to the overall response was consistent with RECIST in six patients, with volumetry in six and with calculated limits in eight cases. There is an impact of different methods for therapy response assessment on treatment decisions. Conclusion A reduction of threshold for SD to ±30–40% of volume change seems reasonable when using volumetry. PMID:22745205
Accounting for methodological, structural, and parameter uncertainty in decision-analytic models: a practical guide.

PubMed

Bilcke, Joke; Beutels, Philippe; Brisson, Marc; Jit, Mark

2011-01-01

Accounting for uncertainty is now a standard part of decision-analytic modeling and is recommended by many health technology agencies and published guidelines. However, the scope of such analyses is often limited, even though techniques have been developed for presenting the effects of methodological, structural, and parameter uncertainty on model results. To help bring these techniques into mainstream use, the authors present a step-by-step guide that offers an integrated approach to account for different kinds of uncertainty in the same model, along with a checklist for assessing the way in which uncertainty has been incorporated. The guide also addresses special situations such as when a source of uncertainty is difficult to parameterize, resources are limited for an ideal exploration of uncertainty, or evidence to inform the model is not available or not reliable. for identifying the sources of uncertainty that influence results most are also described. Besides guiding analysts, the guide and checklist may be useful to decision makers who need to assess how well uncertainty has been accounted for in a decision-analytic model before using the results to make a decision.
A Neural Information Field Approach to Computational Cognition

DTIC Science & Technology

2016-11-18

We have extended our perceptual decision making model to account for the effects of context in this flexible DISTRIBUTION A. Approved for public...developed a new perceptual decision making model; demonstrated adaptive motor control in a large-scale cognitive simulation with spiking neurons (Spaun...TERMS EOARD, Computational Cognition, Mixed-initiative decision making 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT SAR 18. NUMBER OF
Climate Change Impacts and Adaptation on Southwestern DoD Facilities

DTIC Science & Technology

2017-03-03

integrating climate change risks into decision priorities. 15. SUBJECT TERMS adaptation, baseline sensitivity, climate change, climate exposure...four bases we found that integrating climate change risks into the current decision matrix, by linking projected risks to current or past impacts...data and decision tools and methods. Bases have some capacity to integrate climate-related information, but they have limited resources to undertake
A psychosocial analysis of parents' decisions for limiting their young child's screen time: An examination of attitudes, social norms and roles, and control perceptions.

PubMed

Hamilton, Kyra; Spinks, Teagan; White, Katherine M; Kavanagh, David J; Walsh, Anne M

2016-05-01

Preschool-aged children spend substantial amounts of time engaged in screen-based activities. As parents have considerable control over their child's health behaviours during the younger years, it is important to understand those influences that guide parents' decisions about their child's screen time behaviours. A prospective design with two waves of data collection, 1 week apart, was adopted. Parents (n = 207) completed a Theory of Planned Behaviour (TPB)-based questionnaire, with the addition of parental role construction (i.e., parents' expectations and beliefs of responsibility for their child's behaviour) and past behaviour. A number of underlying beliefs identified in a prior pilot study were also assessed. The model explained 77% (with past behaviour accounting for 5%) of the variance in intention and 50% (with past behaviour accounting for 3%) of the variance in parental decisions to limit child screen time. Attitude, subjective norms, perceived behavioural control, parental role construction, and past behaviour predicted intentions, and intentions and past behaviour predicted follow-up behaviour. Underlying screen time beliefs (e.g., increased parental distress, pressure from friends, inconvenience) were also identified as guiding parents' decisions. Results support the TPB and highlight the importance of beliefs for understanding parental decisions for children's screen time behaviours, as well as the addition of parental role construction. This formative research provides necessary depth of understanding of sedentary lifestyle behaviours in young children which can be adopted in future interventions to test the efficacy of the TPB mechanisms in changing parental behaviour for their child's health. What is already known on this subject? Identifying determinants of child screen time behaviour is vital to the health of young people. Social-cognitive and parental role constructions are key influences of parental decision-making. Little is known about the processes guiding parents' decisions to limit their child's screen time. What does this study add? Parental role construction and TPB social-cognitive factors influence parental decisions. The beliefs of parents for their child's behaviour were identified. A range of beliefs guide parents' decisions for their child's screen time viewing. © 2015 The British Psychological Society.
[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-06-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-02-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-12-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
[Advance directives in clinical practice : Living will, healthcare power of attorney and care directive].

PubMed

Hack, J; Buecking, B; Lopez, C L; Ruchholtz, S; Kühne, C A

2017-04-01

In clinical practice, situations continuously occur in which medical professionals and family members are confronted with decisions on whether to extend or limit treatment for severely ill patients in end of life treatment decisions. In these situations, advance directives are helpful tools in decision making according to the wishes of the patient; however, not every patient has made an advance directive and in our experience medical staff as well as patients are often not familiar with these documents. The purpose of this article is therefore to explain the currently available documents (e.g. living will, healthcare power of attorney and care directive) and the possible (legal) applications and limitations in the routine clinical practice.
Bringing freight components into statewide and regional travel demand forecasting: part 1 : final report.

DOT National Transportation Integrated Search

2016-01-01

Transportation decision makers have the difficult task of investment decision making having limited resources while : maximizing benefit to the transportation system. Given the growth in freight transport and its importance to national, : state, and ...
78 FR 24232 - Record of Decision for the Denali Park Road Final Vehicle Management Plan and Environmental...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-24

... the decision making process. ADDRESSES: Copies of the ROD will be available in an electronic format... at the Savage River Check Station. The 160-vehicle limit is derived from traffic model simulation...
7 CFR 1465.30 - Appeals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS AGRICULTURAL MANAGEMENT ASSISTANCE General Administration § 1465.30 Appeals. (a) A participant may obtain administrative review of an adverse decision under AMA in... following decisions are not appealable: (1) Payment rates, payment limits; (2) Funding allocations; (3...
The value of decision tree analysis in planning anaesthetic care in obstetrics.

PubMed

Bamber, J H; Evans, S A

2016-08-01

The use of decision tree analysis is discussed in the context of the anaesthetic and obstetric management of a young pregnant woman with joint hypermobility syndrome with a history of insensitivity to local anaesthesia and a previous difficult intubation due to a tongue tumour. The multidisciplinary clinical decision process resulted in the woman being delivered without complication by elective caesarean section under general anaesthesia after an awake fibreoptic intubation. The decision process used is reviewed and compared retrospectively to a decision tree analytical approach. The benefits and limitations of using decision tree analysis are reviewed and its application in obstetric anaesthesia is discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.
Communal Participation in Payment for Environmental Services (PES): Unpacking the Collective Decision to Enroll

NASA Astrophysics Data System (ADS)

Murtinho, Felipe; Hayes, Tanya

2017-06-01

Payment for Environmental Service programs are increasingly applied in communal settings where resource users collectively join the program and agree to limit their shared use of a common-property resource. Who decides to join PES and the degree to which community members agree with the collective decision is critical for the success of said programs. Yet, we have limited understanding of the factors that influence communal participation and the collective decision process. This paper examines communal participation in a national payment for conservation program in Ecuador. We use quantitative and qualitative analysis to (i) identify the attributes of the communities that participate (or not), and factors that facilitate participation ( n = 67), and (ii) assess household preference and alignment with the collective decision to participate ( n = 212). Household participation preferences indicate varying degrees of consensus with the collective decision to participate, with those using the resource less likely to support participation. At the communal level, however, our results indicate that over time, those communities that depend more heavily on their resource systems may ultimately choose to participate. Our findings suggest that communal governance structures and outside organizations may be instrumental in gaining participation in resource-dependent communities and building consensus. Findings also point to the need for further research on communal decision-processes to ensure that the collective decision is based on an informed and democratic process.
Toward a coherent account of pediatric decision making.

PubMed

Iltis, Ana S

2010-10-01

Within and among societies, there are competing understandings of the status of children, including debates over whether they can bear rights and, if so, which rights they bear and against whom, and their capacity to make decisions and be held responsible and accountable for actions. There also are different understandings of what constitutes a family; what authority parents have over and regarding their children; and what should happen to children who are without parents because of death, desertion, or imprisonment. These and other related debates reflect deep differences in worldviews, in how one understands the legitimate role of the state, in how one comes to know the proper way to raise children, and so on. The United Nations Convention on the Rights of the Child purports to reflect international convergence on the rights of children, on how decisions concerning children should be made, and on how children ought to be treated by the state and by their parents. This paper examines whether the Convention's framework for decision making concerning children is an appropriate framework for pediatric bioethics. Questions about how to make health care decisions for children ultimately are questions of who is in authority to make and judge such decisions. Establishing who is in authority, determining whether there are any limits to that authority and, if so, defining those limits should be the focus of efforts to develop and implement a pediatric decision-making framework.

A locally-blazed ant trail achieves efficient collective navigation despite limited information

PubMed Central

Fonio, Ehud; Heyman, Yael; Boczkowski, Lucas; Gelblum, Aviram; Kosowski, Adrian; Korman, Amos; Feinerman, Ofer

2016-01-01

Any organism faces sensory and cognitive limitations which may result in maladaptive decisions. Such limitations are prominent in the context of groups where the relevant information at the individual level may not coincide with collective requirements. Here, we study the navigational decisions exhibited by Paratrechina longicornis ants as they cooperatively transport a large food item. These decisions hinge on the perception of individuals which often restricts them from providing the group with reliable directional information. We find that, to achieve efficient navigation despite partial and even misleading information, these ants employ a locally-blazed trail. This trail significantly deviates from the classical notion of an ant trail: First, instead of systematically marking the full path, ants mark short segments originating at the load. Second, the carrying team constantly loses the guiding trail. We experimentally and theoretically show that the locally-blazed trail optimally and robustly exploits useful knowledge while avoiding the pitfalls of misleading information. DOI: http://dx.doi.org/10.7554/eLife.20185.001 PMID:27815944
Optimal Limited Contingency Planning

NASA Technical Reports Server (NTRS)

Meuleau, Nicolas; Smith, David E.

2003-01-01

For a given problem, the optimal Markov policy over a finite horizon is a conditional plan containing a potentially large number of branches. However, there are applications where it is desirable to strictly limit the number of decision points and branches in a plan. This raises the question of how one goes about finding optimal plans containing only a limited number of branches. In this paper, we present an any-time algorithm for optimal k-contingency planning. It is the first optimal algorithm for limited contingency planning that is not an explicit enumeration of possible contingent plans. By modelling the problem as a partially observable Markov decision process, it implements the Bellman optimality principle and prunes the solution space. We present experimental results of applying this algorithm to some simple test cases.
Court Reaffirms TIAA Must Pay Equal Pensions.

ERIC Educational Resources Information Center

Fields, Cheryl M.

1984-01-01

A second court decision supporting the payment of equal retirement pensions to men and women through the Teachers Insurance Annuities Association and College Retirement Equities Fund for retirees, effective after May 1, 1980, is discussed. This federal appeals court decision allows limited retroactivity. (MSE)
Planning for deficit irrigation

USDA-ARS?s Scientific Manuscript database

Irrigators with limited water supplies that lead to deficit irrigation management need to make decisions about crop selection, water allocations to each crop, and irrigation schedules. Many of these decisions need to occur before the crop is planted and depend on yield-evapotranspiration (ET) and yi...
Contingent Decision Behavior: A Review and Discussion of Issues.

DTIC Science & Technology

1982-02-01

values) will draw more attention (Yates, et. al., 1978). Studies investigating decision making among partially described alternatives are limited in number...theory that attempts to describe human decison making ." More evidence of range effects is provided in Krzysztofowicz and Ouckstein (1980). A good...activities may move along that intuitive-analytic continuum over time. For that reason he argues that decision researchers need to pay more attention to the
Reforming Pentagon Strategic Decisionmaking. Strategic Forum. Number 221, July 2006

DTIC Science & Technology

2006-07-01

capability that would improve Pentagon decisionmaking. Blink and Think It is commonly assumed that people can and should make decisions as rationally ... rationality ,” which not only helps them make decisions but also introduces a range of nonrational psychologi- cal factors into their thinking. An otherwise...decisionmaking shortcuts that limit their ability to make rational decisions . Strategic Forum No. 221July 2006 Institute for National Strategic Studies
Are insurance companies liable under the Americans with Disabilities Act?

PubMed

Manning, J S

2000-03-01

Federal courts have split on the question of the applicability of the Americans with Disabilities Act to insurance coverage decisions that insurance companies make on the basis of disability; they have similarly split on other issues pertaining to the scope of that Act's application. In deciding whether to read the Act as prohibiting discrimination in insurance decisions that are often crucial in the lives of people with disabilities, courts have faced two problems. First, where it prohibits discrimination in the equal enjoyment of the goods and services of places of public accommodation, the Act's area of concern may be limited to the ability of people with disabilities to gain physical access to facilities; or that area may extend to all forms of disability-based discrimination in the provision of goods and services. This Comment argues that the language and legislative history of the Act are consistent only with the latter view. Second, the provision limiting the Act's applicability to insurance may create an exemption for all insurance decisions; or it may protect only the ability of an insurance company to make an insurance decision to the disadvantage of an insured with a disability where actuarial data support the decision. This comment argues that the ambiguous language of the limiting provision should be resolved in favor of the latter view. Legislative history and the broader background of the history of insurance discrimination law support this resolution. Consequently, the Act should be interpreted as prohibiting disability-based discrimination by insurance companies in selling insurance policies and as defining discrimination as making disability-based insurance decisions without the support of actuarial data. By accepting this interpretation, courts can help stop the pattern of judicial narrowing of the Act's application through inappropriately restrictive statutory construction.
Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-12-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.
Integrating Ecosystem-Based Management Principles of Adaptive Management and Stakeholder Engagement in California Fisheries

NASA Astrophysics Data System (ADS)

Erickson, A.; Martone, R. G.; Hazen, L.; Mease, L.; Gourlie, D.; Le Cornu, E.; Ourens, R.; Micheli, F.

2016-02-01

California's fisheries management law, the Marine Life Management Act (MLMA) of 1998, signaled a transformative shift from traditional single-species management to an ecosystem-based approach. In response, the fisheries management community in California is striving to integrate new science and management innovations while maximizing its limited capacity. However, data gaps, high compliance costs, capacity constraints, and limited access to the best available data and technologies persist. Here we present two decision support tools being developed to aid California fisheries managers as they continue to implement ecosystem-based management (EBM). First, to practice adaptive management, a key principle of EBM, managers must know whether and how their decisions are meeting their management objectives over time. Based on a cross-walk of MLMA goals with metrics and indicators from sustainable fishery certification programs, we present a flexible and practical tool for tracking fishery management performance in California. We showcase a draft series of decision trees and questionnaires managers can use to quantitatively or qualitatively measure both ecological and social outcomes, helping them to prioritize management options and limited resources. Second, state fisheries managers acknowledge the need for more effective stakeholder engagement to facilitate and inform decision-making and long-term outcomes, another key principle of EBM. Here, we present a pilot version of a decision-support tool to aid managers in choosing the most appropriate stakeholder engagement strategies in various types of decision contexts. This online tool will help staff identify their engagement goals, when they can strategically engage stakeholders based on their needs, and the fishery characteristics that will inform how engagement strategies are tailored to specific contexts. We also share opportunities to expand these EBM tools to other resource management contexts and scales.
Beyond evidence-based nursing: tools for practice.

PubMed

Jutel, Annemarie

2008-05-01

This commentary shares my views of evidence-based nursing as a framework for practice, pointing out its limitations and identifying a wider base of appraisal tools required for making good clinical decisions. As the principles of evidence-based nursing take an increasingly greater hold on nursing education, policy and management, it is important to consider the range of other decision-making tools which are subordinated by this approach. This article summarizes nursing's simultaneous reliance on and critique of evidence-based practice (EBP) in a context of inadequate critical reasoning. It then provides an exemplar of the limitations of evidence-based practice and offers an alternative view of important precepts of decision-making. I identify means by which nurses can develop skills to engage in informed and robust critique of practices and their underpinning rationale. Nurses need to be able to locate and assess useful and reliable information for decision-making. This skill is based on a range of tools which include, but also go beyond EBP including: information literacy, humanities, social sciences, public health, statistics, marketing, ethics and much more. This essay prompts nursing managers to reflect upon whether a flurried enthusiasm to adopt EBP neglects other important decision-making skills which provide an even stronger foundation for robust nursing decisions.
The determinants of strategic thinking in preschool children.

PubMed

Brocas, Isabelle; Carrillo, Juan D

2018-01-01

Strategic thinking is an essential component of rational decision-making. However, little is known about its developmental aspects. Here we show that preschoolers can reason strategically in simple individual decisions that require anticipating a limited number of future decisions. This ability is transferred only partially to solve more complex individual decision problems and to efficiently interact with others. This ability is also more developed among older children in the classroom. Results indicate that while preschoolers potentially have the capacity to think strategically, it does not always translate into the ability to behave strategically.
The determinants of strategic thinking in preschool children

PubMed Central

Brocas, Isabelle

2018-01-01

Strategic thinking is an essential component of rational decision-making. However, little is known about its developmental aspects. Here we show that preschoolers can reason strategically in simple individual decisions that require anticipating a limited number of future decisions. This ability is transferred only partially to solve more complex individual decision problems and to efficiently interact with others. This ability is also more developed among older children in the classroom. Results indicate that while preschoolers potentially have the capacity to think strategically, it does not always translate into the ability to behave strategically. PMID:29851954
Decision Making Among Older Adults at the End of Life: A Theoretical Perspective.

PubMed

Romo, Rafael D; Dawson-Rose, Carol S; Mayo, Ann M; Wallhagen, Margaret I

Understanding changes in decision making among older adults across time is important for health care providers. We examined how older adults with a limited prognosis used their perception of prognosis and health in their decision-making processes and related these findings to prospect theory. The theme of decision making in the context of ambiguity emerged, reflecting how participants used both prognosis and health to value choices, a behavior not fully captured by prospect theory. We propose an extension of the theory that can be used to better visualize decision making at this unique time of life among older adults.
The Role of Time-Limited Trials in Dialysis Decision Making in Critically Ill Patients.

PubMed

Scherer, Jennifer S; Holley, Jean L

2016-02-05

Technologic advances, such as continuous RRT, provide lifesaving therapy for many patients. AKI in the critically ill patient, a fatal diagnosis in the past, is now often a survivable condition. Dialysis decision making for the critically ill patient with AKI is complex. What was once a question solely of survival now is nuanced by an individual's definition of quality of life, personal values, and short- and long-term prognoses. Clinical evaluation of AKI in the critically ill is multifaceted. Treatment decision making requires consideration of the natural evolution of the patient's AKI within the context of the global prognosis. Situations are often marked by prognostic uncertainty and clinical unknowns. In the face of these uncertainties, establishment of patient-directed therapies is imperative. A time-limited trial of continuous RRT in this setting is often appropriate but difficult to execute. Using patient preferences as a clinical guide, a proper time-limited trial requires assessment of prognosis, elicitation of patient values, strong communication skills, clear documentation, and often, appropriate integration of palliative care services. A well conducted time-limited trial can avoid interprofessional conflict and provide support for the patient, family, and staff. Copyright © 2016 by the American Society of Nephrology.
New Directions in Health Risk Assessment: A REACH for the Future?

EPA Science Inventory

Health risk assessments have been used to support many decisions in the US to reduce risks from pollutant exposures. These decisions have been highly successful in protecting public health despite uncertainty due to gaps in knowledge and methodological limitations. In recent yea...
32 CFR 2001.13 - Classification prohibitions and limitations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... making the decision to reclassify information that has been declassified and released to the public under... attention to the information at issue. Written notification, classified when appropriate under the Order... not agree with the decision, the information shall nonetheless be temporarily withdrawn from public...
5 CFR 891.106 - Reconsideration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... control from making the request within the time limit. (e) Final decision. After reconsideration, OPM... FEDERAL EMPLOYEES HEALTH BENEFITS Administration and General Provisions § 891.106 Reconsideration. (a) Who may file. A retired employee may request OPM to reconsider its initial decision that he/she is not...
The Impact of Prepersuasion Social Influence Tactics on Military Decision Making

DTIC Science & Technology

2011-03-01

prepersuasion influence. 15. NUMBER OF PAGES 89 14. SUBJECT TERMS Military Decision Making, OODA Loop, Social Influence, Prepersuasion, Storytelling ...Operations ............13 2. Storytelling ..........................................................................................14 3. Limiting and...2. Postinvasion Effects of Fortitude South...........................................40 3. Storytelling and Expectation Setting Shape the Cognitive
Deciding for imperilled newborns: medical authority or parental autonomy?

PubMed Central

McHaffie, H.; Laing, I.; Parker, M.; McMillan, J.

2001-01-01

The ethical issues around decision making on behalf of infants have been illuminated by two empirical research studies carried out in Scotland. In-depth interviews with 176 medical and nursing staff and with 108 parents of babies for whom there was discussion of treatment withholding/withdrawal, generated a wealth of data on both the decision making process and the management of cases. Both staff and parents believe that parents should be involved in treatment limitation decisions on behalf of their babies. However, whilst many doctors and nurses consider the ultimate responsibility too great for families to carry, the majority of parents wish to be the final arbiters. We offer explanations for the differences in perception found in the two groups. The results of these empirical studies provide both aids to ethical reflection and guidance for clinicians dealing with these vulnerable families. They demonstrate the value of empirical data in the philosophical debate. Key Words: Empirical ethics • treatment limitation • parental autonomy • decision making PMID:11314152
Uncertain decision tree inductive inference

NASA Astrophysics Data System (ADS)

Zarban, L.; Jafari, S.; Fakhrahmad, S. M.

2011-10-01

Induction is the process of reasoning in which general rules are formulated based on limited observations of recurring phenomenal patterns. Decision tree learning is one of the most widely used and practical inductive methods, which represents the results in a tree scheme. Various decision tree algorithms have already been proposed such as CLS, ID3, Assistant C4.5, REPTree and Random Tree. These algorithms suffer from some major shortcomings. In this article, after discussing the main limitations of the existing methods, we introduce a new decision tree induction algorithm, which overcomes all the problems existing in its counterparts. The new method uses bit strings and maintains important information on them. This use of bit strings and logical operation on them causes high speed during the induction process. Therefore, it has several important features: it deals with inconsistencies in data, avoids overfitting and handles uncertainty. We also illustrate more advantages and the new features of the proposed method. The experimental results show the effectiveness of the method in comparison with other methods existing in the literature.

Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence.

PubMed

Janvier, Annie; Lorenz, John M; Lantos, John D

2012-08-01

When physicians are asked for a consult for women in premature labour, they face a complex set of challenges. Policy statements recommend that women be given detailed information about the risks of various outcomes, including death, long-term disability and various specific neonatal problems. Both personal narratives and studies suggest that parents also base their decisions on factors other than the probabilistic facts about expected outcomes. Statistics are difficult to understand at any time. Rational decision-making may be difficult when taking life-and-death decisions. Furthermore, the role of emotions is not discussed in peri-viability guidelines. We argue against trying to tell parents every fact that we think might be relevant to their decision. This may be overwhelming for many parents. Instead, doctors should try to discern, on a case-by-case basis, what particular parents want and need. Information and delivery of information should be personalized. Unfortunately, evidence in this area is limited. © 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.
Artificial neural networks in mammography interpretation and diagnostic decision making.

PubMed

Ayer, Turgay; Chen, Qiushi; Burnside, Elizabeth S

2013-01-01

Screening mammography is the most effective means for early detection of breast cancer. Although general rules for discriminating malignant and benign lesions exist, radiologists are unable to perfectly detect and classify all lesions as malignant and benign, for many reasons which include, but are not limited to, overlap of features that distinguish malignancy, difficulty in estimating disease risk, and variability in recommended management. When predictive variables are numerous and interact, ad hoc decision making strategies based on experience and memory may lead to systematic errors and variability in practice. The integration of computer models to help radiologists increase the accuracy of mammography examinations in diagnostic decision making has gained increasing attention in the last two decades. In this study, we provide an overview of one of the most commonly used models, artificial neural networks (ANNs), in mammography interpretation and diagnostic decision making and discuss important features in mammography interpretation. We conclude by discussing several common limitations of existing research on ANN-based detection and diagnostic models and provide possible future research directions.
Shared Decision Making at the Limit of Viability: A Blueprint for Physician Action

PubMed Central

2016-01-01

Objective To document interactions during the antenatal consultation between parents and neonatologist that parents linked to their satisfaction with their participation in shared decision making for their infant at risk of being born at the limit of viability. Methods This multiple-case ethnomethodological qualitative research study, included mothers admitted for a threatened premature delivery between 200/7 and 266/7 weeks gestation, the father, and the staff neonatologist conducting the clinical antenatal consultation. Content analysis of an audiotaped post-antenatal consultation interview with parents obtained their satisfaction scores as well as their comments on physician actions that facilitated their desired participation. Results Five cases, each called a “system—infant at risk”, included 10 parents and 6 neonatologists. From the interviews emerged a blueprint for action by physicians, including communication strategies that parents say facilitated their participation in decision making; such as building trustworthy physician-parent relationships, providing "balanced" information, offering choices, and allowing time to think. Conclusion Parent descriptions indicate that the opportunity to participate to their satisfaction in the clinical antenatal consultation depends on how the physician interacts with them. Practice implications The parent-identified communication strategies facilitate shared decision making regarding treatment in the best interest of the infant at risk to be born at the limit of viability. PMID:27893823
Addressing the limits to adaptation across four damage--response systems

EPA Science Inventory

Our ability to adapt to climate change is not boundless, and previous modeling shows that capacity limited adaptation will play a policy-significant role in future decisions about climate change. These limits are delineated by capacity thresholds, after which climate damages beg...
Heuristics: foundations for a novel approach to medical decision making.

