Priority setting: what constitutes success? A conceptual framework for successful priority setting

PubMed Central

Sibbald, Shannon L; Singer, Peter A; Upshur, Ross; Martin, Douglas K

2009-01-01

Background The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. Methods Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation of patients, caregivers and policy makers; and Delphi study including scholars and decision makers from five countries). Results This paper synthesizes the findings from three studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. Conclusion The ten elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome components. To our knowledge, this is the first framework that describes successful priority setting. The ten elements identified in this research provide guidance for decision makers and a common language to discuss priority setting success and work toward improving priority setting efforts. PMID:19265518

Use of economic evaluation in local health care decision-making in England: a qualitative investigation.

PubMed

Eddama, Oya; Coast, Joanna

2009-03-01

To explore decision-making and the use of economic evaluation at the local health care decision-making level in England (UK). Data collection was over a 16-month period (January 2003 to April 2004). Data collection comprised 29 in-depth interviews with a range of decision makers, 13 observations of decision-making meetings, and analysis of documents produced at meetings. A constant comparative approach was used to identify broad themes and sub-themes arising from the data. Data were analysed using Microsoft Word. National Institute for Health and Clinical Excellence (NICE) guidance provides the main way in which economic evaluation is used at a local level in the UK, although following NICE guidance is often regarded as detrimental to pursuing local priorities. Other than through NICE, economic evaluation is not considered at the local level; we found no evidence for use at the meeting group (by individuals). Although decision makers appear to understand notions of scarcity, with some also referring to value for money, the process of decision-making departs from these principles in practice. Disinvestment decisions are not made nor are decisions weighted against pre-defined criteria. Options appraisal is conducted, but it does not embody the principles of economic evaluation, since options are not considered in terms of their costs and benefits and opportunity cost is not accounted for. There appear to be two reasons why economic evaluation is not used at the local level: (1) the nature of management decisions concerned with the employment of extra staff and new equipment, rather than the choice of medicines or specific interventions usually assessed in published economic evaluation; (2) lack of awareness of the economic evaluation approach to decision-making. These two factors point to a lack of freedom in decision-making at the local level and a lack of understanding of how priority setting can be achieved in practice. A more detailed and rigorous approach to prioritisation at the local level is required. Whilst, PCTs have been given greater responsibility for priority setting, they lack the necessary power and understanding of the ways in which long term solutions to problems in health care can be achieved. Economics can be a valuable asset to priority setting and has already filtered into the jargon used by decision makers. Whilst most concepts are understood, the leap to adopting these concepts into the practice of decision-making needs to be made.

California Policy Options to Accelerate Latino Student Success in Higher Education

ERIC Educational Resources Information Center

Santiago, Deborah A.

2006-01-01

California policy makers and institutional leaders are making critical policy, programmatic, and budgetary decisions affecting segments of the state's population that lack sufficient levels of formal training and education. These decisions are occurring at a time when five critical trends are converging in the state. These trends are: (1)…

US Principals' Attitudes about and Experiences with Single-Sex Schooling

ERIC Educational Resources Information Center

Fabes, Richard A.; Pahlke, Erin; Borders, Adrienne Z.; Galligan, Kathrine

2015-01-01

Despite a lack of scientific evidence supporting the use of single-sex education, the number of US public schools offering single-sex education has increased. However, our understanding as to why decision-makers have implemented single-sex education is lacking. To address this gap, we surveyed US public school principals and assessed their…

Effects-Based Targeting: Another Empty Promise?

DTIC Science & Technology

2001-12-01

lack of coherent campaign planning; lack of adequate component staffing ; the race to find suitable targets. . . . [The] OPLAN focused on brief, sin- gle...effect an action, such as loss of electricity, might have on enemy will or morale. Lacking this knowledge, analysts simply defaulted to ethnocentric ...heavily ethnocentric interpretation of what should have happened. In the majority of the cases, information that gave decision makers confidence

Priority setting in the provincial health services authority: survey of key decision makers

PubMed Central

Teng, Flora; Mitton, Craig; MacKenzie, Jennifer

2007-01-01

Background In recent years, decision makers in Canada and elsewhere have expressed a desire for more explicit, evidence-based approaches to priority setting. To achieve this aim within health care organizations, knowledge of both the organizational context and stakeholder attitudes towards priority setting are required. The current work adds to a limited yet growing body of international literature describing priority setting practices in health organizations. Methods A qualitative study was conducted using in-depth, face-to-face interviews with 25 key decision makers of the Provincial Health Services Authority (PHSA) of British Columbia. Major themes and sub-themes were identified through content analysis. Results Priorities were described by decision makers as being set in an ad hoc manner, with resources generally allocated along historical lines. Participants identified the Strategic Plan and a strong research base as strengths of the organization. The main areas for improvement were a desire to have a more transparent process for priority setting, a need to develop a culture which supports explicit priority setting, and a focus on fairness in decision making. Barriers to an explicit allocation process included the challenge of providing specialized services for disparate patient groups, and a lack of formal training in priority setting amongst decision makers. Conclusion This study identified factors important to understanding organizational context and informed next steps for explicit priority setting for a provincial health authority. While the PHSA is unique in its organizational structure in Canada, lessons about priority setting should be transferable to other contexts. PMID:17565691

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.

Enhancing the informed consent process for critical care research: strategies from a thromboprophylaxis trial.

PubMed

Smith, Orla M; McDonald, Ellen; Zytaruk, Nicole; Foster, Denise; Matte, Andrea; Clarke, France; Fleury, Suzie; Krause, Katie; McArdle, Tracey; Skrobik, Yoanna; Cook, Deborah J

2013-12-01

Critically ill patients lack capacity for decisions about research participation. Consent to enrol these patients in studies is typically obtained from substitute decision-makers. To present strategies that may optimise the process of obtaining informed consent from substitute decision-makers for participation of critically ill patients in trials. We use examples from a randomised trial of heparin thromboprophylaxis in the intensive care unit (PROTECT, clinicaltrials.gov NCT00182143). 3764 patients were randomised, with an informed consent rate of 82%; 90% of consents were obtained from substitute decision-makers. North American PROTECT research coordinators attended three meetings to discuss enrolment: (1) Trial start-up (January 2006); (2) Near trial closure (January 2010); and (3) Post-publication (April 2011). Data were derived from slide presentations, field notes from break-out groups and plenary discussions, then analysed inductively. We derived three phases for the informed consent process: (1) Preparation for the Consent Encounter; (2) The Consent Encounter; and (3) Follow-up to the Consent Encounter. Specific strategies emerged for each phase: Phase 1 (four strategies); Phase 2 (six strategies); and Phase 3 (three strategies). We identified 13 strategies that may improve the process of obtaining informed consent from substitute decision-makers and be generalisable to other settings and studies. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

An Overview of Evidence-Based Program Registers (EBPRs) for Behavioral Health

PubMed Central

Burkhardt, Jason T.; Schröter, Daniela C.; Magura, Stephen; Means, Stephanie N.; Coryn, Chris L.S.

2015-01-01

Evaluations of behavioral health interventions have identified many that are potentially effective. However, clinicians and other decision makers typically lack the time and ability to effectively search and synthesize the relevant research literature. In response to this opportunity, and to increasing policy and funding pressures for the use of evidence-based practices, a number of “what works” websites have emerged to assist decision makers in selecting interventions with the highest probability of benefit. However, these registers as a whole are not well understood. This article, which represents phase one of a concurrent mixed methods study, presents a review of the scopes, structures, dissemination strategies, uses, and challenges faced by evidence-based registers in the behavioral health disciplines. The major findings of this study show that in general, registers of evidence-based practices are able, to a degree, to identify the most effective practices and meet the needs of decision makers. However, much needs to be done to improve the ability of the registers to fully realize their purpose. PMID:25450777

Understanding Mali: Lessons for Policy Makers

DTIC Science & Technology

2014-06-01

and health care . By the same token, the corruption and ethnic inequalities that are rampant in weak and failed states show an obvious lack of social ...one of the means used to take care of the terrorist threat. However, conflicts against terrorists groups such as in Afghanistan have proven long and...instability that led to the present situation in Mali, this study aspires to provide decision makers with concrete factors that should deserve careful

Social Priorities as Data

NASA Astrophysics Data System (ADS)

Grubert, E.

2015-12-01

Decision makers' responses to local risks and expected changes to a community from circumstances like natural hazards, human developments, and demographic changes can greatly affect social and environmental outcomes in a community. Translating physical data based in disciplines like engineering and geosciences into positive outcomes for communities can be challenging and often results in conflict that appears to pit "science" against "the public." Scientists can be reluctant to offer recommendations for action based on their work, often (and often correctly) noting that their role is not to make value judgments for a community - particularly for a community that is not their own. Conversely, decision makers can be frustrated by the lack of guidance they receive to help translate data into effective and acceptable action. The solution posed by this submission, given the goal of co-production of knowledge by scientists and decision makers to foster better community outcomes, is to involve the community directly by integrating social scientific methods that address decision making and community engagement to the scientist-decision maker interaction. Specifically, the missing dataset in many scientist-decision maker interactions is the nature of community priorities. Using scientifically valid methods to rigorously collect and characterize community priorities to help recommend tradeoffs between different outcomes indicated by the work of physical and natural scientists can bridge the gap between science and action by involving the community in the process. This submission presents early work on US preferences for different types of social and environmental outcomes designed to integrate directly with engineering and physical science frameworks like Life Cycle Assessment and Environmental Impact Statements. Cardinal preference data are based on surveys of US adults using tools like the Analytical Hierarchy Process, budget allocation, and ranking.

Habitat scale mapping of fisheries ecosystem services values in estuaries

EPA Science Inventory

Little is known about the variability of ecosystem service values at spatial scales most relevant to local decision makers. Competing definitions of ecosystem services, the paucity of ecological and economic information and the lack of standardization in methodology are major ob...

Interval-valued distributed preference relation and its application to group decision making

PubMed Central

Liu, Yin; Xue, Min; Chang, Wenjun; Yang, Shanlin

2018-01-01

As an important way to help express the preference relation between alternatives, distributed preference relation (DPR) can represent the preferred, non-preferred, indifferent, and uncertain degrees of one alternative over another simultaneously. DPR, however, is unavailable in some situations where a decision maker cannot provide the precise degrees of one alternative over another due to lack of knowledge, experience, and data. In this paper, to address this issue, we propose interval-valued DPR (IDPR) and present its properties of validity and normalization. Through constructing two optimization models, an IDPR matrix is transformed into a score matrix to facilitate the comparison between any two alternatives. The properties of the score matrix are analyzed. To guarantee the rationality of the comparisons between alternatives derived from the score matrix, the additive consistency of the score matrix is developed. In terms of these, IDPR is applied to model and solve multiple criteria group decision making (MCGDM) problem. Particularly, the relationship between the parameters for the consistency of the score matrix associated with each decision maker and those for the consistency of the score matrix associated with the group of decision makers is analyzed. A manager selection problem is investigated to demonstrate the application of IDPRs to MCGDM problems. PMID:29889871

How to survive the medical misinformation mess.

PubMed

Ioannidis, John P A; Stuart, Michael E; Brownlee, Shannon; Strite, Sheri A

2017-11-01

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders. © 2017 Stichting European Society for Clinical Investigation Journal Foundation.

Science informed water resources decision-making: Examples using remote sensing observations in East Africa, the Lower Mekong Basin and the western United States

NASA Astrophysics Data System (ADS)

Granger, S. L.; Andreadis, K.; Das, N.; Farr, T. G.; Ines, A. V. M.; Jayasinghe, S.; Jones, C. E.; Melton, F. S.; Ndungu, L. W.; Lai-Norling, J.; Painter, T. H.

2017-12-01

Across the globe, planners and decision makers are often hampered by organizational and data silos and/or a lack of historic data or scant in situ observations on which to base policy and action plans. The end result is a complex interaction of responsibilities, legal frameworks, and stakeholder needs guided by uncertain information that is essentially bounded by how climate extremes are defined and characterized. Because of the importance of water, considerable resources in the developing and developed world are invested in data and tools for managing water. However, the existing paradigm of water management around the world faces significant challenges including inadequate funding to install, maintain or upgrade monitoring networks, lack of resources to integrate new science and data sources into existing tools, and demands for improved spatial coverage of observations. Add to this, a changing hydrology that is so complex it requires measurements and analyses that have never been done before. Interest in applying remote sensing science and observations into the decision making process is growing the world over, but in order to succeed, it is essential to form partnerships with stakeholder organizations and decision makers at the outset. In this talk, we describe examples of succesful decision-maker and science partnering based on projects that apply remote sensing science and observations in East Africa and the Lower Mekong Basin supported by the SERVIR Initiative, a joint United States Agency for International Development (USAID) and National Aeronautics and Space Administration (NASA) program, and projects in the western United States supported by NASA's Jet Propulsion Laboratory and the Western Water Applications Office (WWAO). All of these examples have benefitted from strong, committed partnerships with end user agencies. Best practices and lessons learned in connecting science to decision making amongst these examples are explored.

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

USGS Publications Warehouse

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

2010-01-01

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

Distributive justice and infertility treatment in Canada.

PubMed

Nisker, Jeff

2008-05-01

An exploration of distributive justice in Canadian infertility treatment requires the integration of ethical, clinical, and economic principles. In 1971, American philosopher John Rawls proposed a theoretical model for fair decision-making in which "rational" and "self-interested" citizens are behind a "veil of ignorance" with respect to both their own position and the position of other decision-makers. Rawls proposed that these self-interested decision-makers, fearing that they are among the least advantaged persons who could be affected by the decision, will agree only upon rules that encode equality of opportunity and that bestow the greatest benefit on the least advantaged citizens. Regarding health policy decision-making, Rawls' model is best illustrated by Canadian philosopher Warren Bourgeois in his panel of "volunteers." These rational and self-interested volunteers receive an amnestic drug that renders them unaware of their health, social, and financial position, but they know that they are representative of diverse spheres of citizens whose well-being will be affected by their decision. After describing fair decision-making, Bourgeois considers the lack of a distributive justice imperative in Canada's Assisted Human Reproduction Act, in contrast to legislation in European nations and Australia, summarizes the economic and clinical considerations that must be provided to the decision-makers behind the "veil of ignorance" for fair decisions to occur, and considers altruism in relation to equality of access. He concludes by noting that among countries with legislation governing assisted reproduction Canada is alone in having legislation that is void of distributive justice in providing access to clinically appropriate infertility care.

Factors influencing decision regret regarding placement of a PEG among substitute decision-makers of older persons in Japan: a prospective study.

PubMed

Kuraoka, Yumiko; Nakayama, Kazuhiro

2017-06-28

A tube feeding decision aid designed at the Ottawa Health Research Institute was specifically created for substitute decision-makers who must decide whether to allow placement of a percutaneous endoscopic gastrostomy (PEG) tube in a cognitively impaired older person. We developed a Japanese version and found that the decision aid promoted the decision-making process of substitute decision-makers to decrease decisional conflict and increase knowledge. However, the factors that influence decision regret among substitute decision-makers were not measured after the decision was made. The objective of this study was to explore the factors that influence decision regret among substitute decision-makers 6 months after using a decision aid for PEG placement. In this prospective study, participants comprised substitute decision-makers for 45 inpatients aged 65 years and older who were being considered for placement of a PEG tube in hospitals, nursing homes and patients' homes in Japan. The Decisional Conflict Scale (DCS) was used to evaluate decisional conflict among substitute decision-makers immediately after deciding whether to introduce tube feeding and the Decision Regret Scale (DRS) was used to evaluate decisional regret among substitute decision-makers 6 months after they made their decision. Normalized scores were evaluated and analysis of variance was used to compare groups. The results of the multiple regression analysis suggest that PEG placement (P < .01) and decision conflict (P < .001) are explanatory factors of decision regret regarding placement of a PEG among substitute decision-makers. PEG placement and decision conflict immediately after deciding whether to allow PEG placement have an influence on decision regret among substitute decision-makers after 6 months.

What do decision makers learn from public forums on climate-related hazards and resilience?

NASA Astrophysics Data System (ADS)

Weller, N.; Farooque, M.; Sittenfeld, D.

2017-12-01

Public engagement around climate resilience efforts can foster learning for both public audiences and decision makers. On the one hand, public audiences learn about environmental hazards and strategies to increase community resilience through effective public engagement. On the other, decision makers and scientists learn about community members' values and priorities and their relation to environmental hazards and resilience strategies. Evidence from other public engagement efforts involving decision makers suggests that decision maker involvement results in reflection by officials on their own values, capacities, and roles. However, few public engagement exercises evaluate impacts on decision makers. As part of the Science Center Public Forums project, which aims to conduct public forums in eight cities across the country on resiliency to drought, heat, extreme precipitation, and sea level rise, we sought to 1) build partnerships with local decision makers and scientists around public forums and 2) explore how decision makers and scientists interacted with the planning and undertaking of those public forums. We held workshops with decision makers and scientists to inform forum content and identify local resilience issues. We will conduct interviews with local decision makers regarding their involvement in forum planning, their reflections and takeaways from the forum itself, and their perspectives on the value of public engagement for policy making. We will present our model of engagement with decision makers, initial findings from interviews, and lessons learned from connecting decision makers and scientists to public engagement efforts.

Possibilities and hindrances for prevention of intimate partner violence: perceptions among professionals and decision makers in a Swedish medium-sized town.

PubMed

Jakobsson, A; von Borgstede, C; Krantz, G; Spak, F; Hensing, G

2013-09-01

Intimate partner violence (IPV) is a major public health problem, but few evidence-based prevention programs have yet been implemented. This study explored the perceptions and beliefs of local-level decision makers, social and health-care professionals, and representatives from the police force regarding the possibilities and hindrances for prevention of IPV. An explorative qualitative approach was used, and participants were strategically selected for focus group discussions. The participants, 19 men and 23 women, were professionals or decision makers within health-care services, social welfare, municipal administration, the police force, local industry, and local politicians in a Swedish town of 54,000 inhabitants. The focus group discussions were audio recorded, transcribed verbatim, and thematically analyzed. A manifest content analysis was performed on the text. Preschools, schools, sports associations, workplaces, and the mass media were suggested as possible arenas for prevention measures. The proposed activities included norm building and improved social support structures. Hindrances were conceptualized as societal beliefs and attitudes, shame, silence, gender inequality, the counteracting influence of the media, and lack of resources. The participants demonstrated closeness and distance to IPV, expressed as acceptance or referral of responsibility to others regarding where and by whom prevention measures should be executed. This study gave new insights in the prevailing perceptions of professionals and decision makers of a medium-sized Swedish town, which can be a useful knowledge in future preventive work and contribute to bridge the gap between research and practice.

Financial Literacy of Freshmen Business School Students

ERIC Educational Resources Information Center

Rosacker, Kirsten M.; Ragothaman, Srini; Gillispie, Michael

2009-01-01

In recent years, financial literacy has increasingly captured the attention of the banking and financial industries, policy makers, government agencies, public interest groups, and members of the news media. These interested parties are concerned that consumers lack the basic skills required to make decisions beneficial to their economic welfare.…

Leadership in ICT Integration and Its Impact on the Haitian Economy

ERIC Educational Resources Information Center

Louis-Jacques, Carmel G.

2013-01-01

As attention increasingly focuses on the role of information communication technology (ICT) in augmenting the efficiency of institutions, researchers have postulated that implementation of effective ICT enables decision makers to explore opportunities and maximize benefits. Review of current literature revealed a lack of information on how Haitian…

Critical Thinking for Natural Resource, Agricultural, and Environmental Ethics Education

ERIC Educational Resources Information Center

Quinn, Courtney; Burbach, Mark E.; Matkin, Gina S.; Flores, Kevin

2009-01-01

Future decision makers in natural resource fields will be required to make judgments on issues that lack clear solutions and with information complicated by ethical challenges. Therefore, natural resource, environmental, and agricultural professionals must possess the ability to think critically about the consequences of policy, economic systems,…

The Costs of Reneging: Reputation and Alliance Formation

ERIC Educational Resources Information Center

Gibler, Douglas M.

2008-01-01

Reputations are supposed to matter. Decision makers consistently refer to reputations for resolve, and international relations theories confirm the value of being able to credibly signal intentions during times of crisis. However, empirical support for the effects of reputation has been lacking. Problems of strategic selection have hampered…

Developing Tomorrow's Decision-Makers: Opportunities for Biotechnology Education Research

ERIC Educational Resources Information Center

Hilton, Annette; Nichols, Kim; Kanasa, Harry

2011-01-01

Globally, science curricula have been described as outdated, and students perceive school science as lacking in relevance. Declines in senior secondary and tertiary student participation in science indicate an urgent need for change if we are to sustain future scientific research and development, and perhaps more importantly, to equip students…

Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers.

PubMed

Zegeye, Elias Asfaw; Mbonigaba, Josue; Kaye, Sylvia Blanche; Wilkinson, Thomas

2017-02-01

Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE. This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia. In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas. A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting. The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.

Who to Blame: Irrational Decision-Makers or Stupid Modelers? (Arne Richter Award for Outstanding Young Scientists Lecture)

NASA Astrophysics Data System (ADS)

Madani, Kaveh

2016-04-01

Water management benefits from a suite of modelling tools and techniques that help simplifying and understanding the complexities involved in managing water resource systems. Early water management models were mainly concerned with optimizing a single objective, related to the design, operations or management of water resource systems (e.g. economic cost, hydroelectricity production, reliability of water deliveries). Significant improvements in methodologies, computational capacity, and data availability over the last decades have resulted in developing more complex water management models that can now incorporate multiple objectives, various uncertainties, and big data. These models provide an improved understanding of complex water resource systems and provide opportunities for making positive impacts. Nevertheless, there remains an alarming mismatch between the optimal solutions developed by these models and the decisions made by managers and stakeholders of water resource systems. Modelers continue to consider decision makers as irrational agents who fail to implement the optimal solutions developed by sophisticated and mathematically rigours water management models. On the other hand, decision makers and stakeholders accuse modelers of being idealist, lacking a perfect understanding of reality, and developing 'smart' solutions that are not practical (stable). In this talk I will have a closer look at the mismatch between the optimality and stability of solutions and argue that conventional water resources management models suffer inherently from a full-cooperation assumption. According to this assumption, water resources management decisions are based on group rationality where in practice decisions are often based on individual rationality, making the group's optimal solution unstable for individually rational decision makers. I discuss how game theory can be used as an appropriate framework for addressing the irrational "rationality assumption" of water resources management models and for better capturing the social aspects of decision making in water management systems with multiple stakeholders.

Against all odds -- Probabilistic forecasts and decision making

NASA Astrophysics Data System (ADS)

Liechti, Katharina; Zappa, Massimiliano

2015-04-01

In the city of Zurich (Switzerland) the setting is such that the damage potential due to flooding of the river Sihl is estimated to about 5 billion US dollars. The flood forecasting system that is used by the administration for decision making runs continuously since 2007. It has a time horizon of max. five days and operates at hourly time steps. The flood forecasting system includes three different model chains. Two of those are run by the deterministic NWP models COSMO-2 and COSMO-7 and one is driven by the probabilistic NWP COSMO-Leps. The model chains are consistent since February 2010, so five full years are available for the evaluation for the system. The system was evaluated continuously and is a very nice example to present the added value that lies in probabilistic forecasts. The forecasts are available on an online-platform to the decision makers. Several graphical representations of the forecasts and forecast-history are available to support decision making and to rate the current situation. The communication between forecasters and decision-makers is quite close. To put it short, an ideal situation. However, an event or better put a non-event in summer 2014 showed that the knowledge about the general superiority of probabilistic forecasts doesn't necessarily mean that the decisions taken in a specific situation will be based on that probabilistic forecast. Some years of experience allow gaining confidence in the system, both for the forecasters and for the decision-makers. Even if from the theoretical point of view the handling during crisis situation is well designed, a first event demonstrated that the dialog with the decision-makers still lacks of exercise during such situations. We argue, that a false alarm is a needed experience to consolidate real-time emergency procedures relying on ensemble predictions. A missed event would probably also fit, but, in our case, we are very happy not to report about this option.

National policy-makers speak out: are researchers giving them what they need?

PubMed Central

Hyder, Adnan A; Corluka, Adrijana; Winch, Peter J; El-Shinnawy, Azza; Ghassany, Harith; Malekafzali, Hossein; Lim, Meng-Kin; Mfutso-Bengo, Joseph; Segura, Elsa; Ghaffar, Abdul

2011-01-01

The objective of this empirical study was to understand the perspectives and attitudes of policy-makers towards the use and impact of research in the health sector in low- and middle-income countries. The study used data from 83 semi-structured, in-depth interviews conducted with purposively selected policy-makers at the national level in Argentina, Egypt, Iran, Malawi, Oman and Singapore. The interviews were structured around an interview guide developed based on existing literature and in consultation with all six country investigators. Transcripts were processed using a thematic-analysis approach. Policy-makers interviewed for this study were unequivocal in their support for health research and the high value they attribute to it. However, they stated that there were structural and informal barriers to research contributing to policy processes, to the contribution research makes to knowledge generally, and to the use of research in health decision-making specifically. Major findings regarding barriers to evidence-based policy-making included poor communication and dissemination, lack of technical capacity in policy processes, as well as the influence of the political context. Policy-makers had a variable understanding of economic analysis, equity and burden of disease measures, and were vague in terms of their use in national decisions. Policy-maker recommendations regarding strategies for facilitating the uptake of research into policy included improving the technical capacity of policy-makers, better packaging of research results, use of social networks, and establishment of fora and clearinghouse functions to help assist in evidence-based policy-making. PMID:20547652

The impact of geographic information systems on emergency management decision making at the U.S. Department of Homeland Security

NASA Astrophysics Data System (ADS)

King, Steven Gray

Geographic information systems (GIS) reveal relationships and patterns from large quantities of diverse data in the form of maps and reports. The United States spends billions of dollars to use GIS to improve decisions made during responses to natural disasters and terrorist attacks, but precisely how GIS improves or impairs decision making is not known. This research examined how GIS affect decision making during natural disasters, and how GIS can be more effectively used to improve decision making for emergency management. Using a qualitative case study methodology, this research examined decision making at the U.S. Department of Homeland Security (DHS) during a large full-scale disaster exercise. This study indicates that GIS provided decision makers at DHS with an outstanding context for information that would otherwise be challenging to understand, especially through the integration of multiple data sources and dynamic three-dimensional interactive maps. Decision making was hampered by outdated information, a reliance on predictive models based on hypothetical data rather than actual event data, and a lack of understanding of the capabilities of GIS beyond cartography. Geospatial analysts, emergency managers, and other decision makers who use GIS should take specific steps to improve decision making based on GIS for disaster response and emergency management.

Family Communication about End-of-Life Decisions and the Enactment of the Decision-Maker Role.

PubMed

Trees, April R; Ohs, Jennifer E; Murray, Meghan C

2017-06-07

End-of-life (EOL) decisions in families are complex and emotional sites of family interaction necessitating family members coordinate roles in the EOL decision-making process. How family members in the United States enact the decision-maker role in EOL decision situations was examined through in-depth interviews with 22 individuals who participated in EOL decision-making for a family member. A number of themes emerged from the data with regard to the enactment of the decision-maker role. Families varied in how decision makers enacted the role in relation to collective family input, with consulting, informing and collaborating as different patterns of behavior. Formal family roles along with gender- and age-based roles shaped who took on the decision-maker role. Additionally, both family members and medical professionals facilitated or undermined the decision-maker's role enactment. Understanding the structure and enactment of the decision-maker role in family interaction provides insight into how individuals and/or family members perform the decision-making role within a cultural context that values autonomy and self-determination in combination with collective family action in EOL decision-making.

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

NASA Astrophysics Data System (ADS)

Becker, Jörg; Bergener, Philipp; Räckers, Michael

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

Dynamic simulation modelling of policy responses to reduce alcohol-related harms: rationale and procedure for a participatory approach.

PubMed

Atkinson, Jo-An; O'Donnell, Eloise; Wiggers, John; McDonnell, Geoff; Mitchell, Jo; Freebairn, Louise; Indig, Devon; Rychetnik, Lucie

2017-02-15

Development of effective policy responses to address complex public health problems can be challenged by a lack of clarity about the interaction of risk factors driving the problem, differing views of stakeholders on the most appropriate and effective intervention approaches, a lack of evidence to support commonly implemented and acceptable intervention approaches, and a lack of acceptance of effective interventions. Consequently, political considerations, community advocacy and industry lobbying can contribute to a hotly contested debate about the most appropriate course of action; this can hinder consensus and give rise to policy resistance. The problem of alcohol misuse and its associated harms in New South Wales (NSW), Australia, provides a relevant example of such challenges. Dynamic simulation modelling is increasingly being valued by the health sector as a robust tool to support decision making to address complex problems. It allows policy makers to ask 'what-if' questions and test the potential impacts of different policy scenarios over time, before solutions are implemented in the real world. Participatory approaches to modelling enable researchers, policy makers, program planners, practitioners and consumer representatives to collaborate with expert modellers to ensure that models are transparent, incorporate diverse evidence and perspectives, are better aligned to the decision-support needs of policy makers, and can facilitate consensus building for action. This paper outlines a procedure for embedding stakeholder engagement and consensus building in the development of dynamic simulation models that can guide the development of effective, coordinated and acceptable policy responses to complex public health problems, such as alcohol-related harms in NSW.

49 CFR 1503.659 - Petition to reconsider or modify a final decision and order of the TSA decision maker on appeal.

Code of Federal Regulations, 2010 CFR

2010-10-01

... and order of the TSA decision maker on appeal. 1503.659 Section 1503.659 Transportation Other... Practice in TSA Civil Penalty Actions § 1503.659 Petition to reconsider or modify a final decision and order of the TSA decision maker on appeal. (a) General. Any party may petition the TSA decision maker to...

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

Integrating Postsecondary Program Planning and Employment Demand. AIR Forum Paper 1978.

ERIC Educational Resources Information Center

Hall, Toni

A major state-coordinated program in Texas is helping education decision makers and the general public who need information about inputs, activities and cost, and also about the results and impacts of educational programs. Educators have encountered two major problems in obtaining information for effective planning and management: the lack of…

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.

Clarifying the disagreements on various reuse options: Repair, recondition, refurbish and remanufacture.

PubMed

Gharfalkar, Mangesh; Ali, Zulfiqur; Hillier, Graham

2016-10-01

Earth's natural resources are finite. To be environmentally sustainable, it may not only be necessary to use them 'efficiently' but also 'effectively'. While we consider 'repair', 'recondition', 'refurbish' and 'remanufacture' to be 'reuse' options, not all researchers agree. Also, there is lack of clarity between the different options that are likely to be challenging for both; the policy makers who formulate policies aimed to encourage 'reuse' of 'waste' products and for decision makers to initiate appropriate action for recovering 'reusable resources' from 'waste streams'. This dichotomy could result into more 'waste' to landfill. A systematic analysis of peer reviewed literature is conducted to understand inconsistencies and/or lack of clarity that exist between the definitions or descriptions of identified `reuse' options. This article proposes a 'hierarchy of reuse options' that plots the relative positions of identified 'reuse' options vis-à-vis five variables, namely work content, energy requirement, cost, performance and warranty. Recommendations are made on how to incentivise original equipment manufacturers (OEMs) to 'remanufacture'. Finally, an alternative 'Type II Resource Effective Close-loop Model' is suggested and a conceptual 'Type II/2 Model of Resource Flows' that is restricted to the use of environmentally benign and renewable resources is introduced. These suggestions are likely to help decision makers to prioritise between 'reuse' options, drive resource effectiveness and also environmental sustainability. © The Author(s) 2016.

Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers

PubMed Central

Clavel, Nathalie; De coster, Carolyn; Pomey, Marie-Pascale; Sanmartin, Claudia; Bohm, Éric; Dunbar, Michael J.; Frank, CY; Hawker, Gillian; Noseworthy, Tom

2016-01-01

Background: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. Objective: While our previous research focused on the appropriateness of TJR from clinical and patient perspectives, this study is aimed at understanding decision-makers' perspectives. Methods: Using a semi-structured guide, we interviewed a convenience sample of decision-makers in four Canadian provinces (Alberta, Manitoba, Nova Scotia and Quebec) between February and March 2013. For the purposes of this study, a decision-maker was defined as a manager, institutional leader or policy maker. Results: Fifteen interviews were conducted with decision-makers at ministry (n = 3), regional (n = 6) and institutional levels (n = 8). Decision-makers see themselves as having a key role in the appropriateness discourse, that of optimizing resource allocation and efficient delivery of services for TJR, to improve population outcomes. Conclusion: The decision-makers' view of appropriateness recognizes the importance of the clinical view, but it offers a very different input into the appropriateness discourse, more closely aligned with appropriateness of setting, which refers to cost-effectiveness considerations. PMID:27027795

New institutional mechanisms to bridge the information gap between climate science and public policy decisions

NASA Astrophysics Data System (ADS)

Rogers, W.; Gulledge, J. M.

2010-12-01

Many decision makers lack actionable scientific information needed to prepare for future challenges associated with climate change. Although the scope and quality of available scientific information has increased dramatically in recent years, this information does not always reach - or is not presented in a form that is useful to - decision makers who need it. The producer (i.e. scientists) community tends to be stovepiped, even though consumers (i.e. decision makers) often need interdisciplinary science and analysis. Consumers, who may also be stovepiped in various agencies or subject areas, may lack familiarity with or access to these separate communities, as well as the tools or time to navigate scientific information and disciplines. Closing the communication gap between these communities could be facilitated by institutionalizing processes designed for this purpose. We recommend a variety of mainstreaming policies within the consumer community, as well as mechanisms to generate a strong demand signal that will resonate more strongly with the producer community. We also recommend institutional reforms and methods of incentivizing policy-oriented scientific analysis within the producer community. Our recommendations focus on improving information flow to national security and foreign policy decision makers, but many are relevant to public policy writ large. Recommendations for Producers 1. The scientific community should formally encourage collaborations between natural and social scientists and reward publications in interdisciplinary outlets Incentives could include research funding and honorary awards recognizing service to public policy. 2. Academic merit review should reward research grants and publications targeted at interdisciplinary and/or policy-oriented audiences. Reforms of merit review may require new policies and engaged institutional leadership. Recommendations for Consumers 1. Congress should amend Title VI of the National Defense Education Act to encourage the development of multidisciplinary educational programs on the national security implications of climate change. 2. Federal agencies should establish funding programs to encourage producers to provide scientific information tailored to consumer needs. 3. The Department of State should appoint climate advisors to serve within the regional bureaus and on the policy and planning staff. 4. Federal agencies, the Department of Education, and the National Science Foundation should develop programs to stimulate new interdisciplinary research partnerships and training of a new generation of interdisciplinary climate change risk thinkers, assessors and managers. 5. Federal agencies should encourage Senior Executive Service decision makers to participate in science policy certi¬fication workshops and include science and technology policy as a core curricu¬lum component of the SES Federal Candidate Development Program. These recommendations are described in detail in a report published by the Center for a New American Security: Rogers, W. and J. Gulledge (2010) Lost in Translation: Closing the Gap Between Climate Science and National Security Policy (available online: http://cnas.org/node/4391)

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

PubMed

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

2010-10-01

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

Voices of decision makers on evidence-based policy: A case of evolving TB/HIV co-infection policy in India.

PubMed

Reddy, K Srikanth; Sahay, Seema

2016-01-01

This study explores decision makers' perspectives on evidence-based policy (EBP) development using the case of TB/HIV co-infection in India. Twelve in-depth interviews were conducted with purposively selected key national and international policy decision makers in India. Verbatim transcripts were processed and analysed thematically using QSR (NUD*IST 6). The decision makers were unequivocal in recognizing the TB/HIV co-infection as an important public health issue in India and stated the problem to be different than Africa. The need of having a "third programme" for co-infection was not felt. According to them, the public health management of this co-infection must be within the realm of these two programmes. The study also emphasized on decision makers' perspectives on evidence and the process of utilization of evidence for decision-making for co-infection. Study findings showed global evidence was not always accepted by the decision makers and study shows several examples of decision makers demanding local evidence for policy decisions. Decision makers did make interim policies based on global evidence but most of the time their mandate was to get local evidence. Thus, operations research/implementation science especially multi-centric studies emerge as important strategy for EBP development. Researcher-policy maker interface was a gap where role of researcher as aggressive communicator of research findings was expected.

Are economic evaluations and health technology assessments increasingly demanded in times of rationing health services? The case of the Argentine financial crisis.

PubMed

Rubinstein, Adolfo; Belizán, María; Discacciati, Vilda

2007-01-01

After 4 years of deepening recession, Argentina's economy plummeted after default in 2002. This crisis critically affected health expenditures and triggered acute rationing. Our objective was to explore health decision-makers' knowledge and attitudes about economic evaluations (EE) and whether health technology assessment (HTA) were increasingly used for decision making. A qualitative design based on semistructured interviews and focus groups was used to explore how decision makers belonging to different health sectors implement resource allocation decisions. Informants were mostly unaware of EE. The most important criteria mentioned to adopt a treatment were evidence of effectiveness, social/stakeholder demand, or resource availability. Despite general positive attitudes about EE, knowledge was rather limited. Although cost considerations were widely accepted by purchasers and managers, clinicians argued about these issues as interfering with the doctor-patient relationship. Other important perceived barriers to HTA use were lack of confidence in the transferability of studies conducted in developed countries and institutional fragmentation of the Argentine healthcare system. The new macroeconomic context was cited as a justification of implicit rationing measures. Although explicit priority setting was implemented by many purchasers and managers, HTA was not used to improve technical and/or allocative efficiency. The crisis seems to be a strong incentive to extend the use of HTA in Argentina, provided decision makers are aware as well as involved in the generation of local studies.

Using Green Building As A Model For Making Health Promotion Standard In The Built Environment.

PubMed

Trowbridge, Matthew J; Worden, Kelly; Pyke, Christopher

2016-11-01

The built environment-the constructed physical parts of the places where people live and work-is a powerful determinant of both individual and population health. Awareness of the link between place and health is growing within the public health sector and among built environment decision makers working in design, construction, policy, and both public and private finance. However, these decision makers lack the knowledge, tools, and capacity to ensure that health and well-being are routinely considered across all sectors of the built environment. The green building industry has successfully established environmental sustainability as a normative part of built environment practice, policy making, and investment. We explore the value of this industry's experience as a template for promoting health and well-being in the built environment. Project HOPE—The People-to-People Health Foundation, Inc.

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions.

PubMed

Husain, Sara; Kadir, Masood; Fatmi, Zafar

2007-01-23

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector.

Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions

PubMed Central

Husain, Sara; Kadir, Masood; Fatmi, Zafar

2007-01-01

Background Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. Methods A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. Results HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. Conclusion Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector. PMID:17244371

Where Are All the Black Teachers? Discrimination in the Teacher Labor Market

ERIC Educational Resources Information Center

D'amico, Diana; Pawlewicz, Robert J.; Earley, Penelope M.; McGeehan, Adam P.

2017-01-01

In this article, Diana D'Amico, Robert J. Pawlewicz, Penelope M. Earley, and Adam P. McGeehan examine the racial composition of one public school district's teacher labor market through teacher application data and subsequent hiring decisions. Researchers and policy makers have long noted the lack of racial diversity among the nation's public…

Best-worst scaling to assess the most important barriers and facilitators for the use of health technology assessment in Austria.

PubMed

Feig, Chiara; Cheung, Kei Long; Hiligsmann, Mickaël; Evers, Silvia M A A; Simon, Judit; Mayer, Susanne

2018-04-01

Although Health Technology Assessment (HTA) is increasingly used to support evidence-based decision-making in health care, several barriers and facilitators for the use of HTA have been identified. This best-worst scaling (BWS) study aims to assess the relative importance of selected barriers and facilitators of the uptake of HTA studies in Austria. A BWS object case survey was conducted among 37 experts in Austria to assess the relative importance of HTA barriers and facilitators. Hierarchical Bayes estimation was applied, with the best-worst count analysis as sensitivity analysis. Subgroup analyses were also performed on professional role and HTA experience. The most important barriers were 'lack of transparency in the decision-making process', 'fragmentation', 'absence of appropriate incentives', 'no explicit framework for decision-making process', and 'insufficient legal support'. The most important facilitators were 'transparency in the decision-making process', 'availability of relevant HTA research for policy makers', 'availability of explicit framework for decision-making process', 'sufficient legal support', and 'appropriate incentives'. This study suggests that HTA barriers and facilitators related to the context of decision makers, especially 'policy characteristics' and 'organization and resources' are the most important in Austria. A transparent and participatory decision-making process could improve the adoption of HTA evidence.

Attunement and alignment of people with schizophrenia and their preferred alternative decision-makers: An exploratory pilot study comparing treatment and research decisions.

PubMed

Roberts, Laura Weiss; Kim, Jane Paik

2015-12-01

Schizophrenia is a serious mental disorder that may affect the decisional capacity, and as a consequence, preferred alternative decision-makers may be engaged to help with clinical care and research-related choices. Ideally, alternative decision-makers will seek to make decisions that fit with the views and preferences of the ill individual. Few data exist, however, comparing the views of alternative decision-makers to those of individuals with schizophrenia. We conducted a written survey with individuals with schizophrenia living in a community setting, and a parallel survey with the person whom the ill individual identified as being a preferred alternative decision-maker. Complete data were obtained on 20 pairs (n = 40, total). Domains queried included (a) burden, happiness, and safety of the ill individual and of his or her family in treatment and research decisions and (b) importance of ethical principles in every day life. Two-sided paired t-tests and graphical summaries were used to compare responses. Individuals with schizophrenia and their linked preferred alternative decision-makers were attuned on four of six aspects of treatment decision-making and on all six aspects of research decision-making that we queried. The preferred alternative decision-makers overall demonstrated attunement to the views of the ill individuals in this small study. Ill individuals and their preferred alternative decision-makers were aligned in their views of ethically-salient aspects of every day life. These novel findings suggest that alternative decision-makers identified by ill individuals may be able to guide choices based on an accurate understanding of the ill individuals' views and values. Copyright © 2015 Elsevier Ltd. All rights reserved.

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.

Experiences with the implementation of Individual Placement and Support for people with severe mental illness: a qualitative study among stakeholders.

PubMed

Vukadin, Miljana; Schaafsma, Frederieke G; Westerman, Marjan J; Michon, Harry W C; Anema, Johannes R

2018-05-24

Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element. A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS. Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier. The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.

Standards and guidelines for observational studies: quality is in the eye of the beholder.

PubMed

Morton, Sally C; Costlow, Monica R; Graff, Jennifer S; Dubois, Robert W

2016-03-01

Patient care decisions demand high-quality research. To assist those decisions, numerous observational studies are being performed. Are the standards and guidelines to assess observational studies consistent and actionable? What policy considerations should be considered to ensure decision makers can determine if an observational study is of high-quality and valid to inform treatment decisions? Based on a literature review and input from six experts, we compared and contrasted nine standards/guidelines using 23 methodological elements involved in observational studies (e.g., study protocol, data analysis, and so forth). Fourteen elements (61%) were addressed by at least seven standards/guidelines; 12 of these elements disagreed in the approach. Nine elements (39%) were addressed by six or fewer standards/guidelines. Ten elements (43%) were not actionable in at least one standard/guideline that addressed the element. The lack of observational study standard/guideline agreement may contribute to variation in study conduct; disparities in what is considered credible research; and ultimately, what evidence is adopted. A common set of agreed on standards/guidelines for conducting observational studies will benefit funders, researchers, journal editors, and decision makers. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Creating dialogue: a workshop on "Uncertainty in Decision Making in a Changing Climate"

NASA Astrophysics Data System (ADS)

Ewen, Tracy; Addor, Nans; Johnson, Leigh; Coltekin, Arzu; Derungs, Curdin; Muccione, Veruska

2014-05-01

Uncertainty is present in all fields of climate research, spanning from projections of future climate change, to assessing regional impacts and vulnerabilities, to adaptation policy and decision-making. In addition to uncertainties, managers and planners in many sectors are often confronted with large amounts of information from climate change research whose complex and interdisciplinary nature make it challenging to incorporate into the decision-making process. An overarching issue in tackling this problem is the lack of institutionalized dialogue between climate researchers, decision-makers and user groups. Forums that facilitate such dialogue would allow climate researchers to actively engage with end-users and researchers in different disciplines to better characterize uncertainties and ultimately understand which ones are critically considered and incorporated into decisions made. We propose that the introduction of students to these challenges at an early stage of their education and career is a first step towards improving future dialogue between climate researchers, decision-makers and user groups. To this end, we organized a workshop at the University of Zurich, Switzerland, entitled "Uncertainty in Decision Making in a Changing Climate". It brought together 50 participants, including Bachelor, Master and PhD students and academic staff, and nine selected speakers from academia, industry, government, and philanthropy. Speakers introduced participants to topics ranging from uncertainties in climate model scenarios to managing uncertainties in development and aid agencies. The workshop consisted of experts' presentations, a panel discussion and student group work on case studies. Pedagogical goals included i) providing participants with an overview of the current research on uncertainty and on how uncertainty is dealt with by decision-makers, ii) fostering exchange between practitioners, students, and scientists from different backgrounds, iii) exposing students, at an early stage of their professional life, to multidisciplinary collaborations and real-world problems involving decisions under uncertainty. An opinion survey conducted before and after the workshop enabled us to observe changes in participants' perspectives on what information and tools should be exchanged between researchers and decision-makers to better address uncertainty. Responses demonstrated a marked shift from a pre-workshop vertical conceptualizations of researcher—user group interaction to a post-workshop horizontal mode: in the former, researchers were portrayed as bestowing data-based products to decision-makers, while in the latter, both sets of actors engaged in institutionalized dialogues and frequent communication, exchanging their needs, expertise, and personnel. In addition to the survey, we will draw on examples from the course evaluation to illustrate the strengths and weaknesses of our approach. By doing so, we seek to encourage the organization of similar events by other universities, with the mid-term goal to improve future dialogue. From a pedagogical perspective, introducing students to these ideas at a very early stage in their research careers is an ideal opportunity to establish new modes of communication with an interdisciplinary perspective and strengthen dialogue between climate researchers, decision-makers and user groups.

Bridging the gap between science and decision making.

PubMed

von Winterfeldt, Detlof

2013-08-20

All decisions, whether they are personal, public, or business-related, are based on the decision maker's beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers' information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making.

Bridging the gap: exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake.

PubMed

Merlo, Gregory; Page, Katie; Ratcliffe, Julie; Halton, Kate; Graves, Nicholas

2015-06-01

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

Trusted Advisors, Decision Models and Other Keys to Communicating Science to Decision Makers

NASA Astrophysics Data System (ADS)

Webb, E.

2006-12-01

Water resource management decisions often involve multiple parties engaged in contentious negotiations that try to navigate through complex combinations of legal, social, hydrologic, financial, and engineering considerations. The standard approach for resolving these issues is some form of multi-party negotiation, a formal court decision, or a combination of the two. In all these cases, the role of the decision maker(s) is to choose and implement the best option that fits the needs and wants of the community. However, each path to a decision carries the risk of technical and/or financial infeasibility as well as the possibility of unintended consequences. To help reduce this risk, decision makers often rely on some type of predictive analysis from which they can evaluate the projected consequences of their decisions. Typically, decision makers are supported in the analysis process by trusted advisors who engage in the analysis as well as the day to day tasks associated with multi-party negotiations. In the case of water resource management, the analysis is frequently a numerical model or set of models that can simulate various management decisions across multiple systems and output results that illustrate the impact on areas of concern. Thus, in order to communicate scientific knowledge to the decision makers, the quality of the communication between the analysts, the trusted advisor, and the decision maker must be clear and direct. To illustrate this concept, a multi-attribute decision analysis matrix will be used to outline the value of computer model-based collaborative negotiation approaches to guide water resources decision making and communication with decision makers. In addition, the critical role of the trusted advisor and other secondary participants in the decision process will be discussed using examples from recent water negotiations.

The neglected heart of science policy (revisited): Balancing knowledge and action in an age of science and technology

NASA Astrophysics Data System (ADS)

Parris, A. S.; Ferguson, D. B.

2016-12-01

In the U.S., the need for effective scientist-decision maker engagement is explicitly endorsed at the highest levels of national science policy-making, including the annual research and development priorities memo of the Executive Office for fiscal year 2017. The call from the Executive Office formalizes a long-standing recognition, among a minority of scientists and practitioners, that the public value of research activities may be enhanced through engagement between scientists and decision makers. However, engagement is often embedded in research efforts, despite the fact that the ability to foster relationships and improve knowledge exchange has progressed primarily through boundary spanning efforts. Consequently, sound practice for engagement is not adequately considered in the design of new institutions, programs, and career development tracks. This gap illustrates a lack of formal learning in science policy and is critical because engagement and, specifically, co-production of knowledge are proving effective in adapting to global change. We examined over 10 different case studies spanning urban planning, natural resource management, and water management. In each case, deliberate strategies were employed to encourage decision maker-scientist engagement, including the formation of new organizations, innovative design of research projects, and training and education for professionals to participate in engagement efforts. Individual cases reveal several outcomes, including but not limited to: increased awareness of risk; information that enabled adaptation or resilience choices; exchange between decision makers from different sectors leading to more coordinated responses to natural resource impacts; and mediation for responsible use of science. Collectively, the body of evidence suggests that engagement may be most important not necessarily in reconciling supply and demand for science, but rebalancing knowledge and action in an age of science and technology.

Good decision-making is associated with an adaptive cardiovascular response to social competitive stress.

PubMed

Alacreu-Crespo, Adrián; Costa, Raquel; Abad-Tortosa, Diana; Salvador, Alicia; Serrano, Miguel Ángel

2018-06-22

Competition elicits different psychological and cardiovascular responses depending on a person's skills. Decision-making has been considered a distal factor that influences competition, but there are no studies analyzing this relationship. Our objective was to analyze whether decision-making affects the response to competition. Specifically, we aimed to test whether good performers on a decision-making test, the Iowa Gambling Task (IGT), showed an adaptive cardiovascular response to competition. In all, 116 participants (44 women) performed the IGT and were classified into Good or Poor decision-makers. Subsequently, they were exposed to a stress task in two different conditions: a face-to-face competition (winners/losers) or a control condition, while an electrocardiogram was recorded. In the competition group, good decision-makers increased their high-frequency respect to the total heart rate variability (HF/HRV) levels during the task, compared to Poor decision-makers. Again, competition group good decision-makers, showed lower LF and higher HF/HRV reactivity than the control group, which represents lower HRV stress pattern. Moreover, in the group of losers, good decision-makers had a decline in low frequency (LF) during the task and faster recovery than poor decision-makers. In conclusion, good decision-makers have a more adaptive stress response and higher levels of mental effort, based on total HRV interpretation. Decision-making skills could be a factor in a more adaptive cardiovascular response to competition.

Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida

PubMed Central

Hayden, Mary H.; Cavanaugh, Jamie L.; Tittel, Christopher; Butterworth, Melinda; Haenchen, Steven; Dickinson, Katherine; Monaghan, Andrew J.; Ernst, Kacey C.

2015-01-01

Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009–2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond. PMID:26078319

Use of economic evaluation in decision making: evidence and recommendations for improvement.

PubMed

Simoens, Steven

2010-10-22

Information about the value for money of a medicine as derived from an economic evaluation can be used for decision-making purposes by policy makers, healthcare payers, healthcare professionals and pharmaceutical companies. This article illustrates the use of economic evaluation by decision makers and formulates a number of recommendations to enhance the use of such evaluations for decision-making purposes. Over the last decades, there has been a substantial increase in the number of economic evaluations assessing the value for money of medicines. Economic evaluation is used by policy makers and healthcare payers to inform medicine pricing/reimbursement decisions in more and more countries. It is a suitable tool to evaluate medicines and to present information about their value for money to decision makers in a familiar format. In order to fully exploit the use of economic evaluation for decision-making purposes, researchers need to take care to conduct such economic evaluations according to methodologically sound principles. Additionally, researchers need to take into account the decision-making context. They need to identify the various objectives that decision makers pursue and discuss how decision makers can use study findings to attain these objectives. These issues require further attention from researchers, policy makers, healthcare payers, healthcare professionals and pharmaceutical companies with a view to optimizing the use of economic evaluation in decision making.

SCIENCE, SCIENTISTS, AND POLICY ADVOCACY

EPA Science Inventory

To effectively resolve many current ecological policy issues, decision-makers require an array of scientific information. Sometimes scientific information is summarized for decision-makers by policy analysts or others, but often it comes directly from scientists to decision-maker...

Determinants of change in Medicaid pharmaceutical cost sharing: does evidence affect policy?

PubMed

Soumerai, S B; Ross-Degnan, D; Fortess, E E; Walser, B L

1997-01-01

Since 1980, many Medicaid programs have instituted, adjusted, or abolished pharmaceutical copayments or limitations on the number of prescriptions per patient (caps). Studies indicate that prescription caps can harm patients and increase Medicaid costs. However, because there is little information on how state policy makers select and evaluate such policies, in-depth telephone interviews were conducted with key informants in Medicaid programs that had recently made changes in cost-sharing policies. Among the barriers to evidence-based policy making were lack of political power, skills, and infrastructure; crisis-oriented decisions; compartmentalized budgeting; lack of advocates for disadvantaged patients; and the absence of timely research. Research was applied successfully when the interests of patient advocates and the drug industry were aligned and when Medicaid analysis were able to identify and communicate relevant research to policy makers at the time, or "teachable moment," that policy was being changed.

Helping decision makers frame, analyze, and implement decisions

USGS Publications Warehouse

Runge, Michael C.; McDonald-Madden, Eve

2018-01-01

All decisions have the same recognizable elements. Context, objectives, alternatives, consequences, and deliberation. Decision makers and analysts familiar with these elements can quickly see the underlying structure of a decision.There are only a small number of classes of decisions. These classes differ in the cognitive and scientific challenge they present to the decision maker; the ability to recognize the class of decision leads a decision maker to tools to aid in the analysis.Sometimes we need more information, sometimes we don’t. The role of science in a decision-making process is to provide the predictions that link the alternative actions to the desired outcomes. Investing in more science is only valuable if it helps to choose a better action.Implementation. The successful integration of decision analysis into environmental decisions requires careful attention to the decision, the people, and the institutions involved.

The Assisted Decision-Making (Capacity) Bill 2013: content, commentary, controversy.

PubMed

Kelly, B D

2015-03-01

Ireland's Assisted Decision-Making (Capacity) Bill (2013) aims to reform the law relating to persons who require assistance exercising their decision-making capacity. When finalised, the Bill will replace Ireland's outdated Ward of Court system which has an all-or-nothing approach to capacity; does not adequately define capacity; is poorly responsive to change; makes unwieldy provision for appointing decision-makers; and has insufficient provision for review. To explore the content and implications of the Assisted Decision-Making (Capacity) Bill. Review of the content of the Assisted Decision-Making (Capacity) Bill and related literature. The new Bill includes a presumption of capacity and defines lack of capacity. All interventions must minimise restriction of rights and freedom, and have due regard for "dignity, bodily integrity, privacy and autonomy". The Bill proposes legal frameworks for "assisted decision-making" (where an individual voluntarily appoints someone to assist with specific decisions relating to personal welfare or property and affairs, by, among other measures, assisting the individual to communicate his or her "will and preferences"); "co-decision-making" (where the Circuit Court declares the individual's capacity is reduced but he or she can make specific decisions with a co-decision-maker to share authority); "decision-making representatives" (substitute decision-making); "enduring power of attorney"; and "informal decision-making on personal welfare matters" (without apparent oversight). These measures, if implemented, will shift Ireland's capacity laws away from an approach based on "best interests" to one based on "will and preferences", and increase compliance with the United Nations' Convention on the Rights of Persons with Disabilities.

Method of predicting a change in an economy

DOEpatents

Pryor, Richard J [Albuquerque, NM; Basu, Nipa [Albany, NY

2006-01-10

An economy whose activity is to be predicted comprises a plurality of decision makers. Decision makers include, for example, households, government, industry, and banks. The decision makers are represented by agents, where an agent can represent one or more decision makers. Each agent has decision rules that determine the agent's actions. Each agent can affect the economy by affecting variable conditions characteristic of the economy or the internal state of other agents. Agents can communicate actions through messages. On a multiprocessor computer, the agents can be assigned to processing elements.