PubMed

Bodemer, Nicolai; Hanoch, Yaniv; Katsikopoulos, Konstantinos V

2015-03-01

Medical decision-making is a complex process that often takes place during uncertainty, that is, when knowledge, time, and resources are limited. How can we ensure good decisions? We present research on heuristics-simple rules of thumb-and discuss how medical decision-making can benefit from these tools. We challenge the common view that heuristics are only second-best solutions by showing that they can be more accurate, faster, and easier to apply in comparison to more complex strategies. Using the example of fast-and-frugal decision trees, we illustrate how heuristics can be studied and implemented in the medical context. Finally, we suggest how a heuristic-friendly culture supports the study and application of heuristics as complementary strategies to existing decision rules.
Making decisions about decision-making: conscience, regulation, and the law.

PubMed

Miola, José

2015-01-01

The exercise of conscience can have far reaching effects. Poor behaviour can be fatal, as it has occurred in various medical scandals over the years. This article takes a wide definition of conscience as its starting point, and argues that the decision-making processes open to society--legal regulation and professional regulation--can serve to limit the options available to an individual and thus her ability to exercise her conscience. The article charts the law's changing attitude to legal intervention, which now seeks to limit the use of conscience by individuals, and addresses concerns that this may serve to 'de-moralise' medicine. It also examines the reasons for this legal change of approach. © The Author [2015]. Published by Oxford University Press; all rights reserved. For Permissions, please email: journals.permissions@oup.com.
Choice and Control Within Family Relationships: The Lived Experience of Adults With Intellectual Disability.

PubMed

Curryer, Bernadette; Stancliffe, Roger J; Dew, Angela; Wiese, Michele Y

2018-06-01

Increased choice and control is a driving force of current disability policy in Australia for people with disability and their families. Yet little is known of how adults with intellectual disability (ID) actually experience choice and control within their family relationships. We used interpretative phenomenological analysis of individual, semistructured interviews conducted with 8 Australian adults with ID to understand the meaning given to their experience of family support received around choice and decision making. Three themes were identified: (1) centrality of family, (2) experience of self-determination, and (3) limitations to choice and control. The participants identified trusted family members from whom guidance around choice and decision making was both sought and received, often involving mutual decision making and limitations to control.
A rough set approach for determining weights of decision makers in group decision making

PubMed Central

Yang, Qiang; Du, Ping-an; Wang, Yong; Liang, Bin

2017-01-01

This study aims to present a novel approach for determining the weights of decision makers (DMs) based on rough group decision in multiple attribute group decision-making (MAGDM) problems. First, we construct a rough group decision matrix from all DMs’ decision matrixes on the basis of rough set theory. After that, we derive a positive ideal solution (PIS) founded on the average matrix of rough group decision, and negative ideal solutions (NISs) founded on the lower and upper limit matrixes of rough group decision. Then, we obtain the weight of each group member and priority order of alternatives by using relative closeness method, which depends on the distances from each individual group member’ decision to the PIS and NISs. Through comparisons with existing methods and an on-line business manager selection example, the proposed method show that it can provide more insights into the subjectivity and vagueness of DMs’ evaluations and selections. PMID:28234974
New Chemical Exposure Limits under TSCA

EPA Pesticide Factsheets

EPA performs risk assessments and makes a risk management decisions on new chemicals. If EPA determines there to be unresonable risk, EPA may establish a New Chemical Exposure Limit (NCEL) to provide protection.
Naturalistic decision-making in expert badminton players.

PubMed

Macquet, A C; Fleurance, P

2007-09-01

This paper reports on a study of naturalistic decision-making in expert badminton players. These decisions are frequently taken under time-pressured conditions, yet normally lead to successful performance. Two male badminton teams participated in this study. Self-confrontation interviews were used to collect data. Inductive data analysis revealed three types of intentions during a rally: to maintain the rally; to take the advantage; and to finish the point. It also revealed eight types of decision taken in this situation: to ensure an action; to observe the opponent's response to an action; to realize a limited choice; to influence the opponent's decision; to put pressure on an opponent; to surprise the opponent; to reproduce an efficient action; and to play wide. A frequent decision was to put pressure on the opponent. Different information and knowledge was linked to specific decisions. The results are discussed in relation to research that has considered naturalistic decision-making.
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
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.
[Limitation of medical treatment and ethics in chronic recurrent Clivus chordoma].

PubMed

Egger, Alexandra; Müller-Busch, H Christof

2008-01-01

In this paper ethical questions concerning the limitation and termination of medical treatment of comatose patients will be discussed on the basis of a case study. The team is confronted with extremely high communicative and ethical demands, since every person engaged in the treatment and care of the patient should take part in this decision making process. The final responsibility regarding the medical decisions, however, lies with the doctor in charge. In such cases advance directives or living wills are important and should be taken into consideration.
The Use of Economic Evidence to Inform Drug Pricing Decisions in Jordan.

PubMed

Hammad, Eman A

2016-01-01

Drug pricing is an example of a priority setting in a developing country with official requirements for the use of cost-effectiveness (CE) evidence. To describe the role of economic evidence in drug pricing decisions in Jordan. A prospective review of all applications submitted between November 2013 and May 2015 to the Jordan Food and Drug Association's drug pricing committee was carried out. All applications that involved requests for CE evidence were reviewed. Details on the type of study, the extent, and whether the evidence submitted was part of the formal deliberations were extracted and summarized. The committee reviewed a total of 1608 drug pricing applications over the period of the study. CE evidence was requested in only 11 applications. The submitted evidence was of limited use to the committee due to concerns about quality, relevance of studies, and lack of pharmacoeconomic expertise. There were also no clear rules describing how CE would inform pricing decisions. Limited local data and health economic experience were the main barriers to the use of economic evidence in drug pricing decisions in Jordan. In addition, there are no official rules describing the elements and process by which the CE evidence would inform drug pricing decisions. This study summarized accumulated observations for the current use of economic evaluations and evidence-based decision making in Jordan. Recommendations have been proposed to applicants and key decision makers to enhance the role of economic evidence in influencing health policies and evidence-based decision making across priority settings. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Keeping all options open: Parents' approaches to advance care planning.

PubMed

Beecham, Emma; Oostendorp, Linda; Crocker, Joanna; Kelly, Paula; Dinsdale, Andrew; Hemsley, June; Russell, Jessica; Jones, Louise; Bluebond-Langner, Myra

2017-08-01

Early engagement in advance care planning (ACP) is seen as fundamental for ensuring the highest standard of care for children and young people with a life-limiting condition (LLC). However, most families have little knowledge or experience of ACP. To investigate how parents of children and young people with LLCs approach and experience ACP. Open-ended, semi-structured interviews were conducted with parents of 18 children; nine children who were currently receiving palliative care services, and nine children who had received palliative care and died. Verbatim transcripts of audiotaped interviews were analysed following principles of grounded theory while acknowledging the use of deductive strategies, taking account of both the child's condition, and the timing and nature of decisions made. Parents reported having discussions and making decisions about the place of care, place of death and the limitation of treatment. Most decisions were made relatively late in the illness and by parents who wished to keep their options open. Parents reported different levels of involvement in a range of decisions; many wished to be involved in decision making but did not always feel able to do so. This study highlights that parents' approaches to decision making vary by the type of decision required. Their views may change over time, and it is important to allow them to keep their options open. We recommend that clinicians have regular discussions over the course of the illness in an effort to understand parents' approaches to particular decisions rather than to drive to closure prematurely. © 2016 The Authors Health Expectations Published by John Wiley & Sons Ltd.
Experiencing cancer treatment decision-making in managed care.

PubMed

Wenzel, Jennifer; Shaha, Maya

2008-09-01

This paper is a report of a study to explore women's perceptions of and experiences with breast cancer treatment decision-making in managed care organizations (MCOs). Managed care organizations are the predominant form of employer-sponsored healthcare insurance in the United States of America. These healthcare financing entities minimize cost by streamlining healthcare delivery and may impose choice restrictions. The extent of these restrictions has not previously been studied from an in-depth patient perspective. A qualitative descriptive approach was adopted using interviews with a purposive sample of 14 managed care enrollees diagnosed with breast cancer at all stages. The data were collected between 2003 and 2005. Data analysis involved a reflexive process of transcript reading, categorization, data reduction and interpretation. The findings are presented as a single theme: 'decisional conflict in managed care', with two distinct categories: decisions regarding (1) the MCOs and (2) treatment. MCO selection was perceived to be limited by employer constraints, cost issues or healthcare plan providers. For study participants, selecting a MCO was less difficult than issues surrounding treatment decision-making. Women reported that their most important treatment-related decisions surrounded diagnosis and involved selecting a treatment facility and provider. Once a satisfactory facility and provider were selected, these women preferred to defer treatment decisions to their healthcare providers. Decision interventions should be focused on assisting women with provider and treatment facility selection early in diagnosis. Our findings might also serve as a basis for policy/practice changes to address healthcare financing limitations and to expand cancer treatment-related choices while providing desired treatment decision-making support.
Independent Research and Independent Exploratory Development at the Navy Personnel Research and Development Center--Fiscal Year 1984.

DTIC Science & Technology

1985-04-01

decision aids consider the cognitive skills of human operators. Data are required on the kinds of decision strategies they invoke, their limitations in...basic electronics, memory for procedural tasks, and career-role learning by officers. Computerized decision aids for surveillance tasks and opportunities...of Navy retention incentives. Computerized aids for plain English in military documents and for tactical action officer training were also developed in
Word Frequency Effects in Dual-Task Studies Using Lexical Decision and Naming as Task 2

NASA Technical Reports Server (NTRS)

Remington, Roger W.; McCann, Robert S.; VanSelst, Mark; Shafto, Michael G. (Technical Monitor)

1997-01-01

Word frequency effects in dual-task lexical decision are variously reported to be additive or underadditive across SOA. We replicate and extend earlier lexical decision studies and find word frequency to be additive across SOA. To more directly capture lexical processing, we examine dual-task naming. Once again, we find word frequency to be additive across SOA. Lexical processing appears to be constrained by central processing limitations.
Word Effects in Dual-Task Studies Using Lexical Decision and Naming as Task 2

NASA Technical Reports Server (NTRS)

Remington, Roger; McCann, Robert S.; VanSelst, Mark; Shafto, Michael (Technical Monitor)

1997-01-01

Word frequency effects in dual-task, lexical decision are variously reported to be additive or under-additive across SOA. We replicate and extend earlier lexical decision studies and find word frequency to be additive across SOA. To more directly capture lexical processing, we examine dual-task naming. Once again we find word frequency to be additive across SOA. Lexical processing appears to be constrained by central processing limitations.
Parental decision-making for medically complex infants and children: an integrated literature review.

PubMed

Allen, Kimberly A

2014-09-01

Many children with life-threatening conditions who would have died at birth are now surviving months to years longer than previously expected. Understanding how parents make decisions is necessary to prevent parental regret about decision-making, which can lead to psychological distress, decreased physical health, and decreased quality of life for the parents. The aim of this integrated literature review was to describe possible factors that affect parental decision-making for medically complex children. The critical decisions included continuation or termination of a high-risk pregnancy, initiation of life-sustaining treatments such as resuscitation, complex cardiothoracic surgery, use of experimental treatments, end-of-life care, and limitation of care or withdrawal of support. PubMed, Cumulative Index of Nursing and Allied Health Literature, and PsycINFO were searched using the combined key terms 'parents and decision-making' to obtain English language publications from 2000 to June 2013. The findings from each of the 31 articles retained were recorded. The strengths of the empirical research reviewed are that decisions about initiating life support and withdrawing life support have received significant attention. Researchers have explored how many different factors impact decision-making and have used multiple different research designs and data collection methods to explore the decision-making process. These initial studies lay the foundation for future research and have provided insight into parental decision-making during times of crisis. Studies must begin to include both parents and providers so that researchers can evaluate how decisions are made for individual children with complex chronic conditions to understand the dynamics between parents and parent-provider relationships. The majority of studies focused on one homogenous diagnostic group of premature infants and children with complex congenital heart disease. Thus comparisons across other child illness categories cannot be made. Most studies also used cross-sectional and/or retrospective research designs, which led to researchers and clinicians having limited understanding of how factors change over time for parents. Copyright © 2014 Elsevier Ltd. All rights reserved.

48 CFR 32.704 - Limitation of cost or funds.

Code of Federal Regulations, 2010 CFR

2010-10-01

... GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Contract Funding 32.704 Limitation of cost or funds... contracting officer shall promptly give the contractor written notice of the decision not to provide funds. (b...
Low-frequency sine wave hard-limiting technique

NASA Technical Reports Server (NTRS)

Anderson, T. O.

1977-01-01

Circuit includes serial-in/parallel-out shift register and weighting network that are used to eliminate effects of noise and other nonrepetitive circuit transients. Register and weighting network average decisions from section of signal where decisions are more dependable or where differences between two consecutive samples are larger.
10 CFR 1023.3 - Principles of general applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... functions or procedures, including ADR. (3) Decisions of the Board shall be final agency decisions and shall... (ADR) Functions. (1) Board judges and personnel shall perform ADR related functions impartially, with... judges limited to the nature, procedures, and availability of ADR through the Board are permitted and...
76 FR 23337 - Record of Decision

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-26

... Environmental Impact Statement for the Tamiami Trail Modifications: Next Steps Project. SUMMARY: Pursuant to 42... Decision (ROD) for the Final Environmental Impact Statement (FEIS) for the Tamiami Trail (U.S. Highway 41...) to construct modifications to U.S. Highway 41 (Tamiami Trail) that were approved in the 2008 Limited...
Memory and Processing Limits in Decision-Making.

ERIC Educational Resources Information Center

Klapp, Stuart T.

According to the classical working memory perspective, tasks such as command and control decision-making should be performed less effectively if extraneous material must be retained in short-term memory. Only marginal support for this prediction was obtained for a simulation involving scheduling trucking and transportation missions, although…
Steps toward Promoting Consistency in Educational Decisions

ERIC Educational Resources Information Center

Klein, Joseph

2010-01-01

Purpose: The literature indicates the advantages of decisions formulated through intuition, as well as the limitations, such as lack of consistency in similar situations. The principle of consistency (invariance), requiring that two equivalent versions of choice-problems will produce the same preference, is violated in intuitive judgment. This…
78 FR 27233 - Clean Water Act: Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9811-4] Clean Water Act: Availability of List Decisions... announces the availability of EPA's action identifying water quality limited segments and associated pollutants in Louisiana to be listed pursuant to Clean Water Act Section 303(d), and request for public...
23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...
23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...
23 CFR 450.210 - Interested parties, public involvement, and consultation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... opportunities for public review and comment at key decision points. (1) The State's public involvement process... agencies, representatives of public transportation employees, freight shippers, private providers of... comment at key decision points, including but not limited to a reasonable opportunity to comment on the...
Organization Development Strategies in Educational Policy Planning and Management.

ERIC Educational Resources Information Center

Jones, B. Kathryn; Biles, Stephen

1990-01-01

This synthesis reviews organizational development (OD) and its decision tools, describes OD applications in educational organizations, explores OD's limitations, and predicts how OD will influence future educational decision making. Findings identify eight specific management and planning areas where OD can be used to improve organizational…
Property.

ERIC Educational Resources Information Center

Piele, Philip K.; Forsberg, James R.

This chapter summarizes and analyze all state supreme court and federal court decisions as well as other significant court decisions involving school property. The cases discussed are generally limited to those decided during 1974 and reported in the General Digest on or before March 1, 1975. In their discussion, the authors attempt to integrate…
Office of the Ombuds Annual Report for Fiscal Year 2010

DTIC Science & Technology

2011-03-22

Academic Honesty, plagiarism , Code of Conduct, conflict of interest) 9b. Values and Culture (questions, concerns or issues about the values or culture...decisions, decisions about requests for administrative and academic services, e.g., exceptions to policy deadlines or limits, refund requests, appeals of
Impact of Decision Criteria on Federal Aviation Administration Certification of Military Commercial Derivative Aircraft

DTIC Science & Technology

2012-03-01

Capt Low was a member of the Sigma Iota Epsilon professional management fraternity. He has performed as an on-equipment and off-equipment...FAA Certification, Military Commercial Derivative Aircraft, Multi-Attribute Decision Making 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF
49 CFR 1108.9 - Decisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... TRANSPORTATION RULES OF PRACTICE ARBITRATION OF CERTAIN DISPUTES SUBJECT TO THE STATUTORY JURISDICTION OF THE... procedures, each party agrees that the decision and award of the Arbitrator shall be binding and judicially enforceable in law and equity in any court of appropriate jurisdiction, subject to a limited right of appeal...
[Application of evidence based medicine to the individual patient: the role of decision analysis].

PubMed

Housset, B; Junod, A F

2003-11-01

The objective of evidence based medicine (EBM) is to contribute to medical decision making by providing the best possible information in terms of validity and relevance. This allows evaluation in a specific manner of the benefits and risks of a decision. The limitations and hazards of this approach are discussed in relation to a clinical case where the diagnosis of pulmonary embolism was under consideration. The individual details and the limited availability of some technical procedures illustrate the need to adapt the data of EBM to the circumstances. The choice between two diagnostic tests (d-dimers and ultrasound of the legs) and their optimal timing is analysed with integration of the consequences for the patient of the treatments proposed. This allows discussion of the concept of utility and the use of sensitivity analysis. If EBM is the cornerstone of rational and explicit practise it should also allow for the constraints of real life. Decision analysis, which depends on the same critical demands as EBM but can also take account of the individual features of each patient and test the robustness of a decision, gives a unique opportunity reconcile rigorous reasoning with individualisation of management.
40 CFR 1501.8 - Time limits.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 33 2011-07-01 2011-07-01 false Time limits. 1501.8 Section 1501.8 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY NEPA AND AGENCY PLANNING § 1501.8 Time limits...) Decision on whether to prepare an environmental impact statement (if not already decided). (ii...
40 CFR 1501.8 - Time limits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Time limits. 1501.8 Section 1501.8 Protection of Environment COUNCIL ON ENVIRONMENTAL QUALITY NEPA AND AGENCY PLANNING § 1501.8 Time limits...) Decision on whether to prepare an environmental impact statement (if not already decided). (ii...
Not just for consumers: context effects are fundamental to decision making.

PubMed

Trueblood, Jennifer S; Brown, Scott D; Heathcote, Andrew; Busemeyer, Jerome R

2013-06-01

Context effects--preference changes that depend on the availability of other options--have attracted a great deal of attention among consumer researchers studying high-level decision tasks. In the experiments reported here, we showed that these effects also arise in simple perceptual-decision-making tasks. This finding casts doubt on explanations limited to consumer choice and high-level decisions, and it indicates that context effects may be amenable to a general explanation at the level of the basic decision process. We demonstrated for the first time that three important context effects from the preferential-choice literature--similarity, attraction, and compromise effects--all occurred within a single perceptual-decision task. Not only do our results challenge previous explanations for context effects proposed by consumer researchers, but they also challenge the choice rules assumed in theories of perceptual decision making.
How Participatory Should Environmental Governance Be? Testing the Applicability of the Vroom-Yetton-Jago Model in Public Environmental Decision-Making

NASA Astrophysics Data System (ADS)

Lührs, Nikolas; Jager, Nicolas W.; Challies, Edward; Newig, Jens

2018-02-01

Public participation is potentially useful to improve public environmental decision-making and management processes. In corporate management, the Vroom-Yetton-Jago normative decision-making model has served as a tool to help managers choose appropriate degrees of subordinate participation for effective decision-making given varying decision-making contexts. But does the model recommend participatory mechanisms that would actually benefit environmental management? This study empirically tests the improved Vroom-Jago version of the model in the public environmental decision-making context. To this end, the key variables of the Vroom-Jago model are operationalized and adapted to a public environmental governance context. The model is tested using data from a meta-analysis of 241 published cases of public environmental decision-making, yielding three main sets of findings: (1) The Vroom-Jago model proves limited in its applicability to public environmental governance due to limited variance in its recommendations. We show that adjustments to key model equations make it more likely to produce meaningful recommendations. (2) We find that in most of the studied cases, public environmental managers (implicitly) employ levels of participation close to those that would have been recommended by the model. (3) An ANOVA revealed that such cases, which conform to model recommendations, generally perform better on stakeholder acceptance and environmental standards of outputs than those that diverge from the model. Public environmental management thus benefits from carefully selected and context-sensitive modes of participation.

How Participatory Should Environmental Governance Be? Testing the Applicability of the Vroom-Yetton-Jago Model in Public Environmental Decision-Making.

PubMed

Lührs, Nikolas; Jager, Nicolas W; Challies, Edward; Newig, Jens

2018-02-01

Public participation is potentially useful to improve public environmental decision-making and management processes. In corporate management, the Vroom-Yetton-Jago normative decision-making model has served as a tool to help managers choose appropriate degrees of subordinate participation for effective decision-making given varying decision-making contexts. But does the model recommend participatory mechanisms that would actually benefit environmental management? This study empirically tests the improved Vroom-Jago version of the model in the public environmental decision-making context. To this end, the key variables of the Vroom-Jago model are operationalized and adapted to a public environmental governance context. The model is tested using data from a meta-analysis of 241 published cases of public environmental decision-making, yielding three main sets of findings: (1) The Vroom-Jago model proves limited in its applicability to public environmental governance due to limited variance in its recommendations. We show that adjustments to key model equations make it more likely to produce meaningful recommendations. (2) We find that in most of the studied cases, public environmental managers (implicitly) employ levels of participation close to those that would have been recommended by the model. (3) An ANOVA revealed that such cases, which conform to model recommendations, generally perform better on stakeholder acceptance and environmental standards of outputs than those that diverge from the model. Public environmental management thus benefits from carefully selected and context-sensitive modes of participation.
Multiple symbol partially coherent detection of MPSK

NASA Technical Reports Server (NTRS)

Simon, M. K.; Divsalar, D.

1992-01-01

It is shown that by using the known (or estimated) value of carrier tracking loop signal to noise ratio (SNR) in the decision metric, it is possible to improve the error probability performance of a partially coherent multiple phase-shift-keying (MPSK) system relative to that corresponding to the commonly used ideal coherent decision rule. Using a maximum-likeihood approach, an optimum decision metric is derived and shown to take the form of a weighted sum of the ideal coherent decision metric (i.e., correlation) and the noncoherent decision metric which is optimum for differential detection of MPSK. The performance of a receiver based on this optimum decision rule is derived and shown to provide continued improvement with increasing length of observation interval (data symbol sequence length). Unfortunately, increasing the observation length does not eliminate the error floor associated with the finite loop SNR. Nevertheless, in the limit of infinite observation length, the average error probability performance approaches the algebraic sum of the error floor and the performance of ideal coherent detection, i.e., at any error probability above the error floor, there is no degradation due to the partial coherence. It is shown that this limiting behavior is virtually achievable with practical size observation lengths. Furthermore, the performance is quite insensitive to mismatch between the estimate of loop SNR (e.g., obtained from measurement) fed to the decision metric and its true value. These results may be of use in low-cost Earth-orbiting or deep-space missions employing coded modulations.
Method and apparatus for determining and utilizing a time-expanded decision network

NASA Technical Reports Server (NTRS)

de Weck, Olivier (Inventor); Silver, Matthew (Inventor)

2012-01-01

A method, apparatus and computer program for determining and utilizing a time-expanded decision network is presented. A set of potential system configurations is defined. Next, switching costs are quantified to create a "static network" that captures the difficulty of switching among these configurations. A time-expanded decision network is provided by expanding the static network in time, including chance and decision nodes. Minimum cost paths through the network are evaluated under plausible operating scenarios. The set of initial design configurations are iteratively modified to exploit high-leverage switches and the process is repeated to convergence. Time-expanded decision networks are applicable, but not limited to, the design of systems, products, services and contracts.
Complexity Science: A Mechanism for Strategic Foresight and Resiliency in National Security Decision-Making.

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

Ackermann, Mark R.; Hayden, Nancy Kay; Backus, George A.

Most national policy decisions are complex with a variety of stakeholders, disparate interests and the potential for unintended consequences. While a number of analytical tools exist to help decision makers sort through the mountains of data and myriad of options, decision support teams are increasingly turning to complexity science for improved analysis and better insight into the potential impact of policy decisions. While complexity science has great potential, it has only proven useful in limited case s and when properly applied. In advance of more widespread use, a national - level effort to refine complexity science and more rigorously establishmore » its technical underpinnings is recommended.« less
Decision aids to increase living donor kidney transplantation

PubMed Central

Gander, Jennifer C.; Gordon, Elisa J.; Patzer, Rachel E.