Research’s Practice and Barriers of Knowledge Translation in Iran

PubMed Central

NEDJAT, Saharnaz; GHOLAMI, Jaleh; YAZDIZADEH, Bahareh; NEDJAT, Sima; MALEKI, Katayoun; MAJDZADEH, Reza

2014-01-01

Abstract Background Knowledge Translation is a process that includes synthesis, dissemination, exchange and application of knowledge to improve the health, services and products In this study we have attempted to examine the knowledge translation practice and its perceived barriers on the universalities and research institutes (research sector) in Iran. Methods Both qualitative and quantitative approaches were used. In the quantitative section, a questionnaire had prepared for this study was completed by 88 authors country wide from randomly selected papers. In the qualitative section 13 in-depth interviews and 6 focus group discussions were held with managers and policy makers, clinical and health service providers, and researchers. Results Twenty four percent of the authors had no interaction whatsoever with the target audience. Lack of expectation toward creating change in the target audience, researchers’ incentives, low level of trust among researchers and decision makers, absence of a predefined mechanism for delivery of research results and inappropriate research priorities were among the most important barriers identified in the qualitative section. Conclusion Translation of research findings into some concrete outputs which can affect health of people is not in mandate of researchers and subsequently they are not prepared for this as well. Based on the barriers identified, it seems that the following interventions are necessary: cooperation among policy makers at macro and meso (organizational) level and the research sector; establishing networks for researchers and decision makers in choosing the research topic, priority setting, and building trust among researchers and policy makers. PMID:25909064

Using Cognitive Conflict to Promote the Use of Dialectical Learning for Strategic Decision-Makers

ERIC Educational Resources Information Center

Woods, Jeffrey G.

2012-01-01

Purpose: The purpose of this paper is to develop a conceptual model that uses dialectical inquiry (DI) to create cognitive conflict in strategic decision-makers for the purpose of improving strategic decisions. Activation of the dialectical learning process using DI requires strategic decision-makers to integrate conflicting information causing…

49 CFR 1503.657 - Appeal from initial decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND ENFORCEMENT PROCEDURES Rules of Practice in TSA Civil Penalty Actions § 1503.657 Appeal from... order of the TSA decision maker have been entered on the record. (b) Issues on appeal. A party may... appeal with the consent of the TSA decision maker. If the TSA decision maker grants an extension of time...

Incapacitated Surrogates: A New and Increasing Dilemma in Hospital Care.

PubMed

Smith, Karen L; Fedel, Patrice; Heitman, Jay

2017-01-01

A power of attorney for healthcare (POAHC) form gives designated individuals legal status to make healthcare decisions when patients are unable to convey their decisions to medical staff. Completion of a POAHC form is crucial in the provision of comprehensive healthcare, since it helps to ensure that patients' interests, values, and preferences are represented in decisions about their medical treatment. Because increasing numbers of people suffer from debilitating illness and cognitive deficits, healthcare systems may be called upon to navigate the complexities of patients' care without clear directives from the patients themselves. Hence, the healthcare industry encourages all individuals to complete a POAHC form to ensure that persons who have the patients' trust are able to act as their surrogate decision makers. However, sometimes POAHC agents, even when they are patients' trusted agents, lack the capacity to make fully informed decisions that are in the patients' best interests. We describe designated surrogate decision makers who have impaired or diminished judgment capacity as incapacitated surrogates. Decision making that is obviously flawed or questionable is a significant impediment to providing timely and appropriate care to patients. Moreover, failure to redress these issues in a timely and efficient manner can result in significant costs to an institution and a diminished quality of patient care. The authors offer a legal, ethical, and interdisciplinary framework to help navigate cases of incapacitated surrogates. Copyright 2017 The Journal of Clinical Ethics. All rights reserved.

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

PubMed

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

2011-08-03

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

ENVIRONMENTAL PLANNING FOR SMALL COMMUNITIES: A GUIDE FOR LOCAL DECISION-MAKERS

EPA Science Inventory

Environmental Planning for Small Communities - A Guide for Local Decision-Makers presents a process for creating and implementing a community environmental plan. With a comprehensive environmental plan, local decision-makers can create an integrated approach to protecting the env...

Guidelines for Using Movement Science to Inform Biodiversity Policy

NASA Astrophysics Data System (ADS)

Barton, Philip S.; Lentini, Pia E.; Alacs, Erika; Bau, Sana; Buckley, Yvonne M.; Burns, Emma L.; Driscoll, Don A.; Guja, Lydia K.; Kujala, Heini; Lahoz-Monfort, José J.; Mortelliti, Alessio; Nathan, Ran; Rowe, Ross; Smith, Annabel L.

2015-10-01

Substantial advances have been made in our understanding of the movement of species, including processes such as dispersal and migration. This knowledge has the potential to improve decisions about biodiversity policy and management, but it can be difficult for decision makers to readily access and integrate the growing body of movement science. This is, in part, due to a lack of synthesis of information that is sufficiently contextualized for a policy audience. Here, we identify key species movement concepts, including mechanisms, types, and moderators of movement, and review their relevance to (1) national biodiversity policies and strategies, (2) reserve planning and management, (3) threatened species protection and recovery, (4) impact and risk assessments, and (5) the prioritization of restoration actions. Based on the review, and considering recent developments in movement ecology, we provide a new framework that draws links between aspects of movement knowledge that are likely the most relevant to each biodiversity policy category. Our framework also shows that there is substantial opportunity for collaboration between researchers and government decision makers in the use of movement science to promote positive biodiversity outcomes.

A QUESTIONNAIRE TO ASSESS THE RELEVANCE AND CREDIBILITY OF OBSERVATIONAL STUDIES TO INFORM HEALTH CARE DECISION MAKING: AN ISPOR-AMCP-NPC GOOD PRACTICE TASK FORCE REPORT

PubMed Central

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, Dan; Yang, Winnie; Mullins, C. Daniel; Kahler, Kristijan; Quon, Nicole C.; Devine, Scott; Graham, John; Cannon, Eric; Crown, William

2014-01-01

Evidence-based healthcare decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. However, widespread adoption of evidence from observational studies has been limited due to a variety of factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two Task Forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision-making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. PMID:24636373

A rapidly changing global medicines environment: How adaptable are funding decision-making systems?

PubMed

Leopold, Christine; Morgan, Steven G; Wagner, Anita K

2017-06-01

With the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased. We aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities. Through interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems' responses and systems' characteristics facilitating or hindering responses to changes and overarching topics for the future. Among the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems' responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public. Going forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care. Copyright © 2017 Elsevier B.V. All rights reserved.

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.

Facilitating access to pre-processed research evidence in public health

PubMed Central

2010-01-01

Background Evidence-informed decision making is accepted in Canada and worldwide as necessary for the provision of effective health services. This process involves: 1) clearly articulating a practice-based issue; 2) searching for and accessing relevant evidence; 3) appraising methodological rigor and choosing the most synthesized evidence of the highest quality and relevance to the practice issue and setting that is available; and 4) extracting, interpreting, and translating knowledge, in light of the local context and resources, into practice, program and policy decisions. While the public health sector in Canada is working toward evidence-informed decision making, considerable barriers, including efficient access to synthesized resources, exist. Methods In this paper we map to a previously developed 6 level pyramid of pre-processed research evidence, relevant resources that include public health-related effectiveness evidence. The resources were identified through extensive searches of both the published and unpublished domains. Results Many resources with public health-related evidence were identified. While there were very few resources dedicated solely to public health evidence, many clinically focused resources include public health-related evidence, making tools such as the pyramid, that identify these resources, particularly helpful for public health decisions makers. A practical example illustrates the application of this model and highlights its potential to reduce the time and effort that would be required by public health decision makers to address their practice-based issues. Conclusions This paper describes an existing hierarchy of pre-processed evidence and its adaptation to the public health setting. A number of resources with public health-relevant content that are either freely accessible or requiring a subscription are identified. This will facilitate easier and faster access to pre-processed, public health-relevant evidence, with the intent of promoting evidence-informed decision making. Access to such resources addresses several barriers identified by public health decision makers to evidence-informed decision making, most importantly time, as well as lack of knowledge of resources that house public health-relevant evidence. PMID:20181270

Fostering climate dialogue by introducing students to uncertainty in decision-making

NASA Astrophysics Data System (ADS)

Addor, N.; Ewen, T.; Johnson, L.; Coltekin, A.; Derungs, C.; Muccione, V.

2014-12-01

Uncertainty is present in all fields of climate research, spanning from climate projections, to assessing regional impacts and vulnerabilities to adaptation policy and decision-making. The complex and interdisciplinary nature of climate information, however, makes the decision-making process challenging. This process is further hindered by a lack of institutionalized dialogue between climate researchers, decision-makers and user groups. Forums that facilitate such dialogue would allow these groups to actively engage with each other to improve decisions. In parallel, introducing students to these challenges is one way to foster such climate dialogue. We present the design and outcome of an innovative workshop-seminar series we convened at the University of Zurich to demonstrate the pedagogical importance of such forums. An initial two-day workshop brought together 50 participants, including bachelor, master and PhD students and academic staff, and nine speakers from academia, industry, government, and philanthropy. The main objectives were to provide participants with tools to communicate uncertainty in their current or future research projects, to foster exchange between practitioners, students and scientists from different backgrounds and finally to expose students to multidisciplinary collaborations and real-world problems involving decisions under uncertainty. An opinion survey conducted before and after the workshop enabled us to observe changes in participants' perspectives on what information and tools should be exchanged between researchers and decision-makers to better address uncertainty. Responses demonstrated a marked shift from a pre-workshop vertical conceptualization of researcher-user group interaction to a post-workshop horizontal mode: in the former, researchers were portrayed as bestowing data-based products to decision-makers, while in the latter, both sets of actors engaged in frequent communication, exchanging their needs and expertise. Drawing on examples from the course evaluation, we seek to encourage the organization of similar events, introducing students to these challenges at an early stage of their education and career as a first step towards improving future dialogue.

[The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].

PubMed

Su, Szu-Huei; Wu, Li-Min

2018-04-01

The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. A cross-sectional, correlation study design was used. A total of 193 surrogate decision makers from six ICUs in a medical center in southern Taiwan were enrolled as participants. Three structured questionnaires were used, including a demographic datasheet, the Family Relationship Scale, and the Behavioral Intention of Medical Decisions Scale. Significantly positive correlations were found between the behavioral intentions underlying medical decisions and the following variables: the relationship of the participant to the patient (Eta = .343, p = .020), the age of the patient (r = .295, p < .01), and whether the patient had signed a currently valid advance healthcare directive (Eta = .223, p = .002). Furthermore, a significantly negative correlation was found between these intentions and length of stay in the ICU (r = -.263, p < .01). Patient age, whether the patient had signed a currently valid advance healthcare directive, and length of stay in the ICU were all predictive factors for the behavioral intentions underlying the medical decisions of the surrogate decision makers, explaining 13.9% of the total variance. In assessing the behavioral intentions underlying the medical decisions of surrogate decision makers, health providers should consider the relationship between critical patients and their surrogate decision makers, patient age, the length of ICU stay, and whether the patient has a pre-signed advance healthcare directive in order to maximize the effectiveness of medical care provided to critically ill patients.

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy: A Review.

PubMed

Mandavia, Rishi; Schilder, Anne G M; Dimitriadis, Panagiotis A; Mossialos, Elias

2017-09-01

Eighty-five percent of investment in medical research has been wasted, with lack of effect on clinical practice and policy. There is increasing effort to improve the likelihood of research being used to influence clinical practice and policy. Tonsillectomy is one of the most common otorhinolaryngologic surgical procedures, and its frequency, cost, and morbidity create a clear need for evidence-based guidelines and policy. The first systematic review on tonsillectomy was conducted 40 years ago and highlighted the lack of definitive evidence for the procedure. Since that study, the body of evidence has still not been able to sufficiently inform policy. This review provides an overview of the key challenges in research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap. The challenges in using research to inform policy can be summarized as 4 main themes: (1) non-policy-focused evidence and lack of available evidence, (2) quality of evidence, (3) communication of research findings, and (4) coordinating time frames. Researchers and decision makers should be aware of the limitations of research designs and conflicts of interest that can undermine policy decisions. Researchers must work with decision makers and patients throughout the research process to identify areas of unmet need and political priority, align research and policy time frames, and disseminate research findings. Incentives for researchers should be reorganized to promote dissemination of findings. It is important to consider why evidence gaps in tonsillectomy research have not been addressed during the past 40 years despite considerable investment in time and resources. These findings and recommendations will help produce research that is more responsive to policy gaps and more likely to result in policy changes.

Targeting Continuing Medical Education on Decision Makers: Who Decides to Transfuse Blood?

ERIC Educational Resources Information Center

Goodnough, Lawrence T.; And Others

1992-01-01

Staff communication patterns were observed during 13 open-heart surgeries to identify the transfusion decision makers. It was determined that targeting decision makers for continuing medical education would improve the quality of transfusion practice and increase the efficiency of continuing education. (SK)

Energy-Water Nexus: Balancing the Tradeoffs between Two-Level Decision Makers

DOE PAGES

Zhang, Xiaodong; Vesselinov, Velimir Valentinov

2016-09-03

Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improvesmore » upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.« less

Energy-Water Nexus: Balancing the Tradeoffs between Two-Level Decision Makers

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

Zhang, Xiaodong; Vesselinov, Velimir Valentinov

Energy-water nexus has substantially increased importance in the recent years. Synergistic approaches based on systems-analysis and mathematical models are critical for helping decision makers better understand the interrelationships and tradeoffs between energy and water. In energywater nexus management, various decision makers with different goals and preferences, which are often conflicting, are involved. These decision makers may have different controlling power over the management objectives and the decisions. They make decisions sequentially from the upper level to the lower level, challenging decision making in energy-water nexus. In order to address such planning issues, a bi-level decision model is developed, which improvesmore » upon the existing studies by integration of bi-level programming into energy-water nexus management. The developed model represents a methodological contribution to the challenge of sequential decisionmaking in energy-water nexus through provision of an integrated modeling framework/tool. An interactive fuzzy optimization methodology is introduced to seek a satisfactory solution to meet the overall satisfaction of the two-level decision makers. The tradeoffs between the two-level decision makers in energy-water nexus management are effectively addressed and quantified. Application of the proposed model to a synthetic example problem has demonstrated its applicability in practical energy-water nexus management. Optimal solutions for electricity generation, fuel supply, water supply including groundwater, surface water and recycled water, capacity expansion of the power plants, and GHG emission control are generated. In conclusion, these analyses are capable of helping decision makers or stakeholders adjust their tolerances to make informed decisions to achieve the overall satisfaction of energy-water nexus management where bi-level sequential decision making process is involved.« less

Development and formative evaluation of a visual e-tool to help decision makers navigate the evidence around health financing.

PubMed

Skordis-Worrall, Jolene; Pulkki-Brännström, Anni-Maria; Utley, Martin; Kembhavi, Gayatri; Bricki, Nouria; Dutoit, Xavier; Rosato, Mikey; Pagel, Christina

2012-12-21

There are calls for low and middle income countries to develop robust health financing policies to increase service coverage. However, existing evidence around financing options is complex and often difficult for policy makers to access. To summarize the evidence on the impact of financing health systems and develop an e-tool to help decision makers navigate the findings. After reviewing the literature, we used thematic analysis to summarize the impact of 7 common health financing mechanisms on 5 common health system goals. Information on the relevance of each study to a user's context was provided by 11 country indicators. A Web-based e-tool was then developed to assist users in navigating the literature review. This tool was evaluated using feedback from early users, collected using an online survey and in-depth interviews with key informants. The e-tool provides graphical summaries that allow a user to assess the following parameters with a single snapshot: the number of relevant studies available in the literature, the heterogeneity of evidence, where key evidence is lacking, and how closely the evidence matches their own context. Users particularly liked the visual display and found navigating the tool intuitive. However there was concern that a lack of evidence on positive impact might be construed as evidence against a financing option and that the tool might over-simplify the available financing options. Complex evidence can be made more easily accessible and potentially more understandable using basic Web-based technology and innovative graphical representations that match findings to the users' goals and context.

Decision making in high-velocity environments: implications for healthcare.

PubMed

Stepanovich, P L; Uhrig, J D

1999-01-01

Healthcare can be considered a high-velocity environment and, as such, can benefit from research conducted in other industries regarding strategic decision making. Strategic planning is not only relevant to firms in high-velocity environments, but is also important for high performance and survival. Specifically, decision-making speed seems to be instrumental in differentiating between high and low performers; fast decision makers outperform slow decision makers. This article outlines the differences between fast and slow decision makers, identifies five paralyses that can slow decision making in healthcare, and outlines the role of a planning department in circumventing these paralyses. Executives can use the proposed planning structure to improve both the speed and quality of strategic decisions. The structure uses planning facilitators to avoid the following five paralyses: 1. Analysis. Decision makers can no longer afford the luxury of lengthy, detailed analysis but must develop real-time systems that provide appropriate, timely information. 2. Alternatives. Many alternatives (beyond the traditional two or three) need to be considered and the alternatives must be evaluated simultaneously. 3. Group Think. Decision makers must avoid limited mind-sets and autocratic leadership styles by seeking out independent, knowledgeable counselors. 4. Process. Decision makers need to resolve conflicts through "consensus with qualification," as opposed to waiting for everyone to come on board. 5. Separation. Successful implementation requires a structured process that cuts across disciplines and levels.

Information processing by networks of quantum decision makers

NASA Astrophysics Data System (ADS)

Yukalov, V. I.; Yukalova, E. P.; Sornette, D.

2018-02-01

We suggest a model of a multi-agent society of decision makers taking decisions being based on two criteria, one is the utility of the prospects and the other is the attractiveness of the considered prospects. The model is the generalization of quantum decision theory, developed earlier for single decision makers realizing one-step decisions, in two principal aspects. First, several decision makers are considered simultaneously, who interact with each other through information exchange. Second, a multistep procedure is treated, when the agents exchange information many times. Several decision makers exchanging information and forming their judgment, using quantum rules, form a kind of a quantum information network, where collective decisions develop in time as a result of information exchange. In addition to characterizing collective decisions that arise in human societies, such networks can describe dynamical processes occurring in artificial quantum intelligence composed of several parts or in a cluster of quantum computers. The practical usage of the theory is illustrated on the dynamic disjunction effect for which three quantitative predictions are made: (i) the probabilistic behavior of decision makers at the initial stage of the process is described; (ii) the decrease of the difference between the initial prospect probabilities and the related utility factors is proved; (iii) the existence of a common consensus after multiple exchange of information is predicted. The predicted numerical values are in very good agreement with empirical data.

Practical problems in aggregating expert opinions

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

Booker, J.M.; Picard, R.R.; Meyer, M.A.

1993-11-01

Expert opinion is data given by a qualified person in response to a technical question. In these analyses, expert opinion provides information where other data are either sparse or non-existent. Improvements in forecasting result from the advantageous addition of expert opinion to observed data in many areas, such as meteorology and econometrics. More generally, analyses of large, complex systems often involve experts on various components of the system supplying input to a decision process; applications include such wide-ranging areas as nuclear reactor safety, management science, and seismology. For large or complex applications, no single expert may be knowledgeable enough aboutmore » the entire application. In other problems, decision makers may find it comforting that a consensus or aggregation of opinions is usually better than a single opinion. Many risk and reliability studies require a single estimate for modeling, analysis, reporting, and decision making purposes. For problems with large uncertainties, the strategy of combining as diverse a set of experts as possible hedges against underestimation of that uncertainty. Decision makers are frequently faced with the task of selecting the experts and combining their opinions. However, the aggregation is often the responsibility of an analyst. Whether the decision maker or the analyst does the aggregation, the input for it, such as providing weights for experts or estimating other parameters, is imperfect owing to a lack of omniscience. Aggregation methods for expert opinions have existed for over thirty years; yet many of the difficulties with their use remain unresolved. The bulk of these problem areas are summarized in the sections that follow: sensitivities of results to assumptions, weights for experts, correlation of experts, and handling uncertainties. The purpose of this paper is to discuss the sources of these problems and describe their effects on aggregation.« less

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

PubMed

Wasserman, Jason Adam; Navin, Mark Christopher

2018-05-01

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

Impact of Cognitive Load on Family Decision Makers' Recall and Understanding of Donation Requests for the Genotype-Tissue Expression (GTEx) Project.

PubMed

Siminoff, Laura A; Wilson-Genderson, Maureen; Mosavel, Maghboeba; Barker, Laura; Trgina, Jennifer; Traino, Heather M; Nathan, Howard M; Hasz, Richard D; Walters, Gary

2018-01-01

Genomic research projects that collect tissues from deceased organ and tissue donors must obtain the authorization of family decision makers under difficult circumstances that may affect the authorization process. Using a quasi-experimental design, the Ethical, Legal, and Social Issues (ELSI) substudy of the Genotype-Tissue Expression (GTEx) project compared the recall and understanding of the donation authorization process of two groups: family members who had authorized donation of tissues to the GTEx project (the comparison group) and family members who had authorized organ and tissue donations in years previous, who subsequently participated in two different mock-authorization processes that mimicked the GTEx authorization process (the intervention groups). Participants in the comparison and intervention groups were matched on key demographic characteristics. We found that participants in the intervention groups who experienced a mock-authorization process demonstrated better recall of the tissue donation request than members of the comparison group. Our data indicate that the stress associated with the loss of a loved one limited the ability of family members to recall details about the GTEx project. However, we found a similar lack of knowledge in both the comparison and the intervention group participants, suggesting lack of knowledge may be due to the complexity and unfamiliarity of the information presented to them during the authorization process. We discuss these findings in the context of everyday clinical decision making in cognitively challenging conditions. Copyright 2018 The Journal of Clinical Ethics. All rights reserved.

Health System Perspective: Variation, Costs, and Physician Behavior.

PubMed

Jevsevar, David S

2015-01-01

With the generalized rise in cost of US health care, renewed emphasis has been placed on defining the relationship between costs and outcome. The quality of health care delivery has been uneven, as measured by existing quality and performance measures, significant variation in the delivery of care, lack of standardization of care leading to avoidable error, lack of meaningful outcomes measurement, and apparent disconnect with cost. Orthopaedic surgeons are at the nexus of implementing change, as we are the primary decision makers regarding care of our patients. This summary will review efforts that address quality, cost, outcome, safety, and variation in care.

Eating and drinking interventions for people at risk of lacking decision-making capacity: who decides and how?

PubMed

Clarke, Gemma; Galbraith, Sarah; Woodward, Jeremy; Holland, Anthony; Barclay, Stephen

2015-06-11

Some people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team. A three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process? Decision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: (1) Risks, burdens and benefits; (2) Treatment goals; (3) Normative ethical values; (4) Interested parties. Decision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of 'who decides' cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum.

Evaluation of decision making and negotiation processes under uncertainties regarding the water management of Peiros-Parapeiros Dam, in Achaia Region (Greece).

NASA Astrophysics Data System (ADS)

Podimata, Marianthi V.; Yannopoulos, Panayotis C.

2015-04-01

Water managers, decision-makers, water practitioners and others involved in Integrated Water Resources Management often encounter the problem of finding a joint agreement among stakeholders concerning the management of a common water body. Handling conflict situations/disputes over water issues and finding an acceptable joint solution remain a thorny issue in water negotiation processes, since finding a formula for wise, fair and sustainable management of a water resource is a complex process that includes environmental, economic, technical, socio-political criteria and their uncertainties. Decision Support Systems and Adaptive Management are increasingly used in that direction. To assist decision makers in handling water disputes and execute negotiations, a conceptual tool is required. The Graph Model for Conflict Resolution is a Decision Support flexible tool for negotiation support regarding water conflicts. It includes efficient algorithms for estimating strategic moves of water stakeholders, even though there is a lack of detail concerning their real motives and prospects. It calculates the stability of their states and encourages what-if analyses. This paper presents a case study of water decision makers' evaluations concerning the management of up-coming technical infrastructure Peiros-Parapeiros Dam, in Achaia Region (Greece). The continuous consultations between institutions and representatives revealed that the formation of a joint agreement between stakeholders is not easy, due to arising conflicts and contradictions regarding the jurisdiction and legal status of the dam operator and the cost undertaking of the dam operation. This paper analyzes the positions of the parties involved in the consultation process and examines possible conflict resolution states, using GMCR II. This methodology tries to minimize uncertainty to a certain extent concerning the possible moves/decisions of involved parties regarding the operation and management of the dam by developing and simulating potential strategic interactions and multilateral negotiations and finding confidence-building cooperation schemes (cooperative arrangements) over water use and management.

Information Needs Assessment for Coastal and Marine Management and Policy: Ecosystem Services Under Changing Climatic, Land Use, and Demographic Conditions.

PubMed

Goldsmith, Kaitlin A; Granek, Elise F; Lubitow, Amy

2015-12-01

Changing climatic, demographic, and land use conditions are projected to alter the provisioning of ecosystem services in estuarine, coastal, and nearshore marine ecosystems, necessitating mitigation and adaptation policies and management. The current paradigm of research efforts occurring in parallel to, rather than in collaboration with, decision makers will be insufficient for the rapid responses required to adapt to and mitigate for projected changing conditions. Here, we suggest a different paradigm: one where research begins by engaging decision makers in the identification of priority data needs (biophysical, economic, and social). This paper uses synthesized interview data to provide insight into the varied demands for scientific research as described by decision makers working on coastal issues in Oregon, USA. The findings highlight the need to recognize (1) the differing framing of ecosystem services by decision makers versus scientists; and (2) the differing data priorities relevant to inland versus coastal decision makers. The findings further serve to highlight the need for decision makers, scientists, and funders to engage in increased communication. This research is an important first step in advancing efforts toward evidence-based decision making in Oregon and provides a template for further research across the US.

A randomized comparison between league tables and funnel plots to inform health care decision-making.

PubMed

Anell, Anders; Hagberg, Oskar; Liedberg, Fredrik; Ryden, Stefan

2016-12-01

Comparison of provider performance is commonly used to inform health care decision-making. Little attention has been paid to how data presentations influence decisions. This study analyzes differences in suggested actions by decision-makers informed by league tables or funnel plots. Decision-makers were invited to a survey and randomized to compare hospital performance using either league tables or funnel plots for four different measures within the area of cancer care. For each measure, decision-makers were asked to suggest actions towards 12-16 hospitals (no action, ask for more information, intervene) and provide feedback related to whether the information provided had been useful. Swedish health care. Two hundred and twenty-one decision-makers at administrative and clinical levels. Data presentations in the form of league tables or funnel plots. Number of actions suggested by participants. Proportion of appropriate actions. For all four measures, decision-makers tended to suggest more actions based on the information provided in league tables compared to funnel plots (44% vs. 21%, P < 0.001). Actions were on average more appropriate for funnel plots. However, when using funnel plots, decision-makers more often missed to react even when appropriate. The form of data presentation had an influence on decision-making. With league tables, decision-makers tended to suggest more actions compared to funnel plots. A difference in sensitivity and specificity conditioned by the form of presentation could also be identified, with different implications depending on the purpose of comparisons. Explanations and visualization aids are needed to support appropriate actions. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Climate Change Boot Camps: Targeting Policy Makers and Outreach Trainers in Arizona to Improve Climate Literacy

NASA Astrophysics Data System (ADS)

Ferguson, D. B.; Guido, Z. S.; Buizer, J.; Roy, M.

2010-12-01

Bringing climate change issues into focus for decision makers is a growing challenge. Decision makers are often confronted with unique informational needs, a lack of useable information, and needs for customized climate change training, among other issues. Despite significant progress in improving climate literacy among certain stakeholders such as water managers, recent reports have highlighted the growing demand for climate-change information in regions and sectors across the US. In recent years many ventures have sprung up to address these gaps and have predominantly focused on K-12 education and resource management agencies such as the National Park Service and National Weather Service. However, two groups that are critical for integrating climate information into actions have received less attention: (1) policy makers and (2) outreach experts, such as Cooperative Extension agents. Climate Change Boot Camps (CCBC) is a joint effort between the Climate Assessment for the Southwest (CLIMAS)—a NOAA Regionally Integrated Sciences and Assessments (RISA) program—and researchers at Arizona State University to diagnose climate literacy and training gaps in Arizona and develop a process that converts these deficiencies into actionable knowledge among the two aforementioned groups. This presentation will highlight the initial phases of the CCBC process, which has as its outcomes the identification of effective strategies for reaching legislators, climate literacy and training needs for both policy makers and trainers, and effective metrics to evaluate the success of these efforts. Specific attention is given to evaluating the process from initial needs assessment to the effectiveness of the workshops. Web curriculum and training models made available on the internet will also be developed, drawing on extensive existing Web resources for other training efforts and converted to meet the needs of these two groups. CCBC will also leverage CLIMAS’ long history of engaging with stakeholders in the Southwest to facilitate to use of climate information in the decision process.

Taking off the white coat: can family members who are physicians be good surrogate decision-makers?

PubMed

Issa, Amalia M

2002-05-01

The challenges inherent in physicians treating members of their own families are well known. However, the issues related to physicians acting as surrogate decision-makers on behalf of relatives have not been addressed. The growing number of older persons will increase the need not only for healthcare resources, but also for physicians to act on behalf of incapacitated family members as surrogate decision-makers. In this paper, some of the clinical and ethical tensions evoked by physicians serving as surrogate decision-makers for family members are explored. Some recommendations for managing these tensions are suggested.

Proxy decision making and dementia: Using Construal Level Theory to analyse the thoughts of decision makers.

PubMed

Convey, Helen; Holt, Janet; Summers, Barbara

2018-07-01

This study explored the feasibility of using Construal Level Theory to analyse proxy decision maker thinking about a hypothetical ethical dilemma, relating to a person who has dementia. Proxy decision makers make decisions on behalf of individuals who are living with dementia when dementia affects that individual's decision making ability. Ethical dilemmas arise because there is a need to balance the individual's past and contemporary values and views. Understanding of how proxy decision makers respond is incomplete. Construal Level Theory contends that individuals imagine reactions and make predications about the future by crossing psychological distance. This involves abstract thinking, giving meaning to decisions. There is no empirical evidence of Construal Level Theory being used to analyse proxy decision maker thinking. Exploring the feasibility of using Construal Level Theory to understand dementia carer thinking regarding proxy decisions may provide insights which inform the support given. Descriptive qualitative research with semi-structured interviews. Seven participants were interviewed using a hypothetical dementia care scenario in February 2016. Interview transcripts were analysed for themes. Construal Level Theory was applied to analyse participant responses within themes using the Linguistic Category Model. Participants travelled across psychological distance, using abstract thinking to clarify goals and provide a basis for decisions. When thinking concretely participants established boundaries regarding the ethical dilemma. Construal Level Theory gives insight into proxy decision maker thinking and the levels of abstraction used. Understanding what dementia carers think about when making proxy decisions may help nurses to understand their perspectives and to provide appropriate support. © 2018 John Wiley & Sons Ltd.

More heads choose better than one: Group decision making can eliminate probability matching.

PubMed

Schulze, Christin; Newell, Ben R

2016-06-01

Probability matching is a robust and common failure to adhere to normative predictions in sequential decision making. We show that this choice anomaly is nearly eradicated by gathering individual decision makers into small groups and asking the groups to decide. The group choice advantage emerged both when participants generated responses for an entire sequence of choices without outcome feedback (Exp. 1a) and when participants made trial-by-trial predictions with outcome feedback after each decision (Exp. 1b). We show that the dramatic improvement observed in group settings stands in stark contrast to a complete lack of effective solitary deliberation. These findings suggest a crucial role of group discussion in alleviating the impact of hasty intuitive responses in tasks better suited to careful deliberation.

[The role of Health Impact Assessment (HIA) in the decision-making].

PubMed

Signorelli, Carlo; Riccò, Matteo; Odone, Anna

2011-01-01

The review describes the evolution of the environmental policies in Italy underlying current delays and discords between the environment and its effects on human health. It also tries to define the major barriers to the introduction of the health impact assessment (HIA) in government policy-making process in Italy; the lack of regulations and the lack of methods to perform an HIA are the main reasons for its limited use. Epidemiology is a fundamental tool to produce effective health impact assessments along with a deep knowledge of medicine, environmental hygiene and risk communication. In conclusion, should the Italian scientific community agreed on a common and constructive approach avoiding possible exploitations and conflicts of interest, HIA could be a valuable method for helping to develop environmental policies and assisting policy-makers in important decisions.

Challenges Associated With Applying Physiologically Based Pharmacokinetic Modeling for Public Health Decision-Making.

PubMed

Tan, Yu-Mei; Worley, Rachel R; Leonard, Jeremy A; Fisher, Jeffrey W

2018-04-01

The development and application of physiologically based pharmacokinetic (PBPK) models in chemical toxicology have grown steadily since their emergence in the 1980s. However, critical evaluation of PBPK models to support public health decision-making across federal agencies has thus far occurred for only a few environmental chemicals. In order to encourage decision-makers to embrace the critical role of PBPK modeling in risk assessment, several important challenges require immediate attention from the modeling community. The objective of this contemporary review is to highlight 3 of these challenges, including: (1) difficulties in recruiting peer reviewers with appropriate modeling expertise and experience; (2) lack of confidence in PBPK models for which no tissue/plasma concentration data exist for model evaluation; and (3) lack of transferability across modeling platforms. Several recommendations for addressing these 3 issues are provided to initiate dialog among members of the PBPK modeling community, as these issues must be overcome for the field of PBPK modeling to advance and for PBPK models to be more routinely applied in support of public health decision-making.

Post Outbreak Review: Dengue Preparedness and Response in Key West, Florida.

PubMed

Hayden, Mary H; Cavanaugh, Jamie L; Tittel, Christopher; Butterworth, Melinda; Haenchen, Steven; Dickinson, Katherine; Monaghan, Andrew J; Ernst, Kacey C

2015-08-01

Dengue is the most prevalent mosquito-borne viral infection. Recent outbreaks in the southern United States illustrate the risk of reemergence. The first autochthonous cases since 1934 in Key West, FL, occurred in 2009-2010. We conducted a survey in 2012 with decision makers instrumental to the control of the outbreak to 1) determine their awareness of the multiple strategies used to control the outbreak and 2) assess their perceptions of the relative effectiveness of these strategies. An online survey was delivered to a predefined list of decision makers from multiple sectors to better understand dengue preparedness and response. Thirty-six out of 45 surveys were returned for an 80% response rate. Results indicate the need to focus prevention strategies on educational campaigns designed to increase population awareness of transmission risk. Respondents remain concerned about future dengue transmission risk in Key West and lack of resources to respond. © The American Society of Tropical Medicine and Hygiene.

Making Health System Performance Measurement Useful to Policy Makers: Aligning Strategies, Measurement and Local Health System Accountability in Ontario

PubMed Central

Veillard, Jeremy; Huynh, Tai; Ardal, Sten; Kadandale, Sowmya; Klazinga, Niek S.; Brown, Adalsteinn D.

2010-01-01

This study examined the experience of the Ontario Ministry of Health and Long-Term Care in enhancing its stewardship and performance management role by developing a health system strategy map and a strategy-based scorecard through a process of policy reviews and expert consultations, and linking them to accountability agreements. An evaluation of the implementation and of the effects of the policy intervention has been carried out through direct policy observation over three years, document analysis, interviews with decision-makers and systematic discussion of findings with other authors and external reviewers. Cascading strategies at health and local health system levels were identified, and a core set of health system and local health system performance indicators was selected and incorporated into accountability agreements with the Local Health Integration Networks. despite the persistence of such challenges as measurement limitations and lack of systematic linkage to decision-making processes, these activities helped to strengthen substantially the ministry's performance management function. PMID:21286268

Taking Wishes and Feelings Seriously: The Views of People Lacking Capacity in Court of Protection Decision-Making

PubMed Central

Munro, Nell

2014-01-01

The Mental Capacity Act requires that where a person (P) lacks capacity to make a decision her wishes and feelings be taken into account when deciding what is in her best interests. This article considers how the Court of Protection evaluates evidence from P concerning her wishes and feelings. It finds that the Court ignores evidence regarding current wishes and fails to engage with more ambiguous evidence where P desires conflicting outcomes or may be concealing her true feelings. This is unhelpful since it makes the resulting judgment unconvincing to observers. It is legally problematic, since the Court should be following the practices of other decision-makers under the Mental Capacity Act (MCA). And it is ethically problematic since it undermines P's dignity and does not treat P as an actor whose evidence regarding her wishes and feelings has intrinsic status which the Court must make active efforts to engage with or discount rather than ignore. PMID:24771987

Value and role of intensive care unit outcome prediction models in end-of-life decision making.

PubMed

Barnato, Amber E; Angus, Derek C

2004-07-01

In the United States, intensive care unit (ICU) admission at the end of life is commonplace. What is the value and role of ICU mortality prediction models for informing the utility of ICU care?In this article, we review the history, statistical underpinnings,and current deployment of these models in clinical care. We conclude that the use of outcome prediction models to ration care that is unlikely to provide an expected benefit is hampered by imperfect performance, the lack of real-time availability, failure to consider functional outcomes beyond survival, and physician resistance to the use of probabilistic information when death is guaranteed by the decision it informs. Among these barriers, the most important technical deficiency is the lack of automated information systems to provide outcome predictions to decision makers, and the most important research and policy agenda is to understand and address our national ambivalence toward rationing care based on any criterion.

Attitudes of Educational Decision Makers toward AVTI Governance and the Local Tax Levy. An Independent Paper.

ERIC Educational Resources Information Center

LiaBraaten, James Clayton

A study investigated the attitudes of vocational education decision makers toward the governance of Minnesota's Area Vocational Technical Institutes (AVTIs) and the impact removal of a local tax to support the AVTIs might have on governance. Five categories of individuals, all considered vocational education decision makers, were surveyed: AVTI…

NREL's Winning Hand of Clean Transportation Tools - Continuum Magazine |

Science.gov Websites

kinds of decision makers-supplying resources for fleets to reduce petroleum use or an individual warehouse that offers invaluable information to decision makers, such as city planners, to help them with ;The TSDC provided useful data for decision-makers. And the state passed what will be a $65 million

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers.

PubMed

Petrinec, Amy B; Mazanec, Polly M; Burant, Christopher J; Hoffer, Alan; Daly, Barbara J

2015-06-01

To assess the coping strategies used by family decision makers of adult critical care patients during and after the critical care experience and the relationship of coping strategies to posttraumatic stress symptoms experienced 60 days after hospitalization. A single-group descriptive longitudinal correlational study. Medical, surgical, and neurological ICUs in a large tertiary care university hospital. Consecutive family decision makers of adult critical care patients from August 2012 to November 2013. Study inclusion occurred after the patient's fifth day in the ICU. None. Family decision makers of incapacitated adult ICU patients completed the Brief COPE instrument assessing coping strategy use 5 days after ICU admission and 30 days after hospital discharge or death of the patient and completed the Impact of Event Scale-Revised assessing posttraumatic stress symptoms 60 days after hospital discharge. Seventy-seven family decision makers of the eligible 176 completed all data collection time points of this study. The use of problem-focused (p=0.01) and emotion-focused (p<0.01) coping decreased over time while avoidant coping (p=0.20) use remained stable. Coping strategies 30 days after hospitalization (R2=0.50, p<0.001) were better predictors of later posttraumatic stress symptoms than coping strategies 5 days after ICU admission (R2=0.30, p=0.001) controlling for patient and decision-maker characteristics. The role of decision maker for a parent and patient death were the only noncoping predictors of posttraumatic stress symptoms. Avoidant coping use 30 days after hospitalization mediated the relationship between patient death and later posttraumatic stress symptom severity. Coping strategy use is a significant predictor of posttraumatic stress symptom severity 60 days after hospitalization in family decision makers of ICU patients.

Linking decision-making research and cancer prevention and control: important themes.

PubMed

McCaul, Kevin D; Peters, Ellen; Nelson, Wendy; Stefanek, Michael

2005-07-01

This article describes 6 themes underlying the multiple presentations from the Basic and Applied Decision Making in Cancer Control meeting, held February 19-20, 2004. The following themes have important implications for research and practice linking basic decision-making research to cancer prevention and control: (a) Traditional decision-making theories fail to capture real-world decision making, (b) decision makers are often unable to predict future preferences, (c) preferences are often constructed on the spot and thus are influenced by situational cues, (d) decision makers often rely on feelings rather than beliefs when making a decision, (e) the perspective of the decision maker is critical in determining preferences, and (f) informed decision making may--or may not--yield the best decisions.

Current status of waste management in Botswana: A mini-review.

PubMed

Mmereki, Daniel

2018-05-01

Effective waste management practices are not all about legislative solutions, but a combination of the environmental, social, technical, technically skilled human resources, financial and technological resources, resource recycling, environmental pollution awareness programmes and public participation. As a result of insufficient resources, municipal solid waste (MSW) in transition and developing countries like Botswana remains a challenge, and it is often not yet given highest priority. In Botswana, the environment, public health and other socio-economic aspects are threatened by waste management practices due to inadequate implementation and enforcement mechanisms of waste management policy. This mini-review paper describes the panorama of waste management practices in Botswana and provides information to competent authorities responsible for waste management and to researchers to develop and implement an effective waste management system. Waste management practices in Botswana are affected by: lack of effective implementation of national waste policy, fragmented tasks and overlapping mandates among relevant institutions; lack of clear guidelines on the responsibilities of the generators and public authorities and on the associated economic incentives; and lack of consistent and comprehensive solid waste management policies; lack of intent by decision-makers to prepare national waste management plans and systems, and design and implement an integrated sustainable municipal solid waste management system. Due to these challenges, there are concerns over the growing trend of the illegal dumping of waste, creating mini dumping sites all over the country, and such actions jeopardize the efforts of lobbying investors and tourism business. Recommendations for concerted efforts are made to support decision makers to re-organize a sustainable waste management system, and this paper provides a reference to other emerging economies in the region and the world.

A questionnaire to assess the relevance and credibility of observational studies to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

PubMed

Berger, Marc L; Martin, Bradley C; Husereau, Don; Worley, Karen; Allen, J Daniel; Yang, Winnie; Quon, Nicole C; Mullins, C Daniel; Kahler, Kristijan H; Crown, William

2014-03-01

Evidence-based health care decisions are best informed by comparisons of all relevant interventions used to treat conditions in specific patient populations. Observational studies are being performed to help fill evidence gaps. Widespread adoption of evidence from observational studies, however, has been limited because of various factors, including the lack of consensus regarding accepted principles for their evaluation and interpretation. Two task forces were formed to develop questionnaires to assist decision makers in evaluating observational studies, with one Task Force addressing retrospective research and the other Task Force addressing prospective research. The intent was to promote a structured approach to reduce the potential for subjective interpretation of evidence and drive consistency in decision making. Separately developed questionnaires were combined into a single questionnaire consisting of 33 items. These were divided into two domains: relevance and credibility. Relevance addresses the extent to which findings, if accurate, apply to the setting of interest to the decision maker. Credibility addresses the extent to which the study findings accurately answer the study question. The questionnaire provides a guide for assessing the degree of confidence that should be placed from observational studies and promotes awareness of the subtleties involved in evaluating those. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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.

Mutual Distrust: Perspectives From Researchers and Policy Makers on the Research to Policy Gap in 2013 and Recommendations for the Future

PubMed Central

Gollust, Sarah E.; Seymour, Jane W.; Pany, Maximilian J.; Goss, Adeline; Meisel, Zachary F.; Grande, David

2017-01-01

The production of health policy-relevant research is necessary, but not sufficient, to promote its utilization in policy. Our objective was to understand the perspectives of United States’ state-level policy makers and health researchers on the barriers and facilitators to the translation of health evidence into the policy process, with a particular focus on issues related to relationship building. We conducted interviews with 215 US health services and health policy researchers and 40 state-level staffers and legislators. Researchers and policy makers faced the same major barrier to research translation: lack of dedicated time to do so. Some policy makers questioned the credibility of research, and researchers questioned policy makers’ authentic desire to use evidence in decision making. For some study participants, a mutual mistrust of the other group challenges stronger relationship formation. Interventions are needed to help both groups understand a broader role that research plays in policy making and to increase personal contact, and ultimately trusted relationships, across various actors in the policy process. PMID:28452251

The current capacity and future development of economic evaluation for policy decision-making: a survey among researchers and decision-makers in Thailand.

PubMed

Chaikledkaew, Usa; Lertpitakpong, Chanida; Teerawattananon, Yot; Thavorncharoensap, Montarat; Tangcharoensathien, Viroj

2009-01-01

This study aims to explore the knowledge, experience, and attitudes toward economic evaluation (EE) among decision-makers and researchers in Thailand. Researchers were purposively selected from Thai academics and both public and private research organizations related to EE. Decision-makers at the provincial level were purposively selected from the members of the Management Committees of Provincial Health Offices, and those at hospital level were randomly selected from members of the public and private hospital formulary drug committees throughout Thailand. The self-administered postal questionnaires were distributed. Univariate and bivariate analyses were applied. Of the total 2575 questionnaires distributed, 758 (29.4% response rate) were completed and sent back. The majority of researchers and decision-makers were not familiar with technical terms commonly used in health EE, e.g., incremental cost-effectiveness ratio, discounting, and sensitivity analysis. More decision-makers (70.6%) had never had EE training compared to researchers (50.0%). Both roles indicated that value for money was one of the important issues to consider for health technology adoption. An extensive unmet demand for EE training among Thai researchers and decision-makers still exists. Findings from this study contribute to the short- and long-term plans for research capacity building.

Characteristics and use of urban health indicator tools by municipal built environment policy and decision-makers: a systematic review protocol.

PubMed

Pineo, Helen; Glonti, Ketevan; Rutter, Harry; Zimmermann, Nicole; Wilkinson, Paul; Davies, Michael

2017-01-13

There is wide agreement that there is a lack of attention to health in municipal environmental policy-making, such as urban planning and regeneration. Explanations for this include differing professional norms between health and urban environment professionals, system complexity and limited evidence for causality between attributes of the built environment and health outcomes. Data from urban health indicator (UHI) tools are potentially a valuable form of evidence for local government policy and decision-makers. Although many UHI tools have been specifically developed to inform policy, there is poor understanding of how they are used. This study aims to identify the nature and characteristics of UHI tools and their use by municipal built environment policy and decision-makers. Health and social sciences databases (ASSIA, Campbell Library, EMBASE, MEDLINE, Scopus, Social Policy and Practice and Web of Science Core Collection) will be searched for studies using UHI tools alongside hand-searching of key journals and citation searches of included studies. Advanced searches of practitioner websites and Google will also be used to find grey literature. Search results will be screened for UHI tools, and for studies which report on or evaluate the use of such tools. Data about UHI tools will be extracted to compile a census and taxonomy of existing tools based on their specific characteristics and purpose. In addition, qualitative and quantitative studies about the use of these tools will be appraised using quality appraisal tools produced by the UK National Institute for Health and Care Excellence (NICE) and synthesised in order to gain insight into the perceptions, value and use of UHI tools in the municipal built environment policy and decision-making process. This review is not registered with PROSPERO. This systematic review focuses specifically on UHI tools that assess the physical environment's impact on health (such as transport, housing, air quality and greenspace). This study will help indicator producers understand whether this form of evidence is of value to built environment policy and decision-makers and how such tools should be tailored for this audience. N/A.

Fuzzy bilevel programming with multiple non-cooperative followers: model, algorithm and application

NASA Astrophysics Data System (ADS)

Ke, Hua; Huang, Hu; Ralescu, Dan A.; Wang, Lei

2016-04-01

In centralized decision problems, it is not complicated for decision-makers to make modelling technique selections under uncertainty. When a decentralized decision problem is considered, however, choosing appropriate models is no longer easy due to the difficulty in estimating the other decision-makers' inconclusive decision criteria. These decision criteria may vary with different decision-makers because of their special risk tolerances and management requirements. Considering the general differences among the decision-makers in decentralized systems, we propose a general framework of fuzzy bilevel programming including hybrid models (integrated with different modelling methods in different levels). Specially, we discuss two of these models which may have wide applications in many fields. Furthermore, we apply the proposed two models to formulate a pricing decision problem in a decentralized supply chain with fuzzy coefficients. In order to solve these models, a hybrid intelligent algorithm integrating fuzzy simulation, neural network and particle swarm optimization based on penalty function approach is designed. Some suggestions on the applications of these models are also presented.

A regret theory approach to decision curve analysis: a novel method for eliciting decision makers' preferences and decision-making.

PubMed

Tsalatsanis, Athanasios; Hozo, Iztok; Vickers, Andrew; Djulbegovic, Benjamin

2010-09-16

Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc).

A regret theory approach to decision curve analysis: A novel method for eliciting decision makers' preferences and decision-making

PubMed Central

2010-01-01

Background Decision curve analysis (DCA) has been proposed as an alternative method for evaluation of diagnostic tests, prediction models, and molecular markers. However, DCA is based on expected utility theory, which has been routinely violated by decision makers. Decision-making is governed by intuition (system 1), and analytical, deliberative process (system 2), thus, rational decision-making should reflect both formal principles of rationality and intuition about good decisions. We use the cognitive emotion of regret to serve as a link between systems 1 and 2 and to reformulate DCA. Methods First, we analysed a classic decision tree describing three decision alternatives: treat, do not treat, and treat or no treat based on a predictive model. We then computed the expected regret for each of these alternatives as the difference between the utility of the action taken and the utility of the action that, in retrospect, should have been taken. For any pair of strategies, we measure the difference in net expected regret. Finally, we employ the concept of acceptable regret to identify the circumstances under which a potentially wrong strategy is tolerable to a decision-maker. Results We developed a novel dual visual analog scale to describe the relationship between regret associated with "omissions" (e.g. failure to treat) vs. "commissions" (e.g. treating unnecessary) and decision maker's preferences as expressed in terms of threshold probability. We then proved that the Net Expected Regret Difference, first presented in this paper, is equivalent to net benefits as described in the original DCA. Based on the concept of acceptable regret we identified the circumstances under which a decision maker tolerates a potentially wrong decision and expressed it in terms of probability of disease. Conclusions We present a novel method for eliciting decision maker's preferences and an alternative derivation of DCA based on regret theory. Our approach may be intuitively more appealing to a decision-maker, particularly in those clinical situations when the best management option is the one associated with the least amount of regret (e.g. diagnosis and treatment of advanced cancer, etc). PMID:20846413

Social and ethical analysis in health technology assessment.

PubMed

Tantivess, Sripen

2014-05-01

This paper presents a review of the domestic and international literature on the assessment of the social and ethical implications of health technologies. It gives an overview of the key concepts, principles, and approaches that should be taken into account when conducting a social and ethical analysis within health technology assessment (HTA). Although there is growing consensus among healthcare experts that the social and ethical ramifications of a given technology should be examined before its adoption, the demand for this kind of analysis among policy-makers around the world, including in Thailand, has so far been lacking. Currently decision-makers mainly base technology adoption decisions using evidence on clinical effectiveness, value for money, and budget impact, while social and ethical aspects have been neglected. Despite the recognized importance of considering equity, justice, and social issues when making decisions regarding health resource allocation, the absence of internationally-accepted principles and methodologies, among other factors, hinders research in these areas. Given that developing internationally agreed standards takes time, it has been recommended that priority be given to defining processes that are justifiable, transparent, and contestable. A discussion of the current situation in Thailand concerning social and ethical analysis of health technologies is also presented.

Web-Based Geospatial Tools to Address Hazard Mitigation, Natural Resource Management, and Other Societal Issues

USGS Publications Warehouse

Hearn,, Paul P.

2009-01-01

Federal, State, and local government agencies in the United States face a broad range of issues on a daily basis. Among these are natural hazard mitigation, homeland security, emergency response, economic and community development, water supply, and health and safety services. The U.S. Geological Survey (USGS) helps decision makers address these issues by providing natural hazard assessments, information on energy, mineral, water and biological resources, maps, and other geospatial information. Increasingly, decision makers at all levels are challenged not by the lack of information, but by the absence of effective tools to synthesize the large volume of data available, and to utilize the data to frame policy options in a straightforward and understandable manner. While geographic information system (GIS) technology has been widely applied to this end, systems with the necessary analytical power have been usable only by trained operators. The USGS is addressing the need for more accessible, manageable data tools by developing a suite of Web-based geospatial applications that will incorporate USGS and cooperating partner data into the decision making process for a variety of critical issues. Examples of Web-based geospatial tools being used to address societal issues follow.

Communication with U.S. federal decision makers : a primer with notes on the use of computer models as a means of communication.

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

Webb, Erik Karl; Tidwell, Vincent Carroll

2009-10-01

This document outlines ways to more effectively communicate with U.S. Federal decision makers by outlining the structure, authority, and motivations of various Federal groups, how to find the trusted advisors, and how to structure communication. All three branches of Federal governments have decision makers engaged in resolving major policy issues. The Legislative Branch (Congress) negotiates the authority and the resources that can be used by the Executive Branch. The Executive Branch has some latitude in implementation and prioritizing resources. The Judicial Branch resolves disputes. The goal of all decision makers is to choose and implement the option that best fitsmore » the needs and wants of the community. However, understanding the risk of technical, political and/or financial infeasibility and possible unintended consequences is extremely difficult. Primarily, decision makers are supported in their deliberations by trusted advisors who engage in the analysis of options as well as the day-to-day tasks associated with multi-party negotiations. In the best case, the trusted advisors use many sources of information to inform the process including the opinion of experts and if possible predictive analysis from which they can evaluate the projected consequences of their decisions. The paper covers the following: (1) Understanding Executive and Legislative decision makers - What can these decision makers do? (2) Finding the target audience - Who are the internal and external trusted advisors? (3) Packaging the message - How do we parse and integrate information, and how do we use computer simulation or models in policy communication?« less

Politics and its intersection with coverage with evidence development: a qualitative analysis from expert interviews.

PubMed

Bishop, Danielle; Lexchin, Joel

2013-03-09

Pressures on health care budgets have led policy makers to discuss how to balance the provision of costly technologies to populations in need and making coverage decisions under uncertainty. Coverage with evidence development (CED) is being employed to meet these challenges. Twenty-four interviews were carried out between June 2009 and December 2010 with researchers, decision makers and policy makers from Australia, Canada, United Kingdom and United States. Three phases of coding occurred, the first being manual coding where the interviews were read and notes were taken and nodes were extracted and imputed. NVIVO coding was applied to the interview transcripts, with both broad general searches for word usages and imputed nodes. Four overarching thematic areas emerged out of contextual analysis of the interviews - (1) what constitutes CED; (2) the lack of a systematic approach/governance structure; (3) the role of the pharmaceutical industry and overt political considerations in CED; and (4) alternatives and barriers to CED. We explore these themes and then use concrete examples of CED projects in each of the four countries to illustrate the political issues that our interviewees raised. Until the underlying political nature of CED is recognized then fundamental questions about its usefulness and operation will remain unresolved.

Politics and its intersection with coverage with evidence development: a qualitative analysis from expert interviews

PubMed Central

2013-01-01

Background Pressures on health care budgets have led policy makers to discuss how to balance the provision of costly technologies to populations in need and making coverage decisions under uncertainty. Coverage with evidence development (CED) is being employed to meet these challenges. Methods Twenty-four interviews were carried out between June 2009 and December 2010 with researchers, decision makers and policy makers from Australia, Canada, United Kingdom and United States. Three phases of coding occurred, the first being manual coding where the interviews were read and notes were taken and nodes were extracted and imputed. NVIVO coding was applied to the interview transcripts, with both broad general searches for word usages and imputed nodes. Results Four overarching thematic areas emerged out of contextual analysis of the interviews – (1) what constitutes CED; (2) the lack of a systematic approach/governance structure; (3) the role of the pharmaceutical industry and overt political considerations in CED; and (4) alternatives and barriers to CED. We explore these themes and then use concrete examples of CED projects in each of the four countries to illustrate the political issues that our interviewees raised. Conclusion Until the underlying political nature of CED is recognized then fundamental questions about its usefulness and operation will remain unresolved. PMID:23497271

Health decision-making preferences among African American men recruited from urban barbershops.

PubMed

Hart, Alton; Smith, Wally R; Tademy, Raymond H; McClish, Donna K; McCreary, Micah

2009-07-01

To examine general health decision-making roles among African American men ages 40 to 70 recruited in barbershops in the Richmond, Virginia, metropolitan area. We adapted the 1-item Control Preference scale to study the associations between health decision-making role preferences and demographic variables. Forty African-American men were recruited from barbershops to complete a self-administered survey. After performing descriptive statistics, we dichotomized our outcome into active vs nonactive (collaborative or passive) decision makers. Data were then analyzed using chi2, Wilcoxon-Mann-Whitney rank sum, and multiple logistic regression. Fifteen subjects responded that they engaged in active decision making, 20 in collaborative, and 5 in passive decision making. Almost all (86.7%) active decision makers were home owners, vs 41.7% of nonactive decision makers. Among active decision makers, 46.7% had incomes of more than $70000, vs 12.5% of nonactive decision makers. The active group reported health status that was good to excellent, while 20.8% of those in the nonactive group reported poor/fair health. African American male barbershop clients preferred an active or collaborative health decision-making role with their physician, rather than a passive role. The relationship among home ownership, income, and decision style may best be understood by considering the historical and cultural influences on gender role socialization among African American males. More comprehensive assessment of decision styles is necessary to better understand health decision making among African American male patients.

The medical decision model and decision maker tools for management of radiological and nuclear incidents.

PubMed

Koerner, John F; Coleman, C Norman; Murrain-Hill, Paula; FitzGerald, Denis J; Sullivan, Julie M

2014-06-01

Effective decision making during a rapidly evolving emergency such as a radiological or nuclear incident requires timely interim decisions and communications from onsite decision makers while further data processing, consultation, and review are ongoing by reachback experts. The authors have recently proposed a medical decision model for use during a radiological or nuclear disaster, which is similar in concept to that used in medical care, especially when delay in action can have disastrous effects. For decision makers to function most effectively during a complex response, they require access to onsite subject matter experts who can provide information, recommendations, and participate in public communication efforts. However, in the time before this expertise is available or during the planning phase, just-in-time tools are essential that provide critical overview of the subject matter written specifically for the decision makers. Recognizing the complexity of the science, risk assessment, and multitude of potential response assets that will be required after a nuclear incident, the Office of the Assistant Secretary for Preparedness and Response, in collaboration with other government and non-government experts, has prepared a practical guide for decision makers. This paper illustrates how the medical decision model process could facilitate onsite decision making that includes using the deliberative reachback process from science and policy experts and describes the tools now available to facilitate timely and effective incident management.

How is the New Public Management applied in the occupational health care system? - decision-makers' and OH personnel's views in Finland

PubMed Central

2011-01-01

Background In many countries occupational health care system is in change. Occupational health studies are mainly focused on occupational health substance and content. This study offers new perspectives on municipal OHS and its operations from management perspective. Aim The aim of this study is to analyse how New Public Management (NPM) doctrines are applied in the Finnish occupational health care system (OHS). The main focus is to describe and compare the views of decision-makers' and OH workers within the framework of NPM. Methods The data were collected by semi-structured interviews from 17 municipal decision-makers' and 26 municipal OH workers. Data was analyzed by examining coded data in a theory-driven way according to Hood's doctrine of NPM. Results The doctrines were not as compatible with the OH personnel view as with the decision-makers' view. Decision-makers and OH personnel highlighted the strict criteria required for operation evaluation. Moreover, decision-makers strongly accentuated professional management in the public sector and the reorganization of public sector units. These were not equally relevant in OH personnel views. In OH personnel views, other doctrines (more attention to performance and accomplishments, emphasizing and augmentation of the competition and better control of public expense and means test) were not similarly in evidence, only weak evidence was observed when their importance viewed as medium by decision-makers. Neither of the respondents group kept the doctrine of management models of the private sector relevant. Conclusions The NPM and Hoods doctrine fitted well with OH research. The doctrine brought out view differences and similarities between decision-makers and OH personnel. For example, policymakers highlighted more strongly the structural change by emphasizing professional management compared to OH personnel. The need for reorganization of municipal OH, regardless of different operational preconditions, was obvious for both decision-makers and OH personnel. The adaptation of more clarify management to a municipal context is not trouble-free. The municipality systemic structure, complex operational environment, and reconciliation of political and officer authority set challenges to management of municipalities. PMID:21880141

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

Limiting the financial risks of electricity generation capital investments under carbon constraints: Applications and opportunities for public policies and private investments

NASA Astrophysics Data System (ADS)

Newcomer, Adam

Increasing demand for electricity and an aging fleet of generators are the principal drivers behind an increasing need for a large amount of capital investments in the US electric power sector in the near term. The decisions (or lack thereof) by firms, regulators and policy makers in response to this challenge have long lasting consequences, incur large economic and environmental risks, and must be made despite large uncertainties about the future operating and business environment. Capital investment decisions are complex: rates of return are not guaranteed; significant uncertainties about future environmental legislation and regulations exist at both the state and national levels---particularly about carbon dioxide emissions; there is an increasing number of shareholder mandates requiring public utilities to reduce their exposure to potentially large losses from stricter environmental regulations; and there are significant concerns about electricity and fuel price levels, supplies, and security. Large scale, low carbon electricity generation facilities using coal, such as integrated gasification combined cycle (IGCC) facilities coupled with carbon capture and sequestration (CCS) technologies, have been technically proven but are unprofitable in the current regulatory and business environment where there is no explicit or implicit price on carbon dioxide emissions. The paper examines two separate scenarios that are actively discussed by policy and decision makers at corporate, state and national levels: a future US electricity system where coal plays a role; and one where the role of coal is limited or nonexistent. The thesis intends to provide guidance for firms and policy makers and outline applications and opportunities for public policies and for private investment decisions to limit financial risks of electricity generation capital investments under carbon constraints.

Decision Theory and the Governance of Technology.

ERIC Educational Resources Information Center

Woodhouse, Edward J.

1987-01-01

Provides an overview of the decision making process for science and technology. Finds that government agencies and officials are not the major decision makers. Examines obstacles to achieving intelligent decisions when policy makers are scientists, business executives, and consumers. Concludes with five strategies for improving technological…

Constructing Perceptions of Climate Change: a case study of regional political decision makers

NASA Astrophysics Data System (ADS)

Bray, D.

2012-12-01

This case study of climate change communications assesses the salient means of communication and the message adopted by regional political decision makers on the German Baltic coast. Realizing that cultural factors and local values (and not simply knowledge) are significant influences in explaining attitudes towards climate change, this analysis draws from the records of regional weather, from scientists with a specific focus on the region, from the political decision makers for that region, and the media message reaching the decision makers, ensuring all elements of the analysis are drawn from the same socioeconomic, geophysical, political and cultural context. This is important as the social dynamics surrounding the trust in science is of critical importance and, as such, all elements of the case study are specifically contained within a common context. If the utility of climate change knowledge is to prompt well conceived adaptation/mitigation strategies then the political decision process, or at least the perceptions shaping it, can best be understood by locating it within the world view of the decision makers involved in the production process. Using the results of two survey questionnaires, one of regional climate scientists and one of regional political decision makers, ten years of local weather records, and a summary of the message from mass media circulation, the discord in perceptions of regional climate change are quantitatively explored. The conclusions drawn from the analysis include, compared to the scientific assessment: The decision makers' perceptions of recent past differ from actual observations. The decision makers' perceptions of the future differ from scientific assessments. The decision makers tend to over estimate the magnitude of regional climate change and its impacts. The decision makers tend to over estimate the sense of immediacy for adaptation measures. The conclusions drawn suggest that in the regional political realm, it is often a social construction of climate change, not scientific claims, that are shaping decisions. While certainty is the common demand of those charged with making decisions concerning climate change, certainty is the quality that seems to be given least value in taking action. Weather records are all but ignored. The direct voice of scientists was heeded but not fully accepted. In the transition, the truth-to-power model appears to be somewhat modified, whereby power states that the future will be different, but the difference is determined by other sources; shaping images of risk and danger. One could not deny that climate and sea level have always been forces shaping patterns of human settlement. And one could not deny that perhaps the time is nigh to reassess the human relationship with nature. However, any measure considered should be done so with a rational sense of objectivity. To do otherwise, there is the risk of misallocating scare resources.

Adaptation by Stealth: Understanding climate information use across scales and decision spaces in water management in the United States

NASA Astrophysics Data System (ADS)

Kirchhoff, C.; Vang Rasmussen, L.; Lemos, M. C.

2016-12-01

While there has been considerable focus on understanding how factors related to the creation of climate knowledge affect its uptake and use, less attention has been paid to the actors, decisions, and processes through which climate information supports, or fails to support, action. This is particularly the case concerning how different scales of decision-making influence information uptake. In this study, we seek to understand how water and resource managers' decision space influences climate information use in two Great Lakes watersheds. We find that despite the availability of tailored climate information, actual use of information in decision making remains low. Reasons include: a) lack of willingness to place climate on agendas because local managers perceive climate change as politically risky and a difficult and intangible problem; b) lack of formal mandate or authority at the city and county scale to translate climate information into on-the-ground action, c) problems with the information itself, and d) perceived lack of demand for climate information by those managers who have the mandate and authority (e.g. at the state level) to use (or help others use) climate information. Our findings suggest that 1) climate scientists and information brokers should produce information that meets a range of decision needs and reserve intensive tailoring efforts for decision makers who have authority and willingness to employ climate information, 2) without support from higher levels of decision-making (e.g. state) it is unlikely that climate information use for adaptation decisions will accelerate significantly in the next few years, and 3) the trend towards adopting more sustainability and resilience practices over climate-specific actions should be supported as an important component of the climate adaptation repertoire.

Consulting as a Strategy for Knowledge Transfer

PubMed Central

Jacobson, Nora; Butterill, Dale; Goering, Paula

2005-01-01

Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics’ traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the “enlightenment” and “interactive” models of knowledge use. Based on three case studies, it develops a model of knowledge transfer–focused consulting that consists of six stages and four types of work. Finally, the article explores how knowledge is generated in consulting and identifies several classes of factors facilitating its use by decision makers. PMID:15960773

Use of modified Delphi to plan knowledge translation for decision makers: an application in the field of advanced practice nursing.

PubMed

Carter, Nancy; Lavis, John N; MacDonald-Rencz, Sandra

2014-01-01

Disseminating research to decision makers is difficult. Interaction between researchers and decision makers can identify key messages and processes for dissemination. To gain agreement on the key findings from a synthesis on the integration of advanced practice nurses, we used a modified Delphi process. Nursing decision makers contributed ideas via e-mail, discussed and clarified ideas face to face, and then prioritized statements. Sixteen (89%) participated and 14 (77%) completed the final phase. Priority key messages were around access to care and outcomes. The majority identified "NPs increase access to care" and "NPs and CNSs improve patient and system outcomes" as priority messaging statements. Participants agreed policy makers and the public were target audiences for messages. Consulting with policy makers provided the necessary context to develop tailored policy messages and is a helpful approach for research dissemination. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Identifying Decision-Makers’ Science Needs for Adaptation to Climate-Related Impacts on Forest Ecosystem Services

NASA Astrophysics Data System (ADS)

Gordon, E.; Lukas, J.

2009-12-01

Through the Western Water Assessment RISA program, we are conducting a research project that will produce science synthesis information to help local, state, and federal decision-makers in Colorado and Wyoming develop adaptation strategies to deal with climate-related threats to forest ecosystem services, in particular bark beetle infestations and stand-replacing wildfires. We begin by using the problem orientation framework, a policy sciences methodology, to understand how decision-makers can most effectively address policy problems that threaten the attainment of socially accepted goals. By applying this framework to the challenges facing decision-makers, we more accurately identify specific areas where scientific research can improve decision-making. WWA researchers will next begin to connect decision-makers with relevant scientific literature and identify specific areas of future scientific research that will be most effective at addressing their needs.

Identifying family members who may struggle in the role of surrogate decision maker.

PubMed

Majesko, Alyssa; Hong, Seo Yeon; Weissfeld, Lisa; White, Douglas B

2012-08-01

Although acting as a surrogate decision maker can be highly distressing for some family members of intensive care unit patients, little is known about whether there are modifiable risk factors for the occurrence of such difficulties. To identify: 1) factors associated with lower levels of confidence among family members to function as surrogates and 2) whether the quality of clinician-family communication is associated with the timing of decisions to forego life support. We conducted a prospective study of 230 surrogate decision makers for incapacitated, mechanically ventilated patients at high risk of death in four intensive care units at University of California San Francisco Medical Center from 2006 to 2007. Surrogates completed a questionnaire addressing their perceived ability to act as a surrogate and the quality of their communication with physicians. We used clustered multivariate logistic regression to identify predictors of low levels of perceived ability to act as a surrogate and a Cox proportional hazard model to determine whether quality of communication was associated with the timing of decisions to withdraw life support. There was substantial variability in family members' confidence to act as surrogate decision makers, with 27% rating their perceived ability as 7 or lower on a 10-point scale. Independent predictors of lower role confidence were the lack of prior experience as a surrogate (odds ratio 2.2, 95% confidence interval [1.04-4.46], p=.04), no prior discussions with the patient about treatment preferences (odds ratio 3.7, 95% confidence interval [1.79-7.76], p<.001), and poor quality of communication with the ICU physician (odds ratio 1.2, 95% confidence interval [1.09-1.35] p<.001). Higher quality physician-family communication was associated with a significantly shorter duration of life-sustaining treatment among patients who died (β=0.11, p=.001). Family members without prior experience as a surrogate and those who had not engaged in advanced discussions with the patient about treatment preferences were at higher risk to report less confidence in carrying out the surrogate role. Better-quality clinician-family communication was associated with both more confidence among family members to act as surrogates and a shorter duration of use of life support among patients who died.

Intelligence Failure: How a Commander Can Prevent It

DTIC Science & Technology

2009-10-23

Failure: How a Commander Can Prevent It The job of intelligence is to provide the decision maker with sufficient understanding of the enemy to make...Failure: How a Commander Can Prevent It The job of intelligence is to provide the decision maker with sufficient understanding of the enemy to make...reinforce these lessons. 1 Introduction The job of intelligence is to provide the decision maker with sufficient understanding of

A Case History of the Science and Management Collaboration in Understanding Hypoxia Events in Long Bay, South Carolina, USA

NASA Astrophysics Data System (ADS)

Sanger, Denise; Hernandez, Debra; Libes, Susan; Voulgaris, George; Davis, Braxton; Smith, Erik; Shuford, Rebecca; Porter, Dwayne; Koepfler, Eric; Bennett, Joseph

2010-09-01

Communication of knowledge between the scientific and management communities is a difficult process complicated by the distinctive nature of professional career goals of scientists and decision-makers. This article provides a case history highlighting a collaboration between the science and management communities that resulted from a response to a 2004 hypoxia, or low dissolved oxygen, event in Long Bay, off Myrtle Beach, South Carolina. A working group of scientists and decision-makers was established at the time of the event and has continued to interact to develop a firm understanding of the drivers responsible for hypoxia formation in Long Bay. Several factors were found to be important to ensure that these collaborative efforts were productive: (1) genuine interest in collaboratively working across disciplines to examine a problem; (2) commitment by agency leadership, decision-makers, and researchers to create successful communication mechanisms; (3) respect for each others’ perspectives and an understanding how science and management are performed and that they are not mutually exclusive; (4) networking among researchers and decision-makers to ensure appropriate team members are involved in the process; (5) use of decision-maker input in the formulation of research and monitoring projects; and (6) commitment of resources for facilitation to ensure that researchers and decision-makers are communicating effectively.

Genital surgery for disorders of sex development: implementing a shared decision-making approach.

PubMed

Karkazis, Katrina; Tamar-Mattis, Anne; Kon, Alexander A

2010-08-01

Ongoing controversy surrounds early genital surgery for children with disorders of sex development, making decisions about these procedures extraordinarily complex. Professional organizations have encouraged healthcare providers to adopt shared decision-making due to its broad potential to improve the decision-making process, perhaps most so when data are lacking, when there is no clear "best-choice" treatment, when decisions involve more than one choice, where each choice has both advantages and disadvantages, and where the ranking of options depends heavily on the decision-maker's values. We present a 6-step model for shared decision-making in decisions about genital surgery for disorders of sex development: (1) Set the stage and develop an appropriate team; (2) Establish preferences for information and roles in decision-making; (3) Perceive and address emotions; (4) Define concerns and values; (5) Identify options and present evidence; and (6) Share responsibility for making a decision. As long as controversy persists regarding surgery for DSD, an SDM process can facilitate the increased sharing of relevant information essential for making important health care decisions.

Combining communication technology utilization and organizational innovation: evidence from Canadian healthcare decision makers.

PubMed

Jbilou, Jalila; Landry, Réjean; Amara, Nabil; El Adlouni, Salaheddine

2009-08-01

Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal's Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as engaging in activities of research acquisition, the administrative position (being a manager), the preference for applied research results as source of information, the degree of novelty of research results, and the gender. Modern Canadian healthcare organizations need contemporary decision makers who use ICT and develop OI, if performance is the target. Our results let us suggest that the isolated administrative agents profile is no more effective in a dynamic and changing world. Contemporary decision makers need to be more active intellectually and to take risks in their decisions. Relying exclusively on research results and on their social network is no more helpful for a real shift. Moreover, the traditional factors, i.e. organization size, time, experience ... are no more effective, especially when we consider combined roles. We propose some practical and theoretical recommendations to support these changes.

Parents and end-of-life decision-making for their child: roles and responsibilities.

PubMed

Sullivan, Jane; Gillam, Lynn; Monagle, Paul

2015-09-01

Whether parents want to be and should be the decision-maker for their child in end-of-life matters are contested clinical and ethical questions. Previous research outcomes are equivocal. A qualitative interview method was used to examine the views and experiences of 25 bereaved parents in end-of-life decision-making for their child. Data were analysed thematically. Three types of decision-making roles were identified: self-determined, guided (both involving active decision-making) and acquiescent (passive).The majority of parents had been active in the decision-making process for their child. They perceived themselves as the ultimate end-of-life decision-maker. This was perceived as part of their parental responsibility. A minority of parents did not consider that they had been an active, ultimate decision-maker. Generally, parents in the self-determined and guided groups reported no negative consequences from their decision-making involvement. Importantly, parents in the acquiescent group described their experience as difficult at the time and subsequently, although not all difficulties related directly to decision-making. Parents considered that in principle parents should be the end-of-life decision-maker for their child, but understood personal characteristics and preference could prevent some parents from taking this role. This study unequivocally supports parents' desire to fulfil the end-of-life decision-making role. It provides a nuanced understanding of parents' roles and contributes evidence for the ethical position that parents should be the end-of-life decision-makers for their child, unless not in the child's best interests. On the whole, parents want this role and can manage its consequences. Indeed, not being the end-of-life decision-maker could be detrimental to parents' well-being. 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.

URBAN DECISION-MAKING, THE UNIVERSITY'S ROLE.

ERIC Educational Resources Information Center

BAILEY, STEPHEN K.

THE AUTHOR EXAMINES THE VARIOUS WAYS IN WHICH THE UNIVERSITY CAN AND SHOULD INFLUENCE URBAN DECISION MAKING. THE CENTRAL UNIVERSITY ROLE IS SENSITIZING THE DECISION MAKERS AND THE CITIZENS TO HUMAN MISERY, SUCH AS BIGOTRY, SQUALOR, DISEASE, UGLINESS, POVERTY, AND IGNORANCE. LONG-RANGE ROLES ARE PINPOINTING THE PROBLEMS URBAN DECISION MAKERS SHOULD…

Is economic valuation of ecosystem services useful to decision-makers? Lessons learned from Australian coastal and marine management.

PubMed

Marre, Jean-Baptiste; Thébaud, Olivier; Pascoe, Sean; Jennings, Sarah; Boncoeur, Jean; Coglan, Louisa

2016-08-01

Economic valuation of ecosystem services is widely advocated as being useful to support ecosystem management decision-making. However, the extent to which it is actually used or considered useful in decision-making is poorly documented. This literature blindspot is explored with an application to coastal and marine ecosystems management in Australia. Based on a nation-wide survey of eighty-eight decision-makers representing a diversity of management organizations, the perceived usefulness and level of use of economic valuation of ecosystem services, in support of coastal and marine management, are examined. A large majority of decision-makers are found to be familiar with economic valuation and consider it useful - even necessary - in decision-making, although this varies across groups of decision-makers. However, most decision-makers never or rarely use economic valuation. The perceived level of importance and trust in estimated dollar values differ across ecosystem services, and are especially high for values that relate to commercial activities. A number of factors are also found to influence respondent's use of economic valuation. Such findings concur with conclusions from other studies on the usefulness and use of ESV in environmental management decision-making. They also demonstrate the strength of the survey-based approach developed in this application to examine this issue in a variety of contexts. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Attitudes and opinions of Palestinian decision-makers about premarital examination law].

PubMed

El Sharif, Nuha; Rifai, Ayshea; Assi, Sana'a; Al Hmidat, Amjad

2006-11-01

We explored the attitudes and opinions of 90 Palestinian decision-makers about the draft law on premarital examination. The findings revealed that decision-makers were aware of the spread of genetic diseases but not infectious diseases. The majority agreed on the draft law; however, they differed on the mode of its application. Half believed that the law is not ready yet for application due to insufficient financial support to establish the needed infrastructure. The most significant recommendations made by the decision-makers were to: enhance community awareness of the law, ensure proper coordination among the concerned ministries and institutions, and establish a national organization to work on endorsement of the tests and issuance of the appropriate application strategies and regulations.

The Use of Research Evidence in Public Health Decision Making Processes: Systematic Review

PubMed Central

Orton, Lois; Lloyd-Williams, Ffion; Taylor-Robinson, David; O'Flaherty, Martin; Capewell, Simon

2011-01-01

Background The use of research evidence to underpin public health policy is strongly promoted. However, its implementation has not been straightforward. The objectives of this systematic review were to synthesise empirical evidence on the use of research evidence by public health decision makers in settings with universal health care systems. Methods To locate eligible studies, 13 bibliographic databases were screened, organisational websites were scanned, key informants were contacted and bibliographies of included studies were scrutinised. Two reviewers independently assessed studies for inclusion, extracted data and assessed methodological quality. Data were synthesised as a narrative review. Findings 18 studies were included: 15 qualitative studies, and three surveys. Their methodological quality was mixed. They were set in a range of country and decision making settings. Study participants included 1063 public health decision makers, 72 researchers, and 174 with overlapping roles. Decision making processes varied widely between settings, and were viewed differently by key players. A range of research evidence was accessed. However, there was no reliable evidence on the extent of its use. Its impact was often indirect, competing with other influences. Barriers to the use of research evidence included: decision makers' perceptions of research evidence; the gulf between researchers and decision makers; the culture of decision making; competing influences on decision making; and practical constraints. Suggested (but largely untested) ways of overcoming these barriers included: research targeted at the needs of decision makers; research clearly highlighting key messages; and capacity building. There was little evidence on the role of research evidence in decision making to reduce inequalities. Conclusions To more effectively implement research informed public health policy, action is required by decision makers and researchers to address the barriers identified in this systematic review. There is an urgent need for evidence to support the use of research evidence to inform public health decision making to reduce inequalities. PMID:21818262

Building capacity for evidence informed decision making in public health: a case study of organizational change.

PubMed

Peirson, Leslea; Ciliska, Donna; Dobbins, Maureen; Mowat, David

2012-02-20

Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.

Cost-effectiveness analysis and formulary decision making in England: findings from research.

PubMed

Williams, Iestyn P; Bryan, Stirling

2007-11-01

In a context of rapid technological advances in health care and increasing demand for expensive treatments, local formulary committees are key players in the management of scarce resources. However, little is known about the information and processes used when making decisions on the inclusion of new treatments. This paper reports research on the use of economic evaluations in technology coverage decisions in England, although the findings have a relevance to other health care systems with devolved responsibility for resource allocation. It reports a study of four local formulary committees in which both qualitative and quantitative data were collected. Our main research finding is that it is an exception for cost-effectiveness analysis to inform technology coverage decisions. Barriers to use include access and expertise levels, concerns relating to the independence of analyses and problems with implementation of study recommendations. Further barriers derive from the constraints on decision makers, a lack of clarity over functions and aims of local committees, and the challenge of disinvestment in medical technologies. The relative weakness of the research-practice dynamics in this context suggests the need for a rethinking of the role of both analysts and decision makers. Our research supports the view that in order to be useful, analysis needs to better reflect the constraints of the local decision-making environment. We also recommend that local decision-making committees and bodies in the National Health Service more clearly identify the 'problems' which they are charged with solving and how their outputs contribute to broader finance and commissioning functions. This would help to establish the ways in which the routine use of cost-effectiveness analysis might become a reality.

Establishing a baseline to measure change in political will and the use of data for decision-making in maternal and newborn health in six African countries.

PubMed

Nove, Andrea; Hulton, Louise; Martin-Hilber, Adriane; Matthews, Zoe

2014-10-01

The Evidence for Action (E4A) program assumes that both resource allocation and quality of care can improve via a strategy that combines evidence and advocacy to stimulate accountability. The present paper explains the methods used to collect baseline monitoring data using two tools developed to inform program design in six focus countries. The first tool is designed to understand the extent to which decision-makers have access to the data they need, when they need it, and in meaningful formats, and then to use the data to prioritize, plan, and allocate resources. The second tool seeks the views of people working in the area of maternal and newborn health (MNH) about political will, including: quality of care, the political and financial priority accorded to MNH, and the extent to which MNH decision-makers are accountable to service users. Findings indicate significant potential to improve access to and use of data for decision-making, particularly at subnational levels. Respondents across all six program countries reported lack of access by ordinary citizens to information on the health and MNH budget, and data on MNH outcomes. In all six countries there was a perceived inequity in the distribution of resources and a perception that politicians do not fully understand the priorities of their constituents. Copyright © 2014. Published by Elsevier Ireland Ltd.

The use of AQUATOOL DSS applied to the System of Environmental-Economic Accounting for Water (SEEAW)

NASA Astrophysics Data System (ADS)

Pedro-Monzonís, María; Jiménez-Fernández, Pedro; Solera, Abel; Jiménez-Gavilán, Pablo

2016-02-01

Currently, water accounts are one of the next steps to be implemented in European River Basin Management Plans. Building water accounts is a complex task, mainly due to the lack of common European definitions and procedures. For their development, when data is not systematically measured, simulation models and estimations are necessary. The main idea of this paper is to present a new approach which enables the combined use of hydrological models and water resources models developed with AQUATOOL Decision Support System (DSS) to fill in the physical water supply and use tables and the asset accounts presented in the System of Economic and Environmental Accounts for Water (SEEAW). The case study is the Vélez River Basin, located in the southern part of the Iberian Peninsula in Spain. In addition to obtaining the physical water supply and use tables and the asset accounts in this river basin, we present here the indicators as a result thereof. These indicators cover many critical aspects of water management, showing a general description of the river basin and allowing decision-makers to characterise the pressures on water resources. As a general conclusion, the union of AQUATOOL DSS and SEEAW will provide more complete information to decision-makers and it enables to introduce these methodological decisions in order to guarantee consistency and comparability of the results between different river basins.

Policy decision-making under scientific uncertainty: radiological risk assessment and the role of expert advisory groups.

PubMed

Mossman, Kenneth L

2009-08-01

Standard-setting agencies such as the U.S. Nuclear Regulatory Commission and the U.S. Environmental Protection Agency depend on advice from external expert advisory groups on matters of public policy and standard-setting. Authoritative bodies including the National Research Council and the National Council on Radiation Protection and Measurements provide analyses and recommendations that enable the technical and scientific soundness in decision-making. In radiological protection the nature of the scientific evidence is such that risk assessment at radiation doses typically encountered in environmental and occupational settings is highly uncertain, and several policy alternatives are scientifically defensible. The link between science and policy is problematic. The fundamental issue is the failure to properly consider risk assessment, risk communication, and risk management and then consolidate them in a process that leads to sound policy. Authoritative bodies should serve as unbiased brokers of policy choices by providing balanced and objective scientific analyses. As long as the policy-decision environment is characterized by high scientific uncertainty and a lack of values consensus, advisory groups should present unbiased evaluations of all scientifically plausible alternatives and recommend selection criteria that decision makers can use in the policy-setting process. To do otherwise (e.g., by serving as single position advocates) weakens decision-making by eliminating options and narrowing discussions of scientific perspectives. Understanding uncertainties and the limitations on available scientific information and conveying such information to policy makers remain key challenges for the technical and policy communities.

Surface transportation weather decision support requirements : user needs and appendices : advanced-integrated decision support using weather information for surface transportation decision makers

DOT National Transportation Integrated Search

2000-01-24

The Federal Highway Administration (FHWA) of the U.S. Department of Transportation (USDOT) : has a responsibility to coordinate and promote projects that will bring the best information on weather to decision makers, in order to improve performance o...

An Introduction to Solar Decision-Making Tools

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

Mow, Benjamin

2017-09-12

The National Renewable Energy Laboratory (NREL) offers a variety of models and analysis tools to help decision makers evaluate and make informed decisions about solar projects, policies, and programs. This fact sheet aims to help decision makers determine which NREL tool to use for a given solar project or policy question, depending on its scope.

User Oriented Techniques to Support Interaction and Decision Making with Large Educational Databases

ERIC Educational Resources Information Center

Hartley, Roger; Almuhaidib, Saud M. Y.

2007-01-01

Information Technology is developing rapidly and providing policy/decision makers with large amounts of information that require processing and analysis. Decision support systems (DSS) aim to provide tools that not only help such analyses, but enable the decision maker to experiment and simulate the effects of different policies and selection…

HOSPITAL MANAGERS' NEED FOR INFORMATION ON HEALTH TECHNOLOGY INVESTMENTS.

PubMed

Ølholm, Anne Mette; Kidholm, Kristian; Birk-Olsen, Mette; Christensen, Janne Buck

2015-01-01

There is growing interest in implementing hospital-based health technology assessment (HB-HTA) as a tool to facilitate decision making based on a systematic and multidisciplinary assessment of evidence. However, the decision-making process, including the informational needs of hospital decision makers, is not well described. The objective was to review empirical studies analysing the information that hospital decision makers need when deciding about health technology (HT) investments. A systematic review of empirical studies published in English or Danish from 2000 to 2012 was carried out. The literature was assessed by two reviewers working independently. The identified informational needs were assessed with regard to their agreement with the nine domains of EUnetHTA's Core Model. A total of 2,689 articles were identified and assessed. The review process resulted in 14 relevant studies containing 74 types of information that hospital decision makers found relevant. In addition to information covered by the Core Model, other types of information dealing with political and strategic aspects were identified. The most frequently mentioned types of information in the literature related to clinical, economic and political/strategic aspects. Legal, social, and ethical aspects were seldom considered most important. Hospital decision makers are able to describe their information needs when deciding on HT investments. The different types of information were not of equal importance to hospital decision makers, however, and full agreement between EUnetHTA's Core Model and the hospital decision-makers' informational needs was not observed. They also need information on political and strategic aspects not covered by the Core Model.

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.

Bridging the gap between science and decision making

PubMed Central

von Winterfeldt, Detlof

2013-01-01

All decisions, whether they are personal, public, or business-related, are based on the decision maker’s beliefs and values. Science can and should help decision makers by shaping their beliefs. Unfortunately, science is not easily accessible to decision makers, and scientists often do not understand decision makers’ information needs. This article presents a framework for bridging the gap between science and decision making and illustrates it with two examples. The first example is a personal health decision. It shows how a formal representation of the beliefs and values can reflect scientific inputs by a physician to combine with the values held by the decision maker to inform a medical choice. The second example is a public policy decision about managing a potential environmental hazard. It illustrates how controversial beliefs can be reflected as uncertainties and informed by science to make better decisions. Both examples use decision analysis to bridge science and decisions. The conclusions suggest that this can be a helpful process that requires skills in both science and decision making. PMID:23940310

Age differences in experiential and deliberative processes in unambiguous and ambiguous decision making.

PubMed

Huang, Yumi H; Wood, Stacey; Berger, Dale E; Hanoch, Yaniv

2015-09-01

Older adults experience declines in deliberative decisional capacities, while their affective or experiential abilities tend to remain intact (Peters & Bruine de Bruin, 2012). The current study used this framework to investigate age differences in description-based and experience-based decision-making tasks. Description-based tasks emphasize deliberative processing by allowing decision makers to analyze explicit descriptions of choice-reward information. Experience-based tasks emphasize affective or experiential processing because they lack the explicit choice-reward information, forcing decision makers to rely on feelings and information derived from past experiences. This study used the Columbia Card Task (CCT) as a description-based task where probability information is provided and the Iowa Gambling Task (IGT) as an experience-based task, where it is not. As predicted, compared to younger adults (N = 65), older adults (N = 65) performed more poorly on the CCT but performed similarly on the IGT. Deliberative capacities (i.e., executive control and numeracy abilities) explained the relationship between age and performance on the CCT, suggesting that age-related differences in description-based decision-making tasks are related to declines in deliberative capacities. However, deliberative capacities were not associated with performance on the IGT for either older or younger adults. Nevertheless, on the IGT, older adults reported more use of affect-based strategies versus deliberative strategies, whereas younger adults reported similar use of these strategies. This finding offers partial support for the idea that decision-making tasks that rely on deliberate processing are more likely to demonstrate age effects than those that are more experiential. (c) 2015 APA, all rights reserved).

Beyond Prediction: the Many Ways in which Climate Science can Inform Adaptation Decisions

NASA Astrophysics Data System (ADS)

Lempert, R. J.

2017-12-01

Climate science provides an increasingly rich understanding of current and future climate, but this understanding is often not fully incorporated into climate adaptation decisions. In particular, the provision of climate information is still trapped in a narrow prediction-based framework, which envisions a sequential process that begins with model-based forecasts of future climate and decision makers then acting on those forecasts. Among its challenges, this framework can discourage action when climate predictions are deemed too uncertain, encourage overconfidence when climate scientists and decision makers fail to focus on decision-relevant but poorly understood extreme events, and offers a too-narrow communication path among climate scientists and decision makers. This talk will describe how robust decision approaches, organized around the idea of stress testing proposed adaptation decisions over a wide range of futures, can enable a richer flow information among climate scientists and decision makers. The talk illustrates these themes with two examples: 1) conservation management that explores the tradeoffs among alternative climate information products with different combinations of ensemble size and spatial resolution and 2) water quality implementation planning that focuses on the handling of extremes.

Bi-Level Decision Making for Supporting Energy and Water Nexus

NASA Astrophysics Data System (ADS)

Zhang, X.; Vesselinov, V. V.

2016-12-01

The inseparable relationship between energy production and water resources has led to the emerging energy-water nexus concept, which provides a means for integrated management and decision making of these two critical resources. However, the energy-water nexus frequently involves decision makers with different and competing management objectives. Furthermore, there is a challenge that decision makers and stakeholders might be making decisions sequentially from a higher level to a lower level, instead of at the same decision level, whereby the objective of a decision maker at a higher level should be satisfied first. In this study, a bi-level decision model is advanced to handle such decision-making situations for managing the energy-water nexus. The work represents a unique contribution to developing an integrated decision-support framework/tool to quantify and analyze the tradeoffs between the two-level energy-water nexus decision makers. Here, plans for electricity generation, fuel supply, water supply, capacity expansion of the power plants and environmental impacts are optimized to provide effective decision support. The developed decision-support framework is implemented in Julia (a high-level, high-performance dynamic programming language for technical computing) and is a part of the MADS (Model Analyses & Decision Support) framework (http://mads.lanl.gov). To demonstrate the capabilities of the developed methodology, a series of analyses are performed for synthetic problems consistent with actual real-world energy-water nexus management problems.

Linking ecosystem characteristics to final ecosystem services for public policy.

PubMed

Wong, Christina P; Jiang, Bo; Kinzig, Ann P; Lee, Kai N; Ouyang, Zhiyun

2015-01-01

Governments worldwide are recognising ecosystem services as an approach to address sustainability challenges. Decision-makers need credible and legitimate measurements of ecosystem services to evaluate decisions for trade-offs to make wise choices. Managers lack these measurements because of a data gap linking ecosystem characteristics to final ecosystem services. The dominant method to address the data gap is benefit transfer using ecological data from one location to estimate ecosystem services at other locations with similar land cover. However, benefit transfer is only valid once the data gap is adequately resolved. Disciplinary frames separating ecology from economics and policy have resulted in confusion on concepts and methods preventing progress on the data gap. In this study, we present a 10-step approach to unify concepts, methods and data from the disparate disciplines to offer guidance on overcoming the data gap. We suggest: (1) estimate ecosystem characteristics using biophysical models, (2) identify final ecosystem services using endpoints and (3) connect them using ecological production functions to quantify biophysical trade-offs. The guidance is strategic for public policy because analysts need to be: (1) realistic when setting priorities, (2) attentive to timelines to acquire relevant data, given resources and (3) responsive to the needs of decision-makers. © 2014 The Authors. Ecology Letters published by John Wiley & Sons Ltd and CNRS.

Linking ecosystem characteristics to final ecosystem services for public policy

PubMed Central

Wong, Christina P; Jiang, Bo; Kinzig, Ann P; Lee, Kai N; Ouyang, Zhiyun

2015-01-01

Governments worldwide are recognising ecosystem services as an approach to address sustainability challenges. Decision-makers need credible and legitimate measurements of ecosystem services to evaluate decisions for trade-offs to make wise choices. Managers lack these measurements because of a data gap linking ecosystem characteristics to final ecosystem services. The dominant method to address the data gap is benefit transfer using ecological data from one location to estimate ecosystem services at other locations with similar land cover. However, benefit transfer is only valid once the data gap is adequately resolved. Disciplinary frames separating ecology from economics and policy have resulted in confusion on concepts and methods preventing progress on the data gap. In this study, we present a 10-step approach to unify concepts, methods and data from the disparate disciplines to offer guidance on overcoming the data gap. We suggest: (1) estimate ecosystem characteristics using biophysical models, (2) identify final ecosystem services using endpoints and (3) connect them using ecological production functions to quantify biophysical trade-offs. The guidance is strategic for public policy because analysts need to be: (1) realistic when setting priorities, (2) attentive to timelines to acquire relevant data, given resources and (3) responsive to the needs of decision-makers. PMID:25394857

Global Forum 2015 dialogue on "From evidence to policy - thinking outside the box": perspectives to improve evidence uptake and good practices in the African Region.

PubMed

Kirigia, Joses Muthuri; Pannenborg, Charles Ok; Amore, Luis Gabriel Cuervo; Ghannem, Hassen; IJsselmuiden, Carel; Nabyonga-Orem, Juliet

2016-07-18

The Global Forum 2015 panel session dialogue entitled "From evidence to policy - thinking outside the box" was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. The Global Forum 2015 debate attributed African Region's low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organizations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening NHRS governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on NHRS strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.

Alternative Fuels Data Center: Telework

Science.gov Websites

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

'Holding the line': a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London.

PubMed

Fraser, Alec; Baeza, Juan I; Boaz, Annette

2017-06-09

Health service reconfigurations are of international interest but remain poorly understood. This article focuses on the use of evidence by senior managerial decision-makers involved in the reconfiguration of stroke services in London 2008-2012. Recent work comparing stroke service reconfiguration in London and Manchester emphasises the ability of senior managerial decision-makers in London to 'hold the line' in the crucial early phases of the stroke reconfiguration programme. In this article, we explore in detail how these decision-makers 'held the line' and ask what the broader power implications of doing so are for the interaction between evidence, health policy and system redesign. The research combined semi-structured interviews (n = 20) and documentary analysis of historically relevant policy papers and contemporary stroke reconfiguration documentation published by NHS London and other interested parties (n = 125). We applied a critical interpretive and reflexive approach to the analysis of the data. We identified two forms of power which senior managerial decision-makers drew upon in order to 'hold the line'. Firstly, discursive power, which through an emphasis on evidence, better patient outcomes, professional support and clinical credibility alongside a tightly managed consultation process, helped to set an agenda that was broadly receptive to the overall decision to change stroke services in the capital in a radical way. Secondly, once the essential parameters of the decision to change services had been agreed, senior managerial decision-makers 'held the line' through hierarchical New Public Management style power to minimise the traditional pressures to de-radicalise the reconfiguration through 'top down' decision-making. We problematise the concept of 'holding the line' and explore the power implications of such managerial approaches in the early phases of health service reconfiguration. We highlight the importance of evidence for senior managerial decision-makers in agenda setting and the limitations of clinical research findings in guiding politically sensitive policy decisions which impact upon regional healthcare systems.

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

PubMed Central

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

2015-01-01

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

Bringing science to the table: Case studies in science-informed decision making on climate change and beyond

NASA Astrophysics Data System (ADS)

Goldman, G. T.; Phartiyal, P.; Mulvey, K.

2016-12-01

Federal government officials often rely on the research and advice of scientists to inform their decision making around climate change and other complex topics. Decision makers, however, are constrained by the time and accessibility needed to obtain and incorporate scientific information. At the same time, scientists have limited capacity and incentive to devote significant time to communicating their science to decision makers. The Union of Concerned Scientists has employed several strategies to produce policy-relevant scientific work and to facilitate engagement between scientists and decision makers across research areas. This talk will feature lessons learned and key strategies for science-informed decision making around climate change and other areas of the geosciences. Case studies will include conducting targeted sea level rise studies to inform rulemaking at federal agencies, bringing science to policy discussions on hydraulic fracturing, and leveraging the voice of the scientific community on specific policy proposals around climate change disclosure of companies. Recommendations and lessons learned for producing policy-relevant science and effectively communicating it with decision makers will be offered.

Making better decisions in uncertain times (Invited)

NASA Astrophysics Data System (ADS)

St John, C.

2013-12-01

Scientific information about climate change and other human impacts on the environment are increasingly available and sought after (often in the form of probabilistic forecasts or technical information related to engineering solutions). However, it is increasingly apparent that there are barriers to the use of this information by decision makers - either from its lack of application altogether, its usability for people without scientific backgrounds, or its ability to inform sound decisions and widespread behavior change. While the argument has been made that an information deficit is to blame, we argue that there is also a motivation deficit contributing to a lack of understanding of information about climate change impacts and solutions. Utilizing insight from over thirty years of research in social and cognitive psychology, in addition to other social sciences, the Center for Research on Environmental Decisions (CRED) seeks to understand how people make environmental decisions under conditions of uncertainty, and how these decisions can be improved. This presentation will focus specifically on recent research that has come forth since the 2009 publication of CRED's popular guide 'The Psychology of Climate Change Communication: A Guide for Scientists, Journalists, Educators, Political Aides, and the Interested Public.' Utilizing case studies from real world examples, this talk will explore how decision making can be improved through a better understanding of how people perceive and process uncertainty and risk. It will explore techniques such as choice architecture and 'nudging' behavior change, how social goals and group participation affect decision making, and how framing of environmental information influences mitigative behavior.

Research-based-decision-making in Canadian health organizations: a behavioural approach.

PubMed

Jbilou, Jalila; Amara, Nabil; Landry, Réjean

2007-06-01

Decision making in Health sector is affected by a several elements such as economic constraints, political agendas, epidemiologic events, managers' values and environment... These competing elements create a complex environment for decision making. Research-Based-Decision-Making (RBDM) offers an opportunity to reduce the generated uncertainty and to ensure efficacy and efficiency in health administrations. We assume that RBDM is dependant on decision makers' behaviour and the identification of the determinants of this behaviour can help to enhance research results utilization in health sector decision making. This paper explores the determinants of RBDM as a personal behaviour among managers and professionals in health administrations in Canada. From the behavioural theories and the existing literature, we build a model measuring "RBDM" as an index based on five items. These items refer to the steps accomplished by a decision maker while developing a decision which is based on evidence. The determinants of RBDM behaviour are identified using data collected from 942 health care decision makers in Canadian health organizations. Linear regression is used to model the behaviour RBDM. Determinants of this behaviour are derived from Triandis Theory and Bandura's construct "self-efficacy." The results suggest that to improve research use among managers in Canadian governmental health organizations, strategies should focus on enhancing exposition to evidence through facilitating communication networks, partnerships and links between researchers and decision makers, with the key long-term objective of developing a culture that supports and values the contribution that research can make to decision making in governmental health organizations. Nevertheless, depending on the organizational level, determinants of RBDM are different. This difference has to be taken into account if RBDM adoption is desired. Decision makers in Canadian health organizations (CHO) can help to build networks, develop partnerships between professionals locally, regionally and nationally, and also act as change agents in the dissemination and adoption of knowledge and innovations in health services. However, the research focused on knowledge use as a support to decision-making, further research is needed to identify and evaluate effective incentives and strategies to implement so as to enhance RBDM adoption among health decision makers and more theoretical development are to complete in this perspective.

Clustering and group selection of multiple criteria alternatives with application to space-based networks.

PubMed

Malakooti, Behnam; Yang, Ziyong

2004-02-01

In many real-world problems, the range of consequences of different alternatives are considerably different. In addition, sometimes, selection of a group of alternatives (instead of only one best alternative) is necessary. Traditional decision making approaches treat the set of alternatives with the same method of analysis and selection. In this paper, we propose clustering alternatives into different groups so that different methods of analysis, selection, and implementation for each group can be applied. As an example, consider the selection of a group of functions (or tasks) to be processed by a group of processors. The set of tasks can be grouped according to their similar criteria, and hence, each cluster of tasks to be processed by a processor. The selection of the best alternative for each clustered group can be performed using existing methods; however, the process of selecting groups is different than the process of selecting alternatives within a group. We develop theories and procedures for clustering discrete multiple criteria alternatives. We also demonstrate how the set of alternatives is clustered into mutually exclusive groups based on 1) similar features among alternatives; 2) ideal (or most representative) alternatives given by the decision maker; and 3) other preferential information of the decision maker. The clustering of multiple criteria alternatives also has the following advantages. 1) It decreases the set of alternatives to be considered by the decision maker (for example, different decision makers are assigned to different groups of alternatives). 2) It decreases the number of criteria. 3) It may provide a different approach for analyzing multiple decision makers problems. Each decision maker may cluster alternatives differently, and hence, clustering of alternatives may provide a basis for negotiation. The developed approach is applicable for solving a class of telecommunication networks problems where a set of objects (such as routers, processors, or intelligent autonomous vehicles) are to be clustered into similar groups. Objects are clustered based on several criteria and the decision maker's preferences.

Changes in Policy Maker Attitudes Toward Active Living Communities Issues in Hawaii, 2007-2013.

PubMed

McGurk, Meghan; Maddock, Jay

2016-10-01

Obesity and lack of physical activity are major public health problems in the United States. Well-designed, active living communities (ALCs) can help support physically active lifestyles. This study assessed attitudes of Hawaii decision makers in 2007 and 2013 to determine if priorities toward ALCs changed. Elected and appointed state and county officials were mailed surveys both years. Respondents rated the importance of 23 specified problems, which included 1 obesity variable and 5 ALC variables. The survey was completed by 126 (70.4%) respondents in 2007 and 117 (60.9%) in 2013. Among the specific problems, only obesity increased in rank from 14th to ninth place. Three variables fell more than 2 places: increasing traffic (fifth to seventh place), poorly planned development and sprawl (seventh to 11th place) and pedestrian safety (12th to 17th place). The other 2 stayed relatively the same: lack of pedestrian walkways, sidewalks, and crosswalks (16th to 15th place) and lack of recreational activities (22nd to 23rd place). Across years, obesity concerns have increased but do not appear to be tied to increases in concern for ALC variables. More education for policymakers on the link between obesity, physical activity, and the built environment is necessary.

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

PubMed

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

2014-01-01

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

Alternative Fuels Data Center: Mass Transit

Science.gov Websites

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

Alternative Fuels Data Center: Transportation System Efficiency

Science.gov Websites

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

Assessing Contractor Capabilities for Streamlined Site Investigations

EPA Pesticide Factsheets

The purpose of this document is to familiarize and encourage brownfields decision makers to investigate and employ innovative methods for characterizing their sites, to assist brownfields decision makers in assessing contractors' capabilities.

Educational Goods and Values: A Framework for Decision Makers

ERIC Educational Resources Information Center

Brighouse, Harry; Ladd, Helen F.; Loeb, Susanna; Swift, Adam

2016-01-01

This article articulates a framework suitable for use when making decisions about education policy. Decision makers should establish what the feasible options are and evaluate them in terms of their contribution to the development, and distribution, of educational goods in children, balanced against the negative effect of policies on important…

Teacher as Decision-Maker.

ERIC Educational Resources Information Center

Smith, Carl B.

The teacher as decisionmaker is a fairly new concept, and yet the choices teachers make--among alternative approaches--afffect the attitudes, knowledge, and skills students carry into adult life. This booklet's chapter titles are as follows: (1) New Image for Teachers--Decision-Maker; (2) Decisions Teachers Make; (3) A Rational Model; (4) Planning…

Sandia National Laboratories: Pathfinder Radar ISR and Synthetic Aperture

Science.gov Websites

Eyes for the Warfighter Actionable Intelligence for the Decision Maker Actionable Intelligence for the Decision Maker All Weather, Persistent, Optical Like All Weather, Persistent, Optical Like Real-time, High radar systems encompass the entire end-to-end connectivity needed for decision superiority to ensure

Negative Attitudes toward Older Workers and Hiring Decisions: Testing the Moderating Role of Decision Makers' Core Self-Evaluations.

PubMed

Fasbender, Ulrike; Wang, Mo

2016-01-01

Organizational hiring practices have been charged for unfair treatment on the grounds of age. Drawing on theories of planned behavior and core self-evaluations, this research investigated the impact of negative attitudes toward older workers on hiring decisions and examined the moderating role of decision-makers' core self-evaluations. We tested our hypotheses based on a structured online questionnaire and a vignette study using a sample of 102 participants working in human resource management across different industries. As predicted, negative attitudes toward older workers were positively related to avoidance of hiring older people, which in turn was negatively related to the likelihood to select the oldest candidate. Because hiring decisions are not only about the hiring subject but also about the decision-maker, we tested the moderating role of decision-makers' core self-evaluations. Results showed that core self-evaluations buffered the relationship between negative attitudes toward older workers and avoidance of hiring older people. Theoretical implications of the findings with regard to hiring decisions about older people and practical recommendations to improve diversity management strategies and age-balanced hiring practices in organizations are discussed.

Do evidence summaries increase policy-makers' use of evidence from systematic reviews: A systematic review protocol.

PubMed

Petkovic, Jennifer; Welch, Vivian; Tugwell, Peter

2015-09-28

Systematic reviews are important for decision-makers. They offer many potential benefits but are often written in technical language, are too long, and do not contain contextual details which makes them hard to use for decision-making. There are many organizations that develop and disseminate derivative products, such as evidence summaries, from systematic reviews for different populations or subsets of decision-makers. This systematic review will assess the effectiveness of systematic review summaries on increasing policymakers' use of systematic review evidence and to identify the components or features of these summaries that are most effective. We will include studies of policy-makers at all levels as well as health-system managers. We will include studies examining any type of "evidence summary," "policy brief," or other products derived from systematic reviews that present evidence in a summarized form. The primary outcomes are the following: (1) use of systematic review summaries decision-making (e.g., self-reported use of the evidence in policy-making, decision-making) and (2) policy-maker understanding, knowledge, and/or beliefs (e.g., changes in knowledge scores about the topic included in the summary). We will conduct a systematic review of randomized controlled trials (RCTs), non-randomized controlled trials (NRCTs), controlled before-after studies (CBA), and interrupted time series (ITS) studies. The results of this review will inform the development of future systematic review summaries to ensure that systematic review evidence is accessible to and used by policy-makers making health-related decisions.

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

PubMed

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

2017-01-01

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

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector.

PubMed

van Dongen, Johanna M; Tompa, Emile; Clune, Laurie; Sarnocinska-Hart, Anna; Bongers, Paulien M; van Tulder, Maurits W; van der Beek, Allard J; van Wier, Marieke F

2013-06-03

Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.

Value of information and pricing new healthcare interventions.

PubMed

Willan, Andrew R; Eckermann, Simon

2012-06-01

Previous application of value-of-information methods to optimal clinical trial design have predominantly taken a societal decision-making perspective, implicitly assuming that healthcare costs are covered through public expenditure and trial research is funded by government or donation-based philanthropic agencies. In this paper, we consider the interaction between interrelated perspectives of a societal decision maker (e.g. the National Institute for Health and Clinical Excellence [NICE] in the UK) charged with the responsibility for approving new health interventions for reimbursement and the company that holds the patent for a new intervention. We establish optimal decision making from societal and company perspectives, allowing for trade-offs between the value and cost of research and the price of the new intervention. Given the current level of evidence, there exists a maximum (threshold) price acceptable to the decision maker. Submission for approval with prices above this threshold will be refused. Given the current level of evidence and the decision maker's threshold price, there exists a minimum (threshold) price acceptable to the company. If the decision maker's threshold price exceeds the company's, then current evidence is sufficient since any price between the thresholds is acceptable to both. On the other hand, if the decision maker's threshold price is lower than the company's, then no price is acceptable to both and the company's optimal strategy is to commission additional research. The methods are illustrated using a recent example from the literature.

Computer based extraction of phenoptypic features of human congenital anomalies from the digital literature with natural language processing techniques.

PubMed

Karakülah, Gökhan; Dicle, Oğuz; Koşaner, Ozgün; Suner, Aslı; Birant, Çağdaş Can; Berber, Tolga; Canbek, Sezin

2014-01-01

The lack of laboratory tests for the diagnosis of most of the congenital anomalies renders the physical examination of the case crucial for the diagnosis of the anomaly; and the cases in the diagnostic phase are mostly being evaluated in the light of the literature knowledge. In this respect, for accurate diagnosis, ,it is of great importance to provide the decision maker with decision support by presenting the literature knowledge about a particular case. Here, we demonstrated a methodology for automated scanning and determining of the phenotypic features from the case reports related to congenital anomalies in the literature with text and natural language processing methods, and we created a framework of an information source for a potential diagnostic decision support system for congenital anomalies.

Mapping a Research Agenda for Home Care Safety: Perspectives from Researchers, Providers, and Decision Makers

ERIC Educational Resources Information Center

Macdonald, Marilyn; Lang, Ariella; MacDonald, Jo-Anne

2011-01-01

The purpose of this qualitative interpretive design was to explore the perspectives of researchers, health care providers, policy makers, and decision makers on key risks, concerns, and emerging issues related to home care safety that would inform a line of research inquiry. Defining safety specifically in this home care context has yet to be…

Making the Connection between Environmental Science and Decision Making

NASA Astrophysics Data System (ADS)

Woodhouse, C. A.; Crimmins, M.; Ferguson, D. B.; Garfin, G. M.; Scott, C. A.

2011-12-01

As society is confronted with population growth, limited resources, and the impacts of climate variability and change, it is vital that institutions of higher education promote the development of professionals who can work with decision-makers to incorporate scientific information into environmental planning and management. Skills for the communication of science are essential, but equally important is the ability to understand decision-making contexts and engage with resource managers and policy makers. It is increasingly being recognized that people who understand the linkages between science and decision making are crucial if science is to better support planning and policy. A new graduate-level seminar, "Making the Connection between Environmental Science and Decision Making," is a core course for a new post-baccalaureate certificate program, Connecting Environmental Science and Decision Making at the University of Arizona. The goal of the course is to provide students with a basic understanding of the dynamics between scientists and decision makers that result in scientific information being incorporated into environmental planning, policy, and management decisions. Through readings from the environmental and social sciences, policy, and planning literature, the course explores concepts including scientific information supply and demand, boundary organizations, co-production of knowledge, platforms for engagement, and knowledge networks. Visiting speakers help students understand some of the challenges of incorporating scientific information into planning and decision making within institutional and political contexts. The course also includes practical aspects of two-way communication via written, oral, and graphical presentations as well as through the interview process to facilitate the transfer of scientific information to decision makers as well as to broader audiences. We aspire to help students develop techniques that improve communication and understanding between scientists and decision-makers, leading to enhanced outcomes in the fields of climate science, water resources, and ecosystem services.