2017-01-01

Purpose of review For the more than 636,000 adults with end-stage renal disease (ESRD) in the U.S., kidney transplantation is the preferred treatment compared to dialysis. Living donor kidney transplantation (LDKT) comprised 31% of kidney transplantations in 2015, an 8% decrease since 2004. We aimed to summarize the current literature on decision aids that could be used to improve LDKT rates. Recent findings Decision aids are evidence-based tools designed to help patients and their families make difficult treatment decisions. LDKT decision aids can help ESRD patients, patients’ family and friends, and healthcare providers engage in treatment decisions and thereby overcome multifactorial LDKT barriers. Summary We identified 12 LDKT decision aids designed to provide information about LDKT, and/or to help ESRD patients identify potential living donors, and/or to help healthcare providers make decisions about treatment for ESRD or living donation. Of these, 4 were shown to be effective in increasing LDKT, donor inquiries, LDKT knowledge, and willingness to discuss LDKT. Although each LDKT decision aid has limitations, adherence to decision aid development guidelines may improve decision aid utilization and access to LDKT. PMID:29034143
Tort Liability.

ERIC Educational Resources Information Center

Hudgins, H. C., Jr.

This chapter summarices and analyzes all state supreme court and federal court decisions as well as other significant court decisions involving the tort liability of school districts and school personnel. The cases discussed are generally limited to those decided during 1974 and reported in the General Digest on or before March 1, 1975. In his…
29 CFR 0.737-9 - Decision on exceptions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of the Secretary of Labor ETHICS AND CONDUCT OF DEPARTMENT OF LABOR EMPLOYEES Post Employment... their respective positions. (b) The Under Secretary shall issue a decision based solely on the record of the proceedings or those portions thereof cited by the parties to limit the issues. (c) If the Under...
5 CFR 846.205 - Reconsideration and appeal rights.

Code of Federal Regulations, 2010 CFR

2010-01-01

... circumstances beyond his or her control from making the request within the time limit. (d) OPM's decision. After... REGULATIONS (CONTINUED) FEDERAL EMPLOYEES RETIREMENT SYSTEM-ELECTIONS OF COVERAGE Elections § 846.205 Reconsideration and appeal rights. (a) Who may file. An individual may request OPM to reconsider a decision of an...
Report: EPA Has Not Reported to Congress on BEACH Act Progress as Statutorily Required or Fully Documented Budget Decisions

EPA Pesticide Factsheets

Report #18-P-0071, January 18, 2018. Failure to submit required reports and keep required records limits congressional, public and EPA knowledge about the impact of the agency's BEACH Act program and decisions regarding the use of taxpayer dollars.
Governance.

ERIC Educational Resources Information Center

Moran, K. D.

This chapter summarized and analyzes all state supreme court and federal court decisions as well as other significant court decisions affecting the realm of school governance. The cases discussed are generally limited to those decided during 1974 and reported in the General Digest on or before March 1, 1975. Because of its unusual significance,…
7 CFR 780.15 - Time limitations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... participant, FSA will provide the participant written notice of the adverse decision and available appeal... appealable must submit a written request for an appealability review to the State Executive Director that is received no later than 30 calendar days from the date a participant receives written notice of the decision...
Medical decision and patient's preference: 'much ethics' and more trust always needed.

PubMed

Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

2011-01-01

There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice.
Teaching the Ethics of Biology.

ERIC Educational Resources Information Center

Johansen, Carol K.; Harris, David E.

2000-01-01

Points out the challenges of educating students about bioethics and the limited training of many biologists on ethics. Discusses the basic principles of ethics and ethical decision making as applied to biology. Explains the models of ethical decision making that are often difficult for students to determine where to begin analyzing. (Contains 28…
36 CFR 251.82 - Appealable decisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Appeal of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.82 Appealable... National Forest System lands, including but not limited to: (1) Permits for ingress and egress to intermingled and adjacent private lands across National Forest System lands, 36 CFR 212.8 and 212.10. (2...
36 CFR 251.82 - Appealable decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Appeal of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.82 Appealable... National Forest System lands, including but not limited to: (1) Permits for ingress and egress to intermingled and adjacent private lands across National Forest System lands, 36 CFR 212.8 and 212.10. (2...
36 CFR 251.82 - Appealable decisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Appeal of Decisions Relating to Occupancy and Use of National Forest System Lands § 251.82 Appealable... National Forest System lands, including but not limited to: (1) Permits for ingress and egress to intermingled and adjacent private lands across National Forest System lands, 36 CFR 212.8 and 212.10. (2...
20 CFR 703.204 - Decision on insurance carrier's application; minimum amount of deposit.

Code of Federal Regulations, 2011 CFR

2011-04-01

... INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.204 Decision on insurance... determining the extent of an insurance carrier's unsecured LHWCA obligations and fixing the amount of security... number of factors in setting the security deposit amount including, but not limited to, the— (1...
20 CFR 703.204 - Decision on insurance carrier's application; minimum amount of deposit.

Code of Federal Regulations, 2012 CFR

2012-04-01

... INSURANCE REGULATIONS Insurance Carrier Security Deposit Requirements § 703.204 Decision on insurance... determining the extent of an insurance carrier's unsecured LHWCA obligations and fixing the amount of security... number of factors in setting the security deposit amount including, but not limited to, the— (1...
Teacher Judgments of Students' Reading Abilities across a Continuum of Rating Methods and Achievement Measures

ERIC Educational Resources Information Center

Begeny, John C.; Krouse, Hailey E.; Brown, Kristina G.; Mann, Courtney M.

2011-01-01

Teacher judgments about students' academic abilities are important for instructional decision making and potential special education entitlement decisions. However, the small number of studies evaluating teachers' judgments are limited methodologically (e.g., sample size, procedural sophistication) and have yet to answer important questions…
7 CFR 3560.752 - Appraisal use, request, review, and release.

Code of Federal Regulations, 2010 CFR

2010-01-01

... appropriate servicing or preservation decisions. Appraisals used for Agency decision-making must be current... Agency or any other financing source. Each type of financing involved, including, but not limited to, interest credit subsidy, low-interest loans from other sources, tax-exempt bond financing, tax credits, and...

75 FR 52735 - Clean Water Act Section 303(d): Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-27

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9189-7] Clean Water Act Section 303(d): Availability of List...: This notice announces the availability of EPA's decision identifying 12 water quality limited waterbodies and associated pollutants in South Dakota to be listed pursuant to the Clean Water Act Section 303...
15 CFR 766.22 - Review by Under Secretary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false Review by Under Secretary. 766.22... ENFORCEMENT PROCEEDINGS § 766.22 Review by Under Secretary. (a) Recommended decision. For proceedings not... the recommended decision and order to the Under Secretary. Because of the time limits provided under...
13 CFR 120.451 - How does a Lender become a PLP Lender?

Code of Federal Regulations, 2010 CFR

2010-01-01

... for final decision. (b) In making its decision, SBA considers whether the Lender: (1) Has the required.... The Lender's Risk Rating, among other factors, will be considered in determining satisfactory SBA performance. Other factors may include, but are not limited to, on-site review/examination assessments...
MULTI-SCALED VULNERABILITY ANALYSES: IMPROVING DECISION-MAKING AT REGIONAL TO LOCAL LEVELS THROUGH PARTNERSHIP

EPA Science Inventory

Decision-makers at all scales are faced with setting priorities for both use of limited resources and for risk management. While there are all kinds of monitoring data and models to project conditions at different spatial and temporal scales, synthesized information to establish ...
Social Capital in Data-Driven Community College Reform

ERIC Educational Resources Information Center

Kerrigan, Monica Reid

2015-01-01

The current rhetoric around using data to improve community college student outcomes with only limited research on data-driven decision-making (DDDM) within postsecondary education compels a more comprehensive understanding of colleges' capacity for using data to inform decisions. Based on an analysis of faculty and administrators' perceptions and…
Modelling a Network of Decision Makers

DTIC Science & Technology

2004-06-01

DATES COVERED 00-00-2004 to 00-00-2004 4. TITLE AND SUBTITLE Modelling a Netowrk of Decision Makers (Briefing Charts) 5a. CONTRACT NUMBER 5b...contains color images. 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT 18. NUMBER OF PAGES 31 19a
A Longitudinal Analysis of Adolescent Decision-Making with the Iowa Gambling Task

ERIC Educational Resources Information Center

Almy, Brandon; Kuskowski, Michael; Malone, Stephen M.; Myers, Evan; Luciana, Monica

2018-01-01

Many researchers have used the standard Iowa Gambling Task (IGT) to assess decision-making in adolescence given increased risk-taking during this developmental period. Most studies are cross-sectional and do not observe behavioral trajectories over time, limiting interpretation. This longitudinal study investigated healthy adolescents' and young…
34 CFR 99.67 - How does the Secretary enforce decisions?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false How does the Secretary enforce decisions? 99.67 Section 99.67 Education Office of the Secretary, Department of Education FAMILY EDUCATIONAL RIGHTS AND... limited to, the following enforcement actions available in accordance with part E of the General Education...
Decision Making and Cancer

PubMed Central

Reyna, Valerie F.; Nelson, Wendy L.; Han, Paul K.; Pignone, Michael P.

2014-01-01

We review decision-making along the cancer continuum in the contemporary context of informed and shared decision making, in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PMID:25730718
Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making.

PubMed

Liu, Shuyan; Schad, Daniel J; Kuschpel, Maxim S; Rapp, Michael A; Heinz, Andreas

2016-01-01

Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes.
Music and Video Gaming during Breaks: Influence on Habitual versus Goal-Directed Decision Making

PubMed Central

Kuschpel, Maxim S.; Rapp, Michael A.; Heinz, Andreas

2016-01-01

Different systems for habitual versus goal-directed control are thought to underlie human decision-making. Working memory is known to shape these decision-making systems and their interplay, and is known to support goal-directed decision making even under stress. Here, we investigated if and how decision systems are differentially influenced by breaks filled with diverse everyday life activities known to modulate working memory performance. We used a within-subject design where young adults listened to music and played a video game during breaks interleaved with trials of a sequential two-step Markov decision task, designed to assess habitual as well as goal-directed decision making. Based on a neurocomputational model of task performance, we observed that for individuals with a rather limited working memory capacity video gaming as compared to music reduced reliance on the goal-directed decision-making system, while a rather large working memory capacity prevented such a decline. Our findings suggest differential effects of everyday activities on key decision-making processes. PMID:26982326
Decision Making in Paediatric Cardiology. Are We Prone to Heuristics, Biases and Traps?

PubMed

Ryan, Aedin; Duignan, Sophie; Kenny, Damien; McMahon, Colin J

2018-01-01

Hidden traps in decision making have been long recognised in the behavioural economics community. Yet we spend very limited, if any time, analysing our decision-making processes in medicine and paediatric cardiology. Systems 1 and 2 thought processes differentiate between rapid emotional thoughts and slow deliberate rational thoughts. For fairly clear cut medical decisions, in-depth analysis may not be needed, but in our field of paediatric cardiology it is not uncommon for challenging cases and occasionally 'simple' cases to generate significant debate and uncertainty as to the best decision. Although morbidity and mortality meetings frequently highlight poor outcomes for our patients, they often neglect to analyse the process of thought which underlined those decisions taken. This article attempts to review commonly acknowledged traps in decision making in the behavioural economics world to ascertain whether these heuristics translate to decision making in the paediatric cardiology environment. We also discuss potential individual and collective solutions to pitfalls in decision making.
Shared decision-making and decision support: their role in obstetrics and gynecology.

PubMed

Tucker Edmonds, Brownsyne

2014-12-01

To discuss the role for shared decision-making in obstetrics/gynecology and to review evidence on the impact of decision aids on reproductive health decision-making. Among the 155 studies included in a 2014 Cochrane review of decision aids, 31 (29%) addressed reproductive health decisions. Although the majority did not show evidence of an effect on treatment choice, there was a greater uptake of mammography in selected groups of women exposed to decision aids compared with usual care; and a statistically significant reduction in the uptake of hormone replacement therapy among detailed decision aid users compared with simple decision aid users. Studies also found an effect on patient-centered outcomes of care, such as medication adherence, quality-of-life measures, and anxiety scores. In maternity care, only decision analysis tools affected final treatment choice, and patient-directed aids yielded no difference in planned mode of birth after cesarean. There is untapped potential for obstetricians/gynecologists to optimize decision support for reproductive health decisions. Given the limited evidence-base guiding practice, the preference-sensitive nature of reproductive health decisions, and the increase in policy efforts and financial incentives to optimize patients' satisfaction, it is increasingly important for obstetricians/gynecologists to appreciate the role of shared decision-making and decision support in providing patient-centered reproductive healthcare.
What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

PubMed

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

2017-01-01

Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed.
Multisensor fusion with non-optimal decision rules: the challenges of open world sensing

NASA Astrophysics Data System (ADS)

Minor, Christian; Johnson, Kevin

2014-05-01

In this work, simple, generic models of chemical sensing are used to simulate sensor array data and to illustrate the impact on overall system performance that specific design choices impart. The ability of multisensor systems to perform multianalyte detection (i.e., distinguish multiple targets) is explored by examining the distinction between fundamental design-related limitations stemming from mismatching of mixture composition to fused sensor measurement spaces, and limitations that arise from measurement uncertainty. Insight on the limits and potential of sensor fusion to robustly address detection tasks in realistic field conditions can be gained through an examination of a) the underlying geometry of both the composition space of sources one hopes to elucidate and the measurement space a fused sensor system is capable of generating, and b) the informational impact of uncertainty on both of these spaces. For instance, what is the potential impact on sensor fusion in an open world scenario where unknown interferants may contaminate target signals? Under complex and dynamic backgrounds, decision rules may implicitly become non-optimal and adding sensors may increase the amount of conflicting information observed. This suggests that the manner in which a decision rule handles sensor conflict can be critical in leveraging sensor fusion for effective open world sensing, and becomes exponentially more important as more sensors are added. Results and design considerations for handling conflicting evidence in Bayes and Dempster-Shafer fusion frameworks are presented. Bayesian decision theory is used to provide an upper limit on detector performance of simulated sensor systems.
English language proficiency, health literacy, and trust in physician are associated with shared decision-making in rheumatoid arthritis

PubMed Central

Barton, Jennifer L.; Trupin, Laura; Tonner, Chris; Imboden, John; Katz, Patricia; Schillinger, Dean; Yelin, Edward H.

2014-01-01

Objective Treat to Target guidelines promote shared decision-making (SDM) in rheumatoid arthritis (RA). Also, due to high cost and potential toxicity of therapies, SDM is central to patient safety. Our objective was to examine patterns of perceived communication around decision-making in two cohorts of adults with RA. Methods Data were derived from patients enrolled in one of two longitudinal, observational cohorts (UCSF RA Cohort and RA Panel). Subjects completed a telephone interview in their preferred language that included a measure of patient-provider communication, including items about decision-making. Measures of trust in physician, education, and language proficiency were also asked. Logistic regression was performed to identify correlates of suboptimal SDM communication. Analyses were performed on each sample separately. Results Of 509 patients across two cohorts, 30% and 32% reported suboptimal SDM communication. Low trust in physician was independently associated with suboptimal SDM communication in both cohorts. Older age and limited English proficiency were independently associated with suboptimal SDM in the UCSF RA Cohort, as was limited health literacy in the RA Panel. Conclusions This study of over 500 adults with RA from two demographically distinct cohorts found that nearly one-third of subjects report suboptimal SDM communication with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts, as was limited English language proficiency and older age in the UCSF RA Cohort and limited health literacy in the Panel. These findings underscore the need to examine the impact of SDM on health outcomes in RA. PMID:24931952
Using the Networked Fire Chief for ego-depletion research: measuring dynamic decision-making effort and performance.

PubMed

Barber, Larissa K; Smit, Brandon W

2014-01-01

This study replicated ego-depletion predictions from the self-control literature in a computer simulation task that requires ongoing decision-making in relation to constantly changing environmental information: the Network Fire Chief (NFC). Ego-depletion led to decreased self-regulatory effort, but not performance, on the NFC task. These effects were also buffered by task enjoyment so that individuals who enjoyed the dynamic decision-making task did not experience ego-depletion effects. These findings confirm that past ego-depletion effects on decision-making are not limited to static or isolated decision-making tasks and can be extended to dynamic, naturalistic decision-making processes more common to naturalistic settings. Furthermore, the NFC simulation provides a methodological mechanism for independently measuring effort and performance when studying ego-depletion.
Toward a synthesis of cognitive biases: how noisy information processing can bias human decision making.

PubMed

Hilbert, Martin

2012-03-01

A single coherent framework is proposed to synthesize long-standing research on 8 seemingly unrelated cognitive decision-making biases. During the past 6 decades, hundreds of empirical studies have resulted in a variety of rules of thumb that specify how humans systematically deviate from what is normatively expected from their decisions. Several complementary generative mechanisms have been proposed to explain those cognitive biases. Here it is suggested that (at least) 8 of these empirically detected decision-making biases can be produced by simply assuming noisy deviations in the memory-based information processes that convert objective evidence (observations) into subjective estimates (decisions). An integrative framework is presented to show how similar noise-based mechanisms can lead to conservatism, the Bayesian likelihood bias, illusory correlations, biased self-other placement, subadditivity, exaggerated expectation, the confidence bias, and the hard-easy effect. Analytical tools from information theory are used to explore the nature and limitations that characterize such information processes for binary and multiary decision-making exercises. The ensuing synthesis offers formal mathematical definitions of the biases and their underlying generative mechanism, which permits a consolidated analysis of how they are related. This synthesis contributes to the larger goal of creating a coherent picture that explains the relations among the myriad of seemingly unrelated biases and their potential psychological generative mechanisms. Limitations and research questions are discussed.
Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.

PubMed

Cook, S A; Rosser, R; Meah, S; James, M I; Salmon, P

2003-07-01

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers. Of 115 authorities approached, 32 reported using guidelines and provided sufficient information for analysis. Guidelines mostly concerned arbitrary sets of cosmetic procedures and lacked reference to an evidence base. They allowed surgery for specified anatomical, functional or symptomatic reasons, but these indications varied between guidelines. Most guidelines also permitted surgery 'exceptionally' for psychological reasons. The guidelines that were studied in detail did not appreciably influence surgeons' decisions, which reflected criteria that were not cited in the guidelines, including cost of the procedure and whether patients sought restoration or improvement of their appearance. Decision guidelines in this area have several limitations. Future guidelines should: include all cosmetic procedures; be informed by a broad range of evidence; and, arguably, include several nonclinical criteria that currently inform surgeons' decision-making.
Measuring the effect of attention on simple visual search.

PubMed

Palmer, J; Ames, C T; Lindsey, D T

1993-02-01

Set-size in visual search may be due to 1 or more of 3 factors: sensory processes such as lateral masking between stimuli, attentional processes limiting the perception of individual stimuli, or attentional processes affecting the decision rules for combining information from multiple stimuli. These possibilities were evaluated in tasks such as searching for a longer line among shorter lines. To evaluate sensory contributions, display set-size effects were compared with cuing conditions that held sensory phenomena constant. Similar effects for the display and cue manipulations suggested that sensory processes contributed little under the conditions of this experiment. To evaluate the contribution of decision processes, the set-size effects were modeled with signal detection theory. In these models, a decision effect alone was sufficient to predict the set-size effects without any attentional limitation due to perception.

Making sense of genetic uncertainty: the role of religion and spirituality.

PubMed

White, Mary T

2009-02-15

This article argues that to the extent that religious and spiritual beliefs can help people cope with genetic uncertainty, a limited spiritual assessment may be appropriate in genetic counseling. The article opens by establishing why genetic information is inherently uncertain and why this uncertainty can be medically, morally, and spiritually problematic. This is followed by a review of the range of factors that can contribute to risk assessments, including a few heuristics commonly used in responses to uncertainty. The next two sections summarize recent research on the diverse roles of religious and spiritual beliefs in genetic decisions and challenges to conducting spiritual assessments in genetic counseling. Based on these findings, religious and spiritual beliefs are posited as serving essentially as a heuristic that some people will utilize in responding to their genetic risks. In the interests of helping such clients make informed decisions, a limited spiritual assessment is recommended and described. Some of the challenges and risks associated with this limited assessment are discussed. Since some religious and spiritual beliefs can conflict with the values of medicine, some decisions will remain problematic. (c) 2009 Wiley-Liss, Inc.
Utility approach to decision-making in extended T1 and limited T2 glottic carcinoma.

PubMed

van Loon, Yda; Stiggelbout, Anne M; Hakkesteegt, Marieke M; Langeveld, Ton P M; de Jong, Rob J Baatenburg; Sjögren, Elisabeth V

2017-04-01

It is still undecided if endoscopic laser surgery or radiotherapy is the preferable treatment in extended T1 and limited T2 glottic tumors. Health utilities assessed from patients can aid in decision-making. Patients treated for extended T1 or limited T2 glottic carcinoma by laser surgery (n = 12) or radiotherapy (n = 14) assigned health utilities using a visual analog scale (VAS), time tradeoff (TTO) technique and scored their voice handicap using the Voice Handicap Index (VHI). VAS and TTO scores were slightly lower for the laser group compared to the radiotherapy group, however, not significantly so. The VHI showed a correlation with the VAS score, which was very low in both groups and can be considered (near) normal. Patients show no clear preference for the outcomes of laser surgery or radiotherapy from a quality of life (QOL) or voice handicap point of view. These data can now be incorporated into decision-making models. © 2017 Wiley Periodicals, Inc. Head Neck, 2017 © 2016 Wiley Periodicals, Inc. Head Neck 39: 779-785, 2017. © 2017 Wiley Periodicals, Inc.
77 FR 12332 - Vogtle Electric Generating Plant, Units 3 and 4; Issuance of Combined Licenses and Limited Work...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-29

... Generating Plant, Units 3 and 4; Issuance of Combined Licenses and Limited Work Authorizations and Record of...) and Limited Work Authorization (LWA) (Nos. LWA-001 and LWA-002) and Record of Decision Issuance. FOR... and NPF-92 and Limited Work Authorizations LWA-001 and LWA-002 to Southern Nuclear Operating Company...
Looking at CER from Medicare's perspective.

PubMed

Mohr, Penny

2012-05-01

Comparative effectiveness research (CER) is rapidly adding to the amount of data available to health care coverage and payment decision makers. Medicare's decisions have a large effect on coverage and reimbursement policies throughout the health insurance industry and will likely influence the entire U.S. health care system; thus, examining its role in integrating CER into policy is crucial. To describe the potential benefits of CER to support payment and coverage decisions in the Medicare program, limitations on its use,the role of the Centers for Medicare & Medicaid Services (CMS) in improving the infrastructure for CER, and to discuss challenges that must be addressed to integrate CER into CMS's decision-making process. A defining feature of CER is that it provides the type of evidence that will help decision makers, such as patients, clinicians, and payers,make more informed treatment and policy decisions. Because CMS is responsible for more than 47 million elderly and disabled beneficiaries, the way that Medicare uses CER has the potential to have a large impact on public and individual health. Currently many critical payment and coverage decisions within the Medicare program are made on the basis of poor quality evidence, and CER has the potential to greatly improve the quality of decision making. Despite common misconceptions, CMS is not prohibited by law from using CER apart from some reasonable limitations. CMS is,however, required to support the development of the CER infrastructure by making their data more readily available to researchers. While CER has substantial potential to improve the quality of the agency's policy decisions,challenges remain to integrate CER into Medicare's processes. These challenges include statutory ambiguities, lack of sufficient staff and internal resources to take advantage of CER, and the lack of an active voice in setting priorities for CER and study design. Although challenges exist, CER has the potential to greatly enhance CMS's ability to make decisions regarding coverage and payment that will benefit both the agency and their patient population.
The role of behavioral economics and behavioral decision making in Americans' retirement savings decisions.

PubMed

Knoll, Melissa A Z

2010-01-01

Traditional economic theory posits that people make decisions by maximizing a utility function in which all of the relevant constraints and preferences are included and weighed appropriately. Behavioral economists and decision-making researchers, however, are interested in how people make decisions in the face of incomplete information, limited cognitive resources, and decision biases. Empirical findings in the areas of behavioral economics and judgment and decision making (JDM) demonstrate departures from the notion that man is economically rational, illustrating instead that people often act in ways that are economically suboptimal. This article outlines findings from the JDM and behavioral-economics literatures that highlight the many behavioral impediments to saving that individuals may encounter on their way to financial security. I discuss how behavioral and psychological issues, such as self-control, emotions, and choice architecture can help policymakers understand what factors, aside from purely economic ones, may affect individuals' savings behavior.
Emotion and decision-making: affect-driven belief systems in anxiety and depression.

PubMed

Paulus, Martin P; Yu, Angela J

2012-09-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches that link emotion and decision-making, and focus on research with anxious or depressed individuals to show how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression, and outline the broader implications of this approach. Copyright © 2012. Published by Elsevier Ltd.
Real-life decision making in college students. I: Consistency across specific decisions.