Are health nudges coercive?

PubMed

Quigley, Muireann

2014-01-01

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as 'nudges' have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this article I focus on claims of coercion, examining nudges within two of the main approaches to coercion-the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature.

Group assessment of key indicators of sustainable waste management in developing countries.

PubMed

Tot, Bojana; Vujić, Goran; Srđević, Zorica; Ubavin, Dejan; Russo, Mário Augusto Tavares

2017-09-01

Decision makers in developing countries are struggling to solve the present problems of solid waste management. Prioritisation and ranking of the most important indicators that influence the waste management system is very useful for any decision maker for the future planning and implementation of a sustainable waste management system. The aim of this study is to evaluate key indicators and their related sub-indicators in a group decision-making environment. In order to gain insight into the subject it was necessary to obtain the qualified opinions of decision makers from different countries who understand the situation in the sector of waste management in developing countries. An assessment is performed by 43 decision makers from both developed and developing countries, and the applied methodology is based on a combined use of the analytic hierarchy process, from the multi-criteria decision-making set of tools, and the preferential voting method known as Borda Count, which belongs to social choice theory. Pairwise comparison of indicators is performed with the analytic hierarchy process, and the ranking of indicators once obtained is assessed with Borda Count. Detailed analysis of the final results showed that the Institutional-Administrative indicator was the most important one, with the maximum weight as derived by both groups of decision makers. The results also showed that the combined use of the analytic hierarchy process and Borda Count contributes to the credibility and objectivity of the decision-making process, allowing its use in more complex waste management group decision-making problems to be recommended.

Using social network analysis to examine the decision-making process on new vaccine introduction in Nigeria.

PubMed

Wonodi, C B; Privor-Dumm, L; Aina, M; Pate, A M; Reis, R; Gadhoke, P; Levine, O S

2012-05-01

The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations to introduce new vaccines. Lack of consensus on the priority, public health value or feasibility of adding a new vaccine can delay policy decisions. Efforts to support country-level decision-making have largely focused on establishing global policies and equipping policy makers with the information to support decision-making on new vaccine introduction (NVI). Less attention has been given to understanding the interactions of policy actors and how the distribution of influence affects the policy process and decision-making. Social network analysis (SNA) is a social science technique concerned with explaining social phenomena using the structural and relational features of the network of actors involved. This approach can be used to identify how information is exchanged and who is included or excluded from the process. For this SNA of vaccine decision-making in Nigeria, we interviewed federal and state-level government officials, officers of bilateral and multilateral partner organizations, and other stakeholders such as health providers and the media. Using data culled from those interviews, we performed an SNA in order to map formal and informal relationships and the distribution of influence among vaccine decision-makers, as well as to explore linkages and pathways to stakeholders who can influence critical decisions in the policy process. Our findings indicate a relatively robust engagement of key stakeholders in Nigeria. We hypothesized that economic stakeholders and implementers would be important to ensure sustainable financing and strengthen programme implementation, but some economic and implementation stakeholders did not appear centrally on the map; this may suggest a need to strengthen the decision-making processes by engaging these stakeholders more centrally and earlier.

49 CFR 1503.603 - Separation of functions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Rules of Practice in TSA Civil Penalty Actions § 1503.603 Separation of functions. (a) Civil penalty... the ALJ or by the TSA decision maker on appeal, except as counsel or a witness in the public... advise the TSA decision maker regarding an initial decision or any appeal of a civil penalty action to...

Participation in treatment decision-making among Chinese-Australian women with breast cancer.

PubMed

Kwok, Cannas; Koo, Fung Kuen

2017-03-01

Using Confucian philosophy as a conceptual framework, this article examines the extent to which cultural values and language affect the participation preferences and experiences of the breast cancer treatment decision-making (TDM) process among Chinese women with breast cancer in Australia. Three focus groups were conducted with 23 Chinese-Australian women diagnosed with breast cancer in their native language (Mandarin and Cantonese). Each interview was translated and transcribed. Content analysis was used to uncover the major themes. Four typologies emerged: the patient as an active decision maker, the patient as a passive decision maker, the patient as a reluctant decision maker and the patient as a reluctant passive decision maker. Language barriers, cultural expectation of doctor's role and family role in Chinese culture appear as influential factors in TDM process among this group of women. Intervention to improve doctors' cultural sensitivities in order to help them assess women's role preferences in TDM and the ability of doctors to communicate in a culturally appropriate manner, may improve the process of breast cancer TDM among women from Chinese background.

Building capacity for evidence informed decision making in public health: a case study of organizational change

PubMed Central

2012-01-01

Background Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit's strategic initiative to develop capacity to make EIDM standard practice. Methods This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. Results The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. Conclusion With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization. PMID:22348688

Alpha-Fair Resource Allocation under Incomplete Information and Presence of a Jammer

NASA Astrophysics Data System (ADS)

Altman, Eitan; Avrachenkov, Konstantin; Garnaev, Andrey

In the present work we deal with the concept of alpha-fair resource allocation in the situation where the decision maker (in our case, the base station) does not have complete information about the environment. Namely, we develop a concept of α-fairness under uncertainty to allocate power resource in the presence of a jammer under two types of uncertainty: (a) the decision maker does not have complete knowledge about the parameters of the environment, but knows only their distribution, (b) the jammer can come into the environment with some probability bringing extra background noise. The goal of the decision maker is to maximize the α-fairness utility function with respect to the SNIR (signal to noise-plus-interference ratio). Here we consider a concept of the expected α-fairness utility function (short-term fairness) as well as fairness of expectation (long-term fairness). In the scenario with the unknown parameters of the environment the most adequate approach is a zero-sum game since it can also be viewed as a minimax problem for the decision maker playing against the nature where the decision maker has to apply the best allocation under the worst circumstances. In the scenario with the uncertainty about jamming being in the system the Nash equilibrium concept is employed since the agents have non-zero sum payoffs: the decision maker would like to maximize either the expected fairness or the fairness of expectation while the jammer would like to minimize the fairness if he comes in on the scene. For all the plots the equilibrium strategies in closed form are found. We have shown that for all the scenarios the equilibrium has to be constructed into two steps. In the first step the equilibrium jamming strategy has to be constructed based on a solution of the corresponding modification of the water-filling equation. In the second step the decision maker equilibrium strategy has to be constructed equalizing the induced by jammer background noise.

A new web-based framework development for fuzzy multi-criteria group decision-making.

PubMed

Hanine, Mohamed; Boutkhoum, Omar; Tikniouine, Abdessadek; Agouti, Tarik

2016-01-01

Fuzzy multi-criteria group decision making (FMCGDM) process is usually used when a group of decision-makers faces imprecise data or linguistic variables to solve the problems. However, this process contains many methods that require many time-consuming calculations depending on the number of criteria, alternatives and decision-makers in order to reach the optimal solution. In this study, a web-based FMCGDM framework that offers decision-makers a fast and reliable response service is proposed. The proposed framework includes commonly used tools for multi-criteria decision-making problems such as fuzzy Delphi, fuzzy AHP and fuzzy TOPSIS methods. The integration of these methods enables taking advantages of the strengths and complements each method's weakness. Finally, a case study of location selection for landfill waste in Morocco is performed to demonstrate how this framework can facilitate decision-making process. The results demonstrate that the proposed framework can successfully accomplish the goal of this study.

Attitudes of Policy Makers in Hawaii toward Public Health and Related Issues before and after an Economic Recession in the United States.

PubMed

Maddock, Jay E; McGurk, Meghan; Lee, Thomas

2015-01-01

Legislation and regulation at the state and local level can often have a greater impact on the public's health than individual-based approaches. Elected and appointed officials have an essential role in protecting and improving public health. Despite this important role, little systematic research has been done to assess the relative importance of public health issues compared to other policy issues in times of economic hardship. This study assessed attitudes of elected and appointed decision makers in Hawaii in 2007 and 2013 to determine if priorities differed before and after the economic recession. Elected and appointed state and county officials were mailed surveys at both time points. Respondents rated the importance of 23 specified problems, of which 9 asked about specific public health issues. The survey was completed by 126 (70.4%) respondents in 2007 and 117 (60.9%) in 2013. Among the public health issues, five saw significant mean decreases. These variables included climate change, pedestrian safety, government response to natural disasters, access to healthcare, and pandemic influenza. Obesity was the only public health issue to increase in importance across the two time points. In terms of relative ranking across the time points, only drug abuse and obesity were among the top 10 priorities. Lack of public health training, pandemic influenza, and government response to natural disasters were among the bottom five priorities. After the economic recession, many public health issues have a lower priority among Hawaii's policy makers than before the downturn. Additional education and advocacy is needed to keep public health issues on the minds of decision makers during tough economic times.

Communicating the Needs of Climate Change Policy Makers to Scientists

NASA Technical Reports Server (NTRS)

Brown, Molly E.; Escobar, Vanessa M.; Lovell, Heather

2012-01-01

This chapter will describe the challenges that earth scientists face in developing science data products relevant to decision maker and policy needs, and will describe strategies that can improve the two-way communication between the scientist and the policy maker. Climate change policy and decision making happens at a variety of scales - from local government implementing solar homes policies to international negotiations through the United Nations Framework Convention on Climate Change. Scientists can work to provide data at these different scales, but if they are not aware of the needs of decision makers or understand what challenges the policy maker is facing, they are likely to be less successful in influencing policy makers as they wished. This is because the science questions they are addressing may be compelling, but not relevant to the challenges that are at the forefront of policy concerns. In this chapter we examine case studies of science-policy partnerships, and the strategies each partnership uses to engage the scientist at a variety of scales. We examine three case studies: the global Carbon Monitoring System pilot project developed by NASA, a forest biomass mapping effort for Silvacarbon project, and a forest canopy cover project being conducted for forest management in Maryland. In each of these case studies, relationships between scientists and policy makers were critical for ensuring the focus of the science as well as the success of the decision-making.

Ethical challenges with hemodialysis patients who lack decision-making capacity: behavioral issues, surrogate decision-makers, and end-of-life situations.

PubMed

Feely, Molly A; Albright, Robert C; Thorsteinsdottir, Björg; Moss, Alvin H; Swetz, Keith M

2014-09-01

Hemodialysis (HD) is routinely offered to patients with end-stage renal disease in the United States who are ineligible for other renal replacement modalities. The frequency of HD among the US population is greater than all other countries, except Taiwan and Japan. In US, patients are often dialyzed irrespective of age, comorbidities, prognosis, or decision-making capacity. Determination of when patients can no longer dialyze is variable and can be dialysis-center specific. Determinants may be related to progressive comorbidities and frailty, mobility or access issues, patient self-determination, or an inability to tolerate the treatment safely for any number of reasons (e.g., hypotension, behavioral issues). Behavioral issues may impact the safety of not only patients themselves, but also those around them. In this article the authors present the case of an elderly patient on HD with progressive cognitive impairment and combative behavior placing him and others at risk of physical harm. The authors discuss the medical, ethical, legal, and psychosocial challenges to care of such patients who lack decision-making capacity with a focus on variable approaches by regions and culture. This manuscript provides recommendations and highlights resources to assist nephrologists, dialysis personnel, ethics consultants, and palliative medicine teams in managing such patients to resolve conflict.

Testing information to improve communication with communities and decision makers.

DOT National Transportation Integrated Search

2011-09-01

This work focuses on important concepts in making information available to decision makers and the : public, specifically focused on the Transportation Industry. The emphasis is on the PowerPoint : presentation and enhancing the message through this ...

Delegating Decisions to Experts

ERIC Educational Resources Information Center

Li, Hao; Suen, Wing

2004-01-01

We present a model of delegation with self-interested and privately informed experts. A team of experts with extreme but opposite biases is acceptable to a wide range of decision makers with diverse preferences, but the value of expertise from such a team is low. A decision maker wants to appoint experts who are less partisan than he is in order…

Identifying research priorities for health care priority setting: a collaborative effort between managers and researchers

PubMed Central

Smith, Neale; Mitton, Craig; Peacock, Stuart; Cornelissen, Evelyn; MacLeod, Stuart

2009-01-01

Background To date there has been relatively little published about how research priorities are set, and even less about methods by which decision-makers can be engaged in defining a relevant and appropriate research agenda. We report on a recent effort in British Columbia to have researchers and decision-makers jointly establish an agenda for future research into questions of resource allocation. Methods The researchers enlisted decision-maker partners from each of British Columbia's six health authorities. Three forums were held, at which researchers and decision-makers from various levels in the health authorities considered possible research areas related to three key focus areas: (1) generation and use of decision criteria and measurement of 'benefit' against such criteria; (2) identification of so-called 'disinvestment' opportunities; and (3) evaluation of the effectiveness of priority setting procedures. Detailed notes were taken from each forum and synthesized into a set of qualitative themes. Results Forum participants suggested that future research into healthcare priority setting would benefit from studies that were longitudinal, comparative, and/or interdisciplinary. As well, participants identified two broad theme areas in which specific research projects were deemed desirable. First, future research might usefully consider how formal priority setting and resource allocation projects are situated within a larger organizational and political context. Second, additional research efforts should be devoted to better understanding and improving the actual implementation of priority setting frameworks, particularly with respect to issues of change management and the resolution of impediments to action on recommendations for resource allocation. Conclusion We were able to validate the importance of initial areas posed to the group and observed emergence of additional concerns and directions of critical importance to these decision-makers at this time. It is likely that the results are broadly applicable to other healthcare contexts. The implementation of this research agenda in British Columbia will depend upon the ability of the researchers and decision-makers to develop particular projects that fit within the constraints of existing funding opportunities. The process of engagement itself had benefits in terms of connecting decision-makers with their peers and sparking increased interest in the use and refinement of priority setting frameworks. PMID:19754969

Fuzzy risk explicit interval linear programming model for end-of-life vehicle recycling planning in the EU.

PubMed

Simic, Vladimir

2015-01-01

End-of-life vehicles (ELVs) are vehicles that have reached the end of their useful lives and are no longer registered or licensed for use. The ELV recycling problem has become very serious in the last decade and more and more efforts are made in order to reduce the impact of ELVs on the environment. This paper proposes the fuzzy risk explicit interval linear programming model for ELV recycling planning in the EU. It has advantages in reflecting uncertainties presented in terms of intervals in the ELV recycling systems and fuzziness in decision makers' preferences. The formulated model has been applied to a numerical study in which different decision maker types and several ELV types under two EU ELV Directive legislative cases were examined. This study is conducted in order to examine the influences of the decision maker type, the α-cut level, the EU ELV Directive and the ELV type on decisions about vehicle hulks procuring, storing unprocessed hulks, sorting generated material fractions, allocating sorted waste flows and allocating sorted metals. Decision maker type can influence quantity of vehicle hulks kept in storages. The EU ELV Directive and decision maker type have no influence on which vehicle hulk type is kept in the storage. Vehicle hulk type, the EU ELV Directive and decision maker type do not influence the creation of metal allocation plans, since each isolated metal has its regular destination. The valid EU ELV Directive eco-efficiency quotas can be reached even when advanced thermal treatment plants are excluded from the ELV recycling process. The introduction of the stringent eco-efficiency quotas will significantly reduce the quantities of land-filled waste fractions regardless of the type of decision makers who will manage vehicle recycling system. In order to reach these stringent quotas, significant quantities of sorted waste need to be processed in advanced thermal treatment plants. Proposed model can serve as the support for the European vehicle recycling managers in creating more successful ELV recycling plans. Copyright © 2014 Elsevier Ltd. All rights reserved.

Biodiversity, conservation biology, and rational choice.

PubMed

Frank, David

2014-03-01

This paper critically discusses two areas of Sahotra Sarkar's recent work in environmental philosophy: biodiversity and conservation biology and roles for decision theory in incorporating values explicitly in the environmental policy process. I argue that Sarkar's emphasis on the practices of conservation biologists, and especially the role of social and cultural values in the choice of biodiversity constituents, restricts his conception of biodiversity to particular practical conservation contexts. I argue that life scientists have many reasons to measure many types of diversity, and that biodiversity metrics could be value-free. I argue that Sarkar's emphasis on the limitations of normative decision theory is in tension with his statement that decision theory can "put science and ethics together." I also challenge his claim that multi-criteria decision tools lacking axiomatic foundations in preference and utility theory are "without a rational basis," by presenting a case of a simple "outranking" multi-criteria decision rule that can violate a basic normative requirement of preferences (transitivity) and ask whether there may nevertheless be contexts in which such a procedure might assist decision makers. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed Central

2010-01-01

Background Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. Discussion We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. Summary In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved. PMID:20504357

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

PubMed

McCaughey, Deirdre; Bruning, Nealia S

2010-05-26

Current healthcare systems have extended the evidence-based medicine (EBM) approach to health policy and delivery decisions, such as access-to-care, healthcare funding and health program continuance, through attempts to integrate valid and reliable evidence into the decision making process. These policy decisions have major impacts on society and have high personal and financial costs associated with those decisions. Decision models such as these function under a shared assumption of rational choice and utility maximization in the decision-making process. We contend that health policy decision makers are generally unable to attain the basic goals of evidence-based decision making (EBDM) and evidence-based policy making (EBPM) because humans make decisions with their naturally limited, faulty, and biased decision-making processes. A cognitive information processing framework is presented to support this argument, and subtle cognitive processing mechanisms are introduced to support the focal thesis: health policy makers' decisions are influenced by the subjective manner in which they individually process decision-relevant information rather than on the objective merits of the evidence alone. As such, subsequent health policy decisions do not necessarily achieve the goals of evidence-based policy making, such as maximizing health outcomes for society based on valid and reliable research evidence. In this era of increasing adoption of evidence-based healthcare models, the rational choice, utility maximizing assumptions in EBDM and EBPM, must be critically evaluated to ensure effective and high-quality health policy decisions. The cognitive information processing framework presented here will aid health policy decision makers by identifying how their decisions might be subtly influenced by non-rational factors. In this paper, we identify some of the biases and potential intervention points and provide some initial suggestions about how the EBDM/EBPM process can be improved.

Linking science, public values, and decision-making: Case study development for public deliberations about climate change resilience

NASA Astrophysics Data System (ADS)

Weller, N.; Bennett, I.; Bernstein, M.; Farooque, M.; Lloyd, J.; Lowenthal, C.; Sittenfeld, D.

2016-12-01

Actionable science seeks to align scientific inquiry with decision-making priorities to overcome rifts between scientific knowledge and the needs of decision makers. Combining actionable science with explorations of public values and priorities creates useful support for decision makers facing uncertainty, tradeoffs, and limited resources. As part of a broader project to create public forums about climate change resilience, we convened workshops with decision makers, resilience experts, and community stakeholders to discuss climate change resilience. Our goals were 1) to create case studies of resilience strategies for use in public deliberations at science museums across 8 U.S. cities; and 2) to build relationships with decision makers and stakeholders interested in these public deliberations. Prior to workshops, we created summaries of resilience strategies using academic literature, government assessments, municipal resilience plans, and conversations with workshop participants. Workshops began with example deliberation activities followed by semi-structured discussions of resilience strategies centered on 4 questions: 1) What are the key decisions to be made regarding each strategy? 2) What stakeholders and perspectives are relevant to each strategy? 3) What available data are relevant to each strategy? 4) What visualizations or other resources are useful for communicating things about each strategy? Workshops yielded actionable dialogue regarding issues of justice, feasibility, and the socio-ecological-technical systems impacted by climate change hazards and resilience strategies. For example, discussions of drought revealed systemic and individual-level challenges and opportunities; discussions of sea level rise included ways to account for the cultural significance of many coastal communities. The workshops provide a model for identifying decision-making priorities and tradeoffs and building partnerships among stakeholders, scientists, and decision makers.

Power Watch - A global, open database of power plants that supports research on climate, water and air pollution impact of the global power sector.

NASA Astrophysics Data System (ADS)

Friedrich, J.; Kressig, A.; Van Groenou, S.; McCormick, C.

2017-12-01

Challenge The lack of transparent, accessible, and centralized power sector data inhibits the ability to research the impact of the global power sector. information gaps for citizens, analysts, and decision makers worldwide create barriers to sustainable development efforts. The need for transparent, accessible, and centralized information is especially important to enhance the commitments outlined in the recently adopted Paris Agreement and Sustainable Development Goals. Offer Power Watch will address this challenge by creating a comprehensive, open-source platform on the world's power systems. The platform hosts data on 85% of global installed electrical capacity and for each power plant will include data points on installed capacity, fuel type, annual generation, commissioning year, with more characteristics like emissions, particulate matter, annual water demand and more added over time. Most of the data is reported from national level sources, but annual generation and other operational characteristiscs are estimated via Machine Learning modeling and remotely sensed data when not officially reported. In addition, Power Watch plans to provide a suite of tools that address specific decision maker needs, such as water risk assessments and air pollution modeling. Impact Through open data, the platform and its tools will allow reserachers to do more analysis of power sector impacts and perform energy modeling. It will help catalyze accountability for policy makers, businesses, and investors and will inform and drive the transition to a clean energy future while reaching development targets.

Issues in Distance Education: A Primer for Higher Education Decision Makers

ERIC Educational Resources Information Center

Beaudoin, Michael

2016-01-01

This chapter presents an overview of current issues related to distance learning in higher education. It identifies central questions, issues, challenges, and opportunities that must be addressed by decision makers, as well as key attributes of effective leaders.

The effect of prognostic data presentation format on perceived risk among surrogate decision makers of critically ill patients: a randomized comparative trial.

PubMed

Chapman, Andy R; Litton, Edward; Chamberlain, Jenny; Ho, Kwok M

2015-04-01

The purpose of this study is to determine whether varying the format used to present prognostic data alters the perception of risk among surrogate decision makers in the intensive care unit (ICU). This was a prospective randomized comparative trial conducted in a 23-bed adult tertiary ICU. Enrolled surrogate decision makers were randomized to 1 of 2 questionnaires, which presented hypothetical ICU scenarios, identical other than the format in which prognostic data were presented (eg, frequencies vs percentages). Participants were asked to rate the risk associated with each prognostic statement. We enrolled 141 surrogate decision makers. The perception of risk varied significantly dependent on the presentation format. For "quantitative data," risks were consistently perceived as higher, when presented as frequencies (eg, 1 in 50) compared with equivalent percentages (eg, 2%). Framing "qualitative data" in terms of chance of "death" rather than "survival" led to a statistically significant increase in perceived risks. Framing "quantitative" data in this way did not significantly affect risk perception. Data format had a significant effect on how surrogate decision makers interpreted risk. Qualitative statements are interpreted widely and affected by framing. Where possible, multiple quantitative formats should be used for presenting prognostic information. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Research of Simple Multi-Attribute Rating Technique for Decision Support

NASA Astrophysics Data System (ADS)

Siregar, Dodi; Arisandi, Diki; Usman, Ari; Irwan, Dedy; Rahim, Robbi

2017-12-01

One of the roles of decision support system is that it can assist the decision maker in obtaining the appropriate alternative with the desired criteria, one of the methods that could apply for the decision maker is SMART method with multicriteria decision making. This multi-criteria decision-making theory has meaning where every alternative has criteria and has value and weight, and the author uses this approach to facilitate decision making with a compelling case. The problems discussed in this paper are classified into problems of a variety Multiobjective (multiple goals to be accomplished) and multicriteria (many of the decisive criteria in reaching such decisions).

Incentives for Optimal Multi-level Allocation of HIV Prevention Resources

PubMed Central

Malvankar, Monali M.; Zaric, Gregory S.

2013-01-01

HIV/AIDS prevention funds are often allocated at multiple levels of decision-making. Optimal allocation of HIV prevention funds maximizes the number of HIV infections averted. However, decision makers often allocate using simple heuristics such as proportional allocation. We evaluate the impact of using incentives to encourage optimal allocation in a two-level decision-making process. We model an incentive based decision-making process consisting of an upper-level decision maker allocating funds to a single lower-level decision maker who then distributes funds to local programs. We assume that the lower-level utility function is linear in the amount of the budget received from the upper-level, the fraction of funds reserved for proportional allocation, and the number of infections averted. We assume that the upper level objective is to maximize the number of infections averted. We illustrate with an example using data from California, U.S. PMID:23766551

Fuzzy sets, rough sets, and modeling evidence: Theory and Application. A Dempster-Shafer based approach to compromise decision making with multiattributes applied to product selection

NASA Technical Reports Server (NTRS)

Dekorvin, Andre

1992-01-01

The Dempster-Shafer theory of evidence is applied to a multiattribute decision making problem whereby the decision maker (DM) must compromise with available alternatives, none of which exactly satisfies his ideal. The decision mechanism is constrained by the uncertainty inherent in the determination of the relative importance of each attribute element and the classification of existing alternatives. The classification of alternatives is addressed through expert evaluation of the degree to which each element is contained in each available alternative. The relative importance of each attribute element is determined through pairwise comparisons of the elements by the decision maker and implementation of a ratio scale quantification method. Then the 'belief' and 'plausibility' that an alternative will satisfy the decision maker's ideal are calculated and combined to rank order the available alternatives. Application to the problem of selecting computer software is given.

Do probabilistic forecasts lead to better decisions?

NASA Astrophysics Data System (ADS)

Ramos, M. H.; van Andel, S. J.; Pappenberger, F.

2012-12-01

The last decade has seen growing research in producing probabilistic hydro-meteorological forecasts and increasing their reliability. This followed the promise that, supplied with information about uncertainty, people would take better risk-based decisions. In recent years, therefore, research and operational developments have also start putting attention to ways of communicating the probabilistic forecasts to decision makers. Communicating probabilistic forecasts includes preparing tools and products for visualization, but also requires understanding how decision makers perceive and use uncertainty information in real-time. At the EGU General Assembly 2012, we conducted a laboratory-style experiment in which several cases of flood forecasts and a choice of actions to take were presented as part of a game to participants, who acted as decision makers. Answers were collected and analyzed. In this paper, we present the results of this exercise and discuss if indeed we make better decisions on the basis of probabilistic forecasts.

Do probabilistic forecasts lead to better decisions?

NASA Astrophysics Data System (ADS)

Ramos, M. H.; van Andel, S. J.; Pappenberger, F.

2013-06-01

The last decade has seen growing research in producing probabilistic hydro-meteorological forecasts and increasing their reliability. This followed the promise that, supplied with information about uncertainty, people would take better risk-based decisions. In recent years, therefore, research and operational developments have also started focusing attention on ways of communicating the probabilistic forecasts to decision-makers. Communicating probabilistic forecasts includes preparing tools and products for visualisation, but also requires understanding how decision-makers perceive and use uncertainty information in real time. At the EGU General Assembly 2012, we conducted a laboratory-style experiment in which several cases of flood forecasts and a choice of actions to take were presented as part of a game to participants, who acted as decision-makers. Answers were collected and analysed. In this paper, we present the results of this exercise and discuss if we indeed make better decisions on the basis of probabilistic forecasts.

Accounting for reasonableness: Exploring the personal internal framework affecting decisions about cancer drug funding.

PubMed

Sinclair, Shane; Hagen, Neil A; Chambers, Carole; Manns, Braden; Simon, Anita; Browman, George P

2008-05-01

Drug decision-makers are involved in developing and implementing policy, procedure and processes to support health resource allocation regarding drug treatment formularies. A variety of approaches to decision-making, including formal decision-making frameworks, have been developed to support transparent and fair priority setting. Recently, a decision tool, 'The 6-STEPPPs Tool', was developed to assist in making decisions about new cancer drugs within the public health care system. We conducted a qualitative study, utilizing focus groups and participant observation, in order to investigate the internal frameworks that supported and challenged individual participants as they applied this decision tool within a multi-stakeholder decision process. We discovered that health care resource allocation engaged not only the minds of decision-makers but profoundly called on the often conflicting values of the heart. Objective decision-making frameworks for new drug therapies need to consider the subjective internal frameworks of decision-makers that affect decisions. Understanding the very human, internal turmoil experienced by individuals involved in health care resource allocation, sheds additional insight into how to account for reasonableness and how to better support difficult decisions through transparent, values-based resource allocation policy, procedures and processes.

Knowledge Style Profiling: An Exploration of Cognitive, Temperament, Demographic and Organizational Characteristics among Decision Makers Using Advanced Analytical Technologies

ERIC Educational Resources Information Center

Polito, Vincent A., Jr.

2010-01-01

The objective of this research was to explore the possibilities of identifying knowledge style factors that could be used as central elements of a professional business analyst's (PBA) performance attributes at work for those decision makers that use advanced analytical technologies on decision making tasks. Indicators of knowledge style were…

On avoiding framing effects in experienced decision makers.

PubMed

Garcia-Retamero, Rocio; Dhami, Mandeep K

2013-01-01

The present study aimed to (a) demonstrate the effect of positive-negative framing on experienced criminal justice decision makers, (b) examine the debiasing effect of visually structured risk messages, and (c) investigate whether risk perceptions mediate the debiasing effect of visual aids on decision making. In two phases, 60 senior police officers estimated the accuracy of a counterterrorism technique in identifying whether a known terror suspect poses an imminent danger and decided whether they would recommend the technique to policy makers. Officers also rated their confidence in this recommendation. When information about the effectiveness of the counterterrorism technique was presented in a numerical format, officers' perceptions of accuracy and recommendation decisions were susceptible to the framing effect: The technique was perceived to be more accurate and was more likely to be recommended when its effectiveness was presented in a positive than in a negative frame. However, when the information was represented visually using icon arrays, there were no such framing effects. Finally, perceptions of accuracy mediated the debiasing effect of visual aids on recommendation decisions. We offer potential explanations for the debiasing effect of visual aids and implications for communicating risk to experienced, professional decision makers.

Linking Space Weather Science and Decision Making (Invited)

NASA Astrophysics Data System (ADS)

Fisher, G. M.

2009-12-01

Linking scientific knowledge to decision making is a challenge for both the science and policy communities. In particular, in the field of space weather, there are unique challenges such as decision makers may not know that space has weather that poses risks to our technologically-dependent economy. Additionally, in an era of limited funds for scientific research, hazards posed by other natural disasters such as flooding and earthquakes are by contrast well known to policy makers, further making the importance of space weather research and monitoring a tough sell. Today, with industries and individuals more dependent on the Global Positioning System, wireless technology, and satellites than ever before, any disruption or inaccuracy can result in severe economic impacts. Therefore, it is highly important to understand how space weather science can most benefit society. The key to connecting research to decision making is to ensure that the information is salient, credible, and legitimate. To achieve this, scientists need to understand the decision makers' perspectives, including their language and culture, and recognize that their needs may evolve. This presentation will take a closer look at the steps required to make space weather research, models, and forecasts useful to decision makers and ultimately, benefit society.

Public Participation Procedure in Integrated Transport and Green Infrastructure Planning

NASA Astrophysics Data System (ADS)

Finka, Maroš; Ondrejička, Vladimír; Jamečný, Ľubomír; Husár, Milan

2017-10-01

The dialogue among the decision makers and stakeholders is a crucial part of any decision-making processes, particularly in case of integrated transportation planning and planning of green infrastructure where a multitude of actors is present. Although the theory of public participation is well-developed after several decades of research, there is still a lack of practical guidelines due to the specificity of public participation challenges. The paper presents a model of public participation for integrated transport and green infrastructure planning for international project TRANSGREEN covering the area of five European countries - Slovakia, Czech Republic, Austria, Hungary and Romania. The challenge of the project is to coordinate the efforts of public actors and NGOs in international environment in oftentimes precarious projects of transport infrastructure building and developing of green infrastructure. The project aims at developing and environmentally-friendly and safe international transport network. The proposed public participation procedure consists of five main steps - spread of information (passive), collection of information (consultation), intermediate discussion, engagement and partnership (empowerment). The initial spread of information is a process of communicating with the stakeholders, informing and educating them and it is based on their willingness to be informed. The methods used in this stage are public displays, newsletters or press releases. The second step of consultation is based on transacting the opinions of stakeholders to the decision makers. Pools, surveys, public hearings or written responses are examples of the multitude of ways to achieve this objective and the main principle of openness of stakeholders. The third step is intermediate discussion where all sides of are invited to a dialogue using the tools such as public meetings, workshops or urban walks. The fourth step is an engagement based on humble negotiation, arbitration and mediation. The collaborative skill needed here is dealing with conflicts. The final step in the procedure is partnership and empowerment employing methods as multi-actor decision making, voting or referenda. The leading principle is cooperation. In this ultimate step, the stakeholders are becoming decision makers themselves and the success factor here is continuous evaluation.

Electricity decision-making: New techniques for calculating statewide economic impacts from new power supply and demand-side management programs

NASA Astrophysics Data System (ADS)

Tegen, Suzanne Isabel Helmholz

This dissertation introduces new techniques for calculating and comparing statewide economic impacts from new coal, natural gas and wind power plants, as well as from demand-side management programs. The impetus for this work was two-fold. First, reviews of current literature and projects revealed that there was no standard way to estimate statewide economic impacts from new supply- and demand-side electricity options. Second, decision-makers who were interviewed stated that they were overwhelmed with data in general, but also lacked enough specific information about economic development impacts to their states from electricity, to make informed choices. This dissertation includes chapters on electricity decision-making and on economic impacts from supply and demand. The supply chapter compares different electricity options in three states which vary in natural resource content: Arizona, Colorado and Michigan. To account for differing capacity factors, resources are compared on a per-megawatt-hour basis. The calculations of economic impacts from new supply include: materials and labor for construction, operations, maintenance, fuel extraction, fuel transport, as well as property tax, financing and landowner revenues. The demand-side chapter compares residential, commercial and industrial programs in Iowa. Impact calculations include: incremental labor and materials for program planning, installation and operations, as well as sales taxes and electricity saved. Results from supply-side calculations in the three states analyzed indicate that adding new wind power can have a greater impact to a state's economy than adding new gas or coal power due to resource location, taxes and infrastructure. Additionally, demand-side management programs have a higher relative percentage of in-state dollar flow than supply-side solutions, though demand-side programs typically involve fewer MWh and dollars than supply-side generation. Methods for this dissertation include researching existing models and data, gathering new data and interviews with industry representatives and policy makers. The new techniques are important for decision-makers, utilities, energy advocates and others who are concerned with economic development and in-state dollar flows from new electricity decisions.

Creating Ecosystem Services Indices with EnviroAtlas Metrics

EPA Science Inventory

To support the well-being of future generations, ecosystem services (ES) need to be fully understood and evaluated by decision-makers. Geospatial tools, such as the EnviroAtlas, allow decision-makers, urban planners, public health professionals, and other stakeholders to view and...

Should childhood MMR vaccination be compulsory? Rights, duties and the public interest

PubMed Central

Sheather, Julian

2013-01-01

When children and young people lack the capacity to make decisions about their care and treatment, decisions have to be made on their behalf based on an assessment of their welfare or interests. In law, parents, or others with the relevant parental responsibility, are ordinarily regarded as the appropriate decision-makers. One way of framing this is to say that parents have certain decision-making rights with respect to their children. Such rights, however, are not generally regarded as absolute, rather they can be seen as secondary to and limited by the duties that parents have with regard to their children, duties to promote their welfare. It is against these parental duties that children could, at least in theory if not in practice, claim a right to certain kinds of protection. The legal rights of parents here, as opposed to the rights of the children, can be thought of as rights that secure for parents the freedom from interference necessary to fulfill the underlying duty. PMID:23732893

Study protocol: DEcisions in health Care to Introduce or Diffuse innovations using Evidence (DECIDE).

PubMed

Turner, Simon; Morris, Stephen; Sheringham, Jessica; Hudson, Emma; Fulop, Naomi J

2016-04-05

A range of evidence informs healthcare decision-making, from formal research findings to 'soft intelligence' or local data, as well as practical experience or tacit knowledge. However, cultural and organisational factors often prevent the translation of such evidence into practice. Using a multi-level framework, this project will analyse how interactions between the evidence available and processes at the micro (individual/group) and meso (organisational/system) levels influence decisions to introduce or diffuse innovations in acute and primary care within the National Health Service in the UK. This study will use a mixed methods design, combining qualitative and quantitative methods, and involves four interdependent work streams: (1) rapid evidence synthesis of relevant literature with stakeholder feedback; (2) in-depth case studies of 'real-world' decision-making in acute and primary care; (3) a national survey and discrete choice experiment; and (4) development of guidance for decision-makers and evaluators to support the use of evidence in decision-making. This study will enhance the understanding of decision-makers' use of diverse forms of evidence. The findings will provide insights into how and why some evidence does inform decisions to introduce healthcare innovations, and why barriers persist in other cases. It will also quantify decision-makers' preferences, including the 'tipping point' of evidence needed to shift stakeholders' views. Practical guidance will be shared with healthcare decision-makers and evaluators on uses of evidence to enable the introduction and diffusion of innovation.

Exploring Institutional Mechanisms for Scientific Input into the Management Cycle of the National Protected Area Network of Peru: Gaps and Opportunities.

PubMed

López-Rodríguez, M D; Castro, H; Arenas, M; Requena-Mullor, J M; Cano, A; Valenzuela, E; Cabello, J

2017-12-01

Understanding how to improve decision makers' use of scientific information across their different scales of management is a core challenge for narrowing the gap between science and conservation practice. Here, we present a study conducted in collaboration with decision makers that aims to explore the functionality of the mechanisms for scientific input within the institutional setting of the National Protected Area Network of Peru. First, we analyzed institutional mechanisms to assess the scientific information recorded by decision makers. Second, we developed two workshops involving scientists, decision makers and social actors to identify barriers to evidence-based conservation practice. Third, we administered 482 questionnaires to stakeholders to explore social perceptions of the role of science and the willingness to collaborate in the governance of protected areas. The results revealed that (1) the institutional mechanisms did not effectively promote the compilation and application of scientific knowledge for conservation practice; (2) six important barriers hindered scientific input in management decisions; and (3) stakeholders showed positive perceptions about the involvement of scientists in protected areas and expressed their willingness to collaborate in conservation practice. This collaborative research helped to (1) identify gaps and opportunities that should be addressed for increasing the effectiveness of the institutional mechanisms and (2) support institutional changes integrating science-based strategies for strengthening scientific input in decision-making. These insights provide a useful contextual orientation for scholars and decision makers interested in conducting empirical research to connect scientific inputs with operational aspects of the management cycle in other institutional settings around the world.

Equilibrium approach towards water resource management and pollution control in coal chemical industrial park.

PubMed

Xu, Jiuping; Hou, Shuhua; Xie, Heping; Lv, Chengwei; Yao, Liming

2018-08-01

In this study, an integrated water and waste load allocation model is proposed to assist decision makers in better understanding the trade-offs between economic growth, resource utilization, and environmental protection of coal chemical industries which characteristically have high water consumption and pollution. In the decision framework, decision makers in a same park, each of whom have different goals and preferences, work together to seek a collective benefit. Similar to a Stackelberg-Nash game, the proposed approach illuminates the decision making interrelationships and involves in the conflict coordination between the park authority and the individual coal chemical company stockholders. In the proposed method, to response to climate change and other uncertainties, a risk assessment tool, Conditional Value-at-Risk (CVaR) and uncertainties through reflecting parameters and coefficients using probability and fuzzy set theory are integrated in the modeling process. Then a case study from Yuheng coal chemical park is presented to demonstrate the practicality and efficiency of the optimization model. To reasonable search the potential consequences of different responses to water and waste load allocation strategies, a number of scenario results considering environmental uncertainty and decision maker' attitudes are examined to explore the tradeoffs between economic development and environmental protection and decision makers' objectives. The results are helpful for decision/police makers to adjust current strategies adapting for current changes. Based on the scenario analyses and discussion, some propositions and operational policies are given and sensitive adaptation strategies are presented to support the efficient, balanced and sustainable development of coal chemical industrial parks. Copyright © 2018 Elsevier Ltd. All rights reserved.

Exploring Institutional Mechanisms for Scientific Input into the Management Cycle of the National Protected Area Network of Peru: Gaps and Opportunities

NASA Astrophysics Data System (ADS)

López-Rodríguez, M. D.; Castro, H.; Arenas, M.; Requena-Mullor, J. M.; Cano, A.; Valenzuela, E.; Cabello, J.

2017-12-01

Understanding how to improve decision makers' use of scientific information across their different scales of management is a core challenge for narrowing the gap between science and conservation practice. Here, we present a study conducted in collaboration with decision makers that aims to explore the functionality of the mechanisms for scientific input within the institutional setting of the National Protected Area Network of Peru. First, we analyzed institutional mechanisms to assess the scientific information recorded by decision makers. Second, we developed two workshops involving scientists, decision makers and social actors to identify barriers to evidence-based conservation practice. Third, we administered 482 questionnaires to stakeholders to explore social perceptions of the role of science and the willingness to collaborate in the governance of protected areas. The results revealed that (1) the institutional mechanisms did not effectively promote the compilation and application of scientific knowledge for conservation practice; (2) six important barriers hindered scientific input in management decisions; and (3) stakeholders showed positive perceptions about the involvement of scientists in protected areas and expressed their willingness to collaborate in conservation practice. This collaborative research helped to (1) identify gaps and opportunities that should be addressed for increasing the effectiveness of the institutional mechanisms and (2) support institutional changes integrating science-based strategies for strengthening scientific input in decision-making. These insights provide a useful contextual orientation for scholars and decision makers interested in conducting empirical research to connect scientific inputs with operational aspects of the management cycle in other institutional settings around the world.

The Art of Influencing Decision Makers.

ERIC Educational Resources Information Center

Diegmueller, Karen

1992-01-01

Influencing educational decision makers requires creating ongoing relationships, keeping everyone informed, and developing persuasive skills. Persuasion requires preparation, refinement, hard work, and a sound understanding of the people being lobbied. Lobbying must be factual and relevant to the audience. The article looks at influence from the…

PUMP-AND-TREAT GROUND-WATER REMEDIATION: A GUIDE FOR DECISION MAKERS AND PRACTITIONERS

EPA Science Inventory

This guide presents decision makers with a foundation for evaluating the appropriateness of conventional or innovative approaches. An introduction to pump-and-treat ground-water remediation, the guide addresses the following questions: When is pump-and-treat an appropriate remedi...

Innovative environmental education contributes to improved management practices in the Mid-Atlantic region of the United States.

PubMed

Bradley, M Patricia; Hanson, Royce; Walbeck, Eric S

2004-06-01

The Mid-Atlantic Integrated Assessment (MAIA) and its partner, University of Maryland, Baltimore County (UMBC) have developed a graduate-level course focused on successful application of science by decision-makers to address a particular problem. Students conduct a literature review, interview the decision-makers and scientists, and synthesize and document the management problem, the science that was applied to that problem, and other issues that might constrain or drive the solution (e.g., legalities, social pressures, expense, politics, personalities, etc.). Students also quantify the results, evaluate who the intended audience is and how they most appropriately target them, and determine if there are other management problems that could be addressed with the science. The final products are short publications geared towards other decision-makers who might have a similar problem and might be seeking successful innovative solutions. MAIA is distributing these short publications to decision-makers throughout the Mid-Atlantic Region. The publications have been very positively received by state and local governments and watershed groups.

Matryoshka Project: lessons learned about early intervention in psychosis programme development.

PubMed

Cheng, Chiachen; Dewa, Carolyn S; Goering, Paula

2011-02-01

This part of the Matryoshka project sought to understand the processes with which early intervention in psychosis (EIP) programmes were implemented and developed. The goals were to understand the key influences of programme implementation in the context of rapid EIP service growth and lack of specific provincial guidelines. Sampling was purposive and data were collected with semi-structured interviews. Five Matryoshka Project programmes were successfully contacted. All interviews were conducted by phone, recorded and transcribed verbatim. Emerging themes were analysed iteratively and discussed among authors. Key themes were validated with participants. The new EIP services were significantly influenced by the provincial EIP network, advocacy groups and clinical mentors. EIP programme decision makers often relied on each other for guidance. Although the research evidence assisted programme decision makers to develop an effective EIP model for their region, implementation was often shaped by funding constraints. Programmes adapted their EIP models according to funding and local service characteristics. The lack of specific guidelines may have allowed innovation; programme creativity and diversity is consistent with EIP values. Despite the challenges related to geography and staffing, programmes experienced important successes such as partnerships across sectors, quality clinical service and the ability to engage hard-to-serve clientele. Although important, research evidence played only a secondary role. Relationships among providers and services, coupled with the dedication of front-line staff, were more critical to knowledge exchange than written documents alone. These findings stress the importance of researcher-front-line relationships to the adoption of evidence-informed practice. © 2011 Blackwell Publishing Asia Pty Ltd.

A technical framework for costing health workforce retention schemes in remote and rural areas

PubMed Central

2011-01-01

Background Increasing the availability of health workers in remote and rural areas through improved health workforce recruitment and retention is crucial to population health. However, information about the costs of such policy interventions often appears incomplete, fragmented or missing, despite its importance for the sound selection, planning, implementation and evaluation of these policies. This lack of a systematic approach to costing poses a serious challenge for strong health policy decisions. Methods This paper proposes a framework for carrying out a costing analysis of interventions to increase the availability of health workers in rural and remote areas with the aim to help policy decision makers. It also underlines the importance of identifying key sources of financing and of assessing financial sustainability. The paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. Results We show that while the debate on the effectiveness of policies and strategies to improve health workforce retention is gaining impetus and attention, there is still a significant lack of knowledge and evidence about the associated costs. To address the concerns stemming from this situation, key elements of a framework to undertake a cost analysis are proposed and discussed. Conclusions These key elements should help policy makers gain insight into the costs of policy interventions, to clearly identify and understand their financing sources and mechanisms, and to ensure their sustainability. PMID:21470420

Information and Decision Superiority: Right Concept, Right Tools, Right Training

DTIC Science & Technology

2007-01-01

individual services, and numerous defense contractors have spoken of " information dominance " and "information superiority." Both, particularly the former...technologies will offer an unimaginable level of information to decision makers and operators. Ideas of information dominance , however, are fundamentally...other futuristic sensors will offer an unimaginable level of information to decision makers and operators. Ideas of information dominance , however

Climate modeling with decision makers in mind

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

Jones, Andrew; Calvin, Katherine; Lamarque, Jean -Francois

The need for regional- and local-scale climate information is increasing rapidly as decision makers seek to anticipate and manage a variety of context-specific climate risks over the next several decades. Furthermore, global climate models are not developed with these user needs in mind, and they typically operate at resolutions that are too coarse to provide information that could be used to support regional and local decisions.

Making Invasion models useful for decision makers; incorporating uncertainty, knowledge gaps, and decision-making preferences

Treesearch

Denys Yemshanov; Frank H Koch; Mark Ducey

2015-01-01

Uncertainty is inherent in model-based forecasts of ecological invasions. In this chapter, we explore how the perceptions of that uncertainty can be incorporated into the pest risk assessment process. Uncertainty changes a decision maker’s perceptions of risk; therefore, the direct incorporation of uncertainty may provide a more appropriate depiction of risk. Our...

A Systems Thinking Framework for Assessing and Addressing Malaria Locally: An Alternative to the Globalization of Anti-Malaria Policies

ERIC Educational Resources Information Center

Willis, Derek W.

2010-01-01

This dissertation analyzes a decision system that was used in the early 1900s in the Federated Malay States (FMS) by Malcolm Watson in order to make anti-malaria program recommendations to decision makers in a wide range of ecological settings. Watson's recommendations to decision makers throughout the FMS led to a dramatic suppression of malaria…

Climate modeling with decision makers in mind

DOE PAGES

Jones, Andrew; Calvin, Katherine; Lamarque, Jean -Francois

2016-04-27

The need for regional- and local-scale climate information is increasing rapidly as decision makers seek to anticipate and manage a variety of context-specific climate risks over the next several decades. Furthermore, global climate models are not developed with these user needs in mind, and they typically operate at resolutions that are too coarse to provide information that could be used to support regional and local decisions.

Improving the Slum Planning Through Geospatial Decision Support System

NASA Astrophysics Data System (ADS)

Shekhar, S.

2014-11-01

In India, a number of schemes and programmes have been launched from time to time in order to promote integrated city development and to enable the slum dwellers to gain access to the basic services. Despite the use of geospatial technologies in planning, the local, state and central governments have only been partially successful in dealing with these problems. The study on existing policies and programmes also proved that when the government is the sole provider or mediator, GIS can become a tool of coercion rather than participatory decision-making. It has also been observed that local level administrators who have adopted Geospatial technology for local planning continue to base decision-making on existing political processes. In this juncture, geospatial decision support system (GSDSS) can provide a framework for integrating database management systems with analytical models, graphical display, tabular reporting capabilities and the expert knowledge of decision makers. This assists decision-makers to generate and evaluate alternative solutions to spatial problems. During this process, decision-makers undertake a process of decision research - producing a large number of possible decision alternatives and provide opportunities to involve the community in decision making. The objective is to help decision makers and planners to find solutions through a quantitative spatial evaluation and verification process. The study investigates the options for slum development in a formal framework of RAY (Rajiv Awas Yojana), an ambitious program of Indian Government for slum development. The software modules for realizing the GSDSS were developed using the ArcGIS and Community -VIZ software for Gulbarga city.

System and method for integrating hazard-based decision making tools and processes

DOEpatents

Hodgin, C Reed [Westminster, CO

2012-03-20

A system and method for inputting, analyzing, and disseminating information necessary for identified decision-makers to respond to emergency situations. This system and method provides consistency and integration among multiple groups, and may be used for both initial consequence-based decisions and follow-on consequence-based decisions. The system and method in a preferred embodiment also provides tools for accessing and manipulating information that are appropriate for each decision-maker, in order to achieve more reasoned and timely consequence-based decisions. The invention includes processes for designing and implementing a system or method for responding to emergency situations.

Challenges in getting workforce research in nursing used for decision-making in policy and practice: a Canadian perspective.

PubMed

O'Brien-Pallas, Linda; Hayes, Laureen

2008-12-01

This paper draws upon empirical research and other published sources to discuss nursing workforce issues, the challenges of using health human resource research in policy decisions and the importance of evidence-based policies and practices for nursing care and outcomes. Increasing evidence points to the critical relationship between registered nurse care and improved patient outcomes. The negative impact that insufficient nurse staffing has on patient, nursing and system outcomes has influenced health human resource researchers to further examine nurses' work environments to determine factors that are amenable to policy change. Survey of literature was conducted. Electronic databases were searched using keywords. Sustained health human resource planning efforts by policy makers are difficult given changing governments and political agendas. The health human resource conceptual framework provides researchers and planners with a guide to decision-making that considers current circumstances as well as those factors that need to be accounted for in predicting future requirements. However, effective use of research depends on communication of findings between researchers and policymakers. Health care managers and other decision-makers in health care organisations often lack an understanding of the research process and do not always have easy access to current evidence. Also, managerial decisions are often constrained by organisational requirements such as resource availability and policies and procedures. Unless nursing workplace issues are addressed, the physiological and psychological stress in the work environments of nurses will continue. Effective health human resource policy and planning (at the macro level) and management strategies (at the micro level) would stabilise the nursing workforce and reduce job stress. Furthermore, the efficiency and cost-effectiveness of the health system could be enhanced through improved health outcomes of care providers and health care clients.

Discounting of Delayed Rewards Is Not Hyperbolic

ERIC Educational Resources Information Center

Luhmann, Christian C.

2013-01-01

Delay discounting refers to decision-makers' tendency to value immediately available goods more than identical goods available only after some delay. In violation of standard economic theory, decision-makers frequently exhibit dynamic inconsistency; their preferences change simply due to the passage of time. The standard explanation for this…

NextGen Future Safety Assessment Game

NASA Technical Reports Server (NTRS)

Ancel, Ersin; Gheorghe, Adian; Jones, Sharon Monica

2010-01-01

The successful implementation of the next generation infrastructure systems requires solid understanding of their technical, social, political and economic aspects along with their interactions. The lack of historical data that relate to the long-term planning of complex systems introduces unique challenges for decision makers and involved stakeholders which in turn result in unsustainable systems. Also, the need to understand the infrastructure at the societal level and capture the interaction between multiple stakeholders becomes important. This paper proposes a methodology in order to develop a holistic approach aiming to provide an alternative subject-matter expert (SME) elicitation and data collection method for future sociotechnical systems. The methodology is adapted to Next Generation Air Transportation System (NextGen) decision making environment in order to demonstrate the benefits of this holistic approach.

NextGen Future Safety Assessment Game

NASA Technical Reports Server (NTRS)

Ancel, Ersin; Gheorghe, Adrian; Jones, Sharon Monica

2011-01-01

The successful implementation of the next generation infrastructure systems requires solid understanding of their technical, social, political and economic aspects along with their interactions. The lack of historical data that relate to the long-term planning of complex systems introduces unique challenges for decision makers and involved stakeholders which in turn result in unsustainable systems. Also, the need to understand the infrastructure at the societal level and capture the interaction between multiple stakeholders becomes important. This paper proposes a methodology in order to develop a holistic approach aiming to provide an alternative subject-matter expert (SME) elicitation and data collection method for future sociotechnical systems. The methodology is adapted to Next Generation Air Transportation System (NextGen) decision making environment in order to demonstrate the benefits of this holistic approach.

Doubt and belief in physicians' ability to prognosticate during critical illness: The perspective of surrogate decision makers

PubMed Central

Zier, Lucas S.; Burack, Jeffrey H.; Micco, Guy; Chipman, Anne K.; Frank, James A.; Luce, John M.; White, Douglas B.

2009-01-01

Objectives: Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ill patients; and 2) how individuals use prognostic information in their role as surrogate decision-makers. Design, Setting, and Patients: Multicenter study in intensive care units of a public hospital, a tertiary care hospital, and a veterans' hospital. We conducted semistructured interviews with 50 surrogate decision-makers of critically ill patients. We analyzed the interview transcripts using grounded theory methods to inductively develop a framework to describe surrogates' beliefs about physicians' ability to prognosticate. Validation methods included triangulation by multidisciplinary analysis and member checking. Measurements and Main Results: Overall, 88% (44 of 50) of surrogates expressed doubt about physicians' ability to prognosticate for critically ill patients. Four distinct themes emerged that explained surrogates' doubts about prognostic accuracy: a belief that God could alter the course of the illness, a belief that predicting the future is inherently uncertain, prior experiences where physicians' prognostications were inaccurate, and experiences with prognostication during the patient's intensive care unit stay. Participants also identified several factors that led to belief in physicians' prognostications, such as receiving similar prognostic estimates from multiple physicians and prior experiences with accurate prognostication. Surrogates' doubts about prognostic accuracy did not prevent them from wanting prognostic information. Instead, most surrogate decision-makers view physicians' prognostications as rough estimates that are valuable in informing decisions, but are not determinative. Surrogates identified the act of prognostic disclosure as a key step in preparing emotionally and practically for the possibility that a patient may not survive. Conclusions: Although many surrogate decision-makers harbor some doubt about the accuracy of physicians' prognostications, they highly value discussions about prognosis and use the information for multiple purposes. (Crit Care Med 2008; 36: 2341–2347) PMID:18596630

Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector

PubMed Central

2013-01-01

Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Conclusions Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this. PMID:23731570

Valuing information for sewer replacement decisions.

PubMed

van Riel, Wouter; Langeveld, Jeroen; Herder, Paulien; Clemens, François

Decision-making for sewer asset management is partially based on intuition and often lacks explicit argumentation, hampering decision transparency and reproducibility. This is not to be preferred in light of public accountability and cost-effectiveness. It is unknown to what extent each decision criterion is appreciated by decision-makers. Further insight into this relative importance improves understanding of decision-making of sewer system managers. As such, a digital questionnaire (response ratio 43%), containing pairwise comparisons between 10 relevant information sources, was sent to all 407 municipalities in the Netherlands to analyse the relative importance and assess whether a shared frame of reasoning is present. Thurstone's law of comparative judgment was used for analysis, combined with several consistency tests. Results show that camera inspections were valued highest, while pipe age was considered least important. The respondents were pretty consistent per individual and also showed consistency as a group. This indicated a common framework of reasoning among the group. The feedback of the group showed, however, the respondents found it difficult to make general comparisons without having a context. This indicates decision-making in practice is more likely to be steered by other mechanisms than purely combining information sources.

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

PubMed

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

2008-12-01

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

Finding the numerical compensation in multiple criteria decision-making problems under fuzzy environment

NASA Astrophysics Data System (ADS)

Gupta, Mahima; Mohanty, B. K.

2017-04-01

In this paper, we have developed a methodology to derive the level of compensation numerically in multiple criteria decision-making (MCDM) problems under fuzzy environment. The degree of compensation is dependent on the tranquility and anxiety level experienced by the decision-maker while taking the decision. Higher tranquility leads to the higher realisation of the compensation whereas the increased level of anxiety reduces the amount of compensation in the decision process. This work determines the level of tranquility (or anxiety) using the concept of fuzzy sets and its various level sets. The concepts of indexing of fuzzy numbers, the risk barriers and the tranquility level of the decision-maker are used to derive his/her risk prone or risk averse attitude of decision-maker in each criterion. The aggregation of the risk levels in each criterion gives us the amount of compensation in the entire MCDM problem. Inclusion of the compensation leads us to model the MCDM problem as binary integer programming problem (BIP). The solution to BIP gives us the compensatory decision to MCDM. The proposed methodology is illustrated through a numerical example.

Irrigation water policy analysis using a business simulation game

NASA Astrophysics Data System (ADS)

Buchholz, M.; Holst, G.; Musshoff, O.

2016-10-01

Despite numerous studies on farmers' responses to changing irrigation water policies, uncertainties remain about the potential of water pricing schemes and water quotas to reduce irrigation. Thus far, policy impact analysis is predominantly based upon rational choice models that assume behavioral assumptions, such as a perfectly rational profit-maximizing decision maker. Also, econometric techniques are applied which could lack internal validity due to uncontrolled field data. Furthermore, such techniques are not capable of identifying ill-designed policies prior to their implementation. With this in mind, we apply a business simulation game for ex ante policy impact analysis of irrigation water policies at the farm level. Our approach has the potential to reveal the policy-induced behavioral change of the participants in a controlled environment. To do so, we investigate how real farmers from Germany, in an economic experiment, respond to a water pricing scheme and a water quota intending to reduce irrigation. In the business simulation game, the participants manage a "virtual" cash-crop farm for which they make crop allocation and irrigation decisions during several production periods, while facing uncertain product prices and weather conditions. The results reveal that a water quota is able to reduce mean irrigation applications, while a water pricing scheme does not have an impact, even though both policies exhibit equal income effects for the farmers. However, both policies appear to increase the variation of irrigation applications. Compared to a perfectly rational profit-maximizing decision maker, the participants apply less irrigation on average, both when irrigation is not restricted and when a water pricing scheme applies. Moreover, the participants' risk attitude affects the irrigation decisions.

Adaptation Planning for Water Resources Management in the Context of Scientific Uncertainty

NASA Astrophysics Data System (ADS)

Lowrey, J.; Kenney, D.

2008-12-01

Several municipalities are beginning to create policies and plans in order to adapt to potential impacts from climate change. A 2007 report from the Heinz Center for Science, Economics, and the Environment, 'A Survey of Climate Change Adaptation Planning,' surveyed fourteen cities or counties across the U.S. and Canada that have created or are working towards creating climate change adaptation plans. Informal interactions with water managers in the Intermountain West indicate an eagerness to learn from those who have already begun adapting to potential climate change. Many of those without plans do not feel comfortable making potentially expensive long-term policy decisions based on impacts derived from uncertain climate change projections. This research identifies how decision makers currently consider climate change in adaptation planning despite imperfect information about climate change impacts, particularly in the water sector. Insights are offered into how best to provide information on climate change projections to regional decision makers so that they can begin adaptation planning for a changing climate. This research analyzes how a subset of the fourteen municipalities justified adaptive planning in the face of scientific uncertainty, paying particular attention to water resource adaptation, using the adaptation approaches studied in the 2007 Heinz Center Report. Interviews will be conducted with decision makers to learn how policies will be implemented and evaluated, and to explore resulting changes in policy or planning. Adaptation strategies are not assessed, but are used to identify how the decision makers plan to evaluate their own adaptation policies. In addition to looking at information use in adaptation plans, we compare how the plans orient themselves (adapting to projected impacts vs. increasing resiliency to current climate variability), how they address barriers and opportunities for adaptation, and whether they follow some key steps for successful adaptation as outlined in the literature. This part of the study will identify any consensus among the municipalities already adapting, and see of the decision makers tend to agree with the points of views expressed in the literature. The conclusions here will not only help decision makers trying to adapt, but it will help researchers orient future research to the informational needs of the decision makers. The work is intended to provide useful information for the Western Water Assessment, a NOAA-funded research boundary organization, which provides climate information to water resource managers in the Intermountain West, including the Colorado River Basin.

Incentivizing Decentralized Sanitation: The Role of Discount Rates.

PubMed

Wood, Alison; Blackhurst, Michael; Garland, Jay L; Lawler, Desmond F

2016-06-21

In adoption decisions for decentralized sanitation technologies, two decision makers are involved: the public utility and the individual homeowner. Standard life cycle cost is calculated from the perspective of the utility, which uses a market-based discount rate in these calculations. However, both decision-makers must be considered, including their differing perceptions of the time trade-offs inherent in a stream of costs and benefits. This study uses the discount rate as a proxy for these perceptions and decision-maker preferences. The results in two case studies emphasize the dependence on location of such analyses. Falmouth, Massachusetts, appears to be a good candidate for incentivizing decentralized sanitation while the Allegheny County Sanitary Authority service area in Pennsylvania appears to have no need for similar incentives. This method can be applied to any two-party decision in which the parties are expected to have different discount rates.

Exploring Scientific Information for Policy Making under Deep Uncertainty

NASA Astrophysics Data System (ADS)

Forni, L.; Galaitsi, S.; Mehta, V. K.; Escobar, M.; Purkey, D. R.; Depsky, N. J.; Lima, N. A.

2016-12-01

Each actor evaluating potential management strategies brings her/his own distinct set of objectives to a complex decision space of system uncertainties. The diversity of these objectives require detailed and rigorous analyses that responds to multifaceted challenges. However, the utility of this information depends on the accessibility of scientific information to decision makers. This paper demonstrates data visualization tools for presenting scientific results to decision makers in two case studies, La Paz/ El Alto, Bolivia, and Yuba County,California. Visualization output from the case studies combines spatiotemporal, multivariate and multirun/multiscenario information to produce information corresponding to the objectives defined by key actors and stakeholders. These tools can manage complex data and distill scientific information into accessible formats. Using the visualizations, scientists and decision makers can navigate the decision space and potential objective trade-offs to facilitate discussion and consensus building. These efforts can support identifying stable negotiatedagreements between different stakeholders.

Characteristics of community health organizations and decision-makers considering the adoption of motivational interviewing.

PubMed

Williams, Jessica Roberts; Dusablon, Tracy; Williams, Weston O; Blais, Marissa Puckett; Hennessy, Kevin D

2014-07-01

Research related to the adoption of comparative effectiveness research (CER) in mental health practice is limited. This study explores the factors that influence decisions to adopt motivational interviewing (MI)-an evidence-based practice (EBP) grounded in CER-among decision-makers (n = 311) in community health organizations (n = 92). Descriptive analyses focus on organization and decision-maker characteristics and processes that may influence the decision to adopt an EBP, including demographics, structure and operations, readiness, attitudes, barriers, and facilitators. Within-group agreement is examined to determine the degree to which participants within each organization gave similar responses. Results show characteristics differed according to type of organization (community health versus community behavioral health) and position (directors versus staff). Within-group agreement was also influenced by position. These findings indicate different strategies may be needed to best disseminate CER to the two groups.

Moral Hazard in Pediatrics.

PubMed

Brunnquell, Donald; Michaelson, Christopher M

2016-07-01

"Moral hazard" is a term familiar in economics and business ethics that illuminates why rational parties sometimes choose decisions with bad moral outcomes without necessarily intending to behave selfishly or immorally. The term is not generally used in medical ethics. Decision makers such as parents and physicians generally do not use the concept or the word in evaluating ethical dilemmas. They may not even be aware of the precise nature of the moral hazard problem they are experiencing, beyond a general concern for the patient's seemingly excessive burden. This article brings the language and logic of moral hazard to pediatrics. The concept reminds us that decision makers in this context are often not the primary party affected by their decisions. It appraises the full scope of risk at issue when decision makers decide on behalf of others and leads us to separate, respect, and prioritize the interests of affected parties.

Overview of EPA tools for supporting local- and regional-scale decision makers addressing energy and environmental issues

EPA Science Inventory

EPA’s Office of Research and Development (ORD) has been developing tools and illustrative case studies for decision makers in local and regional authorities who are facing challenges of establishing resilience to extreme weather events, aging built environment and infrastru...

The Two-Communities Theory and Knowledge Utilization.

ERIC Educational Resources Information Center

Caplan, Nathan

1979-01-01

Discusses strategies to improve policy makers' utilization of research based on the "two-communities" theory that social scientists and policy makers live in two different worlds. Notes that for high level decision making, collaboration must involve more general problems and a decision to use either data-based or nonresearch knowledge for solving…

Putting Educational Forecasts into Perspective: A Guide for Decisionmakers.

ERIC Educational Resources Information Center

Dede, Christopher; Kierstead, Fred

This paper focuses on how educational decision-makers can make use of futures research through a better understanding of forecasters' perspectives. Eight problems in communicating that are significant in contributing to poor usage of forecasts by educational decision-makers are: (1) overuse of jargon, (2) preoccupation with technological…

An analytical framework to assist decision makers in the use of forest ecosystem model predictions

USDA-ARS?s Scientific Manuscript database

The predictions of most terrestrial ecosystem models originate from deterministic simulations. Relatively few uncertainty evaluation exercises in model outputs are performed by either model developers or users. This issue has important consequences for decision makers who rely on models to develop n...

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

The Others: Equitable Access, International Students, and the Community College

ERIC Educational Resources Information Center

Viggiano, Tiffany; López Damián, Ariadna I.; Morales Vázquez, Evelyn; Levin, John S.

2018-01-01

This qualitative investigation explains the ways in which community college decision makers justify the inclusion of international students at three community colleges in the United States. We identify and explain the ways in which decision makers rationalize institutional policy--particularly recruitment strategies and motivations--related to…

Adolescent pediatric decision-making: a critical reconsideration in the light of the data.

PubMed

Partridge, Brian

2014-12-01

Adolescents present a puzzle. There are foundational unclarities about how they should be regarded as decision-makers. Although superficially adolescents may appear to have mature decisional capacity, their decision-making is in many ways unlike that of adults. Despite this seemingly obvious fact, a concern for the claims of autonomy has led to the development of the legal doctrine of the mature minor. This legal construct considers adolescents, as far as possible, as equivalent to adults for the purpose of medical decision-making. The movement to support independent decision-making by adolescents through providing information to them and securing their consent apart from their parents is encouraged by those legal understandings that hold that unemancipated minors should generally be considered as possessing effective decisional capacity. Such legal structures, however, do not adequately take account of the wide variations in adolescent capacities, the immaturity of most adolescent decision-makers, or the important contributions made by parents to the development of their adolescents through parental partnering in the adolescent's decision-making. The data available indicate that in general adolescents should be regarded as apprentice decision-makers who should make decisions in collaboration with their parents until at least the age of 18. Steps should not be taken pre-emptively to isolate adolescents from the guidance of their parents. As a general rule, what Piker has referred to as "collaborative paternalism" appears most likely both to protect adolescents from their own untoward choices, while also very importantly helping them with parental guidance to develop into mature decision-makers with the capacity to make medical choices on their own.

A decision framework for coordinating bioterrorism planning: lessons from the BioNet program.

PubMed

Manley, Dawn K; Bravata, Dena M

2009-01-01

Effective disaster preparedness requires coordination across multiple organizations. This article describes a detailed framework developed through the BioNet program to facilitate coordination of bioterrorism preparedness planning among military and civilian decision makers. The authors and colleagues conducted a series of semistructured interviews with civilian and military decision makers from public health, emergency management, hazardous material response, law enforcement, and military health in the San Diego area. Decision makers used a software tool that simulated a hypothetical anthrax attack, which allowed them to assess the effects of a variety of response actions (eg, issuing warnings to the public, establishing prophylaxis distribution centers) on performance metrics. From these interviews, the authors characterized the information sources, technologies, plans, and communication channels that would be used for bioterrorism planning and responses. The authors used influence diagram notation to describe the key bioterrorism response decisions, the probabilistic factors affecting these decisions, and the response outcomes. The authors present an overview of the response framework and provide a detailed assessment of two key phases of the decision-making process: (1) pre-event planning and investment and (2) incident characterization and initial responsive measures. The framework enables planners to articulate current conditions; identify gaps in existing policies, technologies, information resources, and relationships with other response organizations; and explore the implications of potential system enhancements. Use of this framework could help decision makers execute a locally coordinated response by identifying the critical cues of a potential bioterrorism event, the information needed to make effective response decisions, and the potential effects of various decision alternatives.

Corporate financial decision makers' perceptions of their company's safety performance, programs and personnel: Do company size and industry injury risk matter?

PubMed

DeArmond, Sarah; Huang, Yueng-Hsiang; Chen, Peter Y; Courtney, Theodore K

2010-01-01

Top-level managers make important decisions about safety-related issues, yet little research has been done involving these individuals. The current study explored corporate financial decisions makers' perceptions of their company's safety and their justifications for these perceptions. This study also explored whether their perceptions and justifications varied as a function of company size or industry injury risk. A total of 404 individuals who were the most senior managers responsible for making decisions about property and casualty risk at their companies participated in this study. The participants took part in a telephone survey. The results suggest that corporate financial decision makers have positive views of safety at their companies relative to safety at other companies within their industries. Further, many believe their company's safety is influenced by the attention/emphasis placed on safety and the selection and training of safety personnel. Participants' perceptions varied somewhat based on the size of their company and the level of injury risk in their industry. While definitive conclusions about corporate financial decision makers' perceptions of safety cannot be reached as a result of this single study, this work does lay groundwork for future research aimed at better understanding the perceptions top-level managers.

Producing More Actionable Science Isn't the Problem; It's Providing Decision-Makers with Access to Right Actionable Knowledge

NASA Astrophysics Data System (ADS)

Trexler, M.

2017-12-01

Policy-makers today have almost infinite climate-relevant scientific and other information available to them. The problem for climate change decision-making isn't missing science or inadequate knowledge of climate risks; the problem is that the "right" climate change actionable knowledge isn't getting to the right decision-maker, or is getting there too early or too late to effectively influence her decision-making. Actionable knowledge is not one-size-fit-all, and for a given decision-maker might involve scientific, economic, or risk-based information. Simply producing more and more information as we are today is not the solution, and actually makes it harder for individual decision-makers to access "their" actionable knowledge. The Climatographers began building the Climate Web five years ago to test the hypothesis that a knowledge management system could help navigate the gap between infinite information and individual actionable knowledge. Today the Climate Web's more than 1,500 index terms allow instant access to almost any climate change topic. It is a curated public-access knowledgebase of more than 1,000 books, 2,000 videos, 15,000 reports and articles, 25,000 news stories, and 3,000 websites. But it is also much more, linking together tens of thousands of individually extracted ideas and graphics, and providing Deep Dives into more than 100 key topics from changing probability distributions of extreme events to climate communications best practices to cognitive dissonance in climate change decision-making. The public-access Climate Web is uniquely able to support cross-silo learning, collaboration, and actionable knowledge dissemination. The presentation will use the Climate Web to demonstrate why knowledge management should be seen as a critical component of science and policy-making collaborations.

Consortium for Atlantic Regional Assessment: information tools for community adaptation to changes in climate or land use.

PubMed

Dempsey, Rachael; Fisher, Ann

2005-12-01

To inform local and regional decisions about protecting short-term and long-term quality of life, the Consortium for Atlantic Regional Assessment (CARA) provides data and tools (for the northeastern United States) that can help decision makers understand how outcomes of their decisions could be affected by potential changes in both climate and land use. On an interactive, user-friendly website, CARA has amassed data on climate (historical records and future projections for seven global climate models), land cover, and socioeconomic and environmental variables, along with tools to help decision makers tailor the data for their own decision types and locations. CARA Advisory Council stakeholders help identify what information and tools stakeholders would find most useful and how to present these; they also provide in-depth feedback for subregion case studies. General lessons include: (1) decision makers want detailed local projections for periods short enough to account for extreme events, in contrast to the broader spatial and temporal observations and projections that are available or consistent at a regional level; (2) stakeholders will not use such a website unless it is visually appealing and easy to find the information they want; (3) some stakeholders need background while others want to go immediately to data, and some want maps while others want text or tables. This article also compares what has been learned across case studies of Cape May County, New Jersey, Cape Cod, Massachusetts, and Hampton Roads, Virginia, relating specifically to sea-level rise. Lessons include: (1) groups can be affected differently by physical dangers compared with economic dangers; (2) decisions will differ according to decision makers' preferences about waiting and risk tolerance; (3) future scenarios and maps can help assess the impacts of dangers to emergency evacuation routes, homes, and infrastructure, and the natural environment; (4) residents' and decision makers' perceptions are affected by information about potential local impacts from global climate change.

Importance and Challenges in Use and Uptake of Air Quality Modelling in Developing Countries: Use of CAMx for Air Quality Management in the City of Johannesburg.

NASA Astrophysics Data System (ADS)

Garland, R. M.; Naidoo, M.; Sibiya, B.; Naidoo, S.; Bird, T.; von Gruenewaldt, R.; Liebenberg-Enslin, H.; Nekhwalivhe, M.; Netshandama, J.; Mahlatji, M.

2017-12-01

Ambient air pollution levels are regulated in South Africa; however in many areas pollution concentrations exceed these levels. The South African Air Quality Act also stipulates that government across all levels must have Air Quality Management Plans (AQMP) in place that outline the current state of air quality and emissions, as well as the implementable plan to manage, and where necessary improve, air quality. Historically, dispersion models have been used to support air quality management decisions, including in AQMPs. However, with the focus of air quality management shifting from focusing on industrial point sources to a more integrated and holistic management of all sources, chemical transport models are needed. CAMx was used in the review and development of the City of Johannesburg's AQMP to simulate hot spots of air pollution, as well as to model intervention scenarios. As the pollutants of concern in Johannesburg are ozone and particulate matter, it is critical to use a model that can simulate chemistry. CAMx was run at 1 km with a locally derived emissions inventory for 2014. The sources of pollution in the City are diverse (including, industrial, vehicles, domestic burning, natural), and many sources have large uncertainties in estimating emissions due to lack of necessary data and local emission factors. These uncertainties, together with a lack of measurements to validate the model against, hinder the performance of the model to simulate air quality and thus inform air quality management. However, as air quality worsens in Africa, it is critical for decision makers to have a strong evidence base on the state of air quality and impact of interventions in order to improve air quality effectively. This presentation will highlight the findings from using a chemical transport model for air quality management in the largest city in South Africa, the use and limitations of these for decision-makers, and proposed way forward.

How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study.

PubMed

Lord, Kathryn; Livingston, Gill; Robertson, Sarah; Cooper, Claudia

2016-03-21

People with dementia and their relatives find decisions about the person with dementia living in a care home difficult. We interviewed 20 people with dementia or family carers around the time of this decision in order to design a decision-aid. Decision-makers balanced the competing priorities of remaining somewhere familiar, family's wish they remain at home, reduction of risk and effects on carer's and person with dementia's physical health. The person with dementia frequently resented their lack of autonomy as decisions about care home moves were made after insight and judgment were impaired. Family consultation usually helped carers but sometimes exacerbated tensions. Direct professional support was appreciated where it was available. There is a need for healthcare professionals to facilitate these conversations around decision-making and to include more than signposting to other organisations. There is a need for a healthcare professional facilitated decision-aid. This should detail what might change for the person with dementia and their carer, possible resources and alternatives and assist in facilitating discussion with the wider family; further research will develop and test a tool to facilitate decision making about place of care needs.

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

PubMed

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

2015-09-01

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

Training conservation practitioners to be better decision makers

USGS Publications Warehouse

Johnson, Fred A.; Eaton, Mitchell J.; Williams, James H.; Jensen, Gitte H.; Madsen, Jesper

2015-01-01

Traditional conservation curricula and training typically emphasizes only one part of systematic decision making (i.e., the science), at the expense of preparing conservation practitioners with critical skills in values-setting, working with decision makers and stakeholders, and effective problem framing. In this article we describe how the application of decision science is relevant to conservation problems and suggest how current and future conservation practitioners can be trained to be better decision makers. Though decision-analytic approaches vary considerably, they all involve: (1) properly formulating the decision problem; (2) specifying feasible alternative actions; and (3) selecting criteria for evaluating potential outcomes. Two approaches are available for providing training in decision science, with each serving different needs. Formal education is useful for providing simple, well-defined problems that allow demonstrations of the structure, axioms and general characteristics of a decision-analytic approach. In contrast, practical training can offer complex, realistic decision problems requiring more careful structuring and analysis than those used for formal training purposes. Ultimately, the kinds and degree of training necessary depend on the role conservation practitioners play in a decision-making process. Those attempting to facilitate decision-making processes will need advanced training in both technical aspects of decision science and in facilitation techniques, as well as opportunities to apprentice under decision analysts/consultants. Our primary goal should be an attempt to ingrain a discipline for applying clarity of thought to all decisions.

Decision making, procedural compliance, and outcomes definition in U.S. forest service planning processes

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

Stern, Marc J., E-mail: mjstern@vt.ed; Predmore, S. Andrew, E-mail: sapredmo@vt.ed

2011-04-15

The National Environmental Policy Act (NEPA) dictates a process of analyzing and disclosing the likely impacts of proposed agency actions on the human environment. This study addresses two key questions related to NEPA implementation in the U.S. Forest Service: 1) how do Interdisciplinary (ID) team leaders and decision makers conceptualize the outcomes of NEPA processes? And 2), how does NEPA relate to agency decision making? We address these questions through two separate online surveys that posed questions about recently completed NEPA processes - the first with the ID team leaders tasked with carrying out the processes, and the second withmore » the line officers responsible for making the processes' final decisions. Outcomes of NEPA processes include impacts on public relations, on employee morale and team functioning, on the achievement of agency goals, and on the achievement of NEPA's procedural requirements (disclosure) and substantive intent (minimizing negative environmental impacts). Although both tended to view public relations outcomes as important, decision makers' perceptions of favorable outcomes were more closely linked to the achievement of agency goals and process efficiency than was the case for ID team leaders. While ID team leaders' responses suggest that they see decision making closely integrated with the NEPA process, decision makers more commonly decoupled decision making from the NEPA process. These findings suggest a philosophical difference between ID team leaders and decision makers that may pose challenges for both the implementation and the evaluation of agency NEPA. We discuss the pros and cons of integrating NEPA with decision making or separating the two. We conclude that detaching NEPA from decision making poses greater risks than integrating them.« less

Embedding health policy and systems research into decision-making processes in low- and middle-income countries

PubMed Central

2013-01-01

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization’s Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems. PMID:23924162

A meta-analysis of gender stereotypes and bias in experimental simulations of employment decision making.

PubMed

Koch, Amanda J; D'Mello, Susan D; Sackett, Paul R

2015-01-01

Gender bias continues to be a concern in many work settings, leading researchers to identify factors that influence workplace decisions. In this study we examine several of these factors, using an organizing framework of sex distribution within jobs (including male- and female-dominated jobs as well as sex-balanced, or integrated, jobs). We conducted random effects meta-analyses including 136 independent effect sizes from experimental studies (N = 22,348) and examined the effects of decision-maker gender, amount and content of information available to the decision maker, type of evaluation, and motivation to make careful decisions on gender bias in organizational decisions. We also examined study characteristics such as type of participant, publication year, and study design. Our findings revealed that men were preferred for male-dominated jobs (i.e., gender-role congruity bias), whereas no strong preference for either gender was found for female-dominated or integrated jobs. Second, male raters exhibited greater gender-role congruity bias than did female raters for male-dominated jobs. Third, gender-role congruity bias did not consistently decrease when decision makers were provided with additional information about those they were rating, but gender-role congruity bias was reduced when information clearly indicated high competence of those being evaluated. Fourth, gender-role congruity bias did not differ between decisions that required comparisons among ratees and decisions made about individual ratees. Fifth, decision makers who were motivated to make careful decisions tended to exhibit less gender-role congruity bias for male-dominated jobs. Finally, for male-dominated jobs, experienced professionals showed smaller gender-role congruity bias than did undergraduates or working adults. (c) 2015 APA, all rights reserved.

Embedding health policy and systems research into decision-making processes in low- and middle-income countries.

PubMed

Koon, Adam D; Rao, Krishna D; Tran, Nhan T; Ghaffar, Abdul

2013-08-08

Attention is increasingly directed to bridging the gap between the production of knowledge and its use for health decision-making in low- and middle-income countries (LMICs). An important and underdeveloped area of health policy and systems research (HPSR) is the organization of this process. Drawing from an interdisciplinary conception of embeddedness, a literature review was conducted to identify examples of embedded HPSR used to inform decision-making in LMICs. The results of the literature review were organized according to the World Health Organization's Building Blocks Framework. Next, a conceptual model was created to illustrate the arrangement of organizations that produce embedded HPSR and the characteristics that facilitate its uptake into the arena of decision-making. We found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organization within the network, but rather the qualities the organization possesses, that enable it to be embedded. Our findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. Through this conceptual model, we can understand which conditions are likely to enhance uptake of HPSR in LMIC health systems. This raises several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organizations in health systems.

Do violations of the axioms of expected utility theory threaten decision analysis?

PubMed

Nease, R F

1996-01-01

Research demonstrates that people violate the independence principle of expected utility theory, raising the question of whether expected utility theory is normative for medical decision making. The author provides three arguments that violations of the independence principle are less problematic than they might first appear. First, the independence principle follows from other more fundamental axioms whose appeal may be more readily apparent than that of the independence principle. Second, the axioms need not be descriptive to be normative, and they need not be attractive to all decision makers for expected utility theory to be useful for some. Finally, by providing a metaphor of decision analysis as a conversation between the actual decision maker and a model decision maker, the author argues that expected utility theory need not be purely normative for decision analysis to be useful. In short, violations of the independence principle do not necessarily represent direct violations of the axioms of expected utility theory; behavioral violations of the axioms of expected utility theory do not necessarily imply that decision analysis is not normative; and full normativeness is not necessary for decision analysis to generate valuable insights.

Surrogate End-of-Life Care Decision Makers' Postbereavement Grief and Guilt Responses.

PubMed

Lovell, Geoff P; Smith, Trish; Kannis-Dymand, Lee

2015-01-01

This article examined differences in familial/friend surrogate decision makers' (N = 93) postbereavement grief and guilt associated with decisions to either prioritize comfort or longevity in determining end-of-life care for decisionally incapacitated adult palliative loved ones. Results demonstrated that participants prioritizing the longevity of loved ones experienced significantly and meaningfully higher levels of grief, complicated grief, and trauma related guilt than those who prioritized comfort.

The Roles of Decision Makers in Special Operations

DTIC Science & Technology

2016-12-01

question and hypotheses. 9 II. CASE STUDIES A. OPERATION THUNDERBOLT (THE RAID ON ENTEBBE) The Israeli Special Forces’ hostage rescue operation...Operations Warfare, 338. 28 Herzog, “The War Against Terrorism: Entebbe,” 338. 29 Chaitanya Arun Sathe, “A Case Study on Crisis Management with a...Assessment of the Roles of Decision Makers This assessment is based on this case study , and the decision makers’ roles in the three phases of a

Assessing Generalisability in Model-Based Economic Evaluation Studies: A Structured Review in Osteoporosis

PubMed Central

Urdahl, Hege; Manca, Andrea; Sculpher, Mark J

2008-01-01

Background To support decision making many countries have now introduced some formal assessment process to evaluate whether health technologies represent good ‘value for money’. These often take the form of decision models which can be used to explore elements of importance to generalisability of study results across clinical settings and jurisdictions. The objectives of the present review were to assess: (i) whether the published studies clearly defined the decision-making audience for the model; (ii) the transparency of the reporting in terms of study question, structure and data inputs; (iii) the relevance of the data inputs used in the model to the stated decision-maker or jurisdiction; and (iv) how fully the robustness of the model's results to variation in data inputs between locations was assessed. Methods Articles reporting decision-analytic models in the area of osteoporosis were assessed to establish the extent to which the information provided enabled decision makers in different countries/jurisdictions to fully appreciate the variability of results according to location, and the relevance to their own. Results Of the 18 articles included in the review, only three explicitly stated the decision-making audience. It was not possible to infer a decision-making audience in eight studies. Target population was well reported, as was resource and cost data, and clinical data used for estimates of relative risk reduction. However, baseline risk was rarely adapted to the relevant jurisdiction, and when no decision-maker was explicit it was difficult to assess whether the reported cost and resource use data was in fact relevant. A few studies used sensitivity analysis to explore elements of generalisability, such as compliance rates and baseline fracture risk rates, although such analyses were generally restricted to evaluating parameter uncertainty. Conclusion This review found that variability in cost-effectiveness across locations is addressed to a varying extent in modelling studies in the field of osteoporosis, limiting their use for decision-makers across different locations. Transparency of reporting is expected to increase as methodology develops, and decision-makers publish “reference case” type guidance. PMID:17129074

Learning by doing in practice: a roundtable discussion about stakeholder engagement in implementation research.

PubMed

Arwal, Said Habib; Aulakh, Bhupinder Kaur; Bumba, Ahmed; Siddula, Akshita

2017-12-28

Researchers and policy-makers alike increasingly recognise the importance of engaging diverse perspectives in implementation research. This roundtable discussion presents the experiences and perspectives of three decision-makers regarding the benefits and challenges of their engagement in implementation research. The first perspective comes from a rural district medical officer from Uganda and touches on the success of using data as evidence in a low-resource setting. The second perspective is from an Afghani Ministry of Health expert who used a community-based approach to improving healthcare services in remote regions. Finally, the third perspective highlights the successes and trials of a policy-maker from India who offers advice on how to grow the relationship between decision-makers and researchers. Overall, the stakeholders in this roundtable discussion saw important benefits to their engagement in research. In order to facilitate greater engagement in the future, they advise on closer dialogue between researchers and policy-makers and supporting the development of capacity to stimulate and facilitate engagement in research and the use of evidence in decision-making.

The Morality of University Decision-Makers

ERIC Educational Resources Information Center

Hatier, Cécile

2014-01-01

Ethical failures in UK higher education have recently made the news but are not a recent development. University decision-makers can, in order to adopt an ethical way of reasoning, resort to several ethical traditions. This article focuses, through the use of concrete examples, on three which have had a significant impact in recent higher…

Reluctant to Change: Self-Enhancing Responses to Diverging Performance Measures

ERIC Educational Resources Information Center

Audia, Pino G.; Brion, Sebastien

2007-01-01

Although there is extensive evidence that past performance influences the propensity to make changes, research on how decision makers respond to diverging performance measures has been sparse. This paper addresses this gap in an experimental and a field study in which we examine how decision makers respond to the ambiguity introduced by two…

Students as Rational Decision-Makers: The Question of Beliefs and Attitudes

ERIC Educational Resources Information Center

Sullivan, Alice

2006-01-01

Rational choice theorists have analysed rates of participation in post-compulsory education, and, in particular, class differentials in these rates. Various claims have been made about the motivations of student decision-makers, but these claims have not been grounded empirically. This paper will assess the question of whether students' attitudes…

Reported Influence of Evaluation Data on Decision Makers' Actions: An Empirical Examination

ERIC Educational Resources Information Center

Christie, Christina A.

2007-01-01

Using a set of scenarios derived from actual evaluation studies, this simulation study examines the reported influence of evaluation information on decision makers' potential actions. Each scenario described a context where one of three types of evaluation information (large-scale study data, case study data, or anecdotal accounts) is presented…

Healthy School Meals...Healthy Kids! A Leadership Guide for School Decision-Makers.

ERIC Educational Resources Information Center

Food and Consumer Service (USDA), Washington, DC.

The School Meals Initiative for Healthy Children was launched in June 1994 to improve the health and education of children through better nutrition. This leadership guide provides information to school decision-makers on using materials and resources developed by the U.S. Department of Agriculture and describes Team Nutrition, an implementation…

Children's Participation in Decision-Making in the Philippines: Understanding the Attitudes of Policy-Makers and Service Providers

ERIC Educational Resources Information Center

Bessell, Sharon

2009-01-01

This article explores the ideas about children's participation in decision-making held by government officials and non-government representatives engaged in promoting children's participation in the Philippines. It suggests that the ideas that policy-makers and service deliverers hold about children's participation are heterogeneous, diverse and…

Development of an interactive interface to raise awareness of public, policy makers, and practitioners about natural hazards.

NASA Astrophysics Data System (ADS)

Gordova, Yulia; Gordov, Evgeny; Okladnikov, Igor; Titov, Alexander

2017-04-01

Due to a global climate change the following consequences are predicted: rise in sea level due to melting glaciers and polar ice, changes in precipitation, changes in the hydrological regime, impact on ecosystems, agriculture and forestry. In Russia's vast territory these effects will be most dramatic. According to Hydrometeorological Center of Russian Federation report there is an increase in the magnitude and frequency of extreme weather events, as well as in their damage to ecosystems and infrastructure. In the framework of adaptation to climate change and mitigation of its consequences it is necessary to promote and support activities aimed at reducing possible risks. Adaptation methods include among others improving seasonal weather forecasts, systems of early warning and systems of management of risks. But there is a problem of insufficient awareness among decision-makers, as well a lack of scientific background. Those responsible for making decisions, stakeholders and the public do not have the skills and knowledge to work with the accumulated climate data to development an adaptation and sustainable development strategy. The goal is to provide these groups with tools, skills, thematic information for understanding climate processes occurring in the region. We believe that the preparation of both the persons responsible for decision-making, and the future specialist in environmental sciences shouldn't be realized artificial learning environment, but on the basis of actual operating computational and information systems used in climate research. Such kind of a system was developed by a team of the Institute of Monitoring of Climatic and Ecological Systems SB RAS. The information-computational Web GIS "Climate" (http://climate.climate.scert.ru) provides opportunities to study regional climate change and its consequences providing access to climate and weather models, a large set of geophysical data and means of processing and visualization. Also, the system is used for undergraduate and graduate students training. In addition, the system capabilities allow creating information resources to raise public awareness about climate change, its causes and consequences, which is a necessary step for the subsequent adaptation to these changes. "Climate" allows climatologists, specialists in related fields, decision-makers, stakeholders and the public use a variety of geographically distributed spatially-referenced data, resources and processing services via a web-browser. Currently, an interactive System User Manual for decision-makers is developed. It contains not only the information needed to use the system and perform practical tasks, but also the basic concepts explained in detail. The knowledge necessary for understanding the causes and possible consequences of the processes is given. The results of implementation of practical tasks are available not only in the form of color surface maps, but also on the Internet and in the form of layers for most GIS. Thus these layers can be used in usual desktop GIS which is a common software for most of decision-makers. Thus, this manual helps to prepare qualified users, which in the future will be able to determine the policy of the region to adapt to climate change impacts and hazards. The work is supported by Russian Science Foundation grant № 16-19-10257.

I know why you voted for Trump: (Over)inferring motives based on choice.

PubMed

Barasz, Kate; Kim, Tami; Evangelidis, Ioannis

2018-05-10

People often speculate about why others make the choices they do. This paper investigates how such inferences are formed as a function of what is chosen. Specifically, when observers encounter someone else's choice (e.g., of political candidate), they use the chosen option's attribute values (e.g., a candidate's specific stance on a policy issue) to infer the importance of that attribute (e.g., the policy issue) to the decision-maker. Consequently, when a chosen option has an attribute whose value is extreme (e.g., an extreme policy stance), observers infer-sometimes incorrectly-that this attribute disproportionately motivated the decision-maker's choice. Seven studies demonstrate how observers use an attribute's value to infer its weight-the value-weight heuristic-and identify the role of perceived diagnosticity: more extreme attribute values give observers the subjective sense that they know more about a decision-maker's preferences, and in turn, increase the attribute's perceived importance. The paper explores how this heuristic can produce erroneous inferences and influence broader beliefs about decision-makers. Copyright © 2018 Elsevier B.V. All rights reserved.

Constrained optimization via simulation models for new product innovation

NASA Astrophysics Data System (ADS)

Pujowidianto, Nugroho A.

2017-11-01

We consider the problem of constrained optimization where the decision makers aim to optimize the primary performance measure while constraining the secondary performance measures. This paper provides a brief overview of stochastically constrained optimization via discrete event simulation. Most review papers tend to be methodology-based. This review attempts to be problem-based as decision makers may have already decided on the problem formulation. We consider constrained optimization models as there are usually constraints on secondary performance measures as trade-off in new product development. It starts by laying out different possible methods and the reasons using constrained optimization via simulation models. It is then followed by the review of different simulation optimization approach to address constrained optimization depending on the number of decision variables, the type of constraints, and the risk preferences of the decision makers in handling uncertainties.

Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges.

PubMed

Hill, Sarah R; Vale, Luke; Hunter, David; Henderson, Emily; Oluboyede, Yemi

2017-12-01

Public health interventions have unique characteristics compared to health technologies, which present additional challenges for economic evaluation (EE). High quality EEs that are able to address the particular methodological challenges are important for public health decision-makers. In England, they are even more pertinent given the transition of public health responsibilities in 2013 from the National Health Service to local government authorities where new agents are shaping policy decisions. Addressing alcohol misuse is a globally prioritised public health issue. This article provides a systematic review of EE and priority-setting studies for interventions to prevent and reduce alcohol misuse published internationally over the past decade (2006-2016). This review appraises the EE and priority-setting evidence to establish whether it is sufficient to meet the informational needs of public health decision-makers. 619 studies were identified via database searches. 7 additional studies were identified via hand searching journals, grey literature and reference lists. 27 met inclusion criteria. Methods identified included cost-utility analysis (18), cost-effectiveness analysis (6), cost-benefit analysis (CBA) (1), cost-consequence analysis (CCA) (1) and return-on-investment (1). The review identified a lack of consideration of methodological challenges associated with evaluating public health interventions and limited use of methods such as CBA and CCA which have been recommended as potentially useful for EE in public health. No studies using other specific priority-setting tools were identified. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

CROSS: A GDSS for the Evaluation and Prioritization of Engineering Support Requests and Advanced Technology Projects at NASA

NASA Technical Reports Server (NTRS)

Tavana, Madjid; Lee, Seunghee

1996-01-01

Objective evaluation and prioritization of engineering support requests (ESRs) is a difficult task at the Kennedy Space Center (KSC) Shuttle Project Engineering Office. The difficulty arises from the complexities inherent in the evaluation process and the lack of structured information. The purpose of this project is to implement the consensus ranking organizational support system (CROSS), a multiple criteria decision support system (DSS) developed at KSC that captures the decision maker's beliefs through a series of sequential, rational, and analytical processes. CROSS utilizes the analytic hierarchy process (AHP), subjective probabilities, entropy concept, and maximize agreement heuristic (MAH) to enhance the decision maker's intuition in evaluation ESRs. Some of the preliminary goals of the project are to: (1) revisit the structure of the ground systems working team (GWST) steering committee, (2) develop a template for ESR originators to provide more comple and consistent information to the GSWT steering committee members to eliminate the need for a facilitator, (3) develop an objective and structured process for the initial screening of ESRs, (4) extensive training of the stakeholders and the GWST steering committee to eliminate the need for a facilitator, (5) automate the process as much as possible, (6) create an environment to compile project success factor data on ESRs and move towards a disciplined system that could be used to address supportability threshold issues at the KSC, and (7) investigate the possibility of an organization-wide implementation of CROSS.

Disease management in healthcare organizations: results of in-depth interviews with disease management decision makers.

PubMed

Whellan, David J; Cohen, Elizabeth J; Matchar, David B; Califf, Robert M

2002-07-01

Despite the widening use of disease management (DM) programs throughout the country, little is understood about the "state of DM" in healthcare systems and managed care organizations. To better characterize the range of users of DM in healthcare and to identify critical issues, both present and future, for DM. Qualitative survey. Forty-seven healthcare systems (n = 22) and managed care organizations (n = 25) were randomly selected. Decision makers were identified and interviewed between January 1, 2000, and March 31, 2000. We limited quantitative analysis to tabulations of suitable responses, without statistical testing. Responses were organized around 3 themes: models for DM, implementation strategies, and measurements of success. Of 47 decision makers surveyed, 42 (89%) reported that their organizations currently have (75%) or are working to develop (14%) DM programs. Although the goals of DM programs were similar, organizations took a variety of approaches to achieving these ends. There were typically 3 steps in implementing a DM program: analysis of patient data, external analysis, and organizational analysis. Decision makers believed that DM programs had only achieved partial success in reaching the 2 main goals of improved quality of care and cost savings. Given the variety of DM programs, there is a need to develop a classification scheme to allow for better comparison between programs. Further quantitative studies of decision makers' opinions would be helpful in developing programs and in designing necessary studies of patient management strategies.

Decision Making and Training: A Review of Theoretical and Empirical Studies of Decision Making and Their Implications for the Training of Decision Makers

DTIC Science & Technology

1975-08-01

34 of an outcome for the particular decisi’on maker involved. According to thio formulation the same decision outcome may appeal to dif- ferent...characterizing thes_ sources is in turmu of 1he two properties: degree of passivity and deoqreu of oopcrative,,’s. According to this conceptualizati on...procedure has been, however, is open to question. Data collected during field exercises have indicated that ratinqs often are omitted from spot reports, and

Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes?

PubMed

Wu, Shishi; Legido-Quigley, Helena; Spencer, Julia; Coker, Richard James; Khan, Mishal Sameer

2018-02-23

In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.

Implementing CER: what will it take?

PubMed

Biskupiak, Joseph E; Dunn, Jeffrey D; Holtorf, Anke-Peggy

2012-06-01

Comparative effectiveness research (CER) is undeniably changing how drugs are developed, launched, priced, and reimbursed in the United States. But most organizations are still evaluating what CER can do for them and how and when they can utilize the data. A roundtable of stakeholders, including formulary decision makers, evaluated CER's possible effects on managed care organizations (MCOs) and what it may take to fully integrate CER into decision making. To examine the role of CER in current formulary decision making, compare CER to modeling, discuss ways CER may be used in the future, and describe CER funding sources. While decision makers from different types of organizations, such as pharmacy benefit management (PBM) companies and MCOs, may have varying definitions and expectations of CER, most thought leaders from a roundtable of stakeholders, including formulary decision makers, see value in CER's ability to enhance their formulary decision making. Formulary decision makers may be able to use CER to better inform their coverage decisions in areas such as benefit design, contracting, conditional reimbursement, pay for performance, and other alternative pricing arrangements. Real-world CER will require improvement in the health information technology infrastructure to better capture value-related information. The federal government is viewed as a key driver and funding source behind CER, especially for infrastructure and methods development, while industry will adapt the clinical development and create increasing CER evidence. CER then needs to be applied to determining value (or cost efficacy). It is expected that CER will continue to grow as a valuable component of formulary decision making. Future integration of CER into formulary decision making will require federal government and academic leadership, improvements in the health information technology infrastructure, ongoing funding, and improved and more consistent methodologies.

Intersections of girl child marriage and family planning beliefs and use: qualitative findings from Ethiopia and India.

PubMed

McClendon, Katherine A; McDougal, Lotus; Ayyaluru, Sankari; Belayneh, Yemeserach; Sinha, Anand; Silverman, Jay G; Raj, Anita

2017-10-18

Child marriage and subsequent early first birth is a considerable social, economic and health concern, and a pervasive practice in sub-Saharan Africa and South Asia. This study explores barriers and facilitators to family planning among women and girls, and their marital decision-makers subsequent to receipt of child marriage prevention programmes in Ethiopia and India. In-depth interviews with 128 women and girls who were married as minors or who cancelled or postponed marriage as minors and their marital decision-makers were analysed using content analysis. Respondents identified social norms, including child marriage and pressure to have children, and lack of information as barriers to family planning. Benefits included delayed first birth and increased birth spacing, improved maternal and child health and girls' educational attainment. Respondents associated family planning use with delayed pregnancy and increased educational attainment, particularly in Ethiopia. Child marriage prevention programmes were identified as important sources of family planning information. Ethiopia's school-based programme strengthened access to health workers and contraception more so than India's community-based programme. Findings highlight young wives' vulnerability with regard to reproductive control, and support the need for multi-sector approaches across communities, schools and community health workers to improve family planning among young wives.

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

NASA Astrophysics Data System (ADS)

Neff, B. P.; Pavlick, M.

2017-12-01

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

Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results.

PubMed

Rini, Christine; O'Neill, Suzanne C; Valdimarsdottir, Heiddis; Goldsmith, Rachel E; Jandorf, Lina; Brown, Karen; DeMarco, Tiffani A; Peshkin, Beth N; Schwartz, Marc D

2009-09-01

To investigate high-risk breast cancer survivors' risk reduction decision making and decisional conflict after an uninformative BRCA1/2 test. Prospective, longitudinal study of 182 probands undergoing BRCA1/2 testing, with assessments 1-, 6-, and 12-months postdisclosure. Primary predictors were health beliefs and emotional responses to testing assessed 1-month postdisclosure. Main outcomes included women's perception of whether they had made a final risk management decision (decision status) and decisional conflict related to this issue. There were four patterns of decision making, depending on how long it took women to make a final decision and the stability of their decision status across assessments. Late decision makers and nondecision makers reported the highest decisional conflict; however, substantial numbers of women--even early and intermediate decision makers--reported elevated decisional conflict. Analyses predicting decisional conflict 1- and 12-months postdisclosure found that, after accounting for control variables and decision status, health beliefs and emotional factors predicted decisional conflict at different timepoints, with health beliefs more important 1 month after test disclosure and emotional factors more important 1 year later. Many of these women may benefit from decision making assistance. Copyright 2009 APA, all rights reserved.

The database search problem: a question of rational decision making.

PubMed

Gittelson, S; Biedermann, A; Bozza, S; Taroni, F

2012-10-10

This paper applies probability and decision theory in the graphical interface of an influence diagram to study the formal requirements of rationality which justify the individualization of a person found through a database search. The decision-theoretic part of the analysis studies the parameters that a rational decision maker would use to individualize the selected person. The modeling part (in the form of an influence diagram) clarifies the relationships between this decision and the ingredients that make up the database search problem, i.e., the results of the database search and the different pairs of propositions describing whether an individual is at the source of the crime stain. These analyses evaluate the desirability associated with the decision of 'individualizing' (and 'not individualizing'). They point out that this decision is a function of (i) the probability that the individual in question is, in fact, at the source of the crime stain (i.e., the state of nature), and (ii) the decision maker's preferences among the possible consequences of the decision (i.e., the decision maker's loss function). We discuss the relevance and argumentative implications of these insights with respect to recent comments in specialized literature, which suggest points of view that are opposed to the results of our study. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The essential medicines list for a global patient population.

PubMed

Robertson, J; Hill, S R

2007-11-01

Thirty years after its inception, the role, audience, and contents of the global Essential Medicines List (EML) are reviewed. Challenges for decision makers in applying the principles of medicine selection based on efficacy, safety, burden of disease, and cost effectiveness are discussed and illustrated with recent decisions of the Expert Committee. Areas of controversy for decision makers are highlighted, and the advocacy role of the EML for both drug procurement and development of quality-assured products is described.

The Role of Information and Research in Educational Decision-Making: Some Questions. Le Role De L'Information Et De La Recherche Dans La Prise De Decisions En Matiere D'Education: Quelques Questions.

ERIC Educational Resources Information Center

United Nations Educational, Scientific, and Cultural Organization, Paris (France).

This paper, one of a series of Unesco technical information reports, looks at the educational decision makers in developing nations and examines their access to and use of information and research results. Written in English and in French, the paper consists of five parts. Part one discusses problems encountered by educational policy-makers and…

[Laparoscopic single patient use instruments: expensive outsourcing of product quality?].

PubMed

von Eiff, W; Ziegenbein, R

2000-01-01

The supply of medical goods is an important critical success factor in German hospitals. One major managerial area in the procurement concerns the decision between single patient use (SPU) and multiple patient use (MPU) products. Especially laparoscopic instruments which are generally expensive are a field of interest for decision makers. Due to a lack of quantifiable factors describing the two different forms of supply alternatives with their effects on effectivity and efficiency of the procurement process and the final use are often not taken into account. Since it is expected that in the future more and more laparoscopic instruments will be needed there is a necessity for finding a concept allowing the identification of the "right" product. The Center for Hospital Management (CKM) has the aim to develop a corresponding approach but needs the help of the reader.

Finding common ground to achieve a "good death": family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study.

PubMed

Tan, Amy; Manca, Donna

2013-01-22

Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a "bad death" experience for the patient and family. We aim to describe Canadian family physicians' experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Eleven family physicians with a range of 3 to 40 years in clinical practice participated.The family physicians expressed a desire to achieve a "good death" and described their role in positively influencing the experience of death.Finding Common Ground to Achieve a "Good Death" for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a "good death". These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths.

Neural basis of quasi-rational decision making.

PubMed

Lee, Daeyeol

2006-04-01

Standard economic theories conceive homo economicus as a rational decision maker capable of maximizing utility. In reality, however, people tend to approximate optimal decision-making strategies through a collection of heuristic routines. Some of these routines are driven by emotional processes, and others are adjusted iteratively through experience. In addition, routines specialized for social decision making, such as inference about the mental states of other decision makers, might share their origins and neural mechanisms with the ability to simulate or imagine outcomes expected from alternative actions that an individual can take. A recent surge of collaborations across economics, psychology and neuroscience has provided new insights into how such multiple elements of decision making interact in the brain.

Adopting Cut Scores: Post-Standard-Setting Panel Considerations for Decision Makers

ERIC Educational Resources Information Center

Geisinger, Kurt F.; McCormick, Carina M.

2010-01-01

Standard-setting studies utilizing procedures such as the Bookmark or Angoff methods are just one component of the complete standard-setting process. Decision makers ultimately must determine what they believe to be the most appropriate standard or cut score to use, employing the input of the standard-setting panelists as one piece of information…

Reciprocal Dialogue between Educational Decision Makers and Students of Color: Opportunities and Obstacles

ERIC Educational Resources Information Center

Bertrand, Melanie

2014-01-01

Purpose: This article explores the possibilities for reciprocal dialogue between educational decision makers and Students of Color. Such dialogue--defined as interactions in which participants build on each other's words--may provide the means to develop creative ways to address manifestations of systemic racism in education. The article uses…

Monitoring Values and Practices of Oak Woodland Decision Makers on the Urban Fringe

Treesearch

William Stewart

1991-01-01

Concern over oak woodlands has shifted away from ranch management towards residential areas. This shift has been accompanied by the involvement of decision makers who previously had little involvement with rangeland policies and practices. A survey of three recent Cooperative Extension workshops illustrates a number of important patterns regarding interest and...

Decision Maker Perception of Information Quality: A Case Study of Military Command and Control

ERIC Educational Resources Information Center

Morgan, Grayson B.

2013-01-01

Decision maker perception of information quality cues from an "information system" (IS) and the process which creates such meta cueing, or data about cues, is a critical yet un-modeled component of "situation awareness" (SA). Examples of common information quality meta cueing for quality criteria include custom ring-tones for…

Investigation of Education Databases in Four States To Support Policy Research on Resource Allocation. Policy Report

ERIC Educational Resources Information Center

Pan, Diane; Smith-Hansen, Lotte; Jones, Debra Hughes; Rudo, Zena H.; Alexander, Celeste; Kahlert, Rahel Kahlert, Rahel

2004-01-01

Information is one of the most important tools education decision makers need to help them effectively spend taxpayer money, allocate qualified staff, and determine the effectiveness of education investments. Decision makers must understand the role and influence of monetary and staff resources on the education system, and they must have…

Assessment of Education for Sustainable Development in Universities in Costa Rica: Implications for Latin America and the Caribbean

ERIC Educational Resources Information Center

Garcia, Jairo H.

2010-01-01

Higher Education is a key factor for social change influencing future decision-makers in business, education, politics and science. As such, sustainable development requires creating awareness amongst these decision-makers of their responsibilities and opportunities in this area. Higher education for sustainable development is championed in…

Attention and attribute overlap in preferential choice.

PubMed

Bhatia, Sudeep

2017-07-01

Attributes that are common, or overlapping, across alternatives in two-alternative forced preferential choice tasks are often non-diagnostic. In many settings, attending to and evaluating these attributes does not help the decision maker determine which of the available alternatives is the most desirable. For this reason, many existing behavioural theories propose that decision makers ignore common attributes while deliberating. Across six experiments, we find that decision makers do direct their attention selectively and ignore attributes that are not present in or associated with either of the available alternatives. However, they are as likely to attend to common attributes as they are to attend to attributes that are unique to a single alternative. These results suggest the need for novel theories of attention in preferential choice.

Licensing Surrogate Decision-Makers.

PubMed

Rosoff, Philip M

2017-06-01

As medical technology continues to improve, more people will live longer lives with multiple chronic illnesses with increasing cumulative debilitation, including cognitive dysfunction. Combined with the aging of society in most developed countries, an ever-growing number of patients will require surrogate decision-makers. While advance care planning by patients still capable of expressing their preferences about medical interventions and end-of-life care can improve the quality and accuracy of surrogate decisions, this is often not the case, not infrequently leading to demands for ineffective, inappropriate and prolonged interventions. In 1980 LaFollette called for the licensing of prospective parents, basing his argument on the harm they can do to vulnerable people (children). In this paper, I apply his arguments to surrogate decision-makers for cognitively incapacitated patients, rhetorically suggesting that we require potential surrogates to qualify for this position by demonstrating their ability to make reasonable and rational decisions for others. I employ this theoretical approach to argue that the loose criteria by which we authorize surrogates' generally unchallenged power should be reconsidered.

Approach of Decision Making Based on the Analytic Hierarchy Process for Urban Landscape Management

NASA Astrophysics Data System (ADS)

Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

2013-03-01

This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.

Approach of decision making based on the analytic hierarchy process for urban landscape management.

PubMed

Srdjevic, Zorica; Lakicevic, Milena; Srdjevic, Bojan

2013-03-01

This paper proposes a two-stage group decision making approach to urban landscape management and planning supported by the analytic hierarchy process. The proposed approach combines an application of the consensus convergence model and the weighted geometric mean method. The application of the proposed approach is shown on a real urban landscape planning problem with a park-forest in Belgrade, Serbia. Decision makers were policy makers, i.e., representatives of several key national and municipal institutions, and experts coming from different scientific fields. As a result, the most suitable management plan from the set of plans is recognized. It includes both native vegetation renewal in degraded areas of park-forest and continued maintenance of its dominant tourism function. Decision makers included in this research consider the approach to be transparent and useful for addressing landscape management tasks. The central idea of this paper can be understood in a broader sense and easily applied to other decision making problems in various scientific fields.

Design for sustainability of industrial symbiosis based on emergy and multi-objective particle swarm optimization.

PubMed

Ren, Jingzheng; Liang, Hanwei; Dong, Liang; Sun, Lu; Gao, Zhiqiu

2016-08-15

Industrial symbiosis provides novel and practical pathway to the design for the sustainability. Decision support tool for its verification is necessary for practitioners and policy makers, while to date, quantitative research is limited. The objective of this work is to present an innovative approach for supporting decision-making in the design for the sustainability with the implementation of industrial symbiosis in chemical complex. Through incorporating the emergy theory, the model is formulated as a multi-objective approach that can optimize both the economic benefit and sustainable performance of the integrated industrial system. A set of emergy based evaluation index are designed. Multi-objective Particle Swarm Algorithm is proposed to solve the model, and the decision-makers are allowed to choose the suitable solutions form the Pareto solutions. An illustrative case has been studied by the proposed method, a few of compromises between high profitability and high sustainability can be obtained for the decision-makers/stakeholders to make decision. Copyright © 2016 Elsevier B.V. All rights reserved.