PubMed

Galotti, Kathleen M; Wiener, Hillary J D; Tandler, Jane M

2014-01-01

First-year undergraduates participated in a short-term longitudinal study of real-life decision making over their first 14 months of college. They were surveyed about 7 different decisions: choosing courses for an upcoming term (3 different terms), choosing an academic major (twice), planning for the upcoming summer, and planning for sophomore-year housing. Participants showed moderate levels of consistency in the options they considered and in the criteria they used to decide between options, with about half of the options or criteria being used at 2 different points on the decision repeatedly studied. Participants varied somewhat in structural consistency, the tendency to consider the same number of options or criteria across decisions. They also varied in the way they integrated information across decision-making tasks. We suggest that people attempt to keep the information demands of the task within workable limits, sometimes sacrificing consistency as a result.
Zero-block mode decision algorithm for H.264/AVC.

PubMed

Lee, Yu-Ming; Lin, Yinyi

2009-03-01

In the previous paper , we proposed a zero-block intermode decision algorithm for H.264 video coding based upon the number of zero-blocks of 4 x 4 DCT coefficients between the current macroblock and the co-located macroblock. The proposed algorithm can achieve significant improvement in computation, but the computation performance is limited for high bit-rate coding. To improve computation efficiency, in this paper, we suggest an enhanced zero-block decision algorithm, which uses an early zero-block detection method to compute the number of zero-blocks instead of direct DCT and quantization (DCT/Q) calculation and incorporates two adequate decision methods into semi-stationary and nonstationary regions of a video sequence. In addition, the zero-block decision algorithm is also applied to the intramode prediction in the P frame. The enhanced zero-block decision algorithm brings out a reduction of average 27% of total encoding time compared to the zero-block decision algorithm.
Methodological decisions and the evaluation of possible effects of different family structures on children: The new family structures survey (NFSS).

PubMed

Schumm, Walter R

2012-11-01

Every social science researcher must make a number of methodological decisions when planning and implementing research projects. Each such decision carries with it both advantages and limitations. The decisions faced and made by Regnerus (2012) are discussed here in the wider context of social science literature regarding same-sex parenting. Even though the apparent outcomes of Regnerus's study were unpopular, the methodological decisions he made in the design and implementation of the New Family Structures Survey were not uncommon among social scientists, including many progressive, gay and lesbian scholars. These decisions and the research they produced deserve considerable and continued discussion, but criticisms of the underlying ethics and professionalism are misplaced because nearly every methodological decision that was made has ample precedents in research published by many other credible and distinguished scholars. Copyright © 2012 Elsevier Inc. All rights reserved.
Use of Inverse Reinforcement Learning for Identity Prediction

NASA Technical Reports Server (NTRS)

Hayes, Roy; Bao, Jonathan; Beling, Peter; Horowitz, Barry

2011-01-01

We adopt Markov Decision Processes (MDP) to model sequential decision problems, which have the characteristic that the current decision made by a human decision maker has an uncertain impact on future opportunity. We hypothesize that the individuality of decision makers can be modeled as differences in the reward function under a common MDP model. A machine learning technique, Inverse Reinforcement Learning (IRL), was used to learn an individual's reward function based on limited observation of his or her decision choices. This work serves as an initial investigation for using IRL to analyze decision making, conducted through a human experiment in a cyber shopping environment. Specifically, the ability to determine the demographic identity of users is conducted through prediction analysis and supervised learning. The results show that IRL can be used to correctly identify participants, at a rate of 68% for gender and 66% for one of three college major categories.
Emotion and decision-making: affect-driven belief systems in anxiety and depression

PubMed Central

Paulus, Martin P.; Yu, Angela J.

2012-01-01

Emotion processing and decision-making are integral aspects of daily life. However, our understanding of the interaction between these constructs is limited. In this review, we summarize theoretical approaches to the link between emotion and decision-making, and focus on research with anxious or depressed individuals that reveals how emotions can interfere with decision-making. We integrate the emotional framework based on valence and arousal with a Bayesian approach to decision-making in terms of probability and value processing. We then discuss how studies of individuals with emotional dysfunctions provide evidence that alterations of decision-making can be viewed in terms of altered probability and value computation. We argue that the probabilistic representation of belief states in the context of partially observable Markov decision processes provides a useful approach to examine alterations in probability and value representation in individuals with anxiety and depression and outline the broader implications of this approach. PMID:22898207
Informed choice in direct-to-consumer genetic testing (DTCGT) websites: a content analysis of benefits, risks, and limitations.

PubMed

Singleton, Amanda; Erby, Lori Hamby; Foisie, Kathryn V; Kaphingst, Kimberly A

2012-06-01

An informed choice about health-related direct-to-consumer genetic testing (DTCGT) requires knowledge of potential benefits, risks, and limitations. To understand the information that potential consumers of DTCGT services are exposed to on company websites, we conducted a content analysis of 23 health-related DTCGT websites. Results revealed that benefit statements outweighed risk and limitation statements 6 to 1. The most frequently described benefits were: 1) disease prevention, 2) consumer education, 3) personalized medical recommendations, and 4) the ability to make health decisions. Thirty-five percent of websites also presented at least one risk of testing. Seventy-eight percent of websites mentioned at least one limitation of testing. Based on this information, potential consumers might get an inaccurate picture of genetic testing which could impact their ability to make an informed decision. Practices that enhance the presentation of balanced information on DTCGT company websites should be encouraged.
Critical care physician cognitive task analysis: an exploratory study

PubMed Central

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

2009-01-01

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

PubMed

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

2009-01-01

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

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

Rizzo, Davinia B.; Blackburn, Mark R.

As systems become more complex, systems engineers rely on experts to inform decisions. There are few experts and limited data in many complex new technologies. This challenges systems engineers as they strive to plan activities such as qualification in an environment where technical constraints are coupled with the traditional cost, risk, and schedule constraints. Bayesian network (BN) models provide a framework to aid systems engineers in planning qualification efforts with complex constraints by harnessing expert knowledge and incorporating technical factors. By quantifying causal factors, a BN model can provide data about the risk of implementing a decision supplemented with informationmore » on driving factors. This allows a systems engineer to make informed decisions and examine “what-if” scenarios. This paper discusses a novel process developed to define a BN model structure based primarily on expert knowledge supplemented with extremely limited data (25 data sets or less). The model was developed to aid qualification decisions—specifically to predict the suitability of six degrees of freedom (6DOF) vibration testing for qualification. The process defined the model structure with expert knowledge in an unbiased manner. Finally, validation during the process execution and of the model provided evidence the process may be an effective tool in harnessing expert knowledge for a BN model.« less
Harnessing expert knowledge: Defining a Bayesian network decision model with limited data-Model structure for the vibration qualification problem

DOE PAGES

Rizzo, Davinia B.; Blackburn, Mark R.

2018-03-30

As systems become more complex, systems engineers rely on experts to inform decisions. There are few experts and limited data in many complex new technologies. This challenges systems engineers as they strive to plan activities such as qualification in an environment where technical constraints are coupled with the traditional cost, risk, and schedule constraints. Bayesian network (BN) models provide a framework to aid systems engineers in planning qualification efforts with complex constraints by harnessing expert knowledge and incorporating technical factors. By quantifying causal factors, a BN model can provide data about the risk of implementing a decision supplemented with informationmore » on driving factors. This allows a systems engineer to make informed decisions and examine “what-if” scenarios. This paper discusses a novel process developed to define a BN model structure based primarily on expert knowledge supplemented with extremely limited data (25 data sets or less). The model was developed to aid qualification decisions—specifically to predict the suitability of six degrees of freedom (6DOF) vibration testing for qualification. The process defined the model structure with expert knowledge in an unbiased manner. Finally, validation during the process execution and of the model provided evidence the process may be an effective tool in harnessing expert knowledge for a BN model.« less
Adapting Scott and Bruce's General Decision-Making Style Inventory to Patient Decision Making in Provider Choice.

PubMed

Fischer, Sophia; Soyez, Katja; Gurtner, Sebastian

2015-05-01

Research testing the concept of decision-making styles in specific contexts such as health care-related choices is missing. Therefore, we examine the contextuality of Scott and Bruce's (1995) General Decision-Making Style Inventory with respect to patient choice situations. Scott and Bruce's scale was adapted for use as a patient decision-making style inventory. In total, 388 German patients who underwent elective joint surgery responded to a questionnaire about their provider choice. Confirmatory factor analyses within 2 independent samples assessed factorial structure, reliability, and validity of the scale. The final 4-dimensional, 13-item patient decision-making style inventory showed satisfactory psychometric properties. Data analyses supported reliability and construct validity. Besides the intuitive, dependent, and avoidant style, a new subdimension, called "comparative" decision-making style, emerged that originated from the rational dimension of the general model. This research provides evidence for the contextuality of decision-making style to specific choice situations. Using a limited set of indicators, this report proposes the patient decision-making style inventory as valid and feasible tool to assess patients' decision propensities. © The Author(s) 2015.
'My kidneys, my choice, decision aid': supporting shared decision making.

PubMed

Fortnum, Debbie; Smolonogov, Tatiana; Walker, Rachael; Kairaitis, Luke; Pugh, Debbie

2015-06-01

For patients with chronic kidney disease (CKD) who are progressing to end-stage kidney disease (ESKD) a decision of whether to undertake dialysis or conservative care is a critical component of the patient journey. Shared decision making for complex decisions such as this could be enhanced by a decision aid, a practice which is well utilised in other disciplines but limited for nephrology. A multidisciplinary team in Australia and New Zealand (ANZ) utilised current decision-making theory and best practice to develop the 'My Kidneys, My Choice', a decision aid for the treatment of kidney disease. A patient-centred, five-sectioned tool is now complete and freely available to all ANZ units to support the ESKD education and shared decision-making process. Distribution and education have occurred across ANZ and evaluation of the decision aid in practice is in the first phase. Development of a new tool such as an ESKD decision aid requires vision, multidisciplinary input and ongoing implementation resources. This tool is being integrated into ANZ, ESKD education practice and is promoting the philosophy of shared decision making. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Composite collective decision-making

PubMed Central

Czaczkes, Tomer J.; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

2015-01-01

Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. PMID:26019155
Theoretical Approaches in the Context of Spatial Planning Decisions and the Relation with Urban Sustainability

NASA Astrophysics Data System (ADS)

Kumlu, Kadriye Burcu Yavuz; Tüdeş, Şule

2017-10-01

The sustainability agenda has maintained its importance since the days, when the production system took its capitalist form, as well as the population in the urban areas started to rise. Increasing number of both goods and the people have caused the degradation of the certain systems, which generate the urban areas. These systems could mainly be classified as social, environmental, physical and economical systems. Today, urban areas still have difficulty to protect those systems, due to the significant demand of the population. Therefore, studies related with the sustainable issues are significant in the sense of continuity of the urban systems. Therefore, in this paper, those studies in the context of the effects of physical decisions taken in the spatial planning process on urban sustainability, will be examined. The components of the physical decisions are limited to land use, density and design. Land use decisions will be examined in the context of mixed land use. On the other hand, decisions related with density will be analyzed in the sense of population density and floor area ratio (FAR). Besides, design decisions will be examined, by linking them with neighborhood design criteria. Additionally, the term of urban sustainability will only be limited to its social and environmental contexts in this study. Briefly stated, studies in the sustainable literature concerned with the effects of land use, density and design decisions taken in the spatial planning process on the social and environmental sustainability will be examined in this paper. After the compilation and the analyze of those studies, a theoretical approach will be proposed to determine social and environmental sustainability in the context of land use, density and design decisions, taken in the spatial planning process.

What are the Essential Elements to Enable Patient Participation in Medical Decision Making?

PubMed Central

McGraw, Sarah

2007-01-01

BACKGROUND Patient participation in shared decision making (SDM) results in increased patient knowledge, adherence, and improved outcomes. Despite the benefits of the SDM model, many patients do not attain the level of participation they desire. OBJECTIVE To gain a more complete understanding of the essential elements, or the prerequisites, critical to active patient participation in medical decision making from the patient’s perspective. DESIGN Qualitative study. SETTING Individual, in-depth patient interviews were conducted until thematic saturation was reached. Two analysts independently read the transcripts and jointly developed a list of codes. PATIENTS Twenty-six consecutive subjects drawn from community dwelling subjects undergoing bone density measurements. MEASUREMENTS Respondents’ experiences and beliefs related to patient participation in SDM. RESULTS Five elements were repeatedly described by respondents as being essential to enable patient participation in medical decision making: (1) patient knowledge, (2) explicit encouragement of patient participation by physicians, (3) appreciation of the patient’s responsibility/rights to play an active role in decision making, (4) awareness of choice, and (5) time. LIMITATIONS The generalizability of the results is limited by the homogeneity of the study sample. CONCLUSIONS Our findings have important clinical implications and suggest that several needs must be met before patients can become active participants in decisions related to their health care. These needs include ensuring that patients (1) appreciate that there is uncertainty in medicine and “buy in” to the importance of active patient participation in decisions related to their health care, (2) understand the trade-offs related to available options, and (3) have the opportunity to discuss these options with their physician to arrive at a decision concordant with their values. PMID:17443368
Interventions to enhance informed choices among invitees of screening programmes-a systematic review.

PubMed

van Agt, Heleen M E; Korfage, Ida J; Essink-Bot, Marie-Louise

2014-10-01

Informed decision making about participation has become an explicit purpose in invitations for screening programmes in western countries. An informed choice is commonly defined as based on: (i) adequate levels of knowledge of the screening and (ii) agreement between the invitee's values towards own screening participation and actual (intention to) participation. We systematically reviewed published studies that empirically evaluated the effects of interventions aiming at enhancing informed decision making in screening programmes targeted at the general population. We focused on prenatal screening and neonatal screening for diseases of the foetus/new-born and screening for breast cancer, cervical cancer and colorectal cancer. The Medline, EMBASE and Cochrane databases were searched for studies published till April 2012, using the terms 'informed choice', 'decision making' and 'mass screening' separately and in combination and terms referring to the specific screening programmes. Of the 2238 titles identified, 15 studies were included, which evaluated decision aids (DAs), information leaflets, film, video, counselling and a specific screening visit for informed decision making in prenatal screening, breast and colorectal cancer screening. Most of the included studies evaluated DAs and showed improved knowledge and informed decision making. Due to the limited number of studies the results could not be synthesized. The empirical evidence regarding interventions to improve informed decision making in screening is limited. It is unknown which strategies to enhance informed decision making are most effective, although DAs are promising. Systematic development of interventions to enhance informed choices in screening deserves priority, especially in disadvantaged groups. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
Measuring shared decision making in the consultation: a comparison of the OPTION and Informed Decision Making instruments.

PubMed

Weiss, Marjorie C; Peters, Tim J

2008-01-01

To investigate the applied and conceptual relationship between two measures of shared decision making using the OPTION instrument developed in Wales and the Informed Decision Making instrument developed in Seattle, USA using audio-taped consultation data from a UK general practice population. Twelve general practitioners were recruited from 6 general practices in the southwest of England. One hundred twenty-three GP-patient consultations were audio-recorded. Audiotapes were sent off to, and rated by, respective experts in the use of the OPTION and the Informed Decision Making instruments. Compared to earlier work using the Informed Decision Making tool, consultations in this sample were shorter, had fewer decisions and tended to have a greater number of elements present. Similar to previous research using the OPTION, values using the OPTION instrument were low with two items, giving the patient opportunities to ask questions and checking patient understanding, exhibiting the most variability. Using a 'key' decision in each consultation as the basis for comparison, the Informed Decision Making score was not related to the overall OPTION score (Spearman's rho=0.14, p=0.13). Both instruments also predicted different 'best' and 'worst' doctors. Using a Bland-Altman plot for assessing agreement, the mean difference between the two measures was 1.11 (CI 0.66-1.56) and the limits of agreement were -3.94 to 6.16. There were several elements between the two instruments that appeared conceptually similar and correlations for these were generally higher. These were: discussing alternatives or options (Spearman's rho=0.35, p=0.0001), discussion of the patient's role in decision making (Spearman's rho=0.23, p=0.012), discussion of the pros/cons of the alternatives (Spearman's rho=0.20, p=0.024) and assessment of the patient's understanding (Spearman's rho=0.19, p=0.03). Measures of shared decision making are helpful in identifying those shared decision making skills which may be problematic or difficult to integrate into practice and provide a tool by which the development of skills can be assessed over time. Research may implicitly place undue value on those aspects of shared decision making which are most easily measured. Shared decision making tools are a useful way of capturing the presence or absence of specific shared decision making skills and changes in skills acquisition over time. However there may be limits in the extent to which the concept of shared decision making can be measured and that more easily measured skills will be emphasised to the detriment of other important shared decision making skills.
Cost vs. Risk: Determining the Correct Liability Insurance Limit.

ERIC Educational Resources Information Center

Klinksiek, Glenn

1996-01-01

Presents a model for evaluating liability insurance limits and selecting the correct limit for an individual institution. Argues that many colleges and universities may be making overly conservative decisions that lead to the purchase of too much liability insurance. Also discusses the financial consequences of an uninsured large liability loss.…
Making the most of limited data in the evaluation of advanced traveler information services (ATIS) through experimental resampling : Cincinnati case study

DOT National Transportation Integrated Search

2004-02-01

Researchers and practitioners are commonly faced with the problem of limited data in the evaluation of ITS systems. Due to high data collection costs and limited resources, they are often forced to make decisions about the efficacy of a system or tec...
76 FR 50449 - Fisheries off West Coast States; Pacific Coast Groundfish Fishery Management Plan; Trawl...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

... decision making did not clearly state that Amendment 21 allocations supersede the previous limited entry... 21 supersedes the limited entry/open access allocations for groundfish species allocated through... the limited entry trawl fishery. DATES: Comments on Amendment 21-1 must be received no later than 5 p...
Organizational Factors and Instructional Decision-Making: A Cognitive Perspective

ERIC Educational Resources Information Center

Hora, Matthew Tadashi

2012-01-01

Given the limited adoption of research-based teaching methods at the postsecondary level, research is necessary that examines why faculty choose to teach the way they do. In this article, I draw on insights from research on teacher cognition and naturalistic decision-making research to identify how perceptions of organizational factors influence…
The Limits of Multistakeholder Governance: The Case of the Global Partnership for Education and Private Schooling

ERIC Educational Resources Information Center

Menashy, Francine

2017-01-01

This study investigates collective decision making within a multistakeholder partnership through a case study of the Global Partnership for Education (GPE). Analyzed through the theoretical framework of sociological institutionalism, this study applies the issue of private schooling as a lens to understand policy-related decision making between…
A Debate and Decision-Making Tool for Enhanced Learning

ERIC Educational Resources Information Center

López Garcia, Diego A.; Mateo Sanguino, Tomás de J.; Cortés Ancos, Estefania; Fernández de Viana González, Iñaki

2016-01-01

Debates have been used to develop critical thinking within teaching environments. Many learning activities are configured as working groups, which use debates to make decisions. Nevertheless, in a classroom debate, only a few students can participate; large work groups are similarly limited. Whilst the use of web tools would appear to offer a…
Arbitrary and Capricious Nonrenewal Decisions.

ERIC Educational Resources Information Center

Phay, Robert E.

This chapter discusses the question, To what degree is the school board limited by the requirement that it not be arbitrary or capricious in deciding not to renew a probationary teacher? When teachers have been notified that their employment contracts will not be renewed, they are responsible for initiating a review of the decision. If the school…
Unexpected Effects of a System-Distributed Mobile Application in Maternity Care: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Ledford, Christy J. W.; Womack, Jasmyne J.; Rider, Heather A.; Seehusen, Angela B.; Conner, Stephen J.; Lauters, Rebecca A.; Hodge, Joshua A.

2018-01-01

Background: As pregnant mothers increasingly engage in shared decision making regarding prenatal decisions, such as induction of labor, the patient's level of activation may influence pregnancy outcomes. One potential tool to increase patient activation in the clinical setting is mobile applications. However, research is limited in comparing…
Using soils and land potential as a basis for land use decisions and conservation planning: A resilience-based strategy

USDA-ARS?s Scientific Manuscript database

Land use decisions are becoming increasingly complex and contentious as demands for food, fiber, energy and infrastructure expand. Recent definitions of “planetary boundaries” and arbitrary land use limits circumscribing the “Safe Operating Space” for humans are helpful in drawing attention to globa...
43 CFR 5003.1 - Effect of decisions; general.

Code of Federal Regulations, 2013 CFR

2013-10-01

... risk of wildfire due to drought, fuels buildup, or other reasons, or at immediate risk of erosion or other damage due to wildfire, BLM may make a wildfire management decision made under this part and parts.... Wildfire management includes but is not limited to: (1) Fuel reduction or fuel treatment such as prescribed...
43 CFR 5003.1 - Effect of decisions; general.

Code of Federal Regulations, 2012 CFR

2012-10-01

... risk of wildfire due to drought, fuels buildup, or other reasons, or at immediate risk of erosion or other damage due to wildfire, BLM may make a wildfire management decision made under this part and parts.... Wildfire management includes but is not limited to: (1) Fuel reduction or fuel treatment such as prescribed...
43 CFR 5003.1 - Effect of decisions; general.

Code of Federal Regulations, 2014 CFR

2014-10-01

... risk of wildfire due to drought, fuels buildup, or other reasons, or at immediate risk of erosion or other damage due to wildfire, BLM may make a wildfire management decision made under this part and parts.... Wildfire management includes but is not limited to: (1) Fuel reduction or fuel treatment such as prescribed...
43 CFR 5003.1 - Effect of decisions; general.

Code of Federal Regulations, 2011 CFR

2011-10-01

... risk of wildfire due to drought, fuels buildup, or other reasons, or at immediate risk of erosion or other damage due to wildfire, BLM may make a wildfire management decision made under this part and parts.... Wildfire management includes but is not limited to: (1) Fuel reduction or fuel treatment such as prescribed...
29 CFR 25.7 - Fees; cost; expenses; decisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... limited to per diem, travel expenses and services on a time-worked basis. (e) Upon request, the Secretary... ORDER 10988 § 25.7 Fees; cost; expenses; decisions. (a) Arbitrator's fees, per diem and travel expenses.... Travel and per diem should be paid at the maximum rate payable to Government employees under the...
29 CFR 25.7 - Fees; cost; expenses; decisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... limited to per diem, travel expenses and services on a time-worked basis. (e) Upon request, the Secretary... ORDER 10988 § 25.7 Fees; cost; expenses; decisions. (a) Arbitrator's fees, per diem and travel expenses.... Travel and per diem should be paid at the maximum rate payable to Government employees under the...
Predictors of Career Decision-Making Self-Efficacy in Asian American College Students

ERIC Educational Resources Information Center

Ann-Yi, Sujin

2010-01-01

The purpose of this study was to examine what career development variables, according to the Social Cognitive Career Theory, contribute to career decision-making self-efficacy, one of the key components of career development in a sample of Asian American undergraduate college students. The career literature is historically limited in empirical…
75 FR 71431 - Clean Water Act Section 303(d): Availability of List Decisions Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-23

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9230-1] Clean Water Act Section 303(d): Availability of List... Availability. SUMMARY: This action corrects a Federal Register notice that published on November 9, 2010 at 75 FR 68783 announcing the availability of EPA decisions identifying water quality limited segments and...

77 FR 27770 - Clean Water Act Section 303(d): Availability of List Decisions

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9670-5] Clean Water Act Section 303(d): Availability of List...: This notice announces EPA's decision identifying certain water quality limited waterbodies, and the associated pollutant, in Utah to be listed pursuant to the Clean Water Act Section 303(d)(2), and requests...
75 FR 57230 - 340B Drug Pricing Program Manufacturer Civil Monetary Penalties

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-20

... process incorporating a variety of elements to gather and consider grounds for applying the penalty..., including, but not limited to: Decision-making individual or make-up of the decision making body; ex parte... Process Elements HRSA is seeking comments on the administrative processes that would best administer civil...
Expert Systems: A Conceptual Analysis and Prospects for Their Library Applications.

ERIC Educational Resources Information Center

Dubey, Yogendra P.

This paper begins with a discussion of the decision-making process. The application of operations research technologies to managerial decision-making is noted, and the development of management information systems in organizations and some limitations of these systems are discussed. An overview of the Human Information Processing System (HIPS)…
The Nature of Democratic Decision Making and the Democratic Panacea

ERIC Educational Resources Information Center

Shaw, Robert K.