Increasing the scale and adoption of population health interventions: experiences and perspectives of policy makers, practitioners, and researchers

PubMed Central

2014-01-01

Background Decisions to scale up population health interventions from small projects to wider state or national implementation is fundamental to maximising population-wide health improvements. The objectives of this study were to examine: i) how decisions to scale up interventions are currently made in practice; ii) the role that evidence plays in informing decisions to scale up interventions; and iii) the role policy makers, practitioners, and researchers play in this process. Methods Interviews with an expert panel of senior Australian and international public health policy-makers (n = 7), practitioners (n = 7), and researchers (n = 7) were conducted in May 2013 with a participation rate of 84%. Results Scaling up decisions were generally made through iterative processes and led by policy makers and/or practitioners, but ultimately approved by political leaders and/or senior executives of funding agencies. Research evidence formed a component of the overall set of information used in decision-making, but its contribution was limited by the paucity of relevant intervention effectiveness research, and data on costs and cost effectiveness. Policy makers, practitioners/service managers, and researchers had different, but complementary roles to play in the process of scaling up interventions. Conclusions This analysis articulates the processes of how decisions to scale up interventions are made, the roles of evidence, and contribution of different professional groups. More intervention research that includes data on the effectiveness, reach, and costs of operating at scale and key service delivery issues (including acceptability and fit of interventions and delivery models) should be sought as this has the potential to substantially advance the relevance and ultimately usability of research evidence for scaling up population health action. PMID:24735455

Focusing biodiversity research on the needs of decision makers

NASA Astrophysics Data System (ADS)

Smythe, Katie D.; Bernabo, J. Christopher; Carter, Thomas B.; Jutro, Peter R.

1996-11-01

The project on Biodiversity Uncertainties and Research Needs (BURN) ensures the advancement of usable knowledge on biodiversity by obtaining input from decision makers on their priority information needs about biodiversity and then using this input to engage leading scientists in designing policy-relevant research. Decision makers articulated concerns related to four issues: significance of biodiversity; status and trends of biodiversity; management for biodiversity; and the linkage of social, cultural, economic, legal, and biological objectives. Leading natural and social scientists then identified the research required to address the decision makers' needs and determined the probability of success. The diverse group of experts reached consensus on several fundamental issues, helping to clarify the role of biodiversity in land and resource management. The BURN participants identified several features that should be incorporated into policy-relevant research plans and management strategies for biodiversity. Research and assessment efforts should be: multidisciplinary and integrative, participatory with stakeholder involvement, hierarchical (multiple scales), and problem- and region-specific. The activities should be focused regionally within a global perspective. Meta-analysis of existing data is needed on all fronts to assess the state of the science. More specifically, the scientists recommended six priority research areas that should be pursued to address the information needs articulated by decision makers: (1) characterization of biodiversity, (2) environmental valuation, (3) management for sustainability—for humans and the environment (adaptive management), (4) information management strategies, (5) governance and stewardship issues, and (6) communication and outreach. Broad recommendations were developed for each research area to provide direction for research planning and resource management strategies. The results will directly benefit those groups that require biodiversity research to address their needs—whether to develop policy, manage natural resources, or make other decisions affecting biodiversity.

Sustaining Clinical Programs During Difficult Economic Times: A Case Series from the Hospital Elder Life Program

PubMed Central

SteelFisher, Gillian K.; Martin, Lauren A.; Dowal, Sarah L.; Inouye, Sharon K.

2013-01-01

OBJECTIVES To explore strategies used by clinical programs to justify operations to decision-makers using the example of the Hospital Elder Life Program (HELP), an evidence-based, cost-effective program to improve care for hospitalized older adults. DESIGN Qualitative study design utilizing 62 in-depth, semi-structured interviews conducted with HELP staff members and hospital administrators between September 2008 and August 2009. SETTING 19 HELP sites in hospitals across the U.S. and Canada that had been recruiting patients for at least 6 months. PARTICIPANTS and MEASUREMENTS HELP staff and hospital administrator experiences sustaining the program in the face of actual or perceived financial threats, with a focus on factors they believe are effective in justifying the program to decision-makers in the hospital or health system. RESULTS Using the constant comparative method, a standard qualitative analysis technique, three major themes were identified across interviews. Each focuses on a strategy for successfully justifying the program and securing funds for continued operations: 1) interact meaningfully with decision-makers, including formal presentations that showcase operational successes, and also informal means that highlight the benefits of HELP to the hospital or health system; 2) document day-to-day, operational successes in metrics that resonate with decision-maker priorities; and 3) garner support from influential hospital staff that feed into administrative decision-making, particularly nurses and physicians. CONCLUSION As clinical programs face financially challenging times, it is important to find effective ways to justify their operations to decision-makers. Strategies described here may help clinically-effective and cost-effective programs sustain themselves, and thus may help improve care in their institutions. PMID:22091501

Decision makers' experiences of prioritisation and views about how to finance healthcare costs.

PubMed

Werntoft, Elisabet; Edberg, Anna-Karin

2009-10-01

Prioritisation in healthcare is an issue of growing importance due to scarcity of resources. The aims of this study were firstly to describe decision makers' experience of prioritisation and their views concerning willingness to pay and how to finance healthcare costs. An additional aim was to compare the views of politicians and physicians. The study was a cross-sectional study based on a questionnaire administered to 700 Swedish politicians and physicians. This was analysed using both quantitative and qualitative methods. A majority of the decision makers (55%) suggested that increasing costs should be financed through higher taxation but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety; politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions. This study do not answer the question about how to make prioritisation in health care but the result highlights the different ways that the decision makers view the subject and thereby elicit that publicly elected politicians and physicians perhaps not always work with the same goal ahead. There are needs for more research but also more media focus on the subject so the citizens will be aware and take part in the debate.

An analytical framework to assist decision makers in the use of forest ecosystem model predictions

USGS Publications Warehouse

Larocque, Guy R.; Bhatti, Jagtar S.; Ascough, J.C.; Liu, J.; Luckai, N.; Mailly, D.; Archambault, L.; Gordon, Andrew M.

2011-01-01

The predictions from most forest ecosystem models originate from deterministic simulations. However, few evaluation exercises for model outputs are performed by either model developers or users. This issue has important consequences for decision makers using these models to develop natural resource management policies, as they cannot evaluate the extent to which predictions stemming from the simulation of alternative management scenarios may result in significant environmental or economic differences. Various numerical methods, such as sensitivity/uncertainty analyses, or bootstrap methods, may be used to evaluate models and the errors associated with their outputs. However, the application of each of these methods carries unique challenges which decision makers do not necessarily understand; guidance is required when interpreting the output generated from each model. This paper proposes a decision flow chart in the form of an analytical framework to help decision makers apply, in an orderly fashion, different steps involved in examining the model outputs. The analytical framework is discussed with regard to the definition of problems and objectives and includes the following topics: model selection, identification of alternatives, modelling tasks and selecting alternatives for developing policy or implementing management scenarios. Its application is illustrated using an on-going exercise in developing silvicultural guidelines for a forest management enterprise in Ontario, Canada.

Merging spatially variant physical process models under an optimized systems dynamics framework.

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

Cain, William O.; Lowry, Thomas Stephen; Pierce, Suzanne A.

The complexity of water resource issues, its interconnectedness to other systems, and the involvement of competing stakeholders often overwhelm decision-makers and inhibit the creation of clear management strategies. While a range of modeling tools and procedures exist to address these problems, they tend to be case specific and generally emphasize either a quantitative and overly analytic approach or present a qualitative dialogue-based approach lacking the ability to fully explore consequences of different policy decisions. The integration of these two approaches is needed to drive toward final decisions and engender effective outcomes. Given these limitations, the Computer Assisted Dispute Resolution systemmore » (CADRe) was developed to aid in stakeholder inclusive resource planning. This modeling and negotiation system uniquely addresses resource concerns by developing a spatially varying system dynamics model as well as innovative global optimization search techniques to maximize outcomes from participatory dialogues. Ultimately, the core system architecture of CADRe also serves as the cornerstone upon which key scientific innovation and challenges can be addressed.« less

Framing From Experience: Cognitive Processes and Predictions of Risky Choice.

PubMed

Gonzalez, Cleotilde; Mehlhorn, Katja

2016-07-01

A framing bias shows risk aversion in problems framed as "gains" and risk seeking in problems framed as "losses," even when these are objectively equivalent and probabilities and outcomes values are explicitly provided. We test this framing bias in situations where decision makers rely on their own experience, sampling the problem's options (safe and risky) and seeing the outcomes before making a choice. In Experiment 1, we replicate the framing bias in description-based decisions and find risk indifference in gains and losses in experience-based decisions. Predictions of an Instance-Based Learning model suggest that objective probabilities as well as the number of samples taken are factors that contribute to the lack of framing effect. We test these two factors in Experiment 2 and find no framing effect when a few samples are taken but when large samples are taken, the framing effect appears regardless of the objective probability values. Implications of behavioral results and cognitive modeling are discussed. Copyright © 2015 Cognitive Science Society, Inc.

An approach to and web-based tool for infectious disease outbreak intervention analysis

NASA Astrophysics Data System (ADS)

Daughton, Ashlynn R.; Generous, Nicholas; Priedhorsky, Reid; Deshpande, Alina

2017-04-01

Infectious diseases are a leading cause of death globally. Decisions surrounding how to control an infectious disease outbreak currently rely on a subjective process involving surveillance and expert opinion. However, there are many situations where neither may be available. Modeling can fill gaps in the decision making process by using available data to provide quantitative estimates of outbreak trajectories. Effective reduction of the spread of infectious diseases can be achieved through collaboration between the modeling community and public health policy community. However, such collaboration is rare, resulting in a lack of models that meet the needs of the public health community. Here we show a Susceptible-Infectious-Recovered (SIR) model modified to include control measures that allows parameter ranges, rather than parameter point estimates, and includes a web user interface for broad adoption. We apply the model to three diseases, measles, norovirus and influenza, to show the feasibility of its use and describe a research agenda to further promote interactions between decision makers and the modeling community.

The end of life decisions -- should physicians aid their patients in dying?

PubMed

Sharma, B R

2004-06-01

Decisions pertaining to end of life whether legalized or otherwise, are made in many parts of the world but not reported on account of legal implications. The highly charged debate over voluntary euthanasia and physician assisted suicide was brought into the public arena again when two British doctors confessed to giving lethal doses of drugs to hasten the death of terminally ill patients. Lack of awareness regarding the distinction between different procedures on account of legal status granted to them in some countries is the other area of concern. Some equate withdrawal of life support measures to physician assisted suicide whereas physician assisted suicide is often misinterpreted as euthanasia. Debate among the medical practitioners, law makers and the public taking into consideration the cultural, social and religious ethos will lead to increased awareness, more safeguards and improvement of medical decisions concerning the end of life. International Human Rights Law can provide a consensual basis for such a debate on euthanasia.

Development of a support tool for complex decision-making in the provision of rural maternity care.

PubMed

Hearns, Glen; Klein, Michael C; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-02-01

Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.

Development of a Support Tool for Complex Decision-Making in the Provision of Rural Maternity Care

PubMed Central

Hearns, Glen; Klein, Michael C.; Trousdale, William; Ulrich, Catherine; Butcher, David; Miewald, Christiana; Lindstrom, Ronald; Eftekhary, Sahba; Rosinski, Jessica; Gómez-Ramírez, Oralia; Procyk, Andrea

2010-01-01

Context: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. Objective: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. Design: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. Setting: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. Participants: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). Results: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. Conclusions: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology. PMID:21286270

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.

A multiattribute index for assessing environmental impacts of regional development projects: a case study of Korea.

PubMed

Kwak, Seung-Jun; Yoo, Seung-Hoon; Shin, Chol-Oh

2002-02-01

Evaluating environmental impacts has become an increasingly vital part of environmental management. In the present study, a methodological procedure based on multiattribute utility theory (MAUT) has been applied to obtain a decision-maker's value index on assessment of the environmental impacts. The paper begins with an overview of MAUT. Next, we elicited strategic objectives and several important attributes, and then structured them into a hierarchy, with the aim of structuring and quantifying the basic values for the assessment. An environmental multiattribute index is constructed as a multiattribute utility function, based on value judgements provided by a decision-maker at the Korean Ministry of Environment (MOE). The implications of the results are useful for many aspects of MOE's environmental policies; identifying the strategic objectives and basic values; facilitating communication about the organization's priorities; and recognizing decision opportunities that face decision-makers of Korea.

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.

Answer or Publish - Energizing Online Democracy

NASA Astrophysics Data System (ADS)

Antal, Miklós; Mikecz, Dániel

Enhanced communication between citizens and decision makers furthering participation in public decision making is essential to ease today's democratic deficit. However, it is difficult to sort out the most important public inputs from a large number of comments and questions. We propose an online solution to the selection problem by utilizing the general publicity of the internet. In the envisioned practice, decision makers are obliged either to answer citizens' questions or initiatives or to publish the letter received on a publicly accessible web page. The list of unaddressed questions would mean a motivation to consider public inputs without putting unnecessary burdens on decision makers - due to the reliance on the public, their workload would converge to the societal optimum. The proposed method is analyzed in the course of the existing Hungarian e-practices. The idea is found valuable as a restriction for representatives and a relief for some other officials.

Health services research: building capacity to meet the needs of the health care system

PubMed Central

Barratt, Helen; Shaw, Jay; Simpson, Lisa; Bhatia, Sacha; Fulop, Naomi

2017-01-01

Health services researchers have an important role to play in helping health care systems around the world provide high quality, affordable services. However, gaps between the best evidence and current practice suggest that researchers need to work in new ways. The production of research that meets the needs and priorities of the health system requires researchers to work in partnership with decision-makers to conduct research and then mobilize the findings. To do this effectively, researchers require a new set of skills that are not conventionally taught as part of doctoral research programmes. In addition to wider contextual changes, researchers need to understand better the needs of decision-makers, for example through short placements in health system decision-making settings. Second, researchers need to learn to accommodate those needs throughout the research process, including identifying research needs; conducting research collaboratively with decision-makers and producing effective research products. PMID:28786700

Scientific second-order 'nudging' or lobbying by interest groups: the battle over abdominal aortic aneurysm screening programmes.

PubMed

Ploug, Thomas; Holm, Søren; Brodersen, John

2014-11-01

The idea that it is acceptable to 'nudge' people to opt for the 'healthy choice' is gaining currency in health care policy circles. This article investigates whether researchers evaluating Abdominal Aortic Aneurysm Screening Programmes (AAASP) attempt to influence decision makers in ways that are similar to popular 'nudging' techniques. Comparing two papers on the health economics of AAASP both published in the BMJ within the last 3 years, it is shown that the values chosen for the health economics modelling are not representative of the literature and consistently favour the conclusions of the articles. It is argued (1) that this and other features of these articles may be justified within a Libertarian Paternalist framework as 'nudging' like ways of influencing decision makers, but also (2) that these ways of influencing decision makers raise significant ethical issues in the context of democratic decision making.

Foundations for context-aware information retrieval for proactive decision support

NASA Astrophysics Data System (ADS)

Mittu, Ranjeev; Lin, Jessica; Li, Qingzhe; Gao, Yifeng; Rangwala, Huzefa; Shargo, Peter; Robinson, Joshua; Rose, Carolyn; Tunison, Paul; Turek, Matt; Thomas, Stephen; Hanselman, Phil

2016-05-01

Intelligence analysts and military decision makers are faced with an onslaught of information. From the now ubiquitous presence of intelligence, surveillance, and reconnaissance (ISR) platforms providing large volumes of sensor data, to vast amounts of open source data in the form of news reports, blog postings, or social media postings, the amount of information available to a modern decision maker is staggering. Whether tasked with leading a military campaign or providing support for a humanitarian mission, being able to make sense of all the information available is a challenge. Due to the volume and velocity of this data, automated tools are required to help support reasoned, human decisions. In this paper we describe several automated techniques that are targeted at supporting decision making. Our approaches include modeling the kinematics of moving targets as motifs; developing normalcy models and detecting anomalies in kinematic data; automatically classifying the roles of users in social media; and modeling geo-spatial regions based on the behavior that takes place in them. These techniques cover a wide-range of potential decision maker needs.

Human-computer interface for the study of information fusion concepts in situation analysis and command decision support systems

NASA Astrophysics Data System (ADS)

Roy, Jean; Breton, Richard; Paradis, Stephane

2001-08-01

Situation Awareness (SAW) is essential for commanders to conduct decision-making (DM) activities. Situation Analysis (SA) is defined as a process, the examination of a situation, its elements, and their relations, to provide and maintain a product, i.e., a state of SAW for the decision maker. Operational trends in warfare put the situation analysis process under pressure. This emphasizes the need for a real-time computer-based Situation analysis Support System (SASS) to aid commanders in achieving the appropriate situation awareness, thereby supporting their response to actual or anticipated threats. Data fusion is clearly a key enabler for SA and a SASS. Since data fusion is used for SA in support of dynamic human decision-making, the exploration of the SA concepts and the design of data fusion techniques must take into account human factor aspects in order to ensure a cognitive fit of the fusion system with the decision-maker. Indeed, the tight human factor aspects in order to ensure a cognitive fit of the fusion system with the decision-maker. Indeed, the tight integration of the human element with the SA technology is essential. Regarding these issues, this paper provides a description of CODSI (Command Decision Support Interface), and operational- like human machine interface prototype for investigations in computer-based SA and command decision support. With CODSI, one objective was to apply recent developments in SA theory and information display technology to the problem of enhancing SAW quality. It thus provides a capability to adequately convey tactical information to command decision makers. It also supports the study of human-computer interactions for SA, and methodologies for SAW measurement.

Computational Complexity and Human Decision-Making.

PubMed

Bossaerts, Peter; Murawski, Carsten

2017-12-01

The rationality principle postulates that decision-makers always choose the best action available to them. It underlies most modern theories of decision-making. The principle does not take into account the difficulty of finding the best option. Here, we propose that computational complexity theory (CCT) provides a framework for defining and quantifying the difficulty of decisions. We review evidence showing that human decision-making is affected by computational complexity. Building on this evidence, we argue that most models of decision-making, and metacognition, are intractable from a computational perspective. To be plausible, future theories of decision-making will need to take into account both the resources required for implementing the computations implied by the theory, and the resource constraints imposed on the decision-maker by biology. Copyright © 2017 Elsevier Ltd. All rights reserved.

Anchor effects in decision making can be reduced by the interaction between goal monitoring and the level of the decision maker's executive functions.

PubMed

Schiebener, Johannes; Wegmann, Elisa; Pawlikowski, Mirko; Brand, Matthias

2012-11-01

Models of decision making postulate that interactions between contextual conditions and characteristics of the decision maker determine decision-making performance. We tested this assumption by using a possible positive contextual influence (goals) and a possible negative contextual influence (anchor) in a risky decision-making task (Game of Dice Task, GDT). In this task, making advantageous choices is well known to be closely related to a specific decision maker variable: the individual level of executive functions. One hundred subjects played the GDT in one of four conditions: with self-set goal for final balance (n = 25), with presentation of an anchor (a fictitious Top 10 list, showing high gains of other participants; n = 25), with anchor and goal definition (n = 25), and with neither anchor nor goal setting (n = 25). Subjects in the conditions with anchor made more risky decisions irrespective of the negative feedback, but this anchor effect was influenced by goal monitoring and moderated by the level of the subjects' executive functions. The findings imply that impacts of situational influences on decision making as they frequently occur in real life depend upon the individual's cognitive abilities. Anchor effects can be overcome by subjects with good cognitive abilities.

Comparing Methods for Prioritising Protected Areas for Investment: A Case Study Using Madagascar’s Dry Forest Reptiles

PubMed Central

Gardner, Charlie J.; Raxworthy, Christopher J.; Metcalfe, Kristian; Raselimanana, Achille P.; Smith, Robert J.; Davies, Zoe G.

2015-01-01

There are insufficient resources available to manage the world’s existing protected area portfolio effectively, so the most important sites should be prioritised in investment decision-making. Sophisticated conservation planning and assessment tools developed to identify locations for new protected areas can provide an evidence base for such prioritisations, yet decision-makers in many countries lack the institutional support and necessary capacity to use the associated software. As such, simple heuristic approaches such as species richness or number of threatened species are generally adopted to inform prioritisation decisions. However, their performance has never been tested. Using the reptile fauna of Madagascar’s dry forests as a case study, we evaluate the performance of four site prioritisation protocols used to rank the conservation value of 22 established and candidate protected areas. We compare the results to a benchmark produced by the widely-used systematic conservation planning software Zonation. The four indices scored sites on the basis of: i) species richness; ii) an index based on species’ Red List status; iii) irreplaceability (a key metric in systematic conservation planning); and, iv) a novel Conservation Value Index (CVI), which incorporates species-level information on endemism, representation in the protected area system, tolerance of habitat degradation and hunting/collection pressure. Rankings produced by the four protocols were positively correlated to the results of Zonation, particularly amongst high-scoring sites, but CVI and Irreplaceability performed better than Species Richness and the Red List Index. Given the technological capacity constraints experienced by decision-makers in the developing world, our findings suggest that heuristic metrics can represent a useful alternative to more sophisticated analyses, especially when they integrate species-specific information related to extinction risk. However, this can require access to, and understanding of, more complex species data. PMID:26162073

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.

DECISION-MAKING ALIGNED WITH RAPID-CYCLE EVALUATION IN HEALTH CARE.

PubMed

Schneeweiss, Sebastian; Shrank, William H; Ruhl, Michael; Maclure, Malcolm

2015-01-01

Availability of real-time electronic healthcare data provides new opportunities for rapid-cycle evaluation (RCE) of health technologies, including healthcare delivery and payment programs. We aim to align decision-making processes with stages of RCE to optimize the usefulness and impact of rapid results. Rational decisions about program adoption depend on program effect size in relation to externalities, including implementation cost, sustainability, and likelihood of broad adoption. Drawing on case studies and experience from drug safety monitoring, we examine how decision makers have used scientific evidence on complex interventions in the past. We clarify how RCE alters the nature of policy decisions; develop the RAPID framework for synchronizing decision-maker activities with stages of RCE; and provide guidelines on evidence thresholds for incremental decision-making. In contrast to traditional evaluations, RCE provides early evidence on effectiveness and facilitates a stepped approach to decision making in expectation of future regularly updated evidence. RCE allows for identification of trends in adjusted effect size. It supports adapting a program in midstream in response to interim findings, or adapting the evaluation strategy to identify true improvements earlier. The 5-step RAPID approach that utilizes the cumulating evidence of program effectiveness over time could increase policy-makers' confidence in expediting decisions. RCE enables a step-wise approach to HTA decision-making, based on gradually emerging evidence, reducing delays in decision-making processes after traditional one-time evaluations.

The Insertion of Human Factors Concerns into NextGen Programmatic Decisions

NASA Technical Reports Server (NTRS)

Beard, Bettina L.; Holbrook, Jon Brian; Seely, Rachel

2013-01-01

Since the costs of proposed improvements in air traffic management exceed available funding, FAA decision makers must select and prioritize what actually gets implemented. We discuss a set of methods to help forecast operational and human performance issues and benefits before new automation is introduced. This strategy could minimize the impact of politics, assist decision makers in selecting and prioritizing potential improvements, make the process more transparent and strengthen the link between the engineering and human factors domains.

E-mail as the Appropriate Method of Communication for the Decision-Maker When Soliciting Advice for an Intellective Decision Task.

PubMed

Prahl, Andrew; Dexter, Franklin; Swol, Lyn Van; Braun, Michael T; Epstein, Richard H

2015-09-01

For many problems in operating room and anesthesia group management, there are tasks with optimal decisions, and yet experienced personnel tend to make decisions that are worse or no better than random chance. Such decisions include staff scheduling, case scheduling, moving cases among operating rooms, and choosing patient arrival times. In such settings, operating room management leadership decision-making should typically be autocratic rather than participative. Autocratic-style decision-making calls for managers to solicit and consider feedback from stakeholders in the decision outcome but to make the decision themselves using their expert knowledge and the facts received. For this to be effective, often the manager will obtain expert advice from outside the organization (e.g., health system). In this narrative review, we evaluate the advantages and disadvantages of using prompt asynchronous written communication (i.e., e-mail) as a communication channel for such interaction between a decision-maker (manager) and advisor. A detailed Appendix (Supplemental Digital Content, http://links.lww.com/AA/B72) lists each observational and experimental result. We find that the current ubiquitous role of e-mail for such communication is appropriate. Its benefits include improved time management via asynchronicity, low cognitive load (e.g., relative to Web conferencing), the ability to hide undesirable and irrelevant cues (e.g., physical appearance), the appropriateness of adding desirable cues (e.g., titles and degrees), the opportunity to provide written expression of confidence, and the ability for the advisor to demonstrate the answer for the decision-maker. Given that the manager is e-mailing an advisor whose competence the manager trusts, it is unnecessary to use a richer communication channel to develop trust. Finally, many of the limitations of e-mail can be rectified through training. We expect that decades from now, e-mail (i.e., asynchronous writing) between an expert and decision-maker will remain the dominant means of communication for intellective tasks.

Taking risks and taking advice: The role of experience in airline pilot diversions

NASA Technical Reports Server (NTRS)

Cohen, Marvin S.

1993-01-01

The research asks how pilots make diversion decisions, what factors determine whether they are make well or poorly, and how they may be improved. The results support the view that experienced decision makers may solve problems in a way that is qualitatively different from the approaches of less experienced decision makers. The results also support a concept of expertise that goes beyond a stock of specialized recognitional templates, to include domain-specific methods for processing information. Such metacognitive skills evolve through long experience. They may enhance both the accuracy and the efficiency of decision processes.

Providing Climate Policy Makers With a Strong Scientific Base (Invited)

NASA Astrophysics Data System (ADS)

Struzik, E.

2009-12-01

Scientists can and should inform public policy decisions in the Arctic. But the pace of climate change in the polar world has been occurring far more quickly than most scientists have been able to predict. This creates problems for decision-makers who recognize that difficult management decisions have to be made in matters pertaining to wildlife management, cultural integrity and economic development. With sea ice melting, glaciers receding, permafrost thawing, forest fires intensifying, and disease and invasive species rapidly moving north, the challenge for scientists to provide climate policy makers with a strong scientific base has been daunting. Clashing as this data sometimes does with the “traditional knowledge” of indigenous peoples in the north, it can also become very political. As a result the need to effectively communicate complex data is more imperative now than ever before. Here, the author describes how the work of scientists can often be misinterpreted or exploited in ways that were not intended. Examples include the inappropriate use of scientific data in decision-making on polar bears, caribou and other wildlife populations; the use of scientific data to debunk the fact that greenhouse gases are driving climate change, and the use of scientific data to position one scientist against another when there is no inherent conflict. This work will highlight the need for climate policy makers to increase support for scientists working in the Arctic, as well as illustrate why it is important to find new and more effective ways of communicating scientific data. Strategies that might be considered by granting agencies, scientists and climate policy decision-makers will also be discussed.

Youth advocacy as a tool for environmental and policy changes that support physical activity and nutrition: an evaluation study in San Diego County.

PubMed

Linton, Leslie S; Edwards, Christine C; Woodruff, Susan I; Millstein, Rachel A; Moder, Cheryl

2014-03-27

As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative's half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change.

From science to decision-making: taking the risk to communicate on risks

NASA Astrophysics Data System (ADS)

Leroi, Eric

2015-04-01

Geoscientists and decision-makers have the same responsibility toward the society: reducing the damaging consequences induced by natural phenomena. They have to work together, geoscientists to improve the knowledge and decision-makers to take the "best" decision, both to design and implement balanced solutions, both to communicate. Feedback shows that if the collaboration between them has already improved, a lot has still to be done, especially in terms of communication; endless litany, geoscientists don't communicate in the right way! In a hyperspecialized technological and segmented society with sophisticated methods of communication, geoscientists don't use appropriate tools and terminology. It's true, and a lot of examples can be shown that highlight this! Risks is based on complex concepts, on notions that are poorly understood, even by scientists themselves, especially the concepts of probability and occurrence of phenomena. But the problem rest as well on the role and on the responsibility of the geoscientists. Risk management experts address geosciences and technology to identify problems and define protection, including prohibitive measures (such as not allowing building in hazardous areas). Policy makers and local planners want to know where to develop territories. On one hand the identification of problems, on the other hand the needs of solutions. Dialectic is not the same. When responsibility, money and image are the three main pillars of decision-making, long-term modeling and uncertainty, are the basic ones for geosciences. In our participative democracies people want to be actor of the development of their own territories; they want more freedom, more protection and less tax. Face to unrealistic political answers geoscientists have to explain and convince. It's not possible to gain on everything and some are going to loose. Shall geoscientists let decision-makers communicate on topics they hardly understand? No. Shall geoscientists communicate on sociology, economy, politics…? Yes. But they have to learn how to better communicate, with decision-makers and with the population. They have to address new domains; they need and have to develop new approaches and new tools for communicating; they finally have to take responsibilities and risk! The presentation will address the general problems of communication between geoscientists, decision-makers and population and propose approaches and examples to reduce the gap.

Developing decision-relevant data and information systems for California water through listening and collaboration

NASA Astrophysics Data System (ADS)

Bales, R. C.; Bernacchi, L.; Conklin, M. H.; Viers, J. H.; Fogg, G. E.; Fisher, A. T.; Kiparsky, M.

2017-12-01

California's historic drought of 2011-2015 provided excellent conditions for researchers to listen to water-management challenges from decision makers, particularly with regard to data and information needs for improved decision making. Through the UC Water Security and Sustainability Research Initiative (http://ucwater.org/) we began a multi-year dialog with water-resources decision makers and state agencies that provide data and technical support for water management. Near-term products of that collaboration will be both a vision for a 21st-century water data and information system, and near-term steps to meet immediate legislative deadlines in a way that is consistent with the longer-term vision. While many university-based water researchers engage with state and local agencies on both science and policy challenges, UC Water's focus was on: i) integrated system management, from headwaters through groundwater and agriculture, and on ii) improved decision making through better water information systems. This focus aligned with the recognition by water leaders that fundamental changes in the way the state manages water were overdue. UC Water is focused on three "I"s: improved water information, empowering Institutions to use and to create new information, and enabling decision makers to make smart investments in both green and grey Infrastructure. Effective communication with water decision makers has led to engagement on high-priority programs where large knowledge gaps remain, including more-widespread groundwater recharge of storm flows, restoration of mountain forests in important source-water areas, governance structures for groundwater sustainability, and filling information gaps by bringing new technology to bear on measurement and data programs. Continuing engagement of UC Water researchers in public dialog around water resources, through opinion pieces, feature articles, blogs, white papers, social media, video clips and a feature documentary film have also been key to our continuing engagement. These novel partnerships are leading to decision-relevant tools and an improved integrated praxis in on-the-ground water-resources management. Our research is becoming more embedded in policies and our network remains interconnected with decision makers at multiple levels.

Better Decisions through Consultation and Collaboration

EPA Pesticide Factsheets

This manual discusses the benefits of public involvement to agency decision makers, including expanding shared baseline knowledge, generating support for the decision, and developing ongoing relationships that will help in implementing decisions.

A Social Report for Carroll County: Social Indicators for Rural Development. Sociology Report 134G.

ERIC Educational Resources Information Center

Marshall, Chris; And Others

Since the burden of improving quality of life is often squarely placed on the shoulders of public decision makers, this report (one of the products of Project 2142) provides a basis for assisting county-level decision makers in the planning process. Statistics that "indicate" the social well being or quality of life experienced by people…

The Current Status Of The United States Foreign Military Sales (FMS) Program

DTIC Science & Technology

2004-06-01

changing domestic and global security environment. Strengths, Weaknesses, Opportunities and Threats ( SWOT ) analysis was used to analyze: the information...gathered from the literature review; the importance of various players (domestic and international competitors, interests groups , decision makers...Foreign military assistance, Gulf Wars, the September 11 incidents, Market share, Decision Makers, Interest Groups , Major West European suppliers group

Perspectives of Women Decision-Makers Over the Participation and Recreational Events in Sports: A Turkish Perspective

ERIC Educational Resources Information Center

Guzel, Pinar

2015-01-01

The purpose of this research is to put forth the role of the leisure and recreation events awareness including women decision-makers effects on their fellow women. Three main themes were recognized: Past; "Process of leisure and recreation events of women in Turkey", Present; "Model of Turkey for women on leisure and…

Development of An Analytic Approach to Determine How Environmental Protection Agency’s Integrated Risk Information System (IRIS) Is Used by Non-EPA Decision Makers (Final Contractor Report)

EPA Science Inventory

EPA announced the availability of the final contractor report entitled, Development of an Analytic Approach to Determine How Environmental Protection Agency’s Integrated Risk Information System (IRIS) Is Used By Non EPA Decision Makers. This contractor report analyzed how ...

The GRADE Evidence to Decision (EtD) framework for health system and public health decisions.

PubMed

Moberg, Jenny; Oxman, Andrew D; Rosenbaum, Sarah; Schünemann, Holger J; Guyatt, Gordon; Flottorp, Signe; Glenton, Claire; Lewin, Simon; Morelli, Angela; Rada, Gabriel; Alonso-Coello, Pablo

2018-05-29

To describe a framework for people making and using evidence-informed health system and public health recommendations and decisions. We developed the GRADE Evidence to Decision (EtD) framework for health system and public health decisions as part of the DECIDE project, in which we simultaneously developed frameworks for these and other types of healthcare decisions, including clinical recommendations, coverage decisions and decisions about diagnostic tests. Building on GRADE EtD tables, we used an iterative approach, including brainstorming, consultation of the literature and with stakeholders, and an international survey of policy-makers. We applied the framework to diverse examples, conducted workshops and user testing with health system and public health guideline developers and policy-makers, and observed and tested its use in real-life guideline panels. All the GRADE EtD frameworks share the same basic structure, including sections for formulating the question, making an assessment and drawing conclusions. Criteria listed in the assessment section of the health system and public health framework cover the important factors for making these types of decisions; in addition to the effects and economic impact of an option, the priority of the problem, the impact of the option on equity, and its acceptability and feasibility are important considerations that can inform both whether and how to implement an option. Because health system and public health interventions are often complex, detailed implementation considerations should be made when making a decision. The certainty of the evidence is often low or very low, but decision-makers must still act. Monitoring and evaluation are therefore often important considerations for these types of decisions. We illustrate the different components of the EtD framework for health system and public health decisions by presenting their application in a framework adapted from a real-life guideline. This framework provides a structured and transparent approach to support policy-making informed by the best available research evidence, while making the basis for decisions accessible to those whom they will affect. The health system and public health EtD framework can also be used to facilitate dissemination of recommendations and enable decision-makers to adopt, and adapt, recommendations or decisions.

Controversies in water management: Frames and mental models

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

Kolkman, M.J.; Department of Civil Engineering and Management, Faculty of Engineering Technology; Veen, A. van der

Controversies in decision and policy-making processes can be analysed using frame reflection and mental model mapping techniques. The purpose of the method presented in this paper is to improve the quality of the information and interpretations available to decision makers, by surfacing and juxtaposing the different frames of decision makers, experts, and special interests groups. The research provides a new method to analyse frames. It defines a frame to consist of perspectives and a mental model, which are in close interaction (through second order learning processes). The mental model acts like a 'filter' through which the problem situation is observed.more » Five major perspective types guide the construction of meaning out of the information delivered by the mental model, and determine what actors see as their interests. The perspective types are related to an actor's institutional and personal position in the decision making process. The method was applied to a case, in order to test its viability. The case concerns the decision making process and environmental impact assessment procedure for the improvement of dike ring 53 in the Netherlands, which was initiated by the Dutch 'Flood Defences Act 1996'. In this specific case the perspectives and mental models of stakeholders were elicited to explain controversies. The case was analysed with regard to the conflicts emerging between stakeholders, on an individual level. The influence of institutional embedding of individuals on the use of information and the construction of meaning, and the limits of a participatory approach were analysed within the details of controversies that emerged during the case analysis. Complicating factor appeared to be the interaction between national dike safety norms (short term) and local water management problems (long term). Revealed controversies mainly concerned disputes between an organisational and a technical perspective. But also disputes on distribution of responsibilities between different institutes, on legal and political liability, and on funding issues, involving persons of both perspectives, were found. The case reveals a lack of possibilities to search for an integrated solution which involves all levels of authority, and a lack of possibilities to discuss the additional problems that were raised by the integrated approach in the initial phase of the case project. The complex and unstructured nature of the problem situation caused the traditional substantive approach to fail to deliver a good solution. Legal, socio-economic and institutional factors ultimately dominated the decision making process.« less

Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia.

PubMed

Wilkins, James M

2017-06-17

Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit-burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.

Health Economics Information in Wound Care: The Elephant in the Room

PubMed Central

Carter, Marissa Janine

2013-01-01

Objective To describe the role of health economics (HE) in wound care in relation to coverage and reimbursement. Approach Narrative description of key concepts with supporting references. Results The process of approval or clearance of wound care products within the U.S. regulatory framework often causes lack of high level of evidence regarding clinical outcomes. There is also a paucity of HE information and great reluctance to use such information (when it is available) by insurers and Centers for Medicare and Medicaid, as well as other health-care agencies. Cost-effectiveness (CE) studies are the most common type of HE study in wound care, and the most common outcomes are incremental CE ratios (ICERs). Interpretation of ICERs requires considerable judgment when results are not obvious and is hampered by lack of contemporary and useful benchmarks. While many lessons have been learned in applying CE to coverage and reimbursement decisions in other western countries—including transparency of decision-making and involvement of patients—there is still a major aversion to using CE in the United States Applying CE to basic wound care and advanced therapeutics has the potential to decrease the costs of wound healing considerably. Innovation and Conclusions Many CE approaches, including modeling, provide sufficiently detailed information that decision-makers can make informed decisions about wound care products in regard to coverage and reimbursement. The reluctance to use CE information in the United States, however, is likely to contribute heavily to the ever-increasing costs in wound care. PMID:24527322

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.

Understanding The Decision Context: DPSIR, Decision Landscape, And Social Network Analysis

EPA Science Inventory

Establishing the decision context for a management problem is the critical first step for effective decision analysis. Understanding the decision context allow stakeholders and decision-makers to integrate the societal, environmental, and economic considerations that must be con...

An innovative approach to addressing childhood obesity: a knowledge-based infrastructure for supporting multi-stakeholder partnership decision-making in Quebec, Canada.

PubMed

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L; Dubé, Laurette

2015-01-23

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a "portrait", which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity.

An Innovative Approach to Addressing Childhood Obesity: A Knowledge-Based Infrastructure for Supporting Multi-Stakeholder Partnership Decision-Making in Quebec, Canada

PubMed Central

Addy, Nii Antiaye; Shaban-Nejad, Arash; Buckeridge, David L.; Dubé, Laurette

2015-01-01

Multi-stakeholder partnerships (MSPs) have become a widespread means for deploying policies in a whole of society strategy to address the complex problem of childhood obesity. However, decision-making in MSPs is fraught with challenges, as decision-makers are faced with complexity, and have to reconcile disparate conceptualizations of knowledge across multiple sectors with diverse sets of indicators and data. These challenges can be addressed by supporting MSPs with innovative tools for obtaining, organizing and using data to inform decision-making. The purpose of this paper is to describe and analyze the development of a knowledge-based infrastructure to support MSP decision-making processes. The paper emerged from a study to define specifications for a knowledge-based infrastructure to provide decision support for community-level MSPs in the Canadian province of Quebec. As part of the study, a process assessment was conducted to understand the needs of communities as they collect, organize, and analyze data to make decisions about their priorities. The result of this process is a “portrait”, which is an epidemiological profile of health and nutrition in their community. Portraits inform strategic planning and development of interventions, and are used to assess the impact of interventions. Our key findings indicate ambiguities and disagreement among MSP decision-makers regarding causal relationships between actions and outcomes, and the relevant data needed for making decisions. MSP decision-makers expressed a desire for easy-to-use tools that facilitate the collection, organization, synthesis, and analysis of data, to enable decision-making in a timely manner. Findings inform conceptual modeling and ontological analysis to capture the domain knowledge and specify relationships between actions and outcomes. This modeling and analysis provide the foundation for an ontology, encoded using OWL 2 Web Ontology Language. The ontology is developed to provide semantic support for the MSP process, defining objectives, strategies, actions, indicators, and data sources. In the future, software interacting with the ontology can facilitate interactive browsing by decision-makers in the MSP in the form of concepts, instances, relationships, and axioms. Our ontology also facilitates the integration and interpretation of community data, and can help in managing semantic interoperability between different knowledge sources. Future work will focus on defining specifications for the development of a database of indicators and an information system to help decision-makers to view, analyze and organize indicators for their community. This work should improve MSP decision-making in the development of interventions to address childhood obesity. PMID:25625409

Difficult decisions in times of constraint: Criteria based Resource Allocation in the Vancouver Coastal Health Authority

PubMed Central

2011-01-01

Objectives The aim of the project was to develop a plan to address a forecasted deficit of approximately $4.65 million for fiscal year 2010/11 in the Vancouver Communities division of the Vancouver Coastal Health Authority. For disinvestment opportunities identified beyond the forecasted deficit, a commitment was made to consider options for resource re-allocation within the Vancouver Communities division. Methods A standard approach to program budgeting and marginal analysis (PBMA) was taken with a priority setting working committee and a broader advisory panel. An experienced, non-vested internal project manager worked closely with the two-member external research team throughout the process. Face to face evaluation interviews were held with 10 decision makers immediately following the process. Results The recommendations of the working committee included the implementation of 44 disinvestment initiatives with an annualized value of CAD $4.9 million, as well as consideration of possible investments if the realized savings match expectations. Overall, decision makers viewed the process favorably and the primary aim of addressing the deficit gap was met. Discussion A key challenge was the tight timeline which likely lead to less evidence informed decision making then one would hope for. Despite this, decision makers felt that better decisions were made then had the process not been in place. In the end, this project adds value in finding that PBMA can be used to cover a deficit and minimize opportunity cost through systematic application of criteria whilst ensuring process fairness through focusing on communication, transparency and decision maker engagement. PMID:21756357

Psychological defense, ideological hideaway, or rational reckoning? The role of uncertainty in local adaptation to climate change

NASA Astrophysics Data System (ADS)

Moser, S. C.

2011-12-01

As adaptation planning is rising rapidly on the agenda of decision-makers, the need for adequate information to inform those decisions is growing. Locally relevant climate change (as well as related impacts and vulnerability) information, however, is difficult to obtain and that which can be obtained carries the burden of significant scientific uncertainty. This paper aims to assess how important such uncertainty is in adaptation planning, decision-making, and related stakeholder engagement. Does uncertainty actually hinder adaptation planning? Is scientific uncertainty used to postpone decisions reflecting ideologically agendas? Or is it a convenient defense against cognitive and affective engagement with the emerging and projected - and in some cases daunting - climate change risks? To whom does such uncertainty matter and how important is it relative to other challenges decision-makers and stakeholders face? The paper draws on four sources of information to answer these questions: (1) a statewide survey of California coastal managers conducted in summer 2011, (2) years of continual engagement with, and observation of, decision-makers in local adaptation efforts, (3) findings from focus groups with lay individuals in coastal California; and (4) a review of relevant adaptation literature to guide and contextualize the empirical research. The findings entail some "inconvenient truths" for those claiming critical technical or political importance. Rather, the insights suggest that some uncertainties matter more than others; they matter at certain times, but not at others; and they matter to some decision-makers, but not to others. Implications for scientists communicating and engaging with communities are discussed.

A Web-based graphical user interface for evidence-based decision making for health care allocations in rural areas

PubMed Central

Schuurman, Nadine; Leight, Margo; Berube, Myriam

2008-01-01

Background The creation of successful health policy and location of resources increasingly relies on evidence-based decision-making. The development of intuitive, accessible tools to analyse, display and disseminate spatial data potentially provides the basis for sound policy and resource allocation decisions. As health services are rationalized, the development of tools such graphical user interfaces (GUIs) is especially valuable at they assist decision makers in allocating resources such that the maximum number of people are served. GIS can used to develop GUIs that enable spatial decision making. Results We have created a Web-based GUI (wGUI) to assist health policy makers and administrators in the Canadian province of British Columbia make well-informed decisions about the location and allocation of time-sensitive service capacities in rural regions of the province. This tool integrates datasets for existing hospitals and services, regional populations and road networks to allow users to ascertain the percentage of population in any given service catchment who are served by a specific health service, or baskets of linked services. The wGUI allows policy makers to map trauma and obstetric services against rural populations within pre-specified travel distances, illustrating service capacity by region. Conclusion The wGUI can be used by health policy makers and administrators with little or no formal GIS training to visualize multiple health resource allocation scenarios. The GUI is poised to become a critical decision-making tool especially as evidence is increasingly required for distribution of health services. PMID:18793428

Advancing the use of performance evaluation in health care.

PubMed

Traberg, Andreas; Jacobsen, Peter; Duthiers, Nadia Monique

2014-01-01

The purpose of this paper is to develop a framework for health care performance evaluation that enables decision makers to identify areas indicative of corrective actions. The framework should provide information on strategic pro-/regress in an operational context that justifies the need for organizational adjustments. The study adopts qualitative methods for constructing the framework, subsequently implementing the framework in a Danish magnetic resonance imaging (MRI) unit. Workshops and interviews form the basis of the qualitative construction phase, and two internal and five external databases are used for a quantitative data collection. By aggregating performance outcomes, collective measures of performance are achieved. This enables easy and intuitive identification of areas not strategically aligned. In general, the framework has proven helpful in an MRI unit, where operational decision makers have been struggling with extensive amounts of performance information. The implementation of the framework in a single case in a public and highly political environment restricts the generalizing potential. The authors acknowledge that there may be more suitable approaches in organizations with different settings. The strength of the framework lies in the identification of performance problems prior to decision making. The quality of decisions is directly related to the individual decision maker. The only function of the framework is to support these decisions. The study demonstrates a more refined and transparent use of performance reporting by combining strategic weight assignment and performance aggregation in hierarchies. In this way, the framework accentuates performance as a function of strategic progress or regress, thus assisting decision makers in exerting operational effort in pursuit of strategic alignment.

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

USGS Publications Warehouse

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

2015-01-01

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

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.

From products to processes: Academic events to foster interdisciplinary and iterative dialogue in a changing climate

NASA Astrophysics Data System (ADS)

Addor, Nans; Ewen, Tracy; Johnson, Leigh; Ćöltekin, Arzu; Derungs, Curdin; Muccione, Veruska

2015-08-01

In the context of climate change, both climate researchers and decision makers deal with uncertainties, but these uncertainties differ in fundamental ways. They stem from different sources, cover different temporal and spatial scales, might or might not be reducible or quantifiable, and are generally difficult to characterize and communicate. Hence, a mutual understanding between current and future climate researchers and decision makers must evolve for adaptation strategies and planning to progress. Iterative two-way dialogue can help to improve the decision making process by bridging current top-down and bottom-up approaches. One way to cultivate such interactions is by providing venues for these actors to interact and exchange on the uncertainties they face. We use a workshop-seminar series involving academic researchers, students, and decision makers as an opportunity to put this idea into practice and evaluate it. Seminars, case studies, and a round table allowed participants to reflect upon and experiment with uncertainties. An opinion survey conducted before and after the workshop-seminar series allowed us to qualitatively evaluate its influence on the participants. We find that the event stimulated new perspectives on research products and communication processes, and we suggest that similar events may ultimately contribute to the midterm goal of improving support for decision making in a changing climate. Therefore, we recommend integrating bridging events into university curriculum to foster interdisciplinary and iterative dialogue among researchers, decision makers, and students.

Inter-individual differences in decision-making, flexible and goal-directed behaviors: novel insights within the prefronto-striatal networks.

PubMed

Fitoussi, Aurélie; Renault, Prisca; Le Moine, Catherine; Coutureau, Etienne; Cador, Martine; Dellu-Hagedorn, Françoise

2018-03-01

Inflexible behavior is a hallmark of several decision-making-related disorders such as ADHD and addiction. As in humans, a subset of healthy rats makes poor decisions and prefers immediate larger rewards despite suffering large losses in a rat gambling task (RGT). They also display a combination of traits reminiscent of addiction, notably inflexible behavior and perseverative responses. The goal of the present work was twofold: (1) to elucidate if behavioral inflexibility of poor decision-makers could be related to a lower quality of goal-directed behavior (action-outcome associations); (2) to uncover the neural basis of inter-individual differences in goal-directed behavior. We specifically assessed inter-individual differences in decision-making in the RGT, flexibility in the RGT-reversed version and goal-directed behavior in a contingency degradation test, i.e., response adaptation when dissociating reward delivery from the animal's action. The contributions of the medial prefrontal cortex and the dorsal striatum to action-outcome associations were assessed using Zif268 immunodetection. Inflexible behavior was related to a lower sensitivity to contingency degradation in all poor decision-makers and only in a few good decision-makers. This poorer sensitivity was associated with a lower immunoreactivity in prelimbic and infralimbic cortices and a higher one in the dorsomedial and dorsolateral striatum. These findings suggest that an imbalanced prefronto-striatal activity could underlie inaccurate goal representation in changing environments and may promote maladaptive habit formation among poor decision-makers. These data strengthen our previous work identifying biomarkers of vulnerability to develop psychiatric disorders and demonstrate the relevance of inter-individual differences to model maladaptive behaviors.

Using M and S to Improve Human Decision Making and Achieve Effective Problem Solving in an International Environment

NASA Technical Reports Server (NTRS)

Christie, Vanessa L.; Landess, David J.

2012-01-01

In the international arena, decision makers are often swayed away from fact-based analysis by their own individual cultural and political bias. Modeling and Simulation-based training can raise awareness of individual predisposition and improve the quality of decision making by focusing solely on fact vice perception. This improved decision making methodology will support the multinational collaborative efforts of military and civilian leaders to solve challenges more effectively. The intent of this experimental research is to create a framework that allows decision makers to "come to the table" with the latest and most significant facts necessary to determine an appropriate solution for any given contingency.

Toward consensus on self-management support: the international chronic condition self-management support framework.

PubMed

Mills, Susan L; Brady, Teresa J; Jayanthan, Janaki; Ziabakhsh, Shabnam; Sargious, Peter M

2017-12-01

Self-management support (SMS) initiatives have been hampered by insufficient attention to underserved and disadvantaged populations, a lack of integration between health, personal and social domains, over emphasis on individual responsibility and insufficient attention to ethical issues. This paper describes a SMS framework that provides guidance in developing comprehensive and coordinated approaches to SMS that may address these gaps and provides direction for decision makers in developing and implementing SMS initiatives in key areas at local levels. The framework was developed by researchers, policy-makers, practitioners and consumers from 5 English-speaking countries and reviewed by 203 individuals in 16 countries using an e-survey process. While developments in SMS will inevitably reflect local and regional contexts and needs, the strategic framework provides an emerging consensus on how we need to move SMS conceptualization, planning and development forward. The framework provides definitions of self-management (SM) and SMS, a collective vision, eight guiding principles and seven strategic directions. The framework combines important and relevant SM issues into a strategic document that provides potential value to the SMS field by helping decision-makers plan SMS initiatives that reflect local and regional needs and by catalyzing and expanding our thinking about the SMS field in relation to system thinking; shared responsibility; health equity and ethical issues. The framework was developed with the understanding that our knowledge and experience of SMS is continually evolving and that it should be modified and adapted as more evidence is available, and approaches in SMS advance. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Dying cancer patients talk about physician and patient roles in DNR decision making.

PubMed

Eliott, Jaklin A; Olver, Ian

2011-06-01

Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do-not-resuscitate or do-not-resuscitate (DNR) decision], but there is little analysis of patient perspectives. Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Discursive analysis of qualitative data gathered during semi-structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Participants' descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision-making process. Participants' endorsement of physicians as decision makers rested upon physicians' enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. When patients' and physicians' understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. © 2010 Blackwell Publishing Ltd.

Game theory and neural basis of social decision making

PubMed Central

Lee, Daeyeol

2008-01-01

Decision making in a social group displays two unique features. First, humans and other animals routinely alter their behaviors in response to changes in their physical and social environment. As a result, the outcomes of decisions that depend on the behaviors of multiple decision makers are difficult to predict, and this requires highly adaptive decision-making strategies. Second, decision makers may have other-regarding preferences and therefore choose their actions to improve or reduce the well-beings of others. Recently, many neurobiological studies have exploited game theory to probe the neural basis of decision making, and found that these unique features of social decision making might be reflected in the functions of brain areas involved in reward evaluation and reinforcement learning. Molecular genetic studies have also begun to identify genetic mechanisms for personal traits related to reinforcement learning and complex social decision making, further illuminating the biological basis of social behavior. PMID:18368047

The Current Mind-Set of Federal Information Security Decision-Makers on the Value of Governance: An Informative Study

ERIC Educational Resources Information Center

Stroup, Jay Walter

2014-01-01

Understanding the mind-set or perceptions of organizational leaders and decision-makers is important to ascertaining the trends and priorities in policy and governance of the organization. This study finds that a significant shift in the mind-set of government IT and information security leaders has started and will likely result in placing a…

Evaluation of an Interactive Workshop Designed to Teach Practical Welfare Techniques to Beef Cattle Caretakers and Decision Makers

ERIC Educational Resources Information Center

Dewell, Reneé; Hanthorn, Christy; Danielson, Jared; Burzette, Rebecca; Coetzee, Johann; Griffin, D. Dee; Ramirez, Alejandro; Dewell, Grant

2015-01-01

The purpose of the project was to evaluate the use of an interactive workshop designed to teach novel practical welfare techniques to beef cattle caretakers and decision makers. Following training, respondents reported being more likely to use or recommend use of local anesthesia for dehorning and castration and were more inclined to use meloxicam…

State Decision-Makers Guide for Hazardous Waste Management: Defining Hazardous Wastes, Problem Recognition, Land Use, Facility Operations, Conceptual Framework, Policy Issues, Transportation.

ERIC Educational Resources Information Center

Corson, Alan; And Others

Presented are key issues to be addressed by state, regional, and local governments and agencies in creating effective hazardous waste management programs. Eight chapters broadly frame the topics which state-level decision makers should consider. These chapters include: (1) definition of hazardous waste; (2) problem definition and recognition; (3)…

Knowledge and Attitudes of a Number of Iranian Policy-makers towards Abortion.

PubMed

Hourieh, Shamshiri-Milani; Abolghasem, Pourreza; Feizollah, Akbari

2010-10-01

Unsafe and illegal abortions are the third leading cause of maternal death. It affects physical, emotional and social health of women and their families. Abortion is a multi-dimensional phenomenon with several social, legal, and religious implications. The views of policy-makers affect the approach to abortion in every society. Understanding the attitudes and knowledge of high-ranking decision makers towards abortion was the purpose of this study. A qualitative research was implemented by carrying out individual interviews with 29 out of a selection of 80 presidents of medical sciences universities, senior executive managers in the legal system, forensic medicine and decision-makers in the health system and a number of top Muslim clerics, using a semi-structured questionnaire for data gathering. Content analysis revealed the results. There were considerable unwillingness and reluctance among the interviewees to participate in the study. The majority of participants fairly knew about the prevalence of illegal abortions and their complications. There was strong agreement on abortion when health of the mother or the fetus was at risk. Abortion for reproductive health reasons was supported by a minority of the respondents. The majority of them disagreed with abortion when pregnancy was the result of a rape, temporary marriage or out of wedlock affairs. Making decision for abortion by the pregnant mother, as a matter of her right, did not gain too much approval. It seemed that physical health of the mother or the fetus was of more importance to the respondents than their mental or social health. The mother's hardship was not any indication for induced abortion in the viewpoints of the interviewed policy-makers. Strengthening family planning programs, making appropriate laws in lines with religious orders and advocacy programs targeting decision makers are determined as strategies for improving women's health rights.