2011-01-01

"Democracy thrives because it helps individuals identify with the society of which they are members and because it provides for legitimate decision-making and exercise of power." With this statement, the Council of Europe raises for us some fundamental questions: what is the practice of democracy, its merits and its limitations? A…
Medical Decision and Patient's Preference: 'Much Ethics' and More Trust Always Needed

PubMed Central

Anyfantakis, Dimitrios; Symvoulakis, Emmanouil K

2011-01-01

There is much discussion on medical ethics literature regarding the importance of the patients' right for self-determination. We discuss some of the limitations of patient's autonomy with the aim to draw attention to the ethical complexity of medical decision making in the everyday clinical practice. PMID:21647328
Assessment of Competence in Clinical Reasoning and Decision-Making under Uncertainty: The Script Concordance Test Method

ERIC Educational Resources Information Center

Ramaekers, Stephan; Kremer, Wim; Pilot, Albert; van Beukelen, Peter; van Keulen, Hanno

2010-01-01

Real-life, complex problems often require that decisions are made despite limited information or insufficient time to explore all relevant aspects. Incorporating authentic uncertainties into an assessment, however, poses problems in establishing results and analysing their methodological qualities. This study aims at developing a test on clinical…
42 CFR 405.1042 - The administrative record.

Code of Federal Regulations, 2010 CFR

2010-10-01

... making the decision under review, including, but not limited to, claims, medical records, written... evidence. (3) A party may review the record at the hearing, or, if a hearing is not held, at any time before the ALJ's notice of decision is issued. (4) If a request for review is filed or the case is...
Decision-Making and Thought Processes among Poker Players

ERIC Educational Resources Information Center

St. Germain, Joseph; Tenenbaum, Gershon

2011-01-01

This study was aimed at delineating decision-making and thought processing among poker players who vary in skill-level. Forty-five participants, 15 in each group, comprised expert, intermediate, and novice poker players. They completed the Computer Poker Simulation Task (CPST) comprised of 60 hands of No-Limit Texas Hold 'Em. During the CPST, they…
Exploring the Options: Teaching Economic Decision-Making with Poetry

ERIC Educational Resources Information Center

Johnson, Theresa L.

2012-01-01

High-stakes standardized tests in reading and limited instructional time are two powerful disincentives for teaching economics in the elementary classroom. In this article, integrating instruction in poetry and economic decision-making is presented as one way to maximize the use of scarce instructional time. Following a brief introduction to the…
Building an Evidence Base for Speech-Language Services in the Schools: Challenges and Recommendations

ERIC Educational Resources Information Center

Whitmire, Kathleen A.; Rivers, Kenyatta O.; Mele-McCarthy, Joan A.; Staskowski, Maureen

2014-01-01

Speech-language pathologists are faced with demands for evidence to support practice. Federal legislation requires high-quality evidence for decisions regarding school-based services as part of evidence-based practice. The purpose of this article is to discuss the limited scientific evidence for making appropriate decisions about speech-language…
Standardized Tests and Other Criteria in Admissions Decisions: A Classroom Activity

ERIC Educational Resources Information Center

Pawlow, Laura A.

2010-01-01

This exercise aims to provide a hands-on, role-playing activity that requires students to evaluate the strengths and limitations of standardized tests in making admission decisions. Small groups pretend to be an admissions committee and review fictitious student applications containing both standardized test scores and other information admissions…
31 CFR 29.513 - Appeals to the Department.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 29.513 Money and Finance: Treasury Office of the Secretary of the Treasury FEDERAL BENEFIT... reconsideration decision under § 29.512 must be in writing and must state the basis for the appeal. (b) Time... of the reconsideration decision. (2) The Department may extend the time limit for filing when the...
7 CFR 1412.50 - Matters of general applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., including but not limited to, decisions of whether or not to conduct a lottery, lottery selection process... CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS DIRECT AND COUNTER-CYCLICAL... to §§ 11.3 and 780.5 of this title. Additionally, these rules and any decisions of CCC and FSA that...
Applying a gaming approach to IP strategy.

PubMed

Gasnier, Arnaud; Vandamme, Luc

2010-02-01

Adopting an appropriate IP strategy is an important but complex area, particularly in the pharmaceutical and biotechnology sectors, in which aspects such as regulatory submissions, high competitive activity, and public health and safety information requirements limit the amount of information that can be protected effectively through secrecy. As a result, and considering the existing time limits for patent protection, decisions on how to approach IP in these sectors must be made with knowledge of the options and consequences of IP positioning. Because of the specialized nature of IP, it is necessary to impart knowledge regarding the options and impact of IP to decision-makers, whether at the level of inventors, marketers or strategic business managers. This feature review provides some insight on IP strategy, with a focus on the use of a new 'gaming' approach for transferring the skills and understanding needed to make informed IP-related decisions; the game Patentopolis is discussed as an example of such an approach. Patentopolis involves interactive activities with IP-related business decisions, including the exploitation and enforcement of IP rights, and can be used to gain knowledge on the impact of adopting different IP strategies.
Lost in search: (Mal-)adaptation to probabilistic decision environments in children and adults.

PubMed

Betsch, Tilmann; Lehmann, Anne; Lindow, Stefanie; Lang, Anna; Schoemann, Martin

2016-02-01

Adaptive decision making in probabilistic environments requires individuals to use probabilities as weights in predecisional information searches and/or when making subsequent choices. Within a child-friendly computerized environment (Mousekids), we tracked 205 children's (105 children 5-6 years of age and 100 children 9-10 years of age) and 103 adults' (age range: 21-22 years) search behaviors and decisions under different probability dispersions (.17; .33, .83 vs. .50, .67, .83) and constraint conditions (instructions to limit search: yes vs. no). All age groups limited their depth of search when instructed to do so and when probability dispersion was high (range: .17-.83). Unlike adults, children failed to use probabilities as weights for their searches, which were largely not systematic. When examining choices, however, elementary school children (unlike preschoolers) systematically used probabilities as weights in their decisions. This suggests that an intuitive understanding of probabilities and the capacity to use them as weights during integration is not a sufficient condition for applying simple selective search strategies that place one's focus on weight distributions. PsycINFO Database Record (c) 2016 APA, all rights reserved.
Factors Influencing Abortion Decision-Making Processes among Young Women

PubMed Central

Frederico, Mónica; Michielsen, Kristien; Decat, Peter

2018-01-01

Background: Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. Objective: The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women. Methods: A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. Results: The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Conclusions: Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique. PMID:29438335
What To Do, What To Do? Determining a Course of Action at the Operational Level of War

DTIC Science & Technology

1992-05-18

and making choices can expand the limits of human rationality . 5 Where decisions involve the lives of soldiers and the future of nations, any edge or...ANALYSIS 15. N5Iu,,3E•a -r PAGES115 OPERATIONAL DECISION - MAKING MISSION ANALYSIS 115 COURSE OF ACTION SELECTION STAFF ESTIMATES I1. SECUlPIT... decision - making procedures for the operational level of war. These doctrinal procedures are found in emerging joint doctrine. For these procedures to be
General Formalism of Decision Making Based on Theory of Open Quantum Systems

NASA Astrophysics Data System (ADS)

Asano, M.; Ohya, M.; Basieva, I.; Khrennikov, A.

2013-01-01

We present the general formalism of decision making which is based on the theory of open quantum systems. A person (decision maker), say Alice, is considered as a quantum-like system, i.e., a system which information processing follows the laws of quantum information theory. To make decision, Alice interacts with a huge mental bath. Depending on context of decision making this bath can include her social environment, mass media (TV, newspapers, INTERNET), and memory. Dynamics of an ensemble of such Alices is described by Gorini-Kossakowski-Sudarshan-Lindblad (GKSL) equation. We speculate that in the processes of evolution biosystems (especially human beings) designed such "mental Hamiltonians" and GKSL-operators that any solution of the corresponding GKSL-equation stabilizes to a diagonal density operator (In the basis of decision making.) This limiting density operator describes population in which all superpositions of possible decisions has already been resolved. In principle, this approach can be used for the prediction of the distribution of possible decisions in human populations.
Dynamics of individual perceptual decisions

PubMed Central

Clark, Torin K.; Lu, Yue M.; Karmali, Faisal

2015-01-01

Perceptual decision making is fundamental to a broad range of fields including neurophysiology, economics, medicine, advertising, law, etc. Although recent findings have yielded major advances in our understanding of perceptual decision making, decision making as a function of time and frequency (i.e., decision-making dynamics) is not well understood. To limit the review length, we focus most of this review on human findings. Animal findings, which are extensively reviewed elsewhere, are included when beneficial or necessary. We attempt to put these various findings and data sets, which can appear to be unrelated in the absence of a formal dynamic analysis, into context using published models. Specifically, by adding appropriate dynamic mechanisms (e.g., high-pass filters) to existing models, it appears that a number of otherwise seemingly disparate findings from the literature might be explained. One hypothesis that arises through this dynamic analysis is that decision making includes phasic (high pass) neural mechanisms, an evidence accumulator and/or some sort of midtrial decision-making mechanism (e.g., peak detector and/or decision boundary). PMID:26467513
The relationship between work complexity and nurses' participation in decision making in hospitals.

PubMed

Bacon, Cynthia Thornton; Lee, Shoou-Yih Daniel; Mark, Barbara

2015-04-01

The aim of this study is to examine the relationship between work complexity and nurses' participation in decision making in hospital nursing units. Increasing nurses' participation in decision making has been used as a way to manage work complexity; however, the work of nurses in acute care hospitals has become highly complex, and strategies used to manage this complexity have not been fully explored. The relationship between work complexity and nurse participation in decision making was examined using data from the Outcomes Research in Nursing Administration project. The sample included 3,718 RNs in 278 medical-surgical units in 143 hospitals. When work complexity increased, nurses' participation in decision making decreased. When nurses have limited input into decision making, the information available to the care team may be incomplete. Barriers to nurses' participation in decision making should be explored and interventions developed so that nurses may be full participants in decision making affecting both patients and the work environment.

Aiding Lay Decision Making Using a Cognitive Competencies Approach.

PubMed

Maule, A J; Maule, Simon

2015-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions.
Conceptual framework of knowledge management for ethical decision-making support in neonatal intensive care.

PubMed

Frize, Monique; Yang, Lan; Walker, Robin C; O'Connor, Annette M

2005-06-01

This research is built on the belief that artificial intelligence estimations need to be integrated into clinical social context to create value for health-care decisions. In sophisticated neonatal intensive care units (NICUs), decisions to continue or discontinue aggressive treatment are an integral part of clinical practice. High-quality evidence supports clinical decision-making, and a decision-aid tool based on specific outcome information for individual NICU patients will provide significant support for parents and caregivers in making difficult "ethical" treatment decisions. In our approach, information on a newborn patient's likely outcomes is integrated with the physician's interpretation and parents' perspectives into codified knowledge. Context-sensitive content adaptation delivers personalized and customized information to a variety of users, from physicians to parents. The system provides structuralized knowledge translation and exchange between all participants in the decision, facilitating collaborative decision-making that involves parents at every stage on whether to initiate, continue, limit, or terminate intensive care for their infant.
Aiding Lay Decision Making Using a Cognitive Competencies Approach

PubMed Central

Maule, A. J.; Maule, Simon

2016-01-01

Two prescriptive approaches have evolved to aid human decision making: just in time interventions that provide support as a decision is being made; and just in case interventions that educate people about future events that they may encounter so that they are better prepared to make an informed decision when these events occur. We review research on these two approaches developed in the context of supporting everyday decisions such as choosing an apartment, a financial product or a medical procedure. We argue that the lack of an underlying prescriptive theory has limited the development and evaluation of these interventions. We draw on recent descriptive research on the cognitive competencies that underpin human decision making to suggest new ways of interpreting how and why existing decision aids may be effective and suggest a different way of evaluating their effectiveness. We also briefly outline how our approach has the potential to develop new interventions to support everyday decision making and highlight the benefits of drawing on descriptive research when developing and evaluating interventions. PMID:26779052
Adolescent psychological development, parenting styles, and pediatric decision making.

PubMed

Partridge, Brian C

2010-10-01

The United Nations Convention on the Rights of the Child risks harm to adolescents insofar as it encourages not only poor decision making by adolescents but also parenting styles that will have an adverse impact on the development of mature decision-making capacities in them. The empirical psychological and neurophysiological data weigh against augmenting and expression of the rights of children. Indeed, the data suggest grounds for expanding parental authority, not limiting its scope. At the very least, any adequate appreciation of the moral claims regarding the authority of parents with respect to the decision-making capacity of adolescents needs to be set within an understanding of the psychological and neurophysiological facts regarding the development of adolescent decision-making capacity.
Do humans make good decisions?

PubMed Central

Summerfield, Christopher; Tsetsos, Konstantinos

2014-01-01

Human performance on perceptual classification tasks approaches that of an ideal observer, but economic decisions are often inconsistent and intransitive, with preferences reversing according to the local context. We discuss the view that suboptimal choices may result from the efficient coding of decision-relevant information, a strategy that allows expected inputs to be processed with higher gain than unexpected inputs. Efficient coding leads to ‘robust’ decisions that depart from optimality but maximise the information transmitted by a limited-capacity system in a rapidly-changing world. We review recent work showing that when perceptual environments are variable or volatile, perceptual decisions exhibit the same suboptimal context-dependence as economic choices, and propose a general computational framework that accounts for findings across the two domains. PMID:25488076
Making business decisions using trend information

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

Prevette, S.S., Westinghouse Hanford, Richland, WA

1997-11-24

Performance Measures, and the trend information that results from their analyses, can help managers in their decision making process. The business decisions that are to be discussed are: Assignment of limited Resources, Funding, Budget; Contractor Rewards/Incentives; Where to focus Process Improvement, Reengineering efforts; When to ask ``What Happened?!!``; Determine if a previous decision was effectively implemented. Trending can provide an input for rational Business Decisions. Key Element is determination of whether or not a significant trend exists - segregating Common Cause from Special Cause. The Control Chart is the tool for accomplishment of trending and determining if you are meetingmore » your Business Objectives. Eliminate Numerical Targets; the goal is Significant Improvement. Profound Knowledge requires integrating data results with gut feeling.« less
Freight transportation : strategies needed to address planning and financing limitations

DOT National Transportation Integrated Search

2003-12-01

The General Accounting Office (GAO) was asked to address (1) the challenges to freight mobility, (2) the limitations key stakeholders have encountered in addressing these challenges, and (3) strategies that may aid decision makers in enhancing freigh...
A Multi-layer Dynamic Model for Coordination Based Group Decision Making in Water Resource Allocation and Scheduling

NASA Astrophysics Data System (ADS)

Huang, Wei; Zhang, Xingnan; Li, Chenming; Wang, Jianying

Management of group decision-making is an important issue in water source management development. In order to overcome the defects in lacking of effective communication and cooperation in the existing decision-making models, this paper proposes a multi-layer dynamic model for coordination in water resource allocation and scheduling based group decision making. By introducing the scheme-recognized cooperative satisfaction index and scheme-adjusted rationality index, the proposed model can solve the problem of poor convergence of multi-round decision-making process in water resource allocation and scheduling. Furthermore, the problem about coordination of limited resources-based group decision-making process can be solved based on the effectiveness of distance-based group of conflict resolution. The simulation results show that the proposed model has better convergence than the existing models.
A Decision Fusion Framework for Treatment Recommendation Systems.

PubMed

Mei, Jing; Liu, Haifeng; Li, Xiang; Xie, Guotong; Yu, Yiqin

2015-01-01

Treatment recommendation is a nontrivial task--it requires not only domain knowledge from evidence-based medicine, but also data insights from descriptive, predictive and prescriptive analysis. A single treatment recommendation system is usually trained or modeled with a limited (size or quality) source. This paper proposes a decision fusion framework, combining both knowledge-driven and data-driven decision engines for treatment recommendation. End users (e.g. using the clinician workstation or mobile apps) could have a comprehensive view of various engines' opinions, as well as the final decision after fusion. For implementation, we leverage several well-known fusion algorithms, such as decision templates and meta classifiers (of logistic and SVM, etc.). Using an outcome-driven evaluation metric, we compare the fusion engine with base engines, and our experimental results show that decision fusion is a promising way towards a more valuable treatment recommendation.
Decision theory, motor planning, and visual memory: deciding where to reach when memory errors are costly.

PubMed

Lerch, Rachel A; Sims, Chris R

2016-06-01

Limitations in visual working memory (VWM) have been extensively studied in psychophysical tasks, but not well understood in terms of how these memory limits translate to performance in more natural domains. For example, in reaching to grasp an object based on a spatial memory representation, overshooting the intended target may be more costly than undershooting, such as when reaching for a cup of hot coffee. The current body of literature lacks a detailed account of how the costs or consequences of memory error influence what we encode in visual memory and how we act on the basis of remembered information. Here, we study how externally imposed monetary costs influence behavior in a motor decision task that involves reach planning based on recalled information from VWM. We approach this from a decision theoretic perspective, viewing decisions of where to aim in relation to the utility of their outcomes given the uncertainty of memory representations. Our results indicate that subjects accounted for the uncertainty in their visual memory, showing a significant difference in their reach planning when monetary costs were imposed for memory errors. However, our findings indicate that subjects memory representations per se were not biased by the imposed costs, but rather subjects adopted a near-optimal post-mnemonic decision strategy in their motor planning.
CDC Grand Rounds: Modeling and Public Health Decision-Making.

PubMed

Fischer, Leah S; Santibanez, Scott; Hatchett, Richard J; Jernigan, Daniel B; Meyers, Lauren Ancel; Thorpe, Phoebe G; Meltzer, Martin I

2016-12-09

Mathematical models incorporate various data sources and advanced computational techniques to portray real-world disease transmission and translate the basic science of infectious diseases into decision-support tools for public health. Unlike standard epidemiologic methods that rely on complete data, modeling is needed when there are gaps in data. By combining diverse data sources, models can fill gaps when critical decisions must be made using incomplete or limited information. They can be used to assess the effect and feasibility of different scenarios and provide insight into the emergence, spread, and control of disease. During the past decade, models have been used to predict the likelihood and magnitude of infectious disease outbreaks, inform emergency response activities in real time (1), and develop plans and preparedness strategies for future events, the latter of which proved invaluable during outbreaks such as severe acute respiratory syndrome and pandemic influenza (2-6). Ideally, modeling is a multistep process that involves communication between modelers and decision-makers, allowing them to gain a mutual understanding of the problem to be addressed, the type of estimates that can be reliably generated, and the limitations of the data. As models become more detailed and relevant to real-time threats, the importance of modeling in public health decision-making continues to grow.
What is known about parents' treatment decisions? A narrative review of pediatric decision making.

PubMed

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

2012-01-01

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

PubMed

Rocca, Corinne H; Kimport, Katrina; Roberts, Sarah C M; Gould, Heather; Neuhaus, John; Foster, Diana G

2015-01-01

Arguments that abortion causes women emotional harm are used to regulate abortion, particularly later procedures, in the United States. However, existing research is inconclusive. We examined women's emotions and reports of whether the abortion decision was the right one for them over the three years after having an induced abortion. We recruited a cohort of women seeking abortions between 2008-2010 at 30 facilities across the United States, selected based on having the latest gestational age limit within 150 miles. Two groups of women (n=667) were followed prospectively for three years: women having first-trimester procedures and women terminating pregnancies within two weeks under facilities' gestational age limits at the same facilities. Participants completed semiannual phone surveys to assess whether they felt that having the abortion was the right decision for them; negative emotions (regret, anger, guilt, sadness) about the abortion; and positive emotions (relief, happiness). Multivariable mixed-effects models were used to examine changes in each outcome over time, to compare the two groups, and to identify associated factors. The predicted probability of reporting that abortion was the right decision was over 99% at all time points over three years. Women with more planned pregnancies and who had more difficulty deciding to terminate the pregnancy had lower odds of reporting the abortion was the right decision (aOR=0.71 [0.60, 0.85] and 0.46 [0.36, 0.64], respectively). Both negative and positive emotions declined over time, with no differences between women having procedures near gestational age limits versus first-trimester abortions. Higher perceived community abortion stigma and lower social support were associated with more negative emotions (b=0.45 [0.31, 0.58] and b=-0.61 [-0.93, -0.29], respectively). Women experienced decreasing emotional intensity over time, and the overwhelming majority of women felt that termination was the right decision for them over three years. Emotional support may be beneficial for women having abortions who report intended pregnancies or difficulty deciding.
Setting priorities in the health care sector - the case of oral anticoagulants in nonvalvular atrial fibrillation in Denmark.

PubMed

Poulsen, Peter Bo; Johnsen, Søren Paaske; Hansen, Morten Lock; Brandes, Axel; Husted, Steen; Harboe, Louise; Dybro, Lars

2017-01-01

Resources devoted to health care are limited, therefore setting priorities is required. It differs between countries whether decision-making concerning health care technologies focus on broad economic perspectives or whether focus is narrow on single budgets ("silo mentality"). The cost perspective as one part of the full health economic analysis is important for decision-making. With the case of oral anticoagulants in patients with nonvalvular atrial fibrillation (NVAF), the aim is to discuss the implication of the use of different cost perspectives for decision-making and priority setting. In a cost analysis, the annual average total costs of five oral anticoagulants (warfarin and non-vitamin K oral anticoagulants [NOACs; dabigatran, rivaroxaban, apixaban, and edoxaban]) used in daily clinical practice in Denmark for the prevention of stroke in NVAF patients are analyzed. This is done in pairwise comparisons between warfarin and each NOAC based on five potential cost perspectives, from a "drug cost only" perspective up to a "societal" perspective. All comparisons of warfarin and NOACs show that the cost perspective based on all relevant costs, ie, total costs perspective, is essential for the choice of therapy. Focusing on the reimbursement costs of the drugs only, warfarin is the least costly option. However, with the aim of therapy to prevent strokes and limit bleedings, including the economic impact of this, all NOACs, except rivaroxaban, result in slightly lower health care costs compared with warfarin. The same picture was found applying the societal perspective. Many broad cost-effectiveness analyses of NOACs exist. However, in countries with budget focus in decision-making this information does not apply. The present study's case of oral anticoagulants has shown that decision-making should be based on health care or societal cost perspectives for optimal use of limited resources. Otherwise, the risk is that suboptimal decisions will be likely.
Self-Directed Cooperative Planetary Rovers

NASA Technical Reports Server (NTRS)

Zilberstein, Shlomo; Morris, Robert (Technical Monitor)

2003-01-01

The project is concerned with the development of decision-theoretic techniques to optimize the scientific return of planetary rovers. Planetary rovers are small unmanned vehicles equipped with cameras and a variety of sensors used for scientific experiments. They must operate under tight constraints over such resources as operation time, power, storage capacity, and communication bandwidth. Moreover, the limited computational resources of the rover limit the complexity of on-line planning and scheduling. We have developed a comprehensive solution to this problem that involves high-level tools to describe a mission; a compiler that maps a mission description and additional probabilistic models of the components of the rover into a Markov decision problem; and algorithms for solving the rover control problem that are sensitive to the limited computational resources and high-level of uncertainty in this domain.
Mining Deployment Optimization

NASA Astrophysics Data System (ADS)

Čech, Jozef

2016-09-01

The deployment problem, researched primarily in the military sector, is emerging in some other industries, mining included. The principal decision is how to deploy some activities in space and time to achieve desired outcome while complying with certain requirements or limits. Requirements and limits are on the side constraints, while minimizing costs or maximizing some benefits are on the side of objectives. A model with application to mining of polymetallic deposit is presented. To obtain quick and immediate decision solutions for a mining engineer with experimental possibilities is the main intention of a computer-based tool. The task is to determine strategic deployment of mining activities on a deposit, meeting planned output from the mine and at the same time complying with limited reserves and haulage capacities. Priorities and benefits can be formulated by the planner.
Neural Basis of Strategic Decision Making

PubMed Central

Lee, Daeyeol; Seo, Hyojung

2015-01-01

Human choice behaviors during social interactions often deviate from the predictions of game theory. This might arise partly from the limitations in cognitive abilities necessary for recursive reasoning about the behaviors of others. In addition, during iterative social interactions, choices might change dynamically, as knowledge about the intentions of others and estimates for choice outcomes are incrementally updated via reinforcement learning. Some of the brain circuits utilized during social decision making might be general-purpose and contribute to isomorphic individual and social decision making. By contrast, regions in the medial prefrontal cortex and temporal parietal junction might be recruited for cognitive processes unique to social decision making. PMID:26688301
Surrogates and extra-familial interests.

PubMed

Baergen, Ralph; Woodhouse, William

2013-01-01

A case is presented in which the therapeutic interests of the patient conflict with the safety of a community, and in which the surrogate decision maker has very limited knowledge of or concern for the patient's preferences. The substituted judgment and best interest (or rational patient) standards for surrogate decision making are problematic in this case. It is argued that the interests of even those outside the family ought to be taken seriously when making decisions about such cases, and it is proposed that clinical ethics committees could play a new role here. This case also illustrates the difficulties of making decisions regarding the treatment of a very unlikable patient.
End-of-Life Care Decisions: Importance of Reviewing Systems and Limitations After 2 Recent North American Cases

PubMed Central

Burkle, Christopher M.; Benson, Jeffre J.

2012-01-01

Two recent and unfortunate North American cases involving end-of-life treatment highlight the difficulties surrounding medical futility conflicts. As countries have explored the greater influence that patients and their representatives may play on end-of-life treatment decisions, the benefits and struggles involved with such a movement must be appreciated. These 2 cases are used to examine the present systems existing in the United States and Canada for resolving end-of-life decisions, including the difficulty in defining medical futility, the role of medical ethics committees, and controversies involving surrogate decision making. PMID:23127734
Illuminating hospital discharge planning: staff nurse decision making.

PubMed

Rhudy, Lori M; Holland, Diane E; Bowles, Kathryn H

2010-11-01

This qualitative study proposed to examine staff RN's decision making related to discharge planning and perceptions of their role. Themes resulting from interviews were "following the script" and "RN as coordinator." The decision to consult a discharge planner occurred when the patient's situation did not follow the RN's expectations. Discharge planning for nonroutine situations was considered disruptive to the RN's workflow. The RN's role was limited to oversight when a discharge planner was involved. Understanding RNs' decision making in this key process provides valuable insights into differentiating routine from nonroutine patient situations and deploying appropriate resources in a timely fashion. Copyright © 2010 Elsevier Inc. All rights reserved.

From policy to patients and back: surgical treatment decision making for patients with breast cancer.

PubMed

Katz, Steven J; Hawley, Sarah T

2007-01-01

Persistent use of mastectomy for breast cancer has motivated concerns about overtreatment by surgeons and lack of patient involvement in decisions. However, recent studies suggest that patients perceive substantial involvement and that some patients prefer more invasive surgery, while other research suggests that surgical treatment choices might be poorly informed. Decision-making quality can be improved by increasing patients' knowledge about treatments' risks and benefits and by optimizing their involvement. The mastectomy story underscores the limitations of utilization measures as quality indicators. Strategies to improve patient outcomes should focus on tools to improve the quality of decision making and innovations in multispecialty practice.
What Factors are Associated with Consumer Initiation of Shared Decision Making in Mental Health Visits?

PubMed Central

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

2016-01-01

Understanding consumer initiation of shared decision making (SDM) is critical to improving SDM in mental health consultations, particularly because providers do not always invite consumer participation in treatment decisions. This study examined the association between consumer initiation of nine elements of SDM as measured by the SDM scale, and measures of consumer illness self-management and the consumer-provider relationship. In 63 mental health visits, three SDM elements were associated with self-management or relationship factors: discussion of consumer goals, treatment alternatives, and pros and cons of a decision. Limitations, implications, and future directions are discussed. PMID:26427999
Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making.

PubMed

Adams, Robyn; Jones, Anne; Lefmann, Sophie; Sheppard, Lorraine

2015-03-27

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required. A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities. Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision. The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.
Palliative Medicine and Decision Science: The Critical Need for a Shared Agenda To Foster Informed Patient Choice in Serious Illness

PubMed Central

Kryworuchko, Jennifer; Matlock, Dan D.; Volandes, Angelo E.

2011-01-01

Abstract Assisting patients and their families in complex decision making is a foundational skill in palliative care; however, palliative care clinicians and scientists have just begun to establish an evidence base for best practice in assisting patients and families in complex decision making. Decision scientists aim to understand and clarify the concepts and techniques of shared decision making (SDM), decision support, and informed patient choice in order to ensure that patient and family perspectives shape their health care experience. Patients with serious illness and their families are faced with myriad complex decisions over the course of illness and as death approaches. If patients lose capacity, then surrogate decision makers are cast into the decision-making role. The fields of palliative care and decision science have grown in parallel. There is much to be gained in advancing the practices of complex decision making in serious illness through increased collaboration. The purpose of this article is to use a case study to highlight the broad range of difficult decisions, issues, and opportunities imposed by a life-limiting illness in order to illustrate how collaboration and a joint research agenda between palliative care and decision science researchers, theorists, and clinicians might guide best practices for patients and their families. PMID:21895453
Economic Evaluation of Environmental Health Interventions to Support Decision Making

PubMed Central

Hutton, Guy

2008-01-01

Environmental burden of disease represents one quarter of overall disease burden, hence necessitating greater attention from decision makers both inside and outside the health sector. Economic evaluation techniques such as cost-effectiveness analysis and cost-benefit analysis provide key information to health decision makers on the efficiency of environmental health interventions, assisting them in choosing interventions which give the greatest social return on limited public budgets and private resources. The aim of this article is to review economic evaluation studies in three environmental health areas—water, sanitation, hygiene (WSH), vector control, and air pollution—and to critically examine the policy relevance and scientific quality of the studies for selecting and funding public programmers. A keyword search of Medline from 1990–2008 revealed 32 studies, and gathering of articles from other sources revealed a further 18 studies, giving a total of 50 economic evaluation studies (13 WSH interventions, 16 vector control and 21 air pollution). Overall, the economic evidence base on environmental health interventions remains relatively weak—too few studies per intervention, of variable scientific quality and from diverse locations which limits generalisability of findings. Importantly, there still exists a disconnect between economic research, decision making and programmer implementation. This can be explained by the lack of translation of research findings into accessible documentation for policy makers and limited relevance of research findings, and the often low importance of economic evidence in budgeting decisions. These findings underline the importance of involving policy makers in the defining of research agendas and commissioning of research, and improving the awareness of researchers of the policy environment into which their research feeds. PMID:21572840
Limitations to the Use of Species-Distribution Models for Environmental-Impact Assessments in the Amazon.

PubMed

Carneiro, Lorena Ribeiro de A; Lima, Albertina P; Machado, Ricardo B; Magnusson, William E

2016-01-01

Species-distribution models (SDM) are tools with potential to inform environmental-impact studies (EIA). However, they are not always appropriate and may result in improper and expensive mitigation and compensation if their limitations are not understood by decision makers. Here, we examine the use of SDM for frogs that were used in impact assessment using data obtained from the EIA of a hydroelectric project located in the Amazon Basin in Brazil. The results show that lack of knowledge of species distributions limits the appropriate use of SDM in the Amazon region for most target species. Because most of these targets are newly described and their distributions poorly known, data about their distributions are insufficient to be effectively used in SDM. Surveys that are mandatory for the EIA are often conducted only near the area under assessment, and so models must extrapolate well beyond the sampled area to inform decisions made at much larger spatial scales, such as defining areas to be used to offset the negative effects of the projects. Using distributions of better-known species in simulations, we show that geographical-extrapolations based on limited information of species ranges often lead to spurious results. We conclude that the use of SDM as evidence to support project-licensing decisions in the Amazon requires much greater area sampling for impact studies, or, alternatively, integrated and comparative survey strategies, to improve biodiversity sampling. When more detailed distribution information is unavailable, SDM will produce results that generate uncertain and untestable decisions regarding impact assessment. In many cases, SDM is unlikely to be better than the use of expert opinion.
A structured review of spinal stiffness as a kinesiological outcome of manipulation: its measurement and utility in diagnosis, prognosis and treatment decision-making.

PubMed

Snodgrass, Suzanne J; Haskins, Robin; Rivett, Darren A

2012-10-01

To review and discuss the methods used for measuring spinal stiffness and factors associated with stiffness, how stiffness is used in diagnosis, prognosis, and treatment decision-making and the effects of manipulative techniques on stiffness. A systematic search of MEDLINE, EMBASE, CINAHL, AMED and ICL databases was conducted. Included studies addressed one of four constructs related to stiffness: measurement, diagnosis, prognosis and/or treatment decision-making, and the effects of manipulation on stiffness. Spinal stiffness was defined as the relationship between force and displacement. One hundred and four studies are discussed in this review, with the majority of studies focused on the measurement of stiffness, most often in asymptomatic persons. Eight studies investigated spinal stiffness in diagnosis, providing limited evidence that practitioner-judged stiffness is associated with radiographic findings of sagittal rotational mobility. Fifteen studies investigated spinal stiffness in prognosis or treatment decision-making, providing limited evidence that spinal stiffness is unlikely to independently predict patient outcomes, though stiffness may influence a practitioner's application of non-thrust manipulative techniques. Nine studies investigating the effects of manipulative techniques on spinal stiffness provide very limited evidence that there is no change in spinal stiffness following thrust or non-thrust manipulation in asymptomatic individuals and non-thrust techniques in symptomatic persons, with only one study supporting an immediate, but not sustained, stiffness decrease following thrust manipulation in symptomatic individuals. The existing limited evidence does not support an association between spinal stiffness and manipulative treatment outcomes. There is a need for additional research investigating the effects of manipulation on spinal stiffness in persons with spinal pain. Copyright © 2012 Elsevier Ltd. All rights reserved.
Limitations to the Use of Species-Distribution Models for Environmental-Impact Assessments in the Amazon

PubMed Central

Carneiro, Lorena Ribeiro de A.; Lima, Albertina P.; Machado, Ricardo B.; Magnusson, William E.

2016-01-01

Species-distribution models (SDM) are tools with potential to inform environmental-impact studies (EIA). However, they are not always appropriate and may result in improper and expensive mitigation and compensation if their limitations are not understood by decision makers. Here, we examine the use of SDM for frogs that were used in impact assessment using data obtained from the EIA of a hydroelectric project located in the Amazon Basin in Brazil. The results show that lack of knowledge of species distributions limits the appropriate use of SDM in the Amazon region for most target species. Because most of these targets are newly described and their distributions poorly known, data about their distributions are insufficient to be effectively used in SDM. Surveys that are mandatory for the EIA are often conducted only near the area under assessment, and so models must extrapolate well beyond the sampled area to inform decisions made at much larger spatial scales, such as defining areas to be used to offset the negative effects of the projects. Using distributions of better-known species in simulations, we show that geographical-extrapolations based on limited information of species ranges often lead to spurious results. We conclude that the use of SDM as evidence to support project-licensing decisions in the Amazon requires much greater area sampling for impact studies, or, alternatively, integrated and comparative survey strategies, to improve biodiversity sampling. When more detailed distribution information is unavailable, SDM will produce results that generate uncertain and untestable decisions regarding impact assessment. In many cases, SDM is unlikely to be better than the use of expert opinion. PMID:26784891
Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis

PubMed Central

Montez-Rath, Maria E.; Hall, Yoshio N.; Katz, Ronit; O’Hare, Ann M.

2017-01-01

Background and objectives Little is known about the relation between the content of advance directives and downstream treatment decisions among patients receiving maintenance dialysis. In this study, we determined the prevalence of advance directives specifying treatment limitations and/or surrogate decision-makers in the last year of life and their association with end-of-life care among nursing home residents. Design, setting, participants, & measurements Using national data from 2006 to 2007, we compared the content of advance directives among 30,716 nursing home residents receiving dialysis to 30,825 nursing home residents with other serious illnesses during the year before death. Among patients receiving dialysis, we linked the content of advance directives to Medicare claims to ascertain site of death and treatment intensity in the last month of life. Results In the last year of life, 36% of nursing home residents receiving dialysis had a treatment-limiting directive, 22% had a surrogate decision-maker, and 13% had both in adjusted analyses. These estimates were 13%–27%, 5%–11%, and 6%–13% lower, respectively, than for decedents with other serious illnesses. For patients receiving dialysis who had both a treatment-limiting directive and surrogate decision-maker, the adjusted frequency of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13%, and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients receiving dialysis lacking both components. Conclusions Among nursing home residents receiving dialysis, treatment-limiting directives and surrogates were associated with fewer intensive interventions and inpatient deaths, but were in place much less often than for nursing home residents with other serious illnesses. PMID:28057703
Using measurement uncertainty in decision-making and conformity assessment

NASA Astrophysics Data System (ADS)

Pendrill, L. R.

2014-08-01

Measurements often provide an objective basis for making decisions, perhaps when assessing whether a product conforms to requirements or whether one set of measurements differs significantly from another. There is increasing appreciation of the need to account for the role of measurement uncertainty when making decisions, so that a ‘fit-for-purpose’ level of measurement effort can be set prior to performing a given task. Better mutual understanding between the metrologist and those ordering such tasks about the significance and limitations of the measurements when making decisions of conformance will be especially useful. Decisions of conformity are, however, currently made in many important application areas, such as when addressing the grand challenges (energy, health, etc), without a clear and harmonized basis for sharing the risks that arise from measurement uncertainty between the consumer, supplier and third parties. In reviewing, in this paper, the state of the art of the use of uncertainty evaluation in conformity assessment and decision-making, two aspects in particular—the handling of qualitative observations and of impact—are considered key to bringing more order to the present diverse rules of thumb of more or less arbitrary limits on measurement uncertainty and percentage risk in the field. (i) Decisions of conformity can be made on a more or less quantitative basis—referred in statistical acceptance sampling as by ‘variable’ or by ‘attribute’ (i.e. go/no-go decisions)—depending on the resources available or indeed whether a full quantitative judgment is needed or not. There is, therefore, an intimate relation between decision-making, relating objects to each other in terms of comparative or merely qualitative concepts, and nominal and ordinal properties. (ii) Adding measures of impact, such as the costs of incorrect decisions, can give more objective and more readily appreciated bases for decisions for all parties concerned. Such costs are associated with a variety of consequences, such as unnecessary re-manufacturing by the supplier as well as various consequences for the customer, arising from incorrect measures of quantity, poor product performance and so on.
Decision making and cancer.

PubMed

Reyna, Valerie F; Nelson, Wendy L; Han, Paul K; Pignone, Michael P

2015-01-01

We review decision making along the cancer continuum in the contemporary context of informed and shared decision making in which patients are encouraged to take a more active role in their health care. We discuss challenges to achieving informed and shared decision making, including cognitive limitations and emotional factors, but argue that understanding the mechanisms of decision making offers hope for improving decision support. Theoretical approaches to decision making that explain cognition, emotion, and their interaction are described, including classical psychophysical approaches, dual-process approaches that focus on conflicts between emotion versus cognition (or reason), and modern integrative approaches such as fuzzy-trace theory. In contrast to the earlier emphasis on rote use of numerical detail, modern approaches emphasize understanding the bottom-line gist of options (which encompasses emotion and other influences on meaning) and retrieving relevant social and moral values to apply to those gist representations. Finally, research on interventions to support better decision making in clinical settings is reviewed, drawing out implications for future research on decision making and cancer. PsycINFO Database Record (c) 2015 APA, all rights reserved.
National malaria vector control policy: an analysis of the decision to scale-up larviciding in Nigeria.

PubMed

Tesfazghi, Kemi; Hill, Jenny; Jones, Caroline; Ranson, Hilary; Worrall, Eve

2016-02-01

New vector control tools are needed to combat insecticide resistance and reduce malaria transmission. The World Health Organization (WHO) endorses larviciding as a supplementary vector control intervention using larvicides recommended by the WHO Pesticides Evaluation Scheme (WHOPES). The decision to scale-up larviciding in Nigeria provided an opportunity to investigate the factors influencing policy adoption and assess the role that actors and evidence play in the policymaking process, in order to draw lessons that help accelerate the uptake of new methods for vector control. A retrospective policy analysis was carried out using in-depth interviews with national level policy stakeholders to establish normative national vector control policy or strategy decision-making processes and compare these with the process that led to the decision to scale-up larviciding. The interviews were transcribed, then coded and analyzed using NVivo10. Data were coded according to pre-defined themes from an analytical policy framework developed a priori. Stakeholders reported that the larviciding decision-making process deviated from the normative vector control decision-making process. National malaria policy is normally strongly influenced by WHO recommendations, but the potential of larviciding to contribute to national economic development objectives through larvicide production in Nigeria was cited as a key factor shaping the decision. The larviciding decision involved a restricted range of policy actors, and notably excluded actors that usually play advisory, consultative and evidence generation roles. Powerful actors limited the access of some actors to the policy processes and content. This may have limited the influence of scientific evidence in this policy decision. This study demonstrates that national vector control policy change can be facilitated by linking malaria control objectives to wider socioeconomic considerations and through engaging powerful policy champions to drive policy change and thereby accelerate access to new vector control tools. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
Limits to relational autonomy--the Singaporean experience.

PubMed

Krishna, Lalit Kumar Radha; Watkinson, Deborah S; Beng, Ng Lee

2015-05-01

Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered "content neutral" not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and "operationalize" the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore. © The Author(s) 2014.
Prognostic categories and timing of negative prognostic communication from critical care physicians to family members at end-of-life in an intensive care unit.

PubMed

Gutierrez, Karen M

2013-09-01

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

PubMed

Kamara, Daniella; Weil, Jon; Youngblom, Janey; Guerra, Claudia; Joseph, Galen

2018-02-01

In cancer genetic counseling (CGC), communication across language and culture challenges the model of practice based on shared decision-making. To date, little research has examined the decision-making process of low-income, limited English proficiency (LEP) patients in CGC. This study identified communication patterns in CGC sessions with this population and assessed how these patterns facilitate or inhibit the decision-making process during the sessions. We analyzed 24 audio recordings of CGC sessions conducted in Spanish via telephone interpreters at two public hospitals. Patients were referred for risk of hereditary breast and ovarian cancer; all were offered genetic testing. Audio files were coded by two bilingual English-Spanish researchers and analyzed using conventional content analysis through an iterative process. The 24 sessions included 13 patients, 6 counselors, and 18 interpreters. Qualitative data analyses identified three key domains - Challenges Posed by Hypothetical Explanations, Misinterpretation by the Medical Interpreter, and Communication Facilitators - that reflect communication patterns and their impact on the counselor's ability to facilitate shared decision-making. Overall, we found an absence of patient participation in the decision-making process. Our data suggest that when counseling LEP Latina patients via medical interpreter, prioritizing information with direct utility for the patient and organizing information into short- and long-term goals may reduce information overload and improve comprehension for patient and interpreter. Further research is needed to test the proposed counseling strategies with this population and to assess how applicable our findings are to other populations.
29 CFR 500.269 - Stay pending decision of the Secretary.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The... Judge, pursuant to § 500.264, does not stop the running of the thirty-day time limit in which respondent... of Intent, the Secretary will seek a stay of proceedings in the Court until such time as the...
29 CFR 500.269 - Stay pending decision of the Secretary.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Vacation of Order of Administrative Law Judge § 500.269 Stay pending decision of the Secretary. (a) The... Judge, pursuant to § 500.264, does not stop the running of the thirty-day time limit in which respondent... of Intent, the Secretary will seek a stay of proceedings in the Court until such time as the...
78 FR 40822 - Generalized System of Preferences (GSP): Results of the 2012 Annual GSP Review; Notice of a...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

... earlier reviews. In a Presidential Proclamation dated June 27, 2013, the President implemented his... waiver of CNLs for calcium silicon ferroalloys (HTS 7202.99.20) from Brazil. See List II (Decision on... List III (Decision on Competitive Need Limitation Waiver Revocations). Effective July 1, 2013, imports...
How Do School Peers Influence Student Educational Outcomes? Theory and Evidence from Economics and Other Social Sciences

ERIC Educational Resources Information Center

Harris, Douglas N.

2010-01-01

Background: Interest among social scientists in peer influences has grown with recent resegregation of the nation's schools and court decisions that limit the ability of school districts to consider race in school assignment decisions. If having more advantaged peers is beneficial, then these trends may reduce educational equity. Previous studies…
"Black Magic" and "Gold Dust": The Epistemic and Political Uses of Evidence Tools in Public Health Policy Making

ERIC Educational Resources Information Center

Stewart, Ellen; Smith, Katherine E.

2015-01-01

Concerns about the limited influence of research on decision making have prompted the development of tools intended to mediate evidence for policy audiences. This article focuses on three examples, prominent in public health: impact assessments; systematic reviews; and economic decision-making tools (cost-benefit analysis and scenario modelling).…

78 FR 57106 - Fisheries of the Exclusive Economic Zone Off Alaska; Groundfish of the Gulf of Alaska; Amendment...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-17

... season trawl shallow-water fisheries than deep-water fisheries to provide halibut PSC limit to support... considered in the approval/disapproval decision for Amendment 95 and addressed in the response to comments in the final decision. Background Pacific halibut (Hippoglossus stenolepis) is fully utilized in the...
A Decision Support Prototype Tool for Predicting Student Performance in an ODL Environment

ERIC Educational Resources Information Center

Kotsiantis, S. B.; Pintelas, P. E.

2004-01-01

Machine Learning algorithms fed with data sets which include information such as attendance data, test scores and other student information can provide tutors with powerful tools for decision-making. Until now, much of the research has been limited to the relation between single variables and student performance. Combining multiple variables as…
The Use of Touch in Counseling: An Ethical Decision-Making Model

ERIC Educational Resources Information Center

Calmes, Stephanie A.; Piazza, Nick J.; Laux, John M.

2013-01-01

Although some counselors have advocated for the limited use of touch in counseling, others have argued that touch has no place within the counseling relationship. Despite the controversy, the use of touch has been shown to have a number of therapeutic benefits; however, there are few ethical decision-making models that are appropriate for…
49 CFR 40.355 - What limitations apply to the activities of service agents?

Code of Federal Regulations, 2013 CFR

2013-10-01

... section, you must not make decisions to test an employee based upon reasonable suspicion, post-accident... this section, you may make decisions to test an employee based upon reasonable suspicion, post-accident... behalf of a service agent. (b) You must not act as an intermediary in the transmission of drug test...
49 CFR 40.355 - What limitations apply to the activities of service agents?

Code of Federal Regulations, 2011 CFR

2011-10-01

... section, you must not make decisions to test an employee based upon reasonable suspicion, post-accident... this section, you may make decisions to test an employee based upon reasonable suspicion, post-accident... behalf of a service agent. (b) You must not act as an intermediary in the transmission of drug test...
49 CFR 40.355 - What limitations apply to the activities of service agents?

Code of Federal Regulations, 2012 CFR

2012-10-01

... section, you must not make decisions to test an employee based upon reasonable suspicion, post-accident... this section, you may make decisions to test an employee based upon reasonable suspicion, post-accident... behalf of a service agent. (b) You must not act as an intermediary in the transmission of drug test...
49 CFR 40.355 - What limitations apply to the activities of service agents?

Code of Federal Regulations, 2010 CFR

2010-10-01

... section, you must not make decisions to test an employee based upon reasonable suspicion, post-accident... this section, you may make decisions to test an employee based upon reasonable suspicion, post-accident... behalf of a service agent. (b) You must not act as an intermediary in the transmission of drug test...
49 CFR 40.355 - What limitations apply to the activities of service agents?

Code of Federal Regulations, 2014 CFR

2014-10-01

... section, you must not make decisions to test an employee based upon reasonable suspicion, post-accident... this section, you may make decisions to test an employee based upon reasonable suspicion, post-accident... behalf of a service agent. (b) You must not act as an intermediary in the transmission of drug test...
Sex Discrimination--Court Narrows Gilbert--Some Pregnancy Discrimination Is Sex Related.

ERIC Educational Resources Information Center

Allen, Claudia G.; Powers, Jean C.

1978-01-01

Issues concerning sex discrimination based on pregnancy, presented in Nashville Gas Co. vs. Satty, and the Supreme Court's treatment of the issues are examined. The way in which the Satty opinion limits the scope of the General Electric Co. vs. Gilbert decision, and an analysis of the implications of the Satty decision are included. (JMD)
Supporting Managers, Hearing the Public: A Decision Support Approach for Evaluating Ecosystem Services and Social Benefits from Urban Wetland and Stream-Buffer Restoration

EPA Science Inventory

Public officials and environmental managers face difficult decisions about how to allocate limited funds to the most beneficial restoration projects and how to define what a “beneficial” project is. Beneficial to what? Or to whom? And where? Traditionally, managers ha...
16 CFR 1013.6 - Public availability of transcripts, recordings and minutes of Commission meetings.

Code of Federal Regulations, 2010 CFR

2010-01-01

...) through (10) of § 1013.4 need not be made available to the public. (b) Procedures for making available... Commission for decision. In that event, the Commission decision shall be made within the time limits set... attention of the Chairman, Consumer Product Safety Commission, Washington, D.C. 20207. (ii) The Commission...
Urban and Rural Chinese Adolescents' Judgments and Reasoning about Personal and Group Jurisdiction

ERIC Educational Resources Information Center

Helwig, Charles C.; Yang, Shaogang; Tan, Dingliang; Liu, Chunqiong; Shao, Tiffany

2011-01-01

This research applied social domain theory to illuminate reasoning about the perceived legitimacy and limits of group decision making (majority rule) among adolescents from urban and rural China (N = 160). Study 1 revealed that adolescents from both urban and rural China judged group decision making as acceptable for both social conventional and…
10 CFR 2.621 - Acceptance and docketing of application for early review of site suitability issues in a combined...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Acceptance and docketing of application for early review... Procedures Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application... Issuance of Limited Work Authorizations Early Partial Decisions on Site Suitability-Combined License Under...
10 CFR 2.603 - Acceptance and docketing of application for early review of site suitability issues in a...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Acceptance and docketing of application for early review... Procedures Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application... Issuance of Limited Work Authorizations Early Partial Decisions on Site Suitability-Construction Permit § 2...
Preference vs. Authority: A Comparison of Student Searching in a Subject-Specific Indexing and Abstracting Database and a Customized Discovery Layer

ERIC Educational Resources Information Center

Dahlen, Sarah P. C.; Hanson, Kathlene

2017-01-01

Discovery layers provide a simplified interface for searching library resources. Libraries with limited finances make decisions about retaining indexing and abstracting databases when similar information is available in discovery layers. These decisions should be informed by student success at finding quality information as well as satisfaction…
Designing Species Translocation Strategies When Populaton Growth and Future Funding Are Uncertain

Treesearch

Robert G. Haight; Katherine Ralls; Anthony M. Starfield

2000-01-01

When translocating individuals to found new populations, managers must allocate limited funds among release and monitoring activities that differ in method, cost, and probable result. In addition, managers are increasingly expected to justify the funding decisions they have made. Within the framework of decision analysis, we used robust optimization to formulate and...
Improving the Clarity of the Interprofessional Field: Implications for Research and Continuing Interprofessional Education

ERIC Educational Resources Information Center

Goldman, Joanne; Zwarenstein, Merrick; Bhattacharyya, Onil; Reeves, Scott

2009-01-01

Significant investments are being made around the world to improve interprofessional collaboration, yet limits in our knowledge of this field restrict the ability of decision makers to base their decisions upon evidence. Clarity of the interprofessional field is blurred by a conceptual and semantic confusion that affects our understanding of key…
42 CFR 423.2042 - The administrative record.