Dying cancer patients talk about physician and patient roles in DNR decision making

PubMed Central

Eliott, Jaklin A.; Olver, Ian

2011-01-01

Abstract Background  Within medical and bioethical discourse, there are many models depicting the relationships between, and roles of, physician and patient in medical decision making. Contestation similarly exists over the roles of physician and patient with regard to the decision not to provide cardiopulmonary resuscitation (CPR) following cardiac arrest [the do‐not‐resuscitate or do‐not‐resuscitate (DNR) decision], but there is little analysis of patient perspectives. Objective  Analyse what patients with cancer within weeks before dying say about the decision to forego CPR and the roles of patient and physician in this decision. Design and participants  Discursive analysis of qualitative data gathered during semi‐structured interviews with 28 adult cancer patients close to death and attending palliative or oncology clinics of an Australian teaching hospital. Results  Participants’ descriptions of appropriate patient or physician roles in decisions about CPR appeared related to how they conceptualized the decision: as a personal or a medical issue, with patient and doctor respectively identified as appropriate decision makers; or alternatively, both medical and personal, with various roles assigned embodying different versions of a shared decision‐making process. Participants’ endorsement of physicians as decision makers rested upon physicians’ enactment of the rational, knowledgeable and compassionate expert, which legitimized entrusting them to make the DNR decision. Where this was called into question, physicians were positioned as inappropriate decision makers. Conclusion  When patients’ and physicians’ understandings of the best decision, or of the preferred role of either party, diverge, conflict may ensue. In order to elicit and negotiate with patient preferences, flexibility is required during clinical interactions about decision making. PMID:20860782

Validation in the Absence of Observed Events

DOE PAGES

Lathrop, John; Ezell, Barry

2015-07-22

Here our paper addresses the problem of validating models in the absence of observed events, in the area of Weapons of Mass Destruction terrorism risk assessment. We address that problem with a broadened definition of “Validation,” based on “backing up” to the reason why modelers and decision makers seek validation, and from that basis re-define validation as testing how well the model can advise decision makers in terrorism risk management decisions. We develop that into two conditions: Validation must be based on cues available in the observable world; and it must focus on what can be done to affect thatmore » observable world, i.e. risk management. That in turn leads to two foci: 1.) the risk generating process, 2.) best use of available data. Based on our experience with nine WMD terrorism risk assessment models, we then describe three best use of available data pitfalls: SME confidence bias, lack of SME cross-referencing, and problematic initiation rates. Those two foci and three pitfalls provide a basis from which we define validation in this context in terms of four tests -- Does the model: … capture initiation? … capture the sequence of events by which attack scenarios unfold? … consider unanticipated scenarios? … consider alternative causal chains? Finally, we corroborate our approach against three key validation tests from the DOD literature: Is the model a correct representation of the simuland? To what degree are the model results comparable to the real world? Over what range of inputs are the model results useful?« less

How decisions happen: focal points and blind spots in interdependent decision making.

PubMed

Halevy, Nir; Chou, Eileen Y

2014-03-01

Decision makers often simplify decision problems by ignoring readily available information. The current multimethod research investigated which types of information about interdependence situations are psychologically prominent to decision makers and which tend to go unnoticed. Study 1 used eye-tracking measures to investigate how decision makers allocate their attention in interdependence situations and revealed that individuals fixated on mutual cooperation earlier and longer as compared with alternative combinations of strategies and outcomes. In addition, participants' behavioral cooperation was consistent with their attention allocation. Study 2 introduced a novel information-search paradigm: Participants exchanged yes/no questions and answers to discover which of 25 different games their counterpart chose. Analyzing the contents of participants' questions showed that, consistent with Study 1, participants focused primarily on desirable outcomes and symmetric behavioral choices. Study 3 revealed that outcome desirability is a robust basis of psychological prominence across different types of social relations; in contrast, the psychological prominence of symmetry was moderated by the nature of social relations. Study 4 revealed that whether different bases of psychological prominence directed individuals' attention to the same aspects of the decision-making task moderated the effect of information availability on decision latency and cooperation rates. Taken together, these findings contribute to the mapping of bounded rationality, demonstrate how people think about their interdependence, and enhance our understanding of how decisions happen. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles.

PubMed

Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

2015-01-01

To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders' decision making roles in localized prostate cancer (PCa) treatment. Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients' decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient's treatment due to Malaysia's close-knit family culture. A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa.

Prediction of alcohol and gambling problems in young adults by using a measure of decision making.

PubMed

Harvanko, Arit M; Schreiber, Liana R N; Grant, Jon E

2013-01-01

Individuals who regularly gamble, regularly consume alcohol, or meet criteria for an alcohol-use disorder or pathological gambling may make riskier decisions on cognitive tasks. What remains unclear in the literature is whether these decision-making deficits precede or result from these addictive behaviors. This study aimed to determine whether risky decision making on a cognitive task is predictive of increasing gambling behaviors and alcohol use. Fifty-eight young adults (aged 18-29 years) free from Axis I disorders and reporting no symptoms of at-risk gambling behavior or alcohol consumption, who were participating in a longitudinal study of impulsivity, were grouped as either high-risk decision makers (n = 29) or low-risk decision makers (n = 29) by using the Cambridge Gamble Task. Subjects were assessed at 1-year follow-up to examine gambling frequency, alcohol consumption, at-risk alcohol-use criteria, alcohol-use disorder criteria, at-risk gambling criteria, and pathological gambling criteria. High-risk decision makers were found to be more likely to meet at-risk criteria for alcohol use after 1 year. Decision-making group membership was not significantly correlated with frequency of gambling or development of pathological gambling or alcohol-use disorder over 1 year. A variable measuring risky decision making on the Cambridge Gambling Task may be able to predict who is more likely to increase alcohol use per session later in life.

To Share or Not to Share: Malaysian Healthcare Professionals' Views on Localized Prostate Cancer Treatment Decision Making Roles

PubMed Central

Lee, Yew Kong; Lee, Ping Yein; Cheong, Ai Theng; Ng, Chirk Jenn; Abdullah, Khatijah Lim; Ong, Teng Aik; Razack, Azad Hassan Abdul

2015-01-01

Aim To explore the views of Malaysian healthcare professionals (HCPs) on stakeholders’ decision making roles in localized prostate cancer (PCa) treatment. Methods Qualitative interviews and focus groups were conducted with HCPs treating PCa. Data was analysed using a thematic approach. Four in-depth interviews and three focus group discussions were conducted between December 2012 and March 2013 using a topic guide. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. Findings The participants comprised private urologists (n = 4), government urologists (n = 6), urology trainees (n = 6), government policy maker (n = 1) and oncologists (n = 3). HCP perceptions of the roles of the three parties involved (HCPs, patients, family) included: HCP as the main decision maker, HCP as a guide to patients’ decision making, HCP as a facilitator to family involvement, patients as main decision maker and patient prefers HCP to decide. HCPs preferred to share the decision with patients due to equipoise between prostate treatment options. Family culture was important as family members often decided on the patient’s treatment due to Malaysia’s close-knit family culture. Conclusions A range of decision making roles were reported by HCPs. It is thus important that stakeholder roles are clarified during PCa treatment decisions. HCPs need to cultivate an awareness of sociocultural norms and family dynamics when supporting non-Western patients in making decisions about PCa. PMID:26559947

TIUPAM: A Framework for Trustworthiness-Centric Information Sharing

NASA Astrophysics Data System (ADS)

Xu, Shouhuai; Sandhu, Ravi; Bertino, Elisa

Information is essential to decision making. Nowadays, decision makers are often overwhelmed with large volumes of information, some of which may be inaccurate, incorrect, inappropriate, misleading, or maliciously introduced. With the advocated shift of information sharing paradigm from “need to know” to “need to share” this problem will be further compounded. This poses the challenge of achieving assured information sharing so that decision makers can always get and utilize the up-to-date information for making the right decisions, despite the existence of malicious attacks and without breaching privacy of honest participants. As a first step towards answering this challenge this paper proposes a systematic framework we call TIUPAM, which stands for “Trustworthiness-centric Identity, Usage, Provenance, and Attack Management.” The framework is centered at the need of trustworthiness and risk management for decision makers, and supported by four key components: identity management, usage management, provenance management and attack management. We explore the characterization of both the core functions and the supporting components in the TIUPAM framework, which may guide the design and realization of concrete schemes in the future.

Leveraging human decision making through the optimal management of centralized resources

NASA Astrophysics Data System (ADS)

Hyden, Paul; McGrath, Richard G.

2016-05-01

Combining results from mixed integer optimization, stochastic modeling and queuing theory, we will advance the interdisciplinary problem of efficiently and effectively allocating centrally managed resources. Academia currently fails to address this, as the esoteric demands of each of these large research areas limits work across traditional boundaries. The commercial space does not currently address these challenges due to the absence of a profit metric. By constructing algorithms that explicitly use inputs across boundaries, we are able to incorporate the advantages of using human decision makers. Key improvements in the underlying algorithms are made possible by aligning decision maker goals with the feedback loops introduced between the core optimization step and the modeling of the overall stochastic process of supply and demand. A key observation is that human decision-makers must be explicitly included in the analysis for these approaches to be ultimately successful. Transformative access gives warfighters and mission owners greater understanding of global needs and allows for relationships to guide optimal resource allocation decisions. Mastery of demand processes and optimization bottlenecks reveals long term maximum marginal utility gaps in capabilities.

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

EPA Pesticide Factsheets

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

From science to action: Principles for undertaking environmental research that enables knowledge exchange and evidence-based decision-making.

PubMed

Cvitanovic, C; McDonald, J; Hobday, A J

2016-12-01

Effective conservation requires knowledge exchange among scientists and decision-makers to enable learning and support evidence-based decision-making. Efforts to improve knowledge exchange have been hindered by a paucity of empirically-grounded guidance to help scientists and practitioners design and implement research programs that actively facilitate knowledge exchange. To address this, we evaluated the Ningaloo Research Program (NRP), which was designed to generate new scientific knowledge to support evidence-based decisions about the management of the Ningaloo Marine Park in north-western Australia. Specifically, we evaluated (1) outcomes of the NRP, including the extent to which new knowledge informed management decisions; (2) the barriers that prevented knowledge exchange among scientists and managers; (3) the key requirements for improving knowledge exchange processes in the future; and (4) the core capacities that are required to support knowledge exchange processes. While the NRP generated expansive and multidisciplinary science outputs directly relevant to the management of the Ningaloo Marine Park, decision-makers are largely unaware of this knowledge and little has been integrated into decision-making processes. A range of barriers prevented efficient and effective knowledge exchange among scientists and decision-makers including cultural differences among the groups, institutional barriers within decision-making agencies, scientific outputs that were not translated for decision-makers and poor alignment between research design and actual knowledge needs. We identify a set of principles to be implemented routinely as part of any applied research program, including; (i) stakeholder mapping prior to the commencement of research programs to identify all stakeholders, (ii) research questions to be co-developed with stakeholders, (iii) implementation of participatory research approaches, (iv) use of a knowledge broker, and (v) tailored knowledge management systems. Finally, we articulate the individual, institutional and financial capacities that must be developed to underpin successful knowledge exchange strategies. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effective Decision Maker-Scientist Engagement:Climate Change Vulnerability Analysis of California's Water System to Using Decision Scaling.

NASA Astrophysics Data System (ADS)

Schwarz, A. M.; Ray, P.; Brown, C.; Wi, S.

2016-12-01

For nearly 2 years the California Department of Water Resources (CDWR) has been working with the University of Massachusetts Amherst (UMass) to evaluate climate change vulnerabilities to the California State Water Project. Working cooperatively, the team has developed tools and methods to employ a decision scaling approach to CDWR's existing water system model (CalSim-II/CalLite 3.0). This presentation will discuss how and why this partnership came to be, the co-production model the team has developed to share expertise, the new understanding of the system that has been gained through the process, and current and future efforts to influence planning and investments based on the findings of the work. This cooperative decision-maker-with-scientist engagement is unique in that CDWR has not outsourced the application of the science to their systems, and instead has worked directly with UMass researchers to develop the process, produce results, and interpret findings. Further, CDWR staff has worked with UMass researchers to present results in ways that are more useable and actionable for decision-makers. As will be shown, many of these graphics allow the team to use the science differently to improve decision making.

Finding common ground to achieve a “good death”: family physicians working with substitute decision-makers of dying patients. A qualitative grounded theory study

PubMed Central

2013-01-01

Background Substitute decision-makers are integral to the care of dying patients and make many healthcare decisions for patients. Unfortunately, conflict between physicians and surrogate decision-makers is not uncommon in end-of-life care and this could contribute to a “bad death” experience for the patient and family. We aim to describe Canadian family physicians’ experiences of conflict with substitute decision-makers of dying patients to identify factors that may facilitate or hinder the end-of-life decision-making process. This insight will help determine how to best manage these complex situations, ultimately improving the overall care of dying patients. Methods Grounded Theory methodology was used with semi-structured interviews of family physicians in Edmonton, Canada, who experienced conflict with substitute decision-makers of dying patients. Purposeful sampling included maximum variation and theoretical sampling strategies. Interviews were audio-taped, and transcribed verbatim. Transcripts, field notes and memos were coded using the constant-comparative method to identify key concepts until saturation was achieved and a theoretical framework emerged. Results Eleven family physicians with a range of 3 to 40 years in clinical practice participated. The family physicians expressed a desire to achieve a “good death” and described their role in positively influencing the experience of death. Finding Common Ground to Achieve a “Good Death” for the Patient emerged as an important process which includes 1) Building Mutual Trust and Rapport through identifying key players and delivering manageable amounts of information, 2) Understanding One Another through active listening and ultimately, and 3) Making Informed, Shared Decisions. Facilitators and barriers to achieving Common Ground were identified. Barriers were linked to conflict. The inability to resolve an overt conflict may lead to an impasse at any point. A process for Resolving an Impasse is described. Conclusions A novel framework for developing Common Ground to manage conflicts during end-of-life decision-making discussions may assist in achieving a “good death”. These results could aid in educating physicians, learners, and the public on how to achieve productive collaborative relationships during end-of-life decision-making for dying patients, and ultimately improve their deaths. PMID:23339822

Why do verification and validation?

DOE PAGES

Hu, Kenneth T.; Paez, Thomas L.

2016-02-19

In this discussion paper, we explore different ways to assess the value of verification and validation (V&V) of engineering models. We first present a literature review on the value of V&V and then use value chains and decision trees to show how value can be assessed from a decision maker's perspective. In this context, the value is what the decision maker is willing to pay for V&V analysis with the understanding that the V&V results are uncertain. As a result, the 2014 Sandia V&V Challenge Workshop is used to illustrate these ideas.

Youth Advocacy as a Tool for Environmental and Policy Changes That Support Physical Activity and Nutrition: An Evaluation Study in San Diego County

PubMed Central

Edwards, Christine C.; Woodruff, Susan I.; Millstein, Rachel A.; Moder, Cheryl

2014-01-01

Background As evidence grows about the benefits of policy and environmental changes to support active living and healthy eating, effective tools for implementing change must be developed. Youth advocacy, a successful strategy in the field of tobacco control, should be evaluated for its potential in the field of obesity prevention. Community Context San Diego State University collaborated with the San Diego County Childhood Obesity Initiative to evaluate Youth Engagement and Action for Health! (YEAH!), a youth advocacy project to engage youth and adult mentors in advocating for neighborhood improvements in physical activity and healthy eating opportunities. Study objectives included documenting group process and success of groups in engaging in community advocacy with decision makers. Methods In 2011 and 2012, YEAH! group leaders were recruited from the San Diego County Childhood Obesity Initiative’s half-day train-the-trainer seminars for adult leaders. Evaluators collected baseline and postproject survey data from youth participants and adult group leaders and interviewed decision makers. Outcomes Of the 21 groups formed, 20 completed the evaluation, conducted community assessments, and advocated with decision makers. Various types of decision makers were engaged, including school principals, food service personnel, city council members, and parks and recreation officials. Eleven groups reported change(s) implemented as a result of their advocacy, 4 groups reported changes pending, and 5 groups reported no change as a result of their efforts. Interpretation Even a brief training session, paired with a practical manual, technical assistance, and commitment of adult leaders and youth may successfully engage decision makers and, ultimately, bring about change. PMID:24674636

Framing bioremediation decision making as negotiation: Rationale & guidelineFraming bioremediation decision making as negotiation: Rationale & guidelines

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

Bjornstad, David J.; Wolfe, Amy K.

Framing remediation decision making as negotiation: (1) social choice, not technology choice; (2) prompts decision makers to identify interested and affected parties, anticipate objections, effectively address and ameliorate objections, and avoid unacceptable decisions.

Participatory health impact assessment used to support decision-making in waste management planning: A replicable experience from Italy.

PubMed

Linzalone, Nunzia; Coi, Alessio; Lauriola, Paolo; Luise, Daniela; Pedone, Alessandra; Romizi, Roberto; Sallese, Domenico; Bianchi, Fabrizio

2017-01-01

The lack of participatory tools in Health Impact Assessment (HIA) to support decision-makers is a critical factor that negatively affects the impacts of waste policies. This study describes the participatory HIA used in deciding on the possible doubling of the municipal solid waste incinerating plant located near the city of Arezzo, Italy. Within the framework of the new waste management plan, a methodology for the democratic participation of stakeholders was designed adopting the Local Agenda 21 methodology. Communication and participation events with the stakeholders were set up from the plan's development to its implementation. Eleven different categories of stakeholders including individual citizens were involved in 21 local events, reaching over 500 participants in three years. Actions were performed to build the commitment and ownership of the local administrators. Then, together with the environment and health agencies and a representative from the local committees, the local administrators collaborated with scientists and technicians in the knowledge-building and scoping stages. Focus groups of voluntary citizens worked together with the researchers to provide qualitative and quantitative evidence in the assessment stage. Periodic public forums were held to discuss processes, methods and findings. The local government authority considered the HIA results in the final decision and a new waste strategy was adopted both in the short term (increased curbside collection, waste sustainability program) and in the long term (limited repowering of the incinerator, new targets for separate collection). In conclusion, an effective participatory HIA was carried out at the municipal level to support decision makers in the waste management plan. The HIA21 study contributed to evidence-based decisions and to make a broadly participatory experience. The authors are confident that these achievements may improve the governance of the waste cycle and the trust in the public administration. Copyright © 2016 Elsevier Ltd. All rights reserved.

Three essays on multi-level optimization models and applications

NASA Astrophysics Data System (ADS)

Rahdar, Mohammad

The general form of a multi-level mathematical programming problem is a set of nested optimization problems, in which each level controls a series of decision variables independently. However, the value of decision variables may also impact the objective function of other levels. A two-level model is called a bilevel model and can be considered as a Stackelberg game with a leader and a follower. The leader anticipates the response of the follower and optimizes its objective function, and then the follower reacts to the leader's action. The multi-level decision-making model has many real-world applications such as government decisions, energy policies, market economy, network design, etc. However, there is a lack of capable algorithms to solve medium and large scale these types of problems. The dissertation is devoted to both theoretical research and applications of multi-level mathematical programming models, which consists of three parts, each in a paper format. The first part studies the renewable energy portfolio under two major renewable energy policies. The potential competition for biomass for the growth of the renewable energy portfolio in the United States and other interactions between two policies over the next twenty years are investigated. This problem mainly has two levels of decision makers: the government/policy makers and biofuel producers/electricity generators/farmers. We focus on the lower-level problem to predict the amount of capacity expansions, fuel production, and power generation. In the second part, we address uncertainty over demand and lead time in a multi-stage mathematical programming problem. We propose a two-stage tri-level optimization model in the concept of rolling horizon approach to reducing the dimensionality of the multi-stage problem. In the third part of the dissertation, we introduce a new branch and bound algorithm to solve bilevel linear programming problems. The total time is reduced by solving a smaller relaxation problem in each node and decreasing the number of iterations. Computational experiments show that the proposed algorithm is faster than the existing ones.

Data dialogues: critical connections for designing and implementing future nanomaterial research

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

Powers, Christina M.; Grieger, Khara D.; Beaudrie, Christian

2014-11-07

Individuals and organizations in the engineered nanomaterial (ENM) community have increasingly recognized two related but distinct concerns: 1) discordant data due to differences in experimental design (e.g., material characteristics, experimental model, exposure concentration) or reporting (e.g., dose metric, material characterization details), and 2) a lack of data to inform decisions about ENM environmental, health, and safety (EHS). As one way to help address these issues, this Commentary discusses the important role of “data dialogues” or structured discussions between ENM researchers in EHS fields (e.g., toxicology, exposure science, and industrial hygiene) and decision makers who use the data researchers collect. Themore » importance of these structured discussions is examined here in the context of barriers, solutions, and incentives: barriers to developing research relevant for human and ecological risk assessments; potential solutions to overcome such barriers; and incentives to help implement these or other solutions. These barriers, solutions, and incentives were identified by a group of expert stakeholders and ENM community members at the December 2013 Society for Risk Analysis panel discussion on research needed to support decision making for multiwalled carbon nanotubes (MWCNTs). Key topics discussed by experts and ENM community members include: (1) the value of researchers collaborating with EHS decision makers (e.g., risk analysts, product developers, regulators) to design research that can inform ENM EHS-related decisions (e.g., occupational exposure limits, product safety determinations), (2) the importance of funding incentives for such collaborative research, (3) the need to improve mechanisms for data-sharing within and between sectors (e.g., academia, government, and industry), and (4) the critical need to educate the “next generation” of nanotechnology researchers in EHS topics (e.g., risk assessment, risk management). In presenting these outcomes, this Commentary is not intended to conclude the conversation that took place in December 2013 but rather to support a broader dialogue that helps ensure important risk assessment questions are answered for ENMs.« less

Using an innovative criteria weighting tool for stakeholders involvement to rank MSW facility sites with the AHP.

PubMed

De Feo, Giovanni; De Gisi, Sabino

2010-11-01

The main aim of this study was to verify the efficacy of using an innovative criteria weighting tool (the "priority scale") for stakeholders involvement to rank a list of suitable municipal solid waste (MSW) facility sites with the multi-criteria decision-making (MCDM) technique known as analytic hierarchy process (AHP). One of the main objectives of the study was to verify the behaviour of the "priority scale" with both technical and non-technical decision-makers. All over the world, the siting of MSW treatment or disposal plants is a complex process involving politicians, technicians as well as citizens, where stakeholders who are not effectively involved strongly oppose (or even obstruct) the realization of new facilities. In this study, in order to pursue both the technical (select the best site) and social aims (all the stakeholders have to give their aware contribution), the use of the "priority scale" is suggested as a tool to easily collect non-contradictory criteria preferences by the various decision-makers. Every decision-maker filled in "priority scale", which was subsequently uploaded in the AHP tool in order to indirectly calculate the individual priority of alternatives given by each stakeholder (not using group aggregation techniques). The proposed method was applied to the siting of a composting plant in an area suffering from a serious MSW emergency, which has lasted for over 15 years, in the Campania Region, in Southern Italy. The best site (the "first choice") was taken as the one that appeared the most times at the first place of each decision-maker ranking list. The involved technical and non-technical decision-makers showed the same behaviour in (indirectly) selecting the best site as well as in terms of the most appraised criteria ("absence of areas of the highest value for natural habitats and species of plants and animals"). Moreover, they showed the same AHP inconsistency ratio as well as the same behaviour in comparison with a "balanced decision-maker" (who assigns identical weights to all the considered criteria). Therefore, the proposed criteria weighting tool could be widely as well as easily used for stakeholders involvement to rank MSW facility sites (or other kinds of alternatives) with the AHP or with other MCDM techniques, taking or not into consideration group aggregation methods. Copyright © 2010 Elsevier Ltd. All rights reserved.

Analysis of strengths, weaknesses, opportunities, and threats in the development of a health technology assessment program in Turkey.

PubMed

Kahveci, Rabia; Meads, Catherine

2008-01-01

The Turkish healthcare system is currently undergoing reform, and efficient use of resources has become a key factor in determining the allocation of resources. The objective of this study was to analyze strengths, weaknesses, opportunities, and threats (SWOT) in the development of a health technology assessment (HTA) program in Turkey. A SWOT analysis was performed using a literature review and interviews with key people in the Turkish Ministry of Health and Ministry of Labor and Social Security. Regarding recent reforms in health care, investments for information network and databank are the strengths, but the traditional "expert-based" decision making, poor availability of data, and poor quality of data could be seen as some of the weaknesses. Another major weakness is lack of general awareness of HTA. Increasing demand for transparency in decision making, demand for evidence, and demand for credibility by decision makers are some of the opportunities, and current healthcare reforms, i.e., restructuring of healthcare and general health insurance, could also be seen as major opportunities. These opportunities unfortunately could be threatened by lack of funding, and resources are challenged by large, recent national investments. There is a good opportunity for Turkey to use the skills in HTA currently being developed through activities in Europe and the Americas to assist in the development of a much more cost-effective and transparent healthcare system in Turkey.

Analysis of Multi-Criteria Evaluation Method of Landfill Site Selection for Municipal Solid Waste Management

NASA Astrophysics Data System (ADS)

Mohammed, Habiba Ibrahim; Majid, Zulkepli; Yusof, Norhakim Bin; Bello Yamusa, Yamusa

2018-03-01

Landfilling remains the most common systematic technique of solid waste disposal in most of the developed and developing countries. Finding a suitable site for landfill is a very challenging task. Landfill site selection process aims to provide suitable areas that will protect the environment and public health from pollution and hazards. Therefore, various factors such as environmental, physical, socio-economic, and geological criteria must be considered before siting any landfill. This makes the site selection process vigorous and tedious because it involves the processing of large amount of spatial data, rules and regulations from different agencies and also policy from decision makers. This allows the incorporation of conflicting objectives and decision maker preferences into spatial decision models. This paper particularly analyzes the multi-criteria evaluation (MCE) method of landfill site selection for solid waste management by means of literature reviews and surveys. The study will help the decision makers and waste management authorities to choose the most effective method when considering landfill site selection.

Data and monitoring needs for a more ecological agriculture

NASA Astrophysics Data System (ADS)

Zaks, David P. M.; Kucharik, Christopher J.

2011-01-01

Information on the life-cycle environmental impacts of agricultural production is often limited. As demands grow for increasing agricultural output while reducing its negative environmental impacts, both existing and novel data sources can be leveraged to provide more information to producers, consumers, scientists and policy makers. We review the components and organization of an agroecological sensor web that integrates remote sensing technologies and in situ sensors with models in order to provide decision makers with effective management options at useful spatial and temporal scales for making more informed decisions about agricultural productivity while reducing environmental burdens. Several components of the system are already in place, but by increasing the extent and accessibility of information, decision makers will have the opportunity to enhance food security and environmental quality. Potential roadblocks to implementation include farmer acceptance, data transparency and technology deployment.

A critical review of recent US market level health care strategy literature.

PubMed

Wells, R; Banaszak-Holl, J

2000-09-01

In this review, we argue that it would be profitable if the neoclassical economic theories that have dominated recent US market level health care strategy research could be complemented by greater use of sociological frameworks. Sociological theory can address three central questions that neoclassical economic theories have tended to slight: (1) how decision-makers' preferences are determined; (2) who the decision-makers are; and (3) how decision-makers' plans are translated into organizational action. We suggest five sociological frameworks that would enable researchers to address these issues better relative to market level strategy in health care. The frameworks are (1) institutional theory, (2) organizational ecology, (3) social movements, (4) social networks, and (5) internal organizational change. A recent global trend toward privatization of health care provision makes US market level strategy research increasingly applicable to non-US readers.

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

NASA Astrophysics Data System (ADS)

Gober, P.

2009-12-01

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

Bayesian techniques for analyzing group differences in the Iowa Gambling Task: A case study of intuitive and deliberate decision-makers.

PubMed

Steingroever, Helen; Pachur, Thorsten; Šmíra, Martin; Lee, Michael D

2018-06-01

The Iowa Gambling Task (IGT) is one of the most popular experimental paradigms for comparing complex decision-making across groups. Most commonly, IGT behavior is analyzed using frequentist tests to compare performance across groups, and to compare inferred parameters of cognitive models developed for the IGT. Here, we present a Bayesian alternative based on Bayesian repeated-measures ANOVA for comparing performance, and a suite of three complementary model-based methods for assessing the cognitive processes underlying IGT performance. The three model-based methods involve Bayesian hierarchical parameter estimation, Bayes factor model comparison, and Bayesian latent-mixture modeling. We illustrate these Bayesian methods by applying them to test the extent to which differences in intuitive versus deliberate decision style are associated with differences in IGT performance. The results show that intuitive and deliberate decision-makers behave similarly on the IGT, and the modeling analyses consistently suggest that both groups of decision-makers rely on similar cognitive processes. Our results challenge the notion that individual differences in intuitive and deliberate decision styles have a broad impact on decision-making. They also highlight the advantages of Bayesian methods, especially their ability to quantify evidence in favor of the null hypothesis, and that they allow model-based analyses to incorporate hierarchical and latent-mixture structures.

A preliminary psychometric evaluation of the eight-item cognitive load scale.

PubMed

Pignatiello, Grant A; Tsivitse, Emily; Hickman, Ronald L

2018-04-01

The aim of this article is to report the psychometric properties of the eight-item cognitive load scale. According to cognitive load theory, the formatting and delivery of healthcare education influences the degree to which patients and/or family members can engage their working memory systems for learning. However, despite its relevance, cognitive load has not yet been evaluated among surrogate decision makers exposed to electronic decision support for healthcare decisions. To date, no psychometric analyses of instruments evaluating cognitive load have been reported within healthcare settings. A convenience sample of 62 surrogate decision makers for critically ill patients were exposed to one of two healthcare decision support interventions were recruited from four intensive care units at a tertiary medical center in Northeast Ohio. Participants were administered a battery of psychosocial instruments and the eight-item cognitive load scale (CLS). The CLS demonstrated a bidimensional factor structure with acceptable discriminant validity and internal consistency reliability (Cronbach's α = 0.75 and 0.89). The CLS is a psychometrically sound instrument that may be used in the evaluation of decision support among surrogate decision makers of the critically ill. The authors recommend application of the cognitive load scale in the evaluation and development of healthcare education and interventions. Copyright © 2018 Elsevier Inc. All rights reserved.

Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting.

PubMed

Carpenter, Stephanie M; Yates, J Frank; Preston, Stephanie D; Chen, Lydia

2016-01-01

Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional "coherence shifting," the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed.

Regulating Emotions during Difficult Multiattribute Decision Making: The Role of Pre-Decisional Coherence Shifting

PubMed Central

Carpenter, Stephanie M.; Yates, J. Frank; Preston, Stephanie D.; Chen, Lydia

2016-01-01

Almost all real-life decisions entail attribute conflict; every serious choice alternative is better than its competitors on some attribute dimensions but worse on others. In pre-decisional “coherence shifting,” the decision maker gradually softens that conflict psychologically to the point where one alternative is seen as dominant over its competitors, or nearly so. Specifically, weaknesses of the eventually chosen alternative come to be perceived as less severe and less important while its strengths seem more desirable and significant. The research described here demonstrates that difficult multiattribute decision problems are aversive and that pre-decisional coherence shifting aids individuals in regulating that emotional discomfort. Across three studies, attribute conflict was confirmed to be aversive (Study 1), and skin conductance responses and ratings of decision difficulty both decreased in participants who coherence shifted (Study 2). Coherence shifting was also diminished among decision makers who were depleted of regulatory resources, known to be required for common emotion regulation mechanisms. Further, coherence shifting was shown to be relatively common among people who reported strong suppression tendencies in everyday emotion regulation (Study 3). Overall, the data suggest that, at least in part, coherence shifting serves as a tool that helps decision makers manage the pre-decisional discomfort generated by attribute conflict. Theoretical and practical implications are discussed. PMID:26986752

Multi-criteria decision making--an approach to setting priorities in health care.

PubMed

Nobre, F F; Trotta, L T; Gomes, L F

1999-12-15

The objective of this paper is to present a multi-criteria decision making (MCDM) approach to support public health decision making that takes into consideration the fuzziness of the decision goals and the behavioural aspect of the decision maker. The approach is used to analyse the process of health technology procurement in a University Hospital in Rio de Janeiro, Brazil. The method, known as TODIM, relies on evaluating alternatives with a set of decision criteria assessed using an ordinal scale. Fuzziness in generating criteria scores and weights or conflicts caused by dealing with different viewpoints of a group of decision makers (DMs) are solved using fuzzy set aggregation rules. The results suggested that MCDM models, incorporating fuzzy set approaches, should form a set of tools for public health decision making analysis, particularly when there are polarized opinions and conflicting objectives from the DM group. Copyright 1999 John Wiley & Sons, Ltd.

Decision making in recurrent neuronal circuits.

PubMed

Wang, Xiao-Jing

2008-10-23

Decision making has recently emerged as a central theme in neurophysiological studies of cognition, and experimental and computational work has led to the proposal of a cortical circuit mechanism of elemental decision computations. This mechanism depends on slow recurrent synaptic excitation balanced by fast feedback inhibition, which not only instantiates attractor states for forming categorical choices but also long transients for gradually accumulating evidence in favor of or against alternative options. Such a circuit endowed with reward-dependent synaptic plasticity is able to produce adaptive choice behavior. While decision threshold is a core concept for reaction time tasks, it can be dissociated from a general decision rule. Moreover, perceptual decisions and value-based economic choices are described within a unified framework in which probabilistic choices result from irregular neuronal activity as well as iterative interactions of a decision maker with an uncertain environment or other unpredictable decision makers in a social group.

Comparison of computing capability and information system abilities of state hospitals owned by Ministry of Labor and Social Security and Ministry of Health.

PubMed

Tengilimoğlu, Dilaver; Celik, Yusuf; Ulgü, Mahir

2006-08-01

The main purpose of this study is to give an idea to the readers about how big and important the computing and information problems that hospital managers as well as policy makers will face with after collecting the Ministry of Labor and Social Security (MoLSS) and Ministry of Health (MoH) hospitals under single structure in Turkey by comparing the current level of computing capability of hospitals owned by two ministries. The data used in this study were obtained from 729 hospitals that belong to both ministries by using a data collection tool. The results indicate that there have been considerable differences among the hospitals owned by the two ministries in terms of human resources and information systems. The hospital managers and decision makers making their decisions based on the data produced by current hospital information system (HIS) would more likely face very important difficulties after merging MoH and MoLSS hospitals in Turkey. It is also possible to claim that the level and adequacy of computing abilities and devices do not allow the managers of public hospitals to use computer technology effectively in their information management practices. Lack of technical information, undeveloped information culture, inappropriate management styles, and being inexperienced are the main reasons of why HIS does not run properly and effectively in Turkish hospitals.

Quality Psychological Advice for Teachers, Parents/Carers and LEA Decision-Makers with Respect to Children and Young People with Special Needs

ERIC Educational Resources Information Center

Cameron, R. J. (Sean); Monsen, Jeremy J.

2005-01-01

The main aim of this paper is to describe a working protocol which can offer practising educational psychologists a rational framework within which to investigate and understand the complex problems of children and young people in school and to provide appropriate advice to teachers, parents/carers and LEA decision makers on how they can best…

Work-Based Learning: A Practical Approach for Learning to Work and Working to Learn. A Case Study on Decision-Makers' Professional Development in Iran

ERIC Educational Resources Information Center

Arani, Mohammad Reza Sarkar; Alagamandan, Jafar; Tourani, Heidar

2004-01-01

The work-based learning model of human resource development has captured a great deal of attention and has gained increasing importance in higher education in recent years. Work-based learning is a powerful phenomenon that attempts to help policy-makers, managers and curriculum developers improve the quality of the decision and organizational…

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.

Achieving conservation science that bridges the knowledge-action boundary.

PubMed

Cook, Carly N; Mascia, Michael B; Schwartz, Mark W; Possingham, Hugh P; Fuller, Richard A

2013-08-01

There are many barriers to using science to inform conservation policy and practice. Conservation scientists wishing to produce management-relevant science must balance this goal with the imperative of demonstrating novelty and rigor in their science. Decision makers seeking to make evidence-based decisions must balance a desire for knowledge with the need to act despite uncertainty. Generating science that will effectively inform management decisions requires that the production of information (the components of knowledge) be salient (relevant and timely), credible (authoritative, believable, and trusted), and legitimate (developed via a process that considers the values and perspectives of all relevant actors) in the eyes of both researchers and decision makers. We perceive 3 key challenges for those hoping to generate conservation science that achieves all 3 of these information characteristics. First, scientific and management audiences can have contrasting perceptions about the salience of research. Second, the pursuit of scientific credibility can come at the cost of salience and legitimacy in the eyes of decision makers, and, third, different actors can have conflicting views about what constitutes legitimate information. We highlight 4 institutional frameworks that can facilitate science that will inform management: boundary organizations (environmental organizations that span the boundary between science and management), research scientists embedded in resource management agencies, formal links between decision makers and scientists at research-focused institutions, and training programs for conservation professionals. Although these are not the only approaches to generating boundary-spanning science, nor are they mutually exclusive, they provide mechanisms for promoting communication, translation, and mediation across the knowledge-action boundary. We believe that despite the challenges, conservation science should strive to be a boundary science, which both advances scientific understanding and contributes to decision making. © 2013 Society for Conservation Biology.

Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol

PubMed Central

2014-01-01

Background To improve quality of care and patient outcomes, health system decision-makers need to identify and implement effective interventions. An increasing number of systematic reviews document the effects of quality improvement programs to assist decision-makers in developing new initiatives. However, limitations in the reporting of primary studies and current meta-analysis methods (including approaches for exploring heterogeneity) reduce the utility of existing syntheses for health system decision-makers. This study will explore the role of innovative meta-analysis approaches and the added value of enriched and updated data for increasing the utility of systematic reviews of complex interventions. Methods/Design We will use the dataset from our recent systematic review of 142 randomized trials of diabetes quality improvement programs to evaluate novel approaches for exploring heterogeneity. These will include exploratory methods, such as multivariate meta-regression analyses and all-subsets combinatorial meta-analysis. We will then update our systematic review to include new trials and enrich the dataset by surveying authors of all included trials. In doing so, we will explore the impact of variables not, reported in previous publications, such as details of study context, on the effectiveness of the intervention. We will use innovative analytical methods on the enriched and updated dataset to identify key success factors in the implementation of quality improvement interventions for diabetes. Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results. Discussion This study will inform future systematic reviews of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta-analysis. It will also result in an updated comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes. Systematic review registration PROSPERO registration no. CRD42013005165 PMID:25115289

Creating and synthesizing evidence with decision makers in mind: integrating evidence from clinical trials and other study designs.

PubMed

Atkins, David

2007-10-01

Randomized controlled trials (RCTs) remain the accepted "gold standard" for determining the efficacy of new drugs or medical procedures. Randomized trials alone, however, cannot provide all the relevant information decision makers need to determine the relative risks and benefits when choosing the best treatment of individual patients or weighing the implications of particular policies affecting medical therapies. To demonstrate the limitations of RCTs in providing the information needed by medical decision makers, and to show how information from observational studies can supplement evidence from RCTs. Qualitative description of the limitations of RCTs in providing the information needed by medical decision makers, and demonstration of how evidence from additional sources can aid in decision making, using the examples of deciding whether a 60-year-old woman with mildly elevated blood pressure should take daily low-dose aspirin, and whether a hospital network should implement carotid artery surgery for asymptomatic patients. Even the most rigorously designed RCTs leave many questions central to medical decision making unanswered. Research using cohort and case-control designs, disease and intervention registries, and outcomes studies based on administrative data can all shed light on who is most likely to benefit from the treatment, and what the important tradeoffs are. This suggests the need to revise the traditional evidence hierarchy, whereby evidence progresses linearly from basic research to rigorous RCTs. This revised hierarchy recognizes that other research designs can provide important evidence to strengthen our understanding of how to apply research findings in practice.

The Assisted Decision-Making (Capacity) Act 2015: what it is and why it matters.

PubMed

Kelly, B D

2017-05-01

Ireland's Assisted Decision-Making (Capacity) Act 2015 was signed by President Higgins in December 2015 and scheduled for commencement in 2016. To explore the content and implications of the 2015 Act. Review of the 2015 Act and related literature. The 2015 Act places the "will and preferences" of persons with impaired mental capacity at the heart of decision-making relating to "personal welfare" (including healthcare) and "property and affairs". Capacity is to be "construed functionally" and interventions must be "for the benefit of the relevant person". The Act outlines three levels of decision-making assistance: "decision-making assistant", "co-decision-maker" (joint decision-maker) and "decision-making representative" (substitute decision-maker). There are procedures relating to "enduring power of attorney" and "advance healthcare directives"; in the case of the latter, a "refusal of treatment" can be legally binding, while a "request for a specific treatment" must "be taken into consideration". The 2015 Act is considerably more workable than the 2013 Bill that preceded it. Key challenges include the subtle decision-making required by patients, healthcare staff, Circuit Court judges and the director of the Decision Support Service; implementation of "advance healthcare directives", especially if they do not form part of a broader model of advance care planning (incorporating the flexibility required for unpredictable future circumstances); and the over-arching issue of logistics, as very many healthcare decisions are currently made in situations where the patient's capacity is impaired. A key challenge will lie in balancing the emphasis on autonomy with principles of beneficence, mutuality and care.

Fidelity to a behavioral intervention to improve goals of care decisions for nursing home residents with advanced dementia.

PubMed

Hanson, Laura C; Song, Mi-Kyung; Zimmerman, Sheryl; Gilliam, Robin; Rosemond, Cherie; Chisholm, Latarsha; Lin, Feng-Chang

2016-12-01

Ensuring fidelity to a behavioral intervention implemented in nursing homes requires awareness of the unique considerations of this setting for research. The purpose of this article is to describe the goals of care cluster-randomized trial and the methods used to monitor and promote fidelity to a goals of care decision aid intervention delivered in nursing homes. The cluster randomized trial tested whether a decision aid for goals of care in advanced dementia could improve (1) the quality of communication and decision-making, (2) the quality of palliative care, and (3) the quality of dying for nursing home residents with advanced dementia. In 11 intervention nursing homes, family decision-makers for residents with advanced dementia received a two-component intervention: viewing a video decision aid about goals of care choices and then participating in a structured decision-making discussion with the nursing home care plan team, ideally within 3 months after the decision aid was viewed. Following guidelines from the National Institutes of Health Behavior Change Consortium, fidelity was assessed in study design, in nursing home staff training for intervention implementation, and in monitoring and receipt of the intervention. We also monitored the content and timing of goals of care discussions. Investigators enrolled 151 family decision-maker/resident dyads in intervention sites; of those, 136 (90%) received both components of the intervention, and 92%-99% of discussions addressed each of four recommended content areas-health status, goals of care, choice of a goal, and treatment planning. A total of 94 (69%) of the discussions between family decision-makers and the nursing home care team were completed within 3 months. The methods we used for intervention fidelity allowed nursing home staff to implement a goals of care decision aid intervention for advanced dementia. Key supports for implementation included design features that aligned with nursing home practice, efficient staff training, and a structured guide for goals of care discussions between family decision-makers and staff. These approaches may be used to promote fidelity to behavioral interventions in future clinical trials. © The Author(s) 2016.

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

Expanding Health Technology Assessments to Include Effects on the Environment.

PubMed

Marsh, Kevin; Ganz, Michael L; Hsu, John; Strandberg-Larsen, Martin; Gonzalez, Raquel Palomino; Lund, Niels

2016-01-01

There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case for incorporating environmental impacts into the health technology assessment (HTA) process and discusses the associated challenges. Two arguments favor incorporating environmental impacts into HTA: 1) environmental changes could directly affect people's health and 2) policy decision makers have broad mandates and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some of the value of environmental impacts, especially those generating health impacts, but might not be suitable for addressing broader concerns. Both cost-benefit and multicriteria decision analyses are potential methods for evaluating health and environmental outcomes, but are less familiar to health care decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing and incorporating environmental data as part of HTA. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Breaking up is hard to do: why disinvestment in medical technology is harder than investment.

PubMed

Haas, Marion; Hall, Jane; Viney, Rosalie; Gallego, Gisselle

2012-05-01

Healthcare technology is a two-edged sword - it offers new and better treatment to a wider range of people and, at the same time, is a major driver of increasing costs in health systems. Many countries have developed sophisticated systems of health technology assessment (HTA) to inform decisions about new investments in new healthcare interventions. In this paper, we question whether HTA is also the appropriate framework for guiding or informing disinvestment decisions. In exploring the issues related to disinvestment, we first discuss the various HTA frameworks which have been suggested as a means of encouraging or facilitating disinvestment. We then describe available means of identifying candidates for disinvestment (comparative effectiveness research, clinical practice variations, clinical practice guidelines) and for implementing the disinvestment process (program budgeting and marginal analysis (PBMA) and related techniques). In considering the possible reasons for the lack of progress in active disinvestment, we suggest that HTA is not the right framework as disinvestment involves a different decision making context. The key to disinvestment is not just what to stop doing but how to make it happen - that is, decision makers need to be aware of funding disincentives.

Engaging stakeholders for adaptive management using structured decision analysis

USGS Publications Warehouse

Irwin, Elise R.; Kathryn, D.; Kennedy, Mickett

2009-01-01

Adaptive management is different from other types of management in that it includes all stakeholders (versus only policy makers) in the process, uses resource optimization techniques to evaluate competing objectives, and recognizes and attempts to reduce uncertainty inherent in natural resource systems. Management actions are negotiated by stakeholders, monitored results are compared to predictions of how the system should respond, and management strategies are adjusted in a “monitor-compare-adjust” iterative routine. Many adaptive management projects fail because of the lack of stakeholder identification, engagement, and continued involvement. Primary reasons for this vary but are usually related to either stakeholders not having ownership (or representation) in decision processes or disenfranchisement of stakeholders after adaptive management begins. We present an example in which stakeholders participated fully in adaptive management of a southeastern regulated river. Structured decision analysis was used to define management objectives and stakeholder values and to determine initial flow prescriptions. The process was transparent, and the visual nature of the modeling software allowed stakeholders to see how their interests and values were represented in the decision process. The development of a stakeholder governance structure and communication mechanism has been critical to the success of the project.

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.

Fairness and legitimacy of decisions during delivery of malaria services and ITN interventions in Zambia.

PubMed

Tuba, Mary; Sandoy, Ingvild F; Bloch, Paul; Byskov, Jens

2010-11-01

Malaria is the leading cause of morbidity and the second leading cause of mortality in Zambia. Perceptions of fairness and legitimacy of decisions relating to treatment of malaria cases within public health facilities and distribution of ITNs were assessed in a district in Zambia. The study was conducted within the framework of REsponse to ACcountable priority setting for Trust in health systems (REACT), a north-south collaborative action research study, which evaluates the Accountability for Reasonableness (AFR) approach to priority setting in Zambia, Tanzania and Kenya. This paper is based on baseline in-depth interviews (IDIs) conducted with 38 decision-makers, who were involved in prioritization of malaria services and ITN distribution at district, facility and community levels in Zambia, one Focus Group Discussion (FGD) with District Health Management Team managers and eight FGDs with outpatients' attendees. Perceptions and attitudes of providers and users and practices of providers were systematized according to the four AFR conditions relevance, publicity, appeals and leadership. Conflicting criteria for judging fairness were used by decision-makers and patients. Decision-makers argued that there was fairness in delivery of malaria treatment and distribution of ITNs based on alleged excessive supply of free malaria medicines, subsidized ITNs, and presence of a qualified health-provider in every facility. Patients argued that there was unfairness due to differences in waiting time, distances to health facilities, erratic supply of ITNs, no responsive appeal mechanisms, inadequate access to malaria medicines, ITNs and health providers, and uncaring providers. Decision-makers only perceived government bodies and donors/NGOs to be legitimate stakeholders to involve during delivery. Patients found government bodies, patients, indigenous healers, chiefs and politicians to be legitimate stakeholders during both planning and delivery. Poor status of the AFR conditions of relevance, publicity, appeals and leadership corresponds well to the differing perceptions of fairness and unfairness among outpatient attendees and decision-makers. This may have been re-enforced by existing disagreements between the two groups regarding who the legitimate stakeholders to involve during service delivery were. Conflicts identified in this study could be resolved by promoting application of approaches such as AFR during priority setting in the district.

Multiple-attribute group decision making with different formats of preference information on attributes.

PubMed

Xu, Zeshui

2007-12-01

Interval utility values, interval fuzzy preference relations, and interval multiplicative preference relations are three common uncertain-preference formats used by decision-makers to provide their preference information in the process of decision making under fuzziness. This paper is devoted in investigating multiple-attribute group-decision-making problems where the attribute values are not precisely known but the value ranges can be obtained, and the decision-makers provide their preference information over attributes by three different uncertain-preference formats i.e., 1) interval utility values; 2) interval fuzzy preference relations; and 3) interval multiplicative preference relations. We first utilize some functions to normalize the uncertain decision matrix and then transform it into an expected decision matrix. We establish a goal-programming model to integrate the expected decision matrix and all three different uncertain-preference formats from which the attribute weights and the overall attribute values of alternatives can be obtained. Then, we use the derived overall attribute values to get the ranking of the given alternatives and to select the best one(s). The model not only can reflect both the subjective considerations of all decision-makers and the objective information but also can avoid losing and distorting the given objective and subjective decision information in the process of information integration. Furthermore, we establish some models to solve the multiple-attribute group-decision-making problems with three different preference formats: 1) utility values; 2) fuzzy preference relations; and 3) multiplicative preference relations. Finally, we illustrate the applicability and effectiveness of the developed models with two practical examples.

How to pose the question matters: Behavioural Economics concepts in decision making on the basis of ensemble forecasts

NASA Astrophysics Data System (ADS)

Alfonso, Leonardo; van Andel, Schalk Jan

2014-05-01

Part of recent research in ensemble and probabilistic hydro-meteorological forecasting analyses which probabilistic information is required by decision makers and how it can be most effectively visualised. This work, in addition, analyses if decision making in flood early warning is also influenced by the way the decision question is posed. For this purpose, the decision-making game "Do probabilistic forecasts lead to better decisions?", which Ramos et al (2012) conducted at the EGU General Assembly 2012 in the city of Vienna, has been repeated with a small group and expanded. In that game decision makers had to decide whether or not to open a flood release gate, on the basis of flood forecasts, with and without uncertainty information. A conclusion of that game was that, in the absence of uncertainty information, decision makers are compelled towards a more risk-averse attitude. In order to explore to what extent the answers were driven by the way the questions were framed, in addition to the original experiment, a second variant was introduced where participants were asked to choose between a sure value (for either loosing or winning with a giving probability) and a gamble. This set-up is based on Kahneman and Tversky (1979). Results indicate that the way how the questions are posed may play an important role in decision making and that Prospect Theory provides promising concepts to further understand how this works.

A Comparison of Computational Cognitive Models: Agent-Based Systems Versus Rule-Based Architectures

DTIC Science & Technology

2003-03-01

Java™ How To Program , Prentice Hall, 1999. Friedman-Hill, E., Jess, The Expert System Shell for the Java Platform, Sandia National Laboratories, 2001...transition from the descriptive NDM theory to a computational model raises several questions: Who is an experienced decision maker? How do you model the...progression from being a novice to an experienced decision maker? How does the model account for previous experiences? Are there situations where

[The influence of the relationship between physicians and pharmaceutical companies on the patient from the point of view of policy-makers in Israel].

PubMed

Nissanholtz-Gannot, Rachel; Shani, Segev; Shvarts, Shifra

2010-11-01

The relationship between doctors and pharmaceutical companies is an integral part of the health system in Israel and the whole world. The mutual need for such a relationship requires us, as a society, to examine its influence on the individual and the system as a whole. This research examines the relationship from the points of view of the relevant parties within the health system and outside the health system (decision-makers). The authors used in-depth interviews and qualitative research methods in order to examine and understand the various positions of decision-makers. The position of the decision-makers, regarding all the aspects of this relationship, expresses their wishes and depends on their point of view. The impact of the relationship between the doctors and the pharmaceutical companies was examined with regard to the prescription behavior of the doctor. All the government representatives, all the physicians' representatives and those of the health funds, believe that the physicians' prescription behavior is impacted by the relationship. There are those who perceive this to be a negative trend and some doctors believe it to be a positive trend. With regard to possible harm to the patient, the parties believe that the relationship does not harm the patient, whereas most of the government representatives identify harm to the patients, both on the economic and health levels. The authors believe that the "influence" which exists or could exist on the part of the pharmaceutical companies is the main stumbling block in this relationship, which is expressed in the decision-makers' perspective.

The marketing activities of hospitals: environmental, organizational, and managerial influences.

PubMed

Myrtle, R C; Martinez, C F

1991-03-01

This article reports the results of a study designed to examine the relationship of environmental, organizational and structural factors, perceptions of key decision makers about competitive conditions, and changes in operational performance with the level of the marketing activities engaged in by 145 California hospitals. Measures assessing the impact of environmental conditions and the perception of the key decision makers were found to be related to the marketing activities of the organization. However, the relationship between measures which examined the structural and performance impacts on the marketing activities did not demonstrate the same predictive ability. The results suggest that marketing activities were affected by the key decision maker's assessment of the competitive nature of the environment, influence of key stakeholders, and tangible changes in the organization's task environment. Performance and other measures were not found to be as influential in determining these activities.

Conceptual framework for nutrition surveillance systems.

PubMed

Mock, N B; Bertrand, W E

1993-01-01

This article describes the evolution of nutrition surveillance as an intervention strategy and presents a framework for improving the usefulness of nutrition surveillance programs. It seems clear that such programs' impact on nutritional well-being will depend increasingly on their ability to reach and influence decision-makers. Therefore, it is important to consider political and social forces, and also to realize that if a program is too decentralized or too far removed from key decision-makers, its ability to influence resource flows may be limited. It is of course important that the surveillance information provided be appropriate and of good quality. Therefore, the data collected should be analyzed to ensure they are accurate and representative. Once that has been done, relevant findings should be presented in a readily understandable form designed to meet the intended recipients' information needs. Such findings should also be disseminated to all important decision-maker constituencies, including external donors of nutrition assistance and the general public.

A Chaotic Ordered Hierarchies Consistency Analysis Performance Evaluation Model

NASA Astrophysics Data System (ADS)

Yeh, Wei-Chang

2013-02-01

The Hierarchies Consistency Analysis (HCA) is proposed by Guh in-cooperated along with some case study on a Resort to reinforce the weakness of Analytical Hierarchy Process (AHP). Although the results obtained enabled aid for the Decision Maker to make more reasonable and rational verdicts, the HCA itself is flawed. In this paper, our objective is to indicate the problems of HCA, and then propose a revised method called chaotic ordered HCA (COH in short) which can avoid problems. Since the COH is based upon Guh's method, the Decision Maker establishes decisions in a way similar to that of the original method.

A Design Heritage-Based Forecasting Methodology for Risk Informed Management of Advanced Systems

NASA Technical Reports Server (NTRS)

Maggio, Gaspare; Fragola, Joseph R.

1999-01-01

The development of next generation systems often carries with it the promise of improved performance, greater reliability, and reduced operational costs. These expectations arise from the use of novel designs, new materials, advanced integration and production technologies intended for functionality replacing the previous generation. However, the novelty of these nascent technologies is accompanied by lack of operational experience and, in many cases, no actual testing as well. Therefore some of the enthusiasm surrounding most new technologies may be due to inflated aspirations from lack of knowledge rather than actual future expectations. This paper proposes a design heritage approach for improved reliability forecasting of advanced system components. The basis of the design heritage approach is to relate advanced system components to similar designs currently in operation. The demonstrated performance of these components could then be used to forecast the expected performance and reliability of comparable advanced technology components. In this approach the greater the divergence of the advanced component designs from the current systems the higher the uncertainty that accompanies the associated failure estimates. Designers of advanced systems are faced with many difficult decisions. One of the most common and more difficult types of these decisions are those related to the choice between design alternatives. In the past decision-makers have found these decisions to be extremely difficult to make because they often involve the trade-off between a known performing fielded design and a promising paper design. When it comes to expected reliability performance the paper design always looks better because it is on paper and it addresses all the know failure modes of the fielded design. On the other hand there is a long, and sometimes very difficult road, between the promise of a paper design and its fulfillment; with the possibility that sometimes the reliability promise is not fulfilled at all. Decision makers in advanced technology areas have always known to discount the performance claims of a design to a degree in proportion to its stage of development, and at times have preferred the more mature design over the one of lesser maturity even with the latter promising substantially better performance once fielded. As with the broader measures of performance this has also been true for projected reliability performance. Paper estimates of potential advances in design reliability are to a degree uncertain in proportion to the maturity of the features being proposed to secure those advances. This is especially true when performance-enhancing features in other areas are also planned to be part of the development program.