Code of Federal Regulations, 2010 CFR

2010-10-01

... marked as exhibits, the documents used in making the decision under review, including, but not limited to... admits. (3) An enrollee may review the record at the hearing, or, if a hearing is not held, at any time before the ALJ's notice of decision is issued. (4) If a request for review is filed, the complete record...
Using a model and forecasted weather to predict forage and livestock production for making stocking decisions in the coming growing season

USDA-ARS?s Scientific Manuscript database

Forecasting peak standing crop (PSC) for the coming grazing season can help ranchers make appropriate stocking decisions to reduce enterprise risks. Previously developed PSC predictors were based on short-term experimental data (<15 yr) and limited stocking rates (SR) without including the effect of...
Fast or Frugal, but Not Both: Decision Heuristics under Time Pressure

ERIC Educational Resources Information Center

Bobadilla-Suarez, Sebastian; Love, Bradley C.

2018-01-01

Heuristics are simple, yet effective, strategies that people use to make decisions. Because heuristics do not require all available information, they are thought to be easy to implement and to not tax limited cognitive resources, which has led heuristics to be characterized as fast-and-frugal. We question this monolithic conception of heuristics…

Cost Analysis of Instructional Technology.

ERIC Educational Resources Information Center

Johnson, F. Craig; Dietrich, John E.

Although some serious limitations in the cost analysis technique do exist, the need for cost data in decision making is so great that every effort should be made to obtain accurate estimates. This paper discusses the several issues which arise when an attempt is made to make quality, trade-off, or scope decisions based on cost data. Three methods…
Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

PubMed

Rennie, Sarah C; van Rij, Andre M; Jaye, Chrystal; Hall, Katherine H

2011-06-01

Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.
Composite collective decision-making.

PubMed

Czaczkes, Tomer J; Czaczkes, Benjamin; Iglhaut, Carolin; Heinze, Jürgen

2015-06-22

Individual animals are adept at making decisions and have cognitive abilities, such as memory, which allow them to hone their decisions. Social animals can also share information. This allows social animals to make adaptive group-level decisions. Both individual and collective decision-making systems also have drawbacks and limitations, and while both are well studied, the interaction between them is still poorly understood. Here, we study how individual and collective decision-making interact during ant foraging. We first gathered empirical data on memory-based foraging persistence in the ant Lasius niger. We used these data to create an agent-based model where ants may use social information (trail pheromones), private information (memories) or both to make foraging decisions. The combined use of social and private information by individuals results in greater efficiency at the group level than when either information source was used alone. The modelled ants couple consensus decision-making, allowing them to quickly exploit high-quality food sources, and combined decision-making, allowing different individuals to specialize in exploiting different resource patches. Such a composite collective decision-making system reaps the benefits of both its constituent parts. Exploiting such insights into composite collective decision-making may lead to improved decision-making algorithms. © 2015 The Author(s) Published by the Royal Society. All rights reserved.
Working memory capacity as controlled attention in tactical decision making.

PubMed

Furley, Philip A; Memmert, Daniel

2012-06-01

The controlled attention theory of working memory capacity (WMC, Engle 2002) suggests that WMC represents a domain free limitation in the ability to control attention and is predictive of an individual's capability of staying focused, avoiding distraction and impulsive errors. In the present paper we test the predictive power of WMC in computer-based sport decision-making tasks. Experiment 1 demonstrated that high-WMC athletes were better able at focusing their attention on tactical decision making while blocking out irrelevant auditory distraction. Experiment 2 showed that high-WMC athletes were more successful at adapting their tactical decision making according to the situation instead of relying on prepotent inappropriate decisions. The present results provide additional but also unique support for the controlled attention theory of WMC by demonstrating that WMC is predictive of controlling attention in complex settings among different modalities and highlight the importance of working memory in tactical decision making.
Decision-making in geriatric oncology: systemic treatment considerations for older adults with colon cancer.

PubMed

Moth, Erin B; Vardy, Janette; Blinman, Prunella

2016-12-01

Colon cancer is common and can be considered a disease of older adults with more than half of cases diagnosed in patients aged over 70 years. Decision-making about treatment with chemotherapy for older adults may be complicated by age-related physiological changes, impaired functional status, limited social supports, concerns regarding the occurrence of and ability to tolerate treatment toxicity, and the presence of comorbidities. This is compounded by a lack of high quality evidence guiding cancer treatment decisions for older adults. Areas covered: This narrative review evaluates the evidence for adjuvant and palliative systemic therapy in older adults with colon cancer. The value of an adequate assessment prior to making a treatment decision is addressed, with emphasis on the geriatric assessment. Guidance in making a treatment decision is provided. Expert commentary: Treatment decisions should consider goals of care, a patient's treatment preferences, and weigh up relative benefits and harms.
Optimizing Decision Preparedness by Adapting Scenario Complexity and Automating Scenario Generation

NASA Technical Reports Server (NTRS)

Dunne, Rob; Schatz, Sae; Flore, Stephen M.; Nicholson, Denise

2011-01-01

Klein's recognition-primed decision (RPD) framework proposes that experts make decisions by recognizing similarities between current decision situations and previous decision experiences. Unfortunately, military personnel arQ often presented with situations that they have not experienced before. Scenario-based training (S8T) can help mitigate this gap. However, SBT remains a challenging and inefficient training approach. To address these limitations, the authors present an innovative formulation of scenario complexity that contributes to the larger research goal of developing an automated scenario generation system. This system will enable trainees to effectively advance through a variety of increasingly complex decision situations and experiences. By adapting scenario complexities and automating generation, trainees will be provided with a greater variety of appropriately calibrated training events, thus broadening their repositories of experience. Preliminary results from empirical testing (N=24) of the proof-of-concept formula are presented, and future avenues of scenario complexity research are also discussed.
Use of PRA in Shuttle Decision Making Process

NASA Technical Reports Server (NTRS)

Boyer, Roger L.; Hamlin, Teri L.

2010-01-01

How do you use PRA to support an operating program? This presentation will explore how the Shuttle Program Management has used the Shuttle PRA in its decision making process. It will reveal how the PRA has evolved from a tool used to evaluate Shuttle upgrades like Electric Auxiliary Power Unit (EAPU) to a tool that supports Flight Readiness Reviews (FRR) and real-time flight decisions. Specific examples of Shuttle Program decisions that have used the Shuttle PRA as input will be provided including how it was used in the Hubble Space Telescope (HST) manifest decision. It will discuss the importance of providing management with a clear presentation of the analysis, applicable assumptions and limitations, along with estimates of the uncertainty. This presentation will show how the use of PRA by the Shuttle Program has evolved overtime and how it has been used in the decision making process providing specific examples.
Presenting practice financial information.

PubMed

Webster, Lee Ann H

2007-01-01

Medical practice leadership teams, often consisting primarily of physicians with limited financial backgrounds, must make important business decisions and continuously monitor practice operations. In order to competently perform this duty, they need financial reports that are relevant and easy to understand. This article explores financial reporting and decision-making in a physician practice. It discusses reports and tools, such as ratios, graphs, and comparisons, that practices typically include in their reports. Because profitability and cash flow are often the most important financial considerations for physician practices, reports should generally focus on the impact of various activities and potential decisions upon these concerns. This article also provides communication tips for both those presenting practice financial information and those making the decisions. By communicating effectively, these leaders can best use financial information to improve decision-making and maximize financial performance.
The interrogation decision-making model: A general theoretical framework for confessions.

PubMed

Yang, Yueran; Guyll, Max; Madon, Stephanie

2017-02-01

This article presents a new model of confessions referred to as the interrogation decision-making model . This model provides a theoretical umbrella with which to understand and analyze suspects' decisions to deny or confess guilt in the context of a custodial interrogation. The model draws upon expected utility theory to propose a mathematical account of the psychological mechanisms that not only underlie suspects' decisions to deny or confess guilt at any specific point during an interrogation, but also how confession decisions can change over time. Findings from the extant literature pertaining to confessions are considered to demonstrate how the model offers a comprehensive and integrative framework for organizing a range of effects within a limited set of model parameters. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Can we expect to predict climate if we cannot shadow weather?

NASA Astrophysics Data System (ADS)

Smith, Leonard

2010-05-01

What limits our ability to predict (or project) useful statistics of future climate? And how might we quantify those limits? In the early 1960s, Ed Lorenz illustrated one constraint on point forecasts of the weather (chaos) while noting another (model imperfections). In the mid-sixties he went on to discuss climate prediction, noting that chaos, per se, need not limit accurate forecasts of averages and the distributions that define climate. In short, chaos might place draconian limits on what we can say about a particular summer day in 2010 (or 2040), but it need not limit our ability to make accurate and informative statements about the weather over this summer as a whole, or climate distributions of the 2040's. If not chaos, what limits our ability to produce decision relevant probability distribution functions (PDFs)? Is this just a question of technology (raw computer power) and uncertain boundary conditions (emission scenarios)? Arguably, current model simulations of the Earth's climate are limited by model inadequacy: not that the initial or boundary conditions are unknown but that state-of-the-art models would not yield decision-relevant probability distributions even if they were known. Or to place this statement in an empirically falsifiable format: that in 2100 when the boundary conditions are known and computer power is (hopefully) sufficient to allow exhaustive exploration of today's state-of-the-art models: we will find today's models do not admit a trajectory consistent with our knowledge of the state of the earth in 2009 which would prove of decision support relevance for, say, 25 km, hourly resolution. In short: today's models cannot shadow the weather of this century even after the fact. Restating this conjecture in a more positive frame: a 2100 historian of science will be able to determine the highest space and time scales on which 2009 models could have (i) produced trajectories plausibly consistent with the (by then) observed twenty-first century and (ii) produced probability distributions useful as such for decision support. As it will be some time until such conjectures can be refuted, how might we best advise decision makers of the detail (specifically, space and time resolution of a quantity of interest as a function of lead-time) that it is rational to interpret model-based PDFs as decision-relevant probability distributions? Given the nonlinearities already incorporated in our models, how far into the future can one expect a simulation to get the temperature "right" given the simulation has precipitation badly "wrong"? When can biases in local temperature which melt model-ice no longer be dismissed, and neglected by presenting model-anomalies? At what lead times will feedbacks due to model inadequacies cause the 2007 model simulations to drift away from what today's basic science (and 2100 computer power) would suggest? How might one justify quantitative claims regarding "extreme events" (or NUMB weather)? Models are unlikely to forecast things they cannot shadow, or at least track. There is no constraint on rational scientists to take model distributions as their subjective probabilities, unless they believe the model is empirically adequate. How then are we to use today's simulations to inform today's decisions? Two approaches are considered. The first augments the model-based PDF with an explicit subjective-probability of a "Big Surprise". The second is to look not for a PDF but, following Solvency II, consider the risk from any event that cannot be ruled out at, say, the one in 200 level. The fact that neither approach provides the simplicity and apparent confidence of interpreting model-based PDFs as if they were objective probabilities does not contradict the claim that either might lead to better decision-making.
Signal detection evidence for limited capacity in visual search

PubMed Central

Fencsik, David E.; Flusberg, Stephen J.; Horowitz, Todd S.; Wolfe, Jeremy M.

2014-01-01

The nature of capacity limits (if any) in visual search has been a topic of controversy for decades. In 30 years of work, researchers have attempted to distinguish between two broad classes of visual search models. Attention-limited models have proposed two stages of perceptual processing: an unlimited-capacity preattentive stage, and a limited-capacity selective attention stage. Conversely, noise-limited models have proposed a single, unlimited-capacity perceptual processing stage, with decision processes influenced only by stochastic noise. Here, we use signal detection methods to test a strong prediction of attention-limited models. In standard attention-limited models, performance of some searches (feature searches) should only be limited by a preattentive stage. Other search tasks (e.g., spatial configuration search for a “2” among “5”s) should be additionally limited by an attentional bottleneck. We equated average accuracies for a feature and a spatial configuration search over set sizes of 1–8 for briefly presented stimuli. The strong prediction of attention-limited models is that, given overall equivalence in performance, accuracy should be better on the spatial configuration search than on the feature search for set size 1, and worse for set size 8. We confirm this crossover interaction and show that it is problematic for at least one class of one-stage decision models. PMID:21901574
Beyond shared decision-making: Collaboration in the age of recovery from serious mental illness.

PubMed

Treichler, Emily B H; Spaulding, William D

2017-01-01

The role that people with serious mental illness (SMI) play in making decisions about their own treatment and rehabilitation is attracting increasing attention and scrutiny. This attention is embedded in a broader social/consumer movement, the recovery movement , whose agenda includes extensive reform of the mental health system and advancing respect for the dignity and autonomy of people with SMI. Shared decision-making (SDM) is an approach for enhancing consumer participation in health-care decision-making. SDM translates straightforwardly to specific clinical procedures that systematically identify domains of decision-making and guide the practitioner and consumer through making the decisions. In addition, Collaborative decision-making (CDM) is a set of guiding principles that avoids the connotations and limitations of SDM. CDM looks broadly at the range of decisions to be made in mental health care, and assigns consumers and providers equal responsibility and power in the decision-making process. It recognizes the diverse history, knowledge base, and values of each consumer by assuming patients can lead and contribute to decision-making, contributing both value-based information and technical information. This article further discusses the importance of CDM for people with SMI. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Dissociating sensory from decision processes in human perceptual decision making.

PubMed

Mostert, Pim; Kok, Peter; de Lange, Floris P

2015-12-15

A key question within systems neuroscience is how the brain translates physical stimulation into a behavioral response: perceptual decision making. To answer this question, it is important to dissociate the neural activity underlying the encoding of sensory information from the activity underlying the subsequent temporal integration into a decision variable. Here, we adopted a decoding approach to empirically assess this dissociation in human magnetoencephalography recordings. We used a functional localizer to identify the neural signature that reflects sensory-specific processes, and subsequently traced this signature while subjects were engaged in a perceptual decision making task. Our results revealed a temporal dissociation in which sensory processing was limited to an early time window and consistent with occipital areas, whereas decision-related processing became increasingly pronounced over time, and involved parietal and frontal areas. We found that the sensory processing accurately reflected the physical stimulus, irrespective of the eventual decision. Moreover, the sensory representation was stable and maintained over time when it was required for a subsequent decision, but unstable and variable over time when it was task-irrelevant. In contrast, decision-related activity displayed long-lasting sustained components. Together, our approach dissects neuro-anatomically and functionally distinct contributions to perceptual decisions.
Dissociating sensory from decision processes in human perceptual decision making

PubMed Central

Mostert, Pim; Kok, Peter; de Lange, Floris P.

2015-01-01

A key question within systems neuroscience is how the brain translates physical stimulation into a behavioral response: perceptual decision making. To answer this question, it is important to dissociate the neural activity underlying the encoding of sensory information from the activity underlying the subsequent temporal integration into a decision variable. Here, we adopted a decoding approach to empirically assess this dissociation in human magnetoencephalography recordings. We used a functional localizer to identify the neural signature that reflects sensory-specific processes, and subsequently traced this signature while subjects were engaged in a perceptual decision making task. Our results revealed a temporal dissociation in which sensory processing was limited to an early time window and consistent with occipital areas, whereas decision-related processing became increasingly pronounced over time, and involved parietal and frontal areas. We found that the sensory processing accurately reflected the physical stimulus, irrespective of the eventual decision. Moreover, the sensory representation was stable and maintained over time when it was required for a subsequent decision, but unstable and variable over time when it was task-irrelevant. In contrast, decision-related activity displayed long-lasting sustained components. Together, our approach dissects neuro-anatomically and functionally distinct contributions to perceptual decisions. PMID:26666393
Estimation of metabolic factors related to insulin resistance and metabolic syndrome in young people.

PubMed

Płaczkowska, Sylwia; Pawlik-Sobecka, Lilla; Kokot, Izabela; Piwowar, Agnieszka

2018-05-09

Civilizational developments occurring during recent decades have resulted in an increased incidence of a variety of metabolic disorders related to insulin resistance in younger people. The determination of decision limits for insulin resistance indices, especially among young people, is a significant challenge in clinical practice. The aim of this study was the estimation of metabolic factors related to their relationship to insulin resistance and metabolic syndrome (MS) features in young, apparently healthy people. Moreover, we evaluated the optimal decision limits for patients with MS identification for HOMA1-IR, HOMA2-IR, HOMA2 obtained from C-peptide concentrations. 349 apparently healthy people aged 18-31 (260 women and 89 men), were enrolled in this study. The present analysis of metabolic, anthropometric and clinical parameters observed them in clusters covering the criteria of MS recognition, but MS in this group was only partially related to insulin resistance. The HOMA1-IR decision limit estimation is likely to became be useful in the prognostication of metabolic disturbances in young, apparently healthy people. A measure of insulin resistance that can provide a reliable early prediction of MS is likely to provide an opportunity for instigating preventive measures of significant clinical utility.
Deciding in the dark: advance directives and continuation of treatment in chronic critical illness.

PubMed

Camhi, Sharon L; Mercado, Alice F; Morrison, R Sean; Du, Qingling; Platt, David M; August, Gary I; Nelson, Judith E

2009-03-01

Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation. Prospective cohort study. Respiratory Care Unit (RCU) in a large, tertiary, urban, university-affiliated, hospital. Two hundred three chronically critically ill adults transferred to RCU after tracheotomy for failure to wean from mechanical ventilation in the intensive care unit. None. We interviewed RCU caregivers and reviewed patient records to identify proxy appointments, living wills, or oral statements of treatment preferences, resuscitation directives, and withholding/withdrawal of mechanical ventilation, nutrition, hydration, renal replacement and vasopressors. Forty-three of 203 patients (21.2%) appointed a proxy and 33 (16.2%) expressed preferences in advance directives. Do not resuscitate directives were given for 71 patients (35.0%). Treatment was limited for 39 patients (19.2%). Variables significantly associated with treatment limitation were proxy appointment prior to study entry (time of tracheotomy/RCU transfer) (odds ratio = 6.7, 95% confidence interval [CI], 2.3-20.0, p = 0.0006) and palliative care consultation in the RCU (OR = 40.9, 95% CI, 13.1-127.4, p < 0.0001). Median (interquartile range) time to first treatment limitation was 39 (31.0-45.0) days after hospital admission and 13 (8.0-29.0) days after RCU admission. For patients dying after treatment limitation, median time from first limitation to death ranged from 3 days for mechanical ventilation and hydration to 7 days for renal replacement. Most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments. Despite burdensome symptoms and poor outcomes, limitation of such treatments was rare and occurred late, when patients were near death. Opportunities exist to improve communication and decision-making in chronic critical illness.
What Is Known about Parents’ Treatment Decisions? A Narrative Review of Pediatric Decision Making

PubMed Central

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

2013-01-01

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

NASA Astrophysics Data System (ADS)

Mohamad, Daud; Afandi, Nur Syamimi; Kamis, Nor Hanimah

2015-10-01

Strategic planning is a process of decision making and action for long-term activities in an organization. The Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis has been commonly used to help organizations in strategizing their future direction by analyzing internal and external environment. However, SWOT analysis has some limitations as it is unable to prioritize appropriately the multiple alternative strategic decisions. Some efforts have been made to solve this problem by incorporating Multi Criteria Decision Making (MCDM) methods. Nevertheless, another important aspect has raised concerns on obtaining the decision that is the reliability of the information. Decision makers evaluate differently depending on their level of confidence or sureness in the evaluation. This study proposes a decision making procedure for strategic planning using SWOT-TOPSIS method by incorporating the reliability factor of the evaluation based on Z-number. An example using a local authority in the east coast of Malaysia is illustrated to determine the strategic options ranking and to prioritize factors in each SWOT category.
Consistency in decision making by research ethics committees: a controlled comparison.

PubMed

Angell, E; Sutton, A J; Windridge, K; Dixon-Woods, M

2006-11-01

There has been longstanding interest in the consistency of decisions made by research ethics committees (RECs) in the UK, but most of the evidence has come from single studies submitted to multiple committees. A systematic comparison was carried out of the decisions made on 18 purposively selected applications, each of which was reviewed independently by three different RECs in a single strategic health authority. Decisions on 11 applications were consistent, but disparities were found among RECs on decisions on seven applications. An analysis of the agreement between decisions of RECs yielded an overall measure of agreement of kappa = 0.286 (95% confidence interval -0.06 to 0.73), indicating a level of agreement that, although probably better than chance, may be described as "slight". The small sample size limits the robustness of these findings. Further research on reasons for inconsistencies in decision making between RECs, and on the importance of such inconsistencies for a range of arguments, is needed.
End-of-life decisions in Malaysia: Adequacies of ethical codes and developing legal standards.

PubMed

Kassim, Puteri Nemie Jahn; Alias, Fadhlina

2015-06-01

End-of-life decision-making is an area of medical practice in which ethical dilemmas and legal interventions have become increasingly prevalent. Decisions are no longer confined to clinical assessments; rather, they involve wider considerations such as a patient's religious and cultural beliefs, financial constraints, and the wishes and needs of family members. These decisions affect everyone concerned, including members of the community as a whole. Therefore it is imperative that clear ethical codes and legal standards are developed to help guide the medical profession on the best possible course of action for patients. This article considers the relevant ethical, codes and legal provisions in Malaysia governing certain aspects of end-of-life decision-making. It highlights the lack of judicial decisions in this area as well as the limitations with the Malaysian regulatory system. The article recommends the development of comprehensive ethical codes and legal standards to guide end-of-life decision-making in Malaysia.

Brain mechanisms controlling decision making and motor planning.

PubMed

Ramakrishnan, Arjun; Murthy, Aditya

2013-01-01

Accumulator models of decision making provide a unified framework to understand decision making and motor planning. In these models, the evolution of a decision is reflected in the accumulation of sensory information into a motor plan that reaches a threshold, leading to choice behavior. While these models provide an elegant framework to understand performance and reaction times, their ability to explain complex behaviors such as decision making and motor control of sequential movements in dynamic environments is unclear. To examine and probe the limits of online modification of decision making and motor planning, an oculomotor "redirect" task was used. Here, subjects were expected to change their eye movement plan when a new saccade target appeared. Based on task performance, saccade reaction time distributions, computational models of behavior, and intracortical microstimulation of monkey frontal eye fields, we show how accumulator models can be tested and extended to study dynamic aspects of decision making and motor control. Copyright © 2013 Elsevier B.V. All rights reserved.
Evaluation of Beckman Coulter DxI 800 immunoassay system using clinically oriented performance goals.

PubMed

Akbas, Neval; Schryver, Patricia G; Algeciras-Schimnich, Alicia; Baumann, Nikola A; Block, Darci R; Budd, Jeffrey R; Gaston, S J Stephen; Klee, George G

2014-11-01

We evaluated the analytical performance of 24 immunoassays using the Beckman Coulter DxI 800 immunoassay systems at Mayo Clinic, Rochester, MN for trueness, precision, detection limits, linearity, and consistency (across instruments and reagent lots). Clinically oriented performance goals were defined using the following methods: trueness-published desirable accuracy limits, precision-published desirable biologic variation; detection limits - 0.1 percentile of patient test values, linearity - 50% of total error, and consistency-percentage test values crossing key decision points. Local data were collected for precision, linearity, and consistency. Data were provided by Beckman Coulter, Inc. for trueness and detection limits. All evaluated assays except total thyroxine were within the proposed goals for trueness. Most of the assays met the proposed goals for precision (86% of intra-assay results and 75% of inter-assay results). Five assays had more than 15% of the test results below the minimum detection limits. Carcinoembryonic antigen, total thyroxine and free triiodothyronine exceeded the proposed goals of ±6.3%, ±5% and ±5.7% for dilution linearity. All evaluated assays were within the proposed goals for instrument consistency. Lot-to-lot consistency results for cortisol, ferritin and total thyroxine exceeded the proposed goals of 3.3%, 11.4% and 7% at one medical decision level, while vitamin B12 exceeded the proposed goals of 5.2% and 3.8% at two decision levels. The Beckman Coulter DxI 800 immunoassay system meets most of these proposed goals, even though these clinically focused performance goals represent relatively stringent limits. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Shrinking Sea Ice, Thawing Permafrost, Bigger Storms, and Extremely Limited Data - Addressing Information Needs of Stakeholders in Western Alaska Through Participatory Decisions and Collaborative Science.

NASA Astrophysics Data System (ADS)

Murphy, K. A.; Reynolds, J.

2015-12-01

Communities, Tribes, and decision makers in coastal western Alaska are being impacted by declining sea ice, sea level rise, changing storm patterns and intensities, and increased rates of coastal erosion. Relative to their counterparts in the contiguous USA, their ability to plan for and respond to these changes is constrained by the region's generally meager or non-existent information base. Further, the information needs and logistic challenges are of a scale that perhaps can be addressed only through strong, strategic collaboration. Landscape Conservation Cooperatives (LCCs) are fundamentally about applied science and collaboration, especially collaborative decision making. The Western Alaska LCC has established a process of participatory decision making that brings together researchers, agency managers, local experts from Tribes and field specialists to identify and prioritize shared information needs; develop a course of action to address them by using the LCC's limited resources to catalyze engagement, overcome barriers to progress, and build momentum; then ensure products are delivered in a manner that meets decision makers' needs. We briefly review the LCC's activities & outcomes from the stages of (i) collaborative needs assessment (joint with the Alaska Climate Science Center and the Alaska Ocean Observing System), (ii) strategic science activities, and (iii) product refinement and delivery. We discuss lessons learned, in the context of our recent program focused on 'Changes in Coastal Storms and Their Impacts' and current collaborative efforts focused on delivery of Coastal Resiliency planning tools and results from applied science projects. Emphasis is given to the various key interactions between scientists and decision makers / managers that have been promoted by this process to ensure alignment of final products to decision maker needs.
The feminist approach in the decision-making process for treatment of women with breast cancer.

PubMed

Szumacher, Ewa

2006-09-01

The principal aim of this review was to investigate a feminist approach to the decision-making process for women with breast cancer. Empirical research into patient preferences for being informed about and participating in healthcare decisions has some limitations because it is mostly quantitative and designed within the dominant medical culture. Indigenous medical knowledge and alternative medical treatments are not widely accepted because of the lack of confirmed efficacy of such treatments in evidence-based literature. While discussing their treatment options with oncologists, women with breast cancer frequently express many concerns regarding treatment side effects, and sometimes decline conventional treatment when the risks are too high. A search of all relevant literary sources, including Pub-Med, ERIC, Medline, and the Ontario Institute for Studies in Education at the University of Toronto was conducted. The key words for selection of the articles were "feminism," "decision-making," "patients preferences for treatment," and "breast cancer." Fifty-one literary sources were selected. The review was divided into the following themes: (1) limitations of the patient decision-making process in conventional medicine; (2) participation of native North American patients in healthcare decisions; (3) towards a feminist approach to breast cancer; and (4) towards a feminist theory of breast cancer. This article discusses the importance of a feminist approach to the decision-making process for treatment of patients with breast cancer. As the literature suggests, the needs of minority patients are not completely fulfilled in Western medical culture. Introducing feminist theory into evidence-based medicine will help patients to be better informed about treatment choices and will assist them to select treatment according to their own beliefs and values.
Accuracy of 'My Gut Feeling:' Comparing System 1 to System 2 Decision-Making for Acuity Prediction, Disposition and Diagnosis in an Academic Emergency Department.

PubMed

Cabrera, Daniel; Thomas, Jonathan F; Wiswell, Jeffrey L; Walston, James M; Anderson, Joel R; Hess, Erik P; Bellolio, M Fernanda

2015-09-01

Current cognitive sciences describe decision-making using the dual-process theory, where a System 1 is intuitive and a System 2 decision is hypothetico-deductive. We aim to compare the performance of these systems in determining patient acuity, disposition and diagnosis. Prospective observational study of emergency physicians assessing patients in the emergency department of an academic center. Physicians were provided the patient's chief complaint and vital signs and allowed to observe the patient briefly. They were then asked to predict acuity, final disposition (home, intensive care unit (ICU), non-ICU bed) and diagnosis. A patient was classified as sick by the investigators using previously published objective criteria. We obtained 662 observations from 289 patients. For acuity, the observers had a sensitivity of 73.9% (95% CI [67.7-79.5%]), specificity 83.3% (95% CI [79.5-86.7%]), positive predictive value 70.3% (95% CI [64.1-75.9%]) and negative predictive value 85.7% (95% CI [82.0-88.9%]). For final disposition, the observers made a correct prediction in 80.8% (95% CI [76.1-85.0%]) of the cases. For ICU admission, emergency physicians had a sensitivity of 33.9% (95% CI [22.1-47.4%]) and a specificity of 96.9% (95% CI [94.0-98.7%]). The correct diagnosis was made 54% of the time with the limited data available. System 1 decision-making based on limited information had a sensitivity close to 80% for acuity and disposition prediction, but the performance was lower for predicting ICU admission and diagnosis. System 1 decision-making appears insufficient for final decisions in these domains but likely provides a cognitive framework for System 2 decision-making.
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.
Arthroscopy Journal Prizes Are Major Decisions.

PubMed

Lubowitz, James H; Brand, Jefferson C; Provencher, Matthew T; Rossi, Michael J

2016-01-01

According to the Harvard Business Review, the optimal number of people in a decision-making group is no more than 8. Thus, it is no surprise that 18 Arthroscopy journal associate editors had difficulty making a major decision. In the end, 18 editors did successfully select the 2015 winner of the Best Comparative Study Prize. All studies have limitations, but from a statistical standpoint, the editors believe that the conclusions of the winning study are likely correct. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
Resource allocation. The cost of care: two troublesome cases in health care ethics.

PubMed

Armstrong, C R; Whitlock, R

1998-01-01

With the cost of health care rising rapidly, both physicians and administrators regularly face resource allocation decisions. Under these conditions of relative scarcity, the equitable and appropriate distribution of limited resources becomes an ethical as well as a financial issue. Through ethical analysis, physician executives can assist their physician colleagues and fellow administrators to find rationally defensible answers to questions regarding the distribution of limited resources. Six criteria are frequently "weighted in the balance" by ethicists when analyzing whether justice is served in the distribution of a limited resource: need, equality, contribution, ability to pay, effort, and merit. The authors argue that, from an ethical standpoint, the best single criterion upon which one can base an allocation decision is that of merit, defined as the potential to benefit from the investment of additional resources.
Neural Basis of Strategic Decision Making.

PubMed

Lee, Daeyeol; Seo, Hyojung

2016-01-01

Human choice behaviors during social interactions often deviate from the predictions of game theory. This might arise partly from the limitations in the cognitive abilities necessary for recursive reasoning about the behaviors of others. In addition, during iterative social interactions, choices might change dynamically as knowledge about the intentions of others and estimates for choice outcomes are incrementally updated via reinforcement learning. Some of the brain circuits utilized during social decision making might be general-purpose and contribute to isomorphic individual and social decision making. By contrast, regions in the medial prefrontal cortex (mPFC) and temporal parietal junction (TPJ) might be recruited for cognitive processes unique to social decision making. Copyright © 2015 Elsevier Ltd. All rights reserved.
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.
Who decides? The decision-making process of juvenile judges concerning minors with mental disorders.

PubMed

Cappon, Leen

2016-01-01

Previous research on juvenile judges' decision-making process has neglected the role of the different actors involved in judicial procedures. The decision can be considered as a result of information exchange between the different actors involved. The process of making a decision is equally important as the decision itself, especially when the decision considers minors with mental disorders. The presence and the type of interaction determine the information available to the juvenile judges to make their final decision. The overall aim of this study is to gain insight into the role of all actors, including the juvenile judge, in the juvenile judge's decision-making process in cases relating to minors with mental disorders. Semi-structured interviews were carried out with professional actors (n=32), minors (n=31) and parents (n=17). The findings indicated that the judge's decision is overall the result of an interaction between the juvenile judge, the social services investigator and the youth psychiatrist. The other professional actors, the minors and the parents had only a limited role in the decision-making process. The research concludes that the judge's decision-making process should be based on dialogue, and requires enhanced collaboration between the juvenile court and youth psychiatrists from mental health services. Future decision-making research should pay more attention to the interactions of the actors that guide a juvenile judge's decision. Copyright © 2016 Elsevier Ltd. All rights reserved.
How We Choose One over Another: Predicting Trial-by-Trial Preference Decision

PubMed Central

Bhushan, Vidya; Saha, Goutam; Lindsen, Job; Shimojo, Shinsuke; Bhattacharya, Joydeep

2012-01-01

Preference formation is a complex problem as it is subjective, involves emotion, is led by implicit processes, and changes depending on the context even within the same individual. Thus, scientific attempts to predict preference are challenging, yet quite important for basic understanding of human decision making mechanisms, but prediction in a group-average sense has only a limited significance. In this study, we predicted preferential decisions on a trial by trial basis based on brain responses occurring before the individuals made their decisions explicit. Participants made a binary preference decision of approachability based on faces while their electrophysiological responses were recorded. An artificial neural network based pattern-classifier was used with time-frequency resolved patterns of a functional connectivity measure as features for the classifier. We were able to predict preference decisions with a mean accuracy of 74.3±2.79% at participant-independent level and of 91.4±3.8% at participant-dependent level. Further, we revealed a causal role of the first impression on final decision and demonstrated the temporal trajectory of preference decision formation. PMID:22912859
Volatile decision dynamics: experiments, stochastic description, intermittency control and traffic optimization

NASA Astrophysics Data System (ADS)

Helbing, Dirk; Schönhof, Martin; Kern, Daniel

2002-06-01

The coordinated and efficient distribution of limited resources by individual decisions is a fundamental, unsolved problem. When individuals compete for road capacities, time, space, money, goods, etc, they normally make decisions based on aggregate rather than complete information, such as TV news or stock market indices. In related experiments, we have observed a volatile decision dynamics and far-from-optimal payoff distributions. We have also identified methods of information presentation that can considerably improve the overall performance of the system. In order to determine optimal strategies of decision guidance by means of user-specific recommendations, a stochastic behavioural description is developed. These strategies manage to increase the adaptibility to changing conditions and to reduce the deviation from the time-dependent user equilibrium, thereby enhancing the average and individual payoffs. Hence, our guidance strategies can increase the performance of all users by reducing overreaction and stabilizing the decision dynamics. These results are highly significant for predicting decision behaviour, for reaching optimal behavioural distributions by decision support systems and for information service providers. One of the promising fields of application is traffic optimization.
The Economics of Information: A Classroom Experiment.

ERIC Educational Resources Information Center

Netusil, Noelwah R.; Haupert, Michael

1995-01-01

Describes an economics class experiment where students ranked the quality of baked pies according to limited information. The limited sets of information included brand name and packaging only, price only, advertising only, word-of-mouth, and taste test. Discusses signals of quality and consumer decisions. (MJP)
75 FR 36358 - University of Maine System, et al.; Notice of Consolidated Decision on Applications for Duty-Free...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-25

.... Manufacturer: Japanese Electron-Optics, Limited (JEOL), Japan. Intended Use: See notice at 75 FR 29974, May 28...: Japanese Electron-Optics, Limited, (JEOL), Japan. Intended Use: See notice at 75 FR 29974, May 28, 2010...
True detection limits in an experimental linearly heteroscedastic system. Part 1

NASA Astrophysics Data System (ADS)

Voigtman, Edward; Abraham, Kevin T.

2011-11-01

Using a lab-constructed laser-excited filter fluorimeter deliberately designed to exhibit linearly heteroscedastic, additive Gaussian noise, it has been shown that accurate estimates may be made of the true theoretical Currie decision levels ( YC and XC) and true Currie detection limits ( YD and XD) for the detection of rhodamine 6 G tetrafluoroborate in ethanol. The obtained experimental values, for 5% probability of false positives and 5% probability of false negatives, were YC = 56.1 mV, YD = 125. mV, XC = 0.132 μg /mL and XD = 0.294 μg /mL. For 5% probability of false positives and 1% probability of false negatives, the obtained detection limits were YD = 158. mV and XD = 0.372 μg /mL. These decision levels and corresponding detection limits were shown to pass the ultimate test: they resulted in observed probabilities of false positives and false negatives that were statistically equivalent to the a priori specified values.
Informed choice in direct-to-consumer genetic testing (DTCGT) websites: a content analysis of benefits, risks, and limitations

PubMed Central

Singleton, Amanda; Erby, Lori Hamby; Foisie, Kathryn V.; Kaphingst, Kimberly

2012-01-01

An informed choice about health-related direct-to-consumer genetic testing (DTCGT) requires knowledge of potential benefits, risks, and limitations. To understand the information that potential consumers of DTCGT services are exposed to on company websites, we conducted a content analysis of 23 health-related DTCGT websites. Results revealed that benefit statements outweighed risk and limitation statements 6 to 1. The most frequently described benefits were 1) disease prevention, 2) consumer education, 3) personalized medical recommendations, and 4) the ability to make health decisions. Thirty-five percent of websites also presented at least one risk of testing. Seventy-eight percent of websites mentioned at least one limitation of testing. Based on this information, potential consumers might get an inaccurate picture of genetic testing which could impact their ability to make an informed decision. Practices that enhance the presentation of balanced information on DTCGT company websites should be encouraged. PMID:22194036
The emergency patient's participation in medical decision-making.

PubMed

Wang, Li-Hsiang; Goopy, Suzanne; Lin, Chun-Chih; Barnard, Alan; Han, Chin-Yen; Liu, Hsueh-Erh

2016-09-01

The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. The findings fill a gap in knowledge about the decision-making process among emergency patients. The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff. © 2016 John Wiley & Sons Ltd.
Are the GFRUP's recommendations for withholding or withdrawing treatments in critically ill children applicable? Results of a two‐year survey

PubMed Central

Cremer, R; Binoche, A; Noizet, O; Fourier, C; Leteurtre, S; Moutel, G; Leclerc, F

2007-01-01

Objective To evaluate feasibility of the guidelines of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French‐speaking group of paediatric intensive and emergency care; GFRUP) for limitation of treatments in the paediatric intensive care unit (PICU). Design A 2‐year prospective survey. Setting A 12‐bed PICU at the Hôpital Jeanne de Flandre, Lille, France. Patients Were included when limitation of treatments was expected. Results Of 967 children admitted, 55 were included with a 2‐day median delay. They were younger than others (24 v 60 months), had a higher paediatric risk of mortality (PRISM) score (14 v 4), and a higher paediatric overall performance category (POPC) score at admission (2 v 1); all p<0.002. 34 (50% of total deaths) children died. A limitation decision was made without meeting for 7 children who died: 6 received do‐not‐resuscitate orders (DNROs) and 1 received withholding decision. Decision‐making meetings were organised for 31 children, and the following decisions were made: 12 DNROs (6 deaths and 6 survivals), 4 withholding (1 death and 3 survivals), with 14 withdrawing (14 deaths) and 1 continuing treatment (survival). After limitation, 21 (31% of total deaths) children died and 10 survived (POPC score 4). 13 procedures were interrupted because of death and 11 because of clinical improvement (POPC score 4). Parents' opinions were obtained after 4 family conferences (for a total of 110 min), 3 days after inclusion. The first meeting was planned for 6 days after inclusion and held on the 7th day after inclusion; 80% of parents were immediately informed of the decision, which was implemented after half a day. Conclusions GFRUPs procedure was applicable in most cases. The main difficulties were anticipating the correct date for the meeting and involving nurses in the procedure. Children for whom the procedure was interrupted because of clinical improvement and who survived in poor condition without a formal decision pointed out the need for medical criteria for questioning, which should systematically lead to a formal decision‐making process. PMID:17329379
Fingernail Injuries and NASA's Integrated Medical Model

NASA Technical Reports Server (NTRS)

Kerstman, Eric; Butler, Doug

2008-01-01

The goal of space medicine is to optimize both crew health and performance. Currently, expert opinion is primarily relied upon for decision-making regarding medical equipment and supplies flown in space. Evidence-based decisions are preferred due to mass and volume limitations and the expense of space flight. The Integrated Medical Model (IMM) is an attempt to move us in that direction!

10 CFR 2.623 - Notice of hearing on application for early review of site suitability issues in combined license...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Combined License Under 10 Cfr Part...
10 CFR 2.604 - Notice of hearing on application for early review of site suitability issues in construction...

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Construction Permit § 2.604 Notice...
Using Constructivist Case Study Methodology to Understand Community Development Processes: Proposed Methodological Questions to Guide the Research Process

ERIC Educational Resources Information Center

Lauckner, Heidi; Paterson, Margo; Krupa, Terry

2012-01-01

Often, research projects are presented as final products with the methodologies cleanly outlined and little attention paid to the decision-making processes that led to the chosen approach. Limited attention paid to these decision-making processes perpetuates a sense of mystery about qualitative approaches, particularly for new researchers who will…
On Establishing a "Modus Vivendi": The Exercise of Agency in Decisions to Participate or Not Participate in Higher Education

ERIC Educational Resources Information Center

Kahn, Peter

2009-01-01

It is becoming increasingly clear that the notion of "removing barriers" offers a limited foundation for widening participation to higher education. Drawing on realist social theory, we consider how decisions to participate or not participate form part of a process to establish a "modus vivendi" or "way of life" for…
Money matters: Rapid post-earthquake financial decision-making

USGS Publications Warehouse

Wald, David J.; Franco, Guillermo

2016-01-01

Post-earthquake financial decision-making is a realm beyond that of many people. In the immediate aftermath of a damaging earthquake, billions of dollars of relief, recovery, and insurance funds are in the balance through new financial instruments that allow those with resources to hedge against disasters and those at risk to limit their earthquake losses and receive funds for response and recovery.
The Relationship between Professional Development Engagement and Career Decision Making Self-Efficacy, and Athletic Identity in College Students vs. College Student Athletes

ERIC Educational Resources Information Center

Janosko, Ashley Erin

2018-01-01

There has been limited research that focuses on Division III college student athletes and the career development process. Although previous researchers have studied the relationship between athletic identity and career decision making self-efficacy (CDMSE) among college student athletes, results have been inconsistent, with different researchers…
Frantic Voters: How Context Affects Voter Information Searches

ERIC Educational Resources Information Center

Seib, Jerod Drew

2012-01-01

Scholars have researched how voters make decisions for well over a half a century, but these studies are limited in what they are able to say about how voters make decisions because they have focused on the choice rather than the process. Most of these studies have focused on the choice that voters reach or the way their memories are structured,…
10 CFR 2.623 - Notice of hearing on application for early review of site suitability issues in combined license...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Combined License Under 10 Cfr Part...
10 CFR 2.623 - Notice of hearing on application for early review of site suitability issues in combined license...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Combined License Under 10 Cfr Part...
10 CFR 2.604 - Notice of hearing on application for early review of site suitability issues in construction...

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Construction Permit § 2.604 Notice...
10 CFR 2.604 - Notice of hearing on application for early review of site suitability issues in construction...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Notice of hearing on application for early review of site... Applicable to Early Partial Decisions on Site Suitability Issues in Connection With an Application for a... Limited Work Authorizations Early Partial Decisions on Site Suitability-Construction Permit § 2.604 Notice...
77 FR 52026 - Application for Final Commitment for a Long-term Loan or Financial Guarantee in Excess of $100...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-28

... at a later date, for short- and medium-haul passenger air service in East Asia, South Asia, and/or... Trading Limited. Guarantor(s): N/A. Description of Items Being Exported Boeing 737 aircraft. Information on Decision: Information on the final decision for this transaction will be available in the...
76 FR 50204 - Decision and Order Granting a Waiver to Fujitsu General Limited From the Department of Energy...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-12

... Refrigerant Flow (VRF) multi-split commercial heat pump models specified in Fujitsu's petition for waiver. As... to test and rate these AIRSTAGE V-II VRF multi-split commercial heat pumps. DATES: This Decision and...) Standard 1230-2010, ``Performance Rating of VRF Multi-Split Air-Conditioning and Heat Pump Equipment'' to...
From 'Parent' to 'Expert': How Parents of Children with Autism Spectrum Disorder Make Decisions about Which Intervention Approaches to Access

ERIC Educational Resources Information Center

Edwards, Amelia G.; Brebner, Chris M.; McCormack, Paul F.; MacDougall, Colin J.

2018-01-01

Parents of children with Autism Spectrum Disorder are responsible for deciding which interventions to implement with their child. There is limited research examining parental decision-making with regards to intervention approaches. A constructivist grounded theory methodology was implemented in this study. Semi-structured interviews were…
20 CFR 401.70 - Appeals of refusals to correct records or refusals to allow access to records.

Code of Federal Regulations, 2010 CFR

2010-04-01

... explaining the decision on your appeal. The time limit for making our decision after we receive your appeal... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Appeals of refusals to correct records or refusals to allow access to records. 401.70 Section 401.70 Employees' Benefits SOCIAL SECURITY...
An Investigation of Factors Related to the Retention of Teachers in Rural Middle Schools

ERIC Educational Resources Information Center

Dixon, Timothy M.

2012-01-01

Studies about factors specific to rural middle-school teachers' decisions to remain in the profession are limited. Within a framework of Boylan's spheres of influence, the purpose of this qualitative descriptive case study was to investigate the factors that teachers considered to be most important in decisions to remain teaching in a rural middle…
A Qualitative Exploration of Mattering and Belonging in the Transfer Student Experience

ERIC Educational Resources Information Center

Woodward, William Charles

2013-01-01

Limited research has been conducted on how students' experiences at the colleges in which they initially enroll factor into the decision of where to transfer once a decision to leave the initial institution is made. This study addresses the issue in a context of mattering and belonging among college students. The data analyzed for this qualitative…
Reasoning, learning, and creativity: frontal lobe function and human decision-making.

PubMed

Collins, Anne; Koechlin, Etienne

2012-01-01

The frontal lobes subserve decision-making and executive control--that is, the selection and coordination of goal-directed behaviors. Current models of frontal executive function, however, do not explain human decision-making in everyday environments featuring uncertain, changing, and especially open-ended situations. Here, we propose a computational model of human executive function that clarifies this issue. Using behavioral experiments, we show that unlike others, the proposed model predicts human decisions and their variations across individuals in naturalistic situations. The model reveals that for driving action, the human frontal function monitors up to three/four concurrent behavioral strategies and infers online their ability to predict action outcomes: whenever one appears more reliable than unreliable, this strategy is chosen to guide the selection and learning of actions that maximize rewards. Otherwise, a new behavioral strategy is tentatively formed, partly from those stored in long-term memory, then probed, and if competitive confirmed to subsequently drive action. Thus, the human executive function has a monitoring capacity limited to three or four behavioral strategies. This limitation is compensated by the binary structure of executive control that in ambiguous and unknown situations promotes the exploration and creation of new behavioral strategies. The results support a model of human frontal function that integrates reasoning, learning, and creative abilities in the service of decision-making and adaptive behavior.
Decentralized Opportunistic Spectrum Resources Access Model and Algorithm toward Cooperative Ad-Hoc Networks.

PubMed

Liu, Ming; Xu, Yang; Mohammed, Abdul-Wahid

2016-01-01

Limited communication resources have gradually become a critical factor toward efficiency of decentralized large scale multi-agent coordination when both system scales up and tasks become more complex. In current researches, due to the agent's limited communication and observational capability, an agent in a decentralized setting can only choose a part of channels to access, but cannot perceive or share global information. Each agent's cooperative decision is based on the partial observation of the system state, and as such, uncertainty in the communication network is unavoidable. In this situation, it is a major challenge working out cooperative decision-making under uncertainty with only a partial observation of the environment. In this paper, we propose a decentralized approach that allows agents cooperatively search and independently choose channels. The key to our design is to build an up-to-date observation for each agent's view so that a local decision model is achievable in a large scale team coordination. We simplify the Dec-POMDP model problem, and each agent can jointly work out its communication policy in order to improve its local decision utilities for the choice of communication resources. Finally, we discuss an implicate resource competition game, and show that, there exists an approximate resources access tradeoff balance between agents. Based on this discovery, the tradeoff between real-time decision-making and the efficiency of cooperation using these channels can be well improved.
[The role of epidemiology in the process of decision-making].

PubMed

Prost, A

1997-01-01

Epidemiology is the method of choice for quantifying and interpreting health phenomena, placing them into perspective to allow trend analysis and projections. It is a tool for analysis, evaluation and forecasting and is thus indispensable in the decision-making process. However, this comprehensive technique has its limitations since health is the result of complex interactions: individual requirements do not always correspond to the overall needs of the community; consideration has to be given to solidarity and the necessity for cost-sharing; and the decision process is strongly influenced by social, cultural, religious and political factors which defy quantification and, on occasion, any rational course of action. Each indicator only takes into account one aspect of the situation and the pertinent indicator should therefore be carefully selected. At the same time, any choice implicitly signifies value judgements-often unnoticed-which need to be balanced and validated in relation to the ethical values of the community in order to be of any assistance to decision-making. Decision-making is a qualitative political process which, although based on the quantitative analysis supplied by epidemiology, cannot be limited to it. Each approach enhance the other, but they should not be confused if freedom to act is to be preserved from being locked into some kind of mechanical process that is unacceptable both to man and to society.

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