36 CFR 907.14 - Corporation decision making procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false Corporation decision making... CORPORATION ENVIRONMENTAL QUALITY § 907.14 Corporation decision making procedures. To ensure that at major decision making points all relevant environmental concerns are considered by the Decision Maker, the...

Decision Support | Solar Research | NREL

Science.gov Websites

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

Economic evidence in intellectual disabilities: a review.

PubMed

Romeo, Renée; Molosankwe, Iris

2010-09-01

There has been a drive to meet the needs of people with intellectual disabilities in an environment of resource scarcity. It is also recognized that intervention has the potential to improve social and economic welfare. Economic analyses can be used to inform decision makers about what additional investment is needed (if any) and the impacts on a range of stakeholders of intervention. There is a paucity of economic studies in intellectual disability. The lack of economic studies is a barrier to making policy and practice decisions for people with intellectual disabilities. In the period of review, 10 economic studies were found. Information on resource and cost implications of various treatments and support for people with intellectual disabilities is needed. Economic evaluation techniques can be used to inform decision making. We conducted a systematic review of the literature from January 2006 to February 2010. There was a paucity of economic studies in the field. Analyses assessing a wide range of outcomes alongside costs were the most widely used evaluation method in the review. There is a need for more economic studies in this area.

An approach to and web-based tool for infectious disease outbreak intervention analysis

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

Daughton, Ashlynn R.; Generous, Nicholas; Priedhorsky, Reid

Infectious diseases are a leading cause of death globally. Decisions surrounding how to control an infectious disease outbreak currently rely on a subjective process involving surveillance and expert opinion. However, there are many situations where neither may be available. Modeling can fill gaps in the decision making process by using available data to provide quantitative estimates of outbreak trajectories. Effective reduction of the spread of infectious diseases can be achieved through collaboration between the modeling community and public health policy community. However, such collaboration is rare, resulting in a lack of models that meet the needs of the public healthmore » community. Here we show a Susceptible-Infectious-Recovered (SIR) model modified to include control measures that allows parameter ranges, rather than parameter point estimates, and includes a web user interface for broad adoption. We apply the model to three diseases, measles, norovirus and influenza, to show the feasibility of its use and describe a research agenda to further promote interactions between decision makers and the modeling community.« less

An approach to and web-based tool for infectious disease outbreak intervention analysis

DOE PAGES

Daughton, Ashlynn R.; Generous, Nicholas; Priedhorsky, Reid; ...

2017-04-18

Infectious diseases are a leading cause of death globally. Decisions surrounding how to control an infectious disease outbreak currently rely on a subjective process involving surveillance and expert opinion. However, there are many situations where neither may be available. Modeling can fill gaps in the decision making process by using available data to provide quantitative estimates of outbreak trajectories. Effective reduction of the spread of infectious diseases can be achieved through collaboration between the modeling community and public health policy community. However, such collaboration is rare, resulting in a lack of models that meet the needs of the public healthmore » community. Here we show a Susceptible-Infectious-Recovered (SIR) model modified to include control measures that allows parameter ranges, rather than parameter point estimates, and includes a web user interface for broad adoption. We apply the model to three diseases, measles, norovirus and influenza, to show the feasibility of its use and describe a research agenda to further promote interactions between decision makers and the modeling community.« less

Normative arguments from experts and peers reduce delay discounting.

PubMed

Senecal, Nicole; Wang, Teresa; Thompson, Elizabeth; Kable, Joseph W

2012-09-01

When making decisions that involve tradeoffs between the quality and timing of desirable outcomes, people consistently discount the value of future outcomes. A puzzling finding regarding such decisions is the extremely high rate at which people discount future monetary outcomes. Most economists would argue that decision-makers should only turn down rates of return that are lower than those available to them elsewhere. Yet the vast majority of studies find discount rates that are significantly higher than market interest rates (Frederick et al., 2002). Here we ask whether a lack of knowledge about the normative strategy can explain high discount rates. In an initial experiment, we find that nearly half of subjects do not spontaneously cite elements of the normative strategy when asked how people should make intertemporal monetary decisions. In two follow-up experiments, we find that after subjects read a "financial guide" detailing the normative strategy, discount rates declined by up to 85%, but were still higher than market interest rates. This decline persisted, though attenuated, for at least one month. In a final experiment, we find that peer-generated advice influences discount rates in a similar manner to "expert" advice, and that arguments focusing on normative considerations are at least as effective as others. These studies show that part of the explanation for high discount rates is a lack of knowledge regarding the normative strategy, and quantify how much discount rates are reduced in response to normative arguments. Given the high level of discounting that remains, however, there are other contributing factors to high discount rates that remain to be quantified.

Normative arguments from experts and peers reduce delay discounting

PubMed Central

Senecal, Nicole; Wang, Teresa; Thompson, Elizabeth; Kable, Joseph W

2013-01-01

When making decisions that involve tradeoffs between the quality and timing of desirable outcomes, people consistently discount the value of future outcomes. A puzzling finding regarding such decisions is the extremely high rate at which people discount future monetary outcomes. Most economists would argue that decision-makers should only turn down rates of return that are lower than those available to them elsewhere. Yet the vast majority of studies find discount rates that are significantly higher than market interest rates (Frederick et al., 2002). Here we ask whether a lack of knowledge about the normative strategy can explain high discount rates. In an initial experiment, we find that nearly half of subjects do not spontaneously cite elements of the normative strategy when asked how people should make intertemporal monetary decisions. In two follow-up experiments, we find that after subjects read a “financial guide” detailing the normative strategy, discount rates declined by up to 85%, but were still higher than market interest rates. This decline persisted, though attenuated, for at least one month. In a final experiment, we find that peer-generated advice influences discount rates in a similar manner to “expert” advice, and that arguments focusing on normative considerations are at least as effective as others. These studies show that part of the explanation for high discount rates is a lack of knowledge regarding the normative strategy, and quantify how much discount rates are reduced in response to normative arguments. Given the high level of discounting that remains, however, there are other contributing factors to high discount rates that remain to be quantified. PMID:23596504

Voices and Images of Migrant Women who are Survivors of Domestic Violence

PubMed Central

MOYA, EVA M.; BARAY, SILVIA MARÍA CHÁVEZ; MARTÍNEZ, OMAR

2014-01-01

Twenty-two Mexican immigrant women, using the Photovoice method, discuss their experiences and the challenges they have faced as domestic violence survivors in El Paso, Texas, usa. These include limited access to health services, their status as immigrants, and the lack of education on sexual and reproductive health, in conjunction with their deteriorating physical and mental health as well as that of their children. The final outcome of the project includes a bilingual Photovoice gallery of 28 photographs and stories as well as a “Call-to-action” addressed to policy and decision makers insisting on visibility, gender equality, legal support, education, as well as sexual and reproductive health education. PMID:25328561

Emergence of family medicine in Ethiopia [corrected]: an international collaborative education model.

PubMed

Franey, Cara; Evensen, Ann; Bethune, Cheri; Zemenfes, Daniel

2016-05-01

Family Medicine (FM) is a new specialty in Ethiopia. The first seven family physicians graduated in February 2016 from the inaugural residency programme at Addis Ababa University. Cooperation amongst Ethiopian and expatriate decision-makers and physicians was needed to begin the programme. Intentional replacement of expatriates with Ethiopian family physicians has begun. Barriers include lack of understanding of FM and the human and financial resources needed for scaling up the programme. Regular programme review with resident physician involvement has allowed the FM training programme to adapt and fit the Ethiopian context. Further successes will result from ongoing support and advocacy from the Federal Ministry of Health and other Ethiopian, African, and international primary care organisations.

MED SUV TASK 6.3 Capacity building and interaction with decision makers: Improving volcanic risk communication through volcanic hazard tools evaluation, Campi Flegrei Caldera case study (Italy)

NASA Astrophysics Data System (ADS)

Nave, Rosella; Isaia, Roberto; Sandri, Laura; Cristiani, Chiara

2016-04-01

In the communication chain between scientists and decision makers (end users), scientific outputs, as maps, are a fundamental source of information on hazards zoning and the related at risk areas definition. Anyway the relationship between volcanic phenomena, their probability and potential impact can be complex and the geospatial information not easily decoded or understood by not experts even if decision makers. Focusing on volcanic hazard the goal of MED SUV WP6 Task 3 is to improve the communication efficacy of scientific outputs, to contribute in filling the gap between scientists and decision-makers. Campi Flegrei caldera, in Neapolitan area has been chosen as the pilot research area where to apply an evaluation/validation procedure to provide a robust evaluation of the volcanic maps and its validation resulting from end users response. The selected sample involved are decision makers and officials from Campanian Region Civil Protection and municipalities included in Campi Flegrei RED ZONE, the area exposed to risk from to pyroclastic currents hazard. Semi-structured interviews, with a sample of decision makers and civil protection officials have been conducted to acquire both quantitative and qualitative data. The tested maps have been: the official Campi Flegrei Caldera RED ZONE map, three maps produced by overlapping the Red Zone limit on Orthophoto, DTM and Contour map, as well as other maps included a probabilistic one, showing volcanological data used to border the Red Zone. The outcomes' analysis have assessed level of respondents' understanding of content as displayed, and their needs in representing the complex information embedded in volcanic hazard. The final output has been the development of a leaflet as "guidelines" that can support decision makers and officials in understanding volcanic hazard and risk maps, and also in using them as a communication tool in information program for the population at risk. The same evaluation /validation process has been applied also on the scientific output of MED-SUV WP6, as a tool for the short-term probabilistic volcanic hazard assessment. For the Campi Flegrei volcanic system, the expected tool has been implemented to compute hazard curves, hazard maps and probability maps for tephra fallout on a target grid covering the Campania region. This allows the end user to visualize the hazard from tephra fallout and its uncertainty. The response of end-users to such products will help to determine to what extent end-users understand them, find them useful, and match their requirements. In order to involve also Etna area in WP6 TASK 3 activities, a questionnaire developed in the VUELCO project (Volcanic Unrest in Europe and Latin America) has been proposed to Sicily Civil Protection officials having decision-making responsibility in case of volcanic unrest at Etna and Stromboli, to survey their opinions and requirements also in case of volcanic unrest

Gender inequalities in the workplace: the effects of organizational structures, processes, practices, and decision makers' sexism.

PubMed

Stamarski, Cailin S; Son Hing, Leanne S

2015-01-01

Gender inequality in organizations is a complex phenomenon that can be seen in organizational structures, processes, and practices. For women, some of the most harmful gender inequalities are enacted within human resources (HRs) practices. This is because HR practices (i.e., policies, decision-making, and their enactment) affect the hiring, training, pay, and promotion of women. We propose a model of gender discrimination in HR that emphasizes the reciprocal nature of gender inequalities within organizations. We suggest that gender discrimination in HR-related decision-making and in the enactment of HR practices stems from gender inequalities in broader organizational structures, processes, and practices. This includes leadership, structure, strategy, culture, organizational climate, as well as HR policies. In addition, organizational decision makers' levels of sexism can affect their likelihood of making gender biased HR-related decisions and/or behaving in a sexist manner while enacting HR practices. Importantly, institutional discrimination in organizational structures, processes, and practices play a pre-eminent role because not only do they affect HR practices, they also provide a socializing context for organizational decision makers' levels of hostile and benevolent sexism. Although we portray gender inequality as a self-reinforcing system that can perpetuate discrimination, important levers for reducing discrimination are identified.

Social motives and strategic misrepresentation in social decision making.

PubMed

Steinel, Wolfgang; De Dreu, Carsten K W

2004-03-01

In 4 experiments, the authors studied the influence of social motives on deception and strategic misrepresentation. In a newly developed information provision game, individuals faced a decision maker whose decision would affect both own and other's outcomes. By withholding information or by giving (in)accurate information about payoffs, participants could try to influence other's decision making. Less accurate and more inaccurate information was given when the decision maker was competitive rather than cooperative (Experiment 1), especially when participants had a prosocial rather than selfish value orientation (Experiments 3 and 4). Accurate information was withheld because of fear of exploitation and greed, and inaccurate information was given because of greed (Experiment 2). Finally, participants engaged in strategic misrepresentation that may trick competitive others into damaging their own and increasing the participant's outcomes.

An Approach for Web Service Selection Based on Confidence Level of Decision Maker

PubMed Central

Khezrian, Mojtaba; Jahan, Ali; Wan Kadir, Wan Mohd Nasir; Ibrahim, Suhaimi

2014-01-01

Web services today are among the most widely used groups for Service Oriented Architecture (SOA). Service selection is one of the most significant current discussions in SOA, which evaluates discovered services and chooses the best candidate from them. Although a majority of service selection techniques apply Quality of Service (QoS), the behaviour of QoS-based service selection leads to service selection problems in Multi-Criteria Decision Making (MCDM). In the existing works, the confidence level of decision makers is neglected and does not consider their expertise in assessing Web services. In this paper, we employ the VIKOR (VIšekriterijumskoKOmpromisnoRangiranje) method, which is absent in the literature for service selection, but is well-known in other research. We propose a QoS-based approach that deals with service selection by applying VIKOR with improvement of features. This research determines the weights of criteria based on user preference and accounts for the confidence level of decision makers. The proposed approach is illustrated by an example in order to demonstrate and validate the model. The results of this research may facilitate service consumers to attain a more efficient decision when selecting the appropriate service. PMID:24897426

Use of the recognition heuristic depends on the domain's recognition validity, not on the recognition validity of selected sets of objects.

PubMed

Pohl, Rüdiger F; Michalkiewicz, Martha; Erdfelder, Edgar; Hilbig, Benjamin E

2017-07-01

According to the recognition-heuristic theory, decision makers solve paired comparisons in which one object is recognized and the other not by recognition alone, inferring that recognized objects have higher criterion values than unrecognized ones. However, success-and thus usefulness-of this heuristic depends on the validity of recognition as a cue, and adaptive decision making, in turn, requires that decision makers are sensitive to it. To this end, decision makers could base their evaluation of the recognition validity either on the selected set of objects (the set's recognition validity), or on the underlying domain from which the objects were drawn (the domain's recognition validity). In two experiments, we manipulated the recognition validity both in the selected set of objects and between domains from which the sets were drawn. The results clearly show that use of the recognition heuristic depends on the domain's recognition validity, not on the set's recognition validity. In other words, participants treat all sets as roughly representative of the underlying domain and adjust their decision strategy adaptively (only) with respect to the more general environment rather than the specific items they are faced with.

Entropy Methods For Univariate Distributions in Decision Analysis

NASA Astrophysics Data System (ADS)

Abbas, Ali E.

2003-03-01

One of the most important steps in decision analysis practice is the elicitation of the decision-maker's belief about an uncertainty of interest in the form of a representative probability distribution. However, the probability elicitation process is a task that involves many cognitive and motivational biases. Alternatively, the decision-maker may provide other information about the distribution of interest, such as its moments, and the maximum entropy method can be used to obtain a full distribution subject to the given moment constraints. In practice however, decision makers cannot readily provide moments for the distribution, and are much more comfortable providing information about the fractiles of the distribution of interest or bounds on its cumulative probabilities. In this paper we present a graphical method to determine the maximum entropy distribution between upper and lower probability bounds and provide an interpretation for the shape of the maximum entropy distribution subject to fractile constraints, (FMED). We also discuss the problems with the FMED in that it is discontinuous and flat over each fractile interval. We present a heuristic approximation to a distribution if in addition to its fractiles, we also know it is continuous and work through full examples to illustrate the approach.

When is diagnostic testing inappropriate or irrational? Acceptable regret approach.

PubMed

Hozo, Iztok; Djulbegovic, Benjamin

2008-01-01

The authors provide a new model within the framework of theories of bounded rationality for the observed physicians' behavior that their ordering of diagnostic tests may not be rational. Contrary to the prevailing thinking, the authors find that physicians do not act irrationally or inappropriately when they order diagnostic tests in usual clinical practice. When acceptable regret (i.e., regret that a decision maker finds tolerable upon making a wrong decision) is taken into account, the authors show that physicians tend to order diagnostic tests at a higher level of pretest probability of disease than predicted by expected utility theory. They also show why physicians tend to overtest when regret about erroneous decisions is extremely small. Finally, they explain variations in the practice of medicine. They demonstrate that in the same clinical situation, different decision makers might have different acceptable regret thresholds for withholding treatment, for ordering a diagnostic test, or for administering treatment. This in turn means that for some decision makers, the most rational strategy is to do nothing, whereas for others, it may be to order a diagnostic test, and still for others, choosing treatment may be the most rational course of action.

Moving the science data quality dialogue forward

NASA Astrophysics Data System (ADS)

Robinson, Erin; Meyer, Carol B.; Lenhardt, W. Christopher

2012-05-01

Federation of Earth Science Information Partners Summer 2011 Meeting; Santa Fe, New Mexico, 12-15 July 2011 Scientific data quality is important to scientists, archivists, decision makers, and the public. Uncertain quality costs valuable research dollars and has impacts beyond the initial science. The Federation of Earth Science Information Partners (ESIP) is a consortium of Earth science data and technology professionals spanning the government (NASA, National Oceanic and Atmospheric Administration, U.S. Environmental Protection Agency, U.S. Geological Survey (USGS), National Science Foundation), academia, and private sectors (both commercial and nonprofit). The organization is dedicated to transforming research data and information into useful and usable data and information products for decision makers, policy makers, and the public.

Improving IT Portfolio Management Decision Confidence Using Multi-Criteria Decision Making and Hypervariate Display Techniques

ERIC Educational Resources Information Center

Landmesser, John Andrew

2014-01-01

Information technology (IT) investment decision makers are required to process large volumes of complex data. An existing body of knowledge relevant to IT portfolio management (PfM), decision analysis, visual comprehension of large volumes of information, and IT investment decision making suggest Multi-Criteria Decision Making (MCDM) and…

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

EPA Science Inventory

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

Risk manager formula for success: Influencing decision making.

PubMed

Midgley, Mike

2017-10-01

Providing the ultimate decision makers with a quantitative risk analysis based on thoughtful assessment by the organization's experts enables an efficient decision. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

Toward actionable science: Empowering ecologists to engage in the process of translation through decision-maker and stakeholder partnerships

NASA Astrophysics Data System (ADS)

Enquist, C.; Jackson, S. T.; Garfin, G. M.

2017-12-01

Translational ecology is an approach by which ecologists, stakeholders, and decision-makers work collaboratively to develop and deliver ecological research that, ideally, results in actionable science that leads to improved environmental decision-making. We analyzed a diverse array of real-world case studies and distilled six principles that characterize the practice of translational ecology: communication, commitment, collaboration, engagement, process, and decision-framing. In this talk, we highlight a subset of the case studies that illustrate these principles. Notably, we found that translational ecology is distinct from both basic and applied ecological research. As a practice, the approach deliberately extends research beyond theory or opportunistic applications, motivated by a search for outcomes that directly serve the needs of natural resource managers and decision-makers. Translational ecology is also distinct from knowledge co-production in that it does not require deep engagement between collaborators, although incorporating differing modes of co-production relative to the decision context, associated time frame, and available financial resources can greatly enhance the translational approach. Although there is a need for incentives to pursue in this type of work, we found that the creativity and context-specific knowledge of resource managers, practitioners, and decision-makers informs and enriches the scientific process, helping shape actionable science. Moreover, the process of addressing research questions arising from on-the-ground management issues, rather than from the top-down or expert-oriented perspectives of traditional science, can foster the long-term trust and commitment that is critical for long-term, sustained engagement between partners. Now, perhaps more than ever, the climate and environmental issues facing society are complex, often politicized, and value-laden. We argue that ecological science should play a key role in informing these problems and ecologists can engage as important partners committed to finding solutions. More broadly, scientists that embrace translational approaches are poised to make science-informed decision-making a reality in the face of a rapidly changing global environment.

An Analysis and Review of Measures and Relationships in Space Transportation Affordability

NASA Technical Reports Server (NTRS)

Zapata, Edgar; McCleskey, Carey

2014-01-01

The affordability of transportation to or from space is of continued interest across numerous and diverse stakeholders in our aerospace industry. Such an important metric as affordability deserves a clear understanding among stakeholders about what is meant by affordability, costs, and related terms, as otherwise it's difficult to see where specific improvements are needed or where to target specific investments. As captured in the famous words of Lewis Carroll, "If you don't know where you are going, any road will get you there". As important as understanding a metric may be, with terms such as costs, prices, specific costs, average costs, marginal costs, etc., it is equally important to understand the relationship among these measures. In turn, these measures intermingle with caveats and factors that introduce more measures in need of a common understanding among stakeholders. These factors include flight rates, capability, and payload. This paper seeks to review the costs of space transportation systems and the relationships among the many factors involved in costs from the points of view of diverse decision makers. A decision maker may have an interest in acquiring a single launch considering the best price (along with other factors in their business case), or an interest in many launches over time. Alternately, a decision maker may have a specific interest in developing a space transportation system that will offer certain prices, or flight rate capability, or both, at a certain up-front cost. The question arises for the later, to reuse or to expend? As it is necessary in thinking about the future to clearly understand the past and the present, this paper will present data and graphics to assist stakeholders in visualizing trends and the current state of affairs in the launch industry. At all times, raw data will be referenced (or made available separately) alongside detailed explanations about the data, so as to avoid the confusion or misleading conclusions that occur more often than not with complex graphs or statements when such context is lacking.

Decision Performance Using Spatial Decision Support Systems: A Geospatial Reasoning Ability Perspective

ERIC Educational Resources Information Center

Erskine, Michael A.

2013-01-01

As many consumer and business decision makers are utilizing Spatial Decision Support Systems (SDSS), a thorough understanding of how such decisions are made is crucial for the information systems domain. This dissertation presents six chapters encompassing a comprehensive analysis of the impact of geospatial reasoning ability on…

Decision-Making Phenomena Described by Expert Nurses Working in Urban Community Health Settings.

ERIC Educational Resources Information Center

Watkins, Mary P.

1998-01-01

Expert community health nurses (n=28) described crucial clinical situations. Content analysis revealed that decision making was both rational and intuitive. Eight themes were identified: decision-making focus, type, purpose, decision-maker characteristics, sequencing of events, data collection methods, facilitators/barriers, and decision-making…

49 CFR 1503.655 - Initial decision.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Rules of Practice in TSA Civil Penalty Actions § 1503.655 Initial decision. (a) Contents. The ALJ may... copies of that initial decision available to all parties and the TSA decision maker. (b) Written decision... ALJ is persuasive authority in any other civil penalty action, unless appealed and reversed by the TSA...

Health System Decision Makers' Feedback on Summaries and Tools Supporting the Use of Systematic Reviews: A Qualitative Study

ERIC Educational Resources Information Center

Ellen, Moriah E.; Lavis, John N.; Wilson, Michael G.; Grimshaw, Jeremy; Haynes, R. Brian; Ouimet, Mathieu; Raina, Parminder; Gruen, Russell

2014-01-01

Health system managers and policy makers need timely access to high quality, policy-relevant systematic reviews. Our objectives were to obtain managers' and policy makers' feedback about user-friendly summaries of systematic reviews and about tools related to supporting or assessing their use. Our interviews identified that participants prefer key…

Separating analysis from politics: Acid rain in Europe

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

Patt, A.

Over the last twenty years, policy-makers in Europe have attempted to solve the problem of acid rain using detailed analysis grounded in natural science and economics. The results are impressive, as Europeans have successfully implemented a number of international agreements to reduce pollution emissions, agreements that in theory achieve the greatest environmental benefit at the lowest aggregate cost across Europe. This article examines the analysis on which these policies were based. First, it finds a pattern of investigating the use of cost-benefit analysis, together with a lack of usefulness associated with the actual results of such analysis. Second, it findsmore » that the analytic framework that came to replace cost-benefit analysis--critical loads--contained many of the same uncertainties and political decisions that plagued cost-benefit analysis. Nevertheless, critical loads analysis was seen as less value-laden and more reliable, and contributed significantly to policy development. Desire for rapid action led policy-makers to ignore or overlook the politics and uncertainties inherent in efforts at scientific assessment and modeling.« less

Identification of innovation in public health.

PubMed

Fung, Matthew; Simpson, Sue; Packer, Claire

2011-03-01

The National Horizon Scanning Centre provides national policy-makers in England with forewarning about emerging and new health technologies. This includes public health interventions (PHIs) but identification of these interventions is not always easy. The aim of this study was to explore the meaning and define innovation in public health. We used a quasi-Delphi method with questionnaire 1 sent to 106 public health and horizon scanning professionals and decision-makers in June 2008. Questionnaire 2 was developed based on answers to questionnaire 1 and sent to all respondents. A definition of innovative PHIs was developed: 'Innovative PHIs are generally new and different to established interventions. They should be equitable, applicable to all in a population, cost-effective and may address health determinants in the non-health sector of society. A good evidence base is ideal, but sometimes it may be necessary to consider PHIs lacking evidence'. Sources suggested for identifying innovative PHIs were similar to those used for other types of health technologies. Our findings should help early awareness and alert systems distinguish innovative from non-innovative PHIs, although its application in practice needs trialling.

The game of making decisions under uncertainty: How sure must one be?

NASA Astrophysics Data System (ADS)

Werner, Micha; Verkade, Jan; Wetterhall, Fredrik; van Andel, Schalk-Jan; Ramos, Maria-Helena

2016-04-01

Probabilistic hydrometeorological forecasting is now widely accepted to be more skillful than deterministic forecasts, and is increasingly being integrated into operational practice. Provided they are reliable and unbiased, probabilistic forecasts have the advantage that they give decision maker not only the forecast value, but also the uncertainty associated to that prediction. Though that information provides more insight, it does now leave the forecaster/decision maker with the challenge of deciding at what level of probability of a threshold being exceeded the decision to act should be taken. According to the cost-loss theory, that probability should be related to the impact of the threshold being exceeded. However, it is not entirely clear how easy it is for decision makers to follow that rule, even when the impact of a threshold being exceeded, and the actions to choose from are known. To continue the tradition in the "Ensemble Hydrometeorological Forecast" session, we will address the challenge of making decisions based on probabilistic forecasts through a game to be played with the audience. We will explore how decisions made differ depending on the known impacts of the forecasted events. Participants will be divided into a number of groups with differing levels of impact, and will be faced with a number of forecast situations. They will be asked to make decisions and record the consequence of those decisions. A discussion of the differences in the decisions made will be presented at the end of the game, with a fuller analysis later posted on the HEPEX web site blog (www.hepex.org).

Evidence summaries tailored to health policy-makers in low- and middle-income countries

PubMed Central

Glenton, Claire; Wiysonge, Charles Shey; Abalos, Edgardo; Mignini, Luciano; Young, Taryn; Althabe, Fernando; Ciapponi, Agustín; Marti, Sebastian Garcia; Meng, Qingyue; Wang, Jian; la Hoz Bradford, Ana Maria De; Kiwanuka, Suzanne N; Rutebemberwa, Elizeus; Pariyo, George W; Flottorp, Signe; Oxman, Andrew D

2011-01-01

Abstract Objective To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs). Methods We carried out 21 user tests in six countries to explore users’ experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops. Findings Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan. Conclusion Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions. PMID:21346891

Utilization of Health Research Recommendation in Policy and Planning in Nepal.

PubMed

Dhimal, M; Pandey, A R; Aryal, K K; Budhathoki, C B; Vaidya, D L; Karki, K K; Onta, S

2016-09-01

Over the past decade in Nepal, a large number of studies have been carried in a variety of health areas; however whether evidence derived from these studies has been used to inform health policy has not been explored. This study aims to assess the utilization of recommendations from health research in health policy and plans, and to identify the factors that influence utilization of research findings by policy makers' in Nepal. Qualitative study incorporating literature review and semi-structured interviews was used. Research reports and health related policies were collected from governmental and non-governmental bodies. Documents were reviewed to identify the utilization of research-based recommendations in health policy and plan formulation. In-depth interviews were conducted with key policy makers and researchers to identify factors that hinder the utilization of research recommendations. A total of 83 health related research reports were identified, of which 48 had recommendations. Four policies and three plans, from total 21 identified plans and policies, were found to have incorporated recommendations from research. Of the 48 studies that had recommendations, 35 were found to be used in the policy making process. Lack of appropriate communication mechanisms, and concerns related to the quality of research conducted, were the main factors hindering the translation of evidence into policy. Communication gaps exist between researchers and policy makers, which seem to have impeded the utilization of research-based information and recommendations in decision-making process. Establishing a unit responsible for synthesizing evidences and producing actionable messages for policy makers can improve utilization of research findings.

The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives.

PubMed

Glenton, Claire; Scheel, Inger B; Pradhan, Sabina; Lewin, Simon; Hodgins, Stephen; Shrestha, Vijaya

2010-06-01

The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be characterised by high attrition levels, the FCHV Programme loses fewer than 5% of its volunteers annually. The degree to which decision makers understand community health worker motivations and match these with appropriate incentives is likely to influence programme sustainability. The purpose of this study was to explore the views of stakeholders who have participated in the design and implementation of the Female Community Health Volunteer regarding Volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of Volunteers. Semi-structured interviews were carried out in 2009 with 19 purposively selected non-Volunteer stakeholders, including policy makers and programme managers. Results were compared with data from previous studies of Female Community Health Volunteers and from interviews with four Volunteers and two Volunteer activists. Stakeholders saw Volunteers as motivated primarily by social respect, religious and moral duty. The freedom to deliver services at their leisure was seen as central to the volunteer concept. While stakeholders also saw the need for extrinsic incentives such as micro-credit, regular wages were regarded not only as financially unfeasible, but as a potential threat to the Volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with and previous studies of Female Community Health Volunteers, and appear to be influenced by a tradition of volunteering as moral behaviour, a lack of respect for paid government workers, and the Programme's community embeddedness. Our study suggests that it may not be useful to promote a generic range of incentives, such as wages, to improve community health worker programme sustainability. Instead, programmes should ensure that the context-specific expectations of community health workers, programme managers, and policy makers are in alignment if low attrition and high performance are to be achieved. Copyright 2010 Elsevier Ltd. All rights reserved.

At Least I Tried: The Relationship between Regulatory Focus and Regret Following Action vs. Inaction

PubMed Central

Itzkin, Adi; Van Dijk, Dina; Azar, Ofer H.

2016-01-01

Regret is an unpleasant feeling that may arise following decisions that ended poorly, and may affect the decision-maker's well-being and future decision making. Some studies show that a decision to act leads to greater regret than a decision not to act when both resulted in failure, because the latter is usually the norm. In some cases, when the norm is to act, this pattern is reversed. We suggest that the decision maker's regulatory focus, affects regret after action or inaction. Specifically, promotion-focused individuals, who tend to be more proactive, view action as more normal than prevention-focused individuals, and therefore experience regulatory fit when an action decision is made. Hence, we hypothesized that promotion-focused individuals will feel less regret than prevention-focused individuals when a decision to act ended poorly. In addition, we hypothesized that a trigger for change implied in the situation, decreases the level of regret following action. We tested our hypotheses on a sample of 330 participants enrolled in an online survey. The participants received six decision scenarios, in which they were asked to evaluate the level of regret following action and inaction. Individual regulatory focus was measured by two different scales. Promotion-focused individuals attributed less regret than prevention-focused individuals to action decisions. Regret following inaction was not affected by regulatory focus. In addition, a trigger for change decreases regret following action. Orthodox people tend to attribute more regret than non-orthodox to a person who made an action decision. The results contribute to the literature by showing that not only the situation but also the decision maker's orientation affects the regret after action vs. inaction. PMID:27833581

Gaining Momentum: How Media Influences Public Opinion To Push Civil-Military Decision Makers Into Formulating Foreign Policy

DTIC Science & Technology

2016-02-09

1 AIR WAR COLLEGE AIR UNIVERSITY GAINING MOMENTUM: HOW MEDIA INFLUENCES PUBLIC OPINION TO PUSH CIVIL-MILITARY DECISION MAKERS INTO...engagements from the past, evidence suggest the media or press does have an influence over public opinion, especially during times of war and humanitarian...changes and that leaders must take into consideration that public opinion and the media may provide a large amount of influence over how the nation

The bare necessities? A realist review of necessity argumentations used in health care coverage decisions.

PubMed

Kleinhout-Vliek, Tineke; de Bont, Antoinette; Boer, Bert

2017-07-01

Policy makers and insurance companies decide on coverage of care by both calculating (cost-) effectiveness and assessing the necessity of coverage. To investigate argumentations pertaining to necessity used in coverage decisions made by policy makers and insurance companies, as well as those argumentations used by patients, authors, the public and the media. This study is designed as a realist review, adhering to the RAMESES quality standards. Embase, Medline and Web of Science were searched and 98 articles were included that detailed necessity-based argumentations. We identified twenty necessity-based argumentation types. Seven are only used to argue in favour of coverage, five solely for arguing against coverage, and eight are used to argue both ways. A positive decision appears to be facilitated when patients or the public set the decision on the agenda. Moreover, half the argumentation types are only used by patients, authors, the public and the media, whereas the other half is also used by policy makers and insurance companies. The latter group is more accepted and used in more different countries. The majority of necessity-based argumentation types is used for either favouring or opposing coverage, and not for both. Patients, authors, the public and the media use a broader repertoire of argumentation types than policy makers and insurance companies. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review.

PubMed

Haynes, R Brian; Wilczynski, Nancy L

2010-02-05

Computerized clinical decision support systems are information technology-based systems designed to improve clinical decision-making. As with any healthcare intervention with claims to improve process of care or patient outcomes, decision support systems should be rigorously evaluated before widespread dissemination into clinical practice. Engaging healthcare providers and managers in the review process may facilitate knowledge translation and uptake. The objective of this research was to form a partnership of healthcare providers, managers, and researchers to review randomized controlled trials assessing the effects of computerized decision support for six clinical application areas: primary preventive care, therapeutic drug monitoring and dosing, drug prescribing, chronic disease management, diagnostic test ordering and interpretation, and acute care management; and to identify study characteristics that predict benefit. The review was undertaken by the Health Information Research Unit, McMaster University, in partnership with Hamilton Health Sciences, the Hamilton, Niagara, Haldimand, and Brant Local Health Integration Network, and pertinent healthcare service teams. Following agreement on information needs and interests with decision-makers, our earlier systematic review was updated by searching Medline, EMBASE, EBM Review databases, and Inspec, and reviewing reference lists through 6 January 2010. Data extraction items were expanded according to input from decision-makers. Authors of primary studies were contacted to confirm data and to provide additional information. Eligible trials were organized according to clinical area of application. We included randomized controlled trials that evaluated the effect on practitioner performance or patient outcomes of patient care provided with a computerized clinical decision support system compared with patient care without such a system. Data will be summarized using descriptive summary measures, including proportions for categorical variables and means for continuous variables. Univariable and multivariable logistic regression models will be used to investigate associations between outcomes of interest and study specific covariates. When reporting results from individual studies, we will cite the measures of association and p-values reported in the studies. If appropriate for groups of studies with similar features, we will conduct meta-analyses. A decision-maker-researcher partnership provides a model for systematic reviews that may foster knowledge translation and uptake.

Empowering Local Organizations and Decision-makers in a Changing Climate: EO-guided Environmental Surveillance of Cholera and Rotavirus for South Asia

NASA Astrophysics Data System (ADS)

Akanda, A. S.; Hasan, M. A.; Jutla, A.; Aziz, S.; Alam, M.; Ahsan, G. U.; Huq, A.; Colwell, R. R.

2017-12-01

Despite significant advancements in scientific research, diarrheal diseases remain a leading cause of mortality and morbidity in the developing world. Although under-5 child mortality due to such diseases is dropping, prevalence of most diarrheal diseases has increased over past decades, exerting a terrible toll on global public health. Providing safe water and sanitation access, and a safe and clean environment in a sustainable manner remains a critical challenge in the face of rapid population growth, urbanization and increasing threats of natural hazards in a changing climate. We focus on the Bengal Delta region of South Asia, where Cholera and Rotavirus diarrhea continue to have a devastating impact on the public health burden. Climatic change and anthropogenic forcings have greatly affected available water quantity and quality, while the lack of effective institutions and capacity have greatly affected the water-sanitation and public health sectors. The region suffers from recurring dry season freshwater scarcity and temperature extremes, salinity intrusion in coastal areas, inland flooding during monsoons, and resulting water contamination across the delta region. We use earth observation (EO) datasets and techniques to develop a series of tools for surveillance, analysis and decision support to empower government, academic, and non-government stakeholder organizations in South Asia to monitor changes in environmental conditions related to the two most devastating diarrheal diseases, cholera and rotavirus. The developed tools will enable decision makers and stakeholders to significantly increase their understanding of the threats to public health and environmental and climatic conditions related to these diseases, ways to monitor future projections of disease risk, and help identify required policy interventions and strategies to strengthen prevention efforts and limit disease burden in near- (tactical) and long- (strategic) terms.

Cost and cost-effectiveness of HIV/AIDS prevention strategies in developing countries: is there an evidence base?

PubMed

Walker, Damian

2003-03-01

Many donors and countries are striving to respond to the HIV/AIDS epidemic by implementing prevention programmes. However, the resources available for providing these activities relative to needs are limited. Hence, decision-makers must choose among various types of interventions. Cost information, both measures of cost and cost-effectiveness, serves as a critical input into the processes of setting priorities and allocating resources efficiently. This paper reviews the cost and cost-effectiveness evidence base of HIV/AIDS prevention programmes in low- and middle-income countries (LMICs). None of the studies found have complete cost data for a full range of HIV/AIDS prevention programmes in any one country. However, the range of studies highlight the relative emphasis of different types of HIV/AIDS prevention strategies by region, reflecting the various modes of transmission and hence, to a certain extent, the stage of the epidemic. The costing methods applied and results obtained in this review give rise to questions of reliability, validity and transparency. First, not all of the studies report the methods used to calculate the costs, and/or do not provide all the necessary data inputs such that recalculation of the results is possible. Secondly, methods that are documented vary widely, rendering different studies, even within the same country and programme setting, largely incomparable. Finally, even with consistent and replicable measurement, the results as presented are generally not comparable because of the lack of a common outcome measure. Therefore, the extent to which the available cost and cost-effectiveness evidence base on HIV/AIDS prevention strategies can provide guidance to decision-makers is limited, and there is an urgent need for the generation of this knowledge for planning and decision-making.

Methods for Developing Evidence Reviews in Short Periods of Time: A Scoping Review

PubMed Central

Abou-Setta, Ahmed M.; Jeyaraman, Maya; Attia, Abdelhamid; Al-Inany, Hesham G.; Ferri, Mauricio; Ansari, Mohammed T.; Garritty, Chantelle M.; Bond, Kenneth; Norris, Susan L.

2016-01-01

Introduction Rapid reviews (RR), using abbreviated systematic review (SR) methods, are becoming more popular among decision-makers. This World Health Organization commissioned study sought to summarize RR methods, identify differences, and highlight potential biases between RR and SR. Methods Review of RR methods (Key Question 1 [KQ1]), meta-epidemiologic studies comparing reliability/ validity of RR and SR methods (KQ2), and their potential associated biases (KQ3). We searched Medline, EMBASE, Cochrane Library, grey literature, and checked reference lists, used personal contacts, and crowdsourcing (e.g. email listservs). Selection and data extraction was conducted by one reviewer (KQ1) or two reviewers independently (KQ2-3). Results Across all KQs, we identified 42,743 citations through the literature searches. KQ1: RR methods from 29 organizations were reviewed. There was no consensus on which aspects of the SR process to abbreviate. KQ2: Studies comparing the conclusions of RR and SR (n = 9) found them to be generally similar. Where major differences were identified, it was attributed to the inclusion of evidence from different sources (e.g. searching different databases or including different study designs). KQ3: Potential biases introduced into the review process were well-identified although not necessarily supported by empirical evidence, and focused mainly on selective outcome reporting and publication biases. Conclusion RR approaches are context and organization specific. Existing comparative evidence has found similar conclusions derived from RR and SR, but there is a lack of evidence comparing the potential of bias in both evidence synthesis approaches. Further research and decision aids are needed to help decision makers and reviewers balance the benefits of providing timely evidence with the potential for biased findings. PMID:27930662

Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal.

PubMed

de Oliveira, Ana Paula Cavalcante; Dussault, Gilles; Craveiro, Isabel

2017-03-23

Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development. We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search. The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements. Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.

The Decision-Making Structure and the Dean.

ERIC Educational Resources Information Center

Johnson, Betty M.; George, Shirley A.

1987-01-01

Characteristics in the college academic setting and the external environment that affect the decision-making structure and that the dean should consider before reorganization are examined. Concepts and theories about governance, decision-making, organizational structure, and characteristics of effective decision makers are also briefly reviewed. A…

Spatial planning using probabilistic flood maps

NASA Astrophysics Data System (ADS)

Alfonso, Leonardo; Mukolwe, Micah; Di Baldassarre, Giuliano

2015-04-01

Probabilistic flood maps account for uncertainty in flood inundation modelling and convey a degree of certainty in the outputs. Major sources of uncertainty include input data, topographic data, model structure, observation data and parametric uncertainty. Decision makers prefer less ambiguous information from modellers; this implies that uncertainty is suppressed to yield binary flood maps. Though, suppressing information may potentially lead to either surprise or misleading decisions. Inclusion of uncertain information in the decision making process is therefore desirable and transparent. To this end, we utilise the Prospect theory and information from a probabilistic flood map to evaluate potential decisions. Consequences related to the decisions were evaluated using flood risk analysis. Prospect theory explains how choices are made given options for which probabilities of occurrence are known and accounts for decision makers' characteristics such as loss aversion and risk seeking. Our results show that decision making is pronounced when there are high gains and loss, implying higher payoffs and penalties, therefore a higher gamble. Thus the methodology may be appropriately considered when making decisions based on uncertain information.

Economic Decisions for Others: An Exception to Loss Aversion Law

PubMed Central

Mengarelli, Flavia; Moretti, Laura; Faralla, Valeria; Vindras, Philippe; Sirigu, Angela

2014-01-01

In everyday life, people often make decisions on behalf of others. The current study investigates whether risk preferences of decision-makers differ when the reference point is no longer their own money but somebody else money. Thirty four healthy participants performed three different monetary risky choices tasks by making decisions for oneself and for another unknown person. Results showed that loss aversion bias was significantly reduced when participants were choosing on behalf of another person compared to when choosing for themselves. The influence of emotions like regret on decision-making may explain these results. We discuss the importance of the sense of responsibility embodied in the emotion of regret in modulating economic decisions for self but not for others. Moreover, our findings are consistent with the Risk-as-feelings hypothesis, suggesting that self-other asymmetrical behavior is due to the extent the decision-maker is affected by the real and emotional consequences of his/her decision. PMID:24454788

The Inferential Structure of Actionable Science in Climatological and Hydrological Co-Productions

NASA Astrophysics Data System (ADS)

Brumble, K. C.

2016-12-01

Across the geophysical sciences, and in hydrology in particular, there is a growing emphasis on and desire to produce "actionable science" and "user-inspired" science. Fueled by the need to make research approachable, intelligible, and useful for decision-makers, policy-makers, and across disciplinary boundaries, actionable science endeavors seek to replace the traditional downward flow of information model for knowledge in the sciences. Instead the focus is on more dynamical knowledge flow between the local and contingent and the vast and complex. New methodologies which allow for the co-production of knowledge between modelers, model users, and decision-makers will be surveyed for the structure of knowledge flow present, and for innovations in communicating and handling uncertainties across traditional disciplinary boundaries. Current and possible future methods for handling sources of uncertainty and cascades of uncertainty will be addressed. Examples will be drawn from recent projects involving the interactions between climate modeling groups, hydrological modelers, and decision makers at the local and regional level in water security to try and identify key methodologies for the co-production of actionable knowledge exportable to other applications in the boundary between systems impacted by climate change.

Family medicine in Iran: facing the health system challenges.

PubMed

Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

2014-11-30

In response to the current fragmented context of health systems, it is essential to support the revitalization of primary health care in order to provide a stronger sense of direction and integrity. Around the world, family medicine recognized as a core discipline for strengthening primary health care setting. This study aimed to understand the perspectives of policy makers and decision makers of Iran's health system about the implementation of family medicine in Iran urban areas. This study is a qualitative study with framework analysis. Purposive semi-structured interviews were conducted with Policy and decision makers in the five main organizations of Iran health care system. The codes were extracted using inductive and deductive methods. According to 27 semi-structured interviews were conducted with Policy and decision makers, three main themes and 8 subthemes extracted, including: The development of referral system, better access to health care and the management of chronic diseases. Family medicine is a viable means for a series of crucial reforms in the face of the current challenges of health system. Implementation of family medicine can strengthen the PHC model in Iran urban areas. Attempting to create a general consensus among various stakeholders is essential for effective implementation of the project.

The determinants of efficiency in the Canadian health care system.

PubMed

Allin, Sara; Grignon, Michel; Wang, Li

2016-01-01

In spite of the vast number of studies measuring economic efficiency in health care, there has been little take-up of this evidence by policy-makers to date. This study provides an illustration of how a system-level study drawing on best practice in empirical measurement of efficiency may be of practical use to health system decision makers and managers. We make use of the rich data available in Canada to undertake a robust two-stage data envelopment analysis to calculate efficiency at the regional (sub-provincial) level. Decisions about what the health system produces (the outcome to measure efficiency against) and what are the resources it has to produce that outcome were based on interviews and consultation with health system decision makers. Overall, we find large inefficiencies in the Canadian health care system, which could improve outcomes (here, measured as a reduction in treatable causes of death) by between 18 and 35% across our analyses. Also, we find that inefficiencies are the result of three main sets of factors that policy makers could pay attention to: management factors, such as hospital re-admissions; public health factors, such as obesity and smoking rates; and environmental factors such as the population's average income.

Knowledge and Attitudes of a Number of Iranian Policy-makers towards Abortion

PubMed Central

Shamshiri-Milani, Hourieh; Pourreza, Abolghasem; Akbari, Feizollah

2010-01-01

Introduction Unsafe and illegal abortions are the third leading cause of maternal death. It affects physical, emotional and social health of women and their families. Abortion is a multi-dimensional phenomenon with several social, legal, and religious implications. The views of policy-makers affect the approach to abortion in every society. Understanding the attitudes and knowledge of high-ranking decision makers towards abortion was the purpose of this study. Materials and Methods A qualitative research was implemented by carrying out individual interviews with 29 out of a selection of 80 presidents of medical sciences universities, senior executive managers in the legal system, forensic medicine and decision-makers in the health system and a number of top Muslim clerics, using a semi-structured questionnaire for data gathering. Content analysis revealed the results. Results There were considerable unwillingness and reluctance among the interviewees to participate in the study. The majority of participants fairly knew about the prevalence of illegal abortions and their complications. There was strong agreement on abortion when health of the mother or the fetus was at risk. Abortion for reproductive health reasons was supported by a minority of the respondents. The majority of them disagreed with abortion when pregnancy was the result of a rape, temporary marriage or out of wedlock affairs. Making decision for abortion by the pregnant mother, as a matter of her right, did not gain too much approval. Conclusion It seemed that physical health of the mother or the fetus was of more importance to the respondents than their mental or social health. The mother's hardship was not any indication for induced abortion in the viewpoints of the interviewed policy-makers. Strengthening family planning programs, making appropriate laws in lines with religious orders and advocacy programs targeting decision makers are determined as strategies for improving women's health rights. PMID:23926489

Ethics and public health emergencies: rationing vaccines.

PubMed

Wynia, Matthew K

2006-01-01

There are three broad ethical issues related to handling public health emergencies. They are the three R's-rationing, restrictions and responsibilities. Recently, a severe shortage of annual influenza vaccine in the US, combined with the threat of pandemic flu, has provided an opportunity for policy makers to think about rationing in very concrete terms. Some lessons from annual flu vaccination likely will apply to pandemic vaccine distribution, but many preparatory decisions must be based on very rough estimates. What ethical principles should guide rationing decisions, what data should inform these decisions, how to revise decisions as new data emerge, and how to implement rationing decisions on the ground are all important considerations. In addition, ethicists might be able to help policy makers think through the importance of international cooperation in surmounting global rationing dilemmas and to accept the inevitable responsibilities of government in making and implementing rationing decisions.

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

PubMed

Wang, Bowen; Xiong, Haitao; Jiang, Chengrui

2014-01-01

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

Escalation research: Providing new frontiers for applying behavior analysis to organizational behavior

PubMed Central

Goltz, Sonia M.

2000-01-01

Decision fiascoes such as escalation of commitment, the tendency of decision makers to “throw good money after bad,” can have serious consequences for organizations and are therefore of great interest in applied research. This paper discusses the use of behavior analysis in organizational behavior research on escalation. Among the most significant aspects of behavior-analytic research on escalation is that it has indicated that both the patterns of outcomes that decision makers have experienced for past decisions and the patterns of responses that they make are critical for understanding escalation. This research has also stimulated the refinement of methods by researchers to better assess decision making and the role reinforcement plays in it. Finally, behavior-analytic escalation research has not only indicated the utility of reinforcement principles for predicting more complex human behavior but has also suggested some additional areas for future exploration of decision making using behavior analysis. PMID:22478347

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

PubMed Central

Wang, Bowen; Jiang, Chengrui

2014-01-01

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

CHEMFLO: ONE-DIMENSIONAL WATER AND CHEMICAL MOVEMENT IN UNSATURATED SOILS

EPA Science Inventory

An interactive software system was developed to enable decision-makers, regulators, policy-makers, scientists, consultants, and students to simulate the movement of waterand chemicals in unsaturated soils. Water movement is modeled using Richards (1931) - equation. Chemical trans...

An Overview of NASA's IM&S Verification and Validation Process Plan and Specification for Space Exploration

NASA Technical Reports Server (NTRS)

Gravitz, Robert M.; Hale, Joseph

2006-01-01

NASA's Exploration Systems Mission Directorate (ESMD) is implementing a management approach for modeling and simulation (M&S) that will provide decision-makers information on the model's fidelity, credibility, and quality. This information will allow the decision-maker to understand the risks involved in using a model's results in the decision-making process. This presentation will discuss NASA's approach for verification and validation (V&V) of its models or simulations supporting space exploration. This presentation will describe NASA's V&V process and the associated M&S verification and validation (V&V) activities required to support the decision-making process. The M&S V&V Plan and V&V Report templates for ESMD will also be illustrated.

Eco-informatics for decision makers advancing a research agenda

USGS Publications Warehouse

Cushing, J.B.; Wilson, T.; Brandt, L.; Gregg, V.; Spengler, S.; Borning, A.; Delcambre, L.; Bowker, G.; Frame, M.; Fulop, J.; Hert, C.; Hovy, E.; Jones, J.; Landis, E.; Schnase, J.L.; Schweik, C.; Sonntag, W.; ,

2005-01-01

Resource managers often face significant information technology (IT) problems when integrating ecological or environmental information to make decisions. At a workshop sponsored by the NSF and USGS in December 2004, university researchers, natural resource managers, and information managers met to articulate IT problems facing ecology and environmental decision makers. Decision making IT problems were identified in five areas: 1) policy, 2) data presentation, 3) data gaps, 4) tools, and 5) indicators. To alleviate those problems, workshop participants recommended specific informatics research in modeling and simulation, data quality, information integration and ontologies, and social and human aspects. This paper reports the workshop findings, and briefly compares these with research that traditionally falls under the emerging eco-informatics rubric. ?? Springer-Verlag Berlin Heidelberg 2005.

Comparative analysis of decision maker preferences for equity/efficiency attributes in reimbursement decisions in three European countries.

PubMed

Baji, Petra; García-Goñi, Manuel; Gulácsi, László; Mentzakis, Emmanouil; Paolucci, Francesco

2016-09-01

In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly on decision-maker preferences. To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and to analyse cross-country differences. Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N = 153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance. In all three countries, cost-effectiveness, individual health benefit and severity of the disease were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes. We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.

Engaging the US Military and Local Communities in Planning for Coastal Flooding Risks

NASA Astrophysics Data System (ADS)

Caldas, A.; Dahl, K. A.; Spanger-Siegfried, E.; Udvardy, S.

2016-12-01

Given their central role in U.S. national security, military installations have historically been well protected. But sea level rise, increased tidal flooding, and heightened storm surges have already been observed in several installations. Understanding and preparing for these risks falls to at least three sets of decision-makers: 1) Military leadership responsible for long-term assessment of installation viability; 2) Planners at each military installation who are responsible for day-to-day decision-making; and 3) Local policy-makers and their constituents, who have vested interests in protecting their assets and communities. To enable decision makers in each of these groups to better understand these risks, and how they may unfold this century, the Union of Concerned Scientists (UCS) designed and executed an analysis of coastal flooding risk as sea level rises. At the outset, we engaged experts from the Department of Defense for input on key questions such as which installations to focus on and which sea level rise projections they found most compelling and most credible. With this input, we analyzed the changing risk of coastal flooding at 18 installations along the US East and Gulf Coasts. When we had preliminary results, we engaged planners at as many installations as possible in reviews of the results. Engaging policy-makers and their constituents is ongoing: As part of the report release, we sent press releases to news outlets both large and small, and report authors were available for interviews, press releases, and Congressional staff briefings. Furthermore, we made all results available in publicly accessible online repositories. By engaging subject matter experts in both the planning and initial review of results, then maximizing transparency and availability upon the publication of our analyses, we have produced an analysis that is relevant to all three sets of decision-makers.

Boundary Organizations: Creating a Unique Model for Sustained Dialog Among Scientists and Decison Makers About Long-term Change

NASA Astrophysics Data System (ADS)

Duncan, B.; Carter, H.; Knight, E.; Meyer, R.

2015-12-01

California Ocean Science Trust is a boundary organization formed by the state of California. We work across traditional boundaries between government, science, and communities to build trust and understanding in ocean and coastal science. We work closely with decision makers to understand their priority needs and identify opportunities for science to have a meaningful impact, and we engage scientists and other experts to compile and translate information into innovative products that help to meet those needs. This often sparks new collaborations that live well beyond the products themselves. Through this unique model, we are deepening relationships and facilitating an ongoing dialogue between scientists, decision-makers, and communities. The West Coast of the United States is already experiencing climate-driven changes in marine conditions at both large and small spatial scales. Decision makers are increasingly concerned with the potential threats that these changes pose to coastal communities, industries, ecosystems, and species. Detecting and understanding these multi-stressor changes requires consideration across scientific disciplines and management jurisdictions. Research and monitoring programs must reflect this new reality: they should be designed to connect with the decision makers who may use their results. In this presentation, I will share how we are drawing from the West Coast Ocean Acidification and Hypoxia Science Panel - an interdisciplinary team of scientists convened by Ocean Science Trust from California, Oregon, Washington, and British Columbia - to develop actionable guidance for long-term monitoring for long-term change. Building on our experiences working with the Panel, I will discuss the unique model that boundary organizations provide for sustained dialog across traditionally siloed disciplines and management regimes, and share best practices and lessons learned in working across those boundaries.

Present-value analysis: A systems approach to public decisionmaking for cost effectiveness

NASA Technical Reports Server (NTRS)

Herbert, T. T.

1971-01-01

Decision makers within Governmental agencies and Congress must evaluate competing (and sometimes conflicting) proposals which seek funding and implementation. Present value analysis can be an effective decision making tool by enabling the formal evaluation of the effects of competing proposals on efficient national resource utilization. A project's costs are not only its direct disbursements, but its social costs as well. How much does it cost to have those funds diverted from their use and economic benefit by the private sector to the public project? Comparisons of competing projects' social costs allow decision makers to expand their decision bases by quantifying the projects' impacts upon the economy and the efficient utilization of the country's limited national resources. A conceptual model is established for the choosing of the appropriate discount rate to be used in evaluation decisions through the technique.

Changing Times, Complex Decisions: Presidential Values and Decision Making

ERIC Educational Resources Information Center

Hornak, Anne M.; Garza Mitchell, Regina L.

2016-01-01

Objective: The objective of this article is to delve more deeply into the thought processes of the key decision makers at community colleges and understand how they make decisions. Specifically, this article focuses on the role of the community college president's personal values in decision making. Method: We conducted interviews with 13